{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:49:57Z","timestamp":1791607797722,"version":"4.3.4"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aggressive behavior after stroke is common and linked to poorer outcomes, yet prior studies have not translated this knowledge into operational benchmarks that guide planning (time\u2010limited risk windows, realistic goals, discharge timelines) during postacute rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify service benchmarks after the first electronic health record (EHR)\u2010documented aggression and map them to a standardized, time\u2010boxed response: event rates and short\u2010horizon risks (30\/60\u2009days), functional\/length\u2010of\u2010stay (LOS) gaps in clinical units, and practical targets for planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational cohort with prespecified 1:1 propensity\u2010matched sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single tertiary neurorehabilitation hospital (postacute, inpatient).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>\n                      Adults with first\u2010ever ischemic or hemorrhagic stroke admitted \u22643\u2009months post stroke between 2005 and 2023 (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091683). Aggression was flagged at the first qualifying EHR annotation; 317 (18.8%) had more than one episode.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measure(s)<\/jats:title>\n                    <jats:p>Incidence densities (per 1000 patient\u2010days) and derived 30\u2010\/60\u2010day risks for first aggression, urinary tract infection, and falls; between\u2010group differences in LOS and motor Functional Independence Measure (mFIM) outcomes (gain, efficiency, effectiveness) summarized as median differences (Hodges\u2013Lehmann).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 111,945 patient\u2010days, first\u2010aggression incidence was 2.83\/1000 (95% CI: 2.53\u20133.16), implying 8.1% 30\u2010day and 15.6% 60\u2010day risks. Compared with nonaggressive patients, the aggressive group had higher urinary tract infection rates (rate ratio 1.92, 95% confidence interval [CI]: 1.43\u20132.57) and falls (rate ratio 1.28, 95% CI: 1.00\u20131.63). Functional gaps (median differences, Hodges\u2013Lehmann) favored the nonaggressive group: LOS was longer (+17.9\u2009days, 95% CI +13.8 to +22.0), mFIM efficiency and effectiveness were lower in the full cohort; in the matched subset (317 vs. 317), Hodges\u2013Lehmann differences persisted (eg, LOS +9.8\u2009days, 95% CI +4.1 to +15.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A single EHR\u2010documented aggression provides a planning signal: event rates and 30\u2010\/60\u2010day risks justify a 60\u2010day precaution window, and scaled gaps support realistic goal setting (mFIM) and discharge date updates. These benchmarks offer a framework for bedside counseling, service targets, and audit; multicenter validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.70225","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:15:37Z","timestamp":1791605737000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["First aggression as a planning signal in post\u2010acute stroke rehabilitation: Service benchmarks, goal setting, and a 60\u2010day precaution window from a comprehensive observational cohort"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0853-8334","authenticated-orcid":false,"given":"Alejandro","family":"Garc\u00eda\u2010Rudolph","sequence":"first","affiliation":[{"name":"Department of Research and Innovation Institut Guttmann, Institut Universitari de Neurorehabilitaci\u00f3 adscrit a la UAB  Badalona 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