301
|
Maniadakis N, Ekman M, Fragoulakis V, Papagiannopoulou V, Yfantopoulos J. Economic evaluation of irbesartan in combination with hydrochlorothiazide in the treatment of hypertension in Greece. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:253-261. [PMID: 20411401 DOI: 10.1007/s10198-010-0243-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 03/25/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Hypertension is a major risk factor for cardiovascular disease and a leading cause of morbidity and mortality. This study evaluates irbesartan in relation to commonly used alternative hypertension therapies losartan and valsartan given in combination with hydrochlorothiazide (HCTZ) in the general hypertensive population in Greece. METHODS A Markov model with eight states of health was constructed: hypertension, myocardial infarction (MI), post-MI, angina, stroke, poststroke, heart failure, and death. The model has an annual cycle and estimates mean quality-adjusted survival and treatment cost, which reflect the hypertension treatment and managing cardiovascular events. Risk functions were used to conduct extrapolations. Data on treatment effectiveness, quality of life (QOL) and epidemiology were obtained from published clinical trials and studies. The database of the main Greek National Social Insurance Institute (IKA) was analyzed to estimate the cost of events. The analysis was done from a payer perspective. All outcomes were discounted, and prices correspond to 2008. RESULTS The estimated patient cost per annum was stable angina euro 2,252, unstable angina euro 2,572, myocardial infarction euro 2,473, post-MI euro 1,677, stroke euro 12,233, poststroke euro 1,240, heart failure euro 2,655, coronary angiography euro 1,544, percutaneous transluminal coronary angioplasty euro 6,511, and coronary artery bypass graft surgery euro 11,514. For the baseline group (age 57 years, systolic blood pressure 147 mmHg, cholesterol 6.00 mmol/L, body mass index 29) of men with mild to moderate hypertension, for irbesartan, the total treatment cost was euro 15,146, for losartan euro 15,696 and for valsartan euro 15,613; the quality-adjusted life years (QALYs) were irbesartan 12.67, losartan 12.63 and valsartan 12.64. For the baseline group of women with mild to moderate hypertension, the total treatment cost was euro 12,945 for irbesartan, euro 13,424 for losartan and euro 13,379 for valsartan; QALYs were 14.29 for irbesartan, 14.27 for losartan and 14.27 for valsartan. For men with severe hypertension, for irbesartan and losartan, the total treatment cost was euro 18,679 and euro 21,488 and QALYs 12.47 and 12.37, respectively. For women, the total treatment cost was euro 16,202 and euro 19,099 and QALYs 14.16 and 14.09, respectively. Similar results were obtained in relation to other treatment groups in various sensitivity analysis scenarios. CONCLUSIONS Based on efficacy data from clinical trials and lower attainment costs in various hypertensive patient populations, irbesartan in combination with HCTZ compares favorably with losartan and valsartan in combination with HCTZ in the Greek setting.
Collapse
Affiliation(s)
- Nikos Maniadakis
- Department of Health Services Management, National School of Public Health, 196 Alexandras Avenue, 115 22, Athens, Greece.
| | | | | | | | | |
Collapse
|
302
|
Shuaib A, Bornstein NM, Diener HC, Dillon W, Fisher M, Hammer MD, Molina CA, Rutledge JN, Saver JL, Schellinger PD, Shownkeen H. Partial Aortic Occlusion for Cerebral Perfusion Augmentation. Stroke 2011; 42:1680-90. [DOI: 10.1161/strokeaha.110.609933] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Fewer than 5% of patients with acute ischemic stroke are currently treated, and there is need for additional treatment options. A novel catheter treatment (NeuroFlo) that increases cerebral blood flow was tested to 14 hours.
Methods—
The Safety and Efficacy of NeuroFlo in Acute Ischemic Stroke trial is a randomized trial of the safety and efficacy of NeuroFlo treatment in improving neurological outcome versus standard medical management. The primary safety end point was the incidence of serious adverse events through 90 days. The primary efficacy end point on a modified intent-to-treat population was a global disability end point at 90 days. Secondary end points included mortality, intracranial hemorrhage, modified Rankin scale score outcome of 0 to 2, and modified Rankin scale shift analysis.
Results—
Between October 2005 and January 2010, 515 patients were enrolled at 68 centers in 9 countries. The primary efficacy end point did not reach statistical significance (OR, 1.17; CI, 0.81–1.67;
P
=0.407). The primary safety end point did not show a difference in serious adverse events (
P
=0.923). Ninety-day mortality was 11.3% (26/230) in treatment and 16.3% (42/257) in control (
P
=0.087). Post hoc analyses showed that patients presenting within 5 hours (OR, 3.33; CI, 1.31–8.48), with NIHSS score 8 to 14 (OR, 1.80; CI, 0.99–3.30), or older than age 70 years (OR, 2.02; CI, 1.02–4.03) had better modified Rankin scale score outcomes of 0 to 2; additionally, there were fewer stroke-related deaths in treatment compared to control groups (7.4%=17/230; 14.4%=37/257).
Conclusions—
The trial met its primary safety end point but not its primary efficacy end point. Signals of treatment effect were suggested on all-cause mortality, in patients presenting early, older than age 70 years, or with moderate strokes, but these require confirmation.
Clinical Trial Registration Information—
URL:
http://clinicaltrials.gov
. Unique identifier: NCT00119717.
Collapse
Affiliation(s)
- Ashfaq Shuaib
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Natan M. Bornstein
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Hans-Christoph Diener
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - William Dillon
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Marc Fisher
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Maxim D. Hammer
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Carlos A. Molina
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - J. Neal Rutledge
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Jeffrey L. Saver
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Peter D. Schellinger
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| | - Harish Shownkeen
- From the University of Alberta, Edmonton, Alberta; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University Hospital Essen, Essen, Germany; University of California, San Francisco, CA; University of Massachusetts, Worchester, MA; University of Pittsburgh, Pittsburgh, PA; Hospital Vall d'Hebron, Barcelona, Spain; University Medical Center Brackenridge–Seton, Austin, TX; University of California at Los Angeles, Los Angeles, CA; University Clinic at Erlangen, Erlangen, Germany; Central DuPage
| |
Collapse
|
303
|
Carlsson E, Ehnfors M, Eldh AC, Ehrenberg A. Accuracy and continuity in discharge information for patients with eating difficulties after stroke. J Clin Nurs 2011; 21:21-31. [DOI: 10.1111/j.1365-2702.2010.03648.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
304
|
Wolfe CDA, Crichton SL, Heuschmann PU, McKevitt CJ, Toschke AM, Grieve AP, Rudd AG. Estimates of outcomes up to ten years after stroke: analysis from the prospective South London Stroke Register. PLoS Med 2011; 8:e1001033. [PMID: 21610863 PMCID: PMC3096613 DOI: 10.1371/journal.pmed.1001033] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 04/07/2011] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although stroke is acknowledged as a long-term condition, population estimates of outcomes longer term are lacking. Such estimates would be useful for planning health services and developing research that might ultimately improve outcomes. This burden of disease study provides population-based estimates of outcomes with a focus on disability, cognition, and psychological outcomes up to 10 y after initial stroke event in a multi-ethnic European population. METHODS AND FINDINGS Data were collected from the population-based South London Stroke Register, a prospective population-based register documenting all first in a lifetime strokes since 1 January 1995 in a multi-ethnic inner city population. The outcomes assessed are reported as estimates of need and included disability (Barthel Index <15), inactivity (Frenchay Activities Index <15), cognitive impairment (Abbreviated Mental Test < 8 or Mini-Mental State Exam <24), anxiety and depression (Hospital Anxiety and Depression Scale >10), and mental and physical domain scores of the Medical Outcomes Study 12-item short form (SF-12) health survey. Estimates were stratified by age, gender, and ethnicity, and age-adjusted using the standard European population. Plots of outcome estimates over time were constructed to examine temporal trends and sociodemographic differences. Between 1995 and 2006, 3,373 first-ever strokes were registered: 20%-30% of survivors had a poor outcome over 10 y of follow-up. The highest rate of disability was observed 7 d after stroke and remained at around 110 per 1,000 stroke survivors from 3 mo to 10 y. Rates of inactivity and cognitive impairment both declined up to 1 y (280/1,000 and 180/1,000 survivors, respectively); thereafter rates of inactivity remained stable till year eight, then increased, whereas rates of cognitive impairment fluctuated till year eight, then increased. Anxiety and depression showed some fluctuation over time, with a rate of 350 and 310 per 1,000 stroke survivors, respectively. SF-12 scores showed little variation from 3 mo to 10 y after stroke. Inactivity was higher in males at all time points, and in white compared to black stroke survivors, although black survivors reported better outcomes in the SF-12 physical domain. No other major differences were observed by gender or ethnicity. Increased age was associated with higher rates of disability, inactivity, and cognitive impairment. CONCLUSIONS Between 20% and 30% of stroke survivors have a poor range of outcomes up to 10 y after stroke. Such epidemiological data demonstrate the sociodemographic groups that are most affected longer term and should be used to develop longer term management strategies that reduce the significant poor outcomes of this group, for whom effective interventions are currently elusive. Please see later in the article for the Editors' Summary.
Collapse
Affiliation(s)
- Charles D A Wolfe
- Division of Health and Social Care Research, King's College London, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
305
|
Buerke B, Wittkamp G, Dziewas R, Seidensticker P, Heindel W, Kloska SP. Perfusion-weighted map and perfused blood volume in comparison with CT angiography source imaging in acute ischemic stroke different sides of the same coin? Acad Radiol 2011; 18:347-52. [PMID: 21145763 DOI: 10.1016/j.acra.2010.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 10/22/2010] [Accepted: 10/23/2010] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Computed tomography angiography source imaging (CTA-SI) in acute ischemic stroke improves detection rate and estimation of extent of cerebral infarction. This study compared the new components color-coded perfusion weighted map (PWM) and color-coded perfused blood volume (PBV) derived from CTA data with CTA-SI for the visualization of cerebral infarction. MATERIALS AND METHODS Fifty patients (women = 30; mean age = 74.9 ± 13.3 years) underwent nonenhanced computed tomography and CTA for suspected acute ischemic stroke. PWM, PBV, and CTA-SI were reconstructed with identical slice thickness of 1.0 mm with commercial software. Extent of infarction was measured using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). For statistical analysis, Spearman's R correlation and paired-samples t-test was used. P < .05 was considered significant. RESULTS PBV had superior sensitivity for detection of cerebral infarction with 0.88 compared to PWM and CTA-SI with 0.79 and 0.76, respectively. The accuracy of correct diagnosis was superior for PBV with 0.82 compared to PWM and CTA-SI with 0.76, respectively. ASPECTS of PWM and PBV showed strong correlation with CTA-SI with r = 0.903 (P < .001) and r = 0.866 (P < .001), respectively. Mean ASPECTS of CTA-SI (6.24 ± 3.62) revealed no significant difference with PWM (6.26 ± 3.45), but a significant difference with PBV (5.62 ± 3.41; P < .02). CONCLUSIONS PWM was equal to CTA-SI in detection of cerebral infarction and estimation of extent of cerebral ischemia. Although PBV was superior to CTA-SI in detection of cerebral infarction, PBV seems to overestimate the extent of critical cerebral ischemia. Therefore, CTA-SI information is not identical to PBV and further clinical evaluation is mandatory.
Collapse
Affiliation(s)
- Boris Buerke
- Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany
| | | | | | | | | | | |
Collapse
|
306
|
|
307
|
Timmermans AAA, Lemmens RJM, Geers RPJ, Smeets RJEM, Seelen HAM. A comparison of treatment effects after sensor- and robot-based task-oriented arm training in highly functional stroke patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:3507-3510. [PMID: 22255096 DOI: 10.1109/iembs.2011.6090947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A large number of rehabilitation technologies for stroke patients has been developed in the last decade. To date it is insufficiently clear what the strengths of these different technologies are in relation to certain patient characteristics, such as the level of muscle strength and/or functional ability. One of the reasons is that research protocols differ so much that comparison of treatment results is impossible. This paper compares, while using the same patient inclusion criteria and training protocol, the effectivity of a sensor-supported versus robot-supported task-oriented arm training for highly functional chronic stroke patients. It appeared that individual improvements over time and Hedges's g effect sizes were twice as large for the sensor-based training compared to the robot-supported training in stroke patients with high functional levels. New research is planned to compare both therapy approaches for stroke patients with low and average functional levels.
Collapse
Affiliation(s)
- Annick A A Timmermans
- Dept of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, NL, theNetherlands.
| | | | | | | | | |
Collapse
|
308
|
Kolkert JL, van den Dungen JJ, Loonstra J, Tielliu IF, Verhoeven EL, Beck AW, Zeebregts CJ. Overestimation of contralateral internal carotid artery stenosis before ipsilateral surgical endarterectomy. Eur J Radiol 2011; 77:68-72. [DOI: 10.1016/j.ejrad.2009.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/24/2009] [Accepted: 07/15/2009] [Indexed: 11/27/2022]
|
309
|
Sienkiewicz-Jarosz H, Gtuszkiewicz M, Pniewski J, Niewada M, Członkowska A, Wolfe C, Ryglewicz D. Incidence and case fatality rates of first-ever stroke – comparison of data from two prospective population-based studies conducted in Warsaw. Neurol Neurochir Pol 2011; 45:207-12. [DOI: 10.1016/s0028-3843(14)60073-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
310
|
Wallengren C, Segesten K, Friberg F. Relatives' information needs and the characteristics of their search for information--in the words of relatives of stroke survivors. J Clin Nurs 2010; 19:2888-96. [PMID: 20846233 DOI: 10.1111/j.1365-2702.2010.03259.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To explore relatives' information needs and the characteristics of their information-seeking process shortly after the stroke event and six months later. BACKGROUND Providing relatives of stroke survivors with information is important, as lack of information increases their uncertainty and risk becoming the 'second patient in the family' and early death. Therefore, it is essential to be aware of relatives' information needs and information-seeking process the first six months after stroke. DESIGN This qualitative study has a descriptive design. METHOD Open-ended interviews were conducted with sixteen relatives after stroke survivor's admission to stroke unit and six months later with nine of these relatives. Data were analysed by means of content analysis. RESULTS The identified information needs covered the spectrum from stroke survivor's medical condition because nurses' actions to relatives' changed health and life situation. Furthermore, relatives' information-seeking process was found to be related to their level of personal involvement, situational circumstances, different forms of knowledge and sources of information. CONCLUSIONS Relatives' search for information emerges when health and lifestyle changes occur in survivors or themselves. It is important that this information affect them personally. Also, they need to develop different forms of knowledge when they cannot trust their own competences. As a result, instead of following established curricula based on their beliefs of relatives' information needs, nurses need to practice on identifying relatives' information needs. RELEVANCE TO PRACTICE Different information needs and characteristics described in the study can serve as guidance in the development and implementation of pedagogical interventions to support relatives of stroke survivors. One pedagogical implication is to explore what a specific relative wants to know by how he/she talks or thinks about it. Thus, it must be taken into consideration that level of personal involvement, situational circumstances, sources of information and factual knowledge, understanding and skills are intertwined.
Collapse
Affiliation(s)
- Catarina Wallengren
- Department of Nursing Sciences, Faculty of Social and Life Science, School of Health Sciences, University College of Borås, Borås, Sweden.
| | | | | |
Collapse
|
311
|
Kulesh SD, Filina NA, Frantava NM, Zhytko NL, Kastsinevich TM, Kliatskova LA, Shumskas MS, Hilz MJ, Schwab S, Kolominsky-Rabas PL. Incidence and Case-Fatality of Stroke on the East Border of the European Union. Stroke 2010; 41:2726-30. [DOI: 10.1161/strokeaha.110.596916] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sergey D. Kulesh
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Nina A. Filina
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Nataliya M. Frantava
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Natallia L. Zhytko
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Tatsiana M. Kastsinevich
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Liudmila A. Kliatskova
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Mechyslovas S. Shumskas
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Max J. Hilz
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Stefan Schwab
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| | - Peter L. Kolominsky-Rabas
- From the Department of Neurology (S.D.K.), Grodno State Medical University, Grodno, Belarus; the Department of Neurology (M.J.H., S.S., P.L.K.-R.), University Hospital Erlangen, Erlangen, Germany; the Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH; P.L.K.-R.), University of Erlangen–Nurnberg, Erlangen, Germany; the Stroke Neurological Department (N.A.F., N.M.F., N.L.Z.), Grodno City Clinical Hospital No. 1, Grodno, Belarus; the Department of Neurology (T.M.K
| |
Collapse
|
312
|
Khellaf M, Quantin C, d'Athis P, Fassa M, Jooste V, Hervieu M, Giroud M, Béjot Y. Age-period-cohort analysis of stroke incidence in Dijon from 1985 to 2005. Stroke 2010; 41:2762-7. [PMID: 21071719 DOI: 10.1161/strokeaha.110.592147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Variations in stroke incidence could be explained by changes in vascular and environmental factors that affect the risk of stroke and changes in risk factors that are present in early life. The aim of this study was to identify and measure the effects of 3 interrelated factors, age, calendar period of stroke onset, and birth year cohort, on the incidence rates of stroke from 1985 through 2005. METHODS Age-period-cohort models were used to analyze stroke incidence in Dijon from 1985 to 2005 from a population-based registry that collects data on all stroke patients whatever the type of management, in the public hospital, private hospitals, or at home, in the population of Dijon (150,000 inhabitants). RESULTS For ischemic stroke, the incidence rose with time in men depending not only on age, but also on the period and cohort effects (P = 0.017). For women, the incidence only depended on age (P < 0.001; incidence rate ratio, 1.085; 95% CI, 1.081 to 1.089). For hemorrhagic stroke, the rise in the incidence with time depended only on age in men, whereas in women, it depended on age, period, and cohort effects (P = 0.019). CONCLUSIONS Age, birth cohort, and calendar period contain relevant information to define and explain trends in stroke incidence rates over a long period.
Collapse
Affiliation(s)
- Meheni Khellaf
- University Hospital and Faculty of Medicine of Dijon, University of Burgundy, Burgundy, France
| | | | | | | | | | | | | | | |
Collapse
|
313
|
Kallenberg LAC, Hermens HJ. Motor unit properties of biceps brachii during dynamic contractions in chronic stroke patients. Muscle Nerve 2010; 43:112-9. [PMID: 20928907 DOI: 10.1002/mus.21803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2010] [Indexed: 11/06/2022]
Abstract
The aim of this study was to investigate motor unit (MU) characteristics of the biceps brachii during sinusoidal contractions in chronic stroke patients using high-density surface electromyography. Ten sinusoidal elbow flexion and extension movements were performed both passively and actively by 18 stroke patients and 20 healthy subjects. Motor unit action potentials (MUAPs) were extracted, and their root-mean-square value (RMS(MUAP)) was calculated. RMS(MUAP) was significantly larger in stroke than in healthy subjects. In both groups RMS(MUAP) was smaller during the stretch phase of passive movement than during active movement. The larger MUAPs indicate enlarged MUs, possibly as a result of reinnervation. The lower RMS(MUAP) values during passive stretch than during active movement indicates that the stretch reflex mainly activates smaller MUs, while a larger part of the MU pool can be recruited voluntarily. RMS(MUAP) may have added value for monitoring changes in peripheral MU properties after stroke.
Collapse
Affiliation(s)
- Laura A C Kallenberg
- Roessingh Research and Development, PO Box 310, 7500 AH Enschede, The Netherlands.
| | | |
Collapse
|
314
|
Timmermans AAA, Spooren AIF, Kingma H, Seelen HAM. Influence of task-oriented training content on skilled arm-hand performance in stroke: a systematic review. Neurorehabil Neural Repair 2010; 24:858-70. [PMID: 20921325 DOI: 10.1177/1545968310368963] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This review evaluates the underlying training components currently used in task-oriented training and assesses the effects of these components on skilled arm-hand performance in patients after a stroke. METHODS A computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro, and Cochrane) identified randomized clinical trials, published through March 2009, evaluating the effects of task-oriented training. Relevant article references listed in publications included were also screened. The methodological quality of the selected studies was assessed with the Van Tulder Checklist. For each functional outcome measure used, the effect size (bias corrected Hedges's g) was calculated. RESULTS The intervention results in 528 patients (16 studies) were studied. From these, 15 components were identified to characterize task-oriented training. An average of 7.8 (standard deviation = 2.1) components were used in the included trials. There was no correlation between the number of task-oriented training components used in a study and the treatment effect size. "Distributed practice" and "feedback" were associated with the largest postintervention effect sizes. "Random practice" and "use of clear functional goals" were associated with the largest follow-up effect sizes. CONCLUSION The task-oriented training was operationalized with 15 components. The number of components used in an intervention aimed at improving arm-hand performance after stroke was not associated with the posttreatment effect size. Certain components, which optimize storage of learned motor performance in the long-term memory, occurred more in studies with larger treatment effects.
Collapse
|
315
|
Affiliation(s)
- Fiona Jones
- Faculty of Health & Social Care, St George's University of London and Kingston University, London SW170RE, UK.
| | | |
Collapse
|
316
|
Kirshner HS. Current issues in antiplatelet therapy for stroke prevention: the importance of stroke subtypes and differences between stroke and MI patients. J Neurol 2010; 257:1788-97. [DOI: 10.1007/s00415-010-5667-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 06/22/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
|
317
|
Timmermans AAA, Seelen HAM, Geers RPJ, Saini PK, Winter S, te Vrugt J, Kingma H. Sensor-based arm skill training in chronic stroke patients: results on treatment outcome, patient motivation, and system usability. IEEE Trans Neural Syst Rehabil Eng 2010; 18:284-92. [PMID: 20388603 DOI: 10.1109/tnsre.2010.2047608] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
As stroke incidence increases, therapists' time is under pressure. Technology-supported rehabilitation may offer new opportunities. The objective of this study was to evaluate patient motivation for and the feasibility and effects of a new technology-supported task-oriented arm training regime (T-TOAT). Nine chronic stroke patients performed T-TOAT (2 x 30 min/day, four days/week) during eight weeks. A system including movement tracking sensors, exercise board, and software-based toolkit was used for skill training. Measures were recorded at baseline, after four and eight weeks of training, and six months posttraining. T-TOAT improved arm-hand performance significantly on Fugl-Meyer, Action Research Arm Test, and Motor Activity Log. Training effects lasted at least six months posttraining. Health-related-quality-of-life had improved significantly after eight weeks of T-TOAT with regard to perceived physical health, but not to perceived mental health (SF-36). None of the EuroQol-5D components showed significant differences before and after training. Participants were intrinsically motivated and felt competent to use the system. Furthermore, system usability was rated very good. However, exercise challenge as perceived by participants decreased significantly over eight weeks of training. The results of this study indicate that T-TOAT is feasible. Despite the small number of stroke patients tested, significant and clinically relevant improvements in skilled arm-hand performance were found.
Collapse
Affiliation(s)
- Annick A A Timmermans
- Department of Biomedical Technology, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
318
|
Sieber M, Guenther M, Kohl M, Witte O, Claus R, Frahm C. Inter-age variability of bona fide unvaried transcripts. Neurobiol Aging 2010; 31:654-64. [DOI: 10.1016/j.neurobiolaging.2008.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 05/12/2008] [Accepted: 05/25/2008] [Indexed: 11/16/2022]
|
319
|
|
320
|
Schumann NP, Bongers K, Guntinas-Lichius O, Scholle HC. Facial muscle activation patterns in healthy male humans: A multi-channel surface EMG study. J Neurosci Methods 2010; 187:120-8. [PMID: 20064556 DOI: 10.1016/j.jneumeth.2009.12.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/23/2009] [Accepted: 12/29/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Nikolaus Peter Schumann
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Friedrich-Schiller-University Jena, Erfurter Strasse 35, D-07740 Jena, Germany.
| | | | | | | |
Collapse
|
321
|
Latimer CP, Keeling J, Lin B, Henderson M, Hale LA. The impact of bilateral therapy on upper limb function after chronic stroke: a systematic review. Disabil Rehabil 2010; 32:1221-31. [DOI: 10.3109/09638280903483877] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
322
|
|
323
|
Logman JFS, Heeg BMS, Herlitz J, van Hout BA. Costs and consequences of clopidogrel versus aspirin for secondary prevention of ischaemic events in (high-risk) atherosclerotic patients in Sweden: a lifetime model based on the CAPRIE trial and high-risk CAPRIE subpopulations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2010; 8:251-265. [PMID: 20578780 DOI: 10.2165/11535520-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Antiplatelet therapy plays a central role in the prevention of atherothrombotic events. Both acetylsalicylic acid (aspirin) and clopidogrel have been shown to reduce the risk of recurrent cardiovascular events in various subgroups of patients with vascular disease. OBJECTIVE To estimate the cost effectiveness of clopidogrel versus aspirin in Sweden for the prevention of atherothrombotic events based on CAPRIE trial data. The focus of this study is on two high-risk subpopulations: (i) patients with pre-existing symptomatic atherosclerotic disease; and (ii) patients with polyvascular disease. METHODS A Markov model combining clinical, epidemiological and cost data was used to assess the economic value of clopidogrel compared with aspirin during a patient's lifetime. A societal perspective was used, with costs stated in Swedish kronor (SEK), year 2007 values. For the first 2 years, the clinical input for the model was based on the relevant subpopulations in the CAPRIE trial. Thereafter, transition probabilities were extrapolated, taking account of increased risks related to age and to a history of events. Cost effectiveness of 2 years of therapy is presented as cost per life-year gained (LYG) and as cost per QALY. Univariate and multivariate sensitivity analyses were performed to investigate robustness of results. RESULTS For patients resembling the total CAPRIE population, who were treated with clopidogrel, the expected cost per LYG was SEK217,806 and the cost per QALY was estimated at SEK169,154. For the high-risk CAPRIE subpopulations, costs per QALY were lowest for patients with pre-existing symptomatic atherosclerotic disease (SEK38,153). Using a 'willingness-to-pay' perspective indicated that treatment with clopidogrel instead of aspirin in high-risk patients is associated with a high probability for cost effectiveness; 81% using a threshold of SEK100,000 per QALY and 98% using a threshold of SEK500,000 per QALY. Overall, the results appeared to be robust over the sensitivity analyses performed. CONCLUSION When considering the cost-effectiveness categorization as proposed by the Swedish National Board of Health and Welfare, clopidogrel appears to be associated with costs per QALY that range from intermediate in the total CAPRIE population to low in high-risk atherosclerotic patients.
Collapse
|
324
|
Oblak J, Cikajlo I, Matjacić Z. Universal haptic drive: a robot for arm and wrist rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2009; 18:293-302. [PMID: 19846386 DOI: 10.1109/tnsre.2009.2034162] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper we present a universal haptic drive (UHD), a device that enables rehabilitation of either arm ("ARM" mode) or wrist ("WRIST" mode) movement in two degrees-of-freedom. The mode of training depends on the selected mechanical configuration, which depends on locking/unlocking of a passive universal joint. Actuation of the device is accomplished by utilizing a series elastic actuation principle, which enables use of off-the-shelf mechanical and actuation components. A proportional force control scheme, needed for implementation of impedance control based movement training, was implemented. The device performance in terms of achievable lower and upper bound of viable impedance range was evaluated through adequately chosen sinusoidal movement in eight directions of a planar movement for the "ARM" mode and in eight directions of a combined wrist flexion/extension and forearm pronation/supination movement for the "WRIST" mode. Additionally, suitability of the universal haptic drive for movement training was tested in a series of training sessions conducted with a chronic stroke subject. The results have shown that reliable and repeatable performance can be achieved in both modes of operation for all tested directions.
Collapse
Affiliation(s)
- Jakob Oblak
- Institute for Rehabilitation, Republic of Slovenia, 1000 Ljubljana, Slovenia.
| | | | | |
Collapse
|
325
|
Baetens T, Peersman W, Cambier D. Falls among stroke survivors: an online survey on perceptions and approaches among physiotherapists in Flanders. Disabil Rehabil 2009; 31:818-24. [PMID: 19037770 DOI: 10.1080/09638280802355015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe physiotherapists' perceptions of fall risk and appropriate fall prevention interventions in rehabilitating stroke patients. METHOD A web-based survey addressed to physiotherapy units on a stroke unit, general neurology department or rehabilitation ward/centre in Flanders. RESULTS Hospital response rate was 66.3%. Sixty-five physiotherapy units were taken into account. About 84.6% recognised falls among stroke patients as an essential problem and 73.8% thought falls interfered with the outcome. About 56.9% agreed with the need of a standardised fall assessment at the beginning of the treatment and only 36.9% reported that on their department stroke patients are screened on risk of falling. The most used fall risk assessments are: Berg Balance scale and Tinetti-test. The most popular fall prevention measures are: specific exercises for balance, gait and functional abilities (100%), informative education (92.3%) and adapting or intensifying the treatment after a fall (81.5%). CONCLUSIONS Physiotherapy units acknowledge falls as an essential threat, implying a need for risk screening and prevention. However, results reveal that perception of the necessity of such screening is lower and that the performance is even less. This discrepancy underlines the necessity of guidelines and education of therapists working with stroke patients.
Collapse
Affiliation(s)
- T Baetens
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Faculty of Medicine and Health Sciences, Ghent University, Artevelde University College, Ghent, Belgium.
| | | | | |
Collapse
|
326
|
O’Brien E. Ambulatory blood pressure measurement is indispensable to good clinical practice. HIPERTENSION Y RIESGO VASCULAR 2009. [DOI: 10.1016/j.hipert.2009.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
327
|
Klit H, Finnerup NB, Jensen TS. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009; 8:857-68. [PMID: 19679277 DOI: 10.1016/s1474-4422(09)70176-0] [Citation(s) in RCA: 389] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
328
|
Vuković V, Mikula I, Kesić MJ, Bedeković MR, Morović S, Lovrenčić-Huzjan A, Demarin V. Perception of stroke in Croatia - knowledge of stroke signs and risk factors amongst neurological outpatients. Eur J Neurol 2009; 16:1060-5. [DOI: 10.1111/j.1468-1331.2009.02652.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
329
|
Timmermans AAA, Seelen HAM, Willmann RD, Bakx W, de Ruyter B, Lanfermann G, Kingma H. Arm and hand skills: Training preferences after stroke. Disabil Rehabil 2009; 31:1344-52. [PMID: 19479535 DOI: 10.1080/09638280902823664] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
330
|
Wang JG. A combined role of calcium channel blockers and angiotensin receptor blockers in stroke prevention. Vasc Health Risk Manag 2009; 5:593-605. [PMID: 19688100 PMCID: PMC2725792 DOI: 10.2147/vhrm.s6203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Stroke is a leading cause of death and disability worldwide. The importance of lowering blood pressure for reducing the risk of stroke is well established. However, not all the benefits of antihypertensive treatments in stroke can be accounted for by reductions in BP and there may be differences between antihypertensive classes as to which provides optimal protection. Dihydropyridine calcium channel blockers, such as amlodipine, and angiotensin receptor blockers, such as valsartan, represent the two antihypertensive drug classes with the strongest supportive data for the prevention of stroke. Therefore, when combination therapy is required, a combination of these two antihypertensive classes represents a logical approach.
Collapse
Affiliation(s)
- Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| |
Collapse
|
331
|
Harmsen P, Wilhelmsen L, Jacobsson A. Stroke Incidence and Mortality Rates 1987 to 2006 Related to Secular Trends of Cardiovascular Risk Factors in Gothenburg, Sweden. Stroke 2009; 40:2691-7. [DOI: 10.1161/strokeaha.109.550814] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Per Harmsen
- From Institute of Clinical Neuroscience (P.H.), Department of Internal Medicine (L.W.), Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgren’s Academy (A.J.), University of Gothenburg, Gothenburg, Sweden, and Centre for Epidemiology, the National Board of Health and Welfare, Stockholm, Sweden
| | - Lars Wilhelmsen
- From Institute of Clinical Neuroscience (P.H.), Department of Internal Medicine (L.W.), Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgren’s Academy (A.J.), University of Gothenburg, Gothenburg, Sweden, and Centre for Epidemiology, the National Board of Health and Welfare, Stockholm, Sweden
| | - Anders Jacobsson
- From Institute of Clinical Neuroscience (P.H.), Department of Internal Medicine (L.W.), Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgren’s Academy (A.J.), University of Gothenburg, Gothenburg, Sweden, and Centre for Epidemiology, the National Board of Health and Welfare, Stockholm, Sweden
| |
Collapse
|
332
|
|
333
|
Posterior probability profiles for the automated assessment of the recovery of patients with stroke from activity of daily living tasks. Artif Intell Med 2009; 46:233-49. [DOI: 10.1016/j.artmed.2009.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 02/12/2009] [Accepted: 03/11/2009] [Indexed: 11/18/2022]
|
334
|
Abstract
Background and Purpose—
Comparable data on stroke incidence across European countries are lacking because previous studies have used different methods of case ascertainment, different periods of observation, and different age restrictions.
Methods—
Population-based stroke registers were established in 6 European countries: France (Dijon); Italy (Sesto Fiorentino); Lithuania (Kaunas); the United Kingdom (London); Spain (Menorca); and Poland (Warsaw). Standardized criteria were used among these register including overlapping sources of notification. Overall, a source population of 1087048 inhabitants was observed, ranging from 47236 in Sesto Fiorentino to 365191 in Kaunas. All patients with first-ever stroke of all age groups from the source populations were included. Data collection took part between 2004 and 2006; 4 centers collected data for a 24-month and 2 for a 12-month time period. Crude annual incidence rates were age-adjusted to the European population.
Results—
A total of 2129 patients with first stroke were registered. Median age was 73 years and 51% were female. Annual stroke incidence adjusted to the European population was found in men to be higher in Kaunas and lower in Sesto Fiorentino and Menorca and in women to be higher in Kaunas and Warsaw and lower in Sesto Fiorentino and Menorca compared with mean incidence rates. Total stroke incidence ranged in men from 101.2 per 100000 (95% CI, 82.5 to 123.0) in Sesto Fiorentino to 239.3 per 100000 (95% CI, 209.9 to 271.6) in Kaunas and in women from 63.0 per 100000 (95% CI, 48.5 to 80.7) in Sesto Fiorentino to 158.7 per 100000 (95% CI, 135.0 to 185.4) in Kaunas. Differences in prior-to-stroke risk factors were found among the populations with prevalence of hypertension highest in Warsaw and Kaunas (76% and 67%, respectively) and lowest in Menorca and Sesto Fiorentino (54% and 62%, respectively).
Conclusions—
The risk of stroke among European populations in our study varied more than 2-fold in men and women. On average, higher rates of stroke were observed in eastern and lower rates in southern European countries.
Collapse
|
335
|
Yu G, Borlongan CV, Stahl CE, Hess DC, Ou Y, Kaneko Y, Yu SJ, Yang T, Fang L, Xie X. Systemic delivery of umbilical cord blood cells for stroke therapy: a review. Restor Neurol Neurosci 2009; 27:41-54. [PMID: 19164852 DOI: 10.3233/rnn-2009-0460] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE This review paper summarizes relevant studies, discusses potential mechanisms of transplanted cell-mediated neuroprotection, and builds a case for the need to establish outcome parameters that are critical for transplantation success. In particular, we outline the advantages and disadvantages of systemic delivery of human umbilical cord blood (HUCB) cells in the field of cellular transplantation for treating ischemic stroke. METHODS A MEDLINE/PubMed systematic search of published articles in peer-reviewed journals over the last 25 years was performed focusing on the theme of HUCB as donor graft source for transplantation therapy in neurological disorders with emphasis on stroke. RESULTS Ischemic stroke remains a leading cause of human death and disability. Although stroke survivors may gain spontaneous partial functional recovery, they often suffer from sensory-motor dysfunction, behavioral/neurological alterations, and various degrees of paralysis. Currently, limited clinical intervention is available to prevent ischemic damage and restore lost function in stroke victims. Stem cells from fetal tissues, bone marrow, and HUCB has emerged in the last few years as a potential cell transplant cell source for ischemic stroke, because of their capability to differentiate into multiple cell types and the possibility that they may provide trophic support for cell survival, tissue repair, and functional recovery. CONCLUSION A growing number of studies highlight the potential of systemic delivery of HUCB cells as a novel therapeutic approach for stroke. However, additional preclinical studies are warranted to reveal the optimal HUCB transplant regimen that is safe and efficacious prior to proceeding to large-scale clinical application of these cells for stroke therapy.
Collapse
Affiliation(s)
- Guolong Yu
- Department of Cardiology, Xiangya Hospital, Southern Central University, Changsha, PR China.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
336
|
|
337
|
Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009; 8:345-54. [DOI: 10.1016/s1474-4422(09)70023-7] [Citation(s) in RCA: 553] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
338
|
Béjot Y, Osseby GV, Aboa-éboulé C, Durier J, Lorgis L, Cottin Y, Moreau T, Giroud M. Dijon’s vanishing lead with regard to low incidence of stroke. Eur J Neurol 2009; 16:324-9. [DOI: 10.1111/j.1468-1331.2008.02415.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
339
|
Audebert HJ, Schultes K, Tietz V, Heuschmann PU, Bogdahn U, Haberl RL, Schenkel J. Long-Term Effects of Specialized Stroke Care With Telemedicine Support in Community Hospitals on Behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS). Stroke 2009; 40:902-8. [DOI: 10.1161/strokeaha.108.529255] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heinrich J. Audebert
- From Stroke Unit (H.J.A.), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, King’s, Guy’s and St Thomas’ Medical School, London, UK; Department of Neurology (K.S.), Klinikum Bayreuth, Germany; Department of Neurology (V.T.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany; Division of Health and Social Care Research (P.U.H.), King’s College London, UK; Department of Neurology (U.B.), University of Regensburg, Germany, Department of Neurology (R.L.H.),
| | - Kathrin Schultes
- From Stroke Unit (H.J.A.), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, King’s, Guy’s and St Thomas’ Medical School, London, UK; Department of Neurology (K.S.), Klinikum Bayreuth, Germany; Department of Neurology (V.T.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany; Division of Health and Social Care Research (P.U.H.), King’s College London, UK; Department of Neurology (U.B.), University of Regensburg, Germany, Department of Neurology (R.L.H.),
| | - Viola Tietz
- From Stroke Unit (H.J.A.), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, King’s, Guy’s and St Thomas’ Medical School, London, UK; Department of Neurology (K.S.), Klinikum Bayreuth, Germany; Department of Neurology (V.T.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany; Division of Health and Social Care Research (P.U.H.), King’s College London, UK; Department of Neurology (U.B.), University of Regensburg, Germany, Department of Neurology (R.L.H.),
| | - Peter U. Heuschmann
- From Stroke Unit (H.J.A.), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, King’s, Guy’s and St Thomas’ Medical School, London, UK; Department of Neurology (K.S.), Klinikum Bayreuth, Germany; Department of Neurology (V.T.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany; Division of Health and Social Care Research (P.U.H.), King’s College London, UK; Department of Neurology (U.B.), University of Regensburg, Germany, Department of Neurology (R.L.H.),
| | - Ulrich Bogdahn
- From Stroke Unit (H.J.A.), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, King’s, Guy’s and St Thomas’ Medical School, London, UK; Department of Neurology (K.S.), Klinikum Bayreuth, Germany; Department of Neurology (V.T.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany; Division of Health and Social Care Research (P.U.H.), King’s College London, UK; Department of Neurology (U.B.), University of Regensburg, Germany, Department of Neurology (R.L.H.),
| | - Roman L. Haberl
- From Stroke Unit (H.J.A.), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, King’s, Guy’s and St Thomas’ Medical School, London, UK; Department of Neurology (K.S.), Klinikum Bayreuth, Germany; Department of Neurology (V.T.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany; Division of Health and Social Care Research (P.U.H.), King’s College London, UK; Department of Neurology (U.B.), University of Regensburg, Germany, Department of Neurology (R.L.H.),
| | - Johannes Schenkel
- From Stroke Unit (H.J.A.), Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, King’s, Guy’s and St Thomas’ Medical School, London, UK; Department of Neurology (K.S.), Klinikum Bayreuth, Germany; Department of Neurology (V.T.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany; Division of Health and Social Care Research (P.U.H.), King’s College London, UK; Department of Neurology (U.B.), University of Regensburg, Germany, Department of Neurology (R.L.H.),
| | | |
Collapse
|
340
|
Correlation between US-PSV and MDCTA in the quantification of carotid artery stenosis. Eur J Radiol 2009; 74:99-103. [PMID: 19246169 DOI: 10.1016/j.ejrad.2009.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 01/24/2009] [Accepted: 01/27/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE Stroke is a major cause of death and serious long-lasting neurological disability and the severity of carotid artery stenosis is one of the most important determinants of cerebrovascular events. The purpose of this paper is to evaluate the correlation between multi-detector-row CT angiography (MDCTA) and ultra-sound peak-systolic-velocity (US-PSV) in the quantification of carotid artery stenosis. METHODS AND MATERIAL 52 patients were retrospectively studied by using four-detector row CT and ultra-sound. Each patient was assessed for stenosis degree by using NASCET method when studied by using MDCT and by using PSV when studied by using US. Statistic analysis was performed to determine the entity of correlation (method of Pearson) between MDCTA and US-PSV. The Bland-Altman analysis was applied to assess the level of inter-technique agreement. RESULTS Sonographic PSV measurements ranged from 70 to 589cm/s. Distal ICA velocities ranged from 29 to 238cm/s. Linear regression analysis showed a good correlation (r(2)=0.613) between MDCTA-NASCET linear percentage stenosis and PSV and measured. PSV value that corresponded to a NASCET linear percentage stenosis of 70% was 283cm/s and with this values sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 75%, 88.6%, 90.7% and 70.5%, respectively. CONCLUSIONS Results of our study suggest that NASCET stenosis measured in MDCTA and PSV values have a good correlation. The use of a threshold of 283cm/s allows obtaining good value of sensitivity and specificity.
Collapse
|
341
|
Abstract
BACKGROUND AND PURPOSE Epidemiological studies, mainly based on Western European surveys, have shown that stroke is more common in men than in women. In recent years, sex-specific data on stroke incidence, prevalence, subtypes, severity and case-fatality have become available from other parts of the world. The purpose of this article is to give a worldwide review on sex differences in stroke epidemiology. METHODS We searched PubMed, tables-of-contents, review articles, and reference lists for community-based studies including information on sex differences. In some areas, such as secular trends, ischemic subtypes and stroke severity, noncommunity-based studies were also reviewed. Male/female ratios were calculated. RESULTS We found 98 articles that contained relevant sex-specific information, including 59 incidence studies from 19 countries and 5 continents. The mean age at first-ever stroke was 68.6 years among men, and 72.9 years among women. Male stroke incidence rate was 33% higher and stroke prevalence was 41% higher than the female, with large variations between age bands and between populations. The incidence rates of brain infarction and intracerebral hemorrhage were higher among men, whereas the rate of subarachnoidal hemorrhage was higher among women, although this difference was not statistically significant. Stroke tended to be more severe in women, with a 1-month case fatality of 24.7% compared with 19.7% for men. CONCLUSIONS Worldwide, stroke is more common among men, but women are more severely ill. The mismatch between the sexes is larger than previously described.
Collapse
Affiliation(s)
- Peter Appelros
- Department of Neurology, Orebro University Hospital, Orebro, Sweden.
| | | | | |
Collapse
|
342
|
Timmermans AAA, Seelen HAM, Willmann RD, Kingma H. Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design. J Neuroeng Rehabil 2009; 6:1. [PMID: 19154570 PMCID: PMC2647548 DOI: 10.1186/1743-0003-6-1] [Citation(s) in RCA: 225] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 01/20/2009] [Indexed: 01/19/2023] Open
Abstract
Background It is the purpose of this article to identify and review criteria that rehabilitation technology should meet in order to offer arm-hand training to stroke patients, based on recent principles of motor learning. Methods A literature search was conducted in PubMed, MEDLINE, CINAHL, and EMBASE (1997–2007). Results One hundred and eighty seven scientific papers/book references were identified as being relevant. Rehabilitation approaches for upper limb training after stroke show to have shifted in the last decade from being analytical towards being focussed on environmentally contextual skill training (task-oriented training). Training programmes for enhancing motor skills use patient and goal-tailored exercise schedules and individual feedback on exercise performance. Therapist criteria for upper limb rehabilitation technology are suggested which are used to evaluate the strengths and weaknesses of a number of current technological systems. Conclusion This review shows that technology for supporting upper limb training after stroke needs to align with the evolution in rehabilitation training approaches of the last decade. A major challenge for related technological developments is to provide engaging patient-tailored task oriented arm-hand training in natural environments with patient-tailored feedback to support (re) learning of motor skills.
Collapse
Affiliation(s)
- Annick A A Timmermans
- Faculty of Biomedical Technology, Technical University Eindhoven, Eindhoven, the Netherlands.
| | | | | | | |
Collapse
|
343
|
Della Morte D, Abete P, Gallucci F, Scaglione A, D'Ambrosio D, Gargiulo G, De Rosa G, Dave KR, Lin HW, Cacciatore F, Mazzella F, Uomo G, Rundek T, Perez-Pinzon MA, Rengo F. Transient ischemic attack before nonlacunar ischemic stroke in the elderly. J Stroke Cerebrovasc Dis 2009; 17:257-62. [PMID: 18755403 DOI: 10.1016/j.jstrokecerebrovasdis.2008.03.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 03/07/2008] [Accepted: 03/12/2008] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Several studies suggest transient ischemic attack (TIA) may be neuroprotective against ischemic stroke analogous to preinfarction angina's protection against acute myocardial infarction. However, this protective ischemic preconditioning-like effect may not be present in all ages, especially among the elderly. The purpose of this study was to determine the neuroprotective effect of TIAs (clinical equivalent of cerebral ischemic preconditioning) to neurologic damage after cerebral ischemic injury in patients over 65 years of age. METHODS We reviewed the medical charts of patients with ischemic stroke for presence of TIAs within 72 hours before stroke onset. Stroke severity was evaluated by the National Institutes of Health Stroke Scale and disability by a modified Rankin scale. RESULTS We evaluated 203 patients (>or=65 years) with diagnosis of acute ischemic stroke and categorized them according to the presence (n = 42, 21%) or absence (n = 161, 79%) of TIAs within 72 hours of stroke onset. Patients were monitored until discharged from the hospital (length of hospital stay 14.5 +/- 4.8 days). No significant differences in the National Institutes of Health Stroke Scale and modified Rankin scale scores were observed between those patients with TIAs and those without TIAs present before stroke onset at admission or discharge. CONCLUSION These results suggest that the neuroprotective mechanism of cerebral ischemic preconditioning may not be present or functional in the elderly.
Collapse
Affiliation(s)
- David Della Morte
- Department of Internal Medicine, Cardiovascular Sciences, and Immunology, University Federico II, Naples, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
344
|
Abstract
Stroke is a leading cause of morbidity and mortality worldwide, and it is likely to worsen in developing countries over the next two decades based on the projections by the World Health Organization (WHO). With the current scourge of HIV/AIDS and the battle against other communicable diseases like multi-drug resistant malaria and tuberculosis; Nigeria, the most populous black nation in the world, stands to risk the further straining of its resources as a result of the increasing prevalence of stroke and other cardiovascular diseases due to epidemiological transition. The current prevalence of stroke in Nigeria is 1.14 per 1000 while the 30-day case fatality rate is as high as 40%. Management of the disease is largely conservative while there is little or no funding for high-quality research. Primary prevention is the key to reducing the burden of the disease in a country with such poor resources.
Collapse
Affiliation(s)
- Kolawole Wasiu Wahab
- Division of Neurology, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| |
Collapse
|
345
|
Béjot Y, Giroud M. Estimating nationwide burden of stroke: the exciting but difficult challenge for the 21st century. Eur J Neurol 2008; 15:1259-60. [DOI: 10.1111/j.1468-1331.2008.02326.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
346
|
Vaartjes I, Reitsma JB, de Bruin A, Berger-van Sijl M, Bos MJ, Breteler MMB, Grobbee DE, Bots ML. Nationwide incidence of first stroke and TIA in the Netherlands. Eur J Neurol 2008; 15:1315-23. [DOI: 10.1111/j.1468-1331.2008.02309.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
347
|
Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol 2008; 7:951-64. [DOI: 10.1016/s1474-4422(08)70216-3] [Citation(s) in RCA: 214] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
348
|
|
349
|
Abstract
It is common knowledge that ischemic stroke has major social and economic consequences. However, until now, translation of experimental studies into clinical reality has been sorely lacking. So far, most studies have focused on acute stroke outcome and early treatment paradigms affording neuroprotection. It is increasingly recognized that it will be necessary to harness the capacity of the brain for neuroregeneration to improve longer-term outcome. Endothelial nitric oxide synthase (eNOS) is emerging as a key target in molecular stroke research. eNOS ameliorates acute ischemic injury and promotes recovery following cerebral ischemia. This review summarizes the effects of eNOS on the regulation of cerebral blood flow, hemostasis, inflammation, angiogenesis as well as neurogenesis. The possible impact on stroke prevention as well as on strategies aimed at improving long-term stroke outcome are discussed.
Collapse
Affiliation(s)
- Karen Gertz
- Charité Universitätsmedizin Berlin, Klinik und Poliklinik für Neurologie, Abteilung für Experimentelle Neurologie, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Endres
- Charité Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie und Klinische Neurophysiologie, Campus Benjamin Franklin and Center for Stroke Research Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
350
|
Jones F, Partridge C, Reid F. The Stroke Self-Efficacy Questionnaire: measuring individual confidence in functional performance after stroke. J Clin Nurs 2008; 17:244-52. [PMID: 18578800 DOI: 10.1111/j.1365-2702.2008.02333.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim was to develop a questionnaire for use by practitioners working in stroke care to measure self-efficacy judgements in specific domains of functioning relevant to individuals following stroke. BACKGROUND The prevalence of stroke is set to rise across the developed world especially amongst the elderly population. Recovery and adjustment in the longer term can be affected by many different factors. Current objective measures of functional performance used in many stroke programmes may not fully explain the extent of personal levels of confidence that could ultimately influence outcome. METHODS Three separate studies were conducted to develop the Stroke Self-Efficacy Questionnaire. A total of 112 stroke survivors, between 2 and 24 weeks, poststroke participated in the study. Development of the scale was undertaken between 2004 and 2006. RESULTS The final 13-item Stroke Self-Efficacy Questionnaire was found to have good face validity and feasibility to use in the recovery period following stroke. Cronbach Alpha was 0.90 suggesting good internal consistency, and criterion validity was high compared with the Falls Efficacy Scale, r = 0.803, p < 0.001. The Stroke Self-Efficacy Questionnaire was also able to discriminate between those participants walking and not walking. CONCLUSIONS Preliminary psychometric testing of the new Stroke Self-Efficacy Questionnaire has indicated that it is a valid measure of confidence for functional performance and aspects of self-management relevant for individuals recovering from stroke. RELEVANCE TO CLINICAL PRACTICE The Stroke Self-Efficacy Questionnaire could assist clinicians and researchers working in acute stroke care and rehabilitation to screen levels of confidence of stroke survivors in relation to functional performance and self-management. The Stroke Self-Efficacy Questionnaire could be used as part of battery of stroke outcome measures to provide a more comprehensive overview of factors influencing performance in the individuals recovering from a stroke.
Collapse
Affiliation(s)
- Fiona Jones
- Faculty of Health and Social Care, St George's University of London, London, UK.
| | | | | |
Collapse
|