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Lin Q, Dong X, Huang T, Zhou H. Developmental trajectory of care dependency in older stroke patients. Front Neurol 2024; 15:1374477. [PMID: 38836003 PMCID: PMC11148867 DOI: 10.3389/fneur.2024.1374477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
Background Stroke is the leading cause of death in China. Older stroke survivors often have other chronic conditions, not only musculoskeletal deterioration due to age, but also changes in body image that can be brought on by stroke and other diseases, making them unable to take good care of themselves and dependent on others. The degree of dependency affects the rehabilitation progress of stroke survivors and shows dynamic changes that need to be recognized. Objectives This study investigates the trajectory of dependency changes in older stroke patients with comorbidities and analyze the influencing factors. Methods Grounded in the Chronic Illness Trajectory Framework (CITF), a longitudinal study was conducted from February 2023 to October 2023, tracking 312 older stroke patients with comorbidities admitted to two tertiary hospitals in Guangzhou. Care dependency levels were assessed using Care Dependency Scale on admission day 5 (T0), at discharge (T1), 1 month post-discharge (T2), and 3 months post-discharge (T3). Growth Mixture Model were utilized to identify trajectory categories, and both univariate analysis and multivariate logistic regression methods were employed to explore factors associated with different developmental trajectories. Results A total of four developmental trajectories were fitted, C1 (high independence-slow increased group, 52.0%), C2 (moderate independence-rapid increased group, 13.0%), C3 (moderate independence-slow increased group, 25.0%), and C4 (low independence-increased and decreased group, 10.0%). Length of hospital stay, place of residence, level of social support, residual functional impairments, NIHSS score, and BI index independently influence the trajectory categories. Conclusion There is heterogeneity in care dependency among older stroke patients with comorbidities. Most patients gradually reduce their dependency and become more independent, but others remain dependent for an extended period of time. It is recommended to focus on patients who live in rural areas, have low social support, have high admission NIHSS scores and have residual functional impairment, and provide them with personalized continuity of care and rehabilitation services in order to reduce care dependency and the burden of care, and to improve patients' quality of life.
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Affiliation(s)
- Qinger Lin
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaohang Dong
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tianrong Huang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongzhen Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
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Kim H, Lee C, Kim N, Chung E, Jeon H, Shin S, Kim M. Early functional factors for predicting outcome of independence in daily living after stroke: a decision tree analysis. J Rehabil Med 2024; 56:jrm35095. [PMID: 38712968 DOI: 10.2340/jrm.v56.35095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/20/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the predictive functional factors influencing the acquisition of basic activities of daily living performance abilities during the early stages of stroke rehabilitation using classification and regression analysis trees. METHODS The clinical data of 289 stroke patients who underwent rehabilitation during hospitalization (164 males; mean age: 62.2 ± 13.9 years) were retrospectively collected and analysed. The follow-up period between admission and discharge was approximately 6 weeks. Medical records, including demographic characteristics and various functional assessments with item scores, were extracted. The modified Barthel Index on discharge served as the target outcome for analysis. A "good outcome" was defined as a modified Barthel Index score ≥ 75 on discharge, while a modified Barthel Index score < 75 was classified as a "poor outcome." RESULTS Two classification and regression analysis tree models were developed. The first model, predicting activities of daily living outcomes based on early motor functions, achieved an accuracy of 92.4%. Among patients with a "good outcome", 70.9% exhibited (i) ≥ 4 points in the "sitting-to-standing" category in the motor assessment scale and (ii) 32 points on the Berg Balance Scale score. The second model, predicting activities of daily living outcome based on early cognitive functions, achieved an accuracy of 82.7%. Within the "poor outcome" group, 52.2% had (i) ≤ 21 points in the "visuomotor organization" category of Lowenstein Occupational Therapy Cognitive Assessment, (ii) ≤ 1 point in the "time orientation" category of the Mini Mental State Examination. CONCLUSION The ability to perform "sitting-to-standing" and visuomotor organization functions at the beginning of rehabilitation emerged as the most significant predictors for achieving successful basic activities of daily living on discharge after stroke.
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Affiliation(s)
- Heegoo Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Chanmi Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Nayeong Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Eunhye Chung
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - HyeongMin Jeon
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Seyoung Shin
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea; Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea; Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea.
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Lindvall E, Franzon K, Lundström E, Kilander L. The impact of stroke on the ability to live an independent life at old age: a community-based cohort study of Swedish men. BMC Geriatr 2023; 23:126. [PMID: 36879184 PMCID: PMC9990268 DOI: 10.1186/s12877-023-03817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Few studies with controls from the same cohort have investigated the impact of stroke on the ability to live an independent life at old age. We aimed to analyze how great an impact being a stroke survivor would have on cognition and disability. We also analyzed the predictive value of baseline cardiovascular risk factors. METHODS We included 1147 men, free from stroke, dementia, and disability, from the Uppsala Longitudinal Study of Adult Men, between 69-74 years of age. Follow-up data were collected between the ages of 85-89 years and were available for 481 of all 509 survivors. Data on stroke diagnosis were obtained through national registries. Dementia was diagnosed through a systematic review of medical charts and in accordance with the current diagnostic criteria. The primary outcome, preserved functions, was a composite outcome comprising four criteria: no dementia, independent in personal activities of daily living, ability to walk outside unassisted, and not living in an institution. RESULTS Among 481 survivors with outcome data, 64 (13%) suffered a stroke during the follow-up. Only 31% of stroke cases, compared to 72% of non-stroke cases (adjusted OR 0.20 [95% CI 0.11-0.37]), had preserved functions. The chance of being free of dementia was 60% lower in the stroke group, OR 0.40 [95% CI 0.22-0.72]. No cardiovascular risk factors were independently able to predict preserved functions among stroke cases. CONCLUSION Stroke has long lasting consequences for many aspects of disability at very high age.
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Affiliation(s)
- Elias Lindvall
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala Academic Hospital, Neurological Reception, Sjukhusvägen, 75185, Uppsala, Sweden.
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Erik Lundström
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala Academic Hospital, Neurological Reception, Sjukhusvägen, 75185, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
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Ott J, Champagne SN, Bachani AM, Morgan R. Scoping 'sex' and 'gender' in rehabilitation: (mis)representations and effects. Int J Equity Health 2022; 21:179. [PMID: 36527089 PMCID: PMC9756604 DOI: 10.1186/s12939-022-01787-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Researchers have highlighted a large-scale global unmet need for rehabilitation. While sex and gender have been shown to interact with each other and with other social and structural factors to influence health and wellbeing, less is known about how sex and gender shape rehabilitation participation and outcomes within health systems. METHODS Using an intersectional approach, we examine literature that explores the relationship between sex and/or gender and rehabilitation access, use, adherence, outcomes, and caregiving. Following a comprehensive search, 65 documents met the inclusion criteria for this scoping review of published literature. Articles were coded for rehabilitation-related themes and categorized by type of rehabilitation, setting, and age of participants, to explore how existing literature aligned with documented global rehabilitation needs. Responding to a common conflation of sex and gender in the existing literature and a frequent misrepresentation of sex and gender as binary, the researchers also developed a schema to determine whether existing literature accurately represented sex and gender. RESULTS The literature generally described worse rehabilitation access, use, adherence, and outcomes and a higher caregiving burden for conditions with rehabilitation needs among women than men. It also highlighted the interacting effects of social and structural factors like socioeconomic status, racial or ethnic identity, lack of referral, and inadequate insurance on rehabilitation participation and outcomes. However, existing literature on gender and rehabilitation has focused disproportionately on a few types of rehabilitation among adults in high-income country contexts and does not correspond with global geographic or condition-based rehabilitation needs. Furthermore, no articles were determined to have provided an apt depiction of sex and gender. CONCLUSION This review highlights a gap in global knowledge about the relationship between sex and/or gender and rehabilitation participation and outcomes within health systems. Future research should rely on social science and intersectional approaches to elucidate how gender and other social norms, roles, and structures influence a gender disparity in rehabilitation participation and outcomes. Health systems should prioritize person-centered, gender-responsive care, which involves delivering services that are responsive to the complex social norms, roles, and structures that intersect to shape gender inequitable rehabilitation participation and outcomes in diverse contexts.
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Affiliation(s)
- Jessica Ott
- grid.21107.350000 0001 2171 9311Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sarah N. Champagne
- grid.21107.350000 0001 2171 9311Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Abdulgafoor M. Bachani
- grid.21107.350000 0001 2171 9311Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Rosemary Morgan
- grid.21107.350000 0001 2171 9311Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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5
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Lin GH, Li CY, Sheu CF, Huang CY, Lee SC, Huang YH, Hsieh CL. Using Machine Learning to develop a short-form measure assessing 5 functions in patients with stroke. Arch Phys Med Rehabil 2021; 103:1574-1581. [PMID: 34979129 PMCID: PMC9378042 DOI: 10.1016/j.apmr.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/26/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a machine learning based short measure (the ML-5F) to assess 5 functions (activities of daily living (ADL), balance, upper extremity (UE) and lower extremity (LE) motor function, and mobility) in patients with stroke. DESIGN Secondary data from a previous study. A follow-up study assessed patients with stroke using the Barthel Index (BI), Postural Assessment Scale for Stroke (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) at hospital admission and discharge. SETTING A rehabilitation unit in a medical center. PARTICIPANTS A total of 307 patients. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The BI, PASS, and STREAM. RESULTS A machine learning algorithm, Extreme Gradient Boosting, was used to select 15 items from the BI, PASS, and STREAM, and transformed the raw scores of the selected items into the scores of the ML-5F. The ML-5F demonstrated good concurrent validity (Pearson's r = 0.88-0.98) and responsiveness (standardized response mean = 0.28-1.01). CONCLUSIONS The ML-5F comprises only 15 items but demonstrates sufficient concurrent validity and responsiveness to assess ADL, balance, UE and LE functions, and mobility in patients with stroke. The ML-5F shows great potential as an efficient outcome measure in clinical settings.
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Affiliation(s)
- Gong-Hong Lin
- Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, Texas
| | - Ching-Fan Sheu
- Institute of Education, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yu Huang
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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6
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E Wurzinger H, Abzhandadze T, Rafsten L, Sunnerhagen KS. Dependency in Activities of Daily Living During the First Year After Stroke. Front Neurol 2021; 12:736684. [PMID: 34819908 PMCID: PMC8606514 DOI: 10.3389/fneur.2021.736684] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation. Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke. Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed. Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke. Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.
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Affiliation(s)
- Hannah E Wurzinger
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Rafsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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7
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Nursiswati N, Halfens RJG, Lohrmann C. Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian hospitals. Int J Nurs Sci 2020; 7:330-336. [PMID: 32817856 PMCID: PMC7424155 DOI: 10.1016/j.ijnss.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/16/2020] [Accepted: 06/24/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale (CDS) among stroke survivors. Methods The study was undertaken in four hospitals. We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics, who were rated by nurses to determine the CDS reliability coefficients. The Cronbach's α and Cohen's kappa coefficients were applied. Concurrent validity was conducted for the data on care dependency, which werecollected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index. A Spearman's rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results. Results An analysis of the results of the CDS tested on the inpatient ward and in the outpatient clinic revealed a high level of internal consistency. The reliability analysis yielded the same Cronbach's α coefficient of 0.98 for both the inpatient and outpatient data. A significant, moderate correlation was observed between the CDS and Barthel Index results. Conclusion The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.
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Affiliation(s)
- Nursiswati Nursiswati
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010, Graz, Austria
| | - Ruud J G Halfens
- Maastricht University Maastricht University, Department of Health Services Research, Caphri, Duboisdomein 30, 6229, GT Maastricht, the Netherlands
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010, Graz, Austria
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Abstract
Sex disparities within the field of stroke, including subarachnoid hemorrhages (SAHs), have been in focus during the last 2 decades. It is clear that stroke incidence is higher in men, and also that men have their first stroke earlier than women. On the other hand, women have more severe strokes, mainly because cardioembolic strokes are more common in women. This leads to higher case fatality and worse functional outcome in women. It has often been pointed out that women more often have nontraditional stroke symptoms, and therefore may seek medical help later. After discharge from the hospital, female stroke survivors live alone in many cases and are dependent on external care. Therefore, these women frequently rate their quality of life (QoL) lower than men do. Female spouses more often provide help to their male stroke survivors than the reverse, and they accept a heavier burden. These caregivers are at high risk for depression, low QoL, and low psychologic wellbeing. SAH is a special form of stroke, often caused by a ruptured aneurysm. It is about 20% more common in women. The case fatality is high, but does not differ between the sexes.
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Affiliation(s)
- Peter Appelros
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Signild Åsberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Wentink MM, Meesters J, Berger MAM, de Kloet AJ, Stevens E, Band GPH, Kromme CH, Wolterbeek R, Goossens PH, Vliet Vlieland TPM. Adherence of stroke patients with an online brain training program: the role of health professionals’ support. Top Stroke Rehabil 2018; 25:359-365. [DOI: 10.1080/10749357.2018.1459362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- M. M. Wentink
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - J. Meesters
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - M. A. M. Berger
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - A. J. de Kloet
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - E. Stevens
- Helen Dowling Institute, Bilthoven, The Netherlands
| | - G. P. H. Band
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - C. H. Kromme
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - R. Wolterbeek
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - P. H. Goossens
- Sophia Rehabilitation, The Hague, The Netherlands
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - T. P. M. Vliet Vlieland
- Sophia Rehabilitation, The Hague, The Netherlands
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
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Schnitzer S, Deutschbein J, Nolte CH, Kohler M, Kuhlmey A, Schenk L. How does sex affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund. Top Stroke Rehabil 2017; 24:415-421. [DOI: 10.1080/10749357.2017.1305645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Susanne Schnitzer
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
| | - Johannes Deutschbein
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
| | - Christian H. Nolte
- Center for Stroke Research (CSB), Charité University Medical Center, Berlin, Germany
| | - Martin Kohler
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Adelheid Kuhlmey
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
| | - Liane Schenk
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
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11
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A Review of Risk Factors for Cognitive Impairment in Stroke Survivors. ScientificWorldJournal 2016; 2016:3456943. [PMID: 27340686 PMCID: PMC4906214 DOI: 10.1155/2016/3456943] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/04/2016] [Indexed: 02/02/2023] Open
Abstract
In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.
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12
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Schnitzer S, von dem Knesebeck O, Kohler M, Peschke D, Kuhlmey A, Schenk L. How does age affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund. BMC Geriatr 2015; 15:135. [PMID: 26499064 PMCID: PMC4619540 DOI: 10.1186/s12877-015-0130-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/14/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease? METHODS The study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis. RESULTS 21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0-65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82-16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88-6.71) in patients aged 76-85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %). CONCLUSIONS Our results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.
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Affiliation(s)
- Susanne Schnitzer
- Department of Medical Sociology and Rehabilitation Science, Charité-Universitätmedizin Berlin, Luisenstr. 57, D-10117, Berlin, Germany.
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany.
| | - Martin Kohler
- Central Research Institute of Ambulatory Health Care in Germany, Herbert-Lewin-Platz 3, D-10623, Berlin, Germany.
| | - Dirk Peschke
- Department of Structural Advancement and Quality Management in Health Care, Technische Universität Berlin, Steinplatz 2, D-10623, Berlin, Germany.
| | - Adelheid Kuhlmey
- Department of Medical Sociology and Rehabilitation Science, Charité-Universitätmedizin Berlin, Luisenstr. 57, D-10117, Berlin, Germany.
| | - Liane Schenk
- Department of Medical Sociology and Rehabilitation Science, Charité-Universitätmedizin Berlin, Luisenstr. 57, D-10117, Berlin, Germany.
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Carmo JFD, Morelato RL, Pinto HP, Oliveira ERAD. Disability after stroke: a systematic review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.002.ar02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Stroke is the most common cause of disability in Western countries, yet there is no consensus in the literature on how to measure and describe disability from stroke. Objective To conduct a systematic literature review on disability in stroke survivors. Method Observational studies published in the PubMed, LILACS and SciELO online databases were selected, to evaluate disability in adults and in the elderly after stroke in the period 2002–2012. The Downs and Black checklist for non-randomized studies was used to assess the quality of the articles. Results 212 articles were found from which 16 were selected to compose the study. The mean age of participants was 67 years, and disability affected 24% to 49% of the population evaluated. With regard to measurement instruments, 31% of the studies analyzed presented results of disability by means of the modified Rankin Scale; 19% by means of the World Health Organization’s International Classification of Functioning, Disability and Health; 19% by means of Katz’ Index of Independence in Activities of Daily Living; 12.5% by means of the London Handicap Scale; 12.5 % by means of the Barthel Index; and 6.25% by means of the Functional Independence Measure. Conclusion Literature is not uniform as regards means of measuring disability after stroke, but considering the preference of articles in assessing physical performance in activities of daily living, it can be concluded that a quarter to half of the population that survives stroke has some degree of disability.
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McCarthy MJ, Lyons KS, Powers LE. Expanding Poststroke Depression Research: Movement Toward a Dyadic Perspective. Top Stroke Rehabil 2015; 18:450-60. [DOI: 10.1310/tsr1805-450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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15
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Pohl PS, Billinger SA, Lentz A, Gajewski B. The role of patient demographics and clinical presentation in predicting discharge placement after inpatient stroke rehabilitation: analysis of a large, US data base. Disabil Rehabil 2012; 35:990-4. [PMID: 23072650 DOI: 10.3109/09638288.2012.717587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine whether functional ability at admission and demographics predict discharge placement after inpatient rehabilitation for older adults recovering from stroke. METHOD In this retrospective study, we examined records of 31,910 adults 65 years of age and older who were admitted for inpatient rehabilitation post-stroke. Binary logistic regression was used with the outcome of placement and potential predictors of the admission Functional Independence Measure (FIM) score, age, sex and marital status. RESULTS The average admission FIM was 60.0 out of 126; the average FIM at discharge was 84.8. The mean age was 77.7 ± 7.3 years, 57% were female and 52.5% were not married. More than three quarters of the patients were discharged to home. Odds ratios (ORs) with 95% confidence intervals (CIs) showed that patients with a FIM score below the mean of our sample (OR = 5.8, CI = 5.5-6.2), older than the mean age of our sample (OR = 1.6, CI = 1.5-1.7), and who were not married (OR = 1.9, CI = 1.8-2.0) (p-values <0.001) were more likely to be discharged to residential care. Sex was not predictive of placement. CONCLUSION The admission FIM was an important predictor of discharge placement after rehabilitation in older adults. Age and marital status were also significant predictors of discharge placement. Sex was not a significant predictor.
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Affiliation(s)
- Patricia S Pohl
- Department of Physical Therapy, The Sage Colleges, Troy, NY 12180, USA.
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Gall SL, Tran PL, Martin K, Blizzard L, Srikanth V. Sex Differences in Long-Term Outcomes After Stroke. Stroke 2012; 43:1982-7. [DOI: 10.1161/strokeaha.111.632547] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seana L. Gall
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Pham Lan Tran
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Kara Martin
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Leigh Blizzard
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Velandai Srikanth
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
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Arciniegas DB, Kellermeyer GF, Bonifer NM, Anderson-Salvi KM, Anderson CA. Screening for cognitive decline following single known stroke using the Mini-Mental State Examination. Neuropsychiatr Dis Treat 2011; 7:189-96. [PMID: 21573080 PMCID: PMC3090282 DOI: 10.2147/ndt.s17886] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Progressive cognitive decline develops in a nontrivial minority of stroke survivors. Although commonly used to identify cognitive decline in older stroke survivors, the usefulness of the Mini-Mental State Examination (MMSE) as a screening tool for post-stroke cognitive decline across a wider range of ages is not well established. This study therefore investigated the usefulness of the MMSE for this purpose. METHODS Twenty-seven subjects, aged 18-82 years, with a single known remote stroke were assessed using the MMSE. The frequency of cognitive impairment was determined by comparison of MMSE scores with population-based norms. Relationships between cognitive performance, motor impairments, age, gender, handedness, stroke laterality, and time since stroke also were explored. RESULTS Age-adjusted MMSE scores identified mild cognitive impairment in 22.2% and moderate-to-severe cognitive impairment in 7.4% of subjects. Raw and age-adjusted MMSE scores were inversely correlated with time since stroke, but not with other patient or stroke characteristics. CONCLUSION A relationship between time since single known stroke and MMSE performance was observed in this study. The proportion of subjects identified as cognitively impaired in this group by Z-transformation of MMSE scores using previously published normative data for this measure comports well with the rates of late post-stroke cognitive impairment reported by other investigators. These findings suggest that the MMSE, when normatively interpreted, may identify cognitive decline in the late period following single known stroke. Additionally, the lack of a relationship between MMSE and Fugl-Meyer scores suggests that the severity of post-stroke motor impairments is unlikely to serve as a clinically useful indicator of the need for cognitive assessment. A larger study of stroke survivors is needed to inform more fully on the usefulness of normatively interpreted MMSE scores as a method of screening for post-stroke cognitive decline.
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Affiliation(s)
- David B Arciniegas
- Brain Injury Rehabilitation Unit, HealthONE Spalding Rehabilitation Hospital, Aurora, CO, USA
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Almborg AH, Ulander K, Thulin A, Berg S. Discharged after stroke - important factors for health-related quality of life. J Clin Nurs 2010; 19:2196-206. [DOI: 10.1111/j.1365-2702.2010.03251.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Turner BJ, Fleming JM, Ownsworth TL, Cornwell PL. The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations. Disabil Rehabil 2009; 30:1153-76. [PMID: 17852241 DOI: 10.1080/09638280701532854] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research. METHOD Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review. RESULTS/DISCUSSION A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical. CONCLUSION Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.
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Affiliation(s)
- Benjamin J Turner
- Dvision of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
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Abstract
Stroke is a leading cause of death and serious, long-term disability. Studies evaluating differences between men and women are lacking. Significant differences exist between men and women in terms of risk factors and susceptibility to stroke. Women are less likely to have diagnostic studies performed to evaluate their risk for stroke, and they have a higher mortality following acute stroke. Women however, have a higher rate of arterial recanalization after intravenous tissue plasminogen activator used for the treatment of acute stroke. The data comparing the effectiveness of treatments for prevention of recurrent stroke between men and women is sparse. There have not been any studies comparing results of treatment of musculoskeletal impairments in men and women after stroke.
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