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Wang R, Cao L, He Y, Zhang P, Feng L. Nutrition-associated markers and outcomes among patients receiving enteral nutrition after ischemic stroke: a retrospective cohort study. BMC Neurol 2024; 24:303. [PMID: 39215220 PMCID: PMC11363362 DOI: 10.1186/s12883-024-03812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Early nutrition after acute ischemic stroke is crucial. We explored early enteral nutrition for stroke patients and evaluated changes in blood indicators as a predictor of stroke prognosis. METHODS All hospitalized stroke patients receiving enteral nutrition were included in the study. We retrospectively collected the protein, energy, fat, and carbohydrate values for 7 days after admission. Serum albumin, total protein, and hemoglobin values were reviewed at admission and at one week. The main outcome indicators were the Modified Rankin Score, Barthel Index, and Quality of Life at 3 months. RESULTS A total of 354 patients (mean age, 70.7 years; 59.0% male) were included. The change in serum albumin at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.001), the Barthel Index (p = 0.004), and the modified Rankin Score (p = 0.029). The change in total protein at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.002), the Barthel Index (p = 0.001), and the modified Rankin score (p = 0.011). The change in hemoglobin values at day 7 relative to at admission was positively correlated with the Barthel Index (p = 0.037 but not with the Quality of Life score (p = 0.237) or the modified Rankin score (p = 0.730). CONCLUSIONS Improved nutrition-related blood indicators one week after admission were independently associated with good stroke outcomes. Nutritional support for acute ischemic stroke patients during the early hospitalization stage appears to be advisable. TRIAL REGISTRATION This review was a retrospective cohort study. The study was retrospectively registered in the Chinese Clinical Trial Registry (No: ChiCTR2300077228). Registration date: 1/11/2023.
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Affiliation(s)
- Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yueyue He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ping Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Feng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
- West China School of Nursing, Sichuan University, Chengdu, China.
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Gatenio-Hefling O, Tzemah-Shahar R, Asraf K, Dilian O, Gil E, Agmon M. Revisiting the "Timed Up and Go" test: a 12-s cut-off can predict Hospitalization Associated Functional Decline in older adults. GeroScience 2024:10.1007/s11357-024-01280-3. [PMID: 39014130 DOI: 10.1007/s11357-024-01280-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024] Open
Abstract
Early detection of functional decline, a major risk among hospitalized older adults, can facilitate interventions that could significantly reduce it. We aimed to examine the contribution of the Timed Up and Go (TUG) test in predicting Hospitalization Associated Functional Decline (HAFD) among older adults, able to independently ambulate before admission. We used a cross-sectional study design; a total of 310 older adults (age ≥ 65) hospitalized in internal medicine wards between December 2018 and August 2020 were included; exclusion criteria were inability to ambulate, a diagnosis restricting mobility, hospitalization for end-of-life care, or impaired cognition. The Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients' independence in activities of daily living 2 weeks prior hospitalization, and at discharge. The TUG test was performed on admission and to predict significant functional decline (defined by a reduction of three points or more in the Modified Barthel Index), while accounting for demographics, length of hospitalization, comorbidity burden (Charlson's comorbidity index), and cognitive function (ALFI-MMSE). Participants were divided into three groups according to their TUG score-under or over a cut-off score of 12 s, or inability to complete the test. Adjusting for age, comorbidity, cognitive ability, and duration of hospitalization, the group that performed the test in less than 12 s showed no statistically significant change in the Modified Barthel Index, therefore no significant HAFD. The other groups showed a statistically significant decline in function. Risk for significant HAFD is currently underestimated in clinical settings, limited to subjective assessment, and underused in the context of implementing early interventions to prevent HAFD. The TUG may support screening for those at risk of hospitalizing-associated functional decline and could help identify patients suitable for preventative interventions.
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Affiliation(s)
| | - Roy Tzemah-Shahar
- Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
| | - Kfir Asraf
- Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Omer Dilian
- Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
| | - Efrat Gil
- HaEmek Medical Center, Afula, Israel
- Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Maayan Agmon
- Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel.
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Hajiesmaeili M, Nooraei N, Alamdari NM, Bidgoli BF, Jame SZB, Moghaddam NM, Fathi M. Clinical phenotypes of patients with acute stroke: a secondary analysis. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:168-177. [PMID: 38299606 DOI: 10.2478/rjim-2024-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Stroke is a leading cause of mortality worldwide and a major cause of disability having a high burden on patients, society, and caregiving systems. This study was conducted to investigate the presence of clusters of in-hospital patients with acute stroke based on demographic and clinical data. Cluster analysis reveals patterns in patient characteristics without requiring knowledge of a predefined patient category or assumptions about likely groupings within the data. METHODS We performed a secondary analysis of open-access anonymized data from patients with acute stroke admitted to a hospital between December 2019 to June 2021. In total, 216 patients (78; 36.1% men) were included in the analytical dataset with a mean (SD) age of 60.3 (14.4). Many demographic and clinical features were included in the analysis and the Barthel Index on discharge was used for comparing the functional recovery of the identified clusters. RESULTS Hierarchical clustering based on the principal components identified two clusters of 109 and 107 patients. The clusters were different in the Barthel Index scores on discharge with the mean (SD) of 39.3 (29.3) versus 62.6 (29.4); t (213.87) = -5.818, P <0.001, Cohen's d (95%CI) = -0.80 (-1.07, -0.52). A logistic model showed that age, systolic blood pressure, pulse rate, D-dimer blood level, low-density lipoprotein, hemoglobin, creatinine concentration, the National Institute of Health Stroke Scale value, and the Barthel Index scores on admission were significant predictors of cluster profiles (all P ≤0.029). CONCLUSION There are two clusters in hospitalized patients with acute stroke with significantly different functional recovery. This allows prognostic grouping of hospitalized acute stroke patients for prioritization of care or resource allocation. The clusters can be recognized using easily measured demographic and clinical features.
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Affiliation(s)
- Mohammadreza Hajiesmaeili
- 1Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Nooraei
- 2Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Malekpour Alamdari
- 2Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behruz Farzanegan Bidgoli
- 3Critical Care Quality Improvement Research Center, Dr. Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- 4Department of Health Management and Economics, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Nader Markazi Moghaddam
- 2Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 4Department of Health Management and Economics, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Mohammad Fathi
- 2Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Esht V, Alshehri MM, Balasubramanian K, Sanjeevi RR, Shaphe MA, Alhowimel A, Alenazi AM, Alqahtani BA, Alhwoaimel N. Transcranial direct current stimulation (tDCS) for neurological disability among subacute stroke survivors to improve multiple domains in health-related quality of life: Randomized controlled trial protocol. Neurophysiol Clin 2024; 54:102976. [PMID: 38663043 DOI: 10.1016/j.neucli.2024.102976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/23/2024] [Accepted: 03/23/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES The primary goal of the current proposal is to fill the gaps in the literature by studying the effectiveness of transcranial direct current stimulation (tDCS) on lifestyle parameters, and physical, behavioral, and cognitive functions among stroke survivors, and understanding the factors that mediate the effects of various domains related to Health-related Quality of life (HRQoL) improvements. METHODS Anticipated 64 volunteer subacute stroke survivors (>7 days to 3 months post stroke) aged 40-75 years with National Institutes of Health stroke scale (NIHSS) score of >10 and Mini-Mental State Examination (MMSE) score between 18 and 23 will be randomly assigned at a ratio of 1:1 to receive either: (1) 20 sessions of anodal tDCS or (2) sham tDCS in addition to conventional rehabilitation. Battery driven tDCS will be applied at 2 mA intensity to the dorsolateral prefrontal cortex and primary motor cortex for 20 minutes. The primary endpoints of study will be 36-Item Short Form Survey (SF-36) post intervention at 4 weeks. The secondary outcomes will include Stroke Specific Quality of Life Scale (SS_QOL), Montreal cognitive assessment (MCA), Beck Anxiety Inventory (BAI), Fugl-Meyer Assessment (FMA), 10 m walk test and Modified Barthel Activities of daily living (ADL) Index. At 0.05 level of significance, data normality, within group and between group actual differences will be analyzed with a moderate scope software. DISCUSSION Our knowledge of this technique and its use is expanding daily as tDCS motor recovery studies-mostly single-center studies-in either single session or many sessions have been completed and shown positive results. The field is prepared for a multi-center, carefully planned, sham-controlled, double-blinded tDCS study to comprehensively examine its feasibility and effectiveness in enhancing outcomes in stroke population. CONCLUSION The function of Transcranial Direct Current Stimulation in aiding stroke recuperation will be ascertained.
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Affiliation(s)
- Vandana Esht
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Mohammed M Alshehri
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Karthick Balasubramanian
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ramya R Sanjeevi
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Mohammed A Shaphe
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
| | - Norah Alhwoaimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
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Ribeiro Batista L, Silva SLAD, Cunha Polese J, Silva AC, Teixeira-Salmela LF, Faria CDCDM, Faria-Fortini I. Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke. Disabil Rehabil 2024:1-7. [PMID: 38318868 DOI: 10.1080/09638288.2024.2313124] [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: 06/21/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. MATERIALS AND METHODS 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. RESULTS Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). CONCLUSIONS Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.
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Affiliation(s)
- Ludmilla Ribeiro Batista
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Janaine Cunha Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Aryane Carolina Silva
- Graduate Program in Rehabilitation Sicences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Sodero A, Campagnini S, Paperini A, Castagnoli C, Hochleitner I, Politi AM, Bardi D, Basagni B, Barretta T, Guolo E, Tramonti C, Pancani S, Hakiki B, Grippo A, Mannini A, Nacmias B, Baccini M, Macchi C, Cecchi F. Predicting the functional outcome of intensive inpatient rehabilitation after stroke: results from the RIPS Study. Eur J Phys Rehabil Med 2024; 60:1-12. [PMID: 37934187 PMCID: PMC10938041 DOI: 10.23736/s1973-9087.23.07852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/11/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The complexity of stroke sequelae, the heterogeneity of outcome measures and rehabilitation pathways, and the lack of extensively validated prediction models represent a challenge in predicting stroke rehabilitation outcomes. AIM To prospectively investigate a multidimensional set of variables collected at admission to inpatient post-stroke rehabilitation as potential predictors of the functional level at discharge. DESIGN Multicentric prospective observational study. SETTING Patients were enrolled in four Intensive Rehabilitation Units (IRUs). POPULATION Patients were consecutively recruited in the period December 2019-December 2020 with the following inclusion criteria: aged 18+, with ischemic/haemorrhagic stroke, and undergoing inpatient rehabilitation within 30 days from stroke. METHODS This is a multicentric prospective observational study. The rehabilitation pathway was reproducible and evidence-based. The functional outcome was disability in activities of daily living, measured by the modified Barthel Index (mBI) at discharge. Potential multidimensional predictors, assessed at admission, included demographics, event description, clinical assessment, functional and cognitive profile, and psycho-social domains. The variables statistically associated with the outcome in the univariate analysis were fed into a multivariable model using multiple linear regression. RESULTS A total of 220 patients were included (median [IQR] age: 80 [15], 112 women, 175 ischemic). Median mBI was 26 (43) at admission and 62.5 (52) at discharge. In the multivariable analysis younger age, along with better functioning, fewer comorbidities, higher cognitive abilities, reduced stroke severity, and higher motor functions at admission, remained independently associated with higher discharge mBI. The final model allowed a reliable prediction of discharge functional outcome (adjusted R2=77.2%). CONCLUSIONS The model presented in this study, based on easily collectable, reliable admission variables, could help clinicians and researchers to predict the discharge scores of the global functional outcome for persons enrolled in an evidence-based inpatient stroke rehabilitation program. CLINICAL REHABILITATION IMPACT A reliable outcome prediction derived from standardized assessment measures and validated treatment protocols could guide clinicians in the management of patients in the subacute phase of stroke and help improve the planning of the rehabilitation individualized project.
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Affiliation(s)
- Alessandro Sodero
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Section of Neuroscience, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | - Erika Guolo
- IRCCS Don Gnocchi Foundation, Florence, Italy
| | | | | | | | | | | | - Benedetta Nacmias
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Section of Neuroscience, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Claudio Macchi
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Heltty H, Rosjidi CH, Lisnawati L. Should Patients Be Confident in Their Efficacy in Improving Their Functional Abilities After a Stroke? Cureus 2023; 15:e51105. [PMID: 38274941 PMCID: PMC10809299 DOI: 10.7759/cureus.51105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Background Patients' self-confidence in their abilities needs to be improved to achieve functional abilities after a stroke. Self-efficacy is a prerequisite for self-management after a stroke. This study aimed to analyze the relationship between self-efficacy and the functional abilities of post-stroke patients. Methodology This was an analytical cross-sectional study conducted over two months. A total of 145 respondents were recruited using the convenience sampling method. Respondents were post-stroke patients who had undergone the post-stroke phase during the first three to six months since the acute stroke. Data collection was performed through questionnaire interviews. Data were analyzed using descriptive analysis and Spearman correlation. Results There was a significant positive relationship between self-efficacy and functional independence (p < 0.05). Conclusions Self-efficacy influences motivation to perform activities of daily living, which can increase the achievement of functional abilities.
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Affiliation(s)
- Heltty Heltty
- Medical Surgical Nursing, Universitas Mandala Waluya, Kendari, IDN
| | - Cholik Harun Rosjidi
- Medical Surgical Nursing, Sekolah Tinggi Ilmu Kesehatan Karya Kesehatan, Kendari, IDN
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Zhang H, Ma J, Sun Y, Xiao LD, Yan F, Tang S. Anxiety subtypes in rural ischaemic stroke survivors: A latent profile analysis. Nurs Open 2023; 10:4083-4092. [PMID: 36807562 PMCID: PMC10170921 DOI: 10.1002/nop2.1668] [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: 08/22/2022] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
AIM To determine the potential profile classes of anxiety reported by ischaemic stroke survivors in rural China, and to explore the characteristics of patients having different types of post-stroke anxiety. DESIGN A cross-sectional survey. METHODS A cross-sectional survey was conducted by using convenience sampling to collect data from 661 ischaemic stroke survivors in rural Anyang city, Henan Province, China, from July 2021 to September 2021. The parameters included in the study were the socio-demographic characteristics, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and the Barthel index of daily activity ability. Potential profile analysis was done to recognize subgroups of post-stroke anxiety. The Chi-square test was performed to explore the characteristics of individuals with different types of post-stroke anxiety. RESULTS The model fitting indices of stroke survivors supported three classes of anxiety models which were as follows: (a) Class 1, low-level, stable group (65.3%, N = 431); (b) Class 2, moderate-level, unstable group (17.9%, N = 118) and (c) Class 3, high-level, stable group (16.9%, N = 112). The risk factors associated with post-stroke anxiety were female patients, lower levels of education, living alone, lower monthly household income, other chronic diseases, impaired daily activity ability and depression. CONCLUSIONS This study identified three different subgroups of post-ischaemic stroke anxiety and their characteristics in patients in rural China. IMPACT This study has significance in providing evidence for the development of targeted intervention measures to reduce negative emotions in different subgroups of post-stroke anxiety patients. PATIENT OR PUBLIC CONTRIBUTION In this study, the researchers arranged the time of questionnaire collection with the village committee in advance, gathered the patients to the village committee for face-to-face questionnaire survey and collected the household data of the patients with mobility difficulties.
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Affiliation(s)
- Huimin Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Junyan Ma
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Yuyan Sun
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Fang Yan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Borowicz W, Ptaszkowski K, Ptaszkowska L, Murawska-Ciałowicz E, Rosińczuk J. Assessment of Changes in Serum C-Reactive Protein Levels in Patients after Ischemic Stroke Undergoing Rehabilitation-A Retrospective Observational Study. J Clin Med 2023; 12:jcm12031029. [PMID: 36769677 PMCID: PMC9917915 DOI: 10.3390/jcm12031029] [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: 12/20/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Inflammation plays a key role in the pathogenesis and prognosis of ischemic stroke. C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect the progression of vascular disease. Using a biomarker such as CRP to predict recovery rather than mortality may present clinical value in providing rehabilitation. The primary aim of the study was to analyze changes in serum CRP levels in patients after ischemic stroke during the regenerative-compensatory period and to assess the usefulness of CRP as a potential biomarker during the rehabilitation period. The project was carried out as a retrospective analysis of prospectively collected data from post-stroke patients from the Department of Neurological Rehabilitation of the Regional Specialist Hospital in Wrocław. A group of 52 patients, after their first-ever ischemic stroke with subsequent hemiplegia, was finally qualified to participate in the study. Serum CRP levels were determined during blood laboratory tests. The Modified Rankin Scale (mRS) and Barthel Index (BI) were used to assess functional outcomes. Rehabilitation using neurophysiological methods was applied five days a week (each session lasted 60 min, and the entire period was 42 days). At the first test, serum CRP levels were found to be above 5 mg/L in 19 patients, the second test in 12 patients, the third test in five patients, and the fourth test in 9 patients. Only three patients had values higher than 5 mg/L in all consecutive assessments (p > 0.05). There was a statistically significant increase in BI scores after therapy (p < 0.001) as well as a decrease in the mRS score by 2.2 points (p < 0.001), in CRP values by 5.02 mg/L (p = 0.019), and in cortisol levels by 2.5 nmol/L (p = 0.002). Statistically significant relationships were observed between the CRP levels after rehabilitation and the corresponding mRS scores (rs = 0.29, p = 0.038). Furthermore, the effect of BMI on CRP levels was demonstrated (B = 0.20, p = 0.038). In conclusion, despite demonstrating a significant relationship between CRP levels and corresponding mRS scores, CRP levels alone may not serve as an independent predictor of long-term functional outcomes in ischemic stroke patients undergoing rehabilitation.
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Affiliation(s)
- Wojciech Borowicz
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wroclaw, Poland
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland
- Correspondence:
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Lucyna Ptaszkowska
- Institute of Health Science, University of Opole, Katowicka 68, 45-060 Opole, Poland
| | - Eugenia Murawska-Ciałowicz
- Physiology and Biochemistry Department, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | - Joanna Rosińczuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland
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Xie YL, Yang YX, Jiang H, Duan XY, Gu LJ, Qing W, Zhang B, Wang YX. Brain-machine interface-based training for improving upper extremity function after stroke: A meta-analysis of randomized controlled trials. Front Neurosci 2022; 16:949575. [PMID: 35992923 PMCID: PMC9381818 DOI: 10.3389/fnins.2022.949575] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Upper extremity dysfunction after stroke is an urgent clinical problem that greatly affects patients' daily life and reduces their quality of life. As an emerging rehabilitation method, brain-machine interface (BMI)-based training can extract brain signals and provide feedback to form a closed-loop rehabilitation, which is currently being studied for functional restoration after stroke. However, there is no reliable medical evidence to support the effect of BMI-based training on upper extremity function after stroke. This review aimed to evaluate the efficacy and safety of BMI-based training for improving upper extremity function after stroke, as well as potential differences in efficacy of different external devices. Methods English-language literature published before April 1, 2022, was searched in five electronic databases using search terms including “brain-computer/machine interface”, “stroke” and “upper extremity.” The identified articles were screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.4.1 software. The GRADE method was used to assess the quality of the evidence. Results A total of 17 studies with 410 post-stroke patients were included. Meta-analysis showed that BMI-based training significantly improved upper extremity motor function [standardized mean difference (SMD) = 0.62; 95% confidence interval (CI) (0.34, 0.90); I2 = 38%; p < 0.0001; n = 385; random-effects model; moderate-quality evidence]. Subgroup meta-analysis indicated that BMI-based training significantly improves upper extremity motor function in both chronic [SMD = 0.68; 95% CI (0.32, 1.03), I2 = 46%; p = 0.0002, random-effects model] and subacute [SMD = 1.11; 95%CI (0.22, 1.99); I2 = 76%; p = 0.01; random-effects model] stroke patients compared with control interventions, and using functional electrical stimulation (FES) [SMD = 1.11; 95% CI (0.67, 1.54); I2 = 11%; p < 0.00001; random-effects model]or visual feedback [SMD = 0.66; 95% CI (0.2, 1.12); I2 = 4%; p = 0.005; random-effects model;] as the feedback devices in BMI training was more effective than using robot. In addition, BMI-based training was more effective in improving patients' activities of daily living (ADL) than control interventions [SMD = 1.12; 95% CI (0.65, 1.60); I2 = 0%; p < 0.00001; n = 80; random-effects model]. There was no statistical difference in the dropout rate and adverse effects between the BMI-based training group and the control group. Conclusion BMI-based training improved upper limb motor function and ADL in post-stroke patients. BMI combined with FES or visual feedback may be a better combination for functional recovery than robot. BMI-based trainings are well-tolerated and associated with mild adverse effects.
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Affiliation(s)
- Yu-lei Xie
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Yu-xuan Yang
- Department of Rehabilitation Medicine, The Second Clinical Hospital of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Hong Jiang
- Department of Rehabilitation Medicine, Xichong County People's Hospital, Nanchong Central Hospital, Nanchong, China
| | - Xing-Yu Duan
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Li-jing Gu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wu Qing
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Bo Zhang
- Department of Rehabilitation Medicine, The Second Clinical Hospital of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
- Bo Zhang
| | - Yin-xu Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- *Correspondence: Yin-xu Wang
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