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Fournier J, Finestone H, Lauzon J, Campbell TM. Prevalence, Impact, and Treatment of Co-Occurring Osteoarthritis in Patients With Stroke Undergoing Rehabilitation: A Review. Stroke 2021; 52:e618-e621. [PMID: 34372669 DOI: 10.1161/strokeaha.121.034270] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Early, frequent rehabilitation is an important factor for optimizing stroke recovery outcomes. Medical comorbidities, such as osteoarthritis, that affect the ability to participate in rehabilitation could therefore have a detrimental impact on such outcomes. Both stroke and osteoarthritis are becoming more common in developed nations as the population ages. First-line osteoarthritis treatments, such as oral nonsteroidal anti-inflammatory drugs, are often avoided poststroke due to interaction with secondary prevention stroke risk-factor management. Our objective was to summarize the current literature concerning co-occurring osteoarthritis and stroke prevalence, its functional impact, and treatment options. METHODS Narrative review using a comprehensive literature search of PubMed, osteoarthritis, and stroke guidelines. Outcomes related to co-occurrence prevalence, osteoarthritis as a stroke risk-factor, osteoarthritis-related imaging and treatment were extracted and summarized descriptively. Overall quality of the evidence was summarized using Grading of Recommendations Assessment, Development and Evaluation. RESULTS We identified 23 studies and guidelines related to our objective. Overall quality of the evidence was very low. CONCLUSIONS Few trials have investigated the relationship between osteoarthritis and stroke, nor osteoarthritis-specific pain and function management for stroke survivors. High-quality research evaluating the impact of osteoarthritis on stroke rehabilitation is needed.
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Affiliation(s)
- John Fournier
- Department of Medicine, University of Ottawa, Canada (J.F., H.F., J.L., T.M.C.)
| | - Hillel Finestone
- Department of Medicine, University of Ottawa, Canada (J.F., H.F., J.L., T.M.C.).,Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Canada (H.F., T.M.C.)
| | - Julia Lauzon
- Department of Medicine, University of Ottawa, Canada (J.F., H.F., J.L., T.M.C.)
| | - T Mark Campbell
- Department of Medicine, University of Ottawa, Canada (J.F., H.F., J.L., T.M.C.).,Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Canada (H.F., T.M.C.)
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Aquino MRJ(RV, Turner GM, Mant J. Does characterising patterns of multimorbidity in stroke matter for developing collaborative care approaches in primary care? Prim Health Care Res Dev 2019; 20:e110. [PMID: 32800014 PMCID: PMC6635803 DOI: 10.1017/s1463423619000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/16/2019] [Accepted: 03/06/2019] [Indexed: 12/03/2022] Open
Abstract
Stroke and transient ischaemic attack (TIA) remain leading causes of mortality and morbidity globally. Although mortality rates have been in decline, the number of people affected by stroke has risen. These patients have a range of long-term needs and often present to primary care. Furthermore, many of these patients have multimorbidities which increase the complexity of their healthcare. Long-term impacts from stroke/TIA along with care needs for other morbidities can be challenging to address because care can involve different healthcare professionals, both specialist and generalist. In the ideal model of care, such professionals would work collaboratively to provide care. Despite the commonality of multimorbidity in stroke/TIA, gaps in the literature remain, particularly limited knowledge of pairings or clusters of comorbid conditions and the extent to which these are interrelated. Moreover, integrated care practices are less well understood and remain variable in practice. This article argues that it is important to understand (through research) patterns of multimorbidity, including number, common clusters and types of comorbidities, and current interprofessional practice to inform future directions to improve long-term care.
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Affiliation(s)
| | - Grace M Turner
- Research Fellow, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mant
- Professor of Primary Care Research, Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Gruneir A, Griffith LE, Fisher K, Panjwani D, Gandhi S, Sheng L, Patterson C, Gafni A, Ploeg J, Markle-Reid M. Increasing comorbidity and health services utilization in older adults with prior stroke. Neurology 2016; 87:2091-2098. [PMID: 27760870 DOI: 10.1212/wnl.0000000000003329] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/28/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. METHODS This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. RESULTS A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity. CONCLUSIONS Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.
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Affiliation(s)
- Andrea Gruneir
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
| | - Lauren E Griffith
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Kathryn Fisher
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Dilzayn Panjwani
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Sima Gandhi
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Li Sheng
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Chris Patterson
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Amiram Gafni
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Jenny Ploeg
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
| | - Maureen Markle-Reid
- From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada
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Gallacher KI, Batty GD, McLean G, Mercer SW, Guthrie B, May CR, Langhorne P, Mair FS. Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC Med 2014; 12:151. [PMID: 25280748 PMCID: PMC4220053 DOI: 10.1186/s12916-014-0151-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The prevalence of multimorbidity (the presence of two or more long-term conditions) is rising internationally. Multimorbidity affects patients by increasing their burden of symptoms, but is also likely to increase the self-care demands, or treatment burden, that they experience. Treatment burden refers to the effort expended in operationalising treatments, navigating healthcare systems and managing relations with healthcare providers. This is an important problem for people with chronic illness such as stroke. Polypharmacy is an important marker of both multimorbidity and burden of treatment. In this study, we examined the prevalence of multimorbidity and polypharmacy in a large, nationally representative population of primary care patients with and without stroke, adjusting for age, sex and deprivation. METHODS A cross-sectional study of 1,424,378 participants aged 18 years and over, from 314 primary care practices in Scotland that were known to be demographically representative of the Scottish adult population. Data included information on the presence of stroke and another 39 long-term conditions, plus prescriptions for regular medications. RESULTS In total, 35,690 people (2.5%) had a diagnosis of stroke. Of the 39 comorbidities examined, 35 were significantly more common in people with stroke. Of the people with a stroke, the proportion that had one or more additional morbidities present (94.2%) was almost twice that in the control group (48%) (odds ratio (OR) adjusted for age, sex and socioeconomic deprivation 5.18; 95% confidence interval (CI) 4.95 to 5.43). In the stroke group, 12.6% had a record of 11 or more repeat prescriptions compared with only 1.5% of the control group (OR adjusted for age, sex, deprivation and morbidity count 15.84; 95% CI 14.86 to 16.88). Limitations include the use of data collected for clinical rather than research purposes, a lack of consensus in the literature on the definition of certain long-term conditions, and the absence of statistical weighting in the measurement of multimorbidity, although the latter was deemed suitable for descriptive analyses. CONCLUSIONS Multimorbidity and polypharmacy were strikingly more common in those with a diagnosis of stroke compared with those without. This has important implications for clinical guidelines and the design of health services.
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Gallacher K, Morrison D, Jani B, Macdonald S, May CR, Montori VM, Erwin PJ, Batty GD, Eton DT, Langhorne P, Mair FS. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med 2013; 10:e1001473. [PMID: 23824703 PMCID: PMC3692487 DOI: 10.1371/journal.pmed.1001473] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. METHODS AND FINDINGS The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. CONCLUSIONS Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.
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Affiliation(s)
- Katie Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Bhautesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carl R. May
- Faculty of Health Sciences, University of Southampton, United Kingdom
| | - Victor M. Montori
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Patricia J. Erwin
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom
| | - David T. Eton
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
- * E-mail:
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