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Sütçü Uçmak G, Kılınç M. The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. Top Stroke Rehabil 2024:1-7. [PMID: 38529783 DOI: 10.1080/10749357.2024.2333159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear. OBJECTIVES This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. METHODS The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods. RESULTS The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05). CONCLUSIONS The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.
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Affiliation(s)
- Gülşah Sütçü Uçmak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Akdeniz University, Antalya, Turkey
| | - Muhammed Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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2
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Bailey RR, Neri AL, Serra MC. Evidence Surrounding Dietary Behavior Interventions in Community-Dwelling Stroke Survivors: A Scoping Review. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221138080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To identify and summarize studies that have implemented dietary behavior interventions and reported dietary outcomes in community-dwelling adult stroke survivors. Design: Scoping Review; Setting: Not applicable. Participants: Studies eligible for review included peer-reviewed studies describing both a dietary intervention and a dietary outcome among community-dwelling stroke survivors published between January 2000 and June 2022. Results: We identified 14 articles that included both a dietary behavior intervention and a dietary outcome. All studies (5 pilot randomized controlled trials (RCTs), 6 non-pilot RCTs, 3 cohort studies) delivered multimodal health behavior interventions that included a dietary component. Interventions were delivered weekly to every other month and lasted for 1–24 months. Most studies did not use standardized assessments to assess dietary outcomes; however, 8 studies reported improvement in dietary outcomes. Conclusions: This review provides support for the efficacy of dietary behavior interventions in stroke survivors. Variability in intervention format and assessment measures across studies impedes the ability to conduct meta-analyses of outcomes to inform research knowledge and clinical practice. Additional research is needed to determine mechanisms-of-action for dietary behavior change in stroke survivors.
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Affiliation(s)
- Ryan R. Bailey
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA; School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Geriatric Research Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA; Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio,
| | - Alfonso L. Neri
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA; School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Geriatric Research Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA; Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio,
| | - Monica C. Serra
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA; School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Geriatric Research Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA; Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio,
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3
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Ihl T, Ahmadi M, Laumeier I, Steinicke M, Ferse C, Klyscz P, Endres M, Hastrup S, Poppert H, Palm F, Kandil FI, Weber JE, von Weitzel-Mudersbach P, Wimmer MLJ, Audebert HJ. Patient-Centered Outcomes in a Randomized Trial Investigating a Multimodal Prevention Program After Transient Ischemic Attack or Minor Stroke: The INSPiRE-TMS Trial. Stroke 2022; 53:2730-2738. [PMID: 35703097 DOI: 10.1161/strokeaha.120.037503] [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: 11/16/2022]
Abstract
BACKGROUND The INSPiRE-TMS trial (Intensified Secondary Prevention Intending a Reduction of Recurrent Events in Transient Ischemic Attack and Minor Stroke Patients) investigated effects of a multicomponent support program in patients with nondisabling stroke or transient ischemic attack. Although secondary prevention targets were achieved more frequently in the intensified care group, no significant differences were seen in rates of recurrent major vascular events. Here, we present the effects on prespecified patient-centered outcomes. METHODS In a multicenter trial, we randomized patients with modifiable risk factors either to the intensified or conventional care alone program. Intensified care was provided by stroke specialists and used feedback and motivational interviewing strategies (≥8 outpatient visits over 2 years) aiming to improve adherence to secondary prevention targets. We measured physical fitness, disability, cognitive function and health-related quality of life by stair-climbing test, modified Rankin Scale, Montreal Cognitive Assessment, and European Quality of Life 5 Dimension 3 Level during the first 3 years of follow-up. RESULTS Of 2072 patients (mean age: 67.4years, 34% female) assessed for the primary outcome, patient-centered outcomes were collected in 1,771 patients (877 intensified versus 894 conventional care group). Physical fitness improved more in the intensified care group (mean between-group difference in power (Watt): 24.5 after 1 year (95% CI, 5.5-43.5); 36.1 after 2 years (95% CI, 13.1-59.7) and 29.6 (95% CI, 2.0-57.3 after 3 years). At 1 year, there was a significant shift in ordinal regression analysis of modified Rankin Scale in favor of the intensified care group (common odds ratio, 1.23 [95% CI, 1.03-1.47]) but not after 2 (odds ratio, 1.17 [95% CI, 0.96-1.41]) or 3 years (odds ratio, 1.16 [95% CI, 0.95-1.43]) of follow-up. However, Montreal Cognitive Assessment and European Quality of Life 5 Dimension scores showed no improvement in the intensified intervention arm after 1, 2, or 3 years of follow-up. CONCLUSIONS Patients of the intensified care program group had slightly better results for physical fitness and modified Rankin Scale after 1 year, but none of the other patient-centered outcomes was significantly improved. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01586702.
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Affiliation(s)
- Thomas Ihl
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.)
| | - Michael Ahmadi
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.).,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (M.E., H.J.A.).,Berlin Institute of Health, Germany (M.A., J.E.W.)
| | - Inga Laumeier
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.)
| | - Maureen Steinicke
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.)
| | - Caroline Ferse
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.)
| | - Philipp Klyscz
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.)
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.).,ExcellenceCluster NeuroCure (M.E.).,German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen [DZNE]), partner site Berlin (M.E.).,German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung [DZHK]), partner site Berlin (M.E.)
| | - Sidsel Hastrup
- The Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Denmark (S.H., P.v.W.-M.)
| | - Holger Poppert
- Klinikum Rechts der Isar, Technical University Munich, Germany (H.P.).,Helios Klinikum München West, Munich' Germany (H.P.)
| | | | - Farid I Kandil
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.).,Institute for Computational Neuroscience, University Medical Center Hamburg Eppendorf, Germany (F.I.K.)
| | - Joachim E Weber
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.).,Berlin Institute of Health, Germany (M.A., J.E.W.)
| | | | - Martin L J Wimmer
- Praxis für Neurologie und Psychiatrie am Prinzregentenplatz, Munich, Germany (M.L.J.W.)
| | - Heinrich J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin (T.I., M.A., I.L., M.S., C.F., P.K., M.E., F.I.K., J.E.W., H.J.A.).,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (M.E., H.J.A.)
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Tuomilehto J. How to prevent non-communicable diseases? - A continuous need for a better understanding of the role of nutritional factors through scientific research. Eur J Clin Nutr 2021; 76:1357-1363. [PMID: 34711929 PMCID: PMC9550625 DOI: 10.1038/s41430-021-00997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland. .,Department of Public Health, University of Helsinki, Helsinki, Finland. .,Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia. .,Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.
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Verdelho A, Wardlaw J, Pavlovic A, Pantoni L, Godefroy O, Duering M, Charidimou A, Chabriat H, Biessels GJ. Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee. Eur Stroke J 2021; 6:5-17. [PMID: 33817330 PMCID: PMC7995319 DOI: 10.1177/23969873211000258] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. METHODS The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. FINDINGS Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options.Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Instituto de Medicina Molecular – IMM e Instituto de Saúde Ambiental –ISAMB, Faculdade de Medicina, University of Lisbon, Lisbon, Portugal
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Aleksandra Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Leonardo Pantoni
- Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences1,6 (UR UPJV 4559), Jules Verne Picardy University, Amiens, France
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Hugues Chabriat
- Department of Neurology, FHU NeuroVasc, Hôpital Lariboisiere, University of Paris, Paris, France
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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6
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Hendrickx W, Vlietstra L, Valkenet K, Wondergem R, Veenhof C, English C, Pisters MF. General lifestyle interventions on their own seem insufficient to improve the level of physical activity after stroke or TIA: a systematic review. BMC Neurol 2020; 20:168. [PMID: 32357844 PMCID: PMC7195782 DOI: 10.1186/s12883-020-01730-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background Insufficient amounts of physical activity is a risk factor for (recurrent) stroke. People with a stroke or transient ischemic attack (TIA) have a high risk of recurrent stroke and have lower levels of physical activity than their healthy peers. Though several reviews have looked at the effects of lifestyle interventions on a number of risk factors of recurrent stroke, the effectiveness of these interventions to increase the amounts of physical activity performed by people with stroke or TIA are still unclear. Therefore, the research question of this study was: what is the effect of lifestyle interventions on the level of physical activity performed by people with stroke or TIA? Method A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Pubmed, Embase and Cumulative Index for Nursing and Allied Health Literature (CINAHL), were searched up to August 2018. Randomised controlled trials that compared lifestyle interventions, aimed to increase the amount of physical activity completed by participants with a stroke or TIA, with controls were included. The Physiotherapy Evidence Database (PEDro) score was used to assess the quality of the articles, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method for the best evidence synthesis. Results Eleven trials (n = 2403) met the inclusion criteria. The quality of the trials was mostly high, with 8 (73%) of trials scoring ≥6 on the PEDro scale. The overall best evidence syntheses showed moderate quality evidence that lifestyle interventions do not lead to significant improvements in the physical activity level of people with stroke or TIA. There is low quality evidence that lifestyle interventions that specifically target physical activity are effective at improving the levels of physical activity of people with stroke or TIA. Conclusion Based on the results of this review, general lifestyle interventions on their own seem insufficient in improving physical activity levels after stroke or TIA. Lifestyle interventions that specifically encourage increasing physical activity may be more effective. Further properly powered trials using objective physical activity measures are needed to determine the effectiveness of such interventions. Trial registration PROSPERO, CRD42018094437.
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Affiliation(s)
- Wendy Hendrickx
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Emile Hullebroeckstraat 60, 3543 BZ, Utrecht, The Netherlands.
| | - Lara Vlietstra
- Department of Medicine, Dunedin School of Medicine and School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roderick Wondergem
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Emile Hullebroeckstraat 60, 3543 BZ, Utrecht, The Netherlands.,Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Emile Hullebroeckstraat 60, 3543 BZ, Utrecht, The Netherlands.,Innovation for Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, Newcastle, Australia
| | - Martijn Frits Pisters
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Emile Hullebroeckstraat 60, 3543 BZ, Utrecht, The Netherlands.,Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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7
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Brainin M, Feigin V, Bath PM, Collantes E, Martins S, Pandian J, Sacco R, Teuschl Y. Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization. Int J Stroke 2019; 14:818-825. [DOI: 10.1177/1747493019873706] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs). This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy. (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia. (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs. (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point. Conclusion An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Epifania Collantes
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ralph Sacco
- Miller School of Medicine, University of Miami, FL, USA
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
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Chhetri JK, de Souto Barreto P, Cantet C, Pothier K, Cesari M, Andrieu S, Coley N, Vellas B. Effects of a 3-Year Multi-Domain Intervention with or without Omega-3 Supplementation on Cognitive Functions in Older Subjects with Increased CAIDE Dementia Scores. J Alzheimers Dis 2019; 64:71-78. [PMID: 29865075 DOI: 10.3233/jad-180209] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Findings from recent Alzheimer's disease prevention trials have shown subjects with increased dementia score based upon mid-life cardiovascular risk factors, to benefit from multi-domain intervention strategies to some extent. The effects of such interventions on cognitive functions remains yet to be well-established. This study is a secondary analysis of the MAPT study, 1,293 older subjects (mean age 75 years) with high CAIDE score (i.e., ≥6) were classified according to the four intervention groups: 1) multi-domain intervention plus placebo, 2) isolated supplementation with Omega-3 polyunsaturated fatty acid (n-3 PUFA), 3) combination of the two interventions, and 4) placebo alone. Linear mixed-model repeated-measures analyses were used to assess the cognitive changes according to various neuropsychological test scores between intervention groups compared to the placebo at 36 months from baseline. Compared to the placebo, group with multi-domain intervention in combination withn-3PUFA was found to show significant improvement in the delayed total recall test of the free and cued selective reminding test (FCSRT) (mean±standard error(SE) = 0.20±0.10) and MMSE orientation test (mean±SE = 0.15±0.06) at 36 months. Isolated multi-domain intervention group showed significant less decline in the MMSE orientation test (mean±SE = 0.12±0.06) compared to the placebo. There was significant less improvement (mean±SE = - 1.01±0.46) in the FCSRT free recall test in the n-3 PUFA intervention group compared to the placebo at 36 months. Our findings show high-risk subjects for dementia screened with CAIDE dementia score might benefit from multi-domain intervention strategies as in the MAPT study, particularly in the orientation and delayed recall domain.
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Affiliation(s)
- Jagadish K Chhetri
- Department of Geriatrics, Gérontopôle, CHU Toulouse, Purpan University Hospital, Toulouse, France.,Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China.,NSGG, Kathmandu, Nepal
| | - Philipe de Souto Barreto
- Department of Geriatrics, Gérontopôle, CHU Toulouse, Purpan University Hospital, Toulouse, France
| | - Christelle Cantet
- Department of Geriatrics, Gérontopôle, CHU Toulouse, Purpan University Hospital, Toulouse, France.,Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France
| | - Kristell Pothier
- Department of Geriatrics, Gérontopôle, CHU Toulouse, Purpan University Hospital, Toulouse, France
| | - Matteo Cesari
- Department of Geriatrics, Gérontopôle, CHU Toulouse, Purpan University Hospital, Toulouse, France.,Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France.,INSERM, UMR1027, Université de Toulouse, UPS, Toulouse, France.,Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Sandrine Andrieu
- Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France.,INSERM, UMR1027, Université de Toulouse, UPS, Toulouse, France
| | - Nicola Coley
- Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France.,INSERM, UMR1027, Université de Toulouse, UPS, Toulouse, France
| | - Bruno Vellas
- Department of Geriatrics, Gérontopôle, CHU Toulouse, Purpan University Hospital, Toulouse, France.,Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France.,INSERM, UMR1027, Université de Toulouse, UPS, Toulouse, France
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9
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Huang ZX, Lin XL, Lu HK, Liang XY, Fan LJ, Liu XT. Lifestyles correlate with stroke recurrence in Chinese inpatients with first-ever acute ischemic stroke. J Neurol 2019; 266:1194-1202. [DOI: 10.1007/s00415-019-09249-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/29/2022]
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10
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Hagberg G, Fure B, Sandset EC, Thommessen B, Ihle-Hansen H, Øksengård AR, Nygård S, Wyller TB, Ihle-Hansen H. Long-term effects on survival after a 1-year multifactorial vascular risk factor intervention after stroke or TIA: secondary analysis of a randomized controlled trial, a 7-year follow-up study. Vasc Health Risk Manag 2019; 15:11-18. [PMID: 30799926 PMCID: PMC6369929 DOI: 10.2147/vhrm.s191873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Stroke and coronary heart disease share the same risk factors, and a multifactorial intervention after stroke may potentially result in the same reduction in cardiovascular mortality as seen after coronary events. We aimed to evaluate the effect on survival 7 years after a 1-year multifactorial risk factor intervention, and identify clinical predictors for long-term survival in a hospital-based cohort of patients with first-ever stroke or transient ischemic attack (TIA). Materials and methods We performed a secondary analysis of a randomized controlled trial including patients between February 2007 and July 2008 comparing an intensive risk factor intervention vs usual care the first year poststroke to prevent cognitive impairment. From February 2014 to July 2016, all patients were invited to a follow-up. For patients dying throughout the follow-up period, date of death was obtained from the medical record. Examination at baseline and 1-year follow-up included extensive assessment of vascular risk factors and cognitive assessments. Results A total of 195 patients were randomized. Mean (SD) age was 71.6 (12.5) years, 53.3% were male, mean (SD) body mass index (BMI) was 25.6 (4.1) kg/m2. During follow-up, 35 patients in the intervention group and 41 in the control group died. Kaplan–Meier survival estimates show no significant difference in intention-to-treat (ITT) population or complete case (CC) population (log-rank P=0.29 vs log-rank P=0.07). In multivariable Cox proportional hazards regression analyses, lower age and higher BMI was independently associated with long-term survival, adjusted HR (95% CI) 1.08 (1.05–1.11) per year and 0.91 (0.85–0.97) per kg/m2. Conclusion In this post hoc analysis, we found no significant effect on survival after 7 years of a multifactorial risk factor program given during the first year after first-ever stroke or TIA. Higher BMI was an independent predictor for long-term survival in this cohort.
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Affiliation(s)
- Guri Hagberg
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway, .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,
| | - Brynjar Fure
- Department of Internal Medicine, Karlstad Central Hospital and Institute of Public Health, University of Tromsoe, Tromsoe, Norway
| | | | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway, .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,
| | - Anne Rita Øksengård
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway,
| | - Ståle Nygård
- Department of Informatics, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Torgeir B Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway, .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway, .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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11
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Aguiar LT, Nadeau S, Martins JC, Teixeira-Salmela LF, Britto RR, Faria CDCDM. Efficacy of interventions aimed at improving physical activity in individuals with stroke: a systematic review. Disabil Rehabil 2018; 42:902-917. [PMID: 30451539 DOI: 10.1080/09638288.2018.1511755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature.Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales.Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity.Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.
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Affiliation(s)
- Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,École de réadaptation, Université de Montréal (UdeM), Montréal, Canada
| | - Sylvie Nadeau
- École de réadaptation, Université de Montréal (UdeM), Montréal, Canada
| | - Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Raquel Rodrigues Britto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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12
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Teuschl Y, Ihle-Hansen H, Matz K, Dachenhausen A, Ratajczak P, Tuomilehto J, Ursin MH, Hagberg G, Thommessen B, Øksengård AR, Brainin M. Multidomain intervention for the prevention of cognitive decline after stroke - a pooled patient-level data analysis. Eur J Neurol 2018; 25:1182-1188. [PMID: 29782693 PMCID: PMC6099341 DOI: 10.1111/ene.13684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/03/2018] [Indexed: 12/16/2022]
Abstract
Background and purpose The aim of this pooled patient‐level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post‐stroke care for the prevention of cognitive decline after stroke. Methods This pooled patient‐level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)‐A, TMT‐B and 10‐words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention‐to‐treat (ITT) principle using different imputation approaches and one was based on complete cases. Results Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT‐A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables. Conclusion We found indications that multidomain interventions compared with standard care can improve the scores in TMT‐A at 1 year after stroke but not those for TMT‐B or the 10‐words test. These results have to be interpreted with caution due to the small number of patients.
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Affiliation(s)
- Y Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - H Ihle-Hansen
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - K Matz
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.,Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - A Dachenhausen
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - P Ratajczak
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - J Tuomilehto
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.,Dasman Diabetes Center, Dasman, Kuwait
| | - M H Ursin
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - G Hagberg
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - B Thommessen
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - A R Øksengård
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - M Brainin
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
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13
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Brainin M, Feigin V, Martins S, Matz K, Roy J, Sandercock P, Teuschl Y, Tuomilehto J, Wiseman A. Cut stroke in half: Polypill for primary prevention in stroke. Int J Stroke 2018; 13:633-647. [PMID: 29461155 DOI: 10.1177/1747493018761190] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This review summarizes the potential for polypill therapies for stroke prevention. While a number of studies applying different approaches regarding polypill have been performed, none of them has had a focus on stroke as the main outcome. A combination pill containing drugs such as statins, diuretics, and other antihypertensives is currently available in various formats. Estimates focusing mostly on primary prevention show that using such a combination drug a reduction in the 5-year stroke incidence by 50% can be achieved - especially in low- and middle-income countries with a high prevalence of risk factors even among people at young ages. A combination of a large supporting population-wide program with a registry-based quality control is the most likely perspective and can be achieved within a reasonable time frame and potentially have significant influence in young stroke populations.
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Affiliation(s)
- Michael Brainin
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- 2 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Sheila Martins
- 3 Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Karl Matz
- 4 Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - Jayanta Roy
- 5 AMRI Institute of Neurosciences, Kolkata, India
| | - Peter Sandercock
- 6 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yvonne Teuschl
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Jaakko Tuomilehto
- 7 Dasman Diabetes Institute, Kuwait City, Kuwait.,8 Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,9 Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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