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Park D, Son KJ, Kim JH, Kim HS. Effect of the Frequency of Rehabilitation Treatments on the Long-Term Mortality of Stroke Survivors with Mild-to-Moderate Disabilities under the Korean National Health Insurance Service System. Healthcare (Basel) 2023; 11:healthcare11111587. [PMID: 37297727 DOI: 10.3390/healthcare11111587] [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: 05/03/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Given the increase in stroke-related social costs, studies on survival and functional prognosis after stroke are urgently needed. Therefore, we investigated the relationship between the frequency of rehabilitation treatments in the acute and subacute phases of stroke and the long-term mortality of stroke survivors with mild-to-moderate disabilities. We performed a retrospective cohort study using data from the Korean National Health Insurance Service database. Our final cohort included 733 patients with national disability registration grades 4-6. The number of special rehabilitation treatment claim codes was used as a proxy for the frequency of rehabilitation treatments. Furthermore, we categorized the rehabilitation frequencies within 24 months of stroke onset as 1-50, 51-200, 201-400, and >400. The dependent variable was all-cause mortality, and it was evaluated from 24 to 84 months after stroke onset. Severe disability was associated with a lower long-term mortality rate in the chronic phase (p < 0.001). In the Cox regression analysis, severe disability, older age, male sex, and chronic kidney disease were independent risk factors for long-term mortality in patients with stroke and mild-to-moderate disabilities. However, the frequency of acute/subacute rehabilitation treatments did not significantly improve long-term mortality. Our results suggest that the association between rehabilitation frequency and lower long-term mortality for patients with mild-to-moderate stroke was inconclusive. Therefore, further study is needed to determine a better-customized rehabilitation treatment system for these patients.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang 37659, Republic of Korea
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
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2
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Chen Z, Wang H, Wang Y, Lin H, Zhu X, Wang Y. Use of non-contact infrared thermometers in rehabilitation patients: a randomized controlled study. J Int Med Res 2021; 49:300060520984617. [PMID: 33472462 PMCID: PMC7829519 DOI: 10.1177/0300060520984617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective In this randomized controlled study, we aimed to determine whether
non-contact infrared thermometers (NCITs) are more time-efficient and create
less patient distress than mercury axillary thermometers (MATs) and infrared
tympanic thermometers (ITTs). Methods Forty-five rehabilitation inpatients were randomly assigned to one of three
groups (NCIT, MAT, and ITT). Time required to measure body temperature with
an NCIT, MAT, and ITT was recorded. We examined associations between time
required to take patients’ temperature and measuring device used. Patient
distress experienced during temperature measurement using the three
thermometers was recorded. Results A significantly longer average time was required to measure temperatures
using the MAT (mean 43.17, standard deviation [SD] 8.39) than the ITT (mean
13.74, SD 1.63) and NCIT (mean 12.13, SD 1.18). The thermometer used
influenced the time required to measure body temperature (t = 33.99). There
were significant differences among groups (NCIT vs. ITT, NCIT vs. MAT, and
ITT vs. MAT) regarding patient distress among the different thermometers.
Most distress arose owing to needing help from others, sleep disruption, and
boredom. Conclusion The NCIT has clinically relevant advantages over the ITT and MAT in measuring
body temperature among rehabilitation patients, including saving nurses’
time and avoiding unnecessary patient distress. Clinical trial registration number (http://www.chictr.org.cn): ChiCTR1800019756.
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Affiliation(s)
- Zhen Chen
- Neurorehabilitation Centre, First Rehabilitation Hospital of Shanghai/Affiliated Hospital of Tongji University (Preparatory), No. 349 Hangzhou Road, Yangpu District, Shanghai, China
| | - Hui Wang
- Neurorehabilitation Centre, First Rehabilitation Hospital of Shanghai/Affiliated Hospital of Tongji University (Preparatory), No. 349 Hangzhou Road, Yangpu District, Shanghai, China
| | - Yi Wang
- Center for Translational Neurodegeneration and Regenerative Therapy, Shanghai Tenth People's Hospital affiliated to Tongji University School of Medicine, Shanghai, China
| | - Hongmei Lin
- Neurorehabilitation Centre, First Rehabilitation Hospital of Shanghai/Affiliated Hospital of Tongji University (Preparatory), No. 349 Hangzhou Road, Yangpu District, Shanghai, China
| | - Xiuping Zhu
- Neurorehabilitation Centre, First Rehabilitation Hospital of Shanghai/Affiliated Hospital of Tongji University (Preparatory), No. 349 Hangzhou Road, Yangpu District, Shanghai, China
| | - Yaqin Wang
- Neurorehabilitation Centre, First Rehabilitation Hospital of Shanghai/Affiliated Hospital of Tongji University (Preparatory), No. 349 Hangzhou Road, Yangpu District, Shanghai, China
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3
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Scrutinio D, Ricciardi C, Donisi L, Losavio E, Battista P, Guida P, Cesarelli M, Pagano G, D'Addio G. Machine learning to predict mortality after rehabilitation among patients with severe stroke. Sci Rep 2020; 10:20127. [PMID: 33208913 PMCID: PMC7674405 DOI: 10.1038/s41598-020-77243-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
Stroke is among the leading causes of death and disability worldwide. Approximately 20–25% of stroke survivors present severe disability, which is associated with increased mortality risk. Prognostication is inherent in the process of clinical decision-making. Machine learning (ML) methods have gained increasing popularity in the setting of biomedical research. The aim of this study was twofold: assessing the performance of ML tree-based algorithms for predicting three-year mortality model in 1207 stroke patients with severe disability who completed rehabilitation and comparing the performance of ML algorithms to that of a standard logistic regression. The logistic regression model achieved an area under the Receiver Operating Characteristics curve (AUC) of 0.745 and was well calibrated. At the optimal risk threshold, the model had an accuracy of 75.7%, a positive predictive value (PPV) of 33.9%, and a negative predictive value (NPV) of 91.0%. The ML algorithm outperformed the logistic regression model through the implementation of synthetic minority oversampling technique and the Random Forests, achieving an AUC of 0.928 and an accuracy of 86.3%. The PPV was 84.6% and the NPV 87.5%. This study introduced a step forward in the creation of standardisable tools for predicting health outcomes in individuals affected by stroke.
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Affiliation(s)
| | - Carlo Ricciardi
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy. .,Department of Advanced Biomedical Sciences, University Hospital of Naples "Federico II", Naples, Italy.
| | - Leandro Donisi
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.,Department of Advanced Biomedical Sciences, University Hospital of Naples "Federico II", Naples, Italy
| | | | | | - Pietro Guida
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Mario Cesarelli
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.,Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Gaetano Pagano
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Wang J, Chen Y, Zhang Y, Li M, Jin J. Rehabilitation nursing for motor functional recovery of acute ischaemic stroke: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e037391. [PMID: 32978194 PMCID: PMC7520831 DOI: 10.1136/bmjopen-2020-037391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Stroke is the second-leading cause of death and disability in the world, and patients with stroke often suffer from functional impairments and need rehabilitation. Notably, there is much evidence that rehabilitation can lead to better mortality and morbidity outcomes. The evidence for the effectiveness of rehabilitation nursing, however, is limited. Thus, this study seeks to explore whether rehabilitation nursing is not inferior to usual rehabilitation for motor functional recovery in patients with acute ischaemic stroke. METHODS AND ANALYSIS We will conduct an assessor-blinded parallel randomised controlled trial of patients who meet the inclusion criteria after stratification by weighted corticospinal tract lesion load. The experimental group will receive rehabilitation nursing by trained and qualified nurses (seven consecutive days, two sessions per day, 30 min each session). The control group will receive usual rehabilitation provided by therapists (seven consecutive days, two sessions per day, 30 min each session). The primary outcome measures are the Motor Assessment Scale, the Fugl-Meyer Assessment and the Action Research Arm Test. The secondary outcome measures are the modified Rankin Scale, the modified Barthel Index and the National Institute of Health Stroke Scale. Primary and secondary outcome assessment will be performed before and after the intervention, and secondary outcome be assessed at 4 and 12 weeks follow-up. We will recruit 224 patients within a period of 12-18 months from a hospital in southeastern China. ETHICS AND DISSEMINATION The study was approved by the Human Research Ethics Committee from the corresponding author's hospital (approval Number is Ethical Review Study No. 2018 - 112). Peer-reviewed journals and presentations at national and international conferences will be used to disseminate the results. TRIAL REGISTRATION NUMBER NCT03702452.
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Affiliation(s)
- Jianmiao Wang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuanyuan Chen
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mei Li
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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5
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Chen WS, Hsu HC, Chuang YW, Lee M, Lu KY, Chen YF, Chen CM. Predictors for the use of traditional Chinese medicine among inpatients with first-time stroke: a population-based study. BMC Complement Med Ther 2020; 20:244. [PMID: 32762664 PMCID: PMC7409405 DOI: 10.1186/s12906-020-03037-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 07/26/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Stroke is one of the major causes of death and disability. The treatments that are provided to patients during hospitalization after an acute stroke are very important in stabilizing their medical condition and enabling the recovery of their motor functions. However, limited information is available regarding the use of traditional Chinese medicine (TCM) during hospitalization for first-time stroke patients. The researchers aimed to investigate the factors affecting TCM use and to provide clinicians with comprehensive information on TCM use among first-time stroke inpatients in Taiwan. METHODS The researchers collected and analyzed data, including patient characteristics, TCM use, and TCM prescription patterns, from the National Health Insurance Research Database in Taiwan for first-time stroke inpatients between 2006 and 2012. RESULTS Among the 89,162 first-time stroke patients, 7455 were TCM users, and 81,707 were TCM nonusers. The predictors for TCM use were as follows: age, 45-64 or < 45 years; men; living in a level 2, 4, or 7 urbanized area; insured amount ≥ 576 USD per month; ischemic stroke; hospitalized for first-time stroke for 8-14 days, 15-28 days, or ≥ 29 days; stroke severity index score 0-9 or 10-19; Charlson-Deyo comorbidity index score 0 or 1-2; hospitalization in a regional or community hospital; receiving rehabilitation; and previous experience with outpatient TCM use. An increase in the number of TCM users was observed from 2006 to 2012. Furthermore, 68.8-79.7% of TCM users used acupuncture only, while 17.8-26.1% used both acupuncture and Chinese herbal medicine. CONCLUSIONS An increasing number of first-time stroke patients have been choosing TCM as a complementary treatment during hospitalization. Moreover, TCM use is associated with demographic, clinical, and socioeconomic characteristics. These findings may help clinicians comprehensively understand the trend and the important factors affecting TCM utilization among patients who are hospitalized due to first-time stroke.
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Affiliation(s)
- Wei-Sen Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Department of Physical Medicine and Rehabilitation, Jing Mei Hospital, Taipei, Taiwan
| | - Hung-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.,Department of Natural Biotechnology, Nanhua University, Dalin, Chiayi, Taiwan.,Center for Musculoskeletal Regenerative Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Physical Medicine and Rehabilitation, Xiamen Chang Gung Hospital, Xiamen, China
| | - Yi-Wen Chuang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Jinan Rehabilitation Clinic, Tainan, Taiwan
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuan-Yu Lu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan
| | - Yi-Fei Chen
- School of Traditional Chinese Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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6
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Scrutinio D, Battista P, Guida P, Lanzillo B, Tortelli R. Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke. Front Neurol 2020; 11:84. [PMID: 32132967 PMCID: PMC7040356 DOI: 10.3389/fneur.2020.00084] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023] Open
Abstract
Objective: We sought to determine sex differences in outcomes in patients with severe stroke who had been admitted to inpatient rehabilitation. Methods: We studied 1,316 patients aged 18 to 99 (mean 72) classified as case-mix groups 0108, 0109, and 0110 of the Medicare case-mix classification system. These groups encompass the most severe strokes. Three outcomes were analyzed: (1) 3-year mortality from admission to rehabilitation; (2) combined outcome of transfer to acute care or death within 90 days from admission to rehabilitation; (3) functional outcome, including proportional recovery in motor functioning and good functional outcome as defined by achievement of a Functional Independence Measure (FIM)-motor score ≥65 points at discharge. Multivariable regression analyses were used to assess sex-difference in each outcome between women and men. The covariates examined included age, marital status, comorbidities, time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission. Results: Kaplan-Meier estimated 3-year mortality rate was 20.7% in women and 22.0% in men. The crude hazard ratio (HR) of death for women compared with men was 0.94 (95% CI 0.74-1.20). After adjustment for significant covariates, the HR of 3-year mortality was 0.73 (95% CIs 0.56-0.96; p = 0.025). Comorbidity, including diabetes, anemia, coronary artery disease, atrial fibrillation, and chronic obstructive pulmonary disease, significantly increased mortality risk by 49-88%. The incidence of the combined outcome was 8.3% in women and 8.4% in men. The crude HR of the combined end-point for women compared with men was 1.05 (95% CI 0.72-1.53). After adjustment for significant covariates, the HR was 0.95 (95% CIs 0.65-1.40; p = 0.810). Likewise, no significant difference in proportional recovery or in the rate of achievement of a good functional outcome between women and men was observed. Conclusion: Among patients admitted to inpatient rehabilitation after severe stroke, women and men had comparable crude mortality rates at 3 years. After multivariable adjustment, however, women had lower mortality risk. No sex-differences in the risk of being transferred to acute care or dying within 90 days from admission to rehabilitation or in responsiveness to rehabilitation were observed.
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Affiliation(s)
- Domenico Scrutinio
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Petronilla Battista
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Pietro Guida
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Bernardo Lanzillo
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Rosanna Tortelli
- Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, London, United Kingdom
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7
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Chen CM, Yang YH, Lee M, Chen KH, Huang SS. Economic evaluation of transferring first-stroke survivors to rehabilitation wards: A 10-year longitudinal, population-based study. Top Stroke Rehabil 2019; 27:8-14. [PMID: 31535585 DOI: 10.1080/10749357.2019.1642652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Transferring stroke survivors to the rehabilitation ward for rehabilitation reduces long-term mortality; however, the long-term economic impact remains unknown.Objective: We aimed to assess the 10-year economic outcome of transferring first-stroke survivors to the rehabilitation ward.Methods: In this population-based, retrospective study, we examined the incremental costs per life year gained (ICLYG) for stroke survivors who were transferred to the rehabilitation ward (TR) as compared to that for those who underwent rehabilitation without being transferred to the rehabilitation ward (R) and those who did not undergo rehabilitation (NR). The differences in the daily medical expenditures among the three groups during the 10-year post-stroke period were examined.Results: After balancing characteristics of the three groups, the data of 14,544 first-stroke survivors between 1999 and 2003 were collected. The medical expenditure of index hospitalization was the lowest and the survival period was the longest in the TR group. The ICLYG of TR vs. NR (reference) was -388.5 (95% CI -396.2, -380.8) USD/year and that of TR vs. R (reference) was -121.5 (95% CI -130.4, -112.6) USD/year. The daily medical expenditure of the post-stroke survival period was significantly lower in the TR group (median 11.0, IQR 5.7-22.5 USD) than in the R (median 14.2, IQR 6.4-41.4 USD) and NR (median 19.5, IQR 6.4-88.2 USD) groups.Conclusions: The 10-year post-stroke follow-up showed that transferring patients to the rehabilitation ward is more cost effective than rehabilitation without transfer to the rehabilitation ward and no rehabilitation.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kai-Hua Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
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8
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Chen CM, Lee M, Yang YH, Huang SS, Lin CH. Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke. Sci Rep 2019; 9:11521. [PMID: 31395912 PMCID: PMC6687732 DOI: 10.1038/s41598-019-47975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/m2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson–Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hsieh CY, Huang HC, Wu DP, Li CY, Chiu MJ, Sung SF. Effect of Rehabilitation Intensity on Mortality Risk After Stroke. Arch Phys Med Rehabil 2018; 99:1042-1048.e6. [DOI: 10.1016/j.apmr.2017.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 01/21/2023]
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10
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Hsieh CY, Wu DP, Sung SF. Registry-based stroke research in Taiwan: past and future. Epidemiol Health 2018; 40:e2018004. [PMID: 29421864 PMCID: PMC5847969 DOI: 10.4178/epih.e2018004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/04/2018] [Indexed: 01/08/2023] Open
Abstract
Stroke registries are observational databases focusing on the clinical information and outcomes of stroke patients. They play an important role in the cycle of quality improvement. Registry data are collected from real-world experiences of stroke care and are suitable for measuring quality of care. By exposing inadequacies in performance measures of stroke care, research from stroke registries has changed how we manage stroke patients in Taiwan. With the success of various quality improvement campaigns, mortality from stroke and recurrence of stroke have decreased in the past decade. After the implementation of a nationwide stroke registry, researchers have been creatively expanding how they use and collect registry data for research. Through the use of the nationwide stroke registry as a common data model, researchers from many hospitals have built their own stroke registries with extended data elements to meet the needs of research. In collaboration with information technology professionals, stroke registry systems have changed from web-based, manual submission systems to automated fill-in systems in some hospitals. Furthermore, record linkage between stroke registries and administrative claims databases or other existing databases has widened the utility of registry data in research. Using stroke registry data as the reference standard, researchers have validated several algorithms for ascertaining the diagnosis of stroke and its risk factors from claims data, and have also developed a claims-based index to estimate stroke severity. By making better use of registry data, we believe that we will provide better care to patients with stroke.
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Affiliation(s)
- Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Darren Philbert Wu
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan.,Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
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11
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Liu XH, Huai J, Gao J, Zhang Y, Yue SW. Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials. Neural Regen Res 2017; 12:1443-1450. [PMID: 29089989 PMCID: PMC5649464 DOI: 10.4103/1673-5374.215255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE: The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke. DATA SOURCES: The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, WanFang, Weipu Information Resources System, Chinese Biomedical Literature Database, PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016. DATA SELECTION: We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy (traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis. OUTCOME MEASURES: Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index. RESULTS: A total of 16 prospective randomized controlled trials (379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm (weighted mean difference (WMD) = 10.822; 95% confidence intervals (95% CI): 7.419–14.226), the action research-arm test (WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement (WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index (WMD = 10.706; 95% CI: 4.417–16.966). CONCLUSION: Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.
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Affiliation(s)
- Xi-Hua Liu
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China.,Department of Physical Medicine & Rehabilitation, The Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, Shandong Province, China
| | - Juan Huai
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Jie Gao
- Shandong Institute of Prevention and Control for Endemic Disease, Jinan, Shandong Province, China
| | - Yang Zhang
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Shou-Wei Yue
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
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