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Jia M, Lu Y, Liang X, Tong C, Wang J, Tang J, Yang J, Wang M, Jiao W, Du W, Wei J, Zeng Z, Xu Z, Chen Q, Lei L, Liao X, Zhang Y. Development of a core outcome set for hypertensive intracerebral hemorrhage in clinical trials of traditional Chinese medicine: a study protocol. Trials 2022; 23:871. [PMID: 36224599 PMCID: PMC9559838 DOI: 10.1186/s13063-022-06801-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a devastating disease, its mortality and disability rate are high. In China, hypertensive intracerebral hemorrhage (HICH) is responsible for 75% of all the cases of primary ICH. A lot of randomized controlled trials (RCTs) of traditional Chinese medicine (TCM) for treating HICH have been carried out. However, these RCTs have a lot of problems, such as heterogeneous outcomes, non-uniform point of measurement. These lead to systematic review/meta-analysis only can include a small number of studies. And outcome measures did not take the wishes of patients and other stakeholders into account. The aim of this study is to establish the core outcome set (COS) for future TCM clinical trials of HICH. Methods and analysis First, we will develop a long list of general outcomes by making systematic literature review and semi-structured interviews. Then healthcare professionals and patients with HICH will be invited to participate in two rounds of the Delphi survey to determine the importance of the outcome. Finally, a face-to-face consensus meeting will be conducted to determine the final COS of HICH, including what outcomes should be measured and when and how to measure the outcomes. Results We aim to develop a COS that includes TCM core syndrome for HICH to determine what outcomes should be reported and when and how to measure them. Conclusion By doing this, we can increase the reporting consistency and reduce the reporting bias in the outcome, which leads to the reuse of research data in meta-analysis and the making of informed healthcare decisions. Ethics and dissemination The entire project has received approval from the Ethics Committee of Xiyuan Hospital, China Academy of Chinese Medical Sciences. The final COS will be published and reported at the national and international conferences. Trial registration This study is registered with the Core Outcome Measures in Effectiveness Trials database as study 1475. Registered on December 2019.
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Affiliation(s)
- Min Jia
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Lu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao Liang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chenguang Tong
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jian Wang
- The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Jun Tang
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Jian Yang
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Min Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Weiwei Jiao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wanqing Du
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zixiu Zeng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Zhenmin Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qian Chen
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Lin Lei
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Liao
- Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Yunling Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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2
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Campo M, Toglia J, Jaywant A, O'Dell MW. Young individuals with stroke in rehabilitation: a cohort study. Int J Rehabil Res 2021; 44:314-322. [PMID: 34417407 DOI: 10.1097/mrr.0000000000000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke in younger populations is a public health crisis and the prevalence is rising. Little is known about the progress of younger individuals with stroke in rehabilitation. Characterization of the course and speed of recovery is needed so that rehabilitation professionals can set goals and make decisions. This was a cohort study with data extracted from electronic medical records. Participants were 408 individuals diagnosed with stroke who participated in inpatient rehabilitation in an urban, academic medical center in the USA. The main predictor was age which was categorized as (18-44, 45-64, 65-74 and 75+). Outcomes included baseline-adjusted discharge functional independence measure (FIM) scores and FIM efficiency. In linear regression models for FIM scores, the reference category was the youngest age group. The oldest group was discharged with significantly lower FIM total (B = -8.84), mobility (B = -4.13), self-care (B = -4.07) and cognitive (B = -1.57) scores than the youngest group after controlling for covariates. The 45-64 group also finished with significantly lower FIM total (B = -6.17), mobility (B = -2.61) and self-care (B = -3.01) scores than youngest group. FIM efficiencies were similar for all ages in each of the FIM scales. Younger individuals with stroke make slightly greater functional gains compared to older individuals with stroke, but other factors, such as admission scores, are more important and the rates of recovery may be similar.
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Affiliation(s)
- Marc Campo
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry
- Department of Rehabilitation Medicine, Weill Cornell Medicine
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry
- Department of Rehabilitation Medicine, Weill Cornell Medicine
- New York-Presbyterian Hospital/Weill Cornell Medical Center
| | - Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine
- New York-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine
- New York-Presbyterian Hospital/Weill Cornell Medical Center
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Hosoda T, Hamada S. Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study. BMC Geriatr 2021; 21:638. [PMID: 34772350 PMCID: PMC8586826 DOI: 10.1186/s12877-021-02597-w] [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] [Received: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02597-w.
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Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, 210-0013, Japan.
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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4
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Feng L, Li M, Ren J, Li Y, Wang Q, Zhang P, Zhang X, Wang T, Li Y. Proteomic Analysis Reveals that Di Dang Decoction Protects Against Acute Intracerebral Hemorrhage Stroke in Rats by Regulating S100a8, S100a9 Col1a1, and Col1a2. Neuropsychiatr Dis Treat 2021; 17:3301-3314. [PMID: 34785900 PMCID: PMC8591113 DOI: 10.2147/ndt.s331688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The present study aimed to explore the neuroprotective mechanism of Di Dang decoction (DDD) during acute intracerebral hemorrhage (AICH) stroke in Sprague Dawley rats through proteomic analysis. METHODS A total of 135 healthy Sprague Dawley rats were randomly divided into five groups: control (n = 27), model (n = 27), DDD low-dose (n = 27), DDD medium-dose (n = 27), and DDD high-dose (n = 27). AICH stroke in rats was induced by injecting autologous blood into the caudate nucleus. The modified Neurological Severity Score (mNSS) was used to evaluate the cerebral nerve function deficit. Hematoxylin and eosin (HE) staining was performed to observe the brain tissue at the lesion site. Albumin concentration was assessed on obvious blood-brain barrier damaged and brain water content was used to evaluate the brain injury. For quantitative proteomics, proteins were extracted from the cerebral cortices. Target proteins were identified using mass spectrometer-based targeted proteomic quantification. RESULTS mNSS score, HE staining results, albumin concentration, and brain water content showed the most significant improvements in the neuroprotective in the high-dose group 7 days after DDD exposure. Furthermore, quantitative proteomics analysis showed that, relative to the control group, S100a8 and S100a9 were downregulated by 0.614 (p = 0.033702) and 0.506 times (p = 0.000024) in the high-dose group. Compared with the control group, Col1a1 and Col1a2 were upregulated by 1.319 (p = 0.000184) and 1.348 (p = 0.014097) times in the high-dose group. These results were confirmed using mass spectrometer-based targeted proteomic quantification. CONCLUSION Application of a high-dose DDD for 7 days in AICH stroke rats showed the most significant improvements in neuroprotective. Mechanistically, this effect was mediated by S100a8 and S100a9 protein downregulation and Col1a1 and Col1a2 upregulation.
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Affiliation(s)
- Lina Feng
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Mingquan Li
- Neurology Department, Third Affiliated Clinical Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Jixiang Ren
- Preclinical Department, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Yujuan Li
- Ultrasonic Diagnosis Department, Third Affiliated Clinical Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Qi Wang
- College of Integrated Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Pengqi Zhang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Xinyue Zhang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Tianye Wang
- College of Integrated Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, People's Republic of China
| | - Yunqiang Li
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, People's Republic of China
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5
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Zhu S, Gao Q, Yang L, Yang Y, Xia W, Cai X, Hui Y, Zhu D, Zhang Y, Zhang G, Wu S, Wang Y, Zhou Z, Liu H, Zhang C, Zhang B, Yang J, Feng M, Ni Z, Chen B, Du C, He H, Qu Y, Wei Q, He C, Reinhardt JD. Prevalence and risk factors of disability and anxiety in a retrospective cohort of 432 survivors of Coronavirus Disease-2019 (Covid-19) from China. PLoS One 2020; 15:e0243883. [PMID: 33332386 PMCID: PMC7746260 DOI: 10.1371/journal.pone.0243883] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures. DESIGN Multi-center retrospective cohort study. SETTING Twenty-eight hospitals located in eight provinces of China. METHODS A total of 432 survivors with laboratory-confirmed SARS CoV-2 infection participated in this study. At discharge, we assessed instrumental activities of daily living (IADL) with Lawton's IADL scale, dependence in activities of daily living (ADL) with the Barthel Index, and anxiety with Zung's self-reported anxiety scale. Exposures included comorbidity, smoking, setting (Hubei vs. others), disease severity, symptoms, and length of hospital stay. Other risk factors considered were age, gender, and ethnicity (Han vs. Tibetan). RESULTS Prevalence of at least one IADL problem was 36.81% (95% CI: 32.39-41.46). ADL dependence was present in 16.44% (95% CI: 13.23-20.23) and 28.70% (95% CI: 24.63-33.15) were screened positive for clinical anxiety. Adjusted risk ratio (RR) of IADL limitations (RR 2.48, 95% CI: 1.80-3.40), ADL dependence (RR 2.07, 95% CI 1.15-3.76), and probable clinical anxiety (RR 2.53, 95% CI 1.69-3.79) were consistently elevated in survivors with severe Covid-19. Age was an additional independent risk factor for IADL limitations and ADL dependence; and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a protective factor for anxiety but a risk factor for IADL limitations. CONCLUSION A significant proportion of Covid-19 survivors had disability and anxiety at discharge from hospital. Health systems need to be prepared for an additional burden resulting from rehabilitation needs of Covid-19 survivors.
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Affiliation(s)
- Siyi Zhu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Qiang Gao
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Lin Yang
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Yonghong Yang
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Wenguang Xia
- Hubei Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, Hubei, China
| | - Xiguo Cai
- Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Yanping Hui
- The Second Affiliated Hospital, Medical College of Xi’an Jiaotong University, Xian, Shanxi, China
| | - Di Zhu
- Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China
| | - Yanyan Zhang
- Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Guiqing Zhang
- The First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, China
| | - Shuang Wu
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yiliang Wang
- Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Zhiqiang Zhou
- Inner Mongolia Autonomous Region Baotou Central Hospital, Baotou, China
| | - Hongfei Liu
- General Hospital of General Bureau of Agricultural Reclamation of Heilongjiang Province, Harbin, China
| | - Changjie Zhang
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bo Zhang
- Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Jianrong Yang
- Garze People’s Hospital, Garze Tibetan Autonomous Prefecture, Sichuan, China
| | - Mei Feng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Ni
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Baoyu Chen
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunping Du
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Hongchen He
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Yun Qu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Quan Wei
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Chengqi He
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
- Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu, China
| | - Jan D. Reinhardt
- Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu, China
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
- Xidian Hospital Group, Xi’an, Shaanxi, China
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Verstraeten S, Mark RE, Dieleman J, van Rijsbergen M, de Kort P, Sitskoorn MM. Motor Impairment Three Months Post Stroke Implies A Corresponding Cognitive Deficit. J Stroke Cerebrovasc Dis 2020; 29:105119. [PMID: 32912505 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/06/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND While both motor and cognitive impairment are common after stroke, the focus of (early) treatment has always been on motor deficit. AIMS The objective of the current study was to explore the link between motor and cognitive performance in stroke patients and to examine whether motor performance is associated with cognitive functioning at three months post stroke. METHODS In both stroke patients (n = 142) and controls (n = 135), with the groups matched on age, gender and premorbid IQ, motor functioning was evaluated using both objective (Purdue Pegboard Test) and subjective measures (specific items from the Frenchay Activities Index and Barthel Index). Cognition, specifically information processing speed, working memory and cognitive flexibility, was assessed using objective tasks. The data were analyzed using Pearson product-moment correlation coefficients and logistic regression. RESULTS Significant correlations between motor and cognitive functioning were found in stroke patients. The objective motor task was stronger than subjective measures in statistically explaining and predicting cognitive deficit, irrespective of stroke severity. CONCLUSIONS We conclude that motor impairment at three months post-stroke should serve as a 'red flag' for professionals: cognitive impairment is likely and should also be evaluated.
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Affiliation(s)
- Sonja Verstraeten
- Department of Medical Psychology, Máxima Medical Center, The Netherlands.
| | - Ruth E Mark
- Department of Cognitive Neuropsychology, Tilburg University, The Netherlands
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Use of Selective Serotonin Reuptake Inhibitors and Outcomes in Stroke Rehabilitation: A Prospective Observational Pilot Cohort Study. Drugs R D 2020; 19:367-379. [PMID: 31741176 PMCID: PMC6890586 DOI: 10.1007/s40268-019-00287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose The aim of this study was to examine the association between selective serotonin reuptake inhibitor (SSRI) therapy and rehabilitation outcomes, specifically disability and quality of life (QOL), in a real-world setting of multi-ethnic Asian patients with first-ever stroke. Methods In this prospective observational pilot cohort study, we included patients with first-ever stroke admitted to two inpatient rehabilitation centres in Singapore between January and July 2018. Outcomes were measured using Functional Independence Measure (FIM)-motor scale, modified Barthel Index (MBI) and the Stroke and Aphasia Quality of Life Scale-39 generic (SAQOL-39g) questionnaire. Linear regression was used to assess the association between SSRI therapy and outcomes. Regression coefficients and 95% confidence intervals (CIs) were reported. Results Among 57 patients included for analyses, 38.6% received SSRIs. Although SSRI therapy was significantly associated with gains in MBI (coefficient 11.35; 95% CI 0.21–22.50) and SAQOL-39g overall score (coefficient 0.45; 95% CI 0.05–0.85) based on simple linear regression, no significant association between SSRI therapy and any of the investigated outcomes was found after adjustment for confounders. However, an increase in the mean number of physiotherapy and occupational therapy (PT/OT) sessions per day significantly improved FIM-motor (coefficient 16.86; 95% CI 2.64–31.07) and MBI (coefficient 22.79; 95% CI 2.35–43.23) scores. Conclusion SSRI therapy did not improve disability and QOL in multi-ethnic Asian patients with first-ever stroke undergoing rehabilitation. Electronic supplementary material The online version of this article (10.1007/s40268-019-00287-y) contains supplementary material, which is available to authorized users.
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Cao N, Nguyen B, Li S, Lamba R, Hafner R, Li S. An overview of acupuncture in stroke recovery: A narrative review. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2020. [DOI: 10.4103/jisprm.jisprm_19_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Chiu CT, Yong V, Chen HW, Saito Y. Disabled life expectancy with and without stroke: a 10-year Japanese prospective cohort study. Qual Life Res 2019; 28:3055-3064. [PMID: 31309398 DOI: 10.1007/s11136-019-02246-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE A stroke is a debilitating condition that can cause lifelong disability, severely limiting the ability of individuals to perform daily activities. In Japan, strokes are the fourth leading cause of death; however, no previous studies have examined the influence of strokes on a disabled or disability-free life for older Japanese residents. This study aims to address this gap. METHODS The study used data from the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) and incidence-based multistate life tables to estimate disabled and disability-free life expectancy based on the stroke status of Japanese residents aged 65 and older. RESULTS Japanese stroke survivors aged 65 who experienced an initial disability-free state could expect to live approximately 3 fewer total years of life, 4-5 fewer years in a disability-free state, and 1-2 more years in a disabled state compared to those without history of a stroke (p < 0.05). For those disabled at the beginning of the survey interval, the differences between individuals with and without stroke history were also similar to those disability-free at the beginning of the survey interval (2-4 and 5-6 fewer total and disability-free years, respectively) (p < 0.05). The same pattern was observed for older age groups. CONCLUSION Older adults who have experienced a stroke could experience a shorter total life expectancy, shorter disability-free life expectancy, and longer disabled life expectancy than those who have not experienced a stroke. These results can inform policymakers and rehabilitation practitioners on stroke survivor long-term care needs and their post-stroke health status.
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Affiliation(s)
- Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, No. 128, Sec. 2, Academia Rd., Taipei, Taiwan.
| | - Vanessa Yong
- Population Research Institute, Nihon University, Tokyo, Japan
| | - Hsiao-Wen Chen
- Institute of European and American Studies, Academia Sinica, No. 128, Sec. 2, Academia Rd., Taipei, Taiwan
| | - Yasuhiko Saito
- Population Research Institute, Nihon University, Tokyo, Japan
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10
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Does acupuncture help patients with spasticity? A narrative review. Ann Phys Rehabil Med 2019; 62:297-301. [DOI: 10.1016/j.rehab.2018.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/30/2018] [Accepted: 09/30/2018] [Indexed: 11/17/2022]
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11
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Cai Y, Zhang CS, Liu S, Wen Z, Zhang AL, Guo X, Xue CC, Lu C. Add-On Effects of Chinese Herbal Medicine for Post-Stroke Spasticity: A Systematic Review and Meta-Analysis. Front Pharmacol 2019; 10:734. [PMID: 31316387 PMCID: PMC6610255 DOI: 10.3389/fphar.2019.00734] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Treatment for post-stroke spasticity (PSS) remains a major challenge in clinical practice. Chinese herbal medicine (CHM) is often administered to assist in routine care (RC) in the treatment of PSS, with increasing numbers of clinical research and preclinical studies suggesting that it has potential benefits. Therefore, we conducted a systematic review and meta-analysis to evaluate the add-on effects and safety of CHM for PSS. Methods: Five English and four Chinese databases were searched from their respective inception to 28 February 2018. We included randomized controlled trials that evaluated the add-on effects of CHM for PSS, based on changes in the scores of the (Modified) Ashworth Scale (AS or MAS), Fugl-Meyer Assessment of Sensorimotor Recovery (FMA), and Barthel Index (BI). Results: Thirty-five trials involving 2,457 patients were included. For upper-limb AS or MAS, the estimated add-on effects of CHM to RC were significantly better when using oral (SMD -1.79, 95% CI: -3.00 to -0.57) or topical CHM (SMD -1.06, 95% CI: -1.40 to -0.72). For lower-limb AS or MAS, significant add-on benefits to RC were also detected (SMD -1.01, 95% CI: -1.43 to -0.59 and SMD -1.16, 95% CI: -1.83 to -0.49) using oral and topical CHM, respectively. For FMA and BI, better results were detected when adding CHM to RC, except for the subgroup of oral CHM for upper-limb FMA. Ten of the 35 included studies reported safety information, with two of them mentioning two mild adverse events. Conclusions: Noting the quality concerns of the included trials, this review suggests that CHM appears to be a well-tolerated therapy for patients with PSS, and the potential add-on effects of CHM in reducing spasticity and improving the daily activities of patients with PSS require further rigorous assessment.
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Affiliation(s)
- Yiyi Cai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), the Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.,China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Claire Shuiqing Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Shaonan Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), the Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Zehuai Wen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), the Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), the Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Charlie Changli Xue
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), the Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.,China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Chuanjian Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), the Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.,China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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12
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Lathuilière A, Mareschal J, Graf CE. How to Prevent Loss of Muscle Mass and Strength among Older People in Neuro-Rehabilitation? Nutrients 2019; 11:E881. [PMID: 31010176 PMCID: PMC6521136 DOI: 10.3390/nu11040881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Stroke is the second leading cause of death worldwide but also of disability. Stroke induces certain alterations of muscle metabolism associated with gross muscle atrophy and a decrease in muscle function, leading to sarcopenia. The vast majority of stroke cases occur in adults over 65 years of age, and the prevalence is expected to massively increase in the coming years in this population. Sarcopenia is associated with higher mortality and functional decline. Therefore, the identification of interventions that prevent muscle alterations after stroke is of great interest. The purpose of this review is to carry out a systematic literature review to identify evidence for nutritional and pharmacological interventions, which may prevent loss of muscle mass in the elderly after stroke. The search was performed on Medline in December 2018. Randomized controlled studies, observational studies and case reports conducted in the last 20 years on post-stroke patients aged 65 or older were included. In total, 684 studies were screened, and eight randomized control trials and two cohort studies were finally included and examined. This review reveals that interventions such as amino acid supplementation or anabolic steroid administration are efficient to prevent muscle mass. Little evidence is reported on nutritional aspects specifically in sarcopenia prevention after stroke. It pinpoints the need for future studies in this particular population.
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Affiliation(s)
- Aurélien Lathuilière
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1205 Geneva, Switzerland.
| | - Julie Mareschal
- Clinical Nutrition, Geneva University Hospital, 1205 Geneva, Switzerland.
| | - Christophe E Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1205 Geneva, Switzerland.
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13
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Luo ZJ, Guo TM, Tu Q, Cheng XL, Huang Y, Xiang MQ. Therapeutic effect of integrating Chinese patent medicine Xuesaitong Injection and western medicine in treating patients with hypertensive intracerebral hemorrhage: A prospective randomized controlled trial. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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14
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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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15
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Cai Y, Zhang CS, Ouyang W, Li J, Nong W, Zhang AL, Xue CC, Wen Z. Electroacupuncture for poststroke spasticity (EAPSS): protocol for a randomised controlled trial. BMJ Open 2018; 8:e017912. [PMID: 29487073 PMCID: PMC5855476 DOI: 10.1136/bmjopen-2017-017912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Spasticity is a common complication of stroke. Current therapies for poststroke spasticity (PSS) have been reported to be associated with high costs, lack of long-term benefit and unwanted adverse events (AEs). Electroacupuncture (EA) has been used for PSS, however, its efficacy and safety is yet to be confirmed by high-quality clinical studies. This study is designed to evaluate the add-on effects and safety profile of EA when used in combination with usual care (UC). METHODS AND ANALYSIS This study is a parallel group randomised controlled trial. A total of 136 participants will be included and randomly assigned to either the treatment group (EA plus UC) or the control group (UC alone). Prior to the main trial, a pilot study involving 30 participants will be conducted to assess the feasibility of the trial protocol. EA will be administered by registered acupuncturists for 20min to 30 min, three times per week for 4 weeks. The primary outcome measure (Modified Ashworth Scale) and secondary outcome measures (Fugl-Meyer Assessment and Barthel Index) will be evaluated at baseline, the end of treatment (week 4) and the end of follow-up (week 8). AEs will be monitored, recorded and reported, and their causality will be explored. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committees of Guangdong Provincial Hospital of Chinese Medicine and RMIT University in December 2016. The results will be disseminated in a peer-reviewed journal, and PhD theses and might be presented at international conferences. TRIAL REGISTRATION NUMBER ChiCTR-IOR-16010283; Pre-results.
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Affiliation(s)
- Yiyi Cai
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Claire Shuiqing Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Wenwei Ouyang
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianmin Li
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenheng Nong
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Charlie Changli Xue
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Zehuai Wen
- Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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16
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Cai Y, Zhang CS, Liu S, Wen Z, Zhang AL, Guo X, Lu C, Xue CC. Electroacupuncture for Poststroke Spasticity: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:2578-2589.e4. [DOI: 10.1016/j.apmr.2017.03.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 12/01/2022]
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17
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Chen CC, Chen X, Li TC, Lin HL, Chu YT, Lee HC, Cheng YK, Chen DC, Tsai SC, Cho DY, Hsieh CL. PG2 for patients with acute spontaneous intracerebral hemorrhage: a double-blind, randomized, placebo-controlled study. Sci Rep 2017; 7:45628. [PMID: 28361971 PMCID: PMC5374535 DOI: 10.1038/srep45628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/01/2017] [Indexed: 12/14/2022] Open
Abstract
PG2 is an infusible polysaccharide extracted from Astragalus membranaceus, which is a Chinese herb traditionally used for stroke treatment. We investigated the effect of PG2 on patients with spontaneous acute intracerebral hemorrhage (ICH). A total of 61 patients with acute spontaneous ICH were randomized to either the treatment group (TG, 30 patients), which received 3 doses of PG2 (500 mg, IV) per week for 2 weeks, or the control group (CG, 31 patients), which received PG2 placebo. At 84 days after PG2 administration, the percentage of patients with a good Glasgow outcome scale (GOS 4–5) score in the TG was similar to that in the CG (69.0% vs. 48.4%; p = 0.2). The percentage of good mRS scores (0–2) in the TG was similar to that in the CG (62.1% vs. 45.2%; p = 0.3). In addition, no significant differences were seen when comparing differences in the C-reactive protein, erythrocyte sedimentation rate, interleukin-6 (IL-6), IL-1β, tumor necrosis factor-α, and S100B levels between baseline and days 4, 7, and 14 after PG2 administration (all p > 0.05). The results are preliminary, necessitating a more thorough assessment.
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Affiliation(s)
- Chun-Chung Chen
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan.,Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan.,Stroke Center, China Medical University Hospital, Taichung 40447, Taiwan
| | - XianXiu Chen
- Stroke Center, China Medical University Hospital, Taichung 40447, Taiwan.,Department of Public Health, China Medical University, Taichung 40402, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung 40402, Taiwan
| | - Hung-Lin Lin
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Yen-Tze Chu
- Department of Neurosurgery, Tainan Municipal An-Nan Hospital, Tainan 70965, Taiwan
| | - Han-Chung Lee
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan.,Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Yu-Kai Cheng
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Der-Cherng Chen
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Shiu-Chiu Tsai
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan.,Stroke Center, China Medical University Hospital, Taichung 40447, Taiwan.,Graduate Institute of Immunology, China Medical University, Taichung 40402, Taiwan
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan.,Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.,Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.,Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung 40402, Taiwan
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18
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Yang YJ, Zhang J, Hou Y, Jiang BY, Pan HF, Wang J, Zhong DY, Guo HY, Zhu Y, Cheng J. Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: a prospective multicenter randomized controlled trial. Clin Rehabil 2016; 31:904-912. [PMID: 27512098 DOI: 10.1177/0269215516663009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of Chinese massage therapy (Tui Na) for patients with post-stroke spasticity. DESIGN A prospective, multicenter, blinded, randomized, placebo-controlled intervention trial. SUBJECT A total of 90 patients with post-stroke spasticity were randomly assigned to the experimental (Tui Na therapy) group ( n = 45) or control (placebo Tui Na therapy) group ( n = 45). INTERVENTION Participants in the experimental group received Tui Na therapy, while those in the control group received placebo-Tai Na (gentle rubbing) for 20-25 minutes per limb, once per day, five days per week for a total of four weeks. All participants in both groups received conventional rehabilitation. MAIN MEASURE The Modified Ashworth Scale, the Fugl-Meyer Assessment and the Modified Barthel Index were used to assess the severity of spasticity, motor function of limbs and activities of daily living, respectively. Assessments were performed at baseline, at four weeks and at three months. RESULTS Tui Na group had a significantly greater reduction in Modified Ashworth Scale in only four muscle groups than the control did (elbow flexors, P = 0.026; wrist flexors, P = 0.005; knee flexors, P = 0.023; knee extensors, P = 0.017). Improvements were sustained at three months follow-up. There was no significant difference between the two groups in Fugl-Meyer Assessment ( P = 0.503) and Modified Barthel Index ( P = 0.544). No adverse reaction was recorded in any of the cases mentioned at all study sites. CONCLUSIONS Tui Na might be a safe and effective treatment to reduce post-stroke spasticity of several muscle groups.
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Affiliation(s)
- Yu-Jie Yang
- 1 The Second Clinical Medical School, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Jun Zhang
- 2 The Graduate School, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Ying Hou
- 3 The Rehabilitation Department, The Suzhou Industrial Park Loufeng Hospital, Suzhou, China
| | - Bao-Yin Jiang
- 4 The Rehabilitation Department, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hua-Fei Pan
- 5 The Rehabilitation Department, The Taixing Chinese Medicine Hospital, Taixing, China
| | - Jian Wang
- 6 The Rehabilitation Department, The Dandong Hospital, Dandong, China
| | - Da-Yong Zhong
- 7 The Rehabilitation Department, The Dayi Chinese Medicine Hospital, Dayi, China
| | - Hai-Ying Guo
- 1 The Second Clinical Medical School, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Yi Zhu
- 1 The Second Clinical Medical School, Nanjing University of Chinese Medicine, Jiangsu, China.,8 Rehabilitation Center, Hainan Provincial Nongken General Hospital, Hainan, China
| | - Jie Cheng
- 1 The Second Clinical Medical School, Nanjing University of Chinese Medicine, Jiangsu, China
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19
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Knecht S, Roßmüller J, Unrath M, Stephan KM, Berger K, Studer B. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. J Neurol Neurosurg Psychiatry 2016; 87:526-30. [PMID: 26069298 PMCID: PMC4853552 DOI: 10.1136/jnnp-2015-310344] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE In current clinical practice, old patients with stroke are less frequently admitted to neurorehabilitation units following acute care than younger patients based on an assumption that old age negatively impacts the benefit obtained from high-intensity neurorehabilitation. Our objective was to test this assumption empirically in a large sample of patients with stroke. METHODS Functional recovery during 4 weeks of inpatient neurorehabilitation was assessed with the Barthel Index (BI) in 422 middle-aged (<65 years), 1399 old (65-80 years) and 473 very old (>80 years) patients with stroke. Overall functional recovery, recovery patterns and the relationship between therapy intensity and recovery were statistically compared between the three age groups. RESULTS Overall functional recovery was statistically equivalent in middle-aged, old and very old patients (average improvement in BI total score: middle-aged: 15 points; old: 15 points; very old: 14 points). A novel item-wise logistic regression analysis (see Pedersen, Severinsen & Nielsen, 2014, Neurorehabil Neural Repair) revealed that this was true for 9 of the 10 everyday functions assessed by the BI. Furthermore, functional recovery was predicted by the amount of therapy (R=0.14; p=0.0001), and age did not moderate this relationship between therapy intensity and recovery (p=0.70). CONCLUSIONS Old and even very old patients with stroke benefit from specialised inpatient neurorehabilitation and high amounts of therapy in the same degree as younger patients. Contrary to current clinical practice, old age should not be a criterion against admission to a neurorehabilitation unit following acute stroke treatment.
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Affiliation(s)
- Stefan Knecht
- Department of Neurology, Mauritius Hospital, Meerbusch, Germany Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jens Roßmüller
- Department of Neurology, Mauritius Hospital, Meerbusch, Germany
| | - Michael Unrath
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Bettina Studer
- Department of Neurology, Mauritius Hospital, Meerbusch, Germany Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University, Düsseldorf, Germany
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20
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Civelek GM, Atalay A, Turhan N. Medical complications experienced by first-time ischemic stroke patients during inpatient, tertiary level stroke rehabilitation. J Phys Ther Sci 2016; 28:382-91. [PMID: 27065523 PMCID: PMC4792978 DOI: 10.1589/jpts.28.382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/30/2015] [Indexed: 12/21/2022] Open
Abstract
[Purpose] The aim of this study was to assess the medical complications in first-time
ischemic stroke patients, to identify the factors related to occurrence of complications.
[Subjects and Methods] First-time ischemic stroke patients (n=81) admitted to a tertiary
level inpatient rehabilitation center during a 5 year period were included in the study.
The attending physiatrist noted the presence of specific medical complications and
complications that required transfer to the acute care facility from patient records. The
Oxfordshire Community Stroke Project classification was used to define the clinical
subtypes of the ischemic stroke patients. The Charlson comorbidity index was used to
evaluate co-morbid conditions. Functional disability was assessed using the Functional
Independence Measure at admission and discharge. [Results] We found that 88.9% of the
patients had at least one complication. The five most common complications were urinary
tract infection (48.1%), shoulder pain (37.0%), insomnia (37.0%), depression (32.1%), and
musculoskeletal pain other than shoulder pain (32.1%) and 11.1% of patients were
transferred to acute care facility during rehabilitation period. Functional Independence
Measure scores both at admission and discharge were significantly lower in patients with
at least one complication than in patients with no complications. [Conclusion] Medical
complications are common among patients undergoing stroke rehabilitation. Close
interdisciplinary collaboration between physiatrists and other medical specialities is
necessary for optimal management.
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Affiliation(s)
- Gul Mete Civelek
- Physical Medicine and Rehabilitation Clinic, Ankara Children's Hematology Oncology Training and Research Hospital, Turkey
| | - Ayce Atalay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Acibadem University, Faculty of Medicine, Turkey
| | - Nur Turhan
- Physical Medicine and Rehabilitation Clinic, Bayındır Hospital, Turkey
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21
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Jang SH, Jang WH. Change of the Corticospinal Tract in the Unaffected Hemisphere by Change of the Dominant Hand Following Stroke: A Cohort Study. Medicine (Baltimore) 2016; 95:e2620. [PMID: 26871781 PMCID: PMC4753876 DOI: 10.1097/md.0000000000002620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We investigated the change of the corticospinal tract (CST) in the unaffected hemisphere by the change of the dominant hand in stroke patients, using diffusion tensor tractography (DTT).Forty-eight stroke patients with right-hand dominance were recruited. The patients were assigned to 3 groups: group A (12 patients)-right-hand dominance was maintained after the right-hand weakness, group B (17 patients)-right-hand dominance changed to the left-hand dominance after the right-hand weakness, and group C (19 patients)-right-hand dominance was maintained after the left-hand weakness had developed. The function of the unaffected upper extremity was evaluated using the grip strength (GS), Manual Function Test (MFT), Purdue Pegboard Test (PPT), and modified Barthel Index (MBI). DTT was performed twice (1st DTT, 2nd DTT), and the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and voxel number (VN) of the CST in the unaffected hemisphere were measured.In group B, the VN on 2nd DTT was significantly increased compared with the 1st DTT, and all other clinical data (GS, MFT, PPT, and MBI) showed a significant increase between 1st and 2nd DTT (P < 0.05). The change of the VN showed moderate correlation with the change of the GS (r = 0.499, P < 0.05), PPT (r = 0.531, P < 0.05), and MBI (r = 0.551, P < 0.05).We found that the fiber number of the CST in the unaffected hemisphere was increased by the change of the dominant hand in stroke patients. We believe that our results have important implications in terms of neurorehabilitation.
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Affiliation(s)
- Sung Ho Jang
- From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, Republic of Korea
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22
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Zhang S, Wu B, Liu M, Li N, Zeng X, Liu H, Yang Q, Han Z, Rao P, Wang D. Acupuncture Efficacy on Ischemic Stroke Recovery. Stroke 2015; 46:1301-6. [PMID: 25873601 DOI: 10.1161/strokeaha.114.007659] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 03/18/2015] [Indexed: 02/05/2023]
Abstract
Background and Purpose—
Acupuncture is a frequently used complementary treatment for ischemic stroke in China but the evidence available from previous randomized trials is inconclusive. The objective of this study was to assess the efficacy and safety of acupuncture in a more robustly designed larger scale trial.
Methods—
This is a multicenter, single-blinded, randomized controlled trial. Eight hundred sixty-two hospitalized patients with limb paralysis between 3 to 10 days after ischemic stroke onset were allocated acupuncture plus standard care or standard care alone. The acupuncture was applied 5 times per week for 3 to 4 weeks. The primary outcomes were defined as follows: (1) death/disability according to Barthel index and (2) death/institutional care at 6 months.
Results—
There was a tendency of fewer patients being dead or dependent in acupuncture group (80/385, 20.7%) than in control group (102/396, 25.8%) at 6 months (odds ratio, 0.75; 95% confidence interval, 0.54–1.05). The benefit was noted in subgroup receiving ≥10 sessions of acupuncture (odds ratio, 0.68; 95% confidence interval, 0.47–0.98). There was no statistical difference in death or institutional care between the 2 groups (odds ratio, 1.06; 95% confidence interval, 0.63–1.79). Severe adverse events occurred in 7.6% and 8.3% of patients in the 2 groups, respectively.
Conclusions—
Acupuncture seemed to be safe in the subacute phase of ischemic stroke. If the potential benefits observed are confirmed in future larger study, the health gain from wider use of the treatment could be substantial.
Clinical Trial Registration—
URL:
http://www.chictr.org/en/
. Unique identifier: ChiCTR-TRC-11001353.
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Affiliation(s)
- Shihong Zhang
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Bo Wu
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Ming Liu
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Ning Li
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Xianrong Zeng
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Hua Liu
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Qingcheng Yang
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Zhao Han
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Ping Rao
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
| | - Dong Wang
- From the Department of Neurology (S.Z., B.W., M.L.) and Department of Acupuncture and Moxibustion (N.L.), West China Hospital, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology (X.Z.), the People’s Hospital of Sichuan province, Chengdu, Sichuan Province, China; Department of Neurology (H.L.), the Second Clinical Medical College of North Sichuan Medical College and Nanchong Central Hospital, Nanchong, China; Department
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Abstract
The effect of age on functional outcome after stroke remains uncertain. Many studies have found that younger patients do better than older patients, whereas others have found minimal or no effect of age on rehabilitation outcomes. We examined the effect of advancing age on FIM trade mark gain, length of stay, length of stay efficiency, and home discharge in 979 stroke rehabilitation patients at a long-term acute care rehabilitation hospital. We found a strong relationship of increasing age to poorer outcome in all measures for patients with admission FIM (AFIM) score <40, a variable relationship in those with AFIM 40-80, and no relationship of age to the outcome measures in patients with AFIM >80.
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Affiliation(s)
- Randie M Black-Schaffer
- Young Adult Stroke Service, Spaulding Rehabilitation Hospital, and Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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Acupuncture for spasticity after stroke: a systematic review and meta-analysis of randomized controlled trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:870398. [PMID: 25628750 PMCID: PMC4299539 DOI: 10.1155/2015/870398] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/21/2014] [Indexed: 11/18/2022]
Abstract
The aim of this systematic review was to determine how effective acupuncture or electroacupuncture (acupuncture with electrical stimulation) is in treating poststroke patients with spasticity. We searched publications in Medline, EMBASE, and the Cochrane Library in English, 19 accredited journals in Korean, and the China Integrated Knowledge Resources Database in Chinese through to July 30, 2013. We included randomized controlled trials (RCTs) with no language restrictions that compared the effects of acupuncture or electroacupuncture with usual care or placebo acupuncture. The two investigators assessed the risk of bias and statistical analyses were performed. Three RCTs in English, 1 in Korean, and 1 in Chinese were included. Assessments were performed primarily with the Modified Ashworth Scale (MAS). Meta-analysis showed that acupuncture or electroacupuncture significantly decreased spasticity after stroke. A subgroup analysis showed that acupuncture significantly decreased wrist, knee, and elbow spasticity in poststroke patients. Heterogeneity could be explained by the differences in control, acupoints, and the duration after stroke occurrence. In conclusion, acupuncture could be effective in decreasing spasticity after stroke, but long-term studies are needed to determine the longevity of treatment effects.
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Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, Richardson M, Speechley M. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil 2014; 37:1316-23. [DOI: 10.3109/09638288.2014.963706] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew J. Meyer
- Graduate Program in Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
- Ontario Stroke Network, Toronto, Ontario, Canada,
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Shelialah Pereira
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Andrew McClure
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada,
| | - Robert Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, St Joseph's Health Care, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
- Centre for Studies in Family Medicine, Western University, London Ontario, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
| | - Marina Richardson
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
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The effectiveness of functional electrical stimulation based on a normal gait pattern on subjects with early stroke: a randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:545408. [PMID: 25114907 PMCID: PMC4119719 DOI: 10.1155/2014/545408] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/20/2022]
Abstract
Objective. To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke. Methods. Forty-five subjects were randomly assigned into a four-channel FES group (n = 16), a placebo group (n = 15), or a dual-channel group (n = 14). Stimulation lasted for 30 min in each session with 1 session/day, 5 days a week for 3 weeks. All subjects were assessed at baseline, at 3 weeks of treatment, and at 3 months after the treatment had finished. The assessments included Fugl-Meyer Assessment (FMA), the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Modified Barthel Index (MBI). Results. All 3 groups demonstrated significant improvements in all outcome measurements from pre- to posttreatment and further gains at followup. The score of FMA and MBI improved significantly in the four-channel group at the end of the 3 weeks of training. And the scores of PASS, BBS, MBI, and FAC in the four-channel group were significantly higher than those of the placebo group. Conclusions. This study indicated that four-channel FES can improve motor function, balance, walking ability, and performance of activities of daily living in subjects with early ischemic stroke.
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Seematter-Bagnoud L, Lécureux E, Rochat S, Monod S, Lenoble-Hoskovec C, Büla CJ. Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation. Arch Phys Med Rehabil 2013; 94:2373-2380. [PMID: 23850613 DOI: 10.1016/j.apmr.2013.06.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/17/2013] [Accepted: 06/23/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN Observational study. SETTING Postacute rehabilitation facility. PARTICIPANTS Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.
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Affiliation(s)
- Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Estelle Lécureux
- Medical Direction, Lausanne University Hospital, Lausanne, Switzerland
| | - Stéphane Rochat
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Stéfanie Monod
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Constanze Lenoble-Hoskovec
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Christophe J Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Yanagawa Y, Yoshihara T, Kato H, Iba T, Tanaka H. Significance of urinary incontinence, age, and consciousness level on arrival among patients with stroke. J Emerg Trauma Shock 2013; 6:83-6. [PMID: 23723615 PMCID: PMC3665076 DOI: 10.4103/0974-2700.110750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/05/2012] [Indexed: 01/23/2023] Open
Abstract
Purpose: We retrospectively investigated prognostic factors including urinary incontinence on arrival among the patients with stroke. Materials and Methods: A medical chart review was retrospectively performed for patients with stoke admitted between January 2010 and December 2010 in Ken-o Tokorozawa Hospital which had stroke care unit. The subjects were divided into a control group (functional outcome with modified Rankin scale (mRS) 0-3 at 3 months) and a poor group (severe disability or death, mRS 4-6). Results: There were 160 cases that had favorable outcome (the Control group) and 77 cases that had poor outcome (the Poor group). There were no significant differences between the two groups concerning the sex ratio, systolic blood pressure, heart rate, temperature, ratio of diabetes mellitus. However, the average age, ratio of hemorrhagic stroke, ratio of patients with a previous stroke, ratio of urinary incontinence upon admission, and duration of hospitalization in the Poor group was significantly higher than in the Control group. The Glasgow Coma Scale upon admission and ratio of hypertension in the Poor group were significantly lower than that in the Control group. Using a multiple logistic regression analysis, urinary incontinence (odds ratio, 3.17; 95% confidence interval, 1.45-6.93; P = 0.002), age (odds ratio, 1.04; 95% confidence interval, 1.01-1.07; P = 0.003) and Glasgow Coma Scale (odds ratio, 0.87; 95% confidence interval, 0.78-0.97; P = 0.01) were found to be factors independently associated with a poor outcome. Conclusion: Among the patients with strokes, the presence of urinary incontinence on arrival, the old age, and the level of consciousness are important prognostic factors. Physicians should therefore check for these factors when evaluating a patient who has experienced a stroke or suspected stroke.
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Affiliation(s)
- Youichi Yanagawa
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
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Zhou X, Wu MC, Wang YL, Song XY, Ling NJ, Yang JZ, Zhang D, Li BX, Tao J. Mannitol improves cerebral oxygen content and postoperative recovery after prolonged retroperitoneal laparoscopy. Surg Endosc 2012; 27:1166-71. [DOI: 10.1007/s00464-012-2569-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/27/2012] [Indexed: 11/28/2022]
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Chinese Herb Astragalus membranaceus Enhances Recovery of Hemorrhagic Stroke: Double-Blind, Placebo-Controlled, Randomized Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:708452. [PMID: 22474516 PMCID: PMC3310143 DOI: 10.1155/2012/708452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/21/2011] [Accepted: 12/21/2011] [Indexed: 11/18/2022]
Abstract
We tested the effect of Astragalus membranaceus (AM) on acute hemorrhagic stroke. Seventy-eight patients were randomly assigned to Group A (3 g of AM three times/day for 14 days); or Group B (3 g of placebo herb). A total of 68 patients (Group A 36, Group B 32) completed the trial. The increase of functional independence measure scale score between baseline and week 4 was 24.53 ± 23.40, and between baseline and week 12 was 34.69 ± 28.89, in the Group A was greater than 11.97 ± 11.48 and 23.94 ± 14.8 in the Group B (both P≦0.05). The increase of Glasgow outcome scale score between baseline and week 12 was 0.75 ± 0.77 in the Group A was greater than 0.41 ± 0.50 in the Group B (P < 0.05). The results are preliminary and need a larger study to assess the efficacy of AM after stroke.
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Pereira SRM, Chiu W, Turner A, Chevalier S, Joseph L, Huang AR, Morais JA. How can we improve targeting of frail elderly patients to a geriatric day-hospital rehabilitation program? BMC Geriatr 2010; 10:82. [PMID: 21047403 PMCID: PMC2988789 DOI: 10.1186/1471-2318-10-82] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 11/03/2010] [Indexed: 11/10/2022] Open
Abstract
Background The optimal patient selection of frail elderly persons undergoing rehabilitation in Geriatric Day Hospital (GDH) programs remains uncertain. This study was done to identify potential predictors of rehabilitation outcomes for these patients. Methods This study is a retrospective cohort analysis of patients admitted to the rehabilitation program of our GDH, in Montreal, Canada, over a five year period. The measures considered were: Barthel Index, Older Americans Resources and Services, Folstein Mini Mental Status Exam, Timed Up & Go (TUG), 6-minute walk test (6 MWT), Gait speed, Berg Balance, grip strength and the European Quality of life - 5 Dimensions. Successful improvement with rehabilitation was defined as improvement in three or more tests of physical function. Logistic regression analysis using the Bayesian Information Criterion (BIC) was employed to select the optimal model for making predictions of rehabilitation success. Results A total of 335 patients were studied, but only 233 patients had a complete data set suitable for the predictive model. Average age was 81 years and patients attended the GDH an average of 24 visits. Significant changes were found in several measures of physical performance for many patients ranging from improved gait speed in 21.3% to improved TUG in 62.7% of the cohort. Fifty-eight percent of patients attained successful improvement with rehabilitation by our criteria. This group was characterized by lower test scores on admission. Using BIC, the best predictor model was the 6 MWT [OR: 0.994 per meter walked (95% CI: 0.990-0.997)]. Conclusions The GDH rehabilitation program is effective in improving patients' physical performance. Although no single measure was found to be sufficiently predictive to help target candidates appropriately, the 6 MWT showed a trend to significance. Further research will be done to elucidate the utility of a composite 'rehab appropriateness index' and the role of International Classification of Function concepts for targeting frail elderly to GDH rehabilitation services.
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Affiliation(s)
- Silvia R M Pereira
- Academic Hospital São Francisco de Assis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Wei JW, Heeley EL, Wang JG, Huang Y, Wong LK, Li Z, Heritier S, Arima H, Anderson CS. Comparison of Recovery Patterns and Prognostic Indicators for Ischemic and Hemorrhagic Stroke in China. Stroke 2010; 41:1877-83. [PMID: 20651267 DOI: 10.1161/strokeaha.110.586909] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Limited data exist on the comparative recovery patterns and outcomes of patients with ischemic stroke and intracerebral hemorrhage in China.
Methods—
Data on baseline characteristics and outcomes of 6354 patients at 3 and 12 months poststroke are from ChinaQUEST (QUality Evaluation of Stroke Care and Treatment), a multicenter, prospective, 62-hospital registry study in China. Logistic regression was used to determine factors associated with a poor outcome defined by death/dependency (modified Rankin Scale score of 3 to 5) on follow-up. Generalized estimating equations were used to assess variations in recovery pattern by stroke type.
Results—
Baseline severity and rate of functional recovery in the early phase were significantly greater for intracerebral hemorrhage. However, patients with ischemic stroke were on average twice as likely to experience a good outcome (modified Rankin Scale score <3) by 12 months poststroke (OR: 1.98, CI: 1.76 to 2.24). In patients with ischemic stroke, diabetes and atrial fibrillation were strongly associated with a poor outcome at 12 months poststroke even after adjustment for confounding factors such as age, prior stroke/dependency, time to presentation, and stroke severity, whereas use of antiplatelets and lipid-lowering therapy after stroke were associated with improved outcome. For patients with intracerebral hemorrhage, low education and atrial fibrillation were associated with a poor outcome after adjustment for potential confounders and antihypertensive use was strongly associated with improved outcome.
Conclusions—
Patients with intracerebral hemorrhage and ischemic stroke have different recovery patterns in China. However, they share similar prognostic factors and in the use of evidence-based secondary prevention therapies to maximize chances of a good outcome.
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Affiliation(s)
- Jade W. Wei
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Emma L. Heeley
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Ji-Guang Wang
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Yining Huang
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Lawrence K.S. Wong
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Zhengyi Li
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Stephane Heritier
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Hisatomi Arima
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
| | - Craig S. Anderson
- From the The George Institute for International Health (J.W.W., E.L.H., S.H., H.A., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; the Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; the Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Prince of Wales Hospital (L.K.S.W.), Chinese University of Hong Kong, Hong Kong, China; and Xian
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Bladder management and the functional outcome of elderly ischemic stroke patients. Arch Gerontol Geriatr 2010; 53:e125-8. [PMID: 20708280 DOI: 10.1016/j.archger.2010.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to investigate how bladder management, rather than urinary incontinence, may affect the functional outcome of ischemic stroke patients. We studied 919 consecutive patients admitted for ischemic stroke rehabilitation. Level of bladder management was determined by Functional Independence Measurement (FIM TM) sub-scale scores relevant to bladder control. FIM scores less than 5 points was determined as low-bladder management score (Low-BMS) while FIM scores greater than 5 was determined as high-bladder management score (High-BMS). Data were analyzed by t-test, Pearson correlation, and chi-square test as well as by multiple linear regression analysis. There were 594 low-bladder score patients (Low-BMS) and 325 high-bladder score patients (High-BMS), at admission. Compared with High-BMS, Low-BMS patients were slightly older (p = 0.002), had longer rehabilitation stays (p < 0.001) and lower mini-mental state examination (MMSE) scores (p < 0.001). Total FIM at admission and discharge were lower in Low-BMS, yet their total FIM gain upon discharge was higher, compared with High-BMS (19.5 ± 16.46 vs. 17.59 ± 12.55, p = 0.07). Multiple linear regression analyses showed that total FIM at discharge was inversely associated with Low-BMS at admission (beta = -0.407; p<0.001) and age (beta = -0.127; p < 0.001). A high MMSE score (beta = 0.334; p < 0.001) emerged as predicting higher total FIM scores upon discharge. Low-BMS was independently predictive for total FIM gain at discharge (beta = 0.166; p < 0.001). The findings suggest that Low-BMS should be held as adversely affecting the rehabilitation outcomes of elderly stroke patients. However, Low-BMS patients do obtain significant gains and should not be deprived of rehabilitation.
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Chen YM, Chuang YW, Liao SC, Lin CS, Yang SH, Tang YJ, Tsai JJ, Lan JL, Chen DY. Predictors of functional recovery (FR) for elderly hospitalized patients in a geriatric evaluation and management unit (GEMU) in Taiwan. Arch Gerontol Geriatr 2010; 50 Suppl 1:S1-5. [PMID: 20171448 DOI: 10.1016/s0167-4943(10)00041-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Elderly patients who are hospitalized with acute illnesses frequently have adverse outcomes. To maintain functional independence, the geriatric evaluation and management unit (GEMU) was established to provide the opportunity for functional recovery (FR). This study's aim was to investigate potential prognostic factors for functional improvement in a GEMU of Taichung Veterans General Hospital, Taiwan. A total of 117 elderly patients (age, 80.0+/-6.3 years, 84.6% males) were enrolled. A comprehensive geriatric assessment and functional status evaluation, including the functional reach test (FRT) and the timed up-and-go (TUG) test, were performed. FR was defined by a greater than 10% improvement in the Barthel Index (BI) before GEMU discharge. Lower BI (44.7+/-25.2 vs. 68.7+/-34.5, p < 0.001), lower instrumental activities of daily living (IADL) scores (1.8+/-1.5 vs. 3.5+/-2.6, p < 0.001), impaired FRT (83.3% vs. 63.5%, p = 0.028), and impaired TUG test (94.4% vs. 74.6%, p = 0.008) were predictive factors for functional improvement. On multivariate logistic regression, an impaired TUG test (Odds ratio = OR = 6.18, 95% confidence interval = 95% C.I. = 1.69-22.6, p = 0.006) was an independent variable associated with FR. The results indicate that elderly hospitalized patients, even with poor physical function, could benefit from geriatric integrated care delivered by a GEMU.
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Affiliation(s)
- Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, No. 160 Section 3 Taichung-Kang Road, Taichung, Taiwan
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Oupra R, Griffiths R, Pryor J, Mott S. Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in Thailand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:10-20. [PMID: 19519873 DOI: 10.1111/j.1365-2524.2009.00865.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In Thailand, the crude death rate from stroke is 10.9/100,000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse-led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver's strain and quality of life. This was a non-randomised comparative study with concurrent controls, using a two-group pre-test and post-test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ-28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life.
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Affiliation(s)
- R Oupra
- School of Nursing, College of Health & Science, University of Western Sydney, Sydney, Australia.
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Re: Length of Stay in Rehabilitation Is Associated With Admission Neurologic Deficits and Discharge Destination. PM R 2009; 1:783; author reply 784. [DOI: 10.1016/j.pmrj.2009.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 05/20/2009] [Indexed: 11/18/2022]
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Woo J, Chan SY, Sum MWC, Wong E, Chui YPM. In patient stroke rehabilitation efficiency: influence of organization of service delivery and staff numbers. BMC Health Serv Res 2008; 8:86. [PMID: 18416858 PMCID: PMC2391159 DOI: 10.1186/1472-6963-8-86] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 04/17/2008] [Indexed: 11/29/2022] Open
Abstract
Background Outcomes of inpatient stroke rehabilitation need to be reviewed in terms of optimal resource utilization (staff time, service organization, and duration of stay). We compared FIM efficiency scores between three hospitals, and also variation in FIM scores over a ten year period in one hospital undergoing reduction in staff numbers, to examine the relationship between outcome and service characteristics. Method This is a retrospective study comparing the mean FIM efficiency for stroke patients (FIM score – FIM admission score) divided by duration of stay for 2005 among three rehabilitation hospitals adjusting for age and baseline FIM score, and a longitudinal study of changes in mean FIM efficiency during a ten year period in one hospital, to examine the effects of different service organization and staff numbers. Results FIM efficiency (FIMEG) was inversely associated with age, and positively associated with admission FIM score. FIMEG was higher in the hospital with a coordinated care plan involving medical, nursing, occupational, physiotherapy staff and other healthcare providers working as a team, with a seamless interface with community rehabilitation services. Over a ten year period, reduction in staff numbers was associated with reduction in FIMEG, which may be offset to some extent by service re-engineering. Conclusion Within hospital organization of stroke rehabilitation services may influence outcome. A critical number of staff may be identified for the provision of services, below which rehabilitation efficiency may be affected.
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Affiliation(s)
- Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
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Myint PK, Vowler SL, Redmayne O, Fulcher RA. Cognition, Continence and Transfer Status at the Time of Discharge from an Acute Hospital Setting and Their Associations with an Unfavourable Discharge Outcome after Stroke. Gerontology 2008; 54:202-9. [DOI: 10.1159/000126491] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 01/24/2008] [Indexed: 11/19/2022] Open
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Abstract
AIM To examine the changing needs of Chinese family caregivers before and after stroke survivors' discharge from hospital. BACKGROUND Stroke ranks third as the most common cause of death in Hong Kong and is the leading cause of adult disability. Community care has been adopted as the major source of care for older people in Hong Kong and this has impacted on family caregivers. DESIGN AND METHODS This is a descriptive-correlational design using a within-subjects design. The needs of 40 Chinese family caregivers who met the inclusion criteria were assessed before discharge and two weeks later using the Carer Assessment Scale, Cost of Care Index and one open-ended question. Modified Barthel Index measured the functional ability of stroke survivors. RESULTS Family caregivers are able to anticipate most of their needs and to make provision to meet the basic practical needs before discharge. Although needs changed after discharge the four most important needs persisted. These were associated with emotional and psychological problems and financial difficulties. Discharge destinations made no difference to the total scores obtained using the above scales. CONCLUSIONS This study provides information about need at a time of transition in an under-researched population of Chinese caregivers. Assessment of need is important with Chinese family carers in order to identify focused interventions in a population, i.e. reluctant to make their needs known to professional services. More research about caregiving problems for Chinese family caregivers at the transition from hospital to community is required. RELEVANCE TO CLINICAL PRACTICE Ongoing need assessment by nurses who are in regular contact with caregivers in hospital and community will enable appropriate interventions such as providing education and emotional support both before and after discharge to be offered to Chinese communities.
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Affiliation(s)
- Annie Km Mak
- Rehabilitation unit in Hong Kong, Princess Margaret Hospital, Kwai Chung, NT, Hong Kong
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Harris JE, Eng JJ. Individuals with the dominant hand affected following stroke demonstrate less impairment than those with the nondominant hand affected. Neurorehabil Neural Repair 2006; 20:380-9. [PMID: 16885424 PMCID: PMC3432641 DOI: 10.1177/1545968305284528] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose was to determine if upper extremity impairment and function in individuals with chronic stroke is dependent upon whether the dominant or non-dominant hand is affected. METHODS Ninety-three community-dwelling individuals with stroke. The Modified Ashworth Scale (tone), handheld dynamometry (isometric strength), monofilaments (sensation), Brief Pain Inventory (pain), Chedoke Arm and Hand Activity Inventory Motor Activity Log (paretic arm use), and Reintegration to Normal Living Index (participation) were used to form impairment and function models. RESULTS Multivariate analysis models (Dominance x Severity) were created for impairment and function variables. There was a significant interaction and main effect of Dominance for the impairment model (P = 0.01) but not the function model (P = 0.75). The dependent variables of tone, grip strength, and pain were all significantly affected by Dominance, indicating less impairment if the dominant hand was affected. All dependent variables except pain were affected by Severity. CONCLUSION This study looked at the effect of the dominant hand being affected versus the nondominant in individuals with chronic stroke. Individuals with the dominant hand affected demonstrated less impairment than those with the nondominant hand affected. However, there was no effect of dominance on paretic arm use or performance in activities of daily living. Prospective studies to further explore the issue of hand dominance and poststroke function are suggested.
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Affiliation(s)
- Jocelyn E Harris
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
The objectives of this study were to examine the demographic and clinical characteristics of stroke patients admitted for inpatient rehabilitation, to study the occurrence of medical problems/complications, and to document functional outcome and possible factors influencing outcome. The mean age of this cohort (30 females, 53 males) was 58+/-12 years and the mean length of hospital stay was 45.7+/-23 days. The most common medical comorbidity was hypertension (65%), followed by heart disease (42%) and diabetes mellitus (22%). The length of hospital stay was related to the number of medical comorbidities (r=0.24, P<0.05). Almost all patients experienced several medical problems during rehabilitation stay (average 7.1 events/patient). Shoulder dysfunction (80.7%), symptomatic blood pressure fluctuations (72.3%) and psychosocial problems (57.8%) were among the most common problems. There was a statistically significant improvement in total Functional Independence Measure scores from admission to discharge (56.5 vs. 74.6), with a mean gain of 18.1. Functional Independence Measure gain was significantly correlated with onset to admission time (r=-0.21, P<0.05), length of hospital stay (r=0.50, P<0.001) and the number of previous strokes (r=-0.23, P<0.05), but not with age, onset to admission interval, comorbidities and the presence of medical problems. Discharge total Functional Independence Measure scores were significantly correlated only with the admission total Functional Independence Measure scores (r=0.72, P<0.001) and onset-admission interval (r=-0.23, P<0.05). Significant functional improvements were documented in this cohort of stroke patients after an interdisciplinary rehabilitation approach. Discharge functional status was best correlated with admission functional status. Medical problems/complications were common among patients undergoing stroke rehabilitation. In our patients, functional outcomes were not significantly influenced by the occurrence of medical problems.
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Affiliation(s)
- Nilüfer Gökkaya
- Ankara Physical Medicine and Rehabilitation, Education and Research Hospital, Ankara, Turkey
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Tang WK, Chan SSM, Chiu HFK, Ungvari GS, Wong KS, Kwok TCY, Mok V, Wong KT, Richards PS, Ahuja AT. Frequency and clinical determinants of poststroke cognitive impairment in nondemented stroke patients. J Geriatr Psychiatry Neurol 2006; 19:65-71. [PMID: 16690990 DOI: 10.1177/0891988706286230] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to examine the prevalence and clinical correlates of poststroke cognitive impairment in Chinese stroke patients in Hong Kong. One hundred seventy-nine stroke patients were interviewed by a psychiatrist 3 months after their stroke. Cognitive impairment was determined according to the Mini-Mental State Examination score. Thirty-nine participants (21.8%) had cognitive impairment. Univariate analysis found that cognitive impairment was associated with age, female sex, level of education, previous stroke, prestroke Rankin score, National Institutes of Health Stroke Scale dysarthria and total scores, urinary incontinence, and cerebral atrophy index. Multivariate logistic regression suggested that female sex, education, National Institutes of Health Stroke Scale dysarthria score, urinary incontinence, and atrial fibrillation were independent risk factors of poststroke cognitive impairment. After removal of 54 patients with previous stroke from the sample, the frequency of cognitive impairment decreased to 18.4%. It was concluded that cognitive impairment is common among nondemented Chinese stroke patients in Hong Kong.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
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Landi F, Onder G, Cesari M, Zamboni V, Russo A, Barillaro C, Bernabei R. Functional decline in frail community-dwelling stroke patients. Eur J Neurol 2006; 13:17-23. [PMID: 16420389 DOI: 10.1111/j.1468-1331.2006.01116.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients who suffer a stroke event are at high risk of functional decline after the post-acute rehabilitation period. The aim of the present study was the evaluation of factors associated with functional decline in a large sample of older patients with stroke living in the community. The study population consisted of all patients admitted to home care programs after a post-acute rehabilitation program--with at least 1 year of follow-up--in twenty-two Italian Home Health Agencies from 2000 to 2002 (n=1338). For the present study we selected 355 (26%) patients with diagnosis of stroke. After 1 year of in-home care program, 149 out of 355 stroke survivors (42%) had presented a worsening in the activities of daily living (ADL) scale score. In the final adjusted model, patients with cognitive impairment (OR 2.59, 95% CI, 1.45-4.64), pressure ulcer (OR 2.74, 95% CI, 1.45-5.18), urinary incontinence (OR 1.64, 95% CI, 1.01-3.29), or hearing impairment (OR 1.83, 95% CI, 1.02-3.29) were more likely to significantly decline in physical functioning after a period of 1 year in-home care program. Our study documents that functional decline of stroke patients was largely dependent on specific subjects' clinical characteristics. Three of four concomitant disabling conditions associated in our sample with functional decline--pressure ulcer, urinary incontinence, hearing--can be prevented and eventually treated or modified. Appropriate post-acute rehabilitation programs and adequate home care interventions focused on the prevention and treatment of these conditions might be correlated to better outcomes in older post-stroke patients.
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Affiliation(s)
- F Landi
- Department of Gerontology-Geriatric and Physiatric, Catholic University of Sacred Heart, Rome, Italy.
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Luk JKH, Cheung RTF, Ho SL, Li L. Does Age Predict Outcome in Stroke Rehabilitation? A Study of 878 Chinese Subjects. Cerebrovasc Dis 2006; 21:229-34. [PMID: 16446535 DOI: 10.1159/000091219] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 09/21/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The predicting value of age on stroke rehabilitation has been controversial. There is a lack of large-scale studies in the Chinese population to examine the effect of age on stroke rehabilitation outcomes. This study examines the predictors of a good outcome after rehabilitation in Chinese stroke patients with special attention to age as a factor. PATIENTS AND METHODS This retrospective cohort study includes stroke patients receiving a standard inpatient multidisciplinary rehabilitation program in a neuro-rehabilitation ward of a convalescence hospital in Hong Kong from January 2000 to December 2003. Functional independence measure (FIM) >or=90 was used to define a good outcome. Multivariate regression analysis was used to assess the independent predictors of a good outcome. RESULTS There were important differences in clinical characteristics and complications of stroke among patients of three age groups: <65, >or=65 and <80, and >or=80 years. The total FIM scores both upon admission and at discharge were lower in the older age groups. No significant difference was observed in the changes in FIM scores across these age groups. Age was not an independent predictor for a good outcome. FIM upon admission was an independent predictor for a good outcome (discharge FIM >or=90) in all patients and in individual age groups. Having employment before stroke was a predictor for good outcome in all patients. Living at home prior to stroke was a predictor for the total population and the >or=65 and <80 years group. The length of stay predicted a good outcome in the group >or=80 years. CONCLUSIONS Admission functional status, employment and living at home before stroke but not age per se are predictors of a good outcome following stroke rehabilitation. As older patients show comparable improvement during rehabilitation, intensive rehabilitation should not be withheld in stroke patients simply because of advanced age.
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Affiliation(s)
- James K H Luk
- Acute Geriatrics Unit, Grantham Hospital, Hong Kong, SAR, China.
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Calmels P, Defay C, Yvanes-Thomas M, Laporte S, Fayolle-Minon I, Béthoux F, Blanchon MA, Gonthier R. L'âge très élevé constitue-t-il un facteur pronostique du devenir après un premier accident vasculaire cérébral ? ACTA ACUST UNITED AC 2005; 48:675-81. [PMID: 16185784 DOI: 10.1016/j.annrmp.2005.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 07/06/2005] [Indexed: 11/30/2022]
Abstract
AIM To determine whether very old age, older than 80 years, after a stroke is a significant predictor of mortality, orientation to a specific care pathway after the acute phase and functional status at 6 months after the stroke. PATIENTS A sample of 112 consecutive patients admitted to the emergency department because of a first stroke, with hemiplegia and/or aphasia over 6 months, who satisfied strict inclusion/exclusion criteria. Forty-seven patients were older than 80. METHOD After initial diagnosis and enrolment in the study, follow-up assessments were conducted at 48 hours, 15 days and 6 months. Demographic, medical, and radiographic data were collected, and patients were evaluated on the NIHSS, MMSE, Barthel Index, FIM(TM) and FAM scales. Descriptive statistics were generated, as were uni- and multivariate between group comparisons. RESULTS Our study shows that after a first stroke, old age is significantly associated with a high rate of death, a low rate of orientation to a physical medicine and rehabilitation unit and return to home but not poorer functional outcome. CONCLUSION Old age is therefore a determinant of post stroke management. Further studies are needed to evaluate whether in patient rehabilitation would result in significant functional benefit, considering the high cost of care, high risk of recurrent stroke, and high rate of death.
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Affiliation(s)
- P Calmels
- Service de médecine physique et de réadaptation, hôpital Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 02, France.
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Lin JH, Tsai AYJ, Lo SK, Chang JJ, Huang MH. Predicting the Grade of Disability 1 Year After Stroke Following Rehabilitation. Kaohsiung J Med Sci 2005; 21:212-9. [PMID: 15960067 DOI: 10.1016/s1607-551x(09)70190-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The purpose of this study was to identify predictors of grades of disability at least 1 year after stroke rehabilitation therapy. We recruited stroke patients from the inpatient rehabilitation department of a university hospital. The degree of disability was graded using the disability evaluation at least 1 year after stroke onset. Functional ability was evaluated using the Functional Independence Measure instrument on admission, on discharge from the inpatient rehabilitation program, and at the 6-month follow-up visit after discharge. Major sociodemographic, medical, and rehabilitative factors were also collected during the hospitalization period. Of the 109 patients surveyed, 64 (58.7%) had severe or very severe grades of disability. The correlates of severe or very severe disability in logistic regression analyses were bilaterally affected (odds ratio, OR, 10.8), impaired orientation (OR, 3.6), and poorer functional ability at discharge (OR, 7.6). Based on the significant predictors identified, the logistic regression model correctly classified severe or very severe disability in 68.0% of subjects. The higher frequency of severe or very severe disability in this study may have been due to the relatively more severely affected stroke patient population in the inpatient rehabilitation service and the use of unique disability evaluation criteria. These results may provide information useful in planning continuous rehabilitation care and setting relevant socio-welfare policies for stroke victims.
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Affiliation(s)
- Jau-Hong Lin
- Faculty of Physical Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Abstract
Traditional accounts of right-posterior brain injury describe a syndrome of low-level perceptual sequelae producing marked acute dependency and transient safety concerns. The syndrome is also held to spare cognition and to carry a generally favorable long-term prognosis. The present paper reviews publications and anecdotal data that challenge this picture. Recent theoretical expositions and empirical studies stipulate three major cognitive functions of the right posterior association cortex: processing novel input, guiding reactions to emergencies, and anticipating consequences. Appearing benign after acute recovery, the impairment of these processes produces vocational, social and marital dysfunctions that increase as a function of chronicity, ultimately becoming more broadly disabling than focal injuries in other cortical loci. The unique symptom picture and serious implications suggest that the long-term syndrome should be labeled (Broad-Perspective Perceptual Disorder) and incorporated in future clinical taxonomies, underscoring the need for extraordinary long-term assistance and specialized therapeutics. Procedures for assessment and differential diagnosis are outlined.
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Affiliation(s)
- Larry E Schutz
- Rehabilitation Neuropsychology Associates of Orlando, Florida 32819, USA.
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Tang WK, Ungvari GS, Chiu HFK, Sze KH. Detecting depression in Chinese stroke patients: a pilot study comparing four screening instruments. Int J Psychiatry Med 2005; 34:155-63. [PMID: 15387399 DOI: 10.2190/9yj9-nnxa-rjcy-2dyp] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine which screening instrument is most suitable for detecting depression in Chinese stroke patients. METHOD A random sample of 60 Chinese subjects recruited from consecutively admitted patients with first-ever stroke to a rehabilitation facility were assessed using the Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the Geriatric Depression Scale (GDS). Psychiatric diagnoses, which served as a benchmark for the comparison of screening instruments, were made using the SCID-DSM-III-R. Rating instruments were compared with respect to response rate, sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves. RESULTS The VAMS was not useful in screening for depression in Chinese stroke patients while both the HADS and the GDS demonstrated satisfactory accuracy in detecting depression in Chinese stroke patients. CONCLUSIONS Screening instruments for poststroke depression are culture-specific and even scales well established in other cultures should be tested before being used in clinical practice and research.
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Affiliation(s)
- Wai Kwong Tang
- Chinese University of Hong Kong, Shatin Hospital, Department of Psychiatry, Hong Kong, China.
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Yan T, Hui-Chan CWY, Li LSW. Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke. Stroke 2005; 36:80-5. [PMID: 15569875 DOI: 10.1161/01.str.0000149623.24906.63] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background and Purpose—
The effectiveness of functional electrical stimulation (FES) has been investigated in chronic hemiplegia. The present study examines whether FES, given during acute stroke, was more effective in promoting motor recovery of the lower extremity and walking ability than standard rehabilitation alone.
Methods—
Forty-six subjects, 70.9±8.0 years old and 9.2±4.1 days after stroke, were assigned randomly to 1 of 3 groups receiving standard rehabilitation with FES or placebo stimulation or alone (control). FES was applied 30 minutes and placebo stimulation 60 minutes, 5 days per week for 3 weeks. Outcome measurements included composite spasticity score, maximum isometric voluntary contraction of ankle dorsi-flexors and planter-flexors, and walking ability. They were recorded before treatment, weekly during the 3-week treatment, and at week 8 after stroke.
Results—
No significant differences were found in the baseline measurements. After 3 weeks of treatment, there was a significant reduction in the percentage of composite spasticity score, and a significant improvement in the ankle dorsiflexion torque, accompanied by an increase in agonist electromyogram and a reduction in electromyogram cocontraction ratio in the FES group, when compared with the other 2 groups (
P
<0.05). All subjects in the FES group were able to walk after treatment, and 84.6% of them returned home, in comparison with the placebo (53.3%) and control (46.2%,
P
<0.05) groups.
Conclusions—
Fifteen sessions of FES, applied to subjects with acute stroke plus standard rehabilitation, improved their motor and walking ability to the degree that more subjects were able to return to home.
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Affiliation(s)
- Tiebin Yan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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Ling FM. Stroke Rehabilitation: Predicting Inpatient Length of Stay and Discharge Placement. Hong Kong J Occup Ther 2004. [DOI: 10.1016/s1569-1861(09)70023-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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