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O’Brien MK, Lanotte F, Khazanchi R, Shin SY, Lieber RL, Ghaffari R, Rogers JA, Jayaraman A. Early Prediction of Poststroke Rehabilitation Outcomes Using Wearable Sensors. Phys Ther 2024; 104:pzad183. [PMID: 38169444 PMCID: PMC10851859 DOI: 10.1093/ptj/pzad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Inpatient rehabilitation represents a critical setting for stroke treatment, providing intensive, targeted therapy and task-specific practice to minimize a patient's functional deficits and facilitate their reintegration into the community. However, impairment and recovery vary greatly after stroke, making it difficult to predict a patient's future outcomes or response to treatment. In this study, the authors examined the value of early-stage wearable sensor data to predict 3 functional outcomes (ambulation, independence, and risk of falling) at rehabilitation discharge. METHODS Fifty-five individuals undergoing inpatient stroke rehabilitation participated in this study. Supervised machine learning classifiers were retrospectively trained to predict discharge outcomes using data collected at hospital admission, including patient information, functional assessment scores, and inertial sensor data from the lower limbs during gait and/or balance tasks. Model performance was compared across different data combinations and was benchmarked against a traditional model trained without sensor data. RESULTS For patients who were ambulatory at admission, sensor data improved the predictions of ambulation and risk of falling (with weighted F1 scores increasing by 19.6% and 23.4%, respectively) and maintained similar performance for predictions of independence, compared to a benchmark model without sensor data. The best-performing sensor-based models predicted discharge ambulation (community vs household), independence (high vs low), and risk of falling (normal vs high) with accuracies of 84.4%, 68.8%, and 65.9%, respectively. Most misclassifications occurred with admission or discharge scores near the classification boundary. For patients who were nonambulatory at admission, sensor data recorded during simple balance tasks did not offer predictive value over the benchmark models. CONCLUSION These findings support the continued investigation of wearable sensors as an accessible, easy-to-use tool to predict the functional recovery after stroke. IMPACT Accurate, early prediction of poststroke rehabilitation outcomes from wearable sensors would improve our ability to deliver personalized, effective care and discharge planning in the inpatient setting and beyond.
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Affiliation(s)
- Megan K O’Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Francesco Lanotte
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Rushmin Khazanchi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sung Yul Shin
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Richard L Lieber
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Roozbeh Ghaffari
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - John A Rogers
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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Chevalley O, Truijen S, Opsommer E, Saeys W. Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis. Clin Rehabil 2023; 37:1698-1716. [PMID: 37424501 PMCID: PMC10580673 DOI: 10.1177/02692155231185446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation. DATA SOURCES A search of PubMed, Embase, CINHAL, The Cochrane Library (Trials), Web of Science, and PEDro were conducted up until May 2023. METHODS Two independent reviewers selected studies for population (patients with stroke), predictive factors (physical functioning), outcome (discharge destination), setting (inpatient rehabilitation), and study designs (observational and experimental studies). Predictive factors were identified among assessments of the "body function" and "activity" components of the International Classification of Functioning. Methodological quality was assessed with the Newcastle-Ottawa Scale. The findings used quantitative and narrative syntheses. Meta-analyses were performed with the inverse variance method and the random-effects model using included studies with sufficient data. RESULTS Forty-five studies were included with 204,787 participants. Included studies assessed the association of independence in activities of daily living, walking, rolling, transferring, and balance on admission with a probability of returning home. Motor (odds ratio = 1.23, 95% confidence interval: 1.12-1.35, p < .001) and total (odds ratio = 1.34, 95% confidence interval: 1.14-1.57, p < .001) Functional Independence Measure scores on admission were significantly associated with home discharge in meta-analyses. Additionally, included studies showed that independence in motor activities, such as sitting, transferring, and walking, and scores above thresholds for the Functional Independence Measure and Berg Balance Scale on admission were associated with discharge destination. CONCLUSION This review showed that higher independence in activities of daily living on admission is associated with home discharge after inpatient stroke rehabilitation.
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Affiliation(s)
- Odile Chevalley
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Emmanuelle Opsommer
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Fujita T, Yamane K, Yamamoto Y, Sone T, Ohira Y, Otsuki K, Iokawa K. Age-stroke related dysfunction interaction associated with home discharge of stroke inpatients in the rehabilitation ward. Medicine (Baltimore) 2023; 102:e34152. [PMID: 37352048 PMCID: PMC10289490 DOI: 10.1097/md.0000000000034152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/06/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
The purpose of this study was to investigate whether interactions exist among cognitive and physical functions and activities of daily living (ADL) associated with home discharge of stroke patients in the rehabilitation ward. The subjects were 231 patients with a first stroke. Age, gender, affected side, the stroke impairment assessment set, ADL and discharge destination were collected from the medical record. Using a decision tree, a combination of variables that might have an interaction effect associated with home discharge was extracted. The existence of an interaction between the extracted variables was confirmed by logistic regression analysis. A combination of total score of the stroke impairment assessment set (≤27 points) and age (>76.5 years) at admission was extracted from the decision tree. As a result of the logistic regression analysis, this interaction term was significantly associated with home discharge. The findings of the present study suggest that there is an interaction between age and stroke-related dysfunction related to home discharge. Stroke patients aged over 76.5 years with the stroke impairment assessment set score of 27 or less at admission to the rehabilitation ward may need rehabilitation program considering the difficulty of home discharge.
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Affiliation(s)
- Takaaki Fujita
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Kazuhiro Yamane
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Yuichi Yamamoto
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Toshimasa Sone
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Yoko Ohira
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Koji Otsuki
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Kazuaki Iokawa
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
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Řasová K, Martinková P, Vařejková M, Miznerová B, Pavlíková M, Hlinovská J, Hlinovský D, Philippová Š, Novotný M, Pospíšilová K, Biedková P, Vojíková R, Havlík J, O'Leary VB, Černá M, Bartoš A, Philipp T. COMIRESTROKE—A clinical study protocol for monitoring clinical effect and molecular biological readouts of COMprehensive Intensive REhabilitation program after STROKE: A four-arm parallel-group randomized double blinded controlled trial with a longitudinal design. Front Neurol 2022; 13:954712. [DOI: 10.3389/fneur.2022.954712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
IntroductionWhile the role of physiotherapy as part of a comprehensive inpatient rehabilitation is indisputable, clear evidence concerning the effectiveness of different rehabilitation managements [interdisciplinary implementing the International Classification of Functioning, disability and health (ICF) vs. multidisciplinary model] and physiotherapy categories (neuroproprioceptive “facilitation, inhibition” vs. motor/skill acquisitions using technologies) are still lacking. In this study, four kinds of comprehensive inpatient rehabilitation with different management and content of physical therapy will be compared. Moreover, focus will be placed on the identification of novel biological molecules reflective of effective rehabilitation. Long non-coding RNAs (lncRNAs) are transcripts (>200 bps) of limited coding potential, which have recently been recognized as key factors in neuronal signaling pathways in ischemic stroke and as such, may provide a valuable readout of patient recovery and neuroprotection during therapeutic progression.Methods and analysisAdults after the first ischemic stroke in an early sub-acute phase with motor disability will be randomly assigned to one of four groups and undergo a 3 weeks comprehensive inpatient rehabilitation of different types: interdisciplinary team work using ICF model as a guide; multidisciplinary teamwork implementing neuroproprioceptive “facilitation and inhibition” physiotherapy; multidisciplinary teamwork implementing technology-based physiotherapy; and standard multidisciplinary teamwork. Primary (the Goal Attainment Scale, the Patient-Reported Outcomes Measurement Information System, and the World Health Organization Disability Assessment Schedule) and secondary (motor, cognitive, psychological, speech and swallowing functions, functional independence) outcomes will be measured. A blood sample will be obtained upon consent (20 mls; representing pre-rehabilitation molecular) before and after the inpatient program. Primary outcomes will be followed up again 3 and 12 months after the end of the program. The overarching aim of this study is to determine the effectiveness of various rehabilitation managements and physiotherapeutic categories implemented by patients post ischemic stroke via analysis of primary, secondary and long non-coding RNA readouts. This clinical trial will offer an innovative approach not previously tested and will provide new complex analysis along with public assessable molecular biological evidence of various rehabilitation methodology for the alleviation of the effects of ischemic stroke.Clinical trial registrationNCT05323916, https://clinicaltrials.gov/ct2/show/NCT05323916.
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Andrews AW, Bohannon RW. Functional Independence predicts patients with stroke more likely to be discharged to the community after inpatient rehabilitation. Top Stroke Rehabil 2022; 30:393-401. [PMID: 35156558 DOI: 10.1080/10749357.2022.2038834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Functional domain predictors of discharge destination following inpatient rehabilitation for stroke have not been thoroughly identified. OBJECTIVES 1) Determine the relationships between intrinsic variables (demographic; comorbidities; functional independence at admission to and at discharge from an inpatient rehabilitation facility (IRF)) and discharge to home. 2) Determine cut scores for Functional Independence Measure® (FIM) subscales and domains that predict discharge to the community. METHODS This study was a secondary analysis of a large, multi-IRF dataset from the Uniform Data System for Medical Rehabilitation. Participants were adults with stroke who were discharged from an IRF in 2019 (n = 92,153). RESULTS Correlations with discharge to the community were strongest for discharge FIM scores (r = 0.330 to 0.580), followed by admission FIM scores (r = 0.245 to 0.411), which were stronger than the demographic and comorbidity variables (r = 0.005 to 0.110). Logistic regression analysis indicated 5 of 6 FIM domains (Social Cognition, Self-care, Sphincter, Transfer, and Locomotion) scored at admission and at discharge were predictive of discharge home. Receiver operating characteristic curve analyses determined the best cut point for each domain. For each FIM measure, the area under the curve was greater when the measure was obtained at discharge than it was at admission. CONCLUSIONS Clinicians may consider the cut points presented for each domain at admission and at discharge when setting goals or making recommendations for patients with stroke who aspire to a discharge from an IRF to a community setting.
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Yoshitaka T, Shimaoka Y, Yamanaka I, Tanida A, Tanimoto J, Toda N, Akimori T, Hamawaki J. Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People. Prog Rehabil Med 2022; 7:20220026. [PMID: 35633759 PMCID: PMC9110876 DOI: 10.2490/prm.20220026] [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: 08/27/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Hip fracture is a common injury occurring in elderly people and often impairs their
activities of daily living (ADL). This study aimed to identify and analyze factors
associated with ADL following hip fracture treatment. Methods: A total of 371 consecutive patients with hip fractures who were surgically treated in
our hospital were enrolled. Among these, 103 patients who underwent acute- to
recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the
functional independence measure (mFIM) score was ≥70 before the fracture were finally
included in this study. Single and multiple regression analyses were performed to
identify the factors correlated with ADL. The mFIM at hospital discharge was set as the
outcome variable, and various clinical factors, such as fracture type, surgical
technique, serum and biological data, mini-mental state examination (MMSE) score, and
serial mFIM scores, were used as explanatory variables. Results: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at
discharge, and MMSE had the larger effect on the outcome. Receiver operating
characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an
MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2–3 weeks
postoperatively compared with those with an MMSE score of ≥21. Conclusion: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL
outcomes following hip fracture. Cognitive impairment was the most important factor
affecting ADL; treatment and postoperative rehabilitation should be carefully considered
for cognitively disturbed patients from the acute phase after hip fracture.
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Affiliation(s)
- Teruhito Yoshitaka
- Department of Orthopedic Surgery, Hiroshima City Rehabilitation Hospital, Hiroshima, Japan
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Fujita T, Sone T, Yamamoto Y, Yamane K, Tsuchiya K, Ohira Y, Otsuki K, Iokawa K. Impact of Sensory Impairment on Improvement of Upper-limb Function in Patients under 75 Years of Age with Subacute Stroke: A Preliminary Study. Prog Rehabil Med 2021; 6:20210045. [PMID: 34888427 PMCID: PMC8613479 DOI: 10.2490/prm.20210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: The aim of this study was to investigate whether an interaction exists between sensory impairment and age with respect to the recovery of upper-limb function in patients with subacute stroke. Methods: This retrospective observational study included 83 patients recovering from subacute stroke in a rehabilitation hospital ward. The recovery of upper-limb function in four groups classified by age and sensory impairment were compared using analysis of covariance. Furthermore, multiple regression analysis was performed with recovery of upper-limb function as the dependent variable and with binarized sensory impairment and binarized age and their interaction term as the independent variables. Results: The estimated marginal means of upper-limb recovery were significantly higher in the non-late elderly (≤74 years) without sensory impairment group than in the other three groups. No significant differences were observed among the following three groups: the non-late elderly with sensory impairment, the late elderly (≥75 years) without sensory impairment, and the late elderly with sensory impairment. In multiple regression analysis, the interaction term between sensory impairment and age was significantly associated with improvement in upper-limb function (β=0.16, P <0.05). Age alone was significant, but sensory impairment alone was not significant. Conclusions: Sensory impairment in patients with subacute stroke affects the recovery of upper-limb function as a result of age interactions.
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Affiliation(s)
- Takaaki Fujita
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Toshimasa Sone
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Yuichi Yamamoto
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Japan
| | - Kazuhiro Yamane
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Yoko Ohira
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Japan
| | - Koji Otsuki
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Japan
| | - Kazuaki Iokawa
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
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Campo M, Toglia J, Jaywant A, O'Dell MW. Young individuals with stroke in rehabilitation: a cohort study. Int J Rehabil Res 2021; 44:314-322. [PMID: 34417407 DOI: 10.1097/mrr.0000000000000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke in younger populations is a public health crisis and the prevalence is rising. Little is known about the progress of younger individuals with stroke in rehabilitation. Characterization of the course and speed of recovery is needed so that rehabilitation professionals can set goals and make decisions. This was a cohort study with data extracted from electronic medical records. Participants were 408 individuals diagnosed with stroke who participated in inpatient rehabilitation in an urban, academic medical center in the USA. The main predictor was age which was categorized as (18-44, 45-64, 65-74 and 75+). Outcomes included baseline-adjusted discharge functional independence measure (FIM) scores and FIM efficiency. In linear regression models for FIM scores, the reference category was the youngest age group. The oldest group was discharged with significantly lower FIM total (B = -8.84), mobility (B = -4.13), self-care (B = -4.07) and cognitive (B = -1.57) scores than the youngest group after controlling for covariates. The 45-64 group also finished with significantly lower FIM total (B = -6.17), mobility (B = -2.61) and self-care (B = -3.01) scores than youngest group. FIM efficiencies were similar for all ages in each of the FIM scales. Younger individuals with stroke make slightly greater functional gains compared to older individuals with stroke, but other factors, such as admission scores, are more important and the rates of recovery may be similar.
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Affiliation(s)
- Marc Campo
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry
- Department of Rehabilitation Medicine, Weill Cornell Medicine
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry
- Department of Rehabilitation Medicine, Weill Cornell Medicine
- New York-Presbyterian Hospital/Weill Cornell Medical Center
| | - Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine
- New York-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine
- New York-Presbyterian Hospital/Weill Cornell Medical Center
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Stein J, Rodstein BM, Levine SR, Cheung K, Sicklick A, Silver B, Hedeman R, Egan A, Borg-Jensen P, Magdon-Ismail Z. Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study. Stroke 2021; 53:947-955. [PMID: 34706561 DOI: 10.1161/strokeaha.121.034815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The criteria for determining the level of postacute care for patients with stroke are variable and inconsistent. The purpose of this study was to identify key factors influencing the selection of postacute level of care for these patients. METHODS We used a collaborative 4-round Delphi process to achieve a refined list of factors influencing postacute level of care selection. Our Delphi panel of experts consisted of 32 panelists including physicians, physical therapists, occupational therapists, speech-language pathologists, nurses, stroke survivors, administrators, policy experts, and individuals associated with third-party insurance companies. RESULTS In round 1, 207 factors were proposed, with subsequent discussion resulting in consolidation into 15 factors for consideration. In round 2, 15 factors were ranked with consensus on 10 factors; in round 3,10 factors were ranked with consensus on 9 factors. In round 4, the final round, 9 factors were rated with Likert scores ranging from 5 (most important) to 1(not important). The percentage of panelists who provided a rating of 4 or above were as follows: likelihood to benefit from an active rehabilitation program (97%), need for clinicians with specialized rehabilitation skills (94%), need for active and ongoing medical management and monitoring (84%), ability to tolerate an active rehabilitation program (74%), need for caregiver training to return to the community (48%), family/caregiver support (39%), likelihood to return to community/home (39%), ability to return to physical home environment (32%), and premorbid dementia (16%). CONCLUSIONS This study provides an expert, consensus-based set of key factors to be considered when determining where stroke patients are discharged for postacute care. These factors may be useful in developing a decision support tool for use in clinical settings.
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Affiliation(s)
- Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, NY (J.S.).,Department of Rehabilitation Medicine, Weill Cornell Medical College, NY (J.S.).,NewYork-Presbyterian Hospital, NY (J.S.)
| | - Barry M Rodstein
- University of Massachusetts Medical School-Baystate Health, Springfield (B.M.R.)
| | - Steven R Levine
- Departments of Neurology and Emergency Medicine, and Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY (S.R.L.).,Department of Neurology, Kings County Hospital Center, Brooklyn, NY (S.R.L.).,Jaffe Stroke Center and Department of Neurology, Maimonides Medical Center, Brooklyn, NY (S.R.L.)
| | - Ken Cheung
- Department of Biostatistics, Columbia University Irving Medical Center, NY (K.C.)
| | | | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester (B.S.)
| | | | - Abigail Egan
- The American Heart Association/American Stroke Association, Eastern States, Albany, NY (A.E., P.B.-J., Z.M.-I.)
| | - Pamela Borg-Jensen
- The American Heart Association/American Stroke Association, Eastern States, Albany, NY (A.E., P.B.-J., Z.M.-I.)
| | - Zainab Magdon-Ismail
- The American Heart Association/American Stroke Association, Eastern States, Albany, NY (A.E., P.B.-J., Z.M.-I.).,Capital District Physician's Health Plan, Albany NY (Z.M.-I.)
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Minami S, Fukumoto Y, Kobayashi R, Aoki H, Aoyama T. Effect of home-based rehabilitation of purposeful activity-based electrical stimulation therapy for chronic stroke survivors: a crossover randomized controlled trial. Restor Neurol Neurosci 2021; 39:173-180. [PMID: 33998561 PMCID: PMC8461679 DOI: 10.3233/rnn-211157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study. Objective: The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial. Methods: The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the Fugl–Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light). Results: Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching. Conclusions: The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors.
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Affiliation(s)
- Seigo Minami
- Department of Occupational Therapy, Osaka Kawasaki Rehabilitation University, Mizuma, Kaizuka City, Osaka, Japan.,Graduate School of Medicine, Kyoto University, Shogoinkawaracho, Sakyou-ku, Kyoto City, Kyoto Japan
| | - Yoshihiro Fukumoto
- Graduate School of Medicine, Kyoto University, Shogoinkawaracho, Sakyou-ku, Kyoto City, Kyoto Japan.,Department of Physical Medicine and Rehabilitation, Kansai Medical University, Shin-machi, Hirakata City, Osaka, Japan
| | - Ryuji Kobayashi
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashi-Ogu, Arakawa City, Tokyo, Japan
| | - Hideaki Aoki
- Graduate School of Medicine, Wakayama Medical University, Kimiidera, Wakayama City, Wakayama, Japan
| | - Tomoki Aoyama
- Graduate School of Medicine, Kyoto University, Shogoinkawaracho, Sakyou-ku, Kyoto City, Kyoto Japan
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11
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Aries AM, Pomeroy VM, Sim J, Read S, Hunter SM. Sensory Stimulation of the Foot and Ankle Early Post-stroke: A Pilot and Feasibility Study. Front Neurol 2021; 12:675106. [PMID: 34290663 PMCID: PMC8287025 DOI: 10.3389/fneur.2021.675106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Somatosensory stimulation of the lower extremity could improve motor recovery and walking post-stroke. This pilot study investigated the feasibility of a subsequent randomized controlled trial (RCT) to determine whether task-specific gait training is more effective following either (a) intensive hands-on somatosensory stimulation or (b) wearing textured insoles. Objectives: Determine recruitment and attrition rates, adherence to intervention, acceptability and viability of interventions and outcome measures, and estimate variance of outcome data to inform sample size for a subsequent RCT. Methods: Design: randomized, single-blinded, mixed-methods pilot study. Setting: In-patient rehabilitation ward and community. Participants: n = 34, 18+years, 42-112 days following anterior or posterior circulation stroke, able to follow simple commands, able to walk independently pre-stroke, and providing informed consent. Intervention: Twenty 30-min sessions of task-specific gait training (TSGT) (delivered over 6 weeks) in addition to either: (a) 30-60 min mobilization and tactile stimulation (MTS); or (b) unlimited textured insole (TI) wearing. Outcomes: Ankle range of movement (electrogoniometer), touch-pressure sensory thresholds (Semmes Weinstein Monofilaments), motor impairment (Lower Extremity Motricity Index), walking ability and speed (Functional Ambulation Category, 5-m walk test, pressure insoles) and function (modified Rivermead Mobility Index), measured before randomization, post-intervention, and 1-month thereafter (follow-up). Adherence to allocated intervention and actual dose delivered (fidelity) were documented in case report forms and daily diaries. Focus groups further explored acceptability of interventions and study experience. Analysis: Recruitment, attrition, and dose adherence rates were calculated as percentages of possible totals. Thematic analysis of daily diaries and focus group data was undertaken. Standard deviations of outcome measures were calculated and used to inform a sample size calculation. Results: Recruitment, attrition, and adherence rates were 48.57, 5.88, and 96.88%, respectively. Focus groups, daily-diaries and case report forms indicated acceptability of interventions and outcome measures to participants. The 5-m walk was selected as primary outcome measure for a future trial [mean (SD) at end of intervention: 16.86 (11.24) MTS group and 21.56 (13.57) TI group]; sample size calculation indicated 60 participants are required per group. Conclusion: Recruitment, attrition and adherence rates and acceptability of interventions and outcomes justify a subsequent powered RCT of MTS+TSGT compared with TI+TSGT.
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Affiliation(s)
- Alison M. Aries
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Valerie M. Pomeroy
- Acquired Brain Injury Recovery Alliance (ABIRA), School of Health Sciences, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative, Cambridge, United Kingdom
| | - Julius Sim
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan Read
- School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan M. Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
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Altuntaş O, Taş S, Çetin A. An investigation of the factors that influence functional improvement in stroke rehabilitation. Turk J Med Sci 2021; 51:1448-1454. [PMID: 33705646 PMCID: PMC8283450 DOI: 10.3906/sag-2101-94] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/11/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim The purpose of this study was to determine effect of age, sex, affected extremity, disability severity, treatment type, cerebrovascular accident (CVA) etiology, number of treatment sessions, and CVA duration on the functional improvement of the stroke patients who participated in a physical medicine and rehabilitation program. Materials and methods The research sample consisted of 322 stroke patients. Clinical and demographic features including age, sex, affected extremity, disability severity, treatment type, CVA etiology, number of treatment sessions, and CVA duration were recorded. Functional status was evaluated retrospectively by using the functional independence measure (FIM) at admission and discharge. Results It was detected that discharge FIM score of the patients exhibited an increase of significance level (p < 0.05). It was found that age, number of treatment sessions, CVA duration and FIM admission score were determinative parameters in FIM gain level (p < 0.05) while sex, affected extremity, and CVA etiology were not effective in FIM gain level (p > 0.05). Conclusion Results show that functional improvement after rehabilitation was better in the younger ages, shorter CVA durations and moderate functional disturbances. The findings obtained may be useful for stroke rehabilitation triage.
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Affiliation(s)
- Onur Altuntaş
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Serkan Taş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Alp Çetin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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13
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Biggs J. The Impact of Level of Physical Therapist Assistant Involvement on Patient Outcomes Following Stroke. Phys Ther 2020; 100:2165-2173. [PMID: 32886786 DOI: 10.1093/ptj/pzaa158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/14/2019] [Accepted: 08/02/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). METHODS Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. RESULTS Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. CONCLUSIONS Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. IMPACT The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.
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Affiliation(s)
- Jennifer Biggs
- Doctor of Physical Therapy Program, St Catherine University, 2004 Randolph Ave, St Paul, MN 55105 (USA). Dr Biggs is a certified wound specialist
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14
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Gunn S, Burgess GH. Factors predicting rehabilitation outcomes after severe acquired brain injury in trauma, stroke and anoxia populations: A cohort study. Neuropsychol Rehabil 2020; 32:179-210. [PMID: 32880210 DOI: 10.1080/09602011.2020.1810077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Severe acquired brain injury has long-term physical and cognitive effects. Identifying patient variables predictive of recovery in different brain injury populations would generate improved prognostic information and help rehabilitation teams set appropriate therapeutic goals. This cohort study of 447 NHS neurorehabilitation inpatients aimed to identify functional and cognitive predictors of recovery following severe acquired brain injury caused by trauma, stroke and anoxia. Motor and cognitive impairment ratings were collected at admission and discharge using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM), and injury-related and demographic data were collated from medical records. Predictors of physical, cognitive and overall recovery were identified via hierarchical regression analyses. Several key findings emerged. Firstly, on-admission motor skills predicted functional and overall outcomes across groups. Secondly, on-admission social interaction skills predicted cognitive discharge outcomes in stroke and trauma, and overall outcomes for stroke, but did not predict anoxia outcomes. Thirdly, age predicted all forms of recovery for stroke only. Further group-specific factors were also identified as predicting motor and cognitive recovery, indicating that factors key to the rehabilitation trajectory may differ between populations. These variables should be considered in rehabilitation goal planning, although further research is required to explore their contributions to recovery.
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Affiliation(s)
- Sarah Gunn
- Neuroscience, Psychology and Behaviour, Collesge of Life Sciences, University of Leicester, Leicester, UK
| | - Gerald H Burgess
- Neuroscience, Psychology and Behaviour, Collesge of Life Sciences, University of Leicester, Leicester, UK
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15
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Stein J, Borg-Jensen P, Sicklick A, Rodstein BM, Hedeman R, Bettger JP, Hemmitt R, Silver BM, Thode HC, Magdon-Ismail Z. Are Stroke Survivors Discharged to the Recommended Postacute Setting? Arch Phys Med Rehabil 2020; 101:1190-1198. [PMID: 32272107 DOI: 10.1016/j.apmr.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the processes and barriers involved in providing postdischarge stroke care. DESIGN Prospective study of discharge planners' (DP) and physical therapists' (PT) interpretation of factors contributing to patients' discharge destination. SETTING Twenty-three hospitals in the northeastern United States. PARTICIPANTS After exclusions, data on patients (N=427) hospitalized with a primary diagnosis of stroke between May 2015 and November 2016 were examined. Of the patients, 45% were women, and the median age was 71 years. DPs and PTs caring for these patients were queried regarding the selection of discharge destination. INTERVENTIONS None. MAIN OUTCOME MEASURES Comparison of actual discharge destination for stroke patients with the destinations recommended by their DPs and PTs. RESULTS In total, 184 patients (43.1%) were discharged home, 146 (34.2%) to an inpatient rehabilitation facility, 94 (22.0%) to a skilled nursing facility, and 3 (0.7%) to a long-term acute care hospital. DPs and PTs agreed on the recommended discharge destination in 355 (83.1%) cases. The actual discharge destination matched the DP and PT recommended discharge destination in 92.5% of these cases. In 23 cases (6.5%), the patient was discharged to a less intensive setting than recommended by both respondents. In 4 cases (1.1%), the patient was discharged to a more intensive level of care. In 2 cases (0.6%), the patient was discharged to a long-term acute care hospital rather than an inpatient rehabilitation facility as recommended. Patient or family preference was cited by at least 1 respondent for the discrepancy in discharge destination for 13 patients (3.1%); insurance barriers were cited for 9 patients (2.3%). CONCLUSIONS Most stroke survivors in the northeast United States are discharged to the recommended postacute care destination based on the consensus of DP and PT opinions. Further research is needed to guide postacute care service selection.
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Affiliation(s)
- Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; New York-Presbyterian Hospital, New York, New York.
| | - Pamela Borg-Jensen
- The American Heart Association/American Stroke Association, Eastern States, Albany, New York
| | | | | | | | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Roseanne Hemmitt
- The American Heart Association/American Stroke Association, Eastern States, Albany, New York
| | - Brian M Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Henry C Thode
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Zainab Magdon-Ismail
- The American Heart Association/American Stroke Association, Eastern States, Albany, New York
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16
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Does aneurysm side influence the infarction side and patients´ outcome after subarachnoid hemorrhage? PLoS One 2019; 14:e0224013. [PMID: 31697715 PMCID: PMC6837438 DOI: 10.1371/journal.pone.0224013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background The prognostic factors and outcome of aneurysms appear to be dependent on its locations. Therefore, we compared left- and right- sided aneurysms in patients with aneurysmal subarachnoid hemorrhage (SAH) in terms of differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. A total of 509 patients with aneurysmal subarachnoid hemorrhage were retrospectively selected and stratified in two groups depending on side of ruptured aneurysm (right n = 284 vs. left n = 225). Midline aneurysms of the basilar and anterior communicating arteries were excluded from the analysis. Outcomes were assessed using the modified Rankin Scale (mRS; favorable (mRS 0–2) vs. unfavorable (mRS 3–6)) six months after SAH. Results We did not identify any differences in outcome depending on left- and right-sided ruptured aneurysms. In both groups, the significant negative predictive factors included clinical admission status (WFNS IV+V), Fisher 3- bleeding pattern in CT, the occurrence of delayed cerebral ischemia (DCI), early hydrocephalus and later shunt-dependence. The side of the ruptured aneurysm does not seem to influence patients´ outcome. Interestingly, the aneurysm side predicts the side of infarction, with a significant influence on patients´ outcome in case of left-sided infarctions. In addition, the in multivariate analysis side of aneurysm was an independent predictor for the side of cerebral infarctions. Conclusion The side of the ruptured aneurysms (right or left) did not influence patients’ outcome. However, the aneurysm-side predicts the side of delayed infarctions and outcome appear to be worse in patients with left-sided infarctions.
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17
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Yu J, Jung Y, Park J, Kim JM, Suh M, Cho KG, Kim M. Intensive Rehabilitation Therapy Following Brain Tumor Surgery: A Pilot Study of Effectiveness and Long-Term Satisfaction. Ann Rehabil Med 2019; 43:129-141. [PMID: 31072079 PMCID: PMC6509576 DOI: 10.5535/arm.2019.43.2.129] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of intensive rehabilitation to support recovery of neurological function after brain tumor surgery and assess long-term satisfaction. METHODS This retrospective study included patients with neurological impairment after brain tumor surgery who underwent intensive rehabilitation therapy between December 2013 and May 2017. To assess effectiveness of rehabilitation, functional outcomes (motor, cognition, and activities of daily living [ADL]) were compared between brain tumor group and a control group enrolling stroke patients who received equivalent rehabilitation during the study period. Long-term satisfaction with rehabilitation was evaluated by surveying family caregivers. RESULTS This study included 21 patients with benign brain tumor, 14 with malignant brain tumor, and 108 with stroke. Significant and similar improvement in motor, cognition, and ADL function were noted in both the brain tumor group and the stroke group. Malignancy status did not influence the extent of functional improvement. According to medical records and surveys, 9 (69.2%) patients with malignant tumor and 2 (11.8%) with benign tumor had expired by the time of the survey. Most family caregivers confirmed that rehabilitation was effective for functional improvement (>60%), expressing overall satisfaction and stating they would recommend such therapy to patients with similar conditions (approximately 70%). CONCLUSION Intensive rehabilitation may help promote functional improvement following brain tumor surgery regardless of malignancy compared with stroke patients. Family caregivers expressed overall satisfaction with rehabilitation at long-term follow-up. These findings support the provision of intensive rehabilitation therapy for neurologic function recovery following brain tumor surgery.
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Affiliation(s)
- Junghoon Yu
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Youngsu Jung
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Joonhyun Park
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, Korea
| | - Miri Suh
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, Korea
| | - Kyung Gi Cho
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, Korea
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18
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Bravo G, Richards CL, Corriveau H, Trottier L. Converting Functional Autonomy Measurement System Scores of Patients Post-Stroke to FIM Scores. Physiother Can 2019; 70:349-355. [PMID: 30745720 DOI: 10.3138/ptc.2017-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The Functional Independence Measure (FIM) is widely used to assess persons post-stroke. The Quebec government has selected the Functional Autonomy Measurement System (SMAF) for use in all care settings. In this article, we propose simple equations to convert SMAF scores to FIM scores for persons undergoing post-stroke rehabilitation. Method: Persons post-stroke (n=143) from three rehabilitation centres were assessed at admission and discharge using the FIM and SMAF. The sample was randomly split into derivation and validation data sets. Regression analysis was performed on the first data set to derive a conversion equation at each time point. The validity of the equations was measured using correlation coefficients, and differences between the observed and predicted FIM scores were computed from the second data set. Results: The relationship between the SMAF and FIM scores was linear at admission but quadratic at discharge. The proposed equations are, at admission, FIM=139-1.5×SMAF and, at discharge, FIM=118-0.018×SMAF2. The observed and predicted FIM scores were highly correlated in the validation data set (rs=0.92 and 0.93 at admission and discharge, respectively). Furthermore, the equations performed well in classifying stroke severity compared with a classification based on the observed FIM scores. Conclusions: SMAF scores can be reliably converted to FIM scores using the proposed equations, thus facilitating international trials in stroke rehabilitation.
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Affiliation(s)
- Gina Bravo
- Department of Community Health Sciences.,Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke
| | - Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Que
| | - Hélène Corriveau
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Lise Trottier
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke
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19
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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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Heimann G, Canhos LL, Frik J, Jäger G, Lepko T, Ninkovic J, Götz M, Sirko S. Changes in the Proliferative Program Limit Astrocyte Homeostasis in the Aged Post-Traumatic Murine Cerebral Cortex. Cereb Cortex 2018; 27:4213-4228. [PMID: 28472290 DOI: 10.1093/cercor/bhx112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 12/18/2022] Open
Abstract
Aging leads to adverse outcomes after traumatic brain injury. The mechanisms underlying these defects, however, are not yet clear. In this study, we found that astrocytes in the aged post-traumatic cerebral cortex develop a significantly reduced proliferative response, resulting in reduced astrocyte numbers in the penumbra. Moreover, experiments of reactive astrocytes in vitro reveal that their diminished proliferation is due to an age-related switch in the division mode with reduced cell-cycle re-entry rather than changes in cell-cycle length. Notably, reactive astrocytes in vivo and in vitro become refractory to stimuli increasing their proliferation during aging, such as Sonic hedgehog signaling. These data demonstrate for the first time that age-dependent, most likely intrinsic changes in the proliferative program of reactive astrocytes result in their severely hampered proliferative response to traumatic injury thereby affecting astrocyte homeostasis.
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Affiliation(s)
- Gábor Heimann
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - Luisa L Canhos
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany.,Institute of Stem Cell Research, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - Jesica Frik
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany.,Institute of Stem Cell Research, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany.,Institute of Biotechnology and Molecular Biology (IBBM), Department of Biological Sciences, 1900 La Plata, Argentina
| | - Gabriele Jäger
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - Tjasa Lepko
- Institute of Stem Cell Research, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - Jovica Ninkovic
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany.,Institute of Stem Cell Research, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - Magdalena Götz
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany.,Institute of Stem Cell Research, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany.,Synergy, Excellence Cluster of Systems Neurology, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany
| | - Swetlana Sirko
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, 82152 Planegg, Germany.,Institute of Stem Cell Research, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany
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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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22
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Heiss WD. Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke. Cerebrovasc Dis 2017; 44:266-276. [PMID: 28869961 DOI: 10.1159/000479594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/18/2017] [Indexed: 12/23/2022] Open
Abstract
Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects. The recovery of ischemic tissue and the progression of damage are dependent on the quality of blood supply. Therefore, the status of the supplying arteries and of the collateral flow is not only crucial for determining eligibility for acute interventions, but also has an impact on the potential to integrate areas surrounding the lesion that are not typically part of a functional network into the recovery process. The changes in these functional networks after a localized lesion are assessed by functional imaging methods, which additionally show altered pathways and activated secondary centers related to residual functions and demonstrate changes in activation patterns within these networks with improved performance. These strategies in some instances record activation in secondary centers of a network, for example, also in homolog contralateral areas, which might be inhibitory to the recovery of primary centers. Such findings might have therapeutic consequences, for example, image-guided inhibitory stimulation of these areas. In the future, a combination of morphological imaging including DTI of fiber tracts and activation studies during specific tasks might yield the best information on residual function, reserve capacity, and prospects for recovery after ischemic stroke.
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Trujillo P, Mastropietro A, Scano A, Chiavenna A, Mrakic-Sposta S, Caimmi M, Molteni F, Rizzo G. Quantitative EEG for Predicting Upper Limb Motor Recovery in Chronic Stroke Robot-Assisted Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1058-1067. [DOI: 10.1109/tnsre.2017.2678161] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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24
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Hubbard IJ, Wass S, Pepper E. Stroke in Older Survivors of Ischemic Stroke: Standard Care or Something Different? Geriatrics (Basel) 2017; 2:E18. [PMID: 31011028 PMCID: PMC6371093 DOI: 10.3390/geriatrics2020018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 12/29/2022] Open
Abstract
Stroke is one of the leading causes of death and disability and it is more likely to occur in those who are older. Because people are living longer, the definition of "old" continues to evolve. Age alone should not influence the healthcare that a patient receives, however, evidence indicates that this does occur, especially in older patients. On the basis of the available evidence, it is time to reconsider whether or not stroke care should differ in older survivors of stroke and if so, why. This is a narrative review of stroke-related health care in those with a recent ischemic stroke. It seeks to answer the following question: Should patients aged ≥80 years who have experienced a recent ischemic stroke receive standard care or something different, and if they should receive something different, what should they receive and why? The review focusses on long-term survival, hyper-acute care, secondary prevention, and rehabilitation. The authors propose a number of recommendations in relation to stroke care in older survivors of a recent ischemic stroke.
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Affiliation(s)
- Isobel J Hubbard
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2305, Australia.
| | - Suzanne Wass
- Neurology Department, Calvary Mater Hospital, Newcastle, NSW 2293, Australia.
| | - Elizabeth Pepper
- Neurology Department, Calvary Mater Hospital, Newcastle, NSW 2293, Australia.
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25
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Understanding the Connection between Cognitive Impairment and Mobility: What Can Be Gained from Neuropsychological Assessment? Rehabil Res Pract 2017; 2017:4516219. [PMID: 28536658 PMCID: PMC5425833 DOI: 10.1155/2017/4516219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/06/2017] [Indexed: 12/02/2022] Open
Abstract
The ability of neuropsychological tests to predict rehabilitation outcome is unclear, particularly when other ratings of cognition are available. Neuropsychological test scores and functional ratings of cognition (Functional Independence Measure (FIM) Cognition score) were used to predict improvement in patient mobility and self-care skill, as measured by the FIM Motor score. Regression models used both raw neuropsychology test scores and age-adjusted scores. Retrospective chart review was performed for patients on an inpatient rehabilitation unit and referred for neuropsychological assessment. The group included 126 subjects (average age 64.2 ± 17.1 years) and a variety of medical diagnoses. Neuropsychological tests included the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). After forcing the Admission FIM Cognition score into the model, RBANS scores and duration of rehabilitation predicted FIM Motor improvements (F = 11.42, p < 0.0001). Raw neuropsychological test scores performed better than the model with age-adjusted test scores. FIM Cognition alone did not predict FIM Motor improvements. Neuropsychological tests, combined with duration of rehabilitation, predicted mobility gains for patients undergoing inpatient rehabilitation beyond what was predicted by another, readily available, assessment of cognition. Neuropsychology raw scores performed better than age-adjusted scores, raising questions about the standard use of demographic adjustments for predicting real-world function.
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26
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Rac VE, Sahakyan Y, Fan I, Ieraci L, Hall R, Kelloway L, van der Velde G, Kapral MK, Bayley M, Krahn M. The characteristics of stroke units in Ontario: a pan-provincial survey. BMC Health Serv Res 2017; 17:154. [PMID: 28222715 PMCID: PMC5320701 DOI: 10.1186/s12913-017-2099-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 02/15/2017] [Indexed: 03/26/2024] Open
Abstract
Background Previous studies have demonstrated that organized, multidisciplinary care is the cornerstone of current strategies to reduce the death and disability caused by stroke. Identification of stroke units and an understanding of their composition and operation would provide insight for the further actions required to improve stroke care. The objective of this study was to identify and survey stroke units in Canada’s largest province, Ontario (population of 13 million) in order to describe availability, structure, staffing, processes of care, and type of population stroke units serve. Methods The Ontario Stroke Network (2011) list of stroke units and snowball sampling was used to identify all stroke units. During 2013 – 2014 an interviewer conducted telephone surveys with the stroke unit managers using closed and semi-open ended questions. Descriptive statistics were used to summarize survey responses. Results The survey identified 32 stroke units, and a respondent from every stroke unit (100% response rate) was interviewed. Twenty one were acute stroke units, 10 were integrated stroke units and one was classified as a rehabilitation stroke unit. Stroke units were available in all 14 Local Health Integration Networks except Central West. The estimated average number of stroke patients served per stroke unit was 604 with six-fold variation (242 to 1480) across the province. The typical population served in stroke units were patients with either ischemic or hemorrhagic stroke. Data consistently reported on the processes of stroke care, including the availability of multidisciplinary staff, specific diagnostic imaging, use of validated assessment tools, and the delivery of patient education. Details about the core components of stoke care were provided by 16 stroke units (50%). Conclusions This study demonstrates the heterogeneous structure of stroke units in Ontario and signaled potential disparity in access to stroke units. Many core components are in place, but half of the stroke units in Ontario do not meet all criteria. Areas for potential improvement include stroke care training for the multidisciplinary team, provision of individualized rehabilitation plans, and early discharge assessment. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2099-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valeria E Rac
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
| | - Yeva Sahakyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Iris Fan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Ruth Hall
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.,Ontario Stroke Network, Toronto, ON, Canada
| | | | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Moira K Kapral
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.,Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mark Bayley
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehab Foundations, University Health Network, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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27
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Kim DY, Kim YH, Lee J, Chang WH, Kim MW, Pyun SB, Yoo WK, Ohn SH, Park KD, Oh BM, Lim SH, Jung KJ, Ryu BJ, Im S, Jee SJ, Seo HG, Rah UW, Park JH, Sohn MK, Chun MH, Shin HS, Lee SJ, Lee YS, Park SW, Park YG, Paik NJ, Lee SG, Lee JK, Koh SE, Kim DK, Park GY, Shin YI, Ko MH, Kim YW, Yoo SD, Kim EJ, Oh MK, Chang JH, Jung SH, Kim TW, Kim WS, Kim DH, Park TH, Lee KS, Hwang BY, Song YJ. Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Kang Jae Jung
- Department of Physical Medicine and Rehabilitation, Eulji University Hospital & Eulji University School of Medicine, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hee Suk Shin
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine Dankook University, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary's Hospital, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Nam Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University College of Medicine, Korea
| | - Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Tae-Woo Kim
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea
| | - Kwan-Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Byong-Yong Hwang
- Department of Physical Therapy, Yong-In University College of Health & Welfare, Korea
| | - Young Jin Song
- Department of Rehabilitation Medicine, Asan Medical Center, Korea
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Mirkowski M, Pereira S, Janzen S, Mehta S, Meyer M, McClure A, Speechley M, Teasell R. Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation. Disabil Rehabil 2016; 40:457-461. [PMID: 28006999 DOI: 10.1080/09638288.2016.1260652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke. METHODS A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates. RESULTS Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8 ± 23.6 versus 72.9 ± 20.3; p < 0.01), although both groups achieved a minimal clinically important difference. After controlling for age, gender, admission Functional Independence Measure, and length of hospital stay, caregiver availability explained 1.3% of additional variance, with the final model explaining 41.3% of total variance for functional ability at discharge (F (5,174) = 26.21, p < 0.001). CONCLUSIONS The presence of a caregiver at time of discharge from inpatient rehabilitation is predictive of significantly higher functional ability at discharge in individuals with severe stroke. Implications for rehabilitation The availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke. The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.
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Affiliation(s)
| | | | - Shannon Janzen
- a Lawson Health Research Institute , London , Ontario , Canada
| | - Swati Mehta
- a Lawson Health Research Institute , London , Ontario , Canada.,b Western University , London , Ontario , Canada
| | - Matthew Meyer
- a Lawson Health Research Institute , London , Ontario , Canada.,b Western University , London , Ontario , Canada.,c London Health Sciences Centre , London , Ontario , Canada
| | - Andrew McClure
- a Lawson Health Research Institute , London , Ontario , Canada.,c London Health Sciences Centre , London , Ontario , Canada
| | | | - Robert Teasell
- a Lawson Health Research Institute , London , Ontario , Canada.,b Western University , London , Ontario , Canada.,d St. Joseph's Health Care London, Parkwood Institute , London , Ontario , Canada
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29
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Tsuchiya K, Fujita T, Sato D, Midorikawa M, Makiyama Y, Shimoda K, Tozato F. Post-stroke depression inhibits improvement in activities of daily living in patients in a convalescent rehabilitation ward. J Phys Ther Sci 2016; 28:2253-9. [PMID: 27630408 PMCID: PMC5011572 DOI: 10.1589/jpts.28.2253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/07/2016] [Indexed: 02/04/2023] Open
Abstract
[Purpose] There have been no investigations into the improvement of activities of daily
living among patients suffering from post-stroke depression on admission to convalescent
rehabilitation wards in Japan. This study aimed to assess the improvement of activities in
daily living in patients with or without post-stroke depression at the time of admission
to a convalescent rehabilitation ward. [Subjects and Methods] This retrospective study
included 108 stroke patients divided into two groups according to their Geriatric
Depression Scale 15-item short form scores. Activities of daily living were assessed using
the Functional Independence Measure. The degree of improvement on the Functional
Independence Measure was defined as the difference between scores on admission and at
discharge. [Results] The Functional Independence Measure gain score was significantly
different from the Functional Independence Measure total score. There was a significant
interaction between time period and post-stroke depression factors for the Functional
Independence Measure total score. A multiple regression analysis revealed a significant
association between Geriatric Depression Scale score and Functional Independence Measure
total score. [Conclusion] The present study suggests that post-stroke depression has a
negative impact on recovery of activities of daily living and on rehabilitation outcomes
in a convalescent rehabilitation ward setting.
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Affiliation(s)
- Kenji Tsuchiya
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Japan
| | - Takaaki Fujita
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Japan
| | - Daisuke Sato
- Department of Rehabilitation, Aida Memorial Rehabilitation Hospital, Japan
| | - Manabu Midorikawa
- Department of Rehabilitation, Aida Memorial Rehabilitation Hospital, Japan
| | - Yasushi Makiyama
- Department of Rehabilitation, Aida Memorial Rehabilitation Hospital, Japan
| | - Kaori Shimoda
- Department of Rehabilitation, Gunma Prefectural Cancer Center, Japan
| | - Fusae Tozato
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Japan
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30
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Nagaratnam N, Xavier C, Fabian R. Stroke Subtype—Ataxic Hemiparesis. Neurorehabil Neural Repair 2016. [DOI: 10.1177/154596839901300207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ataxic hemiparesis is a lacunar syndrome of ipsilateral corticospmal and cerebellar- like dysfunction due to supratentorial and brainstem lesions We studied 22 patients with ataxic hemiparesis resulting from brain lesions at three locations: capsular-corona radiata, thalamic, and pontine with regard to (1) their manifestations, (2) the degree and rate of recovery at 12 weeks as measured on the modified Rankm Scale, and (3) factors that may influence recovery The mean age was 67 years. Symptoms and signs were similar in all three groups except qualitative differences observed in the pontine subgroup and to a lesser extent in the thalamic group Age, gender, lateralization, and location were not associated with initial severity. and had no influence on recovery. Twenty (91%) of the 22 patients were in Rankm grades 3-5 at onset, and at 12 weeks only two remained. In this study initial severity and outcome were positively corre lated, and ataxic hemiparesis augurs well with recovery. Key Words: Ataxic hemi paresis— Capsular ataxic hemiparesis—Thalamic ataxic hemiparesis—Pontine ataxic hemiparesis—Rankm Scale—Lacunar syndromes
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31
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Schmidt JG, Drew-Cates J, Dombovy ML. Severe Disability After Stroke: Outcome After Inpatient Rehabilitation. Neurorehabil Neural Repair 2016. [DOI: 10.1177/154596839901300310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Mea sure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diag nosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cog nition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Con clusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.
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Sato A, Fujita T, Ohashi Y, Yamamoto Y, Suzuki K, Otsuki K. A prediction model for activities of daily living for stroke patients in a convalescent rehabilitation ward . ACTA ACUST UNITED AC 2016. [DOI: 10.15563/jalliedhealthsci.7.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Atsushi Sato
- Department of Physical Therapy, Yachiyo Rehabilitation College
| | - Takaaki Fujita
- Department of Rehabilitation, Tohoku Fukushi University
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences
| | - Yuji Ohashi
- Department of Rehabilitation, Northern Fukushima Medical Center
| | - Yuichi Yamamoto
- Department of Rehabilitation, Northern Fukushima Medical Center
| | | | - Koji Otsuki
- Department of Rehabilitation, Northern Fukushima Medical Center
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Prediction of Advisability of Returning Home Using the Home Care Score. Rehabil Res Pract 2015; 2015:501042. [PMID: 26491568 PMCID: PMC4602329 DOI: 10.1155/2015/501042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care.
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Nadeau SE, Dobkin B, Wu SS, Pei Q, Duncan PW. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience. Neurorehabil Neural Repair 2015; 30:615-25. [PMID: 26498434 DOI: 10.1177/1545968315613851] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait.
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Affiliation(s)
- Stephen E Nadeau
- Malcom Randall VA Medical Center, Gainesville, FL, USA University of Florida College of Medicine, Gainesville, FL, USA
| | - Bruce Dobkin
- Geffen/UCLA School of Medicine, Los Angeles, CA, USA
| | - Samuel S Wu
- University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL, USA
| | - Qinglin Pei
- University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL, USA
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Shibasaki K, Ogawa S, Yamada S, Iijima K, Eto M, Kozaki K, Toba K, Ouchi Y, Akishita M. Favorable effect of sympathetic nervous activity on rehabilitation outcomes in frail elderly. J Am Med Dir Assoc 2015; 16:799.e7-799.e12. [PMID: 26170032 DOI: 10.1016/j.jamda.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Previous studies have suggested the relationship between physical function, mortality, and autonomic nervous activity in frail elderly and that maintaining sympathetic nervous activity might lead to improved physical function and mortality in the elderly population. The aim of this study was to investigate the utility of sympathetic nervous activity measured by heart rate variability in frail elderly patients undergoing inpatient rehabilitation, further focusing the nervous activity on the effect of rehabilitation therapy. DESIGN Prospective cohort study. PARTICIPANTS Sixty-one subjects aged 75 years or older were recruited after treatment of acute phase illness. MEASUREMENTS Before undergoing rehabilitation, data of 24-hour Holter monitoring and a blood venous sample were obtained. From RR intervals in the electrocardiogram, heart rate and SDs of all NN intervals in all 5-minute segments of the entire recording, power spectral density, low frequency (LF), high frequency (HF), and low frequency/high frequency (LF/HF) were calculated. Functional Independence Measure (FIM) and Barthel index were used to measure physical function. RESULTS FIM score and Barthel index were 46.8 ± 25.4 and 32.8 ± 31.7, respectively. Serum total protein, albumin, hemoglobin, and total cholesterol were all significantly related to FIM score and Barthel index before rehabilitation. Heart rate variability indices did not show a significant relationship with physical function, whereas the high LH/HF group showed significant improvement in physical function compared with the low LH/HF group. Moreover, LF/HF frequency was a predictive factor for improvement of physical function after 2 months of rehabilitation. CONCLUSION A favorable effect of preserved LF/HF on rehabilitation outcome was observed in elderly undergoing rehabilitation. Preservation of sympathetic nervous activity may lead to improved physical function in the elderly.
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Affiliation(s)
- Koji Shibasaki
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Shizuru Yamada
- Komagane-kogen Ladies Clinic, Komagane City, Nagano, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masato Eto
- General Educational Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Kenji Toba
- National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Yasuyoshi Ouchi
- Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Stineman MG, Strasser DC. Team Process and Effectiveness: Patients, Families, and Staff Characteristics. Top Stroke Rehabil 2015. [DOI: 10.1310/5pug-w320-tuxm-whh3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
The effect of age on functional outcome after stroke remains uncertain. Many studies have found that younger patients do better than older patients, whereas others have found minimal or no effect of age on rehabilitation outcomes. We examined the effect of advancing age on FIM trade mark gain, length of stay, length of stay efficiency, and home discharge in 979 stroke rehabilitation patients at a long-term acute care rehabilitation hospital. We found a strong relationship of increasing age to poorer outcome in all measures for patients with admission FIM (AFIM) score <40, a variable relationship in those with AFIM 40-80, and no relationship of age to the outcome measures in patients with AFIM >80.
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Affiliation(s)
- Randie M Black-Schaffer
- Young Adult Stroke Service, Spaulding Rehabilitation Hospital, and Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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39
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Stein J, Bettger JP, Sicklick A, Hedeman R, Magdon-Ismail Z, Schwamm LH. Use of a Standardized Assessment to Predict Rehabilitation Care After Acute Stroke. Arch Phys Med Rehabil 2015; 96:210-7. [DOI: 10.1016/j.apmr.2014.07.403] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/07/2014] [Accepted: 07/14/2014] [Indexed: 11/26/2022]
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Teasell RW, Foley NC, Bhogal SK, Chakravertty R, Bluvol A. A Rehabilitation Program for Patients Recovering from Severe Stroke. Can J Neurol Sci 2014; 32:512-7. [PMID: 16408584 DOI: 10.1017/s0317167100004534] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT:Objective:The purpose of this study was to describe the outcomes of patients with a severe stroke admitted to a specialized “slow stream” rehabilitation program and to develop a model to predict discharge destination.Methods:Chart review of 196 consecutive non-ambulatory (“lower-band”) stroke patients admitted between 1996-2001, to a specialized in-patient rehabilitation unit designed to accommodate the needs of patients with profound disabilities, and who were considered inappropriate for conventional inpatient rehabilitation programs. Special features of this program included the availability of an independent living unit, therapies tailored to individual tolerance and the opportunity to remain on the unit for an extended period until such time that the patients' rehabilitation potential had been maximized.Results:Patients were admitted to the unit after a median of 49 days following stroke onset. Their median admission and discharge functional independence measure (FIMTM) scores were 46 and 70, respectively. The improvement in ability to perform self-care tasks was statistically significant (Z= -11.18, p<0.0001). By discharge, 54 patients (28%) were able to ambulate independently (with or without an assistive device), while 142 patients (72%) remained wheelchair dependent. Eighty-five patients (43%) returned to their own home upon rehabilitation discharge, while the remainder were admitted to nursing homes or hospitals closer to the patients' home. Admission FIM score, age, no previous history of stroke and male sex were the variables found to most strongly predict discharge home.Conclusions:Patients with severe strokes who received individualized care on a highly specialized stroke rehabilitation unit achieved impressive functional outcomes despite a lag of seven weeks post stroke before rehabilitation was initiated. Many patients were no longer wheelchair dependent and almost half returned home. Active rehabilitation should not be limited to “middle-band” stroke patients.
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Affiliation(s)
- Robert W Teasell
- Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph's Health Care London, London, Ontario, Canada
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41
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Bagherpour R, Dykstra DD, Barrett AM, Luft AR, Divani AA. A Comprehensive Neurorehabilitation Program Should be an Integral Part of a Comprehensive Stroke Center. Front Neurol 2014; 5:57. [PMID: 24795694 PMCID: PMC4001043 DOI: 10.3389/fneur.2014.00057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Reza Bagherpour
- Department of Physical Medicine and Rehabilitation, University of Minnesota , Minneapolis, MN , USA ; Department of Neurology, University of Minnesota , Minneapolis, MN , USA
| | - Dennis D Dykstra
- Department of Physical Medicine and Rehabilitation, University of Minnesota , Minneapolis, MN , USA
| | - A M Barrett
- Stroke Rehabilitation Research, Kessler Foundation , West Orange, NJ , USA
| | - Andreas R Luft
- Clinical Neurorehabilitation, Department of Neurology, University of Zurich , Zurich , Switzerland
| | - Afshin A Divani
- Department of Neurology, University of Minnesota , Minneapolis, MN , USA ; Department of Neurosurgery, University of Minnesota , Minneapolis, MN , USA
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42
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Heiss WD, Kidwell CS. Imaging for prediction of functional outcome and assessment of recovery in ischemic stroke. Stroke 2014; 45:1195-201. [PMID: 24595589 DOI: 10.1161/strokeaha.113.003611] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Wolf-Dieter Heiss
- From the Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.); and Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.)
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Chan DKY, Levi C, Cordato D, O'Rourke F, Chen J, Redmond H, Xu YH, Middleton S, Pollack M, Hankey GJ. Health service management study for stroke: a randomized controlled trial to evaluate two models of stroke care. Int J Stroke 2014; 9:400-5. [PMID: 24393220 DOI: 10.1111/ijs.12240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/07/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial. METHODS Patients with acute stroke were randomized on day one of admission to combined, co-located acute/rehabilitation stroke care or traditionally separated acute/rehabilitation stroke care. Outcomes measured at baseline and 90 days postdischarge included functional independence measure, length of hospital stay, and functional independence measure efficiency (change in functional independence measure score ÷ total length of hospital stay). RESULTS Among 41 patients randomized, 20 were allocated co-located acute/rehabilitation stroke care and 21 traditionally separated acute/rehabilitation stroke care. Baseline measurements showed no significant difference. There was no significant difference in functional independence measure scores between the two groups at discharge and again at 90 days postdischarge (co-located acute/rehabilitation stroke care: 103.6 ± 22.2 vs. traditionally separated acute/rehabilitation stroke care: 99.5 ± 27.7; P = 0.77 at discharge; co-located acute/rehabilitation stroke care: 109.5 ± 21.7 vs. traditionally separated acute/rehabilitation stroke care: 104.4 ± 27.9; P = 0.8875 at 90 days post-discharge). Total length of hospital stay was 5.28 days less in co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (24.15 ± 3.18 vs. 29.42 ± 4.5, P = 0.35). There was significant improvement in functional independence measure efficiency score among participants assigned to co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (co-located acute/rehabilitation stroke care: median 1.60, interquartile range: 0.87-2.81; traditionally separated acute/rehabilitation stroke care: median 0.82, interquartile range: 0.27-1.57, P = 0.0393). Linear regression analysis revealed a high inverse correlation (R(2) = 0.89) between functional independence measure efficiency and time spent in the acute stroke unit. CONCLUSION This proof-of-concept study has shown that co-located acute/rehabilitation stroke care was just as effective as traditionally separated acute/rehabilitation stroke care as reflected in functional independence measure scores, but significantly more efficient as shown in greater functional independence measure efficiency. Co-located acute/rehabilitation stroke care has potential for significantly improved hospital bed utilization with no patient disadvantage.
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Affiliation(s)
- Daniel K Y Chan
- Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Charbonneau R, Kirby RL, Thompson K. Manual Wheelchair Propulsion by People With Hemiplegia: Within-Participant Comparisons of Forward Versus Backward Techniques. Arch Phys Med Rehabil 2013; 94:1707-13. [DOI: 10.1016/j.apmr.2013.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
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45
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A Predictor Model for Discharge Destination in Inpatient Rehabilitation Patients. Am J Phys Med Rehabil 2013; 92:343-50. [DOI: 10.1097/phm.0b013e318278b1df] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Factors Predicting Functional and Cognitive Recovery Following Severe Traumatic, Anoxic, and Cerebrovascular Brain Damage. J Head Trauma Rehabil 2013; 28:131-40. [DOI: 10.1097/htr.0b013e31823c0127] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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White DK, Wilson JC, Keysor JJ. Measures of adult general functional status: SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S297-307. [PMID: 22588752 DOI: 10.1002/acr.20638] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Lo A, Tahair N, Sharp S, Bayley MT. Clinical utility of the AlphaFIM® instrument in stroke rehabilitation. Int J Stroke 2011; 7:118-24. [PMID: 22103839 DOI: 10.1111/j.1747-4949.2011.00694.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items. AIM To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes. METHODS In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions. RESULTS The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R² 0.40 and 0.28, respectively; P < 0.0001) and was weakly correlated with FIM gain and length of stay (adjusted R² 0.04 and 0.09, respectively; P < 0.0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain. CONCLUSIONS The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.
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Affiliation(s)
- Alexander Lo
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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Xiong L, Leung H, Chen XY, Han JH, Leung T, Soo Y, Wong E, Chan A, Lau A, Wong KS. Preliminary findings of the effects of autonomic dysfunction on functional outcome after acute ischemic stroke. Clin Neurol Neurosurg 2011; 114:316-20. [PMID: 22088362 DOI: 10.1016/j.clineuro.2011.10.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 10/24/2011] [Accepted: 10/24/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Impaired autonomic function is common in the acute poststroke phase but little is known about its effects on functional outcome after acute ischemic stroke. This study sought to investigate the impact of autonomic dysfunction by Ewing's classification on functional outcome 2 months after acute ischemic stroke. METHODS 34 consecutive acute ischemic stroke patients within 7 days after onset were enrolled. On admission, autonomic function was assessed by Ewing's battery tests. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS), autonomy in activities of daily living by the Barthel Index (BI), and global disability by the modified Rankin Scale (mRS). BI and mRS were also evaluated 2 months after ischemic stroke onset. RESULTS On admission, eight patients were diagnosed as minor autonomic dysfunction and 26 patients as relatively severe autonomic dysfunction. The prevalence of relatively severe autonomic dysfunction in ischemic stroke patients was 76.5%. There were no significant differences in baseline characteristics between the minor and severe autonomic dysfunction groups. 2 months after stroke onset, the mean BI score of patients with minor autonomic dysfunction and severe autonomic dysfunction increased from 76.3±15.3 on admission to 95.0±7.1, 66.5±15.2 on admission to 74.8±15.9 respectively. The mean BI score after 2-month stroke onset and the change in BI from admission to 2-month outcome (delta BI) in patients with severe autonomic dysfunction were lower than those in patients with minor autonomic dysfunction (all P<0.05). CONCLUSIONS Autonomic dysfunction occurs in acute stroke patients. Relatively severe autonomic dysfunction is related to an unfavorable functional outcome in patients with acute ischemic stroke.
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Affiliation(s)
- Li Xiong
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
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50
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Park SY, Lee IH. The Influence of Age, Lesion Side and Location on Rehabilitation Outcome After Stroke. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - In Hee Lee
- Department of Physical Medicine and Rehabilitation, Keimyung University, Dongsan Hospital
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