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Schmidt J, Düvel JA, Elkenkamp S, Greiner W. Comparing the EQ-5D-5L and stroke impact scale 2.0 in stroke patients: an analysis of measurement properties. Health Qual Life Outcomes 2024; 22:45. [PMID: 38835023 DOI: 10.1186/s12955-024-02252-z] [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: 10/10/2023] [Accepted: 04/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Stroke has evolved to become a chronic disease and a major public health challenge. To adequately capture the full disease burden of stroke patients, the assessment of health-related quality of life (HRQoL) and thus the performance of respective measures is increasingly relevant. The aim of this analysis was to compare the measurement properties of two self-report instruments, the EQ-5D-5L and the Stroke Impact Scale 2.0. METHODS The data used for the analysis was derived from a quasi-experimental case management study for mildly to moderately affected incident stroke and transient ischemic attack (TIA) patients aged ≥ 18 in Germany. Data was collected patient-individually at 3, 6 and 12 months after initial stroke. The EQ-5D-5L and SIS 2.0 were compared in terms of feasibility, ceiling and floor effects, responsiveness and known-groups validity (Kruskal-Wallis H and Wilcoxon rank-sum test). RESULTS A response for all three follow-ups is available for n = 855 patients. The feasibility of the EQ-5D-5L is determined as good (completion rate: 96.4-96.6%, ≥ one item missing: 3.2 - 3.3%), whereas the SIS 2.0 is moderately feasible (overall completion rate: 44.9-46.1%, ≥ one item missing in domains: 4.7 - 28.7%). The SIS 2.0 shows substantial ceiling effects in comparable domains (physical function: 10.4 - 13%, others: 3.5-31.3%) which are mainly larger than ceiling effects in the EQ-5D-5L index (17.1-21.5%). In terms of responsiveness, the EQ-5D-5L shows small to moderate change while the SIS 2.0 presents with moderate to large responsiveness. The EQ-5D-5L index, mobility, usual activities and Visual Analogue Scale show known-groups validity (p < 0.05). Content-related domains of the SIS 2.0 show known-groups validity as well (p < 0.05). However, it is compromised in the emotion domain in both measures (p > 0.05). CONCLUSIONS The EQ-5D-5L seems to be slightly more suitable for this cohort. Nonetheless, the results of both measures indicate limited suitability for TIA patients. Large-scale studies concerning responsiveness and known-groups validity are encouraged. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register, retrospective registration on 21.09.2022. REGISTRATION ID DRKS00030297.
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Affiliation(s)
- Juliana Schmidt
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Juliane Andrea Düvel
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Svenja Elkenkamp
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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McGlinchey MP, Faulkner-Gurstein R, Sackley CM, McKevitt C. Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke - an ethnographic study. Disabil Rehabil 2024; 46:672-684. [PMID: 36734838 DOI: 10.1080/09638288.2023.2172463] [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: 05/30/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. MATERIAL AND METHODS An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. RESULTS Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors' clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors' treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. CONCLUSIONS Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.Implications for rehabilitationMultiple factors guide therapist decision making after severely disabling stroke, some of which result in the use of interventions that do not fully address stroke survivors' clinical needs.Therapists should critically reflect upon their personal beliefs and attitudes about severely disabling stroke to reduce potential sources of bias on decision making.Therapists should consider the timing and intensity of therapy delivery as well as their treatment approach to optimise outcomes after severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- Neurorehabilitation Service, Integrated Local Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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3
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Lim H, Madhavan S. Non-paretic leg movements can facilitate cortical drive to the paretic leg in individuals post stroke with severe motor impairment: Implications for motor priming. Eur J Neurosci 2023; 58:2853-2867. [PMID: 37354080 PMCID: PMC10530620 DOI: 10.1111/ejn.16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
Cross-education, a phenomenon where unilateral strength (or skill) training enhances strength (or skill) in the contralateral untrained limb, has been well studied in able-bodied individuals. Cross-education effect accompanies bilateral changes of corticomotor activity in the motor cortex (M1). Recent reports demonstrated greater cross-education effect in stroke survivors compared to healthy individuals, however, corticomotor responses to cross-education in stroke remains unclear. This study aimed to determine the effects of non-paretic leg movements on corticomotor excitability (CME) and reaction time of the paretic leg in severely impaired stroke survivors. Seventeen post stroke individuals with severe leg motor impairment (Fugl-Meyer lower extremity score less than 21 and absence of motor evoked potential in the paretic leg) performed three 20-min motor trainings using their non-paretic ankle: skill (targeted dynamic movements), strength (isometric resistance) and sham (sub-threshold electrical nerve stimulation). During training, verbal instructions were given to the participants to limit their movement to the non-paretic leg and this was confirmed with visual observation of the paretic leg. Transcranial magnetic stimulation measured CME of the contralateral pathways from the non-lesioned M1 to the non-paretic tibialis anterior (TA) muscle, ipsilateral pathways to the paretic TA and transcallosal inhibition (TCI) from the non-lesioned to lesioned M1. Paretic ankle reaction time was measured using a reaction time paradigm. All outcomes were measured before, immediately post, 30-min post and 60-min post priming. CME of the non-paretic TA increased after skill (.08 ± .10 mV) and strength (.06 ± .05 mV) training (p < .01). Ipsilateral CME of the paretic TA (.02 ± .01 mV) and TCI (.01 ± .01 s, ipsilateral silent period; more inhibition to the lesioned M1) increased after skill (p < .05) but not strength training. Reaction time of the paretic ankle improved after skill and strength training (-.11 ± .2 and -.13 ± .20 s, respectively; p < .05) and was sustained at 60 min. No changes were observed during the sham condition. Our findings may inform future studies for using non-paretic leg movements as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements. Conclusion: Non-paretic leg movements can be used as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
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Pan L, Wang H, Cao X, Ning T, Li X, Cao Y. A Higher Postoperative Barthel Index at Discharge is Associated with a Lower One-Year Mortality After Hip Fracture Surgery for Geriatric Patients: A Retrospective Case‒Control Study. Clin Interv Aging 2023; 18:835-843. [PMID: 37251305 PMCID: PMC10224694 DOI: 10.2147/cia.s409282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose To evaluate the relationship between the postoperative Barthel index assessing activities of daily living at discharge and the one-year mortality after hip fracture surgery. Methods Patients with hip fracture admitted to Peking University First Hospital from January 2015 to January 2020 were enrolled retrospectively according to the inclusion and exclusion criteria. The Barthel index and other related confounding variables were collected. Logistic regression and Kaplan‒Meier survival curves were constructed to explore the relationship between the postoperative Barthel index at discharge and the one-year mortality of geriatric patients after hip fracture surgery. Results A total of 444 patients with a mean age of 81.61±6.14 years were included. A significant difference was not observed in the preoperative Barthel index at admission between the deceased group and the surviving group (38.90±15.83 vs 36.96±10.74, p=0.446). However, the difference in the postoperative Barthel index at discharge between these two groups was statistically significant (43.08±14.40 vs 53.18±13.43, P<0.001). The multivariable logistic regression analysis revealed that the postoperative Barthel index at discharge was an independent risk factor for one-year mortality after adjustment for confounding variables (adjusted OR 0.73, 95% CI 0.55-0.98, p˂0.05). The Kaplan‒Meier survival curve showed that patients who had a high Barthel index (≥50) at discharge had a significantly lower mortality in the long term than patients with a low Barthel index (<50) at discharge (P< 0.001). Conclusion The postoperative Barthel index at discharge was independently associated with the one-year mortality of geriatric patients after hip fracture surgery. A higher postoperative Barthel index at discharge indicated a lower mortality after hip fracture surgery. The Barthel index at discharge has the potential to provide essential prognostic information for early risk stratification and directing future care.
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Affiliation(s)
- Liping Pan
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Hao Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xiangyu Cao
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Taiguo Ning
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yongping Cao
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
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Garcia-Gutierrez S, Villanueva A, Lafuente I, Rodriguez I, Lozano-Bahamonde A, Murga N, Orus J, Camacho ER, Quintana JM, Quiros R, Fernández-Ruiz J, Cacicedo A, Escobar V, Redondo M, Cabello G, Baré M. Factors related to early readmissions after acute heart failure: a nested case-control study. BMC Cardiovasc Disord 2023; 23:17. [PMID: 36635633 PMCID: PMC9837935 DOI: 10.1186/s12872-022-03029-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
AIMS To describe the main characteristics of patients who were readmitted to hospital within 1 month after an index episode for acute decompensated heart failure (ADHF). METHODS AND RESULTS This is a nested case-control study in the ReIC cohort, cases being consecutive patients readmitted after hospitalization for an episode of ADHF and matched controls selected from those who were not readmitted. We collected clinical data and also patient-reported outcome measures, including dyspnea, Minnesota Living with Heart Failure Questionnaire (MLHFQ), Tilburg Frailty Indicator (TFI) and Hospital Anxiety and Depression Scale scores, as well as symptoms during a transition period of 1 month after discharge. We created a multivariable conditional logistic regression model. Despite cases consulted more than controls, there were no statistically significant differences in changes in treatment during this first month. Patients with chronic decompensated heart failure were 2.25 [1.25, 4.05] more likely to be readmitted than de novo patients. Previous diagnosis of arrhythmia and time since diagnosis ≥ 3 years, worsening in dyspnea, and changes in MLWHF and TFI scores were significant in the final model. CONCLUSION We present a model with explanatory variables for readmission in the short term for ADHF. Our study shows that in addition to variables classically related to readmission, there are others related to the presence of residual congestion, quality of life and frailty that are determining factors for readmission for heart failure in the first month after discharge. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03300791. First registration: 03/10/2017.
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Affiliation(s)
- Susana Garcia-Gutierrez
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424267.1Kronikgune Institute for Health Services Research, Barakaldo, Spain ,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain ,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Girona, Spain ,grid.14724.340000 0001 0941 7046Faculty of Health Sciences, Medicine Department, University of Deusto, Bilbo, Spain
| | - Ane Villanueva
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424267.1Kronikgune Institute for Health Services Research, Barakaldo, Spain ,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain ,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Girona, Spain
| | - Iratxe Lafuente
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424868.40000 0004 1762 3896Fundación Vasca de Innovación e Investigación Sanitarias, BIOEF, Barakaldo, Spain
| | - Ibon Rodriguez
- grid.414476.40000 0001 0403 1371Cardiology Department, Hospital Galdakao-Usansolo, Galdakao, Spain
| | | | - Nekane Murga
- grid.414269.c0000 0001 0667 6181Cardiology Department, Hospital Basurto, Bilbo, Spain
| | - Josefina Orus
- grid.414560.20000 0004 0506 7757Cardiology Department, Hospital Parc Taulí, Sabadell, Spain
| | - Emilia Rosa Camacho
- grid.414423.40000 0000 9718 6200Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Jose María Quintana
- Research Unit, Galdakao-Usansolo University Hospital, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya Spain ,grid.424267.1Kronikgune Institute for Health Services Research, Barakaldo, Spain ,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain ,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Girona, Spain
| | - Raul Quiros
- grid.414423.40000 0000 9718 6200Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
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He Y, Nie X, He T, Qi X, Chen Z, Duan W, Wei Y, Liu X, Liu Y. Impact of Early Rehabilitation on Outcomes in Patients With Acute Ischemic Stroke After Endovascular Treatment. Front Neurol 2022; 13:877773. [PMID: 35677333 PMCID: PMC9168462 DOI: 10.3389/fneur.2022.877773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background This study aims to examine the effects of early rehabilitation on functional outcomes in patients with acute ischemic stroke treated with endovascular treatment (EVT). Methods Eligible patients with large vessel occlusion stroke treated with EVT, who received early rehabilitation or standard care treatment during hospitalization, were enrolled in a multicenter registration, prospective observational study, a registration study for Critical Care of Acute Ischemic Stroke After Recanalization. Early rehabilitation was defined as rehabilitation interventions initiated within 1 week after acute stroke. The primary outcome was the favorable functional outcome (defined as modified Rankin Scale scores of 0 to 2) at 90 days. Independent association between early rehabilitation and the primary outcome was investigated using multivariable logistic regression in the entire sample and in subgroups. Results A total of 1,126 patients (enrolled from July 2018 to May 2019) were included in the analyses, 273 (24.2%) in the early rehabilitation group and 853 (75.8%) in the standard care group. There was no significant difference in favorable functional outcomes at 90 days between the two groups (45.4 vs. 42.6%, p = 0.41). Patients in the early rehabilitation group had a lower death rate within 90 days compared with the standard care group (6.2 vs. 20.5%, p < 0.01). The multivariable logistic regression analyses showed that the early rehabilitation was not significantly associated with the favorable functional outcome at 90 days (adjusted odds ratio, 1.01 [95% CI, 0.70–1.47]; p = 0.95). There was no significant difference between subgroups in the favorable functional outcome at 90 days. No significant interaction was found between subgroups. Conclusions Patients with stroke receiving early rehabilitation had a lower death rate. However, these clinically meaningful effects of early rehabilitation did not show on functional outcome at 90 days in patients with large vessel occlusion stroke treated with EVT. Registration URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.
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Affiliation(s)
- Yi He
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao He
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiao Qi
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhenzhen Chen
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Wei Duan
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yufei Wei
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiran Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Liu
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
- *Correspondence: Yong Liu
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Gil K, Abbasi S, Mehta K, McClune B, Sborov D, Ahmed N, Abdallah AO, Ganguly S, McGuirk J, Shune L, Mohyuddin GR. Trends in Inpatient Chemotherapy Hospitalizations, Cost and Mortality for Patients with Acute Leukemias and Myeloma. Clin Hematol Int 2022; 4:56-59. [PMID: 35950203 PMCID: PMC9358787 DOI: 10.1007/s44228-022-00003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/24/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kellen Gil
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Saqib Abbasi
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Kathan Mehta
- Department of Oncology, Kansas University Medical Center, Kansas City, USA
| | - Brian McClune
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, USA
| | - Douglas Sborov
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, USA
| | - Nausheen Ahmed
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Al-Ola Abdallah
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Siddhartha Ganguly
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Joseph McGuirk
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Leyla Shune
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, USA
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Fisher RJ, Riley-Bennett F, Russell L, Lee C, Sturt R, Walker M, Sackley C. Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability. BMJ Open 2021; 11:e052593. [PMID: 34857570 PMCID: PMC8640659 DOI: 10.1136/bmjopen-2021-052593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge. OBJECTIVES To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus. SETTING Virtual nominal group technique (vNGT) across the UK. PARTICIPANTS Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience. METHODS Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique's five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements. RESULTS A combined total of 421 statements achieved positive consensus (>75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required. CONCLUSION The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.
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Affiliation(s)
| | | | - Lal Russell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Lee
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Ruth Sturt
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Cath Sackley
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Fujino Y, Fukata K, Inoue M, Okawa S, Okuma K, Kunieda Y, Miki H, Matsuda T, Amimoto K, Makita S, Takahashi H, Fujiwara T. Examination of Rehabilitation Intensity According to Severity of Acute Stroke: A Retrospective Study. J Stroke Cerebrovasc Dis 2021; 30:105994. [PMID: 34284324 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105994] [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: 05/05/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the intensity and effectiveness of rehabilitation in acute stroke patients according to the severity of functional impairments in them. MATERIALS AND METHODS This retrospective cohort study included 294 patients with acute hemispheric stroke admitted to three acute-care hospitals who subsequently underwent an inpatient rehabilitation program. Stroke severity was classified according to neurological deficits and trunk dysfunction. The following data were obtained from medical records: age, sex, stroke type, lesion side, hospitalization duration, initial functional status determined using the National Institutes of Health Stroke Scale, rehabilitation start date, first day out of bed after admission, total treatment duration, total number of treatment sessions, rehabilitation implementation rate between start of rehabilitation and discharge, trunk control test and Barthel Index score on the first day out of bed after admission and discharge, and post-discharge outcomes. Hierarchical cluster analysis was performed with clusters categorized using the National Institutes of Health Stroke Scale and trunk control test scores. Variables were compared using the Kruskal-Wallis test, and Dunn's nonparametric comparison test was performed for post-hoc analysis to determine differences between clusters. RESULTS The National Institutes of Health Stroke Scale and trunk control test showed a significant correlation (r = -0.816, p < 0.01) using which cluster analysis identified three clusters. Rehabilitation showed a ceiling effect in patients with mild stroke and a floor effect in patients with severe stroke. CONCLUSION These results may guide the determination of rehabilitation intensity with reference to the severity of neurological deficits and trunk dysfunction.
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Affiliation(s)
- Yuji Fujino
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo Bunkyo-ku, Tokyo, Japan.
| | - Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shinsuke Okawa
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | - Katsunobu Okuma
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | - Yota Kunieda
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Hiroshi Miki
- Department of Rehabilitation, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo Bunkyo-ku, Tokyo, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiyuki Fujiwara
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo Bunkyo-ku, Tokyo, Japan; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
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10
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Sih C, Mbatchou-Ngahane BH, Mboue-Djieka Y, Ngueng-Eke MC, Mbarga NT, Verla VS, Choukem SP. Incidence and impact of hospital-acquired complications in an internal medicine unit of a reference hospital in Cameroon: a prospective cohort study. Trans R Soc Trop Med Hyg 2021; 115:772-778. [PMID: 33210110 DOI: 10.1093/trstmh/traa116] [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: 07/15/2020] [Revised: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital-acquired complications (HACs) contribute to increased morbidity, mortality and hospital costs. However, their burden is often overlooked in resource-limited settings. We sought to determine the incidence, risk factors and effects of HACs on direct medical costs. METHODS This was a prospective cohort study conducted in the Internal Medicine inpatient ward of Douala General Hospital over 3 mo. Patients were examined daily from admission to discharge, transfer or death. Incidence of HACs was calculated and risk factors of HACs were determined using univariate and multivariate regression models. RESULTS The cumulative incidence rate of HACs in 230 participants was 29.2/1000 patient-days. The incidence rate of infectious and non-infectious complications was 8.4/1000 and 20.9/1000 patient-days, respectively. The most common HAC was constipation (8.3/1000 patient-days). The most common infection was urinary tract infection (3.7/1000 patient-days). HIV infection and length of stay >8 d were significantly associated with the occurrence of HACs. Deep vein thrombosis was associated with the highest direct medical cost. CONCLUSION The incidence of HACs is high in our setting and leads to increased length of hospital stays as well as greater direct medical costs. Thus, there is a need for effective preventive strategies.
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Affiliation(s)
- Colette Sih
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Bertrand Hugo Mbatchou-Ngahane
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Marie C Ngueng-Eke
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Nicole T Mbarga
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Vincent S Verla
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon
| | - Simeon-Pierre Choukem
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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11
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McGlinchey MP, McKevitt C, Faulkner-Gurstein R, Sackley CM. The rehabilitation of physical function after severely disabling stroke: a survey of UK therapist practice. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Individuals who are severely disabled from stroke (survivors of severely disabling stroke) experience poorer outcomes compared to those who are less disabled from stroke. However, there is a paucity of evidence describing current therapy practice in the management of severely disabling stroke. The aim of the study was to describe intervention and outcome measure use by physiotherapists and occupational therapists in the rehabilitation of physical function of survivors of severely disabling stroke. Methods A mixed-methods survey was conducted, involving an online questionnaire and follow-up interviews. Survey participants were UK-based physiotherapists and occupational therapists with experience treating stroke. Questionnaire data were analysed with descriptive and inferential statistics. Interview data were analysed using content analysis. Results A total of 452 therapists (59% physiotherapists) responded to the questionnaire. Out of the respondents, 18 self-selected therapists participated in follow-up interviews to explain questionnaire data. Whole body positioning, training of upper limb handling and positioning, and sitting balance practice were the most frequently used interventions. Inpatient-based therapists performed more active rehabilitation interventions, whereas community-based therapists performed more training and education. The Barthel Index, Modified Rankin Scale and National Institutes for Health Stroke Scale were the most frequently used outcome measures. Outcome measure use was generally low and was more likely to be completed when it was part of a national audit. Reasons for low outcome measure use were perceived lack of time and insensitivity to detect clinical change. Conclusions A variety of interventions and outcome measures are used in the rehabilitation of survivors of severely disabling stroke. There is a need to evaluate the effectiveness of frequently used interventions and identify outcome measures that are sensitive to the needs of survivors of severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Physiotherapy Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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12
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Chorath K, Luu N, Go BC, Moreira A, Rajasekaran K. ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2021; 166:425-433. [PMID: 34126805 DOI: 10.1177/01945998211019671] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. DATA SOURCE A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy. REVIEW METHODS Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care. RESULTS A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, -0.64 days [95% CI, -0.92 to -0.37]) and hospital costs (in US dollars; mean difference, -307.70 [95% CI, -346.49 to -268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]). CONCLUSION There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.
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Affiliation(s)
- Kevin Chorath
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil Luu
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Beatrice C Go
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Hendriks MMS, van Lotringen JH, Vos-van der Hulst M, Keijsers NLW. Bed Sensor Technology for Objective Sleep Monitoring Within the Clinical Rehabilitation Setting: Observational Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e24339. [PMID: 33555268 PMCID: PMC7971768 DOI: 10.2196/24339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/13/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Since adequate sleep is essential for optimal inpatient rehabilitation, there is an increased interest in sleep assessment. Unobtrusive, contactless, portable bed sensors show great potential for objective sleep analysis. Objective The aim of this study was to investigate the feasibility of a bed sensor for continuous sleep monitoring overnight in a clinical rehabilitation center. Methods Patients with incomplete spinal cord injury (iSCI) or stroke were monitored overnight for a 1-week period during their in-hospital rehabilitation using the Emfit QS bed sensor. Feasibility was examined based on missing measurement nights, coverage percentages, and missing periods of heart rate (HR) and respiratory rate (RR). Furthermore, descriptive data of sleep-related parameters (nocturnal HR, RR, movement activity, and bed exits) were reported. Results In total, 24 participants (12 iSCI, 12 stroke) were measured. Of the 132 nights, 5 (3.8%) missed sensor data due to Wi-Fi (2), slipping away (1), or unknown (2) errors. Coverage percentages of HR and RR were 97% and 93% for iSCI and 99% and 97% for stroke participants. Two-thirds of the missing HR and RR periods had a short duration of ≤120 seconds. Patients with an iSCI had an average nocturnal HR of 72 (SD 13) beats per minute (bpm), RR of 16 (SD 3) cycles per minute (cpm), and movement activity of 239 (SD 116) activity points, and had 86 reported and 84 recorded bed exits. Patients with a stroke had an average nocturnal HR of 61 (SD 8) bpm, RR of 15 (SD 1) cpm, and movement activity of 136 (SD 49) activity points, and 42 reported and 57 recorded bed exits. Patients with an iSCI had significantly higher nocturnal HR (t18=−2.1, P=.04) and movement activity (t18=−1.2, P=.02) compared to stroke patients. Furthermore, there was a difference between self-reported and recorded bed exits per night in 26% and 38% of the nights for iSCI and stroke patients, respectively. Conclusions It is feasible to implement the bed sensor for continuous sleep monitoring in the clinical rehabilitation setting. This study provides a good foundation for further bed sensor development addressing sleep types and sleep disorders to optimize care for rehabilitants.
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Affiliation(s)
- Maartje M S Hendriks
- Department of Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Noël L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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14
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Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:452-459. [PMID: 33598019 PMCID: PMC7863840 DOI: 10.5114/aic.2020.101771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/04/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction The impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) remains unclear. Aim Here, we studied the prevalence and the profile of IRAT in patients with AIS treated with MT, aiming to identify predictive factors and prognostic implications at 90 days after stroke. Material and methods We analyzed parameters available within 24 h after AIS including demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) upon admission and 24 h later, hemorrhagic transformation (HT) on computed tomography, and several clinical and biochemical markers. The outcome measures were the modified Rankin Scale (mRS) 0-2 and 90 days post-stroke mortality. Results We included 291 patients; in 184 (63.2%) patients MT was preceded by intravenous thrombolysis (IVT), and 83 (28.5%) patients developed IRAT. Multivariate analysis showed that male sex and hemorrhagic transformation on CT taken 24 h after stroke increased the risk of IRAT. We found that younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and a lack of hemorrhagic transformation on CT taken 24 h after stroke favorably affected outcome at day 90. Multivariate analysis showed that older age, higher delta NIHSS, unknown stroke etiology and lack of treatment with IVT were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter in the models for the studied outcome measures. Conclusions In AIS patients treated with MT, IRAT is not an independent factor that affects favorable outcome or mortality 90 days after stroke.
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15
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Chorath K, Go B, Shinn JR, Mady LJ, Poonia S, Newman J, Cannady S, Revenaugh PC, Moreira A, Rajasekaran K. Enhanced recovery after surgery for head and neck free flap reconstruction: A systematic review and meta-analysis. Oral Oncol 2020; 113:105117. [PMID: 33360446 DOI: 10.1016/j.oraloncology.2020.105117] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Head and neck free flap reconstruction requires multidisciplinary and coordinated care in the perioperative setting to ensure safe recovery and success. Several institutions have introduced enhanced recovery after surgery (ERAS) protocols to attenuate the surgical stress response and improve postoperative recovery. With multiple studies demonstrating mixed results, the success of these interventions on clinical outcomes has yet to be determined. OBJECTIVE To evaluate the impact of ERAS protocols and clinical care pathways for head and neck free flap reconstruction. METHODS We searched PubMed, SCOPUS, EMBASE, and grey literature up to September 1st, 2020 to identify studies comparing patients enrolled in an ERAS protocol and control group. Our primary outcomes included hospital length of stay (LOS) and readmission. Mortality, reoperations, wound complication and ICU (intensive care unit) LOS comprised our secondary outcomes. RESULTS 18 studies met inclusion criteria, representing a total of 2630 patients. The specific components of ERAS protocols used by institutions varied. Nevertheless, patients enrolled in ERAS protocols had reduced hospital LOS (MD -4.36 days [-7.54, -1.18]), readmission rates (OR 0.64 [0.45;0.92]), and wound complications (RR 0.41 [0.21, 0.83]), without an increase in reoperations (RR 0.65 [0.41, 1.02]), mortality (RR 0.38 [0.05, 2.88]), or ICU LOS (MD -2.55 days [-5.84, 0.74]). CONCLUSION There is growing body of evidence supporting the role of ERAS protocols for the perioperative management of head and neck free flap patients. Our findings reveal that structured clinical algorithms for perioperative interventions improve clinically-meaningful outcomes in patients undergoing complex ablation and microvascular reconstruction procedures.
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Affiliation(s)
- Kevin Chorath
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Beatrice Go
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Justin R Shinn
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Leila J Mady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Seerat Poonia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Jason Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Steven Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter C Revenaugh
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, TX, United States
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
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16
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Ocagli H, Cella N, Stivanello L, Degan M, Canova C. The Barthel index as an indicator of hospital outcomes: A retrospective cross-sectional study with healthcare data from older people. J Adv Nurs 2020; 77:1751-1761. [PMID: 33277770 DOI: 10.1111/jan.14708] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/28/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
AIMS The assessment of functional status is a more appropriate measure in the older people than traditional healthcare outcomes. The present study aimed to analyse the association between functional status assessed using the Barthel Index and length of stay, in-hospital mortality, discharge destination, and Diagnosis-Related Groups-based cost. DESIGN This study was a retrospective study that used administrative data from patients older than 65 discharged from the University Hospital of Padua (Italy) in 2016. METHODS A logistic regression model for categorical variables (length of stay, in-hospital mortality, and discharge destination) and a generalized linear model with gamma distributions and log links for continuous variables (cost of hospitalization) were used to evaluate associations with the Barthel Index. RESULTS A total of 13,484 admissions were included in the analysis. In-hospital mortality, safe discharge, and length of stay were higher in patients with severe dependence than in patients with mild/no dependence with a 12-fold increased risk of death (OR = 12.81; 95% CI 9.22-18.14), a 4 times greater likelihood of safe discharge (OR = 4.64; 95% CI 3.96-5.45), and a 2-fold increase in length of stay (OR = 2.56; 95% CI 2.34-2.81). On the other hand, no significant association was found between the cost of hospitalization and the Barthel Index. CONCLUSIONS Barthel Index was strongly associated with in-hospital mortality, discharge destination, and length of stay. The costs of hospitalization, however, were not related to patients' functional impairment. IMPACT The study considers functional status as an indicator of hospital outcomes. Better comprehension of the relationship between functional status and healthcare outcomes may help with early and adequate healthcare planning and resource management.
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Affiliation(s)
- Honoria Ocagli
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Nicoletta Cella
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.,Department of Internal Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Lucia Stivanello
- Health professional Management Service (DPS) of the University Hospital of Padova, Padova, Italy
| | - Mario Degan
- Health professional Management Service (DPS) of the University Hospital of Padova, Padova, Italy
| | - Cristina Canova
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
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17
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Park EP, Le JM, Gigliotti J, Feinstein J, Ying YP, Morlandt AB. Does Supplemental Regional Anesthesia Decrease Length of Stay and Opioid Use for Patients Undergoing Head and Neck Microvascular Reconstruction? J Oral Maxillofac Surg 2020; 79:712-721. [PMID: 32976833 DOI: 10.1016/j.joms.2020.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to compare length of hospital stay and opioid usage among head and neck surgery (HNS) patients treated with and without regional anesthesia for microvascular free-flap donor sites. METHODS The authors performed a retrospective cohort study for HNS patients undergoing microvascular free-flap reconstruction. The control group received no regional anesthesia. The experimental group had a regional anesthesia nerve block performed immediately before surgery. The primary outcome variable was length of stay, and the secondary outcome variable was total morphine milliequivalents. The data were analyzed using Student t tests, analysis of variance, Mann-Whitney U test, Kruskal-Wallis test, χ2 test, and multiple linear regression. RESULTS The study sample was composed of 148 patients with a mean age of 58.1 years. The mean length of stay for the control group was 6.74 ± 1.57 days, compared with the experimental group at 5.84 ± 1.01 days (P < .0001). The mean morphine milliequivalent was 256.5 ± 164.6 mg for the control group and 208.9 ± 164.8 mg for the experimental group (P = .56). Importantly, the demographics, pathology spectrum, flap selection, duration of procedure, and complication rate were similar in both groups. CONCLUSIONS This study demonstrates that for HNS patients undergoing microvascular reconstruction, regional nerve block at the donor site is associated with significantly shorter hospital stays. Although there was a trend toward decreased opioid usage in the regional anesthesia group, these results did not reach statistical significance. Consideration should be given to incorporate regional anesthesia techniques into early recovery after surgery protocols for centers performing high-volume head and neck microvascular reconstruction.
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Affiliation(s)
- Earl Peter Park
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Science Center, New Orleans, LA.
| | - John Minh Le
- Surgical Resident, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jordan Gigliotti
- Assistant Professor, Department of Oral & Maxillofacial Surgery, McGill University, Montreal, Canada
| | - Joel Feinstein
- Associate Professor and Director of Regional Anesthesia for University Hospitals, Department of Anesthesia and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Yedeh P Ying
- Assistant Professor, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Anthony B Morlandt
- Associate Professor and Section Chief of Oral Oncology and Microvascular Surgery, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
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18
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Liao Y, Vakanski A, Xian M, Paul D, Baker R. A review of computational approaches for evaluation of rehabilitation exercises. Comput Biol Med 2020; 119:103687. [PMID: 32339122 PMCID: PMC7189627 DOI: 10.1016/j.compbiomed.2020.103687] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/27/2022]
Abstract
Recent advances in data analytics and computer-aided diagnostics stimulate the vision of patient-centric precision healthcare, where treatment plans are customized based on the health records and needs of every patient. In physical rehabilitation, the progress in machine learning and the advent of affordable and reliable motion capture sensors have been conducive to the development of approaches for automated assessment of patient performance and progress toward functional recovery. The presented study reviews computational approaches for evaluating patient performance in rehabilitation programs using motion capture systems. Such approaches will play an important role in supplementing traditional rehabilitation assessment performed by trained clinicians, and in assisting patients participating in home-based rehabilitation. The reviewed computational methods for exercise evaluation are grouped into three main categories: discrete movement score, rule-based, and template-based approaches. The review places an emphasis on the application of machine learning methods for movement evaluation in rehabilitation. Related work in the literature on data representation, feature engineering, movement segmentation, and scoring functions is presented. The study also reviews existing sensors for capturing rehabilitation movements and provides an informative listing of pertinent benchmark datasets. The significance of this paper is in being the first to provide a comprehensive review of computational methods for evaluation of patient performance in rehabilitation programs.
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Affiliation(s)
- Yalin Liao
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | | | - Min Xian
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | - David Paul
- Department of Movement Sciences, University of Idaho, Moscow, USA
| | - Russell Baker
- Department of Movement Sciences, University of Idaho, Moscow, USA
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19
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McGlinchey MP, James J, McKevitt C, Douiri A, Sackley C. The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review. BMJ Open 2020; 10:e033642. [PMID: 32029489 PMCID: PMC7045156 DOI: 10.1136/bmjopen-2019-033642] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke. DESIGN Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength. RESULTS 28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence. CONCLUSIONS There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required. PROSPERO REGISTRATION NUMBER CRD42017077737.
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Affiliation(s)
- Mark P McGlinchey
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Jimmy James
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Abdel Douiri
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
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20
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Uivarosan D, Bungau S, Tit DM, Moisa C, Fratila O, Rus M, Bratu OG, Diaconu CC, Pantis C. Financial Burden of Stroke Reflected in a Pilot Center for the Implementation of Thrombolysis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E54. [PMID: 32013001 PMCID: PMC7074434 DOI: 10.3390/medicina56020054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 01/01/2023]
Abstract
Stroke represents a serious illness and is extremely relevant from the public health point of view, implying important social and economic burdens. Introducing new procedures or therapies that reduce the costs both in the acute phase of the disease and in the long term becomes a priority for health systems worldwide. The present study quantifies and compares the direct costs for ischemic stroke in patients with thrombolysis treatment versus conservative treatment over a 24-month period from the initial diagnosis, in one of the 7 national pilot centres for the implementation of thrombolytic treatment. The significant reduction (p < 0.001) of the hospitalization period, especially of the days in the intensive care unit (ICU) for stroke, resulted in a significant reduction (p < 0.001) of the total average costs in the patients with thrombolysis, both at the first hospitalization and for the subsequent hospitalizations, during the period followed in the study. It was also found that the percentage of patients who were re-hospitalized within the first 24-months after stroke was significantly lower (p < 0.001) among thrombolyzed patients. The present study demonstrates that the quick intervention in cases of stroke is an efficient policy regarding costs, of Romanian Public Health System, Romania being the country with the highest rates of new strokes and deaths due to stroke in Europe.
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Affiliation(s)
- Diana Uivarosan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Corina Moisa
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Ovidiu Fratila
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (O.F.); (M.R.)
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (O.F.); (M.R.)
| | - Ovidiu Gabriel Bratu
- Clinical Department 3, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Camelia C. Diaconu
- Department 5, University of Medicine and Pharmacy ”Carol Davila”, 050474 Bucharest, Romania;
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Carmen Pantis
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Emergency Clinical County Hospital, 410169 Oradea, Romania
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Pressure ulcer rates of stroke patients in a public rehabilitation hospital and training rates of nurses for pressure ulcer. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.593148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Tyagi S, Koh GCH, Nan L, Tan KB, Hoenig H, Matchar DB, Yoong J, Finkelstein EA, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Ng YL, Tan CS. Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors. BMC Health Serv Res 2018; 18:881. [PMID: 30466417 PMCID: PMC6251229 DOI: 10.1186/s12913-018-3696-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors. METHODS Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke. RESULTS Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p = 0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p = 0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p = 0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p = 0.032) subgroups respectively, compared to first quarter. CONCLUSION Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Luo Nan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, Durham, USA
| | - David B. Matchar
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Eric A. Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew’s Community Hospital, Singapore, Singapore
| | | | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Sherry H. Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keng Hee Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Reshma A. Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Yu Li Ng
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
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McGlinchey MP, James J, McKevitt C, Douiri A, McLachlan S, Sackley CM. The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke-protocol for a systematic review. Syst Rev 2018; 7:197. [PMID: 30447698 PMCID: PMC6240323 DOI: 10.1186/s13643-018-0870-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/02/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stroke rehabilitation aims to optimise function and reduce complications post-stroke. Rehabilitation to optimise physical function post-stroke has beneficial effects for survivors of mild to moderate stroke. However, little is known about the effectiveness of interventions to rehabilitate physical function or manage immobility-related complications for survivors of severe stroke. The systematic review aims to evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke and identify topics for future research in this area. METHODS A systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, AMED, PEDro, DORIS and CENTRAL) between January 1987 and July 2017 will be undertaken to identify eligible published randomised controlled trials (RCTs) in any language. Ongoing RCTs will be identified by searching health-care trial registers (Stroke Trials Registry, ClinicalTrials.gov). Hand searches of identified study reference lists will also be performed. The PRISMA statement will be used to guide the systematic review. Two reviewers will screen search results, select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Studies comparing the effect of one type of rehabilitation intervention to another or usual care on physical function and immobility-related complications for patients with severe stroke will be included. Studies may include participants with all levels of stroke severity but must provide sub-group analysis based on stroke severity. Studies will focus on any phase of the stroke rehabilitation pathway and will be grouped and analysed according to their timeframe post-stroke into acute and early sub-acute (up to 3 months post-stroke), early sub-acute to late sub-acute (from 3 to 6 months post-stroke) and chronic (greater than 6 months post-stroke). If sufficient studies demonstrate homogeneity, a meta-analysis will pool results of individual outcomes. The GRADE approach will be used to assess the evidence strength. DISCUSSION The results of this systematic review will summarise the strength of evidence for rehabilitation interventions used in the rehabilitation of physical function and immobility-related complications in severe stroke and identify gaps in evidence. SYSTEMATIC REVIEW REGISTRATION The systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO)-registration number CRD77737 .
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Affiliation(s)
- Mark P. McGlinchey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
- Physiotherapy Department, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - Jimmy James
- Physiotherapy Department, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Sarah McLachlan
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Catherine M. Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
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Lee YS, Kwon S, Chae Y, Jang BH, Ko SG. A retrospective cohort study on the outcomes of ischemic stroke patients with adjuvant Korean Medicine treatment. Sci Rep 2018; 8:1656. [PMID: 29374270 PMCID: PMC5786017 DOI: 10.1038/s41598-018-19841-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/08/2018] [Indexed: 12/14/2022] Open
Abstract
This study aims to examine the long-term effect of adjuvant treatment in Korean Medicine (KM) clinics in ischemic stroke patients, using a national sample cohort from the National Health Insurance Service in Korea between 2010 and 2013. The National Health Insurance Service - National Sample Cohort database from 2002 to 2013 was used in this study. Ischemic stroke patients were defined and covariates were included to account for socioeconomic variables, comorbidities and disease severity. Propensity score matching was applied. Cox proportional hazards modeling and Kaplan-Meier analysis were applied to determine the differences between KM and non-KM treated groups. The results shows that KM-treated group had a higher probability of survival than non-KM group patients. No significant difference was observed between the risk of readmission between the treated and non-treated patients. Kaplan-Meier analysis showed a weak effect of KM treatments in the patients with 8 to 28 days of hospital stay for a lower risk of recurrence than in non-treated patients. In conclusion, KM treatment of mild to moderate ischemic stroke patients has a mild effect on the survival probability of stroke. Its effect for improving long-term recurrence need to be explored in the future studies.
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Affiliation(s)
- Ye-Seul Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea.
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
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Schwarz M, Coccetti A, Cardell E, Murdoch A, Davis J. Management of swallowing in thrombolysed stroke patients: Implementation of a new protocol. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:551-561. [PMID: 27686633 DOI: 10.1080/17549507.2016.1221457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE There is a paucity of evidence regarding dysphagia management post-thrombolysis. The aim of this case-control study was to evaluate the impact of a dysphagia management protocol on patient outcomes. Thrombolysis has been completed at our metropolitan hospital since 2011 and a dysphagia management protocol was developed in 2012. METHOD Chart auditing was completed for 83 participants in three groups: pre-protocol (n = 12) (2011), post-protocol (n = 28) (2012-2014), and non-thrombolysed stroke patients (n = 43). RESULT Following the implementation of this clinical protocol, the average time patient remained nil by mouth reduced by 9.5 h, the percentage of patients who were malnourished or at risk reduced by 24% and the number of patients who developed aspiration pneumonia reduced by 11%. The cost of hospital stay reduced by $1505. Service compliance with best practice in dysphagia management in thrombolysed patients increased from 67% to 96% in the thrombolysed patient groups. CONCLUSION The outcomes suggest that a clinical protocol for dysphagia management in thrombolysed patients has the potential to improve service outcomes, reduce complications from dysphagia, have financial benefits for the hospital and increase service compliance. Furthermore, the results lend support for speech pathology services to manage dysphagia on weekends.
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Affiliation(s)
- Maria Schwarz
- a Department of Speech Pathology , Logan Hospital , Meadowbrook , Queensland , Australia
| | - Anne Coccetti
- a Department of Speech Pathology , Logan Hospital , Meadowbrook , Queensland , Australia
| | - Elizabeth Cardell
- b Discipline of Speech Pathology, Menzies Health Institute Queensland , Griffith University, Allied Health Sciences , Meadowbrook , Queensland , Australia , and
| | - Allison Murdoch
- c Department of Safety, Quality and Risk Management , Logan Hospital , Meadowbrook , Queensland , Australia
| | - Jennifer Davis
- a Department of Speech Pathology , Logan Hospital , Meadowbrook , Queensland , Australia
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Schwarz M, Coccetti A, Murdoch A, Cardell E. The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study. J Clin Nurs 2017; 27:e235-e241. [PMID: 28618137 DOI: 10.1111/jocn.13922] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine presence of clinical complications related to dysphagia and to explore their operational outcomes. BACKGROUND Dysphagia is a common complication of stroke. The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and checking for the development of complications such as fever, dehydration and change in medical status. Dysphagia often results in further complications including aspiration pneumonia and the need for nasogastric feeding. Dysphagia-related complications have been shown to have a significant impact on morbidity and mortality, length of stay and cost of admission. DESIGN Retrospective cohort study. METHODS A total of 110 patients presenting with an ischaemic stroke were chart-audited. RESULTS Aspiration pneumonia poststroke was found to be significantly associated with increased overall length of stay, poorer functional outcomes poststroke as well as being associated with a high risk of mortality. The presence of a nasogastric tube was also associated with reduced functional outcomes poststroke and increased risk of death. CONCLUSION High prevalence and cost of complications associated with stroke highlight the complexity of providing nursing and allied health care to this patient population. This provides a snapshot of dysphagia-related complications experienced by stroke patients. RELEVANCE TO CLINICAL PRACTICE This paper highlights that poststroke complications can significantly impact on patient outcomes and operational factors such as cost of admission; therefore, poststroke care requires a multidisciplinary approach to management. Furthermore, preventing and managing complications poststroke is a key element of nursing care and has the potential to significantly reduce incidence of mortality, length of stay and cost of hospital admission.
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Affiliation(s)
| | | | | | - Elizabeth Cardell
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Southport, Qld, Australia
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Janus-Laszuk B, Mirowska-Guzel D, Sarzynska-Dlugosz I, Czlonkowska A. Effect of medical complications on the after-stroke rehabilitation outcome. NeuroRehabilitation 2017; 40:223-232. [DOI: 10.3233/nre-161407] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Barbara Janus-Laszuk
- 2nd Department of Neurology, Rehabilitation Ward, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Dagmara Mirowska-Guzel
- 2nd Department of Neurology, Rehabilitation Ward, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology (CePT), Warsaw, Poland
| | - Iwona Sarzynska-Dlugosz
- 2nd Department of Neurology, Rehabilitation Ward, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Czlonkowska
- 2nd Department of Neurology, Rehabilitation Ward, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology (CePT), Warsaw, Poland
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Kang JH, Bae HJ, Choi YA, Lee SH, Shin HI. Length of Hospital Stay After Stroke: A Korean Nationwide Study. Ann Rehabil Med 2016; 40:675-81. [PMID: 27606274 PMCID: PMC5012979 DOI: 10.5535/arm.2016.40.4.675] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/05/2016] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the length of hospital stay (LOS) after stroke using the database of the Korean Health Insurance Review & Assessment Service. Methods We matched the data of patients admitted for ischemic stroke onset within 7 days in the Departments of Neurology of 12 hospitals to the data from the database of the Korean Health Insurance Review & Assessment Service. We recruited 3,839 patients who were hospitalized between January 2011 and December 2011, had a previous modified Rankin Scale of 0, and no acute hospital readmission after discharge. The patients were divided according to the initial National Institute of Health Stroke Scale score (mild, ≤5; moderate, >5 and ≤13; severe, >13); we compared the number of hospitals that admitted patients and LOS after stroke according to severity, age, and sex. Results The mean LOS was 115.6±219.0 days (median, 19.4 days) and the mean number of hospitals was 3.3±2.1 (median, 2.0). LOS was longer in patients with severe stroke (mild, 65.1±146.7 days; moderate, 223.1±286.0 days; and severe, 313.2±336.8 days). The number of admitting hospitals was greater for severe stroke (mild, 2.9±1.7; moderate, 4.3±2.6; and severe, 4.5±2.4). LOS was longer in women and shorter in patients less than 65 years of age. Conclusion LOS after stroke differed according to the stroke severity, sex, and age. These results will be useful in determining the appropriate LOS after stroke in the Korean medical system.
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Affiliation(s)
- Ji-Ho Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Ah Choi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Heon Lee
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Hyung Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Woznowski-Vu A, Da Costa C, Turgeon-Provost F, Dagenais K, Roy-Mathie B, Aggban M, Preuss R. Factors Affecting Length of Stay in Adult Outpatient Physical Rehabilitation: A Scoping Review of the Literature. Physiother Can 2016; 67:329-40. [PMID: 27504032 DOI: 10.3138/ptc.2014-75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify factors affecting length of stay (LOS) for adults participating in outpatient physical or occupational therapy programmes. METHOD A scoping review of the literature was conducted using the Ovid MEDLINE, EMBASE, CINAHL, AMED, and Cochrane Library databases. RESULTS A total of 19 articles were retained from the search, and 2 additional articles were retrieved from grey literature (i.e., non-published sources). Personal factors affecting LOS are age and sex, both of which had inconsistent effects on LOS, and communication, language, physical, and cognitive difficulties, for which higher levels of function were generally associated with shorter LOS. Institutional factors affecting LOS were location, interdisciplinary communication, number of disciplines involved, and type of rehabilitation setting. Finally, two clinician-related factors-fewer treatment goals and a selection of evidence-informed treatment techniques-were associated with shorter LOS. CONCLUSIONS Research on factors affecting adult outpatient rehabilitation LOS is limited and inconsistent. A preliminary list of LOS factors was produced, but this topic should be further explored with the collaboration of researchers and clinical institutions.
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Affiliation(s)
| | | | | | | | | | - Martina Aggban
- School of Physical and Occupational Therapy, McGill University
| | - Richard Preuss
- School of Physical and Occupational Therapy, McGill University; Constance Lethbridge Rehabilitation Centre, Centre de recherche interdisciplinaire en réadaptation, Montreal
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English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, Bernhardt J, Crotty M, Esterman A, Segal L, Hillier S. Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data. J Physiother 2016; 62:124-9. [PMID: 27320831 DOI: 10.1016/j.jphys.2016.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/14/2016] [Accepted: 05/23/2016] [Indexed: 11/15/2022] Open
Abstract
QUESTIONS Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? DESIGN This study pooled individual data from two randomised, controlled trials (n=350) using an individual patient data meta-analysis and multivariate regression. PARTICIPANTS People with stroke admitted to inpatient rehabilitation facilities. INTERVENTION Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). OUTCOME MEASURES Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. RESULTS Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge. DISCUSSION Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. CLINICAL TRIAL REGISTRATION ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.Journal of Physiotherapy62: 124-129].
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Affiliation(s)
- Coralie English
- School of Health Sciences, University of Newcastle; University of Newcastle Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle; International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide
| | - Nora Shields
- School of Allied Health, La Trobe University; Northern Health
| | - Natasha K Brusco
- School of Allied Health, La Trobe University; Physiotherapy Services, Cabrini Health
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health, Box Hill
| | - Jennifer J Watts
- Centre for Population Health Research, Deakin Health Economics, Deakin University
| | | | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Flinders University, Bedford Park Campus
| | - Adrian Esterman
- Division of Health Sciences, University of South Australia, Adelaide; Australian Institute of Health and Tropical Medicine, James Cook University, Cairns
| | - Leonie Segal
- Health Economics and Social Policy, Health Economics and Social Policy Group, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Susan Hillier
- International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide
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Johnson BH, Bonafede MM, Watson C. Short- and longer-term health-care resource utilization and costs associated with acute ischemic stroke. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:53-61. [PMID: 26966382 PMCID: PMC4770080 DOI: 10.2147/ceor.s95662] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS). Methods This retrospective claims analysis quantifies utilization and costs following inpatient admission for AIS among the commercially insured and Medicare beneficiaries in the Truven Health databases. Patients who were 18 years or older and continuously enrolled for 12 months before and after an AIS event occurring (index) between January 2009 and December 2012 were identified. Patients with AIS in the year preindex were excluded. Demographic and clinical characteristics were evaluated at admission and in the preindex, respectively. Direct costs, readmissions, and inpatient length of stay (LOS) were described in the year postindex. Results The eligible populations comprised 20,314 commercially insured patients and 31,037 Medicare beneficiaries. Average all-cause costs were $61,354 and $44,929 (commercial and Medicare, respectively) in the first year after the AIS. Approximately 50%–55% of total 12-month costs were incurred between day 31 and day 365 following the incident AIS. One quarter (24.6%) of commercially insured patients and 38.8% of Medicare beneficiaries were readmitted within 30 days with 16.6% and 71.7% (commercial and Medicare, respectively) of those having a principal diagnosis of AIS. The average AIS-related readmission length of stay was nearly three times that of the initial hospitalization for both commercially insured patients (3.8 vs 10.8 days) and Medicare beneficiaries (4.0 vs 10.8 days). Conclusion In addition to the substantial costs of the initial hospitalization of an AIS, these costs double within the year following this event. Given the high cost associated with AIS, new interventions reducing either the acute or longer-term burden of AIS are needed.
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Affiliation(s)
| | | | - Crystal Watson
- Health Economics and Outcomes Research, Biogen, Cambridge, MA, USA
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Peltola M, Seppälä TT, Malmivaara A, Belicza É, Numerato D, Goude F, Fletcher E, Heijink R. Individual and Regional-level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries. HEALTH ECONOMICS 2015; 24 Suppl 2:38-52. [PMID: 26633867 DOI: 10.1002/hec.3264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices.
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Affiliation(s)
- Mikko Peltola
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland
| | - Timo T Seppälä
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Dino Numerato
- Centre for Research on Health and Social Care Management, Bocconi University, Milano, Italy
- Department of Sociology, Faculty of Social Sciences, Charles University, Prague, The Czech Republic
| | - Fanny Goude
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Richard Heijink
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Ng CS, Toh MPHS, Ng J, Ko Y. Direct medical cost of stroke in Singapore. Int J Stroke 2015; 10 Suppl A100:75-82. [PMID: 26179153 DOI: 10.1111/ijs.12576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. AIMS To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. METHODS The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. RESULTS A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001). CONCLUSION There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority.
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Affiliation(s)
- Charmaine Shuyu Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Matthias Paul Han Sim Toh
- Information Management, Central Regional Health Office, National Healthcare Group, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jiaying Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Hayward KS, Brauer SG. Dose of arm activity training during acute and subacute rehabilitation post stroke: a systematic review of the literature. Clin Rehabil 2015; 29:1234-43. [PMID: 25568073 DOI: 10.1177/0269215514565395] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
AIM To determine the dose of activity-related arm training undertaken by stroke survivors during acute and subacute rehabilitation. METHODS A systematic review of PubMed, CINAHL and EMBASE up to December 2014 was completed. Studies were eligible if they defined the dose (time or repetitions) of activity-related arm training using observational methods for a cohort of adult stroke survivors receiving acute or subacute rehabilitation. All studies were quality appraised using an evidence-based learning critical appraisal checklist. Data was analysed by method of documented dose per session (minutes, repetitions), environment (acute or subacute rehabilitation) and therapy discipline (physiotherapy, occupational therapy). RESULTS Ten studies were included: two observed stroke survivors during acute rehabilitation and eight during subacute rehabilitation. During acute rehabilitation, one study reported 4.1 minutes per session during physiotherapy and 11.2 minutes during occupational therapy, while another study reported 5.7 minutes per session during physiotherapy only. During inpatient rehabilitation, activity-related arm training was on average undertaken for 4 minutes per session (range 0.9 to 7.9, n = 4 studies) during physiotherapy and 17 minutes per session (range 9.3 to 28.9, n = 3 studies) during occupational therapy. Repetitions per session were reported by two studies only during subacute rehabilitation. One study reported 23 repetitions per session during physiotherapy and occupational therapy, while another reported 32 repetitions per session across both disciplines. CONCLUSION The dose of activity-related arm training during acute and subacute rehabilitation after stroke is limited.
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Affiliation(s)
- Kathryn S Hayward
- Division of Physiotherapy, The University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, The University of Queensland, Brisbane, Australia
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Tistad M, Ytterberg C, Sjöstrand C, Widén Holmqvist L, von Koch L. Shorter Length of Stay in the Stroke Unit: Comparison Between the 1990s and 2000s. Top Stroke Rehabil 2015; 19:172-81. [DOI: 10.1310/tsr1902-172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pereira S, Ross Graham J, Shahabaz A, Salter K, Foley N, Meyer M, Teasell R. Rehabilitation of Individuals With Severe Stroke: Synthesis of Best Evidence and Challenges in Implementation. Top Stroke Rehabil 2015; 19:122-31. [DOI: 10.1310/tsr1902-122] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sugawara N, Metoki N, Hagii J, Saito S, Shiroto H, Tomita T, Yasujima M, Okumura K, Yasui-Furukori N. Effect of depressive symptoms on the length of hospital stay among patients hospitalized for acute stroke in Japan. Neuropsychiatr Dis Treat 2015; 11:2551-6. [PMID: 26491334 PMCID: PMC4599635 DOI: 10.2147/ndt.s91303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression after stroke is one of the most serious complications of stroke. Although many studies have shown that the length of hospital stay (LOHS) is a measurable and important stroke outcome, research has found limited evidence concerning the effect of depression on LOHS among patients who have experienced acute stroke. The objective of this study was to assess the effect of depression on LOHS among patients hospitalized for acute ischemic stroke in Japan. METHODS We retrospectively examined 421 patients who had experienced acute ischemic stroke. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS) on the 7th day of hospitalization. On the 10th day of hospitalization, depressive symptoms and functional assessment were assessed by the Japan Stroke Scale (Depression Scale) and the Functional Independence Measure, respectively. A general linear model was employed to assess the effect of probable depression on LOHS. RESULTS The prevalence of probable depression in the current sample was 16.3% in males and 17.8% in females. The mean LOHS of participants with probable depression (76.4±49.2 days) was significantly longer than that of participants without probable depression (44.9±39.2 days). An analysis using the general linear model to assess the effect on LOHS revealed a significant interaction between the presence of probable depression and NIHSS scores. CONCLUSION Depression after stroke was associated with significant increases in LOHS. Early detection and treatment for depression are necessary for patients with ischemic stroke.
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Affiliation(s)
- Norio Sugawara
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Shin Saito
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | - Tetsu Tomita
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | - Ken Okumura
- Department of Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
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Usui H, Nishida Y. Type A behavior pattern shortens length of stay in comprehensive rehabilitation units. J Phys Ther Sci 2015; 27:183-5. [PMID: 25642069 PMCID: PMC4305557 DOI: 10.1589/jpts.27.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/03/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to describe the importance of patient-related factors
in rehabilitation. We focused on the type A behavior pattern. If individuals with the type
A behavior pattern have better compliance, they would have a shorter length of hospital
stay than those with non-type A behavior. We compared the length of stay of patients with
the type A behavior pattern with that of patients with a non-type A behavior pattern.
[Subjects and Methods] Fifty-seven patients staying in a comprehensive rehabilitation unit
participated in this study. Type A behavior pattern, length of stay, and Barthel Index
were assessed. We use the Student’s t-test to examine the statistical differences in
length of stay and Barthel Index at discharge between subjects with type A behavior and
those without type A behavior. [Results] Age and Barthel Index at discharge were not
significantly different between the two groups. However, length of stay was significantly
higher in the non-type A group compared with the type A group. [Conclusion] Patients with
the type A behavior pattern had a shorter length of hospital stay than patients with a
non-type A behavior pattern. In conclusion, our results suggest that the type A behavior
pattern shortens the length of hospital stay. Those data show that we should consider the
patient’s characteristics in rehabilitation to protect the patient and for financial
benefit.
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Affiliation(s)
- Harunobu Usui
- Rehabilitation Science, Seirei Christopher University: 3453 Mikatabarachou, Kita-ku, Hamamatsu, Shizuoka 433-8558, Japan
- Omaezaki Municipal Hospital, Japan
| | - Yusuke Nishida
- Rehabilitation Science, Seirei Christopher University: 3453 Mikatabarachou, Kita-ku, Hamamatsu, Shizuoka 433-8558, Japan
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Kwon YH, Kwon JW, Lee NK, Kang KW, Son SM. Prevalence and determinants of pain in the ipsilateral upper limb of stroke patients. Percept Mot Skills 2014; 119:799-810. [PMID: 25387036 DOI: 10.2466/26.29.pms.119c28z2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study investigated the prevalence of pain in the ipsilateral upper-limb in stroke patients. 229 stroke patients (133 men, 96 women; M age = 59.0 yr., SD = 12.4) were assessed with the Pain Behaviors Scales and their motor weakness was measured with the Motricity Index. Results indicated that over 27% of patients experienced pain in at least one joint of the ipsilateral upper limb. Shoulder pain was the most common. Further analysis indicated that the occurrence of pain in the ipsilateral upper limb was higher among women, among patients who used a cane, and among patients with a greater weakness of the affected lower limb.
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Affiliation(s)
- Yong Hyun Kwon
- 1 Department of Physical Therapy, Yeungnam University College, Republic of Korea
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Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, Richardson M, Speechley M. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil 2014; 37:1316-23. [DOI: 10.3109/09638288.2014.963706] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew J. Meyer
- Graduate Program in Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
- Ontario Stroke Network, Toronto, Ontario, Canada,
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Shelialah Pereira
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Andrew McClure
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada,
| | - Robert Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, St Joseph's Health Care, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
- Centre for Studies in Family Medicine, Western University, London Ontario, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
| | - Marina Richardson
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
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Admission to and Continuation of Inpatient Stroke Rehabilitation in Queensland, Australia: A Survey of Factors that Contribute to the Consultant's Decision. BRAIN IMPAIR 2014. [DOI: 10.1017/brimp.2014.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aim: To evaluate factors that may contribute to the decision of the consultant medical officer (CMO) to: (1) admit a person with stroke to inpatient rehabilitation from acute hospitalisation; and (2) continue or cease inpatient rehabilitation.Methods: A web-based survey of CMOs practising in Queensland Australia, who were members of the Australian and New Zealand Society of Geriatric Medicine (n ~ 90) or the Queensland Stroke Clinical Network (n ~ 30) was completed. The survey contained two sections to explore factors that could: (1) favour or disfavour admission to inpatient rehabilitation from acute hospitalisation; and (2) favour continuation or cessation of inpatient rehabilitation. Open and closed questions were used.Results: Twenty-one CMOs (13–20% response rate, 43% geriatrician) completed the survey. Factors related to physical function, along with the presence of social supports favoured admission, while the presence of behavioural and cognitive impairments and a lack of staff capacity disfavoured admission. Improvements in function favoured continuation of inpatient rehabilitation, while a lack of improvement favoured cessation.Conclusion: Factors related to the patient, their social support network and the organisation were found to influence the decision of the CMO to admit a person with stroke to inpatient rehabilitation from acute hospitalisation. Once in rehabilitation, demonstration of benefit was consistently reported to indicate continued service need.
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Grant C, Goldsmith CH, Anton HA. Inpatient Stroke Rehabilitation Lengths of Stay in Canada Derived From the National Rehabilitation Reporting System, 2008 and 2009. Arch Phys Med Rehabil 2014; 95:74-8. [DOI: 10.1016/j.apmr.2013.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/30/2013] [Accepted: 08/16/2013] [Indexed: 11/25/2022]
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Adoukonou T, Kouna-Ndouongo P, Codjia JM, Covi R, Tognon-Tchegnonsi F, Preux PM, Houinato D. [Direct hospital cost of stroke in Parakou in northern Benin]. Pan Afr Med J 2013; 16:121. [PMID: 24839529 PMCID: PMC4021979 DOI: 10.11604/pamj.2013.16.121.2790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Les accidents vasculaires cérébraux constituent un véritable problème de santé publique en Afrique avec une charge importante. Les données fiables sur sa réelle charge économique sont rares en Afrique. L'objectif de cette étude était d’évaluer le coût direct hospitalier des AVC à Parakou au Bénin. Méthodes Il s'agissait d'une étude transversale économique ayant inclus des patients hospitalisés pour un AVC à l'hôpital de Parakou entre le 1er Juin 2010 au 31Mai 2011. Les données concernant les différents postes de consommation ont été collectées selon la méthode dite bottom-up. Le coût était envisagé du point de vue de la société et du patient. L'unité du coût était le franc CFA (valeur en 2011). Une régression linéaire multiple était utilisée pour déterminer les meilleurs prédicteurs du coût. Résultats Ils étaient 78 patients dont 52 hommes, âgés en moyenne de 57 ans ± 10.9. Le NIHSS moyen était de 14,4. Le taux de mortalité était de 20,5%. Le coût direct moyen était de 316.810,3 (±230.774,8) F CFA (environ 704 ± 512 Euros). Les grands postes de consommation étaient les explorations paracliniques (34.3%) les soins et médicaments (28.4%) et les frais d'hospitalisation (17.9%). Les meilleurs prédicteurs du coût élevé étaient un AVC hémorragique, un NIHSS élevé à l'admission et une longue durée d'hospitalisation. Conclusion Cette étude suggère un coût élevé de la prise en charge actuelle des AVC à Parakou.
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Affiliation(s)
- Thierry Adoukonou
- UER Neurologie, Faculté de Médecine Université de Parakou, 03BP10 Parakou, Benin ; Unité de Neurologie, Centre Hospitalier départemental du Borgou, Parakou, BP 02 Parakou, Benin
| | | | - Jean-Mannix Codjia
- Unité de Neurologie, Centre Hospitalier départemental du Borgou, Parakou, BP 02 Parakou, Benin
| | - Richmine Covi
- Unité de Neurologie, Centre Hospitalier départemental du Borgou, Parakou, BP 02 Parakou, Benin
| | | | - Pierre-Marie Preux
- INSERM UMR1094, Neuroépidémiologie Tropicale, Limoges, France; Université de Limoges, Faculté de Médecine, Institut d'Epidémiologie neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France; CHU Limoges, France
| | - Dismand Houinato
- UER Neurologie, Faculté des Science de la Santé, Université d'Abomey-Calavi, Bénin
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Ji R, Wang D, Shen H, Pan Y, Liu G, Wang P, Wang Y, Li H, Wang Y. Interrelationship among common medical complications after acute stroke: pneumonia plays an important role. Stroke 2013; 44:3436-44. [PMID: 24178914 DOI: 10.1161/strokeaha.113.001931] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Medical complications are common among patients with stroke. However, little is known about the potential interrelationship among them. In the present study, we aimed to investigate the association between common in-hospital medical complications after acute ischemic stroke (AIS) and spontaneous intracerebral hemorrhage (ICH). METHODS We analyzed patients enrolled in the China National Stroke Registry from 2007 to 2008. The occurrence of 11 common stroke-associated medical complications during acute hospitalization was prospectively registered. Multivariable analysis using generalized estimation equation was performed to assess association between medical complications in AIS and ICH cohort, respectively. RESULTS A total of 14 702 patients with AIS and 5221 patients with ICH were enrolled. The median age was 65 years (interquartile range, 55-74 years), and 38.1% were female. The median length of hospital stay was 14 days (interquartile range, 10-20 days) for AIS and 18 days (interquartile range, 11-26 days) for ICH. Pneumonia was the most common medical complication after AIS (11.4%) and ICH (16.8%). In the AIS cohort, after adjusting for potential confounders, pneumonia was significantly associated with development of gastrointestinal bleeding (adjusted odds ratio [OR], 8.35; 95% confidence interval [CI], 6.27-11.1; P<0.001), decubitus ulcer (adjusted OR, 5.31; 95% CI, 3.39-8.31; P<0.001), deep vein thrombosis (adjusted OR, 4.27; 95% CI, 2.41-7.59; P<0.001), epileptic seizure (adjusted OR, 3.96; 95% CI, 2.67-5.88; P<0.001), urinary tract infection (adjusted OR, 3.34; 95% CI, 2.73-4.10; P<0.001), atrial fibrillation/flutter (adjusted OR, 3.17; 95% CI, 2.58-3.90; P<0.001), and recurrent stroke (adjusted OR, 2.65; 95% CI, 2.07-3.40; P<0.001). Similar significant association between pneumonia and development of several nonpneumonia medical complications was verified in ICH cohort as well. CONCLUSIONS Pneumonia is closely associated with the development of several nonpneumonia medical complications after AIS and ICH.
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Affiliation(s)
- Ruijun Ji
- From the Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., G.L., P.W., Yilong Wang, H.L., Yongjun Wang); Department of Neurology, Illinois Neurological Institute, Peoria (D.W.); and Department of Statistics and Operation Research, University of North Carolina at Chapel Hill (H.S.)
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Myint PK, Clark AB, Kwok CS, Davis J, Durairaj R, Dixit AK, Sharma AK, Ford GA, Potter JF. The SOAR (Stroke subtype, Oxford Community Stroke Project classification, Age, prestroke modified Rankin) score strongly predicts early outcomes in acute stroke. Int J Stroke 2013; 9:278-83. [PMID: 23834262 DOI: 10.1111/ijs.12088] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 11/06/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND Previous prognostic scoring systems in predicting stroke mortality are complex, require multiple measures that vary with time and failed to produce a simple scoring system. AIMS/HYPOTHESIS The study aims to derive and internally validate a stroke prognostic scoring system to predict early mortality and hospital length of stay. METHODS Data from a U.K. multicenter stroke register were examined (1997-2010). Using a prior hypothesis based on our and others observations, we selected five patient-related factors (age, gender, stroke subtype, clinical classification, and prestroke disability) as candidate prognostic indicators. An 8-point score was derived based on multiple logistic regression model using four out of five variables. Performance of the model was assessed by plotting the estimated probability of in-hospital death against the actual probability by testing for overfitting (calibration) and area under the curve methods (discrimination). RESULTS The total sample consisted of 12,355 acute stroke patients (ischemic stroke 91.0%). The score predicted both in-patient and seven-day mortality. The crude in-patient mortality were 1.57%, 4.02%, 10.65%, 21.41%, 46.60%, 62.72%, and 75.81% for those who scored 0, 1, 2, 3, 4, 5, and 6, respectively. The calibration of the model revealed no evidence of overfitting (estimated overfitting 0.001). The area under the curve values for both in-hospital and seven-day mortality were 0.79. The score predicted length of stay with a higher score was associated with longer median length of stay in those discharged alive and shorter median length of stay in those who died (P for both <0.001). CONCLUSIONS A simple 8-point clinical score is highly predictive of acute stroke mortality and length of hospital stay. It could be used as prognostic tool in service planning and also to risk-stratify patients to use these outcomes as markers of stroke care quality across institutions.
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Affiliation(s)
- Phyo Kyaw Myint
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK; Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK; Clinical Gerontology Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
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Kim SM, Lee HJ, Shin DG. Economic Length of Stay and Opportunity Income of Appendectomy and Pneumonia Using Activity-based Costing. HEALTH POLICY AND MANAGEMENT 2013. [DOI: 10.4332/kjhpa.2013.23.2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Chen C, Koh GCH, Naidoo N, Cheong A, Fong NP, Tan YV, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Ng YS, Koh D, Chia KS, Teo YY. Trends in length of stay, functional outcomes, and discharge destination stratified by disease type for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005. Arch Phys Med Rehabil 2013; 94:1342-1351.e4. [PMID: 23333659 DOI: 10.1016/j.apmr.2013.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the trends in length of stay (LOS), rehabilitation functional outcome, and discharge destination of patients admitted for inpatient rehabilitation from 1996 to 2005 and stratified by disease in Singapore. DESIGN Retrospective national data were extracted from medical records of community-based inpatient rehabilitation admissions in Singapore from 1996 to 2005. SETTING Four community hospitals. PARTICIPANTS There were 12,506 first admissions for rehabilitation; 40.6% were for stroke, 30.4% for fracture, 2.9% for lower limb (LL) joint replacement, 2.3% for LL amputation, 1.9% for cancer, 1.8% for falls, 1.6% for pneumonia, and 18.5% for other illnesses. The overall mean age ± SD was 73.2±11.5 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES LOS, rehabilitation outcomes (rehabilitation effectiveness [R-effectiveness], rehabilitation efficiency [R-efficiency], relative functional efficiency [Relative-FE]), and discharge destination. RESULTS The overall median LOS for all disease groups decreased by 16.2% (37 to 31d) from 1996 to 2005. The sharpest decline in LOS among the 8 disease groups was observed in the LL amputation group. The overall mean ± SD admission and discharge activities of daily living scores were 45.6±25.7 and 60.3±28.9, respectively; median R-effectiveness was 28.8%, median R-efficiency was 12.9/30d, and median Relative-FE was 27.7%/30d. From 1996 to 2005, mean R-effectiveness increased by 184% (14% to 40%), R-efficiency increased by 104% (9 to 19 units/30d), and Relative-FE increased by 145% (21% to 51%/30d). Among all inpatient admissions, most were discharged home (78.2%), 10.9% were discharged to an acute hospital, and 9.8% were discharged to nursing or sheltered homes, with no significant change during the 10-year period. CONCLUSIONS Rehabilitation outcomes of patients admitted to Singapore's community hospitals have improved between 1996 and 2005 despite a decreasing LOS. Discharge destinations have largely remained unchanged over this period.
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Affiliation(s)
- Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
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48
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Caballero-Estévez N, Domínguez-Rodríguez A, Dorta-Jiménez CA, Marí-López B, Abreu-González P, Avanzas P. [Role of nursing in the cardiac intensive care unit for predicting mean hospital stay based on the Barthel Index in patients with acute coronary syndrome]. Med Intensiva 2012; 37:620-1. [PMID: 23260266 DOI: 10.1016/j.medin.2012.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/25/2012] [Accepted: 10/29/2012] [Indexed: 11/26/2022]
Affiliation(s)
- N Caballero-Estévez
- Servicio de Cardiología, Hospital Universitario de Canarias, Tenerife, España
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Jung SH, Lee KM, Park SW, Chun MH, Jung HY, Kim IS, Kim SH, Han TR. Inpatient Course and Length of Hospital Stay in Patients with Brain Disorders in South Korea: A Population-based Registry Study. Ann Rehabil Med 2012. [PMID: 23185724 PMCID: PMC3503935 DOI: 10.5535/arm.2012.36.5.609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe inpatient course and length of hospital stay (LOS) for people who sustain brain disorders nationwide. METHOD We interviewed 1,903 randomly selected community-dwelling patients registered as 'disabled by brain disorders' in 28 regions of South Korea. RESULTS Seventy-seven percent were initially admitted to a Western medicine hospital, and 18% were admitted to a traditional Oriental medicine hospital. Forty-three percent were admitted to two or more hospitals. Mean LOS was 192 days. Most patients stayed in one hospital for more than 4 weeks. The transfer rate to other hospitals was 30-40%. Repeated admissions and increased LOS were related to younger onset age, higher education, non-family caregiver employment, smaller families, and more severe disability. CONCLUSION Korean patients with brain disorders showed significantly prolonged LOS and repeated admissions. Factors increasing burden of care influenced LOS significantly.
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Affiliation(s)
- Se Hee Jung
- Department of Rehabilitation Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 156-707, Korea
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Koh GCH, Wee LE, Rizvi NA, Chen C, Cheong A, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Petrella R, Thind A, Koh D, Chia KS. Socio-demographic and Clinical Profile of Admissions to Community Hospitals in Singapore from 1996 to 2005: A Descriptive Study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n11p494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Little data is available on community hospital admissions. We examined the differences between community hospitals and the annual trends in sociodemographic characteristics of all patient admissions in Singaporean community hospitals over a 10-year period from 1996 to 2005. Materials and Methods: Data were manually extracted from medical records of 4 community hospitals existent in Singapore from 1996 to 2005. Nineteen thousand and three hundred and sixty patient records were examined. Chi-square test was used for univariate analysis of categorical variables by type of community hospitals. For annual trends, test for linear by linear association was used. ANOVA was used to generate beta coefficients for continuous variables. Results: Mean age of all patient admissions has increased from 72.8 years in 1996 to 74.8 years in 2005. The majority was Chinese (88.4%), and female (58.1%) and admissions were mainly for rehabilitation (88.0%). Almost one third had foreign domestic workers as primary caregivers and most (73.5%) were discharged to their own home. There were significant differences in socio-demographic profile of admissions between hospitals with one hospital having more patients with poor social support. Over the 10-year period, the geometric mean length of stay decreased from 29.7 days (95% CI, 6.4 to 138.0) to 26.7 days (95% CI, 7.5 to 94.2), and both mean admission and discharge Barthel Index scores increased from 41.0 (SD = 24.9) and 51.8 (SD = 30.0), respectively in 1996 to 48.4 (SD = 24.5) and 64.2 (SD = 27.3) respectively in 2005. Conclusion: There are significant differences in socio-demographic characteristics and clinical profile of admissions between various community hospitals and across time. Understanding these differences and trends in admission profiles may help in projecting future healthcare service needs.
Key words: Annual trends, Barthel Index scores, Caregivers, Length of stay, Rehabilitation
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Affiliation(s)
- Gerald CH Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Nashia Ali Rizvi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | | | | | - Chye Hua Ee
- Elderly Care and Health Consultancy, Singapore
| | | | - Robert Petrella
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Amardeep Thind
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - David Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
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