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He Y, Wang R, Mo L, Chen M, Jiang Q, Feng L. Comparison of clinical outcomes between family caregivers and professional caregivers in in-hospital patients with acute ischaemic stroke: A prospective cohort study. J Clin Nurs 2024. [PMID: 38873867 DOI: 10.1111/jocn.17319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/26/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
AIM This study explored the impact of different care modes on the outcome of hospitalized patients with acute ischaemic stroke (AIS) during hospitalization and 3 months after discharge. METHODS This was a prospective cohort study comparing the outcomes at hospitalization, at discharge, and at 3 months post discharge among AIS patients with different caregiving arrangements from 9, December 2022 to 20, August 2023. The general information questionnaire, Modified Barthel Index, Shortened General Comfort Questionnaire, Perceived Social Support scale, Herth Hope Index, modified Rankin scale and EQ-5D-5L were utilized for the investigation. RESULTS The psychological evaluation scores during hospitalization, including comfort, perceived social support, and hope, did not significantly differ between the two groups of AIS patients (p > .05). Moreover, there were no significant impacts observed in terms of length of stay (LOS) at the hospital or hospitalization expense (p > .05). The proportion of patients with intact functionality was greater in the family caregiver group 3 months after discharge (16.5%). However, when stratified based on prognosis, the difference in outcomes between the two groups of patients did not reach statistical significance (p > .05). The analysis of ADL, quality of life and stroke recurrence in 276 surviving ischaemic stroke patients 3 months post discharge indicated no differences between the two groups across all three aspects (p > .05). CONCLUSION Older and divorced or widowed AIS patients tend to prefer professional caregivers. The psychological state during hospitalization, length of hospital stay and hospitalization expenses are not influenced by the caregiving model. Three months post discharge, a greater proportion of patients in the family caregiving group had intact mRS functionality, but this choice did not impact patient prognosis, stroke recurrence, quality of life or independence in ADL.
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Affiliation(s)
- Yueyue He
- Department of Neurology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Linqi Mo
- Department of Neurology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Min Chen
- Department of Neurology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Qian Jiang
- Department of Neurology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
- West China Tianfu Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ling Feng
- Department of Neurology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
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Ferfeli S, Galanos A, Dontas IA, Triantafyllou A, Triantafyllopoulos IK, Chronopoulos E. Reliability and validity of the Greek adaptation of the Modified Barthel Index in neurorehabilitation patients. Eur J Phys Rehabil Med 2024; 60:44-54. [PMID: 37877957 PMCID: PMC10938040 DOI: 10.23736/s1973-9087.23.08056-5] [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: 05/30/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The Modified Barthel Index (MBI) (Shah version) is a widely used functional assessment measure with greater sensitivity and improved reliability compared to the original Barthel Index. AIM The aim of this study was to adapt the MBI for use in Greece and measure its reliability and validity on a Greek neuro-rehabilitation population. DESIGN Observational study. SETTING KAT Hospital Rehabilitation Clinic and National Rehabilitation Centre in Athens, Greece. POPULATION A total of 100 rehabilitation inpatients and outpatients consisting of 50 stroke and 50 spinal cord injury (SCI) patients were evaluated. METHODS The MBI underwent the proper translation and cultural adaptation procedure as required by the World Health Organization and was administered to 100 rehabilitation patients. For criterion validity evaluation all patients were also assessed with the Katz Index of Independence in Activities of Daily Living (Katz Index) and the 36-Item Short Form Survey (SF-36) physical functioning subscale, both questionnaires having been validated for use in Greece. RESULTS The unidimensionality solution was rejected and a two- factor solution was adopted based on exploratory and confirmatory factor analysis (Factor 1 - Transfers and Activities of Daily Living, Factor 2 - Mobility). Very high correlation was presented between the Katz Index score and the Greek MBI Factor 1 (r=0.888, P<0.001) and total score (r=0.873 P<0.001) respectively and high with MBI Factor 2 (r=0.561, P<0.001). High correlation was observed between the SF-36 physical functioning subscale score with MBI Factor 1 (r=0.522, P<0.001), MBI Factor 2 (r=0.590, P<0.001) and MBI Total score (r=0.580, P<0.001). The internal consistency of the MBI Factor 1, Factor 2 and Total score was 0.920, 0.860 and 0.923 respectively. Test-retest reliability was remarkably consistent (total score 0.994, P<0.001). CONCLUSIONS The Greek version of the Modified Barthel Index has been found to exhibit satisfactory levels of reliability and validity. CLINICAL REHABILITATION IMPACT The Greek MBI adaptation is an adequate and useful instrument for use on Greek neuro-rehabilitation patients.
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Affiliation(s)
- Sofia Ferfeli
- Section of Physical Medicine and Rehabilitation, Department of Medicine, Hospice for Neurodisability, Athens, Greece -
| | - Antonios Galanos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
| | - Ismene A Dontas
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
| | - Aggeliki Triantafyllou
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
| | | | - Efstathios Chronopoulos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
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Monteiro MCD, Martins MMFPDS, Schoeller SD. Interdisciplinary health consultations for older people in Portugal: primary care and hospitals. Rev Gaucha Enferm 2023; 44:e20220275. [PMID: 37909513 DOI: 10.1590/1983-1447.2023.20220275.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To analyze the perspective of doctors, nurses, and social workers about practices for older people health in primary care and in hospitals; to create guidelines for the practice of interdisciplinary consultations. METHOD Cross-sectional study involving 291 professionals from public institutions in the northern region of Portugal. Data were collected between May/2018 and March/2019, using a questionnaire which was then subjected to descriptive and analytical statistical analysis. RESULTS The usefulness of scales for elderly people showed no differences between hospital and primary care. Hospital professionals collected the following data: eyesight/hearing; medication; direct contact or contact by writing between professionals; daily team meetings; need to share information among colleagues. Primary care professionals, in turn, valued: weight/height, swallowing; the need for home visits; direct contact or via e-mail between professionals; weekly team meetings. CONCLUSION The practices of the professionals suggested an intervention model with common aspects in both groups, but with specificities for both primary and hospital care.
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Affiliation(s)
| | | | - Soraia Dornelles Schoeller
- Universidade Federal de Santa Catarina (UFSC). Departamento de Enfermagem. Florianópolis, Santa Catarina, Brasil
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Pournajaf S, Pellicciari L, Proietti S, Agostini F, Gabbani D, Goffredo M, Damiani C, Franceschini M. Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? A secondary analysis retrospective cohort study. Int J Rehabil Res 2023; 46:230-237. [PMID: 37334818 PMCID: PMC10396075 DOI: 10.1097/mrr.0000000000000584] [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: 01/25/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
The modified Barthel Index (mBI) is a well-established patient-centered outcome measure commonly administrated in rehabilitation settings to evaluate the functional status of patients at admission and discharge. This study aimed to detect which mBI items collected on admission can predict the total mBI at discharge from first inpatient rehabilitation in large cohorts of orthopedic (n = 1864) and neurological (n = 1684) patients. Demographic and clinical data (time since the acute event 11.8 ± 17.2 days) at patients' admission and mBI at discharge were collected. Univariate and multiple binary logistic regressions were performed to study the associations between independent and dependent variables for each cohort separately. In neurological patients, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with feeding, personal hygiene, bladder, and transfers were independently associated with higher total mBI at discharge (R 2 = 0.636). In orthopedic patients, age, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with personal hygiene, dressing, and bladder were independently associated with higher total mBI at discharge (R 2 = 0.622). Our results showed that different activities in neurological (i.e. feeding, personal hygiene, bladder, and transfer) and orthopedic sample (i.e. personal hygiene, dressing, and bladder) are positively associated with better function (measured by mBI) at the discharge. Clinicians have to take into account these predictors of functionality when they plan an appropriate rehabilitation treatment.
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Affiliation(s)
- Sanaz Pournajaf
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | | | | | - Francesco Agostini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome
| | - Debora Gabbani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Carlo Damiani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- San Raffaele University, Rome, Italy
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FENG X, WANG T, JIANG Y, LIU Y, YANG H, DUAN Z, JI L, WEI J. Cerebral Theta-Burst Stimulation Combined with Physiotherapy in Patients with Incomplete Spinal Cord Injury: A Pilot Randomized Controlled Trial. J Rehabil Med 2023; 55:jrm00375. [PMID: 36779636 PMCID: PMC9941982 DOI: 10.2340/jrm.v55.4375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/04/2023] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE To measure the effects of cerebral intermittent theta-burst stimulation with physiotherapy on lower extremity motor recovery in patients with incomplete spinal cord injury. DESIGN Randomized, double-blinded, sham-controlled trial. SUBJECTS Adults with incomplete spinal cord injury. METHODS A total of 38 patients with incomplete spinal cord injury were randomized into either an intermittent theta-burst stimulation or a sham group. Both groups participated in physiotherapy 5 times per week for 9 weeks, and cerebral intermittent theta-burst stimulation or sham intermittent theta-burst stimulation was performed daily, immediately before physiotherapy. The primary outcomes were lower extremity motor score (LEMS), root-mean square (RMS), RMS of the quadriceps femoris muscle, walking speed (WS), and stride length (SL). Secondary outcomes comprised Holden Walking Ability Scale (HWAS) and modified Barthel Index (MBI). The outcomes were assessed before the intervention and 9 weeks after the start of the intervention. RESULTS Nine weeks of cerebral intermittent theta-burst stimulation with physiotherapy intervention resulted in improved recovery of lower extremity motor recovery in patients with incomplete spinal cord injury. Compared with baseline, the changes in LEMS, WS, SL, RMS, HWAS, and MBI were significant in both groups after intervention. The LEMS, WS, SL, RMS, HWAS, and MBI scores were improved more in the intermittent theta-burst stimulation group than in the sham group. CONCLUSION Cerebral intermittent theta-burst stimulation with physiotherapy promotes lower extremity motor recovery in patients with incomplete spinal cord injury. However, this study included a small sample size and lacked a comparison of the treatment effects of multiple stimulation modes, the further research will be required in the future.
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Affiliation(s)
- Xiaojun FENG
- Department of Rehabilitation Medicine,Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province,Department of Rehabilitation Medicine, The Fuyang Hospital of Anhui Medical University, Fuyang City, Anhui Province, China
| | - Tingting WANG
- Department of Rehabilitation Medicine,Department of Rehabilitation Medicine, The Fuyang Hospital of Anhui Medical University, Fuyang City, Anhui Province, China
| | - Yan JIANG
- Department of Rehabilitation Medicine
| | - Yi LIU
- Department of Rehabilitation Medicine
| | - Haifeng YANG
- Department of Rehabilitation Medicine, The Fuyang Hospital of Anhui Medical University, Fuyang City, Anhui Province, China
| | - Zongyu DUAN
- Department of Rehabilitation Medicine, The Fuyang Hospital of Anhui Medical University, Fuyang City, Anhui Province, China
| | - Leilei JI
- Department of Rehabilitation Medicine
| | - Juan WEI
- Department of Rehabilitation Medicine
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Feng L, He Y, Dong S, Wang R, Long S, He L. An exploratory descriptive cohort study of 90-day prognosis after acute ischaemic stroke with mechanical thrombectomy. Contemp Nurse 2022; 58:264-275. [PMID: 36052463 DOI: 10.1080/10376178.2022.2107038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the relationship between nursing assessment findings at discharge and acute ischaemic stroke (AIS) patient prognosis after mechanical thrombectomy (MT). METHODS We analysed the characteristics of 144 AIS patients with MT treatment admitted to a university affiliated teaching hospital in Chengdu, Sichuan Province China, from January 2020 to December 2020. The modified Rankin Scale (mRS) score was used to assess outcomes 90-days after discharge. Exploratory analyses were undertaken using IBM SPSS Statistics (Version 26.0). RESULTS At 90-days, 47.9% (n = 69) had a good prognosis (mRS ≤ 2) including 22.2%(n = 32) fully recovered patients. There were 5 (3.5%) deceased patients and 48.6% (n =70) of patients had a poor prognosis (mRS ≥ 3). In univariate analysis, clinical prognosis correlated with the need for inpatient endotracheal intubation (p = 0.02), nasogastric tube (p<0.001), indwelling urinary catheter (p<0.001), central venous catheter (p = 0.03), health knowledge needs of pressure injury prevention (p = 0.03), National Institute of Health Stroke Scale (NIHSS) score (p<0.001) and Activities of Daily Living (ADL) score (p<0.001) at the time of discharge from hospital. The average hospitalisation time of the 144 patients was 12[IQR, 9-25] days, and the average cost of hospitalisation was $Y$21291.93 (SD 9165.01). CONCLUSION Almost half of the surviving patients had a poor prognosis. In our country, this surgery and rehabilitation impose a significant financial burden that needs to be addressed. However, the longer length of hospital stay and higher costs at discharge may be contributing factors to worse outcomes. The outcomes of comprehensive nursing assessment of the patients, including nursing needs, activities of daily living, and neurological function, can predict their outcome. IMPACT STATEMENT We recommend a comprehensive nursing assessment at discharge that predicts patient outcomes and can be used for subsequent targeted interventions. The prognosis of patients with acute ischaemic stroke after mechanical thrombectomy is poor, and the financial burden needs to be considered.
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Affiliation(s)
- Ling Feng
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Yueyue He
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu China
| | - Rui Wang
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Shiyan Long
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu China
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