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Sumiya K, Shogenji M, Ikenaga Y, Ogawa Y, Hirako K, Fujita A, Shimada T, Hashimoto M, Masuda A, Nagamoto T, Tamai I, Ogura H, Toyama T, Wada T, Sai Y. Association between switching prescribed drugs for lower urinary tract symptoms and independence of urination in post-stroke patients: A retrospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:107419. [PMID: 37839304 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107419] [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: 04/06/2023] [Revised: 08/24/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES Stroke patients frequently exhibit loss of independence of urination, and their lower urinary tract symptoms change with the phase of stroke. However, it is unclear whether switching prescribed drugs for lower urinary tract symptoms during hospitalization from acute care wards to convalescence rehabilitation wards affects patients' independence of urination at discharge. It is also unclear whether the impact of switching varies by stroke type. This retrospective cohort study aimed to examine these issues. MATERIALS AND METHODS We analyzed 990 patients registered in the Kaga Regional Cooperation Clinical Pathway for Stroke database during 2015-2019. Prescriptions for lower urinary tract symptoms from pre-onset to convalescence rehabilitation were surveyed. Logistic regression analysis was performed to examine the association between switching drugs and independence of urination based on bladder management and voiding location at discharge. Stroke types were also examined in subgroup analyses. RESULTS About 21 % of patients had their lower urinary tract symptoms prescriptions switched during hospitalization. Switching was positively associated with independence of bladder management (odds ratio 1.65, 95 % confidence interval 1.07 to 2.49) and voiding location (odds ratio 2.72, 95 % confidence interval 1.72 to 4.37). Similar associations were observed in different stroke types. CONCLUSIONS Approximately 20 % of patients had their lower urinary tract symptoms medications switched upon transfer from acute to convalescence rehabilitation wards. Switching was significantly associated with improved urinary independence at discharge. Consistent results were observed across different stroke types, suggesting that switching medications contributes to urinary independence after stroke, regardless of the etiology or severity of stroke.
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Affiliation(s)
- Koyomi Sumiya
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Miho Shogenji
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan; Council of Kaga Local Stroke Network, South Ishikawa, Japan
| | - Yoru Ogawa
- Council of Kaga Local Stroke Network, South Ishikawa, Japan; Department of Pharmacy, Komatsu Municipal Hospital, Ishikawa, Japan
| | - Kohei Hirako
- Frontier Science and Social Co-creation Initiative, Kanazawa University, Ishikawa, Japan; The Establishment Preparation Office for The Faculty of Interdisciplinary Economics, Kinjo University, Ishikawa, Japan
| | - Arimi Fujita
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Tsutomu Shimada
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan.
| | | | | | | | - Ikumi Tamai
- Division of Pharmacy, Graduate School of Pharmaceutical Sciences, Kanazawa University, Ishikawa, Japan; AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan
| | - Hisayuki Ogura
- AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan; Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Tadashi Toyama
- AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan; Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yoshimichi Sai
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan; AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan
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Uchida K, Uchiyama Y, Domen K, Koyama T. Outcome Prediction for Patients With Ischemic Stroke in Acute Care: New Three-Level Model by Eating and Bladder Functions. Ann Rehabil Med 2021; 45:215-223. [PMID: 34126671 PMCID: PMC8273726 DOI: 10.5535/arm.20226] [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: 10/20/2020] [Accepted: 01/11/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To develop a new prediction model by combining independence in eating and bladder management functions, and to assess its utility in an acute care setting. METHODS Patients with ischemic stroke who were admitted in our acute stroke care unit (n=250) were enrolled in this study. Functional Independence Measure (FIM) scores for eating and bladder management on the initial day of rehabilitative treatment (median, 3 days) were collected as predictive variables. These scores were divided into low (<5) and high (≥5) and categorized as values 0 and 1, respectively. From the simple summation of these two-level model values, we derived a three-level model that categorized the scores as values 0, 1, and 2. The FIM-motor scores at discharge (median, 14 days) were collected as outcome measurements. The three-level model was assessed by observing the distribution patterns of the outcome FIM-motor scores and logistic regression analyses. RESULTS The median outcome FIM-motor score was 19 (interquartile range [IQR],13.8-45.3) for the value 0 category (n=14), 66.5 (IQR, 59.5-81.8) for the value 1 category (n=16), and 84 (IQR, 77-89) for the value 2 category (n=95) in the three-level model. Data fitting by logistic regression for FIM-motor scores of 41.3 and 61.4 reached 50% probability of values 1 and 2, respectively. CONCLUSION Despite the simplicity of the three-level model, it may be useful for predicting outcomes of patients with ischemic stroke in acute care.
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Affiliation(s)
- Kensaku Uchida
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.,Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Effectiveness and Safety of Electroacupuncture on Poststroke Urinary Incontinence: Study Protocol of a Pilot Multicentered, Randomized, Parallel, Sham-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:5709295. [PMID: 28042304 PMCID: PMC5155105 DOI: 10.1155/2016/5709295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/23/2016] [Accepted: 11/03/2016] [Indexed: 11/17/2022]
Abstract
This pilot multicentered, randomized, parallel, sham-controlled trial is intended to evaluate the effectiveness and safety of electroacupuncture therapy for poststroke patients with urinary incontinence. Forty stroke survivors aged >19 years will be recruited in 2 hospitals in the Republic of Korea. Patients who experienced stroke within 2 years and satisfy criteria of urinary frequencies ≥2 with either 3 to 4 points on the Patient Perception of Intensity of Urgency Scale or 13 points or more on the Korean version of the International Prostate Symptom Scale (K-IPSS) will be identified, along with other eligibility criteria. Patients will be randomly allocated to either a treatment or control group to receive 10 sessions of electroacupuncture or sham therapies, respectively. Patients and outcome assessors will be blinded. The primary outcome is the change of Total Urgency and Frequency Score between the baseline and the trial endpoint. The K-IPSS, the International Consultation on Incontinence Questionnaire for Urinary Incontinence Short Form, and the Lower Urinary Tract Symptoms Outcome Score will be evaluated for effectiveness assessment. Adverse events will be reported after every session. The Blinding Index will also be calculated. Data will be statistically analyzed with 0.05 significance levels by 2-sided testing.
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Electroacupuncture versus sham electroacupuncture for urinary retention in poststroke patients: study protocol for a multicenter, randomized controlled trial. Trials 2016; 17:197. [PMID: 27072880 PMCID: PMC4828778 DOI: 10.1186/s13063-016-1315-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 03/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study protocol evaluates the effectiveness of adjuvant electroacupuncture (EA) for urinary retention in poststroke patients undergoing conventional treatments, in comparison with that of a sham control. METHODS/DESIGN A multicenter, blinded, randomized controlled trial will be conducted in three hospitals in the Republic of Korea. We are recruiting 54 stroke survivors (aged >19 years), who were diagnosed with urinary retention based on the results of two consecutive post-void residual (PVR) tests, and dividing them randomly into two arms: the EA and Park-sham control groups. They will receive ten sessions of EA or sham treatment for 2 weeks. The participants will be blinded with non-penetrating needles and fake sounds of EA stimulators. The daily PVR ratio will be primarily measured at baseline and at the end of the study to statistically test the effectiveness of EA for poststroke urinary retention. Then, the Korean version of the Qualiveen Questionnaire, the Korean version of the International Prostate Symptom Score, and the blinding index will be assessed. After each EA session or sham EA, adverse events will be reported to evaluate the safety of EA. Results will be analyzed by using the independent t-test or Mann-Whitney U test, based on both intention-to-treat and per-protocol principles. DISCUSSION The findings will provide clinical evidence for the effectiveness of EA treatment to improve urinary retention in stroke survivors. TRIAL REGISTRATION This study protocol was registered in ClinicalTrials.gov (NCT02472288) on 10 June 2015.
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Kulaklı F, Koklu K, Ersoz M, Ozel S. Relationship between urinary dysfunction and clinical factors in patients with traumatic brain injury. Brain Inj 2014; 28:323-7. [PMID: 24377376 DOI: 10.3109/02699052.2013.865268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Examination of relations between urinary dysfunction and Functional Independence Measurement (FIM) values and other clinical factors. MATERIALS AND METHODS Twenty-nine patients with TBI were included in the study. Patients' demographic values, lower urinary tract symptoms (LUTS) and urinary drainage methods were recorded. Functional assessment was performed using FIM. Urodynamic studies were carried out and maximum cystometric capacity (MCC), storage and voiding function, type of detrusor, urodynamic abnormality and post-void residual urine volume values were investigated. RESULTS Total FIM and FIM sphincter control sub-group scores were significantly lower in patients with storage dysfunction and urodynamic abnormality than patients without storage dysfunction and urodynamic abnormality (p < 0.05). In tetraparetic patients, frequency of storage dysfunction was significantly higher than hemiparetic patients (p < 0.05). Urodynamic abnormality was detected in five of nine patients with LUTS and in 12 of 20 patients without LUTS. There was no significant correlation between LUTS and urodynamic abnormality (p > 0.05). CONCLUSIONS Storage dysfunction and urodynamic abnormality is associated with poorly functional outcomes in TBI patients. There is a direct correlation between motor deficit and urodynamic abnormality. All of the TBI patients with or without LUTS should be evaluated neuro-urologically; urodynamic evaluation and treatment should be arranged if needed.
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Affiliation(s)
- Fazıl Kulaklı
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital , Ankara , Turkey
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Chang EY, Chang EH, Cragg S, Cramer SC. Predictors of Gains During Inpatient Rehabilitation in Patients with Stroke- A Review. ACTA ACUST UNITED AC 2013; 25:203-221. [PMID: 25541570 DOI: 10.1615/critrevphysrehabilmed.2013008120] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Stroke remains a major cause of disability. The cost of stroke rehabilitation is substantial. Understanding the factors that predict response to inpatient stroke rehabilitation may be useful, for example, to best individualize the content of therapy, or to maximize the efficiency with which resources are directed. This review reviewed the literature and found that numerous variables were associated with outcome after inpatient stroke rehabilitation. The strongest evidence exists for factors such as age, stroke subtype, nutritional status, psychosocial factors such as living with family prior to stroke or presence of a caregiver. Functional status on admission, urinary incontinence, post-stroke infection, and aphasia each can also impact prognosis. Strengths and weaknesses of cited studies are considered in an attempt to inform design of future studies examining the factors that predict response to inpatient rehabilitation after stroke.
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Affiliation(s)
- Eric Y Chang
- Division of Pain Medicine Department of Anesthesiology & Perioperative Care Department of Physical Medicine & Rehabilitation Reeve-Irvine Research Center for Spinal Cord Injury University of California, Irvine
| | - Enoch H Chang
- Department of Physical Medicine & Rehabilitation University of California, Irvine
| | - Samantha Cragg
- Department of Physical Medicine & Rehabilitation University of California, Irvine
| | - Steven C Cramer
- Department of Neurology Department of Anatomy & Neurobiology Department of Physical Medicine & Rehabilitation University of California, Irvine
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