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Lelli D, Pérez Bazan LM, Calle Egusquiza A, Onder G, Morandi A, Ortolani E, Mesas Cervilla M, Pedone C, Inzitari M. 25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study. Osteoporos Int 2019; 30:887-895. [PMID: 30652217 DOI: 10.1007/s00198-019-04845-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
Abstract
UNLABELLED Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for "deficiency"). An early 25(OH)D dosage may be advisable for this population. INTRODUCTION Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units. METHODS We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models. RESULTS We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5-18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67-5.33]; Q3, OR [95% CI] = 4.01 [1.35-13.48]; Q4, OR [95% CI] = 2.18 [0.81-6.21]). CONCLUSIONS In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.
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Affiliation(s)
- D Lelli
- Area di Geriatria, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - L M Pérez Bazan
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - A Calle Egusquiza
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Onder
- Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Morandi
- Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy
| | - E Ortolani
- Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy
| | - M Mesas Cervilla
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - C Pedone
- Area di Geriatria, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Inzitari
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Zucchella C, Consilvio M, Iacoviello L, Intiso D, Tamburin S, Casale R, Bartolo M. Rehabilitation in oldest-old stroke patients: a comparison within over 65 population. Eur J Phys Rehabil Med 2018; 55:148-155. [PMID: 30160435 DOI: 10.23736/s1973-9087.18.05297-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Considering the demographic trend, characterized by a marked aging due to the increase in life expectancy and the improvement in medical care, in the next future elderly patients will represent the majority of stroke victims with a strong impact on rehabilitative services. AIM To investigate and characterize differences in functional outcome in elderly patients after stroke. DESIGN Observational study. SETTING Post-acute inpatient rehabilitation. POPULATION Subjects aged ≥65 years with acute (i.e. within 30 days from onset) ischemic or hemorrhagic stroke. METHODS At admission, all patients underwent neurological and clinical examination, functional evaluation and laboratory assessment. Comorbidities and clinical complications during hospital stay were recorded. Functional status was evaluated by means of the Functional Independence Measure (FIM) administered at admission and discharge. All patients underwent neuromotor rehabilitation, and speech therapy in case of aphasia, once a day, six days per week. RESULTS The study enrolled 402 patients, who were stratified in three groups according to age: 145 patients in Group 1, the young-old (65-74.9 years, G1), 206 in Group 2, the middle-old (75-84.9 years, G2) and 51 in Group 3, the oldest-old (≥85 years, G3). At discharge, FIM total scores increased significantly for all the groups (P<0.001); however FIM gains, as well as the efficiency parameters derived from FIM were significantly lower in G3 when compared with G1 and G2. G3 showed a significantly higher rate of comorbidities and a higher presence of pressure sores; infections occurred mainly in G2 and G3. Hospitalization was significantly longer for G1 and G2 with respect to G3, while mortality rates were significantly higher in G2 and G3 with respect to G1. The variables that predicted functional outcome were age, previous stroke, stroke severity and functional status at admission. CONCLUSIONS Despite advancing age seems to be associated with a reduced effectiveness of the rehabilitation process and a greater number of complications, intensive rehabilitation can produce significant functional gains for all stroke survivors, regardless of age. CLINICAL REHABILITATION IMPACT Understanding the specificity of this population will offer older subjects targeted interventions and, for health systems, better allocation of resources and the development of more effective approaches.
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Affiliation(s)
| | - Marco Consilvio
- Division of Neurologic, Cardiologic, and Pneumological Rehabilitation, European Institute of Rehabilitation, Isernia, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, NEUROMED Mediterranean Neurological Institute for Research and Care, Pozzilli, Isernia, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Domenico Intiso
- Unit of Physical Medicine and Neurorehabilitation, Casa Sollievo della Sofferenza Institute for Research and Care, San Giovanni Rotondo, Foggia, Italy
| | - Stefano Tamburin
- Unit of Neurology, University Hospital of Verona, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Casale
- Scientific Direction, HABILITA, Zingonia di Ciserano, Bergamo, Italy
| | - Michelangelo Bartolo
- Unit of Neurorehabilitation, Department of Rehabilitation, HABILITA, Zingonia di Ciserano, Bergamo, Italy -
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Khanittanuphong P, Tipchatyotin S. Correlation of the gait speed with the quality of life and the quality of life classified according to speed-based community ambulation in Thai stroke survivors. NeuroRehabilitation 2018; 41:135-141. [PMID: 28527227 DOI: 10.3233/nre-171465] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gait abnormality commonly resulted from stroke which affected patients living and probably quality of life (QOL). OBJECTIVE To assess the relationship between gait speed and the QOL in Thai stroke patients and to compare the QOL among three patient groups that were categorized by gait speed: i) household ambulators <0.4 m/s, ii) limited community ambulators 0.4-0.8 m/s and iii) community ambulators >0.8 m/s. METHODS This was a cross-sectional descriptive research study. The demographic data of 92 stroke patients at Songklanagarind Hospital in Thailand were collected. The gait speed was calculated by the 10 meter walk test. The Thai version of the Stroke Impact Scale (SIS) 3.0 evaluated the QOL of the patients. RESULTS The gait speed was correlated with the SIS score (r = 0.64, p < 0.001). The relationship between the gait speed and most domains of the SIS (i.e., strength, mobility, hand function, activities of daily living [ADL], emotion, social participation and thinking of recovery) were also statistically significant. The community ambulators had a higher total SIS score (729.8) than the limited community (600.8) or household ambulators (478.8) (p < 0.001). For each SIS domain mentioned above, there were significant mean scores except for emotion in the community ambulators compared with the others. CONCLUSIONS The gait speed was significantly correlated with the physical domains of the QOL in stroke patients. The community ambulators had the highest QOL among the three groups.
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Affiliation(s)
- Phichamon Khanittanuphong
- Rehabilitation Division, Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Suttipong Tipchatyotin
- Rehabilitation Division, Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Piravej K, Konjen N, Cowintaveewat V, Kuptniratsaikul V, Kuptniratsaikul PSA. Early interdisciplinary intensive rehabilitation significantly improves the quality of life of stroke survivors: a multi-center study. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0801.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Interdisciplinary and intensive stroke rehabilitation programs have been shown to be positively correlated with improved functional outcomes. However, data regarding their combined use on the quality of life (QOL) of stroke survivors appears scant.
Objective: To evaluate whether interdisciplinary intensive rehabilitation programs for stroke survivors can improve their health-related QOL (HRQOL) scores and whether the timing of the interdisciplinary intensive rehabilitation has a significant effect on HRQOL scores.
Materials and Methods: This was a multi-center, prospective study. Patients were retrospectively selected from the Thai Stroke Rehabilitation Registry database. Three hundred seventy-six stroke patients from nine main tertiary hospitals in Thailand who had received acute stroke rehabilitation were screened between March and December 2006. Two hundred seven patients completed World Health Organization Quality of Life scale abbreviated Thai version (WHOQOL-BREF-Thai) questionnaires and were divided into two groups based on the time after onset of stroke to start interdisciplinary intensive rehabilitation: sub-acute (<1 month) and chronic (≥1 month). WHOQOL-BREF-Thai questionnaires were composed of four domains (physical health, psychological well being, social relationships and environment satisfaction), which were administered to the patients before and after interdisciplinary intensive rehabilitation to assess QOL.
Results: After interdisciplinary intensive rehabilitation, patients from both groups showed significant improvement in their quality of life in all domains, sex life and family relationships. However, patients from the sub-acute group had more significant improvement in their environment domain, family relationships and overall WHOQOL scores than those in the chronic group.
Conclusion: Early interdisciplinary intensive stroke rehabilitation can significantly improve environment domain, family relationships and overall WHOQOL of stroke patients.
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Affiliation(s)
- Krisna Piravej
- MD, Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nipaporn Konjen
- Rehabilitation Center, Thai Red Cross Society, Samut Prakarn 10270, Thailand
| | | | - Vilai Kuptniratsaikul
- Rehabilitation Medicine Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10400, Thailand
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Yonamine CY, Matsuo T, Souza RKTD, Loch MR, Cabrera MAS. Functional disability for mobility in adults: a population-based study. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.003.ao02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Functional disability is an important health indicator associated with worse quality of life. Objective: To estimate the prevalence of functional disability for mobility and to identify factors associated with difficulty going up and down stairs in adults aged 40 years or over. Methods: Cross-sectional, population-based study, with residents of the Municipality of Cambé, PR, interviewed in 2011. The dependent variable was the difficulty of going up and down stairs. Analysis of associated factors was performed using Poisson regression for each subgroup (40 - 59 years and 60 years or older). Results: In total, 24% of the subjects presented some kind of difficulty going up stairs (p < .01). In both subgroups, a significantly higher prevalence in women, among those inactive during leisure time and those with a history of cerebrovascular disease was observed. In the subgroup aged 40 to 59 years, age 50 - 59 years, hypertension, diabetes and falls in the previous 12 months were also associated with the outcome. Conclusion: The results suggest the need to expand the actions of health promotion, prevention and control of chronic conditions, especially among middle-aged people.
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Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Massakulpan P, Permsirivanich W, Kuptniratsaikul PSA. Motor recovery of stroke patients after rehabilitation: one-year follow-up study. Int J Neurosci 2016; 127:37-43. [PMID: 26759075 DOI: 10.3109/00207454.2016.1138474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p < 0.001). The percentage of patients with BMRS III- VI at 6 months was greater than that at discharge, but the recovery at 12 months was slightly higher than that at 6 months. It seems that motor recovery from stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) <30 d during the first admission and Barthel index at discharge ≥10 were related to the improvement of BMRS of the hand, arm and leg on multivariate analysis. Additionally, no complication at discharge was associated with the improvement of BMRS of the leg. Conclusions Approximately half of our stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.
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Affiliation(s)
- Vilai Kuptniratsaikul
- a Faculty of Medicine, Department of Rehabilitation Medicine, Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Apichana Kovindha
- b Faculty of Medicine, Department of Rehabilitation Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Sumalee Suethanapornkul
- c Department of Rehabilitation Medicine , Phramongkutklao Hospital and College of Medicine , Bangkok , Thailand
| | - Pornpimon Massakulpan
- d Department of Rehabilitation Medicine , Prasat Neurological Institute, Ministry of Public Health , Bangkok , Thailand
| | - Wutichai Permsirivanich
- e Department of Orthopaedic Surgery and Rehabilitation Medicine , Prince of Songkla University , Songkla , Thailand
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Yang DJ, Park SK, Kim JH, Heo JW, Lee YS, Uhm YH. Effect of changes in postural alignment on foot pressure and walking ability of stroke patients. J Phys Ther Sci 2015; 27:2943-5. [PMID: 26504330 PMCID: PMC4616131 DOI: 10.1589/jpts.27.2943] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/18/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aims of this study were to determine (1) the significance of walking and
foot pressure in stroke patients, and (2) the association between changes in postural
alignment of stroke patients. [Subjects and Methods] Foot pressure and walking ability
based on postural alignment were measured in 50 stroke patients. Trunk imbalance, trunk
rotation, pelvic tilt, kyphosis, lordosis were measured using DIERS formetric4D (DIERS
International GmbH, Schlangenbad, Germany), which anlalyzes 3-dimensional spinal structure
in order to measure postural alignment. To determine foot pressure, the support rate of
weight and, average foot pressure were measured using DIERS pedoscan (DIERS International
GmbH, Schlangenbad, Germany) apparatus as a pressure platform. [Results] DIERS formetric
4D, DIERS pedoscan, and a 10 m walking test were utilized to measure foot pressure and
walking ability relative to changes in postural alignment in participating stroke
patients. [Conclusion] This study confirmed the significance of foot pressure and walking
ability as related postural alignment, indicating that postural alignment education and a
recovery therapy program for functional improvement of stroke patients should be provided
together.
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Affiliation(s)
- Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Jae Won Heo
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yong Seon Lee
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Sehan University Mokpo Rehabilitation Hospital, Republic of Korea
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[Subacute care of stroke-affected patients. Satisfaction and results]. ACTA ACUST UNITED AC 2014; 29:150-7. [PMID: 24745872 DOI: 10.1016/j.cali.2014.01.002] [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: 10/14/2013] [Revised: 12/28/2013] [Accepted: 01/07/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. MATERIAL AND METHOD Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. RESULTS The patient profile is a 71 year-old male, with low/intermediate social risk, high co-morbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. CONCLUSIONS Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving.
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Abstract
Stroke affects the long-term quality of life and the well-being of patients and families. Stroke patients gain benefits from rehabilitation. Authors reported 1-year outcomes of stroke rehabilitation in 327 patients registered to the Thai Stroke Rehabilitation Registry. The outcomes included death rate, readmission rate, functional ability score (Barthel Index, BI), and factors affecting BI score. Of 327 patients, 214 (65.4%) had adequate follow-up data for analysis. The average age was 62.1 ± 12.5 years, and 57.9% were male. The mortality rate was 2.5% and the readmission rate was 11.2%. The number of the patients who could function independently increased from 5.5% at discharge to 22.9% and 25.5% at month 6 and month 12, respectively. The change in functional ability level of 214 patients included improvement (51.5%), deterioration (12.8%), and equivocal (35.7%). The low functional score at month 12 was significantly correlated with longer length of stay (LOS), longer onset to admission interval, and higher depression score at month-12. In conclusion, approximately half of the patients had an improvement in the disability level for at least one grade at 1-year follow-up. The low functional score by the end of the first year is associated with longer LOS during the first admission, delay in rehabilitation program, and psychological depression.
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Bai YL, Li L, Hu YS, Wu Y, Xie PJ, Wang SW, Yang M, Xu YM, Zhu B. Prospective, randomized controlled trial of physiotherapy and acupuncture on motor function and daily activities in patients with ischemic stroke. J Altern Complement Med 2013; 19:684-9. [PMID: 23600965 DOI: 10.1089/acm.2012.0578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the value of acupuncture for promoting the recovery of patients with ischemic stroke and to determine whether the outcomes of combined physiotherapy and acupuncture are superior to those with physiotherapy alone. DESIGN Prospective randomized controlled trial. SETTING Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, P. R. China. PARTICIPANTS 120 inpatients and outpatients (84 men and 36 women). INTERVENTIONS Acupuncture, physiotherapy, and physiotherapy combined with acupuncture. MAIN OUTCOME MEASURES Motor function in the limbs was measured with the Fugl-Meyer assessment (FMA). The modified Barthel index (MBI) was used to rate activities of daily living. All evaluations were performed by assessors blinded to treatment group. RESULTS On the first day of therapy (day 0, baseline), FMA and MBI scores did not significantly differ among the treatment groups. Compared with baseline, on the 28th day of therapy the mean FMA scores of the physiotherapy, acupuncture, and combined treatment groups had increased by 65.6%, 57.7%, and 67.2%, respectively; on the 56th day, FMA scores had increased by 88.1%, 64.5%, and 88.6%, respectively (p<0.05). The respective MBI scores in the three groups increased by 85.2%, 60.4%, and 63.4% at day 28 and by 108.0%, 71.2%, and 86.2% at day 56, respectively (p<0.05). However, FMA scores did not significantly differ among the three treatment groups on the 28th day. By the 56th day, the FMA and MBI scores of the physiotherapy group were 46.1% and 33.2% greater, respectively, than those in the acupuncture group p<0.05). No significant differences were seen between the combined treatment group and the other groups. In addition, the FMA subscores for the upper extremities did not reflect any significant improvement in any group on the 56th day. Although the FMA subscores for the upper and lower extremities and the MBI score in the combined treatment group were higher than those in the acupuncture group, the differences were not statistically significant. CONCLUSIONS Acupuncture is less effective for the outcome measures studied than is physiotherapy. Moreover, the therapeutic effect of combining acupuncture with physiotherapy was not superior to that of physiotherapy alone. A larger-scale clinical trial is necessary to confirm these findings.
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Affiliation(s)
- Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y. Long-term morbidities in stroke survivors: a prospective multicenter study of Thai stroke rehabilitation registry. BMC Geriatr 2013; 13:33. [PMID: 23586971 PMCID: PMC3635998 DOI: 10.1186/1471-2318-13-33] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/05/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stroke-related complications are barriers to patients' recovery leading to increasing morbidity, mortality, and health care costs, decreasing patient's quality of life. The purpose of this study was to quantify incidence and risk factors of stroke-related complications during the first year after discharge from rehabilitation ward. METHODS A prospective observational study was conducted in nine tertiary-care rehabilitation centers. We evaluated the incidence of morbidities during the first year after stroke, including musculoskeletal pain, neuropathic pain, pneumonia, deep vein thrombosis (DVT), pressure ulcer, spasticity, shoulder subluxation, joint contracture, dysphagia, urinary incontinence, anxiety and depression. The complications at discharge and at month-12 were compared using the McNemar test. Univariate analysis and multiple logistic regression analysis by forward stepwise method were used to determine factors predicting the complications at month-12. RESULTS Two hundred and fourteen from 327 patients (65.4%) were included. The age was 62.1 ± 12.5 years, and 57.9% were male. In 76.8% of the patients at least one complication was found during the first year after stroke. Those complications were musculoskeletal pain (50.7%), shoulder subluxation (29.3%), depression (21.2%), spasticity (18.3%), joint contracture (15.7%) and urinary incontinence (14.4%). Other complications less than 5% were dysphagia (3.5%), pressure ulcer (2.6%), infection (1.5%), and neuropathic pain (3.0%). Nearly 60% of patients with complications at discharge still had the same complaints after one year. Only 7.6% were without any complication. Morbidity was significantly associated with age and type of stroke. Using multiple logistic regression analysis, age and physical complications at discharge were significant risk factors for physical and psychological morbidities after stroke respectively (OR = 2.1, 95% CI 1.2, 3.7; OR = 3.1, 95% CI 1.3, 7.1). CONCLUSION Long-term complications are common in stroke survivors. More than three-fourths of the patients developed at least one during the first year after rehabilitation. Strategies to prevent complications should be concerned especially on musculoskeletal pain which was the most common complaint. Physical complications at discharge period associated with psychological complications at 1 year followed up. More attention should be emphasized on patients age older than 60 years who were the major risk group for developing such complications.
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Affiliation(s)
- Vilai Kuptniratsaikul
- Rehabilitation Medicine Department, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkok, 10700, Thailand
| | - Apichana Kovindha
- Rehabilitation Medicine Department, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sumalee Suethanapornkul
- Rehabilitation Medicine Department, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nuttaset Manimmanakorn
- Rehabilitation Medicine Department, Faculty of Medicine, KhonKaen University, Khon Kaen, Thailand
| | - Yingsumal Archongka
- Sirindhorn National Medical Rehabilitation Center, Department of Medical Service, Ministry of Public Health, Nonthaburi, Thailand
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Chaiyawat P, Kulkantrakorn K. Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression. Psychogeriatrics 2012; 12:193-9. [PMID: 22994618 DOI: 10.1111/j.1479-8301.2012.00412.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with major stroke are often left with disability and may have depression and dementia during the recovery phase. Rehabilitation programmes have been shown to improve short-term physical outcome, but their long-term effectiveness and impact on dementia and depression are uncertain. METHODS We performed a 6-month randomized controlled trial of a home rehabilitation programme and compared it with the standard care patients with recent ischemic stroke receive. The intervention group received home-based physical therapy once a month for 6 months, along with educational support, counselling and audiovisual materials. The control group received rehabilitation as prescribed by a physician and educational materials upon discharge from hospital. The primary measurement was a change in Barthel Index. Secondary measurements were the Hospital Anxiety and Depression Scale (HADS) and Thai Mini-Mental State Examination. RESULTS Of the 68 screened patients, 60 patients were enrolled. At baseline, there was no significant difference in patient characteristics between the two groups. Over 2 years, the mean Barthel Index and Hospital Anxiety and Depression Scale were significantly improved in the intervention group compared to the control group (Barthel Index mean: from 31.7 ± 5.9 to 97.2 ± 2.8 vs from 33.2 ± 4.8 to 76.4 ± 9.4, P < 0.001; Hospital Anxiety and Depression Scale mean: from 16.1 ± 7.6 to 9.1 ± 0.3 vs 16.4 ± 4.9 to 9.1 ± 0.3, P= 0.003). Depression was strongly associated with being dependent on others. However, the Thai Mini-Mental State Examination in both groups did not significantly differ (Thai Mini-Mental State Examination mean: from 24.4 ± 2.0 to 24.6 vs 23.8 ± 1.9 to 24.1 ± 0.3, P= 0.068). There was no significant interaction between baseline characteristics and treatment outcome. CONCLUSIONS At 2 years follow-up, it was evident that a 6-month home rehabilitation programme after ischemic stroke improved functional outcome and reduced incidence of depression, but not dementia.
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Dalvandi A, Heikkilä K, Maddah SSB, Khankeh HR, Ekman SL. Life experiences after stroke among Iranian stroke survivors. Int Nurs Rev 2010; 57:247-53. [PMID: 20579161 DOI: 10.1111/j.1466-7657.2009.00786.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stroke is a major cause of disability worldwide. It is a life-threatening and life-altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long-term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. AIM To illuminate how stroke survivors experience and perceive life after stroke. METHOD A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors. FINDINGS The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio-economical situation and life disintegration. The core concept of life after stroke was functional disturbances. CONCLUSIONS The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.
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Affiliation(s)
- A Dalvandi
- University of Social Welfare and Rehabilitation Sciences, 1985713831 Tehran, Iran.
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Shimodozono M, Kawahira K, Ogata A, Etoh S, Tanaka N. Addition of an Anabolic Steroid to Strength Training Promotes Muscle Strength in the Nonparetic Lower Limb of Poststroke Hemiplegia Patients. Int J Neurosci 2010; 120:617-24. [DOI: 10.3109/00207454.2010.505352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y. Complications during the rehabilitation period in Thai patients with stroke: a multicenter prospective study. Am J Phys Med Rehabil 2009; 88:92-9. [PMID: 19077674 DOI: 10.1097/phm.0b013e3181909d5f] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the frequency and types of complications in patients with stroke. DESIGN A multicenter, prospective cohort study was performed in 327 patients with stroke (134 women, 193 men), who attended inpatient rehabilitation in nine centers. The frequency and severity of consequences and complications related to strokes were monitored weekly. In addition, correlations with stroke-related complications were analyzed. RESULTS At least one complication after a stroke was found in 232 (71.0%) patients. The mean age was 62 (+/-12) yrs, and 59% were men. Shoulder subluxation was found in 37.3% with mild to moderate degree. Limb spasticity was presented in 41.6%, and almost all were a severity grade of less than 3 on the Modified Ashworth Scale. The common complications were musculoskeletal pain (32.4%), bowel/bladder dysfunction (31.5%), infection (16.5%), depression (13.8%), and anxiety (5.8%). Symptomatic urinary tract infection was found in 35 (10.7%) patients. Urinary incontinence was the most common among bowel/bladder problems (24.5%). Time since onset of stroke > or = 1 mo (adjusted odds ratio [OR] = 2.12; 95% confidence interval [CI] = 1.07-4.17), length of stay > 21 days (adjusted OR = 2.36; 95% CI = 1.26-4.43), and anxiety score at admission > or = 11 (adjusted OR = 6.87; 95% CI = 2.45-19.29) were statistically associated with stroke-related complications. CONCLUSIONS Medical complications were common among patients with stroke who had been hospitalized longer, during inpatient rehabilitation and among those who had high anxiety scores.
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