1
|
Altuntaş O, Taş S, Çetin A. An investigation of the factors that influence functional improvement in stroke rehabilitation. Turk J Med Sci 2021; 51:1448-1454. [PMID: 33705646 PMCID: PMC8283450 DOI: 10.3906/sag-2101-94] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/11/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim The purpose of this study was to determine effect of age, sex, affected extremity, disability severity, treatment type, cerebrovascular accident (CVA) etiology, number of treatment sessions, and CVA duration on the functional improvement of the stroke patients who participated in a physical medicine and rehabilitation program. Materials and methods The research sample consisted of 322 stroke patients. Clinical and demographic features including age, sex, affected extremity, disability severity, treatment type, CVA etiology, number of treatment sessions, and CVA duration were recorded. Functional status was evaluated retrospectively by using the functional independence measure (FIM) at admission and discharge. Results It was detected that discharge FIM score of the patients exhibited an increase of significance level (p < 0.05). It was found that age, number of treatment sessions, CVA duration and FIM admission score were determinative parameters in FIM gain level (p < 0.05) while sex, affected extremity, and CVA etiology were not effective in FIM gain level (p > 0.05). Conclusion Results show that functional improvement after rehabilitation was better in the younger ages, shorter CVA durations and moderate functional disturbances. The findings obtained may be useful for stroke rehabilitation triage.
Collapse
Affiliation(s)
- Onur Altuntaş
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Serkan Taş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Alp Çetin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
2
|
Zhang S, Chen M, Gao L, Liu Y. Investigating Muscle Function After Stroke Rehabilitation with 31P-MRS: A Preliminary Study. Med Sci Monit 2018; 24:2841-2848. [PMID: 29730667 PMCID: PMC5958628 DOI: 10.12659/msm.907372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND New evidence reveals significant metabolic changes in skeletal muscle after stroke. However, it is unknown if 31P magnetic resonance spectroscopy (31P-MRS) can evaluate these metabolic changes. Our objective here was to investigate: (a) if muscle energy metabolism changes in the affected side; (b) if muscle energy metabolism changes after rehabilitation; and (c) if energy metabolism measured by 31P-MRS can reflect changes in the Modified Modified Ashworth Scale (MMAS) and Fugl-Meyer assessment-lower extremity (FMA-LE) scores after rehabilitation. MATERIAL AND METHODS We enrolled 13 patients with stroke symptoms and hemiplegia. Lower-limb motor status on the affected side was evaluated by FMA-LE and MMAS. The 31P-MRS measures included phosphocreatine (PCr), inorganic phosphate (Pi), PCr/Pi, and pH. We statistically compared these measures in the affected and unaffected lower leg muscles before rehabilitation and after rehabilitation on the affected side. Spearman correlational analyses was performed to determine correlations between change in energy metabolism and change in FMA-LE score and MMAS score after rehabilitation. RESULTS PCr and PCr/Pi were significantly lower in the affected muscle compared to the unaffected muscle; however, there were no significant differences in Pi or pH. After rehabilitation, PCr, Pi, PCr/Pi, and pH did not significantly change. However, FMA-LE and MMAS score improved significantly after rehabilitation. Changes in energy metabolism measured by 31P-MRS had no correlation with FMA-LE change after rehabilitation. However, changes in PCr and PCr/Pi were correlated with change in MMAS score after rehabilitation. CONCLUSIONS 31P-MRS can evaluate changes in muscle energy metabolism in patients with stroke. PCr measured by 31P-MRS can reflect changes in MMAS after rehabilitation.
Collapse
Affiliation(s)
- Shuai Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Graduate School, Peking Union Medical College, Beijing, P.R. China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Graduate School, Peking Union Medical College, Beijing, P.R. China
| | - Lei Gao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Department of Rehabilitation, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Ying Liu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Graduate School, Peking University Health Science Center, Peking University, Beijing, P.R. China
| |
Collapse
|
3
|
Kabboord AD, Van Eijk M, Buijck BI, Koopmans RTCM, van Balen R, Achterberg WP. Comorbidity and intercurrent diseases in geriatric stroke rehabilitation: a multicentre observational study in skilled nursing facilities. Eur Geriatr Med 2018; 9:347-353. [PMID: 29887923 PMCID: PMC5972181 DOI: 10.1007/s41999-018-0043-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/02/2018] [Indexed: 10/29/2022]
Abstract
Background Older patients often have multiple comorbidities and are susceptible to develop intercurrent diseases during rehabilitation. This study investigates intercurrent diseases and associated factors in patients undergoing geriatric stroke rehabilitation, focussing on pre-existing comorbid conditions, overall comorbidity and baseline functional status. Materials and methods This multicentre prospective cohort study included 15 skilled nursing facilities. Data were collected at baseline and at discharge. The primary outcome measures were presence and number of intercurrent diseases. Furthermore, their impact on change in rehabilitation goals or length of stay was examined. Comorbidity was assessed with the Charlson index, and functional status with the Barthel index (BI). Results Of the 175 included patients, 51% developed an intercurrent disease. A lower baseline BI, a higher Charlson index, presence of diabetes mellitus (DM) and kidney disease were related to the occurrence of an intercurrent disease (p < 0.05). Moreover, a lower BI, a higher Charlson index, and particularly the presence of DM were independently associated. If both comorbidity and a lower baseline functional status were present, the odds ratio (95% CI) of developing intercurrent diseases was 6.70 [2.33-19.2], compared to 1.73 [0.52-5.72] (comorbidity only) and 1.62 [0.53-4.94] (only BI ≤ 14). Conclusions On admission, functional impairments and comorbidity, particularly diabetes, independently contribute to developing intercurrent diseases during geriatric stroke rehabilitation. Therefore, routine evaluation of comorbidity integrated with functional status at the start of rehabilitation is essential to identify patients at risk. Finally, particular attention should be paid to patients with DM to prevent intercurrent diseases and support optimal functional recovery .
Collapse
Affiliation(s)
- Anouk D Kabboord
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Monica Van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Bianca I Buijck
- Department of Neurology, Erasmus MC University Medical Center, 's-Gravendijkwal 230, Rotterdam, The Netherlands.,Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,"Joachim en Anna", Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| |
Collapse
|
4
|
Simić-Panić D, Bošković K, Milićević M, Rabi Žikić T, Cvjetković Bošnjak M, Tomašević-Todorović S, Jovićević M. The Impact of Comorbidity on Rehabilitation Outcome after Ischemic Stroke. Acta Clin Croat 2018; 57:5-15. [PMID: 30256006 PMCID: PMC6400340 DOI: 10.20471/acc.2018.57.01.01] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Comorbidity decreases survival but it still remains unknown to what extent functional recovery after ischemic stroke is affected. The aim of this research was to determine the prevalence of the most common comorbidities in patients with ischemic stroke and to examine their predictive value on the functional status and recovery. In order to obtain relevant information for this research, we conducted a prospective study over a two-year period. It included patients with acute/subacute ischemic stroke who had inhospital rehabilitation treatment in our institution. Functional status of the patients was evaluated by the following three aspects at the beginning and at the end of rehabilitation treatment: Rivermead Mobility Index was used for mobility, Barthel Index for independence in activities of daily living, and modified Rankin Scale for total disability. Modified Charlston Comorbidity Index was used to assess comorbidity. Multivariate analysis was applied to evaluate the impact of recorded comorbidities on the patient functional outcome. Independent predictors of rehabilitation success in our study were the value of modified Charlston Comorbidity Index, atrial fibrillation and myocardial infarction. Our study demonstrated that patients with more comorbidities had worse functional outcome after stroke, so it is important to consider the comorbidity status when planning the rehabilitation treatment.
Collapse
Affiliation(s)
| | - Ksenija Bošković
- Faculty of Medicine, University of Novi Sad, Department of Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Marija Milićević
- Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Tamara Rabi Žikić
- Faculty of Medicine, University of Novi Sad, Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Mina Cvjetković Bošnjak
- Faculty of Medicine, University of Novi Sad, Department of Psychiatry, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Snežana Tomašević-Todorović
- Faculty of Medicine, University of Novi Sad, Department of Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Mirjana Jovićević
- Faculty of Medicine, University of Novi Sad, Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| |
Collapse
|
5
|
Tam AKH, Bayley MT. A narrative review of the impact of medical comorbidities on stroke rehabilitation outcomes. Disabil Rehabil 2017; 40:1842-1848. [PMID: 28374631 DOI: 10.1080/09638288.2017.1309465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Medical comorbidities in stroke patients influence acute mortality, but may also affect participation of survivors in rehabilitation. There is limited research investigating the impact of comorbidities on stroke rehabilitation outcomes. The review will explore the literature on the impact of comorbidities on stroke rehabilitation outcome. MATERIALS AND METHODS The literature was searched systematically, including MEDLINE database, EMBASE and PsychINFO, combining variations of the terms stroke, rehabilitation and comorbidities. Results were limited to English language publications. Included studies had a functional outcome. RESULTS Twenty relevant articles were identified. Fifteen small prospective or large retrospective studies using global comorbidity scales produced conflicting relationships between comorbidities and rehabilitation outcomes. Five publications addressed specific comorbidities, with three studies finding negative correlation between diabetes and rehabilitation outcomes, although effects diminished with age. In general, there were discrepancies in how comorbidities were identified. Few studies specifically focused on comorbidities and/or rehabilitation outcomes. CONCLUSIONS There is conflicting evidence regarding the impact of comorbidities on stroke rehabilitation outcomes. However, the presence of more severe diabetes may be associated with worse outcomes. The role of comorbidities in stroke rehabilitation would be best clarified with a large cohort study, with precise comorbidity identification measured against rehabilitation specific outcomes. Implications for rehabilitation Benefit of rehabilitation after stroke in improving functional outcome is well-established. Many stroke patients have comorbid conditions which can impact rehabilitation participation, leading to less benefit obtained from rehabilitation. The burden of comorbid conditions may slow rehabilitation progress, which may warrant a longer duration of rehabilitation to obtain required functional gain to be discharged into the community.
Collapse
Affiliation(s)
- Alan K H Tam
- a Department of Medicine, Division of Physical Medicine & Rehabilitation , University of Toronto , Toronto , Canada
| | - Mark T Bayley
- a Department of Medicine, Division of Physical Medicine & Rehabilitation , University of Toronto , Toronto , Canada
| |
Collapse
|
6
|
Yan LL, Li C, Chen J, Miranda JJ, Luo R, Bettger J, Zhu Y, Feigin V, O'Donnell M, Zhao D, Wu Y. Prevention, management, and rehabilitation of stroke in low- and middle-income countries. eNeurologicalSci 2016; 2:21-30. [PMID: 29473058 PMCID: PMC5818135 DOI: 10.1016/j.ensci.2016.02.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 12/28/2022] Open
Abstract
Although stroke incidence in high-income countries (HICs) decreased over the past four decades, it increased dramatically in low- and middle-income countries (LMICs). In this review, we describe the current status of primary prevention, treatment, and management of acute stroke and secondary prevention of and rehabilitation after stroke in LMICs. Although surveillance, screening, and accurate diagnosis are important for stroke prevention, LMICs face challenges in these areas due to lack of resources, awareness, and technical capacity. Maintaining a healthy lifestyle, such as no tobacco use, healthful diet, and physical activity are important strategies for both primary and secondary prevention of stroke. Controlling high blood pressure is also critically important in the general population and in the acute stage of hemorrhagic stroke. Additional primary prevention strategies include community-based education programs, polypill, prevention and management of atrial fibrillation, and digital health technology. For treatment of stroke during the acute stage, specific surgical procedures and medications are recommended, and inpatient stroke care units have been proven to provide high quality care. Patients with a chronic condition like stroke may require lifelong pharmaceutical treatment, lifestyle maintenance and self-management skills, and caregiver and family support, in order to achieve optimal health outcomes. Rehabilitation improves physical, speech, and cognitive functioning of disabled stroke patients. It is expected that home- or community-based services and tele-rehabilitation may hold special promise for stroke patients in LMICs.
Collapse
Affiliation(s)
- Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, USA
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Chaoyun Li
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Jie Chen
- Institute for Medical Humanities, Peking University Health Science Center, Beijing, China
| | - J. Jaime Miranda
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Janet Bettger
- Duke School of Nursing, Duke University, Durham, USA
- Duke Clinical Research Institute, Duke University, Durham, USA
| | - Yishan Zhu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | | | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University School of Public Health and Clinical Research Institute, Beijing, China
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Tanovic E, Selimovic S, Tanovic H. Assessment of the effects of rehabilitation after cerebrovascular accident in patients with diabetes mellitus and hypertension as risk factors. Med Arch 2014; 68:124-7. [PMID: 24937938 PMCID: PMC4272494 DOI: 10.5455/medarh.2014.68.124-127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: The aim of this study is to evaluate the results of rehabilitation, to determine the prevalence of major risk factors in cerebrovascular accident and their consequences, as well as to propose measures and procedures that will affect the better rehabilitation. Methods: The survey analyzed: age, sex, duration of rehabilitation, activities in daily life through the Barthel index at admission and at discharge, presence of risk factors HTA and DM. The study included a total of 116 patients, the majority of patients are older than 61 years. We had 49% of male patients and 51% of female patients and they spent 31-40 days at the rehabilitation. Results: The most common risk factor is HTA (83%) and diabetes (33%). Most of the patients at admission had a BI from 0 to 4 (32.7%), and at discharge BI in the range 17-20 (36.2%). Statistical analysis shows that there is a statistically significant correlation between the BI at admission, BI at discharge and risk factors of HTA and diabetes mellitus. Conclusions: the rehabilitation results in most patients is good results of rehabilitation. The most important risk factors in patients are HTA, DM and directly affect on results of rehabilitation. For the better results we should have energetic fight against risk factors for HTA and DM through primary and secondary prevention and patient education about early detection and treatment of these risk factors.
Collapse
Affiliation(s)
- Edina Tanovic
- Clinic of Physiatry and Rehabilitation, Clinical center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
- Corresponding author: Edina Tanovic, ass.prof. Clinic of Physiatry and Rehabilitation, KCUS, Sarajevo, Bosnia and Herzegovina. Phone: +387 33 278 465; :
| | | | - Haris Tanovic
- Clinic of Abdominal Surgery, Clinical canter of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
9
|
Uysal-Bozkir Ö, Parlevliet JL, de Rooij SE. Insufficient cross-cultural adaptations and psychometric properties for many translated health assessment scales: A systematic review. J Clin Epidemiol 2013; 66:608-18. [DOI: 10.1016/j.jclinepi.2012.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 11/27/2012] [Accepted: 12/07/2012] [Indexed: 11/28/2022]
|
10
|
Abstract
We reviewed the literature on walking recovery of stroke patients as it relates to the following subjects:epidemiology of walking dysfunction, recovery course of walking, and recovery mechanism of walking (neural control of normal walking, the evaluation methods for leg motor function, and motor recovery mechanism of leg).The recovery of walking is one of the primary goals in stroke patients, along with the recovery of hand function and cognition. Walking function has greater potential for recovery than hand function because motor function of the leg is less dependent on the lateral corticospinal tract than that of hand function. This suggests that detailed knowledge of walking can be used to increase the likelihood that stroke patients recover their ability to walk. Therefore, we suggest that further research should focus on these topics, especially, on the neural control mechanism of walking and motor recovery mechanisms of the leg in stroke patients.
Collapse
|
11
|
Ozyemisci-Taskiran O, Gunendi Z, Aknar O, Karatas GK, Sepici V. Revisiting Length of Stay in Stroke Rehabilitation in Turkey. Arch Phys Med Rehabil 2011; 92:257-64. [DOI: 10.1016/j.apmr.2010.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/18/2010] [Accepted: 08/23/2010] [Indexed: 11/28/2022]
|
12
|
Mizrahi EH, Fleissig Y, Arad M, Adunsky A. The Impact of Previous Strokes on the Rehabilitation of Elderly Patients Sustaining a Hip Fracture. Arch Phys Med Rehabil 2007; 88:1136-9. [PMID: 17826458 DOI: 10.1016/j.apmr.2007.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether a previous stroke may affect the functional outcome gain of elderly patients undergoing rehabilitation for a hip fracture. DESIGN A retrospective cohort study. SETTING The division of geriatric medicine with rehabilitation wards at a university-affiliated referral hospital. PARTICIPANTS Patients with hip fractures (N=460) undergoing a standard rehabilitation course. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The functional outcome of previous stroke- and nonprevious stroke (NPS)-affected patients assessed by the FIM instrument at admission and discharge from the rehabilitation facility. Data were analyzed by t tests, Pearson correlation, chi-square tests, and linear regression analysis. RESULTS Both admission and discharge total FIM scores were significantly higher in NPS compared with previous stroke patients (63.53+/-19.89 vs 52.19+/-19.37, P<.001) and (84.23+/-24.93 vs 71.37+/-25.03, P=.001), respectively. However, changes in total FIM (20.70+/-11.68 vs 19.17+/-13.32, P=.38) and in motor FIM (19.84+/-10.63 vs 17.96+/-11.21, P=.23) at discharge were not statistically significant between the 2 groups. A linear regression analysis showed that a previous stroke was not predictive of a worse total FIM gain at discharge (P=.58). CONCLUSIONS NPS hip fracture elderly patients show higher admission and discharge FIM scores compared with previous stroke patients. Nevertheless, both groups achieve similar FIM gains during rehabilitation period. A previous stroke should not be considered as adversely affecting the rehabilitation of such patients.
Collapse
Affiliation(s)
- Eliyahu H Mizrahi
- Department of Geriatric Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel.
| | | | | | | |
Collapse
|
13
|
Brainin M, Teuschl Y, Kalra L. Acute treatment and long-term management of stroke in developing countries. Lancet Neurol 2007; 6:553-61. [PMID: 17509490 DOI: 10.1016/s1474-4422(07)70005-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Developing countries have some of the highest stroke mortality rates in the world that account for over two-thirds of stroke deaths worldwide. Hospital-based studies suggest that the patterns of stroke types and causes of stroke differ between developing and developed countries, resulting in differing needs for acute and long-term care. Data on stroke care provision in developing countries are sparse and most of the available studies are biased towards urban settings in reasonably resourced health-care systems. A general overview shows that the quality and quantity of stroke care is largely patchy in low-income and middle-income countries, with areas of excellence intermixed with areas of severe need, depending upon patients' location, socioeconomic status, education, and cultural beliefs. Here we review the available literature on acute and long-term stroke management in developing countries. On the basis of available studies, largely from developed countries, we discuss the need to develop basic organised stroke-unit care in developing countries.
Collapse
Affiliation(s)
- Michael Brainin
- Centre of Clinical Neurosciences, Department of Clinical Medicine and Preventive Medicine, Danube University, Austria.
| | | | | |
Collapse
|