1
|
Armstrong A, Yang T, Leng T, Xiong ZG. Inhibition of ASIC1a Improves Behavioral Recovery after Stroke. eNeuro 2024; 11:ENEURO.0341-23.2023. [PMID: 38233146 PMCID: PMC10866329 DOI: 10.1523/eneuro.0341-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 01/19/2024] Open
Abstract
Stroke continues to be a leading cause of death and long-term disabilities worldwide, despite extensive research efforts. The failure of multiple clinical trials raises the need for continued study of brain injury mechanisms and novel therapeutic strategies for ischemic stroke. The contribution of acid-sensing ion channel 1a (ASIC1a) to neuronal injury during the acute phase of stroke has been well studied; however, the long-term impact of ASIC1a inhibition on stroke recovery has not been established. The present study sought to bridge part of the translational gap by focusing on long-term behavioral recovery after a 30 min stroke in mice that had ASIC1a knocked out or inhibited by PcTX1. The neurological consequences of stroke in mice were evaluated before and after the stroke using neurological deficit score, open field, and corner turn test over a 28 d period. ASIC1a knock-out and inhibited mice showed improved neurological scores more quickly than wild-type control and vehicle-injected mice after the stroke. ASIC1a knock-out mice also recovered from mobility deficits in the open field test more quickly than wild-type mice, while PcTX1-injected mice did not experience significant mobility deficits at all after the stroke. In contrast to vehicle-injected mice that showed clear-sidedness bias in the corner turn test after stroke, PcTX1-injected mice never experienced significant-sidedness bias at all. This study supports and extends previous work demonstrating ASIC1a as a potential therapeutic target for the treatment of ischemic stroke.
Collapse
Affiliation(s)
- Ariel Armstrong
- Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia 30310
| | - Tao Yang
- Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia 30310
| | - Tiandong Leng
- Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia 30310
| | - Zhi-Gang Xiong
- Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia 30310
| |
Collapse
|
2
|
Pan Y, Xu M, Mei Y, Wang Y, Zhang Q. Activities of daily living predict periprocedural myocardial infarction and injury following percutaneous coronary intervention: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:427. [PMID: 37644419 PMCID: PMC10466711 DOI: 10.1186/s12872-023-03468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In recent years, there has been growing interest in exploring the relationship between activities of daily living (ADL) and cardiovascular diseases. This retrospective cross-sectional study aimed to investigate the association of ADL measured by Barthel index (BI) with periprocedural myocardial infarction (PMI) and injury following percutaneous coronary intervention (PCI). METHODS Enrolled patients were stratified into impaired and unimpaired ADL groups according to their BI scores. Logistic regressions were conducted to explore the association of ADL on admission with periprocedural myocardial injury and infarction. Restricted cubic spline (RCS) curve and subgroup analysis were also performed. RESULTS Totally, 16.4% of patients suffered from PMI; the mean age was 65.8 ± 10.4 years old. RCS analysis showed that the morbidity of periprocedural myocardial infarction and injury showed a downward tendency with increasing BI scores. Multivariable logistic regression analysis demonstrated that impaired ADL was an independent risk factor for periprocedural myocardial infarction (OR = 1.190, 95% CI [1.041, 1.360], P = 0.011) and injury (OR = 1.131, 95% CI [1.017, 1.257], P = 0.023). Subgroup analysis showed that the association between ADL and PMI was founded in several subgroups, while the association between ADL and periprocedural myocardial injury was founded only in BMI ≥ 24 kg/m2 subgroup. CONCLUSION Impaired ADL at hospital admission was an independent risk factor for periprocedural myocardial infarction and injury among patients following PCI.
Collapse
Affiliation(s)
- Yifan Pan
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Min Xu
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Yaosheng Mei
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Yunxiang Wang
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Qiongli Zhang
- Department of Cardiology, Yongkang Hospital, Yongkang, Zhejiang, 321300, China.
| |
Collapse
|
3
|
Koltai T, Dénes RV, Dénes Z. Analysis of the effect of patients' health status on efficiency: Application of data envelopment analysis in healthcare. Health Serv Manage Res 2023; 36:2-9. [PMID: 35061548 DOI: 10.1177/09514848211065464] [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: 01/25/2023]
Abstract
The effective and efficient operation of public healthcare systems is more and more important as a consequence of the increasing amount of money spent on their operation. For this reason, accurate and science-based efficiency information is needed for managers and healthcare policy makers. The evaluation of the efficiency in this sector is particularly difficult because several measures and indicators are used. Data envelopment analysis (DEA) can provide aggregate and overall measures of efficiency. The purpose of this paper is the examination of the efficiency of in-patient rehabilitation units curing musculoskeletal disorders in Hungary. The research presented focuses on rehabilitation units which attend to patients recovering from stroke or other acquired brain injuries. Output-oriented, slack-based DEA models are applied for the evaluation of in-patient rehabilitation units using data of a national survey. The novelty of the method presented is the consideration of the change in patients' functional status when efficiency is evaluated using DEA.
Collapse
Affiliation(s)
- Tamás Koltai
- Management and Business Economics, 61810Budapest University of Technology and Economics, Budapest, Hungary
| | - Rita V Dénes
- Department of Management and Business Law, Eötvös Loránd University, Budapest, Hungary
| | - Zoltán Dénes
- 72854National Institute for Medical Rehabilitation, Budapest, Hungary
| |
Collapse
|
4
|
Hu Y, Xiao Q, Shi Z, Hou Y, Chen Z, Cheng J, Li G. Safety and efficacy of low-dose and long-course tirofiban in large hemispheric infarction. Front Neurol 2022; 13:987859. [PMID: 36158948 PMCID: PMC9500446 DOI: 10.3389/fneur.2022.987859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background The clinical efficacy and safety of tirofiban in the treatment of large hemispheric infarction (LHI) remain controversial. Methods This study prospectively enrolled patients with acute LHI who were admitted to Putuo Hospital affiliated with Shanghai University of Traditional Chinese Medicine from June 2021 to December 2021. The patients were randomly assigned to the tirofiban group [3–4 μg/(kg·h)] or control group (clopidogrel 75 mg/d). Results A total of 71 patients with acute LHI were selected: 36 in the tirofiban group and 35 in the control group. The reduction of the NIHSS score in the tirofiban group was 2.92 ± 9.31 at discharge, and that of the control group was −3.23 ± 12.06 (p = 0.021, OR, 0.006; 95% CI, 0.004–0.008). Six patients (16.7%) in tirofiban group and 14 patients (40%) in control group died during hospitalization (p = 0.029, OR, 0.300; 95% CI, 0.099–0.908). There was significant difference in Modified Rankin Scale (mRS) 5–6 scores at 90 days between the two groups (p = 0.023, OR, 0.327; 95% CI, 0.124–0.867). However, there was no significant difference in mRS 0–1 (p = 0.321, OR, 0.972; 95% CI, 0.920–1.027), mRS 2 (p = 0.572, OR, 2.00; 95% CI, 0.173–23.109), mRS 3 (p = 0.225, OR, 2.214; 95% CI, 0.601–8.161), or mRS 4(p = 0.284, OR, 1.859; 95% CI, 0.593–5.825) scores between the two groups. There was no difference in symptomatic intracranial hemorrhage (p = 0.29, OR, 0.305; 95% CI, 0.030–3.081), asymptomatic intracranial hemorrhage (p = 0.123, OR, 0.284; 95% CI, 0.053–1.518). There was a significant difference in systemic bleeding events during hospitalization (p = 0.044, OR, 0.309; 95% CI, 0.096–1.000). Conclusions Low-dose and long-course tirofiban treatment may significantly improve the early neurological function and reduce the in-hospital mortality in LHI patients. Meanwhile, tirofiban does not increase the risk of any type of bleeding events.
Collapse
|
5
|
Ghose M, Das R, Barua AR, Deka P, Barman A, Borah NC, Chowdhury N, Barman A. A Five-Year Retrospective Cohort Study of Survivality and Functional Outcomes of Stroke Patients Following Hospital Admission. Ann Neurosci 2022; 29:144-150. [DOI: 10.1177/09727531221109106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Stroke is the fourth leading cause of death in India. Data on long-term outcomes of patients with stroke in India are relatively sparse. Objective To document survival and long-term functional outcomes of patients with acute stroke and to assess the measures taken for secondary prevention of stroke. Methods and Material A five-year retrospective cohort study involving 118 patients with acute stroke was conducted. Details about five years’ survival, functional outcomes (modified Rankin Scale [mRS], Barthel index [BI], and Hamilton Depression Rating Scale [HDRS]), and secondary prevention measures were investigated. Results Among the patients, 38.1% were diagnosed with ischemic stroke and 61.8% were diagnosed with hemorrhagic stroke. Hypertension was observed to be the predominant risk factor in a majority of the admitted patients. About 30.5% of patients died in the hospital within zero to four weeks after the index event, while 27.1% died during the follow-up period of five years. Approximately 21.1% of patients experienced a recurrent stroke over the next five years which turned out fatal. The quality of life was seriously affected in 32.4% of survivors. It was seen that 40.5% of survivors were fully independent and 45.9% were able to return to their occupation after five years poststroke. Prevalence of severe and very severe depression was observed in 3.4% and 1.7% of survivors, respectively. The majority of the survivors (93.9%) were aware of the risk of recurrent stroke. Physical activities as measures for the prevention of stroke were undertaken by 60.6% of survivors. Conclusion Effective strategies for secondary prevention and also for long-term survival after stroke should be initiated as early as possible after the onset of the initial stroke. Stroke survivors should be closely monitored for their functional recovery and behavioral and emotional improvement poststroke.
Collapse
Affiliation(s)
- Manash Ghose
- Department of Neurology, GNRC Hospitals, Dispur, Assam, India
| | - Rupjyoti Das
- Department of Neurology, GNRC Hospitals, Dispur, Assam, India
| | | | - Prasenjit Deka
- Department of Neurology, GNRC Hospitals, Six mile, Assam, India
| | | | | | - Nupur Chowdhury
- Department of Research and Analytics, GNRC Hospitals, Dispur, Assam, India
| | - Ananya Barman
- Department of Research and Analytics, GNRC Hospitals, Dispur, Assam, India
| |
Collapse
|
6
|
Adams HP. Clinical Scales to Assess Patients With Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Tarvonen-Schröder S, Niemi T, Hurme S, Koivisto M. Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1960600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Tuuli Niemi
- Department of Expert Services, Turku University Hospital, Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| |
Collapse
|
8
|
Abstract
BACKGROUND Informal caregiving of stroke survivors often begins with intensity compared with the linear caregiving trajectories in progressive conditions. Informal caregivers of stroke survivors are often inadequately prepared for their caregiving role, which can have detrimental effects on their well-being. A greater depth of understanding about caregiving burden is needed to identify caregivers in most need of intervention. The purpose of this study was to examine caregiver burden and associated factors among a cohort of informal caregivers of stroke survivors. METHODS A cross-sectional study of 88 informal caregivers of stroke survivors was completed. Caregiver burden was determined with the Zarit Burden Interview, caregiver depressive symptoms were measured with the Patient Health Questionnaire-9, and stroke survivor functional disability was assessed with the Barthel Index. Ordinal logistic regression was used to identify independent factors associated with caregiver burden. RESULTS Forty-three informal caregivers (49%) reported minimal or no caregiver burden, 30 (34%) reported mild to moderate caregiver burden, and 15 (17%) reported moderate to severe caregiver burden. Stroke survivor functional disability was associated with informal caregiver burden (P = .0387). The odds of having mild to moderate caregiver burden were 3.7 times higher for informal caregivers of stroke survivors with moderate to severe functional disability than for caregivers of stroke survivors with no functional disability. The presence of caregiver depressive symptoms was highly correlated with caregiver burden (P < .001). CONCLUSION Caregivers of stroke survivors with functional disabilities and caregivers experiencing depressive symptoms may have severer caregiver burden. Trials of interventions aimed at decreasing informal caregiver burden should consider the potential impact of stroke survivors' functional disability and the presence of depressive symptoms.
Collapse
|
9
|
Stroke outcome assessment: Optimizing cutoff scores for the Longshi Scale, modified Rankin Scale and Barthel Index. PLoS One 2021; 16:e0251103. [PMID: 33984006 PMCID: PMC8118543 DOI: 10.1371/journal.pone.0251103] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
The Longshi Scale, a visual-based scale, is reliable and valid in activity assessment, but lacks cutoff definition corresponding to classical scales such as the modified Rankin Scale and Barthel Index. Therefore, this study aimed to investigate the relationships of the Longshi Scale with the modified Rankin Scale and Barthel Index and optimize cutoff scores of these scales in stroke outcomes assessment. This is a cross-sectional study. Stroke patients were measured concurrently by the Longshi scale, modified Rankin Scale and Barthel Index. Kruskal-Wallis test and Spearman correlation analysis were used to analyze the differences and associations among the three scales. The receiver operating characteristic curve was performed to determine the optimal cutoff scores. A total of 5475 stroke patients (67.3% ischemic) were included in this study. There are close relationships of the Longshi Scale with adjusted modified Rankin Scale and Barthel Index (r = -0.861, 0.922; p<0.001, <0.001; respectively). The activity levels assessed by adjusted modified Rankin Scale and Barthel Index among different Longshi scale grades were significantly different (χ2:4217.27, 4676.55; p<0.001, <0.001; respectively). The optimal cutoff scores were adjusted modified Rankin Scale 4, 3, 3, 3, 2 for Longshi scale grade 2 to 6 (sensitivity%: 96.12, 70.24, 89.10, 96.80, 86.23, specificity%: 72.72, 98.29, 93.81, 79.82, 92.89, respectively), and Barthel Index 15, 45, 60, 75, 80 for Longshi scale grade 2 to 6 (sensitivity%: 92.54, 89.28, 91.32, 90.30, 95.65, specificity%: 95.48, 89.51, 94.02, 90.41, 90.62, respectively). In conclusion, the classification of Longshi Scale is consistent with those of modified Rankin Scale and Barthel Index. We recommend the Longshi Scale as an effective supplement for modified Rankin Scale and Barthel Index in assessing the outcome in acute stroke patients.
Collapse
|
10
|
Smits-Engelsman BCM, Smit E, Doe-Asinyo RX, Lawerteh SE, Aertssen W, Ferguson G, Jelsma DL. Inter-rater reliability and test-retest reliability of the Performance and Fitness (PERF-FIT) test battery for children: a test for motor skill related fitness. BMC Pediatr 2021; 21:119. [PMID: 33706742 PMCID: PMC7948346 DOI: 10.1186/s12887-021-02589-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background The Performance and Fitness (PERF-FIT) test battery for children is a recently developed, valid assessment tool for measuring motor skill-related physical fitness in 5 to 12-year-old children living in low-income settings. The aim of this study was to determine: (1) inter-rater reliability and (2) test-retest reliability of the PERF-FIT in children from 3 different countries (Ghana, South Africa and the Netherlands). Method For inter-rater reliability 29 children, (16 boys and 13 girls, 6–10 years) were scored by 2 raters simultaneously. For test–retest reliability 72 children, (33 boys and 39 girls, 5–12 years) performed the test twice, minimally 1 week and maximally 2 weeks apart. Relative and absolute reliability indices were calculated. ANOVA was used to examine differences between the three assessor teams in the three countries. Results The PERF-FIT demonstrated excellent inter-rater reliability (ICC, 0.99) and good test-retest reliability (ICC, ≥ 0.80) for 11 of the 12 tasks, with a poor ICC for the Jumping item, due to low spread in values. A significant difference between first and second test occasion was present on half of the items, but the differences were small (Cohen’s d 0.01–0.17), except for Stepping, Side jump and Bouncing and Catching (Cohen’s d 0.34, 0.41 and 0.33, respectively). Overall, measurement error, Limits of Agreement and Coefficient of Variation had acceptable levels to support clinical use. No systematic dissimilarities in error were found between first and second measurement between the three countries but for one item (Overhead throw). Conclusions The PERF-FIT can reliably measure motor skill related fitness in 5 to 12-year-old children in different settings and help clinicians monitor levels of fundamental motor skills (throwing, bouncing, catching, jumping, hopping and balance), power and agility.
Collapse
Affiliation(s)
- Bouwien C M Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Eline Smit
- Avansplus, University for professionals, Breda, The Netherlands
| | - Rosemary Xorlanyo Doe-Asinyo
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Occupational Therapy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Stella Elikplim Lawerteh
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics, 37 Military Hospital, Accra, Ghana
| | - Wendy Aertssen
- Avansplus, University for professionals, Breda, The Netherlands
| | - Gillian Ferguson
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dorothee L Jelsma
- Developmental and Clinical Neuropsychology, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
11
|
Current status of the management and outcomes of acute aortic dissection in Japan: Analyses of nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination data. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:S21-S31. [DOI: 10.1177/2048872619872847] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background:
Despite recent advances in the diagnosis and management, the mortality of acute aortic dissection remains high. This study aims to clarify the current status of the management and outcome of acute aortic dissection in Japan.
Methods:
A total of 18,348 patients with acute aortic dissection (type A: 10,131, type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012–March 2015 were studied. Characteristics, clinical presentation, management, and in-hospital outcomes were analyzed.
Results:
Seasonal onset variation (autumn- and winter-dominant) was found in both types. More than 90% of patients underwent computed tomography for primary diagnosis. The overall in-hospital mortality of types A and B was 24.3% and 4.5%, respectively. The mortality in type A patients managed surgically was significantly lower than in those not receiving surgery (11.8% (799/6788) vs 49.7% (1663/3343); p<0.001). The number of cases managed endovascularly in type B increased 2.2-fold during the period, and although not statistically significant, the mortality gradually decreased (5.2% to 4.1%, p=0.49). Type A showed significantly longer length of hospitalization (median 28 days) and more than five times higher medical costs (6.26 million Japanese yen) than those in type B. The mean Barthel index at discharge was favorable in both type A (89.0±22.6) and type B (92.6±19.0). More than two-thirds of type A patients and nearly 90% of type B patients were directly discharged home.
Conclusions:
This nationwide study elucidated the clinical features and outcomes in contemporary patients with acute aortic dissections in real-world clinical practice in Japan.
Collapse
|
12
|
Ahmed T, Kumar R, Bahurupi Y. Factors Affecting Quality of Life among Post-Stroke Patients in the Sub-Himalayan Region. J Neurosci Rural Pract 2020; 11:616-622. [PMID: 33144800 PMCID: PMC7595802 DOI: 10.1055/s-0040-1716927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Stroke is one of the most debilitating conditions contributing to significant disability and death globally. Identifying risk factors for quality of life (QoL) will enable to improve home-based rehabilitation in post-stroke phase.
Objective
This study was aimed to identify the risk factors of QoL in stroke patients in the sub-Himalayan region.
Materials and Methods
A cross-sectional hospital-based study assessed the QoL among stroke patients within a week after the onset of acute stroke and then re-evaluated at 3 months. World Health Organization QoL-BREF, Beck Depression Inventory, the Barthel Index, and Montreal Cognitive Assessment (MOCA) were used to seek data on QoL, depression, cognitive, and functional dependence status, respectively. Appropriate statistics were used to compute the results.
Results
In total, 129 stroke patients recruited, out of which 102 returned to a 3-month follow-up. QoL, MOCA, disability index, and depression score were compared using Wilcoxon Singed-rank test. In multivariate analysis, depression and disability together predicted 60% of the variance for physical QoL (
p
< 0.0001). Similarly, poststroke depression and disability together predicted 61% of the variance for psychological QoL (
p
< 0.0001) in stroke patients.
Conclusion
Findings indicated that depression and disability are leading risk factors of QoL in stroke patients. Early identification of poststroke depression and functional dependence status is, therefore, essential to devise screening procedure and to develop targeted intervention to improve rehabilitation outcomes.
Collapse
Affiliation(s)
- Tarannum Ahmed
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Rajesh Kumar
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
13
|
Applicability of International Classification of Functioning, Disability and Health-based participation measures in stroke survivors in Africa: a systematic review. Int J Rehabil Res 2020; 43:3-11. [PMID: 31633581 DOI: 10.1097/mrr.0000000000000377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To appraise available International Classification of Functioning, Disability and Health (ICF)-based tools for the measurement of participation after stroke and to examine their applicability in the African sociocultural context. Pubmed/Medline, Science Direct, Cochrane Library, and Hinari databases were systematically searched. The literature search was limited to studies published in the English or French language from January 2001 up to May 2019. Two reviewers independently screened all identified studies and selected eligible articles. Disagreements about inclusion or exclusion of studies were resolved by consensus. Two reviewers independently extracted the psychometric properties of each instrument using the Consensus-based Standard for the Selection of Health Measurement Instruments checklist and examined the methodological quality of each selected study using the MacDermid checklist. A total of 1030 articles were systematically reviewed for relevance, yielding 22 studies that met inclusion criteria. These studies were related to nine participation tools. The MacDermid scores ranged from 13 to 21 out of 24. The number of investigated psychometric properties and the number of ICF participation domains covered by each tool varied among studies. This systematic review revealed nine ICF-based tools for the measurement of participation after stroke. We examined the content of these tools and provided valuable information that can be used to guide researchers in Africa in their selection of the most appropriate tool for the measurement of participation after stroke.
Collapse
|
14
|
Jung HJ, Lee YM, Kim M, Uhm KE, Lee J. Suggested Assessments for Sarcopenia in Patients With Stroke Who Can Walk Independently. Ann Rehabil Med 2020; 44:20-37. [PMID: 32130836 PMCID: PMC7056329 DOI: 10.5535/arm.2020.44.1.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate variables for assessment of stroke-related sarcopenia that are alternative options to the current assessment for sarcopenia, which focuses on age-related sarcopenia and also has limitations in addressing sarcopenia due to weakness resulting from stroke. Methods Forty patients (17 men, 23 women; mean age, 66.9±15.4 years) with first-ever stroke who can walk independently were included. Muscle mass was determined by measuring ultrasonographic muscle thickness of vastus intermedius, rectus femoris, tibialis anterior, medial gastrocnemius, and biceps brachii muscles in addition to using the skeletal muscle index (SMI) with bioelectrical impedance analysis. Muscle strength was assessed with the Medical Research Council (MRC) sum score as well as handgrip (HG) strength. Physical performance was measured by the Berg Balance Scale (BBS) along with 4-meter gait speed (4MGS). Correlations between each assessment in the three categories were analyzed and adjusted by stroke severity, comorbidity, and nutritional status. Results For muscle mass, SMI showed the highest correlation with the tibialis anterior muscle (r=0.783, p<0.001) among the other muscles. Regarding muscle strength, the MRC sum score correlated with the HG (r=0.660, p<0.001). For physical performance, the BBS correlated with the 4MGS (r=0.834, p<0.001). The same result was obtained after adjusting for factors of stroke severity, comorbidity, and nutritional status. Conclusion These results suggest that ultrasonographic muscle thickness of the tibialis anterior, the MRC sum score, and BBS might be alternatives to SMI, HG, and usual gait speed for sarcopenia in stroke patients.
Collapse
Affiliation(s)
- Ho Joong Jung
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Min Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Minsun Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea.,International Healthcare Research Institute, Konkuk University, Seoul, Korea
| |
Collapse
|
15
|
Yang M, Huo X, Miao Z, Wang Y. Platelet Glycoprotein IIb/IIIa Receptor Inhibitor Tirofiban in Acute Ischemic Stroke. Drugs 2019; 79:515-529. [PMID: 30838514 DOI: 10.1007/s40265-019-01078-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tirofiban is a non-peptide selective glycoprotein (GP) IIb/IIIa receptor inhibitor that reversibly inhibits fibrinogen-dependent platelet aggregation and subsequent formation of thrombi, which contribute to the major atherosclerotic complications in the development, progression, and resolution of ischemic stroke. The adjunctive use of tirofiban has been extensively evaluated in progressive stroke, combined intravenous thrombolysis (IVT), and endovascular treatment (EVT) in both preclinical and clinical studies. A body of evidence has been accumulated on the risks and benefits associated with tirofiban in terms of prevention of stroke progression, stent thrombosis, improvement in functional independence, and mortality, especially among high-risk ischemic stroke patients as a further strategy alongside conventional treatment. In general, tirofiban has a favorable tolerability and efficacy profile in the improvement of vascular recanalization and long-term functional outcome, although the optimum dosage, application setting, and precise target patients are not yet well-established. However, its specific inhibition of ongoing platelet aggregation and thrombus formation rather than absolute thrombolysis suggests that tirofiban, one of the most widely used GP IIb/IIIa inhibitors, with high affinity and a short plasma/biologic half-life, may have great potential in the acute treatment of ischemic stroke. Substantial practical progress is likely as our understanding of the mechanism of action and pharmacological actions of tirofiban in atherosclerotic ischemic disease improves. Therefore, we classify and summarize the available findings regarding tirofiban in acute ischemic stroke to stimulate and guide further research and clinical practice.
Collapse
Affiliation(s)
- Ming Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Nan Sihuan West Road, Fengtai District, Beijing, 100160, People's Republic of China.,Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Xiaochuan Huo
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Zhongrong Miao
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Nan Sihuan West Road, Fengtai District, Beijing, 100160, People's Republic of China. .,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| |
Collapse
|
16
|
Lin CH, Hsu KC, Johnson KR, Luby M, Fann YC. Applying density-based outlier identifications using multiple datasets for validation of stroke clinical outcomes. Int J Med Inform 2019; 132:103988. [PMID: 31590140 DOI: 10.1016/j.ijmedinf.2019.103988] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Clinicians commonly use the modified Rankin Scale (mRS) and the Barthel Index (BI) to measure clinical outcome after stroke. These are potential targets in machine learning models for stroke outcome prediction. Therefore, the quality of the measurements is crucial for training and validation of these models. The objective of this study was to apply and evaluate density-based outlier detection methods for identifying potentially incorrect measurements in multiple large stroke datasets to assess the measurement quality. METHOD We applied three density-based outlier detection methods including density-based spatial clustering of applications (DBSCAN), hierarchical DBSCAN (HDBSCAN) and local outlier factor (LOF) based on a large dataset obtained from a nationwide prospective stroke registry in Taiwan. The testing of each method was done by using four different NINDS funded stroke datasets. RESULT The DBSCAN achieved a high performance across all mRS values where the highest average accuracy was 99.2 ± 0.7 at mRS of 4 and the lowest average accuracy was 92.0 ± 4.6 at mRS of 3. The LOF also achieved similar performance, however, the HDBSCAN with default parameters setting required further tuning improvement. CONCLUSION The density-based outlier detection methods were proven to be promising for validation of stroke outcome measures. The outlier detection algorithm developed from a large prospective registry dataset was effectively applied in four different NINDS stroke datasets with high performance results. The tool developed from this detection algorithm can be further applied to real world datasets to increase the data quality in stroke outcome measures.
Collapse
Affiliation(s)
- Ching-Heng Lin
- Center for Information Technology, National Institutes of Health, Bethesda, MD, United States
| | - Kai-Cheng Hsu
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kory R Johnson
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Marie Luby
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Yang C Fann
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States.
| |
Collapse
|
17
|
Yamaguchi T, Nakai M, Sumita Y, Nishimura K, Tazaki J, Kyuragi R, Kinoshita Y, Miyamoto T, Sakata Y, Nozato T, Ogino H. Editor's Choice – Endovascular Repair Versus Surgical Repair for Japanese Patients With Ruptured Thoracic and Abdominal Aortic Aneurysms: A Nationwide Study. Eur J Vasc Endovasc Surg 2019; 57:779-786. [DOI: 10.1016/j.ejvs.2019.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/22/2019] [Indexed: 11/24/2022]
|
18
|
Oort Q, Taphoorn MJB, Sikkes SAM, Uitdehaag BMJ, Reijneveld JC, Dirven L. Evaluation of the content coverage of questionnaires containing basic and instrumental activities of daily living (ADL) used in adult patients with brain tumors. J Neurooncol 2019; 143:1-13. [PMID: 30887244 PMCID: PMC6482128 DOI: 10.1007/s11060-019-03136-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/26/2019] [Indexed: 11/15/2022]
Abstract
Background Everyday functioning can be assessed using measures of basic activities of daily living (BADL) or instrumental activities of daily living (IADL). The aim of this review was to provide an overview of the scope and specific content of BADL and/or IADL covered by currently used questionnaires in adult brain tumor patient studies. Methods Electronic databases were searched up to April 2017 to identify all eligible questionnaires with items regarding BADL/IADL in studies with adult brain tumor patients. Articles were selected using predetermined in- and exclusion criteria. Items with similar content were clustered into domains based on type of activity. Results Thirty-one unique questionnaires containing at least one BADL and/or IADL item were identified; 21 and 29 questionnaires containing ≥ 1 BADL or IADL item, respectively. The percentage of ADL items in these questionnaires ranged from 4 to 100%. Only two questionnaires were specifically developed to measure BADL (Barthel Index and Katz-ADL) and two specifically for IADL (Lawton-Brody IADL and preliminary IADL-BN). Content clustering revealed that IADL had a larger variation in content (31 domains, e.g. work or leisure time activities) compared to BADL (15 domains, e.g. mobility or bathing/washing). Conclusion Thirty-one questionnaires previously used in brain tumor studies contained items on BADL and/or IADL and covered a wide range of content, in particular for IADL. It is currently unclear which BADL/IADL are most relevant for brain tumor patients, and this should therefore be evaluated. Next, existing questionnaires could be adapted or validated, or new measures can be developed to meet these needs. Electronic supplementary material The online version of this article (10.1007/s11060-019-03136-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Sietske A M Sikkes
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers (Location VUmc), Amsterdam, The Netherlands.,Alzheimer Center, Amsterdam University Medical Centers (Location VUmc), Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam University Medical Centers (Location AMC), Amsterdam, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| |
Collapse
|
19
|
Merchán-Baeza JA, González-Sánchez M, Cuesta-Vargas AI. Using Smartphones to Collect Quantitative Data on Lower Limb Functionality in People Who Have Suffered a Stroke. J Stroke Cerebrovasc Dis 2018; 27:3555-3562. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/08/2018] [Indexed: 01/23/2023] Open
|
20
|
Hiraga A, Yamaoka T, Sakai Y, Osakabe Y, Suzuki A, Hirose N. Relationship between outcome in acute stroke patients and multiple stroke related scores obtained after onset of stroke. J Phys Ther Sci 2018; 30:1310-1314. [PMID: 30349170 PMCID: PMC6181659 DOI: 10.1589/jpts.30.1310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to examine the effectiveness of a stroke-related
scale with regard to outcome, onset, and timing of stroke patients. [Participants and
Methods] The participants included 583 out of 996 patients who were admitted to the stroke
care unit.The outcomes and 3 stroke scale (National Institutes of Health Stroke Scale:
NIHSS, Functional Independence Measure: FIM, modified Rankin Scale: mRS) scores
immediately at hospitalization, on day 7 after onset, and on day 30 after onset were
investigated. This study was analyzed using a generalization linear model with a binomial
distribution. The comparisons between outcomes were made in terms of home discharge versus
convalescence, and convalescence versus hospital transfer. [Results] Comparisons of home
discharge versus convalescence hospital transfer showed a significant difference in the
NIHSS and mRS scores at the time of hospitalization, and a significant difference in the
NIHSS scale score on day 7 after onset. In comparisons between convalescence and hospital
transfer, significant differences were observed in NIHSS and FIM scores at
hospitalization, and the FIM scale score showed significant differences on day 7 and day
30. [Conclusion] The study suggested the efficacy of using multiple scales for prediction
of stroke outcome with higher accuracy.
Collapse
Affiliation(s)
- Atsushi Hiraga
- Department of Physical Therapy, Faculty of Medical Sciences, Teikyo University of Science: 2525 Yatsusawa, Uenohara, Yamanashi 409-0193, Japan
| | | | | | | | - Aki Suzuki
- Yokohamashintoshi Neurosurgical Hospital, Japan
| | - Noboru Hirose
- Graduate School of Medical Science, Teikyo University of Science, Japan
| |
Collapse
|
21
|
Kodama A, Koyama A, Sugimoto M, Niimi K, Banno H, Komori K. Association Between Preoperative Frailty and Mortality in Patients With Critical Limb Ischemia Following Infrainguinal Bypass Surgery ― Usefulness of the Barthel Index ―. Circ J 2018; 82:267-274. [DOI: 10.1253/circj.cj-17-0369] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Akio Koyama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Masayuki Sugimoto
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kiyoaki Niimi
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hiroshi Banno
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| |
Collapse
|
22
|
Criterion Validity of the "HRQOLISP-E": A New Context-Specific Screening Tool for Poststroke Depression. Behav Neurol 2017; 2017:6515769. [PMID: 29158623 PMCID: PMC5660745 DOI: 10.1155/2017/6515769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives The optimal tool for identifying postsroke depression (PSD) is yet to be identified. In the present study, we rely on the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) as a meaningful criterion to investigate the psychometric properties of the HRQOLISP-E, a new context-specific screening tool for PSD developed from a large cross-cultural sample. Methods We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤one month) stroke survivors. Depression was measured using the HADS-D and the HRQOLISP-E. We determined sensitivity, specificity, likelihood ratios, and posttest probability. The area under a receiver operator curve (AUC) and the most appropriate HRQOLISP-E cut-off were also determined using standard procedures. Results Using data derived from 387 recent stroke survivors, the HRQOLISP-E showed high agreement with the HADS-D, sensitivity = 73.7%, specificity = 79.3%, and posterior test probability = 88% (95% CI = 84%–91%). The AUC was 0.81 (95% CI = 0.76–0.86). The HRQOLISP-E cut-off, corresponding to HADS-D score ≥ 8, was 20/21 (out of a total score of 30). Conclusions Within limitations of using the HADS-D as a referent criterion, the present results provide justification for further development of the HRQOLISP-E as the first stroke-specific screening tool for depression.
Collapse
|
23
|
Nayak L, DeAngelis LM, Brandes AA, Peereboom DM, Galanis E, Lin NU, Soffietti R, Macdonald DR, Chamberlain M, Perry J, Jaeckle K, Mehta M, Stupp R, Muzikansky A, Pentsova E, Cloughesy T, Iwamoto FM, Tonn JC, Vogelbaum MA, Wen PY, van den Bent MJ, Reardon DA. The Neurologic Assessment in Neuro-Oncology (NANO) scale: a tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria. Neuro Oncol 2017; 19:625-635. [PMID: 28453751 PMCID: PMC5464449 DOI: 10.1093/neuonc/nox029] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The Macdonald criteria and the Response Assessment in Neuro-Oncology (RANO) criteria define radiologic parameters to classify therapeutic outcome among patients with malignant glioma and specify that clinical status must be incorporated and prioritized for overall assessment. But neither provides specific parameters to do so. We hypothesized that a standardized metric to measure neurologic function will permit more effective overall response assessment in neuro-oncology. Methods An international group of physicians including neurologists, medical oncologists, radiation oncologists, and neurosurgeons with expertise in neuro-oncology drafted the Neurologic Assessment in Neuro-Oncology (NANO) scale as an objective and quantifiable metric of neurologic function evaluable during a routine office examination. The scale was subsequently tested in a multicenter study to determine its overall reliability, inter-observer variability, and feasibility. Results The NANO scale is a quantifiable evaluation of 9 relevant neurologic domains based on direct observation and testing conducted during routine office visits. The score defines overall response criteria. A prospective, multinational study noted a >90% inter-observer agreement rate with kappa statistic ranging from 0.35 to 0.83 (fair to almost perfect agreement), and a median assessment time of 4 minutes (interquartile range, 3-5). Conclusion The NANO scale provides an objective clinician-reported outcome of neurologic function with high inter-observer agreement. It is designed to combine with radiographic assessment to provide an overall assessment of outcome for neuro-oncology patients in clinical trials and in daily practice. Furthermore, it complements existing patient-reported outcomes and cognition testing to combine for a global clinical outcome assessment of well-being among brain tumor patients.
Collapse
Affiliation(s)
- Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Science, Bologna, Italy
| | - David M Peereboom
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Riccardo Soffietti
- Department of Neurology and Neuro-Oncology, University of Turin, Turin, Italy
| | - David R Macdonald
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Marc Chamberlain
- Department of Neurology, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, University of Washington School of Medicine, Seattle, Washington, USA
| | - James Perry
- Division of Neurology, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada
| | - Kurt Jaeckle
- Department of Neurology and Hematology/Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Roger Stupp
- Department of Oncology, University of Zurich, Zurich, Switzerland
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Timothy Cloughesy
- Neuro-Oncology Program, Ronald Reagan UCLA Medical Center, University of CaliforniaLos Angeles, Los Angeles, California, USA
| | - Fabio M Iwamoto
- Division of Neuro-Oncology, Neurological Institute of New York College of Physicians and Surgeons, Columbia University, New York, USA
| | | | - Michael A Vogelbaum
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Martin J van den Bent
- Neuro-Oncology Unit, Erasmus MC Cancer Center, Erasmus MC, Rotterdam, The Netherlands
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Menon B, Ramalingam K, Conjeevaram J, Munisusmitha K. Role of brain natriuretic peptide as a novel prognostic biomarker in acute ischemic stroke. Ann Indian Acad Neurol 2016; 19:462-466. [PMID: 27994354 PMCID: PMC5144466 DOI: 10.4103/0972-2327.194422] [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] [Indexed: 02/05/2023] Open
Abstract
Aim: We investigated to study the prognostic importance of brain natriuretic peptide (BNP) in ischemic stroke. Materials and Methods: We prospectively enrolled 100 patients with acute ischemic stroke and measured plasma BNP levels and compared with age- and sex-matched healthy controls. Risk factors, biochemical parameters, lipid profile, carotid and vertebral Doppler, imaging, and cardiac evaluation were done. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) score on admission and functional disability by Barthel Index (BI) at 3 months. Ischemic stroke subtype was classified according to the Oxfordshire Community Stroke Project (OCSP). Data were entered in MS Excel, and appropriate statistical analysis was done using the SPSS software version 21.0. A P = 0.05 was considered as significant. Results: Mean age of patients was 55.17 ± 11.37 years with a male:female ratio 3:1. OCSP showed total anterior circulation infarct (TACI) 35, partial anterior circulation infarct 9, lacunar infarct 12, and posterior circulation infarct 44. NIHSS on admission was average 10 ± 7 and BI was 57 ± 30. BNP in patients (435 ng/ml) was very high as compared to controls (<60 ng/ml) (P < 0.001). There was a positive correlation between age and BNP (R2 = 0.34; P < 0.00); NIHSS and BNP (R2 = 0.255; P < 0.01), negative correlation between BI and BNP (R2 = −0.064; P < 0.01). Mean BNP levels across the OCSP showed higher values in TACI (F = 4.609 P = 0.005). Regression analysis showed that BNP can predict BI which was statistically significant. Conclusion: Plasma BNP levels was significantly elevated in patients with ischemic stroke. Our study concludes that high BNP levels are seen in large anterior circulation stroke and is a predictor for the poor functional outcome at 3 months. Determination of BNP levels as a biomarker could be helpful in predicting the outcome in stroke patients.
Collapse
Affiliation(s)
- Bindu Menon
- Department of Neurology, Apollo Speciality Hospitals, Nellore, Andhra Pradesh, India
| | - Krishnana Ramalingam
- Department of Biochemistry, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Jyoti Conjeevaram
- Department of Community Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - K Munisusmitha
- Department of Community Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| |
Collapse
|
25
|
Conductive Education as a Method of Stroke Rehabilitation: A Single Blinded Randomised Controlled Feasibility Study. Stroke Res Treat 2016; 2016:5391598. [PMID: 27418997 PMCID: PMC4935920 DOI: 10.1155/2016/5391598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background. Conductive Education for stroke survivors has shown promise but randomised evidence is unavailable. This study assessed the feasibility of a definitive randomised controlled trial to evaluate efficacy. Methods. Adult stroke survivors were recruited through local community notices. Those completing the baseline assessment were randomised using an online program and group allocation was independent. Intervention group participants received 10 weekly 1.5-hour sessions of Conductive Education at the National Institute of Conductive Education in Birmingham, UK. The control group participants attended two group meetings. The study evaluated the feasibility of recruitment procedures, delivery of the intervention, retention of participants, and appropriateness of outcome measures and data collection methods. Independent assessments included the Barthel Index, the Stroke Impact Scale, the Timed Up and Go test, and the Hospital Anxiety and Depression Scale. Results. Eighty-two patients were enrolled; 77 completed the baseline assessment (46 men, mean age 62.1 yrs.) and were randomised. 70 commenced the intervention (n = 37) or an equivalent waiting period (n = 33). 32/37 completed the 10-week training and 32/33 the waiting period. There were no missing items from completed questionnaires and no adverse events. Discussion. Recruitment, intervention, and assessment methods worked well. Transport issues for intervention and assessment appointments require review. Conclusion. A definitive trial is feasible. This trial is registered with ISRCTN84064492.
Collapse
|
26
|
Song F, Jerosch-Herold C, Holland R, Drachler MDL, Mares K, Harvey I. Statistical methods for analysing Barthel scores in trials of poststroke interventions: a review and computer simulations. Clin Rehabil 2016; 20:347-56. [PMID: 16719033 DOI: 10.1191/0269215506cr948oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and purpose: Arguments persist as to whether parametric or nonparametric methods should be used to analyse ordinal data in trials. This paper aims to assess methods used for presenting and analysing an ordinal scale, the Barthel Index, in trials of poststroke interventions. Methods: All randomized controlled trials (RCTs) of poststroke interventions published from 1995 to 2004 in two journals (Strokeand Clinical Rehabilitation) were scrutinized for methods used to present and analyse Barthel scores. Computer simulations were used to compare the type I errors and the statistical power of different statistical methods under a range of assumed circumstances. Results: One hundred and fifty-six RCTs were identified within the two journals. The central tendency of Barthel scores was measured by the median in 47 trials and by the mean in 35 trials. Non-parametric analyses of Barthel scores were conducted in 47 trials and parametric methods used in 18 trials. The results of computer simulations demonstrate that the t-test has a similar type I error rate and statistical power when compared with the rank sum test. However, when a zero final Barthel score is assigned to patients who have died, the statistical power of the t-test is much reduced. The possible maximal statistical power of dichotomization and ordinal regression is usually much lower than that of the rank sum test. Conclusions: To facilitate comparison and meta-analysis, we recommend that mean values (with standard deviations or standard errors) of Barthel scores should be routinely reported in trials of poststroke interventions. The rank sum test appears the most powerful inferential technique for detecting differences in Barthel scores.
Collapse
Affiliation(s)
- Fujian Song
- School of Allied Health Professions, Institute of Health, University of East Anglia, Norwich, UK.
| | | | | | | | | | | |
Collapse
|
27
|
Impact of glucose fluctuation on acute cerebral infarction in type 2 diabetes. Can J Neurol Sci 2016; 41:486-92. [PMID: 24878474 DOI: 10.1017/s0317167100018539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to describe the frequency and temporal profile of acute cerebral infarction (ACI) using a continuous glucose monitoring system (CGMS) in patients with and without type 2 diabetes mellitus (T2DM) and explore the impact of blood glucose fluctuations on the short-term prognosis of ACI. METHODS The subjects were divided into four groups: T2DM with acute cerebral infarction (DMCI, Group A, n=56); T2DM without acute cerebral infarction (DM-NCI, Group B, n=36); Acute cerebral infarction patients without T2DM (NDM-CI, Group C, n=54); Healthy control group (NG, Group D, n=36). The National Institutes of Health Stoke Scale (NIHSS) and modified Rankin scale (mRs) were collected in Group A and C. All subjects were monitored for 72 hours using the CGMS. Indices such as fasting blood glucose (FBG) and mean amplitude of glycemic excursions (MAGE) were calculated. Glycemic excursions were compared between Group A, B, C and Group D, respectively. Multiple linear regression analysis and logistic analysis was applied. RESULTS MAGE is related to NIHSS, homocysteine (HCY), HOMA-IR, FBG, CRP and IMT, while NIHSS is related to CRP, HCY, HOMA-IR, IMT. The factors impacting the short-term prognosis of ACI were NIHSS, HBA1C and MAGE. CONCLUSION Larger glucose fluctuations are associated with more stroke risk factors and are associated with a poorer short-term prognosis. More attention should be paid to glucose fluctuations in patients with ACI and a history of T2DM.
Collapse
|
28
|
|
29
|
Higuchi S, Kabeya Y, Matsushita K, Taguchi H, Ishiguro H, Kohshoh H, Yoshino H. Barthel Index as a Predictor of 1-Year Mortality in Very Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome: Better Activities of Daily Living, Longer Life. Clin Cardiol 2015; 39:83-9. [PMID: 26720494 DOI: 10.1002/clc.22497] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/01/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated. HYPOTHESIS Better ADL is associated with better 1-year prognosis. METHODS This retrospective study included 91 consecutive very elderly patients with ACS. We calculated the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to BI: high BI (≥85) and low BI (<85). The BI was assessed both on admission (pre-BI) and at discharge (post-BI). RESULTS In the 91 patients (mean age, 88.2 ± 3.0 years, 52% male), 1-year mortality was 33%. The Cox regression model demonstrated that low pre-BI was not a risk factor for 1-year mortality (hazard ratio: 0.73, 95% confidence interval [CI]: 0.30-1.78, P = 0.490). However, post-BI was significantly associated with 1-year mortality (hazard ratio: 0.25, 95% CI: 0.11-0.57, P = 0.001). The 1-year mortality of the high and the low post-BI group was estimated as 21% (95% CI: 12%-35%) and 62% (95% CI: 42%-82%), respectively. A 5-unit decrease in post-BI was related to a 1.10-fold increased risk for 1-year mortality (95% CI: 1.05-1.15, P < 0.001). CONCLUSIONS Activities of daily living at discharge, although not before admission, may be a useful predictor for 1-year mortality in very elderly patients undergoing PCI for ACS.
Collapse
Affiliation(s)
- Satoshi Higuchi
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| | - Yusuke Kabeya
- Division of General Internal Medicine, Department of Internal Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Kenichi Matsushita
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroki Taguchi
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| | - Haruhisa Ishiguro
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideyasu Kohshoh
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| |
Collapse
|
30
|
Sangha RS, Caprio FZ, Askew R, Corado C, Bernstein R, Curran Y, Ruff I, Cella D, Naidech AM, Prabhakaran S. Quality of life in patients with TIA and minor ischemic stroke. Neurology 2015; 85:1957-63. [PMID: 26537051 DOI: 10.1212/wnl.0000000000002164] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system. METHODS Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of ≤5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression. RESULTS Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS >1 or Barthel Index <95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months. CONCLUSIONS Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales.
Collapse
Affiliation(s)
- Rajbeer S Sangha
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Fan Z Caprio
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Askew
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlos Corado
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard Bernstein
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yvonne Curran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilana Ruff
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew M Naidech
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shyam Prabhakaran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
| |
Collapse
|
31
|
Merchán-Baeza JA, González-Sánchez M, Cuesta-Vargas A. Mobile Functional Reach Test in People Who Suffer Stroke: A Pilot Study. JMIR Rehabil Assist Technol 2015; 2:e6. [PMID: 28582239 PMCID: PMC5454544 DOI: 10.2196/rehab.4102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/23/2015] [Accepted: 04/26/2015] [Indexed: 02/06/2023] Open
Abstract
Background Postural instability is one of the major complications found in people who survive a stroke. Parameterizing the Functional Reach Test (FRT) could be useful in clinical practice and basic research, as this test is a clinically accepted tool (for its simplicity, reliability, economy, and portability) to measure the semistatic balance of a subject. Objective The aim of this study is to analyze the reliability in the FRT parameterization using inertial sensor within mobile phones (mobile sensors) for recording kinematic variables in patients who have suffered a stroke. Our hypothesis is that the sensors in mobile phones will be reliable instruments for kinematic study of the FRT. Methods This is a cross-sectional study of 7 subjects over 65 years of age who suffered a stroke. During the execution of FRT, the subjects carried two mobile phones: one placed in the lumbar region and the other one on the trunk. After analyzing the data obtained in the kinematic registration by the mobile sensors, a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the mobile sensors were distance, maximum angular lumbosacral/thoracic displacement, time for maximum angular lumbosacral/thoracic displacement, time of return to the initial position, and total time. Using these data, we calculated speed and acceleration of each. A descriptive analysis of all kinematic outcomes recorded by the two mobile sensors (trunk and lumbar) was developed and the average range achieved in the FRT. Reliability measures were calculated by analyzing the internal consistency of the measures with 95% confidence interval of each outcome variable. We calculated the reliability of mobile sensors in the measurement of the kinematic variables during the execution of the FRT. Results The values in the FRT obtained in this study (2.49 cm, SD 13.15) are similar to those found in other studies with this population and with the same age range. Intrasubject reliability values observed in the use of mobile phones are all located above 0.831, ranging from 0.831 (time B_C trunk area) and 0.894 (displacement A_B trunk area). Likewise, the observed intersubject values range from 0.835 (time B_C trunk area) and 0.882 (displacement A_C trunk area). On the other hand, the reliability of the FRT was 0.989 (0.981-0.996) and 0.978 (0.970-0.985), intrasubject and intersubject respectively. Conclusions We found that mobile sensors in mobile phones could be reliable tools in the parameterization of the Functional Reach Test in people who have had a stroke.
Collapse
Affiliation(s)
- Jose Antonio Merchán-Baeza
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Andalucia Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetria (FE-14), Universidad de Málaga, Málaga, Spain
| | - Manuel González-Sánchez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Andalucia Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetria (FE-14), Universidad de Málaga, Málaga, Spain
| | - Antonio Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Andalucia Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetria (FE-14), Universidad de Málaga, Málaga, Spain.,School of Clinical Sciences of the Faculty of Health, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
32
|
Merchán-Baeza JA, González-Sánchez M, Cuesta-Vargas AI. Comparison of kinematic variables obtained by inertial sensors among stroke survivors and healthy older adults in the Functional Reach Test: cross-sectional study. Biomed Eng Online 2015; 14:49. [PMID: 26025461 PMCID: PMC4448179 DOI: 10.1186/s12938-015-0047-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balance dysfunction is one of the most common problems in people who suffer stroke. To parameterize functional tests standardized by inertial sensors have been promoted in applied medicine. The aim of this study was to compare the kinematic variables of the Functional Reach Test (FRT) obtained by two inertial sensors placed on the trunk and lumbar region between stroke survivors (SS) and healthy older adults (HOA) and to analyze the reliability of the kinematic measurements obtained. METHODS Cross-sectional study. Five SS and five HOA over 65. A descriptive analysis of the average range as well as all kinematic variables recorded was developed. The intrasubject and intersubject reliability of the measured variables was directly calculated. RESULTS In the same intervals, the angular displacement was greater in the HOA group; however, they were completed at similar times for both groups, and HOA conducted the test at a higher speed and greater acceleration in each of the intervals. The SS values were higher than HOA values in the maximum and minimum acceleration in the trunk and in the lumbar region. CONCLUSIONS The SS show less functional reach, a narrower, slower and less accelerated movement during the FRT execution, but with higher peaks of acceleration and speed when they are compared with HOA.
Collapse
Affiliation(s)
- José Antonio Merchán-Baeza
- Departamento de Psiquiatría y Fisioterapia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, 29071, Málaga, Spain.
| | - Manuel González-Sánchez
- Departamento de Psiquiatría y Fisioterapia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, 29071, Málaga, Spain.
| | - Antonio Ignacio Cuesta-Vargas
- Departamento de Psiquiatría y Fisioterapia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, 29071, Málaga, Spain. .,School of Clinical Sciences of the Faculty of Health, Queensland University of Technology, Level 6, O Block, D Wing, Kelvin Grove, Brisbane, Australia.
| |
Collapse
|
33
|
Merchán-Baeza JA, Gonzalez-Sanchez M, Cuesta-Vargas A. Clinical effect size of an educational intervention in the home and compliance with mobile phone-based reminders for people who suffer from stroke: protocol of a randomized controlled trial. JMIR Res Protoc 2015; 4:e33. [PMID: 25757808 PMCID: PMC4376126 DOI: 10.2196/resprot.4034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/10/2014] [Accepted: 01/14/2015] [Indexed: 11/15/2022] Open
Abstract
Background Stroke is the third-leading cause of death and the leading cause of long-term neurological disability in the world. Cognitive, communication, and physical weakness combined with environmental changes frequently cause changes in the roles, routines, and daily occupations of stroke sufferers. Educational intervention combines didactic and interactive intervention, which combines the best choices for teaching new behaviors since it involves the active participation of the patient in learning. Nowadays, there are many types of interventions or means to increase adherence to treatment. Objective The aim of this study is to enable patients who have suffered stroke and been discharged to their homes to improve the performance of the activities of daily living (ADL) in their home environment, based on advice given by the therapist. A secondary aim is that these patients continue the treatment through a reminder app installed on their mobile phones. Methods This study is a clinical randomized controlled trial. The total sample will consist of 80 adults who have suffered a stroke with moderate severity and who have been discharged to their homes in the 3 months prior to recruitment to the study. The following tests and scales will be used to measure the outcome variables: Barthel Index, the Functional Independence Measure, the Mini-Mental State Examination, the Canadian Neurological Scale, the Stroke Impact Scale-16, the Trunk Control Test, the Modified Rankin Scale, the Multidimensional Scale of Perceived Social Support, the Quality of Life Scale for Stroke, the Functional Reach Test, the Romberg Test, the Time Up and Go test, the Timed-Stands Test, a portable dynamometer, and a sociodemographic questionnaire. Descriptive analyses will include mean, standard deviation, and 95% confidence intervals of the values for each variable. The Kolmogov-Smirnov (KS) test and a 2x2 mixed-model analysis of variance (ANOVA) will be used. Intergroup effect sizes will be calculated (Cohen’s d). Results Currently, the study is in the recruitment phase and implementation of the intervention has begun. The authors anticipate that during 2015 the following processes should be completed: recruitment, intervention, and data collection. It is expected that the analysis of all data and the first results should be available in early-to-mid 2016. Conclusions An educational intervention based on therapeutic home advice and a reminder app has been developed by the authors with the intention that patients who have suffered stroke perform the ADL more easily and use their affected limbs more actively in the ADL. The use of reminders via mobile phone is proposed as an innovative tool to increase treatment adherence in this population. Trial Registration ClinicalTrials.gov NCT01980641; https://clinicaltrials.gov/ct2/show/NCT01980641 (Archived by WebCite at http://www.webcitation.org/6WRWFmY6U).
Collapse
|
34
|
Kim SK, Kim SH, Jo MW, Lee SI. Estimation of minimally important differences in the EQ-5D and SF-6D indices and their utility in stroke. Health Qual Life Outcomes 2015; 13:32. [PMID: 25889191 PMCID: PMC4359514 DOI: 10.1186/s12955-015-0227-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background The aim of the present study was to estimate minimally important differences (MIDs) in EQ-5D and SF-6D indices and to explore the responsiveness of EQ-5D and SF-6D indices in stroke. Methods We used observational longitudinal survey data of EQ-5D and SF-36 that were administered to stroke patients at baseline and at 10 months. A range of MIDs for both indexes was estimated using anchor-based approaches. The modified Rankin scale and the Barthel index were used as an anchor. Results The MID estimates for EQ-5D ranged from 0.08 to 0.12 and those for SF-6D ranged from 0.04 to 0.14 in stroke patients. The MID values for these two utility measures differed in absolute magnitude, as the SF-6D index has wider range that that of the EQ-5D index. Conclusions The MID values for these two utility measures differed in absolute magnitude, as the SF-6D index has wider range that that of the EQ-5D index. These MID estimates may assist the interpretation of health related quality of life assessments related to health care intervention in stroke patients.
Collapse
Affiliation(s)
- Sang-Kyu Kim
- Department of Preventive Medicine, Dongguk University College of Medicine, 123, Dongdae-ro, Gyeongju-si, Gyeongbuk, South Korea.
| | - Seon-Ha Kim
- Department of Nursing, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam, South Korea.
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
| | - Sang-il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
| |
Collapse
|
35
|
Bennett MH, Weibel S, Wasiak J, Schnabel A, French C, Kranke P. Hyperbaric oxygen therapy for acute ischaemic stroke. Cochrane Database Syst Rev 2014; 2014:CD004954. [PMID: 25387992 PMCID: PMC10754477 DOI: 10.1002/14651858.cd004954.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Most cases of stroke are caused by impairment of blood flow to the brain (ischaemia), which results in a reduction in available oxygen and subsequent cell death. It has been postulated that hyperbaric oxygen therapy (HBOT) may reduce the volume of brain that will die by greatly increasing available oxygen, and it may further improve outcomes by reducing brain swelling. Some centres are using HBOT routinely to treat people with stroke. This is an update of a Cochrane Review first published in 2005.Objectives To assess the effectiveness and safety of adjunctive HBOT in the treatment of people with acute ischaemic stroke.Search methods We searched the Cochrane Stroke Group Trials Register (last searched April 2014), the Cochrane Central Register of Controlled Trials(CENTRAL) (April 2014), MEDLINE (1966 to April 2014), EMBASE (1980 to April 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to April 2014), the Database of Randomised Controlled Trials in Hyperbaric Medicine(DORCTIHM) (searched April 2014) and the reference lists of articles.We handsearched relevant publications and contacted researchers to identify additional published and unpublished studies.Selection criteria Randomised controlled trials (RCTs) that compared the effects of adjunctive HBOT versus those of no HBOT (no treatment or sham).Data collection and analysis Three review authors independently extracted data, assessed each trial for internal validity and resolved differences by discussion.Main results We included 11 RCTs involving 705 participants. The methodological quality of the trials varied. We could pool data only for case fatalities. No significant differences were noted in the case fatality rate at six months in those receiving HBOT compared with the control group (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.34 to 2.75, P value 0.96). Four of 14 scale measures of disability and functional performance indicated improvement following HBOT, for example, the mean Trouillas Disability Scale score was lower with HBOT (mean difference (MD) 2.2 point reduction with HBOT, 95% CI 0.15 to 4.3, P value 0.04), and the mean Orgogozo Scale score was higher (MD 27.9 points, 95% CI 4.0 to 51.8, P value 0.02).Authors' conclusions We found no good evidence to show that HBOT improves clinical outcomes when applied during acute presentation of ischaemic stroke. Although evidence from the 11 RCTs is insufficient to provide clear guidelines for practice, the possibility of clinical benefit has not been excluded. Further research is required to better define the role of HBOT in this condition.
Collapse
Affiliation(s)
- Michael H Bennett
- Prince of Wales HospitalDepartment of AnaesthesiaBarker StreetRandwickNSWAustralia2031
| | - Stephanie Weibel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Jason Wasiak
- The Epworth HospitalDepartment of Orthopaedic Surgery89 Bridge RdRichmondAustralia3121
| | - Alexander Schnabel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Christopher French
- University of MelbourneDepartment of Medicine (RMH)MBC Neurosciences BuildingParkvilleMelbourneVictoriaAustralia
| | - Peter Kranke
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | | |
Collapse
|
36
|
Moniche F, Montaner J, Gonzalez-Marcos JR, Carmona M, Piñero P, Espigado I, Cayuela A, Escudero I, de la Torre-Laviana FJ, Boada C, Rosell A, Mayol A, Jimenez MD, Gil-Peralta A, Gonzalez A. Intra-arterial bone marrow mononuclear cell transplantation correlates with GM-CSF, PDGF-BB, and MMP-2 serum levels in stroke patients: results from a clinical trial. Cell Transplant 2014; 23 Suppl 1:S57-64. [PMID: 25335778 DOI: 10.3727/096368914x684934] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bone marrow mononuclear cell (BM-MNC) intra-arterial transplantation improves recovery in experimental models of ischemic stroke through secretion of cytokines and growth factors (GFs), enhancing neoangiogenesis, and enhancing neuroplasticity. In this study, we tested whether BM-MNC transplantation in stroke patients induces changes in serum levels of cytokines and GFs. A phase I/II trial was conducted in middle cerebral artery (MCA) stroke patients with autologous intra-arterial BM-MNC transplantation between 5 and 9 days after stroke. Follow-up was done for up to 6 months. Eight cases and nine controls were included, and the serum levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), platelet-derived growth factor-BB (PDGF-BB), β nerve growth factor (β-NGF), and matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9) were measured before and 4, 8, and 90 days after transplantation. The correlation of these serum levels with dose of cells and clinical outcomes was studied. A total of 1.59 × 10(8) (±1.21 × 10(8)) BM-MNCs were injected in cases; of them 3.38 × 10(6) (±2.33 × 10(6)) were CD34(+) cells. There was a positive correlation between total BM-MNCs injected and levels of GM-CSF and PDGF-BB at 90 days after transplantation (r = 0.929, p = 0.001 and r = 0.714, p = 0.047, respectively), and a negative correlation between total CD34(+) cells injected and MMP-2 levels at 4 days after transplantation (r = -0.786, p = 0.036). Lower plasma levels of MMP-2 at 4 days and higher levels of PDGF-BB at 90 days were associated with better functional outcomes during follow-up (p = 0.019 and p = 0.037, respectively). When administered intra-arterially in subacute MCA stroke patients, BM-MNCs seem to induce changes in serum levels of GM-CSF, PDGF-BB, and MMP-2, even 3 months after transplantation, which could be associated with better functional outcomes. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.
Collapse
Affiliation(s)
- Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Viken JI, Jood K, Jern C, Blomstrand C, Samuelsson H. Ipsilesional Bias and Processing Speed are Important Predictors of Functional Dependency in the Neglect Phenomenon After a Right Hemisphere Stroke. Clin Neuropsychol 2014; 28:974-93. [DOI: 10.1080/13854046.2014.950335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
38
|
Reliability in the parameterization of the functional reach test in elderly stroke patients: a pilot study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:637671. [PMID: 24868537 PMCID: PMC4020530 DOI: 10.1155/2014/637671] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 01/01/2023]
Abstract
Background. Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. Objectives. To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. Design. Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). Participants. Five subjects over 65 who suffer from a stroke. Measurements. FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. Results. FRT measure is 12.75 ± 2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983–0.992) and 0.983 (0.979–0.989) intersubject and intrasubject, respectively. Conclusion. The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.
Collapse
|
39
|
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
| |
Collapse
|
40
|
Lower systolic blood pressure is associated with poorer survival in long-term survivors of stroke. J Hypertens 2014; 32:904-11. [DOI: 10.1097/hjh.0000000000000098] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
41
|
Kim BJ, Kim JS. Ischemic stroke subtype classification: an asian viewpoint. J Stroke 2014; 16:8-17. [PMID: 24741560 PMCID: PMC3961817 DOI: 10.5853/jos.2014.16.1.8] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 01/20/2023] Open
Abstract
Proper classification of the causative mechanism of stroke is important for optimizing stroke treatment and assessing prognosis. The primary etiology of stroke differs according to race and ethnicity: emboli originating from the heart or extracranial large arteries are common in Western populations, whereas small-vessel occlusion or intracranial atherosclerosis is more prevalent in Asians. Intracranial atherosclerosis frequently leads to stroke by branch-artery occlusion, and the degree of stenosis in these cases is often <50%. Mild intracranial atherosclerotic stenosis may cause distal embolization, if the atherosclerotic plaque is sufficiently vulnerable. Moreover, high-resolution magnetic resonance imaging studies have identified small plaques causing infarction, even in patients with normal-appearing vascular findings. Such cases, which are prevalent in Asia, could not be classified as large-artery atherosclerosis by previous classification systems. Additionally, single subcortical infarctions, which are usually attributed to lipohyalinotic small-vessel disease, can have other causes, including microatheroma of perforators and atherothrombotic lesions at the parental artery. Single subcortical infarctions associated with parental artery disease or those bordering on the main vessel more often have atherosclerotic characteristics than do those associated with lipohyalinosis of the penetrating artery. In countries where intracranial atherosclerosis is common, such atherosclerotic single subcortical infarctions are predicted to be prevalent. These cases, however, could not be appropriately classified in previous systems. Further effort should be devoted to formulate ischemic stroke classification systems that adequately incorporate results of recent studies and reflect the underling pathologic mechanisms, especially in patients with single subcortical infarction and intracranial atherosclerosis.
Collapse
Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea
| |
Collapse
|
42
|
Chen DC, Lin SZ, Fan JR, Lin CH, Lee W, Lin CC, Liu YJ, Tsai CH, Chen JC, Cho DY, Lee CC, Shyu WC. Intracerebral implantation of autologous peripheral blood stem cells in stroke patients: a randomized phase II study. Cell Transplant 2014; 23:1599-612. [PMID: 24480430 DOI: 10.3727/096368914x678562] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In our previous study, intracerebral implantation of peripheral blood stem cells (PBSCs) improved functional outcome in rats with chronic cerebral infarction. Based on this finding, a randomized, single blind controlled study was conducted in 30 patients [PBSC group (n = 15) and control group (n = 15)] with middle cerebral artery infarction confirmed on a T2-weighted MRI 6 months to 5 years after a stroke. Only subjects with neurological deficits of intermediate severity based on the National Institute of Health Stroke Scale (NIHSS; range: 9-20) that had been stable for at least 3 months were enrolled. Those in the PBSC group received subcutaneous G-CSF injections (15 µg/kg/day) for 5 consecutive days, and then stereotaxic implantation of 3-8 × 10(6) CD34(+) immunosorted PBSCs. All 30 patients completed the 12-month follow-up. No serious adverse events were noted during study period. Improvements in stroke scales (NIHSS, ESS, and EMS) and functional outcomes (mRS) from baseline to the end of the 12-month follow-up period were significantly greater in the PBSC than the control group. The fiber numbers asymmetry (FNA) scores based on diffusion tensor image (DTI) tractography were reduced in every PBSC-treated subject, but not in the control group. Reduction in the FNA scores correlated well with the improvement in NIHSS. Furthermore, a positive motor-evoked potential (MEP) response by transcranial magnetic stimulation (TMS) appeared in 9 of the 15 subjects in the PBSC group. This phase II study demonstrated that implantation of autologous CD34(+) PBSC was safe, feasible, and effective in improving functional outcome.
Collapse
Affiliation(s)
- Der-Cherng Chen
- Center for Neuropsychiatry, China Medical University Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Miao ZL, Jiang L, Xu X, Chen KL, Lu XJ. Microsurgical treatment assisted by intraoperative ultrasound localization: A controlled trial in patients with hypertensive basal ganglia hemorrhage. Br J Neurosurg 2013; 28:478-82. [DOI: 10.3109/02688697.2013.869548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
44
|
Galindo-Ocaña J, Bernabeu-Wittel M, Ollero-Baturone M, Barón-Franco B, Murcia-Zaragoza JM, Fernández-Moyano A, Díez-Manglano J, Moreno-Gaviño L. Reliability of a short questionnaire for the diagnosis of severe disability in polypathological patients attended in hospital setting. Eur J Intern Med 2013; 24:375-81. [PMID: 23312896 DOI: 10.1016/j.ejim.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND A comprehensive evaluation of polypathological patients (PP) should always include a functional evaluation. For this purpose, a modified version of the Barthel Index (BI) is the most applied questionnaire, and it consists of a 10-variable scale. The aim of this study was to develop a screening and confirmation tool to diagnose high disability with the fewest number of dimensions of the BI as possible. METHOD This present cross-sectional observational multicentre study included PP attended in 36 Spanish hospitals that were divided into two geographical areas (Western and Eastern). The Western area was considered to be the derivation subgroup of PP, and the Eastern area was the validation subgroup. Complete disability for each item (value of 0) was assessed for the diagnosis of severe disability. Diagnostic validity indices (sensitivity, specificity, negative and positive predictive values [NPV and PPV, respectively], and negative and positive likelihood ratios [NLR and PLR, respectively]) were determined for the derivation subgroup. The dimensions with the best diagnostic validity indices were then used to evaluate the validation subgroup. RESULTS The analysis included 1521 PP, 753 PP from the Western area and 768 PP from the Eastern area. Needing complete help for bathing showed the highest NPV and lowest NLR in the derivation/validation subgroups (NPV 96.87/95.54, NLR 0.07/0.13). Being disabled for feeding alone showed high PPV and PLR values (PPV 97.97/95.65, PLR 109.25/49.62), as did disability for transfers (PPV 98.48/97.96, PLR 143.36/107.68). In addition, complete disability for feeding and transfers had the best PPV and PLR in both subgroups (PPV 100/100, PLR X/0). CONCLUSIONS A two-dimension mini-Barthel Index may represent a reliable diagnostic test for severe disability in PP.
Collapse
Affiliation(s)
- Javier Galindo-Ocaña
- Internal Medicine Department, Hospital Universitario Virgen del Rocío, Seville, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Cheng SC, Lin CH, Chang YJ, Lee TH, Ryu SJ, Chen CH, Chang HK, Chang CJ, Hu WL, Hung YC. Fire-heat and Qi deficiency syndromes as predictors of short-term prognosis of acute ischemic stroke. J Altern Complement Med 2013; 19:721-8. [PMID: 23600945 DOI: 10.1089/acm.2012.0546] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To explore the relationships between traditional Chinese medicine (TCM) syndromes and disease severity and prognoses after ischemic stroke, such as neurologic deficits and decline in activities of daily living (ADLs). METHODS The study included 211 patients who met the inclusion criteria of acute ischemic stroke based on clinical manifestations, computed tomography or magnetic resonance imaging findings, and onset of ischemic stroke within 72 hours with clear consciousness. To assess neurologic function and ADLs in patients with different TCM syndromes, the TCM Syndrome Differentiation Diagnostic Criteria for Apoplexy scale (containing assessments of wind, phlegm, blood stasis, fire-heat, qi deficiency, and yin deficiency with yang hyperactivity syndromes) was used within 72 hours of stroke onset, and Western medicine-based National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) assessments were performed at both admission and discharge. RESULTS The most frequent TCM syndromes associated with acute ischemic stroke were wind syndrome, phlegm syndrome, and blood stasis syndrome. Improvement according to the BI at discharge and days of admission were significantly different between patients with and those without fire-heat syndrome. Patients with qi deficiency syndrome had longer hospital stays and worse NIHSS and BI assessments at discharge than patients without qi deficiency syndrome. All the reported differences reached statistical significance. CONCLUSIONS These results provide evidence that fire-heat syndrome and qi deficiency syndrome are essential elements that can predict short-term prognosis of acute ischemic stroke.
Collapse
Affiliation(s)
- Shu-Chen Cheng
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Liou LM, Lin HF, Tsai CL, Lin RT, Lai CL. Timing of stroke onset determines discharge-functional status but not stroke severity: A hospital-based study. Kaohsiung J Med Sci 2013; 29:32-6. [DOI: 10.1016/j.kjms.2012.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 02/17/2012] [Indexed: 11/27/2022] Open
|
47
|
Nye BR, Hyde CE, Tsivgoulis G, Albright KC, Alexandrov AV, Alexandrov AW. Slim stroke scales for assessing patients with acute stroke: ease of use or loss of valuable assessment data? Am J Crit Care 2012; 21:442-7; quiz 448. [PMID: 23117907 DOI: 10.4037/ajcc2012633] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Scientific guidelines recommend the National Institutes of Health Stroke Scale for ischemic stroke assessment. However, many nurses find "slim" National Institutes of Health Stroke Scale versions or the Glasgow Coma Scale easier to use. OBJECTIVE To compare 3 "slim" versions of the National Institutes of Health Stroke Scale and the Glasgow Coma Scale with the full National Institutes of Health Stroke Scale. METHODS Components of the full National Institutes of Health Stroke Scale and Glasgow Coma Scale were abstracted from records of consecutive stroke patients. Items were subtracted from the full National Institutes of Health Stroke Scale, with items contained in "slim" versions retained. False-negative rates for neurological disability were calculated for the "slim" versions and the Glasgow Coma Scale. RESULTS Data were collected from 172 acute stroke patients (median [interquartile range] 6 [3-12] for National Institutes of Health Stroke Scale, 15 [12-15] for Glasgow Coma Scale): 143 (83%) were ischemic stroke patients (27% posterior circulation strokes) and 29 (17%) were intracerebral hemorrhage patients. The value of "slim" scales and the Glasgow Coma Scale declined in a stepwise manner as the full National Institutes of Health Stroke Scale decreased because of false-negative results despite the presence of a measurable disabling deficit. False-negative rates were 5% to 19% on "slim" versions and 56% with the Glasgow Coma Scale. CONCLUSIONS Use of "slim" scales, and in particular the Glasgow Coma Scale, substantially decreases the value of a structured neurological assessment, particularly in patients with low National Institutes of Health Stroke Scale scores.
Collapse
|
48
|
de Weerd L, Luijckx GJR, Groenier KH, van der Meer K. Quality of life of elderly ischaemic stroke patients one year after thrombolytic therapy. A comparison between patients with and without thrombolytic therapy. BMC Neurol 2012; 12:61. [PMID: 22835054 PMCID: PMC3444943 DOI: 10.1186/1471-2377-12-61] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 07/12/2012] [Indexed: 11/10/2022] Open
Abstract
Background An observational study to examine whether thrombolytic therapy in stroke patients realizes better quality of life outcomes compared to patients without thrombolytic therapy one year after stroke. We also examined whether daily functioning, mental functioning and activities improved after thrombolytic treatment. Methods A total of 88 stroke patients were interviewed at home one year post-stroke. Health-related quality of life (HRQOL) was assessed using the RAND-36, disability with the Barthel Index, depression and anxiety with the Hospital Anxiety and Depression Scale, and a questionnaire about patient way of life was completed. People aged under 60, moving to a nursing home or with a haemorrhage were excluded. Results The thrombolysis group (TG) had more severe stroke (higher NIHSS) scores and were younger than the group without thrombolytic therapy (WTG). The primary outcome was HRQOL, which was high and nearly identical in both groups, however the TG had significantly better HRQOL for the ‘mental health’ and ‘vitality’ scales. Patients who stopped or reduced their hobbies because of stroke had a significantly worse HRQOL. One year after stroke, more patients in the TG were totally or severely ADL dependent (12% TG and 0% WTG, p = 0.022). The level of dependence decreased in the TG (p = 0.042) and worsened in the WTG (p < 0.001) after one year. Being more dependent is related to diminishing daily occupations in both groups. In the TG the level of dependence had less impact on visiting family and friends and going on holiday. The prevalence of anxiety disorder and depression was low compared to other studies and there is no significant difference between the two groups. Conclusion No major differences in the primary outcome (HRQOL) could be found between the two groups. In addition, no essential difference could be found in mental functioning and participation. We expected that patients undergoing thrombolytic therapy would have worse quality of life because of the greater initial severity of their stroke. Therefore, thrombolytic therapy seems to be of great importance in achieving better quality of life in ischemic stroke patients who respond to this therapy.
Collapse
Affiliation(s)
- Leonie de Weerd
- Department of General Practice, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | | | | | | |
Collapse
|
49
|
Functional outcome prediction following intracerebral hemorrhage. J Clin Neurosci 2012; 19:795-8. [DOI: 10.1016/j.jocn.2011.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 11/05/2011] [Indexed: 11/18/2022]
|
50
|
Ojo Owolabi M. HRQOLISP-26: A Concise, Multiculturally Valid, Multidimensional, Flexible, and Reliable Stroke-Specific Measure. ISRN NEUROLOGY 2011; 2011:295096. [PMID: 22389812 PMCID: PMC3263553 DOI: 10.5402/2011/295096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 09/12/2011] [Indexed: 11/23/2022]
Abstract
Background. A multidimensional, brief, and flexible stroke-specific health-related quality of life (HRQOL) measure is still needed. The aim was to develop a shortened version of the HRQOLISP-102, a multiculturally generated measure with excellent psychometric properties. Methods. Participants included 100 (Ibadan, Nigeria) and 103 (Berlin, Germany) stroke patients compared to 100 (Ibadan) and 50 (Berlin) apparently healthy adults. Using standard protocol, the 26-item version was generated, consisting of therapeutically relevant physical, psychological, cognitive, and ecosocial domains. Criterion validity of the HRQOLISP-26 was determined using Bland-Altman statistics. "Known groups" validity was assessed using NIHSS, stroke levity score, and modified Rankin scale. Results. HRQOLISP-26 was easily interpretable and precise with no significant floor/ceiling effect. It can be completed within 7 minutes. It showed good content, construct, "known groups," and criterion validity. It demonstrated good internal consistency (α = 0.81, 0.89) and test-retest reliability. Conclusions. HRQOLISP-26 is novel, brief, multiculturally-valid, and flexible for routine assessment of HRQOL in stroke patients.
Collapse
Affiliation(s)
- Mayowa Ojo Owolabi
- Department of Medicine, University College Hospital, PMB 5116, Ibadan 200001, Nigeria
| |
Collapse
|