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Nakamura T, Kurosaki S, Baba M, Irisawa H, Mizushima T. Effectiveness of rehabilitation for young patients with extensive right hemisphere cerebral infarction: A report of two cases. Clin Case Rep 2024; 12:e9328. [PMID: 39135767 PMCID: PMC11317890 DOI: 10.1002/ccr3.9328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/22/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
Key Clinical Message In younger patients, including those with extensive infarction involving the anterior and middle cerebral artery regions of the right hemisphere, appropriate treatment for rare causes and goal-oriented long-term rehabilitation could improve severe hemiplegia and higher brain dysfunction, and allow for further education and employment. Abstract Although the number of young stroke patients is small, many have serious sequelae and rare causes. In addition to independence in activities of daily living, education and employment are desired. We present two cases of extensive infarction in the right cerebrum in patients who underwent rehabilitation with good outcomes.
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Affiliation(s)
- Tomoyuki Nakamura
- Department of Rehabilitation MedicineDokkyo Medical UniversityShimotsuga‐gunTochigiJapan
- Department of Rehabilitation MedicineJapanese Red Cross Ashikaga HospitalAshikagaTochigiJapan
| | - Shuhei Kurosaki
- Department of Rehabilitation MedicineJapanese Red Cross Ashikaga HospitalAshikagaTochigiJapan
| | - Mikoto Baba
- Department of Rehabilitation MedicineJapanese Red Cross Ashikaga HospitalAshikagaTochigiJapan
| | - Hiroshi Irisawa
- Department of Rehabilitation MedicineDokkyo Medical UniversityShimotsuga‐gunTochigiJapan
| | - Takashi Mizushima
- Department of Rehabilitation MedicineDokkyo Medical UniversityShimotsuga‐gunTochigiJapan
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Burfein P, Roxbury T, Doig EJ, McSween MP, de Silva N, Copland DA. Return to work for stroke survivors with aphasia: A quantitative scoping review. Neuropsychol Rehabil 2024:1-35. [PMID: 39087687 DOI: 10.1080/09602011.2024.2381874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
The international incidence of stroke in people of working age is rising. As such, meaningful work return is a major rehabilitation goal for many individuals, including those with aphasia. This scoping review aimed to outline the post-stroke aphasia evidence related to work outcomes, factors influencing employment along with contemporary vocational-language and communication rehabilitation practice. The review employed terms related to aphasia, stroke, rehabilitation, and return to work in publications preceding 25.6.2023. Data were descriptively analysed, and vocational outcomes were summarized at defined timepoints. Of the 908 articles reviewed, 31 papers were included. Individuals with post-stroke aphasia consistently have lower rates of return to work than those post-stroke without aphasia. Employment at one year was 34.29% for those with aphasia compared to 58.46% for people without aphasia. No literature reported vocational-language assessment practices and there were minimal work-focused aphasia interventions identified. There was insufficient evidence to clearly identify person-related, rehabilitation, workplace or other factors influencing work return. This scoping review has identified that there are gaps in knowledge about the factors that influence work return and targeted vocational rehabilitation for this group. Future research to optimize return to work for individuals with aphasia is recommended.
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Affiliation(s)
- P Burfein
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - T Roxbury
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - E J Doig
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - M-P McSween
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - N de Silva
- Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - D A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
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Matos J, Moura A, Teixeira F, Henriques A, Alves E. Professional reintegration among professionally active Portuguese stroke survivors: a multicentric study. Disabil Rehabil 2024; 46:2619-2628. [PMID: 37370241 DOI: 10.1080/09638288.2023.2228200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To assess professional reintegration, the perceived impact of stroke on work, and the main determinants of return to work (RTW) among stroke survivors. MATERIALS AND METHODS A cross-sectional study was performed, based on a cohort of stroke survivors. A structured questionnaire was administered to previously working stroke survivors, 18-24 months post-stroke. Data on sociodemographic characteristics, stroke features and their impact on work, access to rehabilitation services during hospital admission and after discharge, social support, and professional reintegration were reported by 553 stroke survivors. RESULTS On average, 56.6% (95% CI 52.4-60.8) of stroke survivors resumed professional activity, 20 months after stroke. Approximately 90% of survivors who RTW, returned to the same job and same function they performed before stroke. The majority did not receive reintegration support. The main determinants of RTW were lower age, higher socioeconomic status, and better functional status. CONCLUSIONS Professional reintegration and vocational support after stroke, remained below the international goals for community reintegration of stroke survivors. Future studies should explore the impact of professional and social reintegration on the psychological health and quality of life of stroke survivors and the barriers, challenges, and strategies used to overcome them, to allow for effective professional reintegration policies.
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Affiliation(s)
- Joana Matos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Aveiro, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ana Moura
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Centre for Research and Intervention in Education (CIIE), Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Filipa Teixeira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ana Henriques
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Elisabete Alves
- São João de Deus School of Nursing, University of Évora Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Mazzeo S, Pancani S, Sodero A, Castagnoli C, Politi AM, Barnabè M, Ciullini F, Baccini M, Grippo A, Hakiki B, Macchi C, Cecchi F. Depressive Symptoms Moderate the Association Between Functional Level at Admission to Intensive Post-Stroke Rehabilitation and Effectiveness of the Intervention. J Geriatr Psychiatry Neurol 2024; 37:222-233. [PMID: 37828783 DOI: 10.1177/08919887231204543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Previous studies showed that depression acts as an independent factor in functional recovery after stroke. In a prospective cohort of patients admitted to intensive inpatient rehabilitation after a stroke, we aimed to test depression as a moderator of the relationship between the functional level at admission and the effectiveness of rehabilitation at discharge. METHODS All patients admitted to within 30 days from an ischemic or hemorrhagic stroke to 4 intensive rehabilitation units were prospectively screened for eligibility to a multicenter prospective observational study. Enrolled patients underwent an evidence-based rehabilitation pathway. We used clinical data collected at admission (T0) and discharge (T1). The outcome was the effectiveness of recovery at T1 on the modified Barthel Index (proportion of achieved over potential functional improvement). Moderation analysis was performed by using the PROCESS macro for SPSS using the bootstrapping procedure. RESULTS Of 278 evaluated patients, 234 were eligible and consented to enrolment; 81 patients were able to answer to the Hospital Anxiety and Depression Scale (HADS) and were included in this analysis. The relationship between the functional status at admission and rehabilitation effectiveness was significant only in persons with fewer depressive symptoms; depression (HADS cut-off score: 5.9) moderated this relationship (P = .047), independent from age and neurological impairment. CONCLUSIONS Our results suggest that depression moderates between the functional status at admission and the functional recovery after post-stroke rehabilitation. This approach facilitates the identification of subgroups of individuals who may respond differently to stroke rehabilitation based on depression.
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Affiliation(s)
- Salvatore Mazzeo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | | | | | - Monica Barnabè
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | | | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Wechsler PM, Pandya A, Parikh NS, Razzak JA, White H, Navi BB, Kamel H, Liberman AL. Cost-Effectiveness of Increased Use of Dual Antiplatelet Therapy After High-Risk Transient Ischemic Attack or Minor Stroke. J Am Heart Assoc 2024; 13:e032808. [PMID: 38533952 PMCID: PMC11179775 DOI: 10.1161/jaha.123.032808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Rates of dual antiplatelet therapy (DAPT) after high-risk transient ischemic attack or minor ischemic stroke (TIAMIS) are suboptimal. We performed a cost-effectiveness analysis to characterize the parameters of a quality improvement (QI) intervention designed to increase DAPT use after TIAMIS. METHODS AND RESULTS We constructed a decision tree model that compared current national rates of DAPT use after TIAMIS with rates after implementing a theoretical QI intervention designed to increase appropriate DAPT use. The base case assumed that a QI intervention increased the rate of DAPT use to 65% from 45%. Costs (payer and societal) and outcomes (stroke, myocardial infarction, major bleed, or death) were modeled using a lifetime horizon. An incremental cost-effectiveness ratio <$100 000 per quality-adjusted life year was considered cost-effective. Deterministic and probabilistic sensitivity analyses were performed. From the payer perspective, a QI intervention was associated with $9657 in lifetime cost savings and 0.18 more quality-adjusted life years compared with current national treatment rates. A QI intervention was cost-effective in 73% of probabilistic sensitivity analysis iterations. Results were similar from the societal perspective. The maximum acceptable, initial, 1-time payer cost of a QI intervention was $28 032 per patient. A QI intervention that increased DAPT use to at least 51% was cost-effective in the base case. CONCLUSIONS Increasing DAPT use after TIAMIS with a QI intervention is cost-effective over a wide range of costs and proportion of patients with TIAMIS treated with DAPT after implementation of a QI intervention. Our results support the development of future interventions focused on increasing DAPT use after TIAMIS.
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Affiliation(s)
- Paul M. Wechsler
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Ankur Pandya
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMA
| | - Neal S. Parikh
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Junaid A. Razzak
- Department of Emergency MedicineWeill Cornell MedicineNew YorkNY
| | - Halina White
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Babak B. Navi
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Hooman Kamel
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Ava L. Liberman
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
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Li J, Pan X, Wang Z, Zhong W, Yao L, Xu L. Interventions to Support the Return to Work for Individuals with Stroke: A Systematic Review and Meta-analysis. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10178-y. [PMID: 38512392 DOI: 10.1007/s10926-024-10178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention. METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs). RESULTS A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I2 = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals' functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I2 = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I2 = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity. CONCLUSION Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke. SYSTEMATIC REVIEW REGISTRATION PROSPERO Registration Number, CRD42023443668.
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Affiliation(s)
- Jiaxuan Li
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xi Pan
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhi Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Weiying Zhong
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lin Yao
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lan Xu
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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7
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Aslan A, Abuzahra S, Adeeb N, Musmar B, Salim HA, Kandregula S, Dmytriw AA, Griessenauer CJ, De Alba L, Arevalo O, Burkhardt JK, Pereira VM, Jabbour P, Guthikonda B, Cuellar HH. The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory. J Neurointerv Surg 2024:jnis-2023-021368. [PMID: 38471764 DOI: 10.1136/jnis-2023-021368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the expected infarction is large (defined as an Alberta Stroke Program Early CT Score of <6). OBJECTIVE To perform a meta-analysis of recent trials comparing MT with best medical management (BMM) for treatment of acute ischemic stroke with large infarction territory, and then to determine the cost-effectiveness associated with those treatments. METHODS A meta-analysis of the RESCUE-Japan, SELECT2, and ANGEL-ASPECT trials was conducted using R Studio. Statistical analysis employed the weighted average normal method for calculating mean differences from medians in continuous variables and the risk ratio for categorical variables. TreeAge software was used to construct a cost-effectiveness analysis model comparing MT with BMM in the treatment of ischemic stroke with large infarction territory. RESULTS The meta-analysis showed significantly better functional outcomes, with higher rates of patients achieving a modified Rankin Scale score of 0-3 at 90 days with MT as compared with BMM. In the base-case analysis using a lifetime horizon, MT led to a greater gain in quality-adjusted life-years (QALYs) of 3.46 at a lower cost of US$339 202 in comparison with BMM, which led to the gain of 2.41 QALYs at a cost of US$361 896. The incremental cost-effectiveness ratio was US$-21 660, indicating that MT was the dominant treatment at a willingness-to-pay of US$70 000. CONCLUSIONS This study shows that, besides having a better functional outcome at 90-days' follow-up, MT was more cost-effective than BMM, when accounting for healthcare cost associated with treatment outcome.
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Affiliation(s)
- Assala Aslan
- Department of Radiology, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Saad Abuzahra
- Department of Radiology, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Nimer Adeeb
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Basel Musmar
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Hamza A Salim
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Sandeep Kandregula
- Department of Neurosurgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, Massachusetts, USA
- Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Luis De Alba
- Department of Radiology, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Octavio Arevalo
- Department of Radiology, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vitor M Pereira
- Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Hugo H Cuellar
- Department of Radiology, Louisiana State University Shreveport, Shreveport, Louisiana, USA
- Department of Neurosurgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mehrens D, Fabritius MP, Reidler P, Liebig T, Afat S, Ospel JM, Fröhlich MF, Schwarting J, Ricke J, Dimitriadis K, Goyal M, Kunz WG. Cost-effectiveness of endovascular treatment versus best medical management in basilar artery occlusion stroke: A U.S. healthcare perspective. Eur Stroke J 2024; 9:97-104. [PMID: 37905959 PMCID: PMC10916810 DOI: 10.1177/23969873231209616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/08/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Two recent studies showed clinical benefit for endovascular treatment (EVT) in basilar artery occlusion (BAO) stroke up to 12 h (ATTENTION) and between 6 and 24 h from onset (BAOCHE). Our aim was to investigate the cost-effectiveness of EVT from a U.S. healthcare perspective. MATERIALS AND METHODS Clinical input data were available for both trials, which were analyzed separately. A decision model was built consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a healthcare and a societal perspective. Incremental cost-effectiveness ratios (ICER) were calculated, deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. RESULTS EVT in addition to best medical management (BMM) resulted in additional lifetime costs of $32,063 in the ATTENTION trial and lifetime cost savings of $7690 in the BAOCHE trial (societal perspective). From a healthcare perspective, EVT led to incremental costs and effectiveness of $37,389 and 2.0 QALYs (ATTENTION) as well as $3516 and 1.9 QALYs (BAOCHE), compared to BMM alone. The ICER values were $-4052/QALY (BAOCHE) and $15,867/QALY (ATTENTION) from a societal perspective. In each trial, PSA showed EVT to be cost-effective in most calculations (99.9%) for a willingness-to-pay threshold of $100,000/QALY. Cost of EVT and age at stroke represented the greatest impact on the ICER. DISCUSSION From an economic standpoint with a lifetime horizon, EVT in addition to BMM is estimated to be highly effective and cost-effective in BAO stroke.
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Affiliation(s)
- Dirk Mehrens
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Paul Reidler
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Saif Afat
- Department of Radiology, University of Tübingen, Tübingen, Germany
| | - Johanna M Ospel
- Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University Hospital of Basel, Basel, Switzerland
| | - Matthias F Fröhlich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Julian Schwarting
- Department of Diagnostic and Interventional Neuroradiology, Technical University Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Konstantinos Dimitriadis
- Institute for Stroke and Dementia Research, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Mayank Goyal
- Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Wolfgang G Kunz
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
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Orange C, Lanhers C, Coll G, Coste N, Dutheil F, Hauret I, Pereira B, Coudeyre E. Determinants of Return to Work After a Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:359-368. [PMID: 37797913 DOI: 10.1016/j.apmr.2023.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/13/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To identify prognostic factors for return to work (RTW) after stroke. DATA SOURCES PubMed, MEDLINE, Cochrane, and Embase were systematically searched. STUDY SELECTION Studies had to include people of working age (<65 years old) at the time of stroke (ischemic, hemorrhagic, or subarachnoid hemorrhage). The evaluation of RTW and rate of RTW had to be mentioned. Study selection was done by 2 independent authors. In total, 1241 articles were screened, 39 met all inclusion criteria. DATA EXTRACTION Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. Quality was assessed using the Scottish Intercollegiate Guidelines Network quality assessment tool. DATA SYNTHESIS Among the 39 studies, prognostic factors for RTW were hemorrhagic stroke (odds ratio 0.53 [95% confidence interval 0.45-0.60], n=18 studies), sex (men) (1.26 [1.14-1.40], n=31), aphasia (0.37 [0.20-0.69], n=7), occupation (white collar worker) (1.84 [1.64-2.06], n=17), independence in activities of daily living (3.99 [1.73-9.23], n=7), and stroke severity (NIHSS) (1.23 [1.08-1.39], n=6). CONCLUSIONS This meta-analysis highlighted positive and negative prognostic factors associated with RTW after stroke. Two categories were distinguished: modifiable and non-modifiable prognostic factors. This study provides information to help understand the issues, set appropriate objectives and implement appropriate strategies to guide people to RTW after stroke. Randomized controlled studies are needed to better evaluate work-place intervention programs as well as the effects of intravenous thrombolysis, and cognitive and neuropsychological rehabilitation on return-to-work rates after stroke.
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Affiliation(s)
- Charles Orange
- Physical Medicine and Rehabilitation, CMPR Maurice Gantchoula Pionsat, France; Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Charlotte Lanhers
- Physical Medicine and Rehabilitation, CMPR Maurice Gantchoula Pionsat, France
| | - Guillaume Coll
- University hospital of Clermont-Ferrand, Neurosurgery B, Clermont-Ferrand, France
| | - Nicolas Coste
- Physical Medicine and Rehabilitation, Notre-Dame, Chamalières, France
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CNRS, LaPSCo, Physiological and Psychosocial Stress, university hospital of Clermont-Ferrand, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Hauret
- Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical research and innovation direction, biostatistics, university hospital of Clermont-Ferrand, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Markovic G, Bartfai A, Schult ML, Ekholm J. Rehabilitation with intensive attention training early after acquired brain injury promotes better long-term status on health-related quality of life, daily activities, work ability and return to work. J Rehabil Med 2024; 56:jrm5308. [PMID: 38214119 PMCID: PMC10802788 DOI: 10.2340/jrm.v56.5308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To describe long-term effects on activity, participation, and quality of life (i) at different post-injury starting time points of attention training and (ii) of two different types of rehabilitation with attention training in patients after stroke or traumatic brain injury; and to describe their functioning level. DESIGN 2 years after rehabilitation intervention, comparisons were made in one cohort receiving attention training subacute (< 4 months) or post-acute (4-12 months) and in one cohort with two different training methods, a process-based and an activity-based method respectively. PATIENTS 100 patients were recruited from our earlier RCT study. They had mild to moderate stroke or traumatic brain injury with relatively limited symptomatology, and all had moderate to severe attention impairment. METHODS A questionnaire-based interview: EuroQol 5 dimensions, Occupational Gaps Questionnaire, Work Ability Index, self-assessed work status, self-reported employment conditions, sick leave, and experienced cognitive limitations in work performance. RESULTS An advantage for patients receiving subacute attention training regarding daily activities, work ability and returning to work. CONCLUSION The results indicate that subacute rehabilitation with attention training (< 4 months) is preferable compared to post-acute intervention (4-12 months). There were only minor differences between the training methods.
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Affiliation(s)
- Gabriela Markovic
- aKarolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Division of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.
| | - Aniko Bartfai
- Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Division of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marie-Louise Schult
- Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Division of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Jan Ekholm
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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Ospel JM, Kunz WG, McDonough RV, Goyal M, Uchida K, Sakai N, Yamagami H, Yoshimura S. Cost-effectiveness of Endovascular Treatment for Acute Stroke with Large Infarct: A United States Perspective. Radiology 2023; 309:e223320. [PMID: 37787675 DOI: 10.1148/radiol.223320] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background The health economic benefit of endovascular treatment (EVT) in addition to best medical management for acute ischemic stroke with large ischemic core is uncertain. Purpose To assess the cost-effectiveness of EVT plus best medical management versus best medical management alone in treating acute ischemic stroke with large vessel occlusion and a baseline Alberta Stroke Program Early CT Score (ASPECTS) 3-5. Materials and Methods This is a secondary analysis of the randomized RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Large Ischemic Core Trial), with enrollment November 2018 to September 2021, in which the primary outcome was the modified Rankin Scale (mRS) score at 90 days. Participants with a baseline ASPECTS 3-5 (on the basis of noncontrast CT and diffusion-weighted imaging) were randomized 1:1 to receive EVT plus best medical management (n = 100) or best medical management alone (n = 102). The primary outcome of the current study was cost-effectiveness, determined according to the incremental cost-effectiveness ratio (ICER). A decision model consisting of a short-term component (cycle length of 3 months) and a long-term Markov state transition component (cycle length of 1 year) was used to estimate expected lifetime costs and quality-adjusted life-years (QALYs) from health care and societal perspectives in the United States. Upper and lower willingness-to-pay (WTP) thresholds were set at $100 000 and $50 000 per QALY, respectively. A deterministic one-way sensitivity analysis to determine the impact of participant age and a probabilistic sensitivity analysis to assess the impact of parameter uncertainty were conducted. Results A total of 202 participants were included in the study (mean age, 76 years ± 10 [SD]; 112 male). EVT plus best medical management resulted in ICERs of $15 743 (health care perspective) and $19 492 (societal perspective). At the lower and upper WTP thresholds, EVT was cost-effective up to 85 and 90 years (health care perspective) and 84 and 89 years (societal perspective) of age, respectively. When analyzing participants with the largest infarcts (ASPECTS 3) separately, EVT was not cost-effective (ICER, $337 072 [health care perspective] and $383 628 [societal perspective]). Conclusion EVT was cost-effective for participants with an ASPECTS 4-5, but not for those with an ASPECTS 3. ClinicalTrials.gov registration no. NCT03702413 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Widjaja in this issue.
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Affiliation(s)
- Johanna Maria Ospel
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
| | - Wolfgang Gerhard Kunz
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
| | - Rosalie Victoria McDonough
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
| | - Mayank Goyal
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
| | - Kazutaka Uchida
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
| | - Nobuyuki Sakai
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
| | - Hiroshi Yamagami
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
| | - Shinichi Yoshimura
- From the Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (J.M.O., R.V.M., M.G.); Department of Radiology, University Hospital, LMU Munich, Munich, Germany (W.G.K.); Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (K.U., S.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.); Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.)
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12
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Coutts E, Cooper K. Return to work for adults following stroke: a scoping review of interventions, factors, barriers, and facilitators. JBI Evid Synth 2023; 21:1794-1837. [PMID: 37255032 DOI: 10.11124/jbies-22-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This scoping review aimed to map the literature on interventions, factors, barriers, and facilitators for return to work for adults post-stroke with or without communication disorders. INTRODUCTION Difficulties in returning to work can significantly impact individuals following a stroke (eg, their sense of purpose and self-esteem), not only financially, but also as they adjust to the change in their situation. Such difficulties may arise from communication disorders as well as physical impairments. Previous reviews on return to work post-stroke have focused on specific aspects, such as interventions, or barriers and facilitators, but have not provided a comprehensive map of the field. Further, no systematic or scoping reviews to date have focused on literature addressing return to work for people with communication disorders post-stroke. INCLUSION CRITERIA This review considered literature that reported on interventions, barriers, and facilitators for return to work for adults (aged 16 years or older) following an ischemic or hemorrhagic stroke. Records focusing on transient ischemic attacks or acquired brain injury were excluded, as were those in which a comorbidity or disability (eg, learning disability, dementia, respiratory disorder) had a significant impact on the individual's ability to work. METHODS This review followed the JBI scoping review methodology. Primary research of any type, systematic and non-systematic reviews, and gray literature from developed countries written in English from 2010 to the present day were identified from 7 databases, 2 gray literature repositories, JBI Evidence Synthesis , and an internet search. Records were screened for relevance to the review topic by 2 independent reviewers, and data relevant to the review questions were extracted. Findings were presented as narrative supported by tables. RESULTS Of the 106 sources included, 61 addressed demographic-based, socioeconomic-based, impairment-based, or recovery-based factors related to return to work. One of these 61 sources, a narrative review, focused on communication disorders. Thirty-eight sources explored barriers and facilitators for return to work from different stakeholders' perspectives; 3 of these 38 sources, including 2 qualitative studies and 1 narrative review, focused on post-stroke communication disorders. Eleven sources focused on interventions, including 7 studies (reported across 9 sources) that developed or tested return-to-work interventions. Of these primary studies, 1 randomized controlled trial and 1 retrospective cohort study were identified. The remaining intervention studies were case studies or case series. None of these intervention studies addressed communication disorders. CONCLUSIONS While there has been extensive research on factors, barriers, and facilitators for return to work post-stroke, there is a lack of research on interventions supporting return to work. There is also a significant gap in the evidence base on returning to work with a post-stroke communication disorder, highlighting the need for further research in this important area.
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Affiliation(s)
- Emma Coutts
- Speech and Language Therapy, NHS Grampian, Fraserburgh UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Robert Gordon University, Aberdeen, UK
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13
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Ospel JM, Adams C, Tymianski M, Goyal M, Hill M. Health economic impact of Nerinetide in addition to mechanical thrombectomy without concurrent alteplase. Interv Neuroradiol 2023:15910199231193455. [PMID: 37590087 DOI: 10.1177/15910199231193455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND PURPOSE The ESCAPE-NA1 trial has shown that intravenous Nerinetide improves clinical outcomes in acute ischemic stroke patients with large vessel occlusion undergoing endovascular treatment without concurrent intravenous alteplase. We assessed the health economic impact of intravenous Nerinetide as an adjunctive treatment in endovascular treatment patients who do not receive concurrent intravenous alteplase. METHODS Data are from the ESCAPE-NA1 trial, in which acute ischemic stroke with large vessel occlusion endovascular treatment patients were randomized to receive intravenous Nerinetide or placebo. Only those patients not treated with concurrent intravenous alteplase were included in this analysis. We used a Markov state transition model (12 months cycle length) to estimate expected lifetime costs and outcomes, assuming Nerinetide cost being zero for the purpose of this analysis. We calculated incremental cost-effectiveness ratios and derived mean net monetary benefits with 95% prediction intervals from a probabilistic sensitivity analysis. Upper, middle, and lower willingness-to-pay thresholds were set at $50,000,$100,000, and $150,000. RESULTS The incremental cost-effectiveness ratio for Nerinetide in addition to endovascular treatment was $13,721/quality-adjusted life year (healthcare perspective) and $14,453/quality-adjusted life year (societal perspective). At the upper willingness-to-pay threshold, Nerinetide in addition to endovascular treatment resulted in a higher mean net monetary benefit compared to endovascular treatment alone, both from a healthcare perspective (449,526 [95% prediction interval: 448,627-450,425] vs. 382,584 [381,781-383,386]) and a societal perspective (350,750 [349,842-351,658] vs. 282,896 [282,068-283,725]). Mean net monetary benefits were also higher for Nerinetide in addition to endovascular treatment at the middle and lower willingness-to-pay thresholds. CONCLUSION Treating patients with a cerebroprotectant, such as Nerinetide, in addition to endovascular treatmentl in patients who cannot receive intravenous alteplase may be beneficial from a health-economic standpoint.
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Affiliation(s)
- Johanna M Ospel
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | | | - Mayank Goyal
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michael Hill
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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14
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Wechsler PM, Liberman AL, Restifo D, Abramson EL, Navi BB, Kamel H, Parikh NS. Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack. Stroke 2023; 54:992-1000. [PMID: 36866670 PMCID: PMC10050136 DOI: 10.1161/strokeaha.122.040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Smoking cessation rates after stroke and transient ischemic attack are suboptimal, and smoking cessation interventions are underutilized. We performed a cost-effectiveness analysis of smoking cessation interventions in this population. METHODS We constructed a decision tree and used Markov models that aimed to assess the cost-effectiveness of varenicline, any pharmacotherapy with intensive counseling, and monetary incentives, compared with brief counseling alone in the secondary stroke prevention setting. Payer and societal costs of interventions and outcomes were modeled. The outcomes were recurrent stroke, myocardial infarction, and death using a lifetime horizon. Estimates and variance for the base case (35% cessation), costs and effectiveness of interventions, and outcome rates were imputed from the stroke literature. We calculated incremental cost-effectiveness ratios and incremental net monetary benefits. An intervention was considered cost-effective if the incremental cost-effectiveness ratio was less than the willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY) or when the incremental net monetary benefit was positive. Probabilistic Monte Carlo simulations modeled the impact of parameter uncertainty. RESULTS From the payer perspective, varenicline and pharmacotherapy with intensive counseling were associated with more QALYs (0.67 and 1.00, respectively) at less total lifetime costs compared with brief counseling alone. Monetary incentives were associated with 0.71 more QALYs at an additional cost of $120 compared with brief counseling alone, yielding an incremental cost-effectiveness ratio of $168/QALY. From the societal perspective, all 3 interventions provided more QALYs at less total costs compared with brief counseling alone. In 10 000 Monte Carlo simulations, all 3 smoking cessation interventions were cost-effective in >89% of runs. CONCLUSIONS For secondary stroke prevention, it is cost-effective and potentially cost-saving to deliver smoking cessation therapy beyond brief counseling alone.
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Affiliation(s)
- Paul M Wechsler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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15
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Ospel JM, Kunz WG, McDonough RV, van Zwam W, Pinckaers F, Saver JL, Hill MD, Demchuk AM, Jovin TG, Mitchell P, Campbell BCV, White P, Muir K, Achit H, Bracard S, Brown S, Goyal M. Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration. Stroke 2023; 54:226-233. [PMID: 36472199 DOI: 10.1161/strokeaha.121.038407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2. METHODS Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed. RESULTS EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only. CONCLUSIONS From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.
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Affiliation(s)
- Johanna M Ospel
- Department of Neuroradiology, University Hospital Basel, Switzerland (J.M.O.).,Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
| | - Rosalie V McDonough
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Wim van Zwam
- Department of Radiology, Maastricht University Medical Center, the Netherlands (W.v.Z.)
| | | | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Michael D Hill
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Tudor G Jovin
- Department of Neurology, Cooper University Health Care, Camden (T.G.J.)
| | - Peter Mitchell
- Department of Radiology (P.M.), Royal Melbourne Hospital, University of Melbourne, Australia
| | - Bruce C V Campbell
- Department of Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia
| | - Phil White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (P.W.)
| | - Keith Muir
- Department of Neurology, University of Glasgow, Scotland (K.M.)
| | - Hamza Achit
- Department of Medicine (H.A.), Nancy University Hospital, France
| | - Serge Bracard
- Department of Neuroradiology (S.B.), Nancy University Hospital, France
| | - Scott Brown
- Altair Biostatistics, St Louis Park' MN (S.B.)
| | - Mayank Goyal
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
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16
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Khunte M, Wu X, Koo A, Payabvash S, Matouk C, Heit JJ, Wintermark M, Albers GW, Sanelli PC, Gandhi D, Malhotra A. Cost-effectiveness of thrombectomy in patients with minor stroke and large vessel occlusion: effect of thrombus location on cost-effectiveness and outcomes. J Neurointerv Surg 2023; 15:39-45. [PMID: 35022300 DOI: 10.1136/neurintsurg-2021-018375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND To evaluate the cost-effectiveness of endovascular thrombectomy (EVT) to treat large vessel occlusion (LVO) in patients with acute, minor stroke (National Institute of Health Stroke Scale (NIHSS) <6) and impact of occlusion site. METHODS A Markov decision-analytic model was constructed accounting for both costs and outcomes from a societal perspective. Two different management strategies were evaluated: EVT and medical management. Base case analysis was done for three different sites of occlusion: proximal M1, distal M1 and M2 occlusions. One-way, two-way and probabilistic sensitivity analyses were performed. RESULTS Base-case calculation showed EVT to be the dominant strategy in 65-year-old patients with proximal M1 occlusion and NIHSS <6, with lower cost (US$37 229 per patient) and higher effectiveness (1.47 quality-adjusted life years (QALYs)), equivalent to 537 days in perfect health or 603 days in modified Rankin score (mRS) 0-2 health state. EVT is the cost-effective strategy in 92.7% of iterations for patients with proximal M1 occlusion using a willingness-to-pay threshold of US$100 000/QALY. EVT was cost-effective if it had better outcomes in 2%-3% more patients than intravenous thrombolysis (IVT) in absolute numbers (base case difference -16%). EVT was cost-effective when the proportion of M2 occlusions was less than 37.1%. CONCLUSIONS EVT is cost-effective in patients with minor stroke and LVO in the long term (lifetime horizon), considering the poor outcomes and significant disability associated with non-reperfusion. Our study emphasizes the need for caution in interpreting previous observational studies which concluded similar results in EVT versus medical management in patients with minor stroke due to a high proportion of patients with M2 occlusions in the two strategies.
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Affiliation(s)
- Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Andrew Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jeremy J Heit
- Radiology, Neuroadiology and Neurointervention Division, Stanford University, Stanford, California, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, TX, USA
| | - Gregory W Albers
- Department of Neurology and Neurosurgery, Stanford University, Stanford, California, USA
| | - Pina C Sanelli
- Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Dheeraj Gandhi
- Department of Interventional Neuroradiology, University of Maryland, Baltimore, Maryland, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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Moving from traditional to more advanced treatments in stroke care is cost-effective: A case study from Greece. J Stroke Cerebrovasc Dis 2022; 31:106764. [PMID: 36095859 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/04/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Stroke is the most common cause of disability in high-income countries. Several countries offer a limited range of advanced treatments with implications for outcomes, disability and costs. This study estimates the burden of disability that could have been avoided through the transition from traditional (no intravenous thrombolytic therapy (IVT), or endovascular thrombectomy (EVT)) to modern stroke treatments (treatment in stroke units, IVT and EVT). We perform a cost-effectiveness analysis comparing best practice with traditional stroke care, using Greece as a case study. MATERIALS AND METHODS A Markov model was used to calculate costs and Quality Adjusted Life Years (QALYs) for each treatment strategy, using a lifetime horizon. Data for model inputs were derived from meta-analyses of trials, and national and international cost databases. Sensitivity analyses were also performed to address potential uncertainty and test the robustness of the findings. RESULTS Incremental effectiveness comprised 0.22 QALYs per patient and year. Best practice was cost-effective for more than 90% of all iterations (ICER for the baseline scenario: €2,109.25/QALY). Sensitivity analysis demonstrated that the findings remain robust. Considering the stroke incidence in Greece, the annual additional cost to implement best practice was calculated to be between 0.07%-0.15% of the total health expenditure. CONCLUSION Best practice stroke treatment was cost-effective and affordable in a case study based on Greece. The results could be leveraged by including effects of preventive policies and rehabilitation. They also highlight the importance of adopting modern treatment strategies from a cost-effectiveness perspective, apart from the improved clinical outcomes.
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Ribeiro de Souza F, Sales M, Rabelo Laporte L, Melo A, Manoel da Silva Ribeiro N. Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review. Top Stroke Rehabil 2022:1-14. [PMID: 35787246 DOI: 10.1080/10749357.2022.2095086] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Stroke is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. OBJECTIVE To identify body structure/function impairments and activity limitations in post-stroke that predict social participation restrictions in the community. METHODS cohort studies were selected, involving adult post-stroke participants, which investigated body structure and function impairments or activity limitations of post-stroke individuals as predictors of social participation in the community. Studies that included individuals with subarachnoid hemorrhage, other neurological disorders and participants in long-term care facilities were excluded. The Newcastle-Ottawa quality assessment scale was applied to assess the methodological quality. The results were synthesized according to the found exposures, considering the used statistical models. RESULTS Eleven articles were included, with a total of 2,412 individuals, 58.4% men, 83.7% ischemic stroke. Seven exposures were assessed across studies, in which 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function), and 8 studies assessed activity exposures (daily living activity and walking ability). CONCLUSION There is some evidence that stroke severity, mental and motor deficits, limitations in activities of daily living and the ability to walk after a stroke can predict social participation in the community. PROSPERO registration CRD42020177591.
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Affiliation(s)
| | - Matheus Sales
- Epidemiologia, Universidade Federal da BahiaDivisão de Neurologia e , Salvador, Brazil
| | - Larrie Rabelo Laporte
- Grupo Brasileiro de Metaciência, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Ailton Melo
- Epidemiologia, Universidade Federal da BahiaDivisão de Neurologia e , Salvador, Brazil.,Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da BahiaDepartamento de Neurociências e , Salvador, Brasil
| | - Nildo Manoel da Silva Ribeiro
- Epidemiologia, Universidade Federal da BahiaDivisão de Neurologia e , Salvador, Brazil.,Departamento de fisioterapia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brasil
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19
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Gait, Function, and Strength Following Lower Limb Salvage Surgery for a Primary Malignant Bone Tumor: A Systematic Review. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Khunte M, Wu X, Avery EW, Gandhi D, Payabvash S, Matouk C, Heit JJ, Wintermark M, Albers GW, Sanelli P, Malhotra A. Impact of collateral flow on cost-effectiveness of endovascular thrombectomy. J Neurosurg 2022; 137:1801-1810. [PMID: 35535841 DOI: 10.3171/2022.2.jns212887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/07/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Acute ischemic stroke patients with large-vessel occlusion and good collateral blood flow have significantly better outcomes than patients with poor collateral circulation. The purpose of this study was to evaluate the cost-effectiveness of endovascular thrombectomy (EVT) based on collateral status and, in particular, to analyze its effectiveness in ischemic stroke patients with poor collaterals. METHODS A decision analysis study was performed with Markov modeling to estimate the lifetime quality-adjusted life-years (QALYs) and associated costs of EVT based on collateral status. The study was performed over a lifetime horizon with a societal perspective in the US setting. Base-case analysis was done for good, intermediate, and poor collateral status. One-way, two-way, and probabilistic sensitivity analyses were performed. RESULTS EVT resulted in greater effectiveness of treatment compared to no EVT/medical therapy (2.56 QALYs in patients with good collaterals, 1.88 QALYs in those with intermediate collaterals, and 1.79 QALYs in patients with poor collaterals), which was equivalent to 1050, 771, and 734 days, respectively, in a health state characterized by a modified Rankin Scale (mRS) score of 0-2. EVT also resulted in lower costs in patients with good and intermediate collaterals. For patients with poor collateral status, the EVT strategy had higher effectiveness and higher costs, with an incremental cost-effectiveness ratio (ICER) of $44,326/QALY. EVT was more cost-effective as long as it had better outcomes in absolute numbers in at least 4%-8% more patients than medical management. CONCLUSIONS EVT treatment in the early time window for good outcome after ischemic stroke is cost-effective irrespective of the quality of collateral circulation, and patients should not be excluded from thrombectomy solely on the basis of collateral status. Despite relatively lower benefits of EVT in patients with poor collaterals, even smaller differences in better outcomes have significant long-term financial implications that make EVT cost-effective.
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Affiliation(s)
- Mihir Khunte
- 1Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Xiao Wu
- 2Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Emily W Avery
- 1Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Dheeraj Gandhi
- 3Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland
| | - Seyedmehdi Payabvash
- 1Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Charles Matouk
- 1Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut.,4Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Jeremy J Heit
- 5Department of Radiology.,6Department of Neurosurgery, and
| | | | - Gregory W Albers
- 6Department of Neurosurgery, and.,7Department of Neurology, Stanford University, Stanford, California; and
| | - Pina Sanelli
- 8Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, New York
| | - Ajay Malhotra
- 1Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
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21
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A systematic review of cost-effectiveness analyses on endovascular thrombectomy in ischemic stroke patients. Eur Radiol 2022; 32:3757-3766. [PMID: 35301558 DOI: 10.1007/s00330-022-08671-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/26/2021] [Accepted: 01/23/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to examine the published cost-effectiveness analyses (CEAs) on endovascular thrombectomy (EVT) in acute stroke patients, with a particular focus on the practice of accounting for costs and utilities. METHODS We conducted a systematic review of published CEAs on EVT in acute stroke patients from 1/1/2009 to 10/1/2019. Published CEAs were searched in Ovid Embase, Ovid MEDLINE, and Web of Science. Cost or comparative effectiveness analyses were excluded. Risk of bias and quality assessment was based on the Consolidated Health Economic Evaluation Reporting Standard checklist. RESULTS Twenty-one studies were included in the final analysis, from the USA, Canada, Europe, Asia, and Australia. They all concluded EVT to be cost-effective, but with significant variations in methodology. Fifteen studies employed a long-term horizon (> 20 years), while only 11 incorporated risk of recurrent strokes. The willingness-to-pay (WTP) threshold varied from $10,000/quality-adjusted life year (QALY) to $120,000/QALY, with $50,000/QALY and $100,000/QALY being the most commonly used. Five studies undertook a societal perspective, but only one accounted for indirect costs. Seventeen studies based outcomes on 90-day modified Rankin Scale (mRS) scores, and 9 of these 17 studies grouped outcomes by mRS 0-2 and 3-5. Among these 9 studies, the range of QALY score reported for mRS 0-2 was 0.71-0.85 QALY, and that of mRS 3-5 was 0.21-0.40. CONCLUSIONS Our study reveals significant heterogeneity in previously published thrombectomy CEAs, highlighting need for better standardization in future CEAs. KEY POINTS • All included studies concluded thrombectomy to be cost-effective, from both long- and short-term perspectives. • Only 5 out of 22 studies undertook a societal perspective, and only 1 accounted for indirect costs. • The range of value for mRS 0-2 was 0.71-0.85 quality-adjusted life year (QALY) and 0.21-0.40 QALY for mRS 3-5.
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22
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Kunz WG, Sporns PB, Psychogios MN, Fiehler J, Chapot R, Dorn F, Grams A, Morotti A, Musolino P, Lee S, Kemmling A, Henkes H, Nikoubashman O, Wiesmann M, Jensen-Kondering U, Möhlenbruch M, Schlamann M, Marik W, Schob S, Wendl C, Turowski B, Götz F, Kaiser D, Dimitriadis K, Gersing A, Liebig T, Ricke J, Reidler P, Wildgruber M, Mönch S. Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke: An Analysis of the Save ChildS Study. J Stroke 2022; 24:138-147. [PMID: 35135067 PMCID: PMC8829473 DOI: 10.5853/jos.2021.01606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population.
Methods In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY.
Results The model results yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives.
Conclusions EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke.
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Affiliation(s)
- Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Correspondence: Wolfgang G. Kunz Department of Radiology, University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany Tel: +49-89-4400-73630 Fax: +49-89-4400-78832 E-mail:
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios N. Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Chapot
- Department of Neuroradiology, Alfried-Krupp Hospital, Essen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Stanford, CA, USA
| | - André Kemmling
- Department for Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Hans Henkes
- Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Martin Wiesmann
- Department of Neuroradiology, Aachen University, Aachen, Germany
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Schob
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Turowski
- Institute of Neuroradiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Friedrich Götz
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Daniel Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Alexandra Gersing
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Mönch
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Khunte M, Wu X, Payabvash S, Zhu C, Matouk C, Schindler J, Sanelli P, Gandhi D, Malhotra A. Cost-effectiveness of endovascular thrombectomy in patients with acute stroke and M2 occlusion. J Neurointerv Surg 2021; 13:784-789. [PMID: 33077578 DOI: 10.1136/neurintsurg-2020-016765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The cost-effectiveness of endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to M2 branch occlusion remains uncertain. OBJECTIVE To evaluate the cost-effectiveness of EVT compared with medical management in patients with acute stroke presenting with M2 occlusion using a decision-analytic model. METHODS A decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years and associated costs of EVT-treated patients compared with no-EVT/medical management. The study was performed over a lifetime horizon with a societal perspective in the Unites States setting. Base case, one-way, two-way, and probabilistic sensitivity analyses were performed. RESULTS EVT was the long-term cost-effective strategy in 93.37% of the iterations in the probabilistic sensitivity analysis, and resulted in difference in health benefit of 1.66 QALYs in the 65-year-old age groups, equivalent to 606 days in perfect health. Varying the outcomes after both strategies shows that EVT was more cost-effective when the probability of good outcome after EVT was only 4-6% higher relative to medical management in clinically likely scenarios. EVT remained cost-effective even when its cost exceeded US$200 000 (threshold was US$209 111). EVT was even more cost-effective for 55-year-olds than for 65-year-old patients. CONCLUSION Our study suggests that EVT is cost-effective for treatment of acute M2 branch occlusions. Faster and improved reperfusion techniques would increase the relative cost-effectiveness of EVT even further in these patients.
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Affiliation(s)
- Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sam Payabvash
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chengcheng Zhu
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Joseph Schindler
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Pina Sanelli
- Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Dheeraj Gandhi
- Department of Interventional Neuroradiology, University of Maryland, Baltimore, Maryland, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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Cain S, Churilov L, Collier JM, Carvalho LB, Borschmann K, Moodie M, Thijs V, Bernhardt J. Factors associated with paid employment 12 months after stroke in A Very Early Rehabilitation Trial (AVERT). Ann Phys Rehabil Med 2021; 65:101565. [PMID: 34325037 DOI: 10.1016/j.rehab.2021.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/17/2021] [Accepted: 06/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Returning to work is an important outcome for stroke survivors. OBJECTIVES This sub-study of a randomised controlled trial aimed to provide characteristics of working-age stroke participants and identify factors associated with return to work at 12 months. METHODS We used paid employment data collected as part of A Very Early Rehabilitation Trial (AVERT, n=2104), an international randomised controlled trial studying the effects of very early mobilisation after stroke at 56 acute stroke units across Australia, New Zealand, the United Kingdom, Malaysia and Singapore. For the present analysis, data for trial participants < 65 years old were included if they were working at the time of stroke and had complete 12-month return-to-work data. The primary outcome was 12-month return to paid work. Univariable and multivariable logistic regression analyses were conducted to determine the association of multiple factors with return to work. RESULTS In total, 376 AVERT participants met the inclusion criteria for this sub-study. By 12 months, 221 (59%) participants had returned to work at a median of 38 hr per week. Similar rates were found across geographic regions. On univariable analysis, the odds of returning to paid employment were increased with younger age (OR per year 0.95, 95%CI 0.92-0.97), no previous diabetes (0.4, 0.24-0.67), lower stroke severity (OR per National Institutes of Health Stroke Scale point 0.82, 0.78-0.86), less 3-month depressive traits (Irritability Depression Anxiety [IDA] scale) (OR per IDA point 0.87, 0.80-0.93), less 3-month disability (modified Rankin Scale), and prior full-time work (2.04, 1.23-3.38). On multivariable analysis, return to work remained associated with younger age (OR 0.94, 95%CI 0.91-0.98), lower stroke severity (0.92, 0.86-0.99), prior full-time work (2.33, 1.24-4.40), and less 3-month disability. CONCLUSIONS Return to work at 12 months after stroke was associated with young age, acute stroke severity, 3-month disability and full-time employment before stroke. Greater understanding of this topic could help in developing programs to support successful resumption of work post-stroke.
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Affiliation(s)
| | | | - Janice M Collier
- Stroke, Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Lilian B Carvalho
- Stroke, Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Karen Borschmann
- Stroke, Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Vincent Thijs
- Austin Health, Heidelberg, Victoria, Australia; Stroke, Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Julie Bernhardt
- Stroke, Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia.
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Samuelsson H, Viken J, Redfors P, Holmegaard L, Blomstrand C, Jern C, Jood K. Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery. Eur J Neurol 2021; 28:3692-3701. [PMID: 34242459 DOI: 10.1111/ene.15014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE This cross-sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7 years post-stroke in order to analyze the relation between late cognitive ability and employment. METHODS Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55 years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score ≤2 on the National Institutes of Health Stroke Scale at long-term follow-up 7 years post-stroke were included. At this follow-up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self-reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function. RESULTS Seven years post-stroke 112/142 (79%) had part-time or full-time work and 30/142 (21%) had full-time disability pension or sick leave. Compared to those with full-time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self-ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self-rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61-4.21), processing speed (OR 3.50, 95% CI 1.67-7.33) and self-rated communication skills (OR 3.46, 95% CI 1.75-6.85) as most important correlates (area under the curve 0.83-0.87) of having current employment. CONCLUSION This study indicates that cognitive dysfunction is an important contributor to long-term work disability amongst young stroke survivors with good physical recovery.
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Affiliation(s)
- Hans Samuelsson
- Department of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jo Viken
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lukas Holmegaard
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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26
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Yousef HA, Khalil HW, Nazzal MS, El-Salem KI, Hawamdeh ZM, Almeida P. Prevalence and predictors of return to work among stroke survivors in Jordan. Work 2021; 67:817-827. [PMID: 33337400 DOI: 10.3233/wor-203334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Returning to work (RTW) is an essential goal for many stroke survivors. Currently, the prevalence of RTW post stroke in developing countries such as Jordan is unknown. Additionally, more research is required to identify factors that contribute to RTW post stroke. OBJECTIVES This study aims to (1) determine the prevalence of RTW among stroke survivors in Jordan, and (2) determine the predictors of RTW from a holistic perspective using the Occupational Therapy Practice Framework (OTPF) 3rd edition. METHODS Recruitment was carried out from different Jordanian hospitals and rehabilitation centers. A complete battery of outcome measures was used to reflect OTPF domains. These included outcome measures of occupations, client factors, performance skills, and context and environment. Logistic regression was used to determine factors that predicted RTW. RESULTS 69 participants were enrolled; 45 Males, 24 females; mean age±SD, 52.2±11.07 years. Only 29% succeeded in RTW during the first year after stroke onset. The highest percentage of RTW was among craft workers (40% ), and those who were self-employed (60% ). Of those who resumed work, 35% returned to their previous work, while 65% needed to make work modifications, or change positions or jobs. Factors that predicted higher rates of RTW were walking speed (Odds ratio (OR)=0.004, 95% confidence interval (CI)=0.00-0.55, P < 0.02), as well as absence of environmental restrictions (OR = 21.16, 95% CI = 1.91-233.5, P < 0.013). CONCLUSIONS The alarming low prevalence of RTW among stroke survivors in Jordan emphasizes the essential need to develop vocational rehabilitation programs. Clinicians should pay attention to enhancing walking abilities and reducing environmental restrictions post stroke, in order to improve the occurrence of RTW.
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Affiliation(s)
- Huda A Yousef
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan W Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Nazzal
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid I El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad M Hawamdeh
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Patrícia Almeida
- Department of Physiotherapy, Alcoitao School of Health Sciences, Alcoitao, Portugal
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27
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Sarraj A, Pizzo E, Lobotesis K, Grotta JC, Hassan AE, Abraham MG, Blackburn S, Day AL, Dannenbaum MJ, Hicks W, Vora NA, Budzik RF, Sharrief AZ, Martin-Schild S, Sitton CW, Pujara DK, Lansberg MG, Gupta R, Albers GW, Kunz WG. Endovascular thrombectomy in patients with large core ischemic stroke: a cost-effectiveness analysis from the SELECT study. J Neurointerv Surg 2020; 13:875-882. [DOI: 10.1136/neurintsurg-2020-016766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/04/2022]
Abstract
BackgroundIt is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.MethodsIn the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as computed tomography (CT) ASPECTS<6 or computed tomography perfusion (CTP) ischemic core volume (rCBF<30%) ≥50 cc. A Markov model estimated costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) of EVT compared with medical management (MM) over lifetime. The willingness to pay (WTP) per QALY was set at $50 000 and $100 000 and the net monetary benefits (NMB) were calculated. Probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEAC) for EVT were assessed in SELECT and other pivotal trials.ResultsFrom 361 patients enrolled in SELECT, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT vs 6 (14%) MM patients achieved modified Rankin Scale (mRS) score 0–2 (OR 3.27, 95% CI 1.11 to 9.62, P=0.03) with a shift towards better mRS (cOR 2.12, 95% CI 1.05 to 4.31, P=0.04). Over the projected lifetime of patients presenting with large core, EVT led to incremental costs of $33 094 and a gain of 1.34 QALYs per patient, resulting in ICER of $24 665 per QALY. EVT has a higher NMB compared with MM at lower (EVT -$42 747, MM -$76 740) and upper (EVT $155 041, MM $57 134) WTP thresholds. PSA confirmed the results and CEAC showed 77% and 92% acceptability of EVT at the WTP of $50 000 and $100 000, respectively. EVT was associated with an increment of $29 225 in societal costs. The pivotal EVT trials (HERMES, DAWN, DEFUSE 3) were dominant in a sensitivity analysis at the same inputs, with societal cost-savings of $37 901, $86 164 and $22 501 and a gain of 1.62, 2.36 and 2.21 QALYs, respectively.ConclusionsIn a non-randomized prospective cohort study, EVT resulted in better outcomes in large core patients with higher QALYs, NMB and high cost-effectiveness acceptability rates at current WTP thresholds. Randomized trials are needed to confirm these results.Clinical trial registrationNCT02446587
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Kunz WG, Hunink MG, Almekhlafi MA, Menon BK, Saver JL, Dippel DWJ, Majoie CBLM, Jovin TG, Davalos A, Bracard S, Guillemin F, Campbell BCV, Mitchell PJ, White P, Muir KW, Brown S, Demchuk AM, Hill MD, Goyal M. Public health and cost consequences of time delays to thrombectomy for acute ischemic stroke. Neurology 2020; 95:e2465-e2475. [PMID: 32943483 DOI: 10.1212/wnl.0000000000010867] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 06/12/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine public health and cost consequences of time delays to endovascular thrombectomy (EVT) for patients, health care systems, and society, we estimated quality-adjusted life-years (QALYs) of EVT-treated patients and associated costs based on times to treatment. METHODS The Markov model analysis was performed from US health care and societal perspectives over a lifetime horizon. Contemporary data from 7 trials within the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) collaboration served as data source. Aside from cumulative lifetime costs, we calculated the net monetary benefit (NMB) to determine the economic value of care. We used a contemporary willingness-to-pay threshold of $100,000 per QALY for NMB calculations. RESULTS Every 10 minutes of earlier treatment resulted in an average gain of 39 days (95% prediction interval 23-53 days) of disability-free life. Overall, the cumulative lifetime costs for patients with earlier or later treatment were similar. Patients with later treatment had higher morbidity-related costs but over a shorter time span due to their shorter life expectancy, resulting in similar lifetime costs as in patients with early treatment. Regarding the economic value of care, every 10 minutes of earlier treatment increased the NMB by $10,593 (95% prediction interval $5,549-$14,847) and by $10,915 (95% prediction interval $5,928-$15,356) taking health care and societal perspectives, respectively. CONCLUSIONS Any time delay to EVT reduces QALYs and decreases the economic value of care provided by this intervention. Health care policies to implement efficient prehospital triage and to accelerate in-hospital workflow are urgently needed.
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Affiliation(s)
- Wolfgang G Kunz
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Myriam G Hunink
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Mohammed A Almekhlafi
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Bijoy K Menon
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Jeffrey L Saver
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Diederik W J Dippel
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Charles B L M Majoie
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Tudor G Jovin
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Antoni Davalos
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Serge Bracard
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Francis Guillemin
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Bruce C V Campbell
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Peter J Mitchell
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Philip White
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Keith W Muir
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Scott Brown
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Andrew M Demchuk
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Michael D Hill
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN
| | - Mayank Goyal
- From the University of Calgary (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.), Alberta, Canada; Department of Radiology (W.G.K.), University Hospital, LMU Munich, Germany; Harvard T.H. Chan School of Public Health (M.G.H.), Boston, MA; Erasmus MC (M.G.H., D.W.J.D.), University Medical Center Rotterdam, the Netherlands; Faculty of Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia; David Geffen School of Medicine (J.L.S.), University of California-Los Angeles; Academic Medical Center (C.B.L.M.M.), Amsterdam, the Netherlands; University of Pittsburgh Medical Center (T.G.J.), PA; Hospital Germans Trias i Pujol (A.D.), Barcelona, Spain; University Hospital of Nancy (S. Bracard, F.G.), France; University of Melbourne (B.C.V.C., P.J.M.), Australia; Newcastle University (P.W.), UK; University of Glasgow (K.W.M.), UK; and Altair Biostatistics (S. Brown), St. Louis Park, MN.
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Zhang L, Zhang Z, Mei Y, Liu Q. Dyadic appraisals, dyadic coping, and mental health among couples coping with stroke: A longitudinal study protocol. J Adv Nurs 2020; 76:3164-3170. [PMID: 32857428 DOI: 10.1111/jan.14495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to describe a longitudinal research protocol for exploring the relationship of dyadic appraisal, dyadic coping (DC), and dyadic mental health among stroke survivors and their spouses and its action path. BACKGROUND Stroke can be considered as a dyad phenomenon which affects the mental health of both the survivors and their spouse caregivers. Studies based on dyadic theories are needed to examine the roles of dyadic appraisal and DC on the mental health of stroke dyads. DESIGN Longitudinal study. METHODS Stroke survivors and their spouse caregivers will be recruited from hospital, when the survivors are stable and about to discharge. Follow-up assessments will take place in 3, 6, 9, and 12 months after participants discharge. The structural equation modelling will be used for statistic analysing. DISCUSSION Our study seeks to expand the theory of Developmental-Contextual Model to examine the association among variables including dyadic appraisal, DC, and mental health for the couples coping with stroke.
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Affiliation(s)
- Leyun Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Qingxuan Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, P. R. China
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Ghanbari Ghoshchi S, De Angelis S, Morone G, Panigazzi M, Persechino B, Tramontano M, Capodaglio E, Zoccolotti P, Paolucci S, Iosa M. Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145233. [PMID: 32698430 PMCID: PMC7399919 DOI: 10.3390/ijerph17145233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022]
Abstract
Cerebrovascular diseases, including stroke, are historically considered diseases of old adults so only in a few studies has “return to work” (RTW) been considered as an index of rehabilitative outcome. At the moment, data on RTW in patients with stroke are highly variable: four different reviews reported the following ranges: 11–85%, 19–73%, 22–53%, and 40–45%. The absence of re-integration to work after a stroke is shown to be associated with an increase of cardiac disorders and depression, with a higher level of mortality, with social isolation and with insufficient adaptive skills. The aim of this study was to verify the effectiveness of technological treatment, performed with optic (SonicHand) and wearable (Riablo™) systems providing auditory and visual biofeedback, on RTW in patients with stroke. RTW was found to be associated with a higher independence in the activities of daily living (assessed by the Modified Barthel Index). No significant differences were found between technological versus conventional rehabilitation in terms of RTW, despite the former showing a higher odds ratio than the latter (OR = 9 vs. 6). Assistive devices were mainly used in patients who had not returned to work. Finally, quality of life was found higher in those patients who returned to work with the same conditions (work duties and time) as before stroke.
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Affiliation(s)
- Sheyda Ghanbari Ghoshchi
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Sara De Angelis
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Giovanni Morone
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27040 Montescano, Italy;
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27100 Pavia, Italy;
| | - Benedetta Persechino
- Italian Workers’ Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, 00078 Rome, Italy;
| | - Marco Tramontano
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, 00135 Rome, Italy
| | - Edda Capodaglio
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27100 Pavia, Italy;
| | - Pierluigi Zoccolotti
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Paolucci
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Marco Iosa
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Correspondence:
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Matos I, Fernandes A, Maso I, Oliveira-Filho J, de Jesus PA, Fraga-Maia H, Pinto EB. Investigating predictors of community integration in individuals after stroke in a residential setting: A longitutinal study. PLoS One 2020; 15:e0233015. [PMID: 32421731 PMCID: PMC7233578 DOI: 10.1371/journal.pone.0233015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To identify potential predictors of community integration in individuals after stroke using a residential setting-based strategy. Method A prospective cohort of post-stroke individuals was recruited from the Stroke Unit of the Roberto Santos General Hospital (UAVC-HGRS). All included individuals were aged over 18 years, received a diagnosis of ischemic stroke confirmed by neuroimaging and resided in the city of Salvador (Bahia, Brazil). Following discharge from the stroke unit, the individuals themselves, or their responsible parties, were contacted by telephone to schedule a home visit no less than three months after discharge. All subjects were examined in their homes, at which time the Community Integration Questionnaire (CIQ) was also applied. A robust linear regression model was used to assess community reintegration using CIQ score as the outcome variable. Results A total of 124 individuals effectively fulfilled the eligibility criteria: 51.6% were females, the median (IQR) age was 63(53–69) years, 82.3% were non-white, 53.2% were married, the median (IQR) of years of schooling was 6 (4–12) and family income averaged two minimum monthly wages. Investigated individuals presented a median (IQR) NIH Stroke Scale (NIHSS) score of 7 (4–12). Multivariate linear regression identified the following independent predictors of community integration: age (β = -0.095; 95% CI = -0.165 to -0.025; p = 0.008), diabetes mellitus (β = -2.348; 95% CI = -4.125 to -0.571; p = 0.010), smoking habit (β = -2.951; 95% CI = -5.081 to -0.821; p = 0.007), functional capacity upon hospital discharge (β = 0.168; 95% CI = 0.093 to 0.242; p = <0.001) and stroke severity (β = -0.163; CI = -0.318 to -0.009); p = 0.038). Conclusions Regardless of length of time since stroke, individuals present restrictions that compromise their reintegration into their respective communities. The demographic, clinical and functional factors identified herein as potential predictors should be considered when conducting regular follow-up, as well as in the rehabilitation of individuals after stroke with the purpose to identify the interventions necessary to optimize their reintegration into the community.
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Affiliation(s)
- Isabela Matos
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Adriana Fernandes
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Iara Maso
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Roberto Santos General Hospital, Salvador, Brazil
| | | | - Pedro Antônio de Jesus
- Roberto Santos General Hospital, Salvador, Brazil
- Federal University of Bahia, Bahia, Brazil
| | | | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
- * E-mail:
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Kunz WG, Almekhlafi MA, Menon BK, Saver JL, Hunink MG, Dippel DW, Majoie CB, Liebeskind DS, Jovin TG, Davalos A, Bracard S, Guillemin F, Campbell BC, Mitchell PJ, White P, Muir KW, Brown S, Demchuk AM, Hill MD, Goyal M. Public Health and Cost Benefits of Successful Reperfusion After Thrombectomy for Stroke. Stroke 2020; 51:899-907. [DOI: 10.1161/strokeaha.119.027874] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and Purpose—
The benefit that endovascular thrombectomy offers to patients with stroke with large vessel occlusions depends strongly on reperfusion grade as defined by the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Our aim was to determine the lifetime health and cost consequences of the quality of reperfusion for patients, healthcare systems, and society.
Methods—
A Markov model estimated lifetime quality-adjusted life years (QALY) and lifetime costs of endovascular thrombectomy–treated patients with stroke based on eTICI grades. The analysis was performed over a lifetime horizon in a United States setting, adopting healthcare and societal perspectives. The reference case analysis was conducted for stroke at 65 years of age. National health and cost consequences of improved eTICI 2c/3 reperfusion rates were estimated. Input parameters were based on best available evidence.
Results—
Lifetime QALYs increased for every grade of improved reperfusion (median QALYs for eTICI 0/1: 2.62; eTICI 2a: 3.46; eTICI 2b: 5.42; eTICI 2c: 5.99; eTICI 3: 6.73). Achieving eTICI 3 over eTICI 2b reperfusion resulted on average in 1.31 incremental QALYs as well as healthcare and societal cost savings of $10 327 and $20 224 per patient. A 10% increase in the eTICI 2c/3 reperfusion rate of all annually endovascular thrombectomy–treated patients with stroke in the United States is estimated to yield additional 3656 QALYs and save $21.0 million and $36.8 million for the healthcare system and society, respectively.
Conclusions—
Improved reperfusion grants patients with stroke additional QALYs and leads to long-term cost savings. Procedural strategies to achieve complete reperfusion should be assessed for safety and feasibility, even when initial reperfusion seems to be adequate.
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Affiliation(s)
- Wolfgang G. Kunz
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Mohammed A. Almekhlafi
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Bijoy K. Menon
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Jeffrey L. Saver
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Myriam G. Hunink
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Diederik W.J. Dippel
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Charles B.L.M. Majoie
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - David S. Liebeskind
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Tudor G. Jovin
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Antoni Davalos
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Serge Bracard
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Francis Guillemin
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Bruce C.V. Campbell
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Peter J. Mitchell
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Philip White
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Keith W. Muir
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Scott Brown
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Andrew M. Demchuk
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Michael D. Hill
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
| | - Mayank Goyal
- From the University of Calgary, Alberta, Canada (W.G.K., M.A.A., B.K.M., A.M.D., M.D.H., M.G.)
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
- David Geffen School of Medicine, University of California-Los Angeles (J.L.S., D.S.L.)
- Harvard T.H. Chan School of Public Health, Boston, MA (M.G.H.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (M.G.H., D.W.J.D.)
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Westerlind E, Persson HC, Eriksson M, Norrving B, Sunnerhagen KS. Return to work after stroke: A Swedish nationwide registry-based study. Acta Neurol Scand 2020; 141:56-64. [PMID: 31659744 PMCID: PMC6916554 DOI: 10.1111/ane.13180] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A substantial proportion of individuals with stroke are of working age. After stroke, it is important to return to work (RTW), both for the individual's satisfaction with life and economically for society. The current comprehensive, long-term study aimed at investigating in what time period the RTW continues after stroke and what factors could predict RTW. MATERIALS AND METHODS All individuals registered in the registry Riksstroke with stroke in Sweden at ages 18-58 years during 2011 were eligible for participation. RTW was based on sickness absence data from the Social Insurance Agency covering 1 year prestroke to 5 years post-stroke. Time to RTW was analyzed with Kaplan-Meier curves. Potential predictors of RTW were analyzed with Cox regression and logistic regression. RESULTS For RTW analyses, 1695 participants were included. Almost 50% RTW within 3 months, 70% within 1 year, and 80% within 2 years post-stroke. However, the RTW continued for several years, with a total of 85% RTW. Predictors of favorable time to RTW were male sex, ischemic stroke, and long university education compared with primary school education. Predictors of unfavorable times to RTW were higher stroke severity, defined by the level of consciousness, and older ages. Participants with self-expectations of RTW 1 year post-stroke had higher odds of RTW within 5 years. CONCLUSIONS The RTW continues for a longer time after stroke than previously known. Both self-expectations and demographical, socioeconomic, stroke-related factors were important predictors of RTW. This knowledge could assist healthcare professionals to individualize the rehabilitation post-stroke.
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Affiliation(s)
- Emma Westerlind
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Hanna C. Persson
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | | | - Bo Norrving
- Department of Clinical SciencesSection of NeurologyLund UniversitySkåne University HospitalLundSweden
| | - Katharina S. Sunnerhagen
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Sargénius Landahl K, Sandqvist J, Bartfai A, Schult ML. Is a structured work task application for the assessment of work performance in a constructed environment, useful for patients with attention deficits? Disabil Rehabil 2019; 43:1699-1709. [PMID: 31642716 DOI: 10.1080/09638288.2019.1674391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of our study was to develop a Structured Work Task application for the Assessment of Work Performance for patients with attention deficits. MATERIAL AND METHODS We developed a computer-based registration task titled the Attention-demanding Registration Task. It had a structured administrative procedure with additional scoring regarding time and accuracy, also linked to the original scoring of the Assessment of Work Performance. We evaluated the Attention-demanding Registration Task for content validity. Furthermore, we investigated it concerning sensitivity and specificity in patients with attention deficits due to acquired brain injury (n = 65) against a comparison group of healthy people (n = 47). RESULTS Our investigation on content validity using the Assessment of Work Characteristics confirmed that the Attention-demanding Registration Task sets high demands on process skills, especially on energy, temporal organization, and adaptation. The Attention-demanding Registration Task showed high sensitivity and specificity in differing between patients with attention deficits and a healthy working group; nine out of ten participants were placed in the correct group. CONCLUSIONS To assess work performance, the use of a Structured Work Task application, the Attention-demanding Registration Task, linked with the Assessment of Work Performance, proved to be sensitive to attention deficits.Implications for rehabilitationA Structured Work Task application for the Assessment of Work Performance was developed for use in people with attention deficits and showing a high degree of sensitivity and specificity.Linking performance time and accuracy to the Assessment of Work Performance scoring and providing a guide for linking task performance to the Assessment of Work Performance skills in addition to the usual observations performed, may increase scoring accuracy.Reference data for a comparison group of healthy subjects are provided.The use of the Attention demanding Registration Task, while using the Assessment of Work Performance within clinical practice ensures a more accurate description of process skills in performance.
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Affiliation(s)
- Kristina Sargénius Landahl
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jan Sandqvist
- The Rehabilitation Medicine University Clinic, Danderyd Hospital, Stockholm, Sweden.,Department of Social Welfare Studies, Faculty of Health Sciences, Linkoping University, Norrkoping, Sweden
| | - Aniko Bartfai
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Marie-Louise Schult
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Westerlind E, Abzhandadze T, Rafsten L, Persson HC, Sunnerhagen KS. Very early cognitive screening and return to work after stroke. Top Stroke Rehabil 2019; 26:602-607. [PMID: 31369365 DOI: 10.1080/10749357.2019.1645440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Stroke is a common cause of long-term disability worldwide, and an increasing number of persons affected by stroke are of working age. In addition to physical impairments, a majority of patients reportedly suffer cognitive impairments after stroke. Reduced cognitive function may hinder poststroke return to work (RTW); however, most studies of this relationship have assessed cognitive function months after the stroke.Objectives: The current study aims to investigate the degree of post-stroke RTW, and whether very early cognitive function screening can predict RTW after a stroke.Methods: This study included 145 persons treated for stroke at 18-63 years of age at a large university hospital in Sweden between 2011 and 2016. Data were retrieved from the GOTVED database. Within 36-48 h after hospital admission, cognitive function was screened using the Montreal Cognitive Assessment (MoCA). Full and partial RTW were assessed based on the Swedish Social Insurance Agency's register. Logistic regression was performed to analyze the potential predictors of RTW at 6 months and 18 months.Results: Neither global cognitive function nor executive function at 36-48 h after stroke predicted any degree of RTW at 6 or 18 months. Male sex, lower stroke severity, and not being on sick leave prior to stroke were significant predictors of RTW.Conclusions: Screening for cognitive impairments at 36-48-h post stroke is apparently too early for predicting RTW, and thus cannot be the sole basis for discharge planning after stroke. Additional research is needed to further analyze cognitive function early after stroke and RTW.
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Affiliation(s)
- Emma Westerlind
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Rafsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna C Persson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Han J, Lee HI, Shin YI, Son JH, Kim SY, Kim DY, Sohn MK, Lee J, Lee SG, Oh GJ, Lee YS, Joo MC, Han EY, Chang WH, Kim YH. Factors influencing return to work after stroke: the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. BMJ Open 2019; 9:e028673. [PMID: 31300502 PMCID: PMC6629413 DOI: 10.1136/bmjopen-2018-028673] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the rate of return to work and identify key factors associated with return to work between 3 months and 2 years after stroke. DESIGN Prospective cohort study. SETTING The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) in Korea. PARTICIPANTS A total of 193 persons with first-ever stroke who reported working status at 3 months after stroke. OUTCOME MEASURES Data on baseline characteristics were collected from medical records. Functional assessments were performed using the National Institutes of Health Stroke Scale, the modified Rankin Scale, the Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the Korean version of the Frenchay Aphasia Screening Test, the American Speech-Language-Hearing Association National Outcomes Measurement System, the Korean-Modified Barthel Index, the Geriatric Depression Scale-Short Form and the EuroQol-5 dimensions. An enumeration survey included the Reintegration to Normal Living Index, the Psychosocial Well-being Index-Short Form (, the Family Support Index and the Caregivers Burden Index. RESULTS Overall, 145 (75.1%) patients who had a stroke in the "Continuously-Employed" group and 48 (24.9%) in the "Employed-Unemployed" group returned to work between 3 months and 2 years after stroke. Multivariate logistic analysis demonstrated that in patients who had a stroke, characteristics such as age, PWI-SF Score, and caregiver characteristics, including age, sex (female) and living arrangements, were significantly associated with return to work between 3 months and 2 years after stroke. CONCLUSION Age and PWI-SF Score of patients who had a stroke, as well as the age, sex and living arrangements of caregivers, are key factors influencing the return to work after stroke. TRIAL REGISTRATION NUMBER NCT03402451.
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Affiliation(s)
- Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, The Republic of Korea
| | - Hae In Lee
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Ju Hyun Son
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, The Republic of Korea
| | - Min Kyun Sohn
- School of Medicine, Department of Rehabilitation Medicine, Chungnam National University, Daejeon, The Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, The Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, The Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, The Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, School of Medicine, Jeju National University, Jeju, The Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
- Department of Health Sciences and Technology,Department of Medical Device Management & Research, Department of DigitalHealth, SAIHST, Sungkyunkwan University, Seoul, The Republic of Korea
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Duong P, Sauvé-Schenk K, Egan MY, Meyer MJ, Morrison T. Operational Definitions and Estimates of Return to Work Poststroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2019; 100:1140-1152. [DOI: 10.1016/j.apmr.2018.09.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
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Fukuda S, Ueba Y, Fukuda H, Kangawa T, Nakashima Y, Hashimoto Y, Ueba T. Impact of Upper Limb Function and Employment Status on Return to Work of Blue-Collar Workers after Stroke. J Stroke Cerebrovasc Dis 2019; 28:2187-2192. [PMID: 31126785 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Return to work (RTW) after stroke is the ultimate goal of the working population to achieve economic independence and well-being. Previous studies have reported lower RTW rates of blue-collar workers versus white-collar workers. Thus, investigating predictive factors for RTW of blue-collar workers is meaningful to improve RTW after stroke. Here, we investigate the physical, cognitive, and social factors associated with the RTW of blue-collar workers after stroke. METHODS Poststroke rehabilitation data for 71 patients aged 15-64 years who had been active blue-collar workers at stroke onset were analyzed from a single-center observational cohort database. Baseline characteristics, social background factors, and quantitative assessments of the upper limb, lower limb, and cognitive functions at discharge were analyzed to identify any association with RTW. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of continuous valuables with significant associations. RESULTS Functional upper limb represented by an increasing Simple Test for Evaluating hand Function (STEF) score was independently associated with RTW of blue-collar workers by multivariable logistic regression analysis (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01-1.14; p = .017). Correlation with self-employment status was also significant compared to that with employee status (OR, 185; 95% CI, 1.05-32400; p = .048). The cutoff value of the 100-point scale STEF to discriminate between RTW and non-RTW was 82. CONCLUSIONS Functional upper limb and self-employment status were independent predictors for the RTW of blue-collar workers after stroke.
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Affiliation(s)
- Shinya Fukuda
- Department of Rehabilitation, Wafukai-Hashimoto Hospital, Mitoyo, Kagawa, Japan; Department of Neurosurgery, Kochi University Graduate School of Medicine, Nankoku, Kochi, Japan
| | - Yusuke Ueba
- Department of Neurosurgery, Kochi University Graduate School of Medicine, Nankoku, Kochi, Japan
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi University Graduate School of Medicine, Nankoku, Kochi, Japan.
| | - Takumi Kangawa
- Department of Rehabilitation, Wafukai-Hashimoto Hospital, Mitoyo, Kagawa, Japan
| | - Yumi Nakashima
- Department of Rehabilitation, Wafukai-Hashimoto Hospital, Mitoyo, Kagawa, Japan
| | - Yasuko Hashimoto
- Department of Rehabilitation, Wafukai-Hashimoto Hospital, Mitoyo, Kagawa, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi University Graduate School of Medicine, Nankoku, Kochi, Japan
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Gracies JM, Pradines M, Ghédira M, Loche CM, Mardale V, Hennegrave C, Gault-Colas C, Audureau E, Hutin E, Baude M, Bayle N. Guided Self-rehabilitation Contract vs conventional therapy in chronic stroke-induced hemiparesis: NEURORESTORE, a multicenter randomized controlled trial. BMC Neurol 2019; 19:39. [PMID: 30871480 PMCID: PMC6419473 DOI: 10.1186/s12883-019-1257-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/14/2019] [Indexed: 12/30/2022] Open
Abstract
Background After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to “maintenance” rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year. Methods One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician’s prescription. The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections. Discussion This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis. Trial registration ClinicalTrials.gov: NCT02202954, July 29, 2014.
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Affiliation(s)
- Jean-Michel Gracies
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Maud Pradines
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France. .,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France.
| | - Mouna Ghédira
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Catherine-Marie Loche
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Valentina Mardale
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Catherine Hennegrave
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Caroline Gault-Colas
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Etienne Audureau
- AP-HP, Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France.,DHU A-TVB, IRMB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris Est-Créteil, F-94010, Créteil, France
| | - Emilie Hutin
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Marjolaine Baude
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Nicolas Bayle
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
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Saeki S, Hachisuka A, Itoh H, Kato N, Ochi M, Matsushima Y. Overview of the returning to work after stroke. ACTA ACUST UNITED AC 2019. [DOI: 10.3995/jstroke.10668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Satoru Saeki
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Akiko Hachisuka
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Hideaki Itoh
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Noriaki Kato
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Mitsuhiro Ochi
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Yasuyuki Matsushima
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
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Aarnio K, Rodríguez-Pardo J, Siegerink B, Hardt J, Broman J, Tulkki L, Haapaniemi E, Kaste M, Tatlisumak T, Putaala J. Return to work after ischemic stroke in young adults: A registry-based follow-up study. Neurology 2018; 91:e1909-e1917. [PMID: 30315074 PMCID: PMC6260196 DOI: 10.1212/wnl.0000000000006510] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW. METHODS Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were included. Data on periods of payment came from the Finnish Centre for Pensions, and death data from Statistics Finland. Multivariate logistic regression analyses assessed factors associated with NRTW 1 year after IS, and lasagna plots visualized the proportion of patients returning to work over time. RESULTS We included a total of 769 patients, of whom 289 (37.6%) were not working at 1 year, 323 (42.0%) at 2 years, and 361 (46.9%) at 5 years from IS. When adjusted for age, sex, socioeconomic status, and NIH Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit. CONCLUSIONS NRTW is a frequent adverse outcome after IS in young adults with mild to moderate IS. Clinical variables available during acute hospitalization may allow prediction of NRTW.
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Affiliation(s)
- Karoliina Aarnio
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jorge Rodríguez-Pardo
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bob Siegerink
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Juliane Hardt
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenna Broman
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lauri Tulkki
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elena Haapaniemi
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markku Kaste
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Turgut Tatlisumak
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden
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Kunz WG, Hunink MG, Dimitriadis K, Huber T, Dorn F, Meinel FG, Sabel BO, Othman AE, Reiser MF, Ertl-Wagner B, Sommer WH, Thierfelder KM. Cost-effectiveness of Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review of the Impact of Patient Age. Radiology 2018; 288:518-526. [DOI: 10.1148/radiol.2018172886] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: A systematic review. Int J Stroke 2017; 13:243-256. [PMID: 29189108 DOI: 10.1177/1747493017743059] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The incidence of stroke in young adults is increasing. While many young survivors are able to achieve a good physical recovery, subtle dysfunction in other domains, such as cognition, often persists, and could affect return to work. However, reported estimates of return to work and factors affecting vocational outcome post-stroke vary greatly. Aims The aims of this systematic review were to determine the frequency of return to work at different time points after stroke and identify predictors of return to work. Summary of review Two electronic databases (Medline and Embase) were systematically searched for articles according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 6473 records were screened, 68 were assessed for eligibility, and 29 met all inclusion criteria (working-age adults with stroke, return to work evaluated as an outcome, follow-up duration reported, and publication within the past 20 years). Return to work increased with time, with median frequency increasing from 41% between 0 and 6 months, 53% at 1 year, 56% at 1.5 years to 66% between 2 and 4 years post-stroke. Greater independence in activities of daily living, fewer neurological deficits, and better cognitive ability were the most common predictors of return to work. Conclusion This review highlights the need to examine return to work in relation to time from stroke and assess cognition in working age and young stroke survivors. The full range of factors affecting return to work has not yet been explored and further evaluations of return to work interventions are warranted.
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Affiliation(s)
- Jodi D Edwards
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Canada.,4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Arunima Kapoor
- 5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Elizabeth Linkewich
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Richard H Swartz
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
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44
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Glader EL, Jonsson B, Norrving B, Eriksson M. Socioeconomic factors' effect on return to work after first stroke. Acta Neurol Scand 2017; 135:608-613. [PMID: 27439693 DOI: 10.1111/ane.12639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this nationwide study was to analyze how functional status and socioeconomic status affect return to work (RTW) among younger patients with first-time stroke in a Sweden. MATERIAL AND METHODS This register-based cohort study included employed patients aged 25-55 with first-time stroke between 2008 and 2011 and primary outcome was RTW within 1 year after stroke. Data regarding functional status and employment status were retrieved from the Swedish Stroke Register, Riksstroke, and socioeconomic data (income, education, and country of birth) from Statistics Sweden. RESULTS We included 2539 patients who had answered the question on RTW, and 1880 (74.0%) had RTW within 12 months. Patients with low income (69.9% in lowest income group vs 79.9% in highest group, P<.001), patients born in countries outside the Nordic countries (Sweden 75.5%, Nordic countries 74.3%, European countries 61.7%, other countries 57.3%, P<.001), and the youngest patients (25-34, 63.1%; 35-44, 75.9%; 45-55, 74.3%; P=.008) were less likely to RTW. Pain, low mood, and answering the questionnaire with help were more common in low socioeconomic groups, and when adjusting for these variables, together with age and sex, income and country of birth were no longer independent predictors for RTW. CONCLUSION Patients with low socioeconomic status less often RTW 1 year after stroke.Impaired functional status after stroke is more common in patients with lower socioeconomic status and mediates socioeconomic differences in RTW. Improvement of functional status should be targeted to facilitate RTW among stroke patients with low socioeconomic status.
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Affiliation(s)
- E.-L. Glader
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - B. Jonsson
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - B. Norrving
- Department of Clinical Sciences; Section of Neurology; Lund University; Lund Sweden
| | - M. Eriksson
- Department of Statistics; USBE; Umeå University; Umeå Sweden
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van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA. Return to work after mild-to-moderate stroke: work satisfaction and predictive factors. Neuropsychol Rehabil 2017; 29:638-653. [DOI: 10.1080/09602011.2017.1313746] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jet van der Kemp
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Tanja C. W. Nijboer
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Coen A. M. van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, the Netherlands
- Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Johanna M. A. Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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Öst Nilsson A, Eriksson G, Johansson U, Hellman T. Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme. Scand J Occup Ther 2016; 24:349-356. [DOI: 10.1080/11038128.2016.1249404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Annika Öst Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Ulla Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Therese Hellman
- Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Solna, Sweden
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47
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Jellema S, van Hees S, Zajec J, van der Sande R, Nijhuis-van der Sanden MW, Steultjens EM. What environmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings. Clin Rehabil 2016; 31:936-947. [PMID: 27681480 PMCID: PMC5482381 DOI: 10.1177/0269215516671013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Identify the environmental factors that influence stroke-survivors' reengagement in personally valued activities and determine what specific environmental factors are related to specific valued activity types. DATA SOURCES PubMed, CINAHL and PsycINFO were searched until June 2016 using multiple search-terms for stroke, activities, disability, and home and community environments. REVIEW METHODS An integrated mixed-method systematic review of qualitative, quantitative and mixed-design studies was conducted. Two researchers independently identified relevant studies, assessed their methodological quality and extracted relevant findings. To validly compare and combine the various findings, all findings were classified and grouped by environmental category and level of evidence. RESULTS The search yielded 4024 records; 69 studies were included. Most findings came from low-evidence-level studies such as single qualitative studies. All findings were consistent in that the following factors facilitated reengagement post-stroke: personal adapted equipment; accessible environments; transport; services; education and information. Barriers were: others' negative attitudes and behaviour; long distances and inconvenient environmental conditions (such as bad weather). Each type of valued activity, such as mobility or work, had its own pattern of environmental influences, social support was a facilitator to all types of activities. Although in many qualitative studies others' attitudes, behaviour and stroke-related knowledge were seen as important for reengagement, these factors were hardly studied quantitatively. CONCLUSION A diversity of environmental factors was related to stroke-survivors' reengagement. Most findings came from low-evidence-level studies so that evidence on causal relationships was scarce. In future, more higher-level-evidence studies, for example on the attitudes of significant others, should be conducted.
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Affiliation(s)
- Sandra Jellema
- 1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands
| | - Suzanne van Hees
- 3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Jana Zajec
- 3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Rob van der Sande
- 2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.,4 Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- 1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.,3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Esther Mj Steultjens
- 2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands
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Bonner B, Pillai R, Sarma PS, Lipska KJ, Pandian J, Sylaja PN. Factors predictive of return to work after stroke in patients with mild−moderate disability in India. Eur J Neurol 2015; 23:548-53. [DOI: 10.1111/ene.12887] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- B. Bonner
- Harvard Medical School Boston MA USA
| | - R. Pillai
- Department of Neurology Comprehensive Stroke Program Sree Chitra Tirunal for Medical Science and Technology Trivandum India
| | - P. S. Sarma
- Department of Neurology Comprehensive Stroke Program Sree Chitra Tirunal for Medical Science and Technology Trivandum India
| | - K. J. Lipska
- Section of Endocrinology Department of Internal Medicine Yale School of Medicine New Haven CT USA
| | - J. Pandian
- Department of Neurology CMC Ludhiana Punjab India
| | - P. N. Sylaja
- Department of Neurology Comprehensive Stroke Program Sree Chitra Tirunal for Medical Science and Technology Trivandum India
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