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van Allen Z, Orsholits D, Boisgontier MP. Pre-stroke physical activity matters for functional limitations: A longitudinal case-control study of 12,860 participants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.09.14.23295576. [PMID: 37745591 PMCID: PMC10516084 DOI: 10.1101/2023.09.14.23295576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective In the chronic phase after a stroke, limitations in activities of daily living (ADLs) and instrumental ADL (IADLs) initially plateau before steadily increasing. The benefits of pre-stroke physical activity on these limitations remain unclear. To clarify this relationship, we examined the effect of physical activity on the long-term evolution of functional limitations in a cohort of stroke survivors and compared it to a cohort of matched stroke-free adults. Methods Longitudinal data from 2,143 stroke survivors and 10,717 stroke-free adults aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; 8 data collection waves). Physical activity was assessed in the pre-stroke wave. Functional limitations were assessed in the post-stroke waves. Each stroke survivor was matched with 5 stroke-free adults who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADL and IADL, chronic conditions and country of residence, before any of the participants from either cohort had experienced a stroke. Results Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the effect of physical activity being stronger in stroke survivors (b = -0.345, 95% CI = -0.438 to -0.252) than in stroke-free adults (b = -0.269, 95% CI = -0.269 to -0.241). Conclusion The beneficial effect of pre-stroke physical activity on ADL limitations after stroke is stronger than its effect in matched stroke-free adults followed for a similar number of years. Impact Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, pre-stroke levels of physical activity can inform the prognosis of functional dependence in stroke survivors.
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Affiliation(s)
- Zack van Allen
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care, Ottawa, Canada
| | - Dan Orsholits
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
| | - Matthieu P. Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care, Ottawa, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
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Stolwyk RJ, Mihaljcic T, Wong DK, Chapman JE, Rogers JM. Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes: A Systematic Review and Meta-Analysis. Stroke 2021; 52:748-760. [PMID: 33493048 DOI: 10.1161/strokeaha.120.032215] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis aimed to investigate whether cognition is associated with activity and participation outcomes in adult stroke survivors. Five databases were systematically searched for studies investigating the relationship between general- and domain-specific cognition and longer-term (>3 months) basic activities of daily living (ADL), instrumental ADLs, and participation outcomes. Eligibility for inclusion, data extraction, and study quality was evaluated by 2 reviewers using a standardized protocol. Effect sizes (r) were estimated using a random-effects model. Sixty-two publications were retained for review, comprising 7817 stroke survivors (median age 63.57 years, range:18-96 years). Median length of follow-up was 12 months (range: 3 months-11 years). Cognition (all domains combined) demonstrated a significant medium association with all 3 functional outcomes combined, r=0.37 (95% CI, 0.33-0.41), P<0.001. Moderator analyses revealed these effects persisted regardless of study quality, order in which outcomes were collected (sequential versus concurrent), age, sample size, or follow-up period. Small to medium associations were also identified between each individual cognitive domain and the separate ADL, instrumental ADL, and participation outcomes. In conclusion, poststroke cognitive impairment is associated with early and enduring activity limitations and participation restrictions, and the association is robust to study design factors, such as sample size, participant age, follow-up period, or study quality. Cognitive assessment early poststroke is recommended to facilitate early detection of disability, prediction of functional outcomes, and to inform tailored rehabilitation therapies.
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Affiliation(s)
- Renerus J Stolwyk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Tijana Mihaljcic
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Dana K Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia (D.K.W.)
| | - Jodie E Chapman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Jeffrey M Rogers
- Faculty of Medicine and Health, The University of Sydney, Australia (J.M.R.)
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Jingwen J, Han J, Yu Z, Xiaojun H, Junpeng Z, Fanxia S, Jianrong L. Quality of life among patients during subacute phase following stroke during hospitalisation period in Shanghai. Int J Psychiatry Clin Pract 2018; 22:296-303. [PMID: 29457918 DOI: 10.1080/13651501.2018.1432763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: This study aimed to investigate the factors influencing the quality of life of in-hospital subacute stroke patients. Methods: The patients of subacute stroke (within four weeks) in our institution between 2015 and 2016 were recruited. Patients' characteristics and QOL were obtained from medical charts and stroke-specific quality of life scale (SS-QOL). Associations of each domain in SS-QOL with socio-demographic, clinical factors and patient satisfaction were investigated using the linear regression models. Results: Among the 203 subjects, 60 were diagnosed as large artery atherosclerosis (LAA), 80 were small-artery occlusion (SAO), 28 were cardioembolism (CE) and 35 were intracranial haemorrhage (ICH). The ICH group had the worst self-care ability and upper extremity function. Worse severity of stroke was associated with lower levels of language ability, mobility, mood status and upper-extremity function. Participants who had better satisfaction had high levels of capability of conducting family roles, positive emotions, personality consistency, self-care ability and capacity of conducting social roles. Conclusions: The level of patient satisfaction, duration of hospitalisation and the severity of stroke were found to be the three important factors associated with SS-QOL at hospital discharge, indicating doctors might assist patients adjust to the consequences of stroke and improve the QOL of subacute stroke.
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Affiliation(s)
- Jiang Jingwen
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Jin Han
- b Centre for Mental Health Research , The Australian National University , Canberra , Australia
| | - Zhang Yu
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Huang Xiaojun
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Zhuang Junpeng
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Shen Fanxia
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Liu Jianrong
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
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Acute Predictors of Social Integration Following Mild Stroke. J Stroke Cerebrovasc Dis 2018; 27:1025-1032. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/19/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022] Open
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Mandić M, Arandjelović M, Nikolić M, Rančić N. ASSESSMENT OF HEALTH - RELATED QUALITY OF LIFE OF POST - STROKE SURVIVORS. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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A structural equation model of the relationship between muscle strength, balance performance, walking endurance and community integration in stroke survivors. PLoS One 2017; 12:e0185807. [PMID: 29049293 PMCID: PMC5648126 DOI: 10.1371/journal.pone.0185807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To use structural equation modelling (SEM) to determine (1) the direct and indirect associations of strength of paretic lower limb muscles with the level of community integration, and (2) the direct association of walking endurance and balance performance with the level of community integration in community-dwelling stroke survivors. Materials and methods In this cross-sectional study of 105 stroke survivors, the Subjective Index of Physical and Social Outcome (SIPSO) was used to measure the level of community integration. Lower-limb strength measures included isometric paretic ankle strength and isokinetic paretic knee peak torque. The Berg Balance Scale (BBS) and the 6-minute walk test (6MWT) were used to evaluate balance performance and walking endurance, respectively. Results SEM revealed that the distance walked on the 6MWT had the strongest direct association with the SIPSO score (β = 0.41, p <0.001). An increase of one standard deviation in the 6MWT distance resulted in an increase of 0.41 standard deviations in the SIPSO score. Moreover, dorsiflexion strength (β = 0.18, p = 0.044) and the BBS score (β = 0.21, p = 0.021) had direct associations with the SIPSO score. Conclusions The results of the proposed model suggest that rehabilitation training of community-dwelling stroke survivors could focus on walking endurance, balance performance and dorsiflexor muscle strengthening if the aim is to augment the level of community integration.
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George S, Wilcock AA, Stanley M. Depression and Lability: The Effects on Occupation following Stroke. Br J Occup Ther 2016. [DOI: 10.1177/030802260106400907] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Case study methodology was used to explore the effect of emotional changes following a stroke on engagement in occupation. Two people who had had a stroke, and their partners, were interviewed. The participants' medical case notes from acute, rehabilitation and outpatient treatment were also reviewed. As a result of the stroke, one participant experienced depression and the other lability. The case studies illustrate the impact that emotional changes can have on the performance of occupations. They also illustrate the reverse, that perceived competence in the performance of occupations can affect emotions, either negatively or positively. The results point to a need for occupational therapists to take an occupational perspective, if wellbeing is to be maximised, as they consider and address the effects of emotional changes with people who have had a stroke.
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Karube N, Sasaki A, Hondoh F, Odagiri C, Hagii J, Seino S, Yasujima M, Osanai T. Quality of Life in Physical and Psychological Health and Social Environment at Posthospitalization Period in Patients with Stroke. J Stroke Cerebrovasc Dis 2016; 25:2482-7. [PMID: 27363621 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/06/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Interaction of quality of life (QOL) in physical and psychological health and social environment has not been tested in stroke during a posthospitalization period, and a better understanding of the components of QOL would lead to a more integrated and person-centered approach to health management and outcome optimization. We investigated how QOL emerges from the sequelae of stroke and interacts with each other during the posthospitalization period. METHODS We performed a cross-sectional study in 53 outpatients of stroke survivors (39 men and 14 women with a mean age of 66 years, 46 infarctions, and 7 hemorrhages). RESULTS Eight QOL domains of psychological health were scored by interview, and 2 of them ("desire to distend what they can do" or "desire to do rehabilitation") were associated with the improvement of physical health during the posthospitalization period (P < .05 and P = .08, respectively). These patients were characterized by the items like "I need to succeed for health improvement, to go home, to go back to work, and to see grandchildren" as goals to achieve their desire (P < .05). In interaction of QOL in psychological health and social environment, another psychological domain "to gain satisfaction from the experience" was closely related to the presence of hobby or work before stroke attack (P < .05). CONCLUSION During the posthospitalization period, QOL of psychological health may support that of physical health, being associated with the presence of hobby or work before stroke attack.
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Affiliation(s)
- Narumi Karube
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Aya Sasaki
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Fumika Hondoh
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Chiyo Odagiri
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Satoshi Seino
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | - Tomohiro Osanai
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan.
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Ibeneme SC, Anyachukwu CC, Nwosu A, Ibeneme GC, Bakare M, Fortwengel G. Symptoms of Poststroke Depression among Stroke Survivors: An Appraisal of Psychiatry Needs and Care during Physiotherapy Rehabilitation. SCIENTIFICA 2016; 2016:5646052. [PMID: 27190683 PMCID: PMC4846762 DOI: 10.1155/2016/5646052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
Abstract
Purpose. To identify stroke survivors with symptoms of poststroke depression and the extent of psychiatry needs and care they have received while on physiotherapy rehabilitation. Participants. Fifty stroke survivors (22 females and 28 males) at the outpatient unit of Physiotherapy Department, University of Nigeria Teaching Hospital, Enugu, who gave their informed consent, were randomly selected. Their age range and mean age were 26-66 years and 54.76 ± 8.79 years, respectively. Method. A multiple case study of 50 stroke survivors for symptoms of poststroke depression was done with Beck's Depression Inventory, mini mental status examination tool, and Modified Motor Assessment Scale. The tests were performed independently by the participants except otherwise stated and scored on a scale of 0-6. Data were analyzed using Z-test for proportional significance and chi-square test for determining relationship between variables, at p < 0.05. Results. Twenty-one (42.0%) stroke survivors had symptoms of PSD, which was significantly dependent on duration of stroke (χ (2) = 21.680, df = 6, and p = 0.001), yet none of the participants had a psychiatry review. Conclusions. Symptoms of PSD may be common in cold compared to new cases of stroke and may need psychiatry care while on physiotherapy rehabilitation.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu 40024, Nigeria
- German UNESCO Unit on Bioethics, Fakultat III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, 30539 Hannover, Germany
| | - Canice Chukwudi Anyachukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu 40024, Nigeria
| | - Akachukwu Nwosu
- National Institute for Sports, Surulere, Lagos 101283, Nigeria
| | - Georgian Chiaka Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Medicine, Ebonyi State University, Abakaliki 5480214, Nigeria
| | - Muideen Bakare
- Federal Neuro-Psychiatric Hospital, New Haven, Enugu 400221, Nigeria
| | - Gerhard Fortwengel
- German UNESCO Unit on Bioethics, Fakultat III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, 30539 Hannover, Germany
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Yoon JA, Park SG, Roh HL. Comparisons of social interaction and activities of daily living between long-term care facility and community-dwelling stroke patients. J Phys Ther Sci 2015; 27:3127-31. [PMID: 26644659 PMCID: PMC4668150 DOI: 10.1589/jpts.27.3127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 07/09/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study was conducted to compare the correlation between social interaction
and activities of daily living (ADL) between community-dwelling and long-term care
facility stroke patients. [Subjects and Methods] The Subjects were 65 chronic stroke
patients (32 facility-residing, 33 community-dwelling). The Evaluation Social Interaction
(ESI) tool was used to evaluate social interaction and the Assessment of Motor and Process
Skills (AMPS) measure was used to evaluate ADL. [Results] Both social interaction and ADL
were higher in community-dwelling than facility-residing stroke patients. There was a
correlation between ESI and ADL for both motor and process skills among facility-residing
patients, while only ADL process skills and ESI correlated among community-dwelling
patients. In a partial correlation analysis using ADL motor and process skills as control
variables, only process skills correlated with ESI. [Conclusion] For rehabilitation of
stroke patients, an extended treatment process that combines ADL and social activities is
likely to be required. Furthermore, treatment programs and institutional systems that can
improve social interaction and promote health maintenance for community-dwelling and
facility-residing chronic stroke patients are needed throughout the rehabilitation
process.
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Affiliation(s)
- Jeong-Ae Yoon
- Department of Occupational Therapy, Daejeon Health Science College, Republic of Korea
| | - Se-Gwan Park
- Department of Physical Therapy, Daejeon Verterans Hospital, Republic of Korea
| | - Hyo-Lyun Roh
- Department of Physical Therapy, Kangwon National University, Republic of Korea
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McCarthy MJ, Lyons KS, Powers LE. Expanding Poststroke Depression Research: Movement Toward a Dyadic Perspective. Top Stroke Rehabil 2015; 18:450-60. [DOI: 10.1310/tsr1805-450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Rachpukdee S, Howteerakul N, Suwannapong N, Tang-Aroonsin S. Quality of life of stroke survivors: a 3-month follow-up study. J Stroke Cerebrovasc Dis 2012; 22:e70-8. [PMID: 22749628 DOI: 10.1016/j.jstrokecerebrovasdis.2012.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/07/2012] [Accepted: 05/12/2012] [Indexed: 11/25/2022] Open
Abstract
The assessment of stroke survivors' quality of life (QoL) is essential for planning poststroke therapy strategies. This study aimed to assess, compare, and identify predictors of unsatisfactory QoL in different dimensions of stroke survivors at 1 month and 3 months poststroke. A total of 125 stroke survivors were recruited from 4 public hospitals under the auspices of the Department of Medical Services, Bangkok Metropolitan Administration, Thailand, and followed for 3 months. QoL was assessed using the self-administered SF-36 Health Survey, version 2.0. Six specific dimensions of QoL--physical function, role-physical, bodily pain, general health, vitality, and role-emotional--were significantly improved at 3 months poststroke; however, 2 dimensions--social function and mental health--were not. Multiple logistic regression analysis revealed that at 1 month poststroke, significant predictors of unsatisfactory QoL were being dependent (Barthel Index score <80), severe cognitive impairment (Canadian Neurological Scale score <7), right hemisphere lesions, being single or widowed, age ≥ 60 years, and being unemployed poststroke. At 3 months poststroke, significant predictors of unsatisfactory QoL were being dependent (Barthel Index score <80), severe cognitive impairment (Canadian Neurological Scale score <7), being single or widowed, being unemployed poststroke, and self-supporting/other support for treatment fees. This follow-up study demonstrated a significant improvement in QoL from 1 month to 3 months poststroke. Predictors of QoL varied both over time poststroke and over the specific dimensions of QoL being considered.
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Saxena SK, Ng TP, Yong D, Fong NP, Koh G. Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation. Acta Neurol Scand 2008; 117:133-40. [PMID: 18184349 DOI: 10.1111/j.1600-0404.2007.00922.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subthreshold depression (sD) and cognitive impairment but not demented (CIND) in stroke patients are associated with poorer rehabilitative outcomes. Their diagnosis can easily be operationalized using validated scales. AIM The aim of the study was to ascertain the prevalence of depressive symptoms and cognitive impairment in stroke patients during three crucial stages of the rehabilitative process, viz. upon admission, upon planned discharges from rehabilitation hospitals and at 6 months post-stroke, using validated scales like the Geriatric Depression Scale and Abbreviated Mental Test (recommended by the British Geriatric Society). Their baseline risk factors were also ascertained. RESULTS On admission, the prevalence of depressive symptoms and cognitive impairment was 60% and 54% respectively. The prevalence upon planned discharges and 6 months post-stroke, respectively, of depressive symptoms was 38% and 34% and that of impaired cognition was 33% and 40%. Baseline independent correlates at 6 months post-stroke depressive symptoms were: recurrent stroke (OR 3.34); on admission cognitive impairment (OR 4.78) and ADL dependence (OR 5.28). And that of cognitive impairment were: increasing age (OR 8.07); post-stroke dysphagia (OR 4.58); on admission cognitive impairment (OR 23.95) and on admission depressive symptoms (OR 3.50). CONCLUSIONS Continuous screening and appropriate intervention, especially at baseline, would significantly decrease the burden posed by stroke patients with such psychological impairments in the community.
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Chung L, Wang YH, Chen TJ, Pan AW. The predictive factors for length of stay for stroke patients in Taiwan using the path model. Int J Rehabil Res 2006; 29:137-43. [PMID: 16609325 DOI: 10.1097/01.mrr.0000194391.11031.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the predictive factors, and their relative strengths, for predicting length of rehabilitation stay using the path model. One hundred and seventeen stroke patients were recruited from two rehabilitation units in university-affiliated hospitals in northern Taiwan. The Taiwanese Rehabilitation Database System was used to collect the patient's relevant information. Path analysis was used to explore the relative strengths of each predictive factor. The results showed that the ability to engage in self-care activities was the only direct predictor, whereas subjective well-being and cognitive social skills had an indirect effect on the length of rehabilitation stay, mediating through cognitive-social skills and ability to engage in activities of daily living, respectively. The effect of subjective well-being, mediating through cognitive-social skills, on the length of stay was about 1.5 times that of the effects of ability to engage in self-care activities on length of stay. The results of the study confirmed that the ability of stroke patients to engage in self-care activities consistently had a major impact on the length of stay. The effect of subjective well-being of the patients on the rehabilitation outcome raised the issue of psychosocial rehabilitation as an important part of successful rehabilitation services.
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Affiliation(s)
- Lylnn Chung
- Department of Statistics, College of Business, National Taipei University, Taiwan
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Abstract
The objectives of this study were to examine the demographic and clinical characteristics of stroke patients admitted for inpatient rehabilitation, to study the occurrence of medical problems/complications, and to document functional outcome and possible factors influencing outcome. The mean age of this cohort (30 females, 53 males) was 58+/-12 years and the mean length of hospital stay was 45.7+/-23 days. The most common medical comorbidity was hypertension (65%), followed by heart disease (42%) and diabetes mellitus (22%). The length of hospital stay was related to the number of medical comorbidities (r=0.24, P<0.05). Almost all patients experienced several medical problems during rehabilitation stay (average 7.1 events/patient). Shoulder dysfunction (80.7%), symptomatic blood pressure fluctuations (72.3%) and psychosocial problems (57.8%) were among the most common problems. There was a statistically significant improvement in total Functional Independence Measure scores from admission to discharge (56.5 vs. 74.6), with a mean gain of 18.1. Functional Independence Measure gain was significantly correlated with onset to admission time (r=-0.21, P<0.05), length of hospital stay (r=0.50, P<0.001) and the number of previous strokes (r=-0.23, P<0.05), but not with age, onset to admission interval, comorbidities and the presence of medical problems. Discharge total Functional Independence Measure scores were significantly correlated only with the admission total Functional Independence Measure scores (r=0.72, P<0.001) and onset-admission interval (r=-0.23, P<0.05). Significant functional improvements were documented in this cohort of stroke patients after an interdisciplinary rehabilitation approach. Discharge functional status was best correlated with admission functional status. Medical problems/complications were common among patients undergoing stroke rehabilitation. In our patients, functional outcomes were not significantly influenced by the occurrence of medical problems.
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Affiliation(s)
- Nilüfer Gökkaya
- Ankara Physical Medicine and Rehabilitation, Education and Research Hospital, Ankara, Turkey
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Turner-Stokes L, Hassan N. Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 1: Diagnosis, frequency and impact. Clin Rehabil 2002; 16:231-47. [PMID: 12017511 DOI: 10.1191/0269215502cr487oa] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital. This systematic review was undertaken as a preliminary step to explore the available evidence on which to base an integrated care pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting. It is divided into two parts. AIMS AND OBJECTIVES In part 1 we review the frequency of depression in stroke and its impact on functional recovery. Also the different methods for diagnosis and measurement. METHODS Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews. MAIN FINDINGS PSD is common and is associated with cognitive, functional and social deficits which potentially limit the outcome from rehabilitation. However, diversity of assessment tools and diagnostic criteria confound assimilation of the available literature. The Beck Depression Inventory (BDI), Hamilton Depression Rating Scale and Zung Self-rating Depression Scale were most commonly used and have demonstrable validity in stroke patients but tend to exclude those with aphasia. Instruments developed specifically to include aphasic patients, such as the Stroke Aphasic Depression Scale, are promising but have yet to be fully evaluated. CONCLUSIONS Further work is required to adapt and evaluate instruments to measure depression in the context of stroke. Development of an integrated care pathway may help to establish a more consistent approach to assessment and diagnosis of PSD.
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Affiliation(s)
- Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK.
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Ozdemir F, Birtane M, Tabatabaei R, Kokino S, Ekuklu G. Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings. Arch Phys Med Rehabil 2001; 82:1375-9. [PMID: 11588740 DOI: 10.1053/apmr.2001.25973] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare outcomes in stroke survivors who received rehabilitation services in an acute inpatient rehabilitation setting (multidisciplinary rehabilitation team) with outcomes in survivors in a home-based setting (family caregivers, limited team supervision). DESIGN Randomized clinical trial, with mean follow-up after 60 days. SETTING Inpatient rehabilitation setting and home-based settings. PATIENTS Sixty patients (age range, 43-80yr) who had a stroke between 1996 and 1999 and had been referred after medical stabilization, randomly divided into 2 groups: group 1, inpatient rehabilitation; group 2, home-based rehabilitation. INTERVENTIONS Group 1: therapeutical and neuromuscular exercises with occupational therapy with professional supervision; group 2: conventional exercises with family caregiver and limited professional supervision. MAIN OUTCOME MEASURES Spasticity was evaluated with the Ashworth Scale, motor status with Brunnstrom's stages, functional status with the FIM instrument, and cognitive status with the Mini-Mental State Examination before and after rehabilitation. RESULTS Patients rehabilitated in acute inpatient settings had better motor, functional, and cognitive outcomes (p < .05). Spasticity changes did not differ between the groups. CONCLUSION Intense inpatient rehabilitation services for stroke survivors provide significantly more favorable functional and cognitive outcomes with relatively low complications than did nonintense rehabilitation efforts in home settings.
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Affiliation(s)
- F Ozdemir
- Department of Physical Medicine and Rehabilitation, Trakya University School of Medicine, Edirne, Turkey
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Golomb BA, Vickrey BG, Hays RD. A review of health-related quality-of-life measures in stroke. PHARMACOECONOMICS 2001; 19:155-185. [PMID: 11284381 DOI: 10.2165/00019053-200119020-00004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The objective of this review was to evaluate health-related quality of life (HR-QOL) measures for use with patients with stroke. HR-QOL measures are increasingly used for assessment in many health conditions; these measures may serve an important role in evaluating the impact of stroke and of stroke interventions. HR-QOL measures used in patients with stroke should: (i) cover the domains of HR-QOL that may be affected by stroke; (ii) have administration characteristics suitable for use in patients with stroke; and (iii) have undergone reliability and validity assessment in patients with stroke. The present study evaluates HR-QOL measures with reference to these requirements. A systematic literature review was conducted to identify and evaluate HR-QOL measures of potential use in studies of patients with stroke. Identified measures were assessed with regard to stroke-relevant domains covered, measure characteristics (e.g. self-administration versus administration by an interviewer, interviewer time to complete) and psychometric properties of reliability and validity. The measures evaluated vary widely on domains covered, and limited assessment of the performance of HR-QOL measures has been conducted in patients with stroke. No existing measure comprehensively covers all relevant domains or addresses fully the issues of obtaining and combining HR-QOL assessments in patients and proxies in many stroke populations. Additional psychometric testing in stroke populations is needed for existing HR-QOL measures. In addition, stroke-targeted HR-QOL measures need to be developed and evaluated with patients with stroke.
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Affiliation(s)
- B A Golomb
- RAND Health Sciences Program and Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA.
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Green WL. Evidence-based emergency medicine. Feedback: "think or die!". Ann Emerg Med 2000; 36:253-4. [PMID: 10969232 DOI: 10.1067/mem.2000.109943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- W L Green
- Department of Emergency Medicine, Caritas Medical Center, University of Louisville, Louisville KY, USA
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Abstract
The effect of social functioning and depression on recovery from stroke was examined in 142 patients with acute stroke who were followed over 2 years. Examination included a semistructured mental status examination, the Social Functioning Examination (SFE) and diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom criteria for major and minor depressive disorders. At short-term follow-up (3 to 6 months), both impairment in social functioning and depression were related to impaired recovery in activities of daily living and cognitive functioning. On the other hand, at long-term follow-up (1 to 2 years), only depression influenced recovery from physical impairment. In addition, we found no significant interaction between depression and social impairment on activities of daily living or social functioning. These data suggest that both depression and impaired social function have independent negative effects on physical recovery from stroke. These data also suggest that treatment of depression as well as early psychosocial intervention may play an important role in the quality of life after acute stroke.
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Affiliation(s)
- K Shimoda
- Department of Psychiatry, University of Iowa College of Medicine, Iowa City, USA
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22
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Sinoff G, Ore L. The Barthel activities of daily living index: self-reporting versus actual performance in the old-old (> or = 75 years). J Am Geriatr Soc 1997; 45:832-6. [PMID: 9215334 DOI: 10.1111/j.1532-5415.1997.tb01510.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The Barthel Index for assessing activities of daily living (ADL) was developed particularly for young stroke patients, but it now has a wider application in the geriatric assessment profile. This study tests the validity of the Barthel Index by self-report in the old-old (> or = 75 years). If more than 10% of the studied population assessed themselves incorrectly (> or = 15-point discrepancy), the test may have limitations. We set out to try to quantify and explain this discrepancy. METHODS During a 3-month period, we tested 126 old-old patients, both geriatric medical inpatients and subjects from the community, in a cross-sectional study. Using the Barthel Index, their functional status was assessed by self-report and by observation of performance. A measure of the magnitude of discrepancy between the two methods (discrepancy score) was calculated as the difference between the self-report and performance total scores. RESULTS Comparing the self-report with actual ADL performance scores, the mean score for self-report was higher (90 vs 88). There was a low Kappa score in all areas of the scale (range 0.103-0.398). Twenty of the 126 patients (15.9%) scored 15 or more points in the discrepancy score. By running a multiple linear regression, we were able to explain only 21% of the variance in the discrepancy score (R2 = .21). Significant explanatory variables were the presence of cognitive impairment, source of patients from acute geriatric ward, and age (very old > or = 85 years). CONCLUSION For the purpose of this study, use of the Barthel Index by self-reporting was found to have its limitations in the old-old (> or = 75 years), particularly with regard to the very old (> or = 85 years) medical geriatric inpatients. Therefore, we suggest that the older people may have to be assessed by the rehabilitation services using a performance-based measure or a different self-report test for documenting their activities of daily living, bearing in mind that self-reported and performance-based measures capture physical abilities differently.
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Affiliation(s)
- G Sinoff
- Department of Geriatrics, Carmel Medical Center, Haifa, Israel
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Bailey M, Rennie N. Physiotherapy support for carers of stroke patients: a survey of carer's opinions. ACTA ACUST UNITED AC 1997. [DOI: 10.12968/bjtr.1997.4.2.14507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maggie Bailey
- Department of Physiotherapy Studies at Keele University, Keele, Staffordshire ST5 5BG and
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Glass TA, Maddox GL. The quality and quantity of social support: stroke recovery as psycho-social transition. Soc Sci Med 1992; 34:1249-61. [PMID: 1641684 DOI: 10.1016/0277-9536(92)90317-j] [Citation(s) in RCA: 150] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The impact of various types and amounts of social support is examined in the context of recovery from first stroke. We conceptualize the rehabilitation process as a psychosocial transition. In a longitudinal design, 44 patients were followed for 6 months following first stroke. Growth-curve analysis (repeated measures MANOVA) was utilized to examine the impact of three types of social support on changes in functional status during recovery. While all three types of support (emotional, instrumental and informational) were shown to be significantly related to recovery of functional capacity, substantial differences were found in the nature of those effects. The impact of social support does not appear during the first month of rehabilitation, indicating the importance of longitudinal designs and longer observation. Patients reporting high level of emotional support showed dramatic improvement despite having the lowest baseline functional status. Instrumental support is most closely related to positive outcomes when provided in moderate amounts. Unlike the other two types, the effect of informational support is mediated by disease severity.
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Affiliation(s)
- T A Glass
- Department of Epidemiology and Public Health, Yale University, School of Medicine, New Haven, CT 06510-8034
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25
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Reintegration for Stroke Survivors. Nurs Clin North Am 1991. [DOI: 10.1016/s0029-6465(22)00314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Stroke is the third leading cause of death in North America. Most studies indicate that women are just as likely as men to have an initial stroke but less likely to have a recurrent stroke. Aspirin and ticlopidine are two antiplatelet drugs that reduce the risk of recurrent stroke by 25% to 30%. In some stroke prevention trials, aspirin has been shown to be more effective for men than for women. In contrast, major stroke prevention trials using ticlopidine have demonstrated equal benefit in women and in men. The overall incidence of adverse effects seen with ticlopidine is not significantly different from that observed with aspirin. There are now two effective agents useful in stroke prevention in both men and women.
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Affiliation(s)
- L A Hershey
- Department of Neurology, State University of New York, Buffalo
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Wong DH. Perioperative stroke. Part I: General surgery, carotid artery disease, and carotid endarterectomy. Can J Anaesth 1991; 38:347-73. [PMID: 2036698 DOI: 10.1007/bf03007628] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although stroke, defined as a focal neurological deficit lasting more than 24 hr, is uncommon in the perioperative period, its associated mortality and long-term disability are high. No large-scale data are available to identify the importance of recognized risk factors for stroke in the perioperative period. A review of the literature shows that the incidence and mechanism of its occurrence are influenced by the presence of cardiovascular disease and the type of surgery. The most common cause of perioperative stroke is embolism. In non-cardiac surgery, the incidence of perioperative stroke is higher among the elderly. Properly administered, controlled hypotension is associated with minimal risk of stroke. Cerebral vasospasm may be the cause of focal cerebral ischaemia in eclamptic patients, and the aggressive treatment of hypertension may exacerbate the neurological damage. The risk of stroke associated with carotid endarterectomy is closely related to the preoperative neurological presentation, and the experience of the surgical/anaesthetic team. Symptomatic cerebrovascular disease, acute stroke, asymptomatic carotid lesions, preoperative assessment of risk, local and general anaesthesia, cerebral protection and monitoring during carotid endarterectomy are discussed with reference to reducing the risk of perioperative stroke. Adequate monitoring and protection have minimized the risk of ischaemia from carotid clamping, and the major mechanism of stroke is embolization.
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Affiliation(s)
- D H Wong
- Department of Anaesthesia, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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