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Ikeda S, Yakushiji Y, Tanaka J, Nishihara M, Ogata A, Eriguchi M, Ono S, Kosugi M, Suzuyama K, Mizoguchi M, Shichijo C, Ide T, Nagaishi Y, Ono N, Yoshikawa M, Katsuki Y, Irie H, Abe T, Koike H, Hara H. Cerebral small vessel disease markers and long-term prognosis in spontaneous intracerebral hemorrhage: the HAGAKURE-ICH study. Hypertens Res 2024:10.1038/s41440-024-01906-1. [PMID: 39300296 DOI: 10.1038/s41440-024-01906-1] [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: 04/19/2024] [Revised: 08/27/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024]
Abstract
We investigated the effects of individual and cumulative cerebral small vessel disease (SVD) markers on long-term clinical outcomes in spontaneous intracerebral hemorrhage (sICH) patients. This prospective, single-center cohort study was conducted from 2012 to 2019. SVD markers, including lacunae, cerebral microbleeds, white matter hyperintensity (WMH), and perivascular spaces in the basal ganglia, were assessed to calculate a summary SVD score. Patients were categorized into severe (score ≥3) and non-severe (score 0-2) SVD burden groups. Functional prognosis was defined as recovery, no change, or decline based on modified Rankin Scale changes at 2 years after discharge, excluding death. Associations of SVD burden and individual SVD markers with outcomes were evaluated using Cox proportional hazards modeling for recurrent stroke and all-cause mortality, and using ordinal logistic regression for functional prognosis. Among 155 sICH patients who underwent MRI, 98 showed severe SVD burden. Recurrent stroke and all-cause mortality rates were 2.2 and 8.3 per 100 patient-years, respectively, over a median 2.1-year follow-up. In terms of functional prognosis, 57 patients (51.8%) recovered, 32 (29.1%) showed no change, and 21 (19.1%) declined. A significant association was apparent between severe SVD burden and poorer functional prognosis (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.04-6.04; p = 0.042), particularly with moderate-to-severe WMH (OR 2.54, 95%CI 1.02-6.54; p = 0.048). The cumulative effects of SVD markers inhibited long-term functional recovery in sICH patients. Severe SVD burden, as well as moderate-to-severe WMH, can be indicators of long-term prognosis after sICH.
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Affiliation(s)
- Shuhei Ikeda
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
- Department of Neurology, Kansai Medical University, Hirakata, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
- Department of Neurology, Kansai Medical University, Hirakata, Japan.
| | - Jun Tanaka
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masashi Nishihara
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Atsushi Ogata
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Makoto Eriguchi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shohei Ono
- Department of Neurology, Kansai Medical University, Hirakata, Japan
| | - Masafumi Kosugi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kohei Suzuyama
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Megumi Mizoguchi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Chika Shichijo
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yukiko Nagaishi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Natsuki Ono
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Yoshikawa
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshiko Katsuki
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Haruki Koike
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Lin Q, Dong X, Huang T, Zhou H. Developmental trajectory of care dependency in older stroke patients. Front Neurol 2024; 15:1374477. [PMID: 38836003 PMCID: PMC11148867 DOI: 10.3389/fneur.2024.1374477] [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: 01/26/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
Background Stroke is the leading cause of death in China. Older stroke survivors often have other chronic conditions, not only musculoskeletal deterioration due to age, but also changes in body image that can be brought on by stroke and other diseases, making them unable to take good care of themselves and dependent on others. The degree of dependency affects the rehabilitation progress of stroke survivors and shows dynamic changes that need to be recognized. Objectives This study investigates the trajectory of dependency changes in older stroke patients with comorbidities and analyze the influencing factors. Methods Grounded in the Chronic Illness Trajectory Framework (CITF), a longitudinal study was conducted from February 2023 to October 2023, tracking 312 older stroke patients with comorbidities admitted to two tertiary hospitals in Guangzhou. Care dependency levels were assessed using Care Dependency Scale on admission day 5 (T0), at discharge (T1), 1 month post-discharge (T2), and 3 months post-discharge (T3). Growth Mixture Model were utilized to identify trajectory categories, and both univariate analysis and multivariate logistic regression methods were employed to explore factors associated with different developmental trajectories. Results A total of four developmental trajectories were fitted, C1 (high independence-slow increased group, 52.0%), C2 (moderate independence-rapid increased group, 13.0%), C3 (moderate independence-slow increased group, 25.0%), and C4 (low independence-increased and decreased group, 10.0%). Length of hospital stay, place of residence, level of social support, residual functional impairments, NIHSS score, and BI index independently influence the trajectory categories. Conclusion There is heterogeneity in care dependency among older stroke patients with comorbidities. Most patients gradually reduce their dependency and become more independent, but others remain dependent for an extended period of time. It is recommended to focus on patients who live in rural areas, have low social support, have high admission NIHSS scores and have residual functional impairment, and provide them with personalized continuity of care and rehabilitation services in order to reduce care dependency and the burden of care, and to improve patients' quality of life.
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Affiliation(s)
- Qinger Lin
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaohang Dong
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tianrong Huang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongzhen Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
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Kim H, Lee C, Kim N, Chung E, Jeon H, Shin S, Kim M. Early functional factors for predicting outcome of independence in daily living after stroke: a decision tree analysis. J Rehabil Med 2024; 56:jrm35095. [PMID: 38712968 DOI: 10.2340/jrm.v56.35095] [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: 12/17/2023] [Accepted: 04/20/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the predictive functional factors influencing the acquisition of basic activities of daily living performance abilities during the early stages of stroke rehabilitation using classification and regression analysis trees. METHODS The clinical data of 289 stroke patients who underwent rehabilitation during hospitalization (164 males; mean age: 62.2 ± 13.9 years) were retrospectively collected and analysed. The follow-up period between admission and discharge was approximately 6 weeks. Medical records, including demographic characteristics and various functional assessments with item scores, were extracted. The modified Barthel Index on discharge served as the target outcome for analysis. A "good outcome" was defined as a modified Barthel Index score ≥ 75 on discharge, while a modified Barthel Index score < 75 was classified as a "poor outcome." RESULTS Two classification and regression analysis tree models were developed. The first model, predicting activities of daily living outcomes based on early motor functions, achieved an accuracy of 92.4%. Among patients with a "good outcome", 70.9% exhibited (i) ≥ 4 points in the "sitting-to-standing" category in the motor assessment scale and (ii) 32 points on the Berg Balance Scale score. The second model, predicting activities of daily living outcome based on early cognitive functions, achieved an accuracy of 82.7%. Within the "poor outcome" group, 52.2% had (i) ≤ 21 points in the "visuomotor organization" category of Lowenstein Occupational Therapy Cognitive Assessment, (ii) ≤ 1 point in the "time orientation" category of the Mini Mental State Examination. CONCLUSION The ability to perform "sitting-to-standing" and visuomotor organization functions at the beginning of rehabilitation emerged as the most significant predictors for achieving successful basic activities of daily living on discharge after stroke.
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Affiliation(s)
- Heegoo Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Chanmi Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Nayeong Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Eunhye Chung
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - HyeongMin Jeon
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Seyoung Shin
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea; Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea; Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea.
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Iwasa S, Uchiyama Y, Tauchi Y, Koyama T, Domen K. Impact of functional independence and sociodemographic factors on post-stroke discharge destination in a super-aged rural community in Japan. J Rural Med 2024; 19:33-39. [PMID: 38196805 PMCID: PMC10774001 DOI: 10.2185/jrm.2023-033] [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: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 01/11/2024] Open
Abstract
Objective: This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors. Patients and Methods: We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed. Results: The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one's spouse were the most powerful predictors of a higher probability of returning home. Conclusion: This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.
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Affiliation(s)
- Saya Iwasa
- Department of Rehabilitation Medicine, Sasayama Medical Center, Hyogo Medical University, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
| | - Yuta Tauchi
- Department of Rehabilitation Medicine, Sasayama Medical Center, Hyogo Medical University, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
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de Menezes KKP, Scianni AA, Avelino PR, de Faria-Fortini I, Teixeira-Salmela LF, Faria CDCDM. Balance deficit is the domain of the Fugl-Meyer scale that best explain limitations in functional independence during hospitalization after a stroke. J Stroke Cerebrovasc Dis 2023; 32:107386. [PMID: 37797412 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107386] [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: 05/17/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To investigate which of the residual sensorimotor impairments, assessed by the Fugl-Meyer scale, would best explain functional independence during hospitalization after a stroke. METHODS This cross-sectional study retrieved data from medical records between January 2014 to December 2021. Explanatory independent variables were the following domains of the Fugl-Meyer scale: joint pain, joint range of motion, balance, sensory function, and motor function of the upper and lower limbs. Functional independence was measured by the Functional Independence Measure (FIM). Step-wise multiple linear regression analysis was used to identify which measures would explain functional independence (α=5%). RESULTS Data from 1,344 individuals, who had a mean age of 64 years, were retrieved. All included explanatory variables were significantly correlated with the FIM scores (0.24 ≤ r ≤ 0.87). Balance alone explained 76 % (F=4.24; p<0.001) of the variance in the FIM scores. When sensory function and upper-limb motor function scores were included in the model, the explained variance increased to 82 % (F = 1.935; p < 0.001). CONCLUSIONS Balance, which is important for carrying-out self-care activities, is the domain of the Fugl-Meyer scale that best explained functional independence during hospitalization after a stroke. Although sensory function and motor function of the upper limb added little to the explained variance, they should not be underlooked. Future research is needed to determine whether progressive balance training interventions would enhance functional independence after a stroke.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, MG 31270-901, Brazil
| | - Patrick Roberto Avelino
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Iza de Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luci Fuscaldi Teixeira-Salmela
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, MG 31270-901, Brazil
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Li S. Stroke Recovery Is a Journey: Prediction and Potentials of Motor Recovery after a Stroke from a Practical Perspective. Life (Basel) 2023; 13:2061. [PMID: 37895442 PMCID: PMC10608684 DOI: 10.3390/life13102061] [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: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Stroke recovery is a journey. Stroke survivors can face many consequences that may last the rest of their lives. Assessment of initial impairments allows reasonable prediction of biological spontaneous recovery at 3 to 6 months for a majority of survivors. In real-world clinical practice, stroke survivors continue to improve their motor function beyond the spontaneous recovery period, but management plans for maximal recovery are not well understood. A model within the international classification of functioning (ICF) theoretical framework is proposed to systematically identify opportunities and potential barriers to maximize and realize the potentials of functional recovery from the acute to chronic stages and to maintain their function in the chronic stages. Health conditions of individuals, medical and neurological complications can be optimized under the care of specialized physicians. This permits stroke survivors to participate in various therapeutic interventions. Sufficient doses of appropriate interventions at the right time is critical for stroke motor rehabilitation. It is important to highlight that combining interventions is likely to yield better clinical outcomes. Caregivers, including family members, can assist and facilitate targeted therapeutic exercises for these individuals and can help stroke survivors comply with medical plans (medications, visits), and provide emotional support. With health optimization, comprehensive rehabilitation, support from family and caregivers and a commitment to a healthy lifestyle, many stroke survivors can overcome barriers and achieve potentials of maximum recovery and maintain their motor function in chronic stages. This ICF recovery model is likely to provide a guidance through the journey to best achieve stroke recovery potentials.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center—Houston, Houston, TX 77025, USA;
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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Optimizing intraluminal monofilament model of ischemic stroke in middle-aged Sprague-Dawley rats. BMC Neurosci 2022; 23:75. [PMID: 36494808 PMCID: PMC9733327 DOI: 10.1186/s12868-022-00764-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Intraluminal monofilament model of middle cerebral artery occlusion (MCAO) is widely adopted for ischemic stroke; and Sprague-Dawley (SD) rats are commonly used rodents for preclinical research. Due to the paucity of information on the appropriate monofilament size for inducing MCAO in SD rats and the importance of including middle-aged models in ischemic stroke studies, we aimed to: (i). determine an appropriate Doccol® monofilament size for middle-aged male SD rats which weighed > 500 g following 24-h transient MCAO survival as well as (ii). demonstrate the optimal Doccol® filament size for middle-aged males (≤ 500 g) and females (273-300 g) while using young adult male SD rats (372-472 g) as control for severity of infarct volume following 7-days post-MCAO. All rats were subjected to 90-min transient MCAO. We show that 0.43 mm Doccol® monofilament size is more appropriate to induce large infarct lesion and optimal functional deficit when compared to 0.45 mm and 0.47 mm at 24 h post-MCAO. Our data on infarct volumes at 7 days post-MCAO as well as the observed weight loss and functional deficits at post-MCAO days 1, 3 and 7 demonstrate that 0.41 mm, 0.37 mm and 0.39 mm are optimal Doccol® filament sizes for middle-aged male (477.3 ± 39.61 g) and female (302.6 ± 26.28 g) as well as young-adult male (362.2 ± 28.38 g) SD rats, respectively.
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Robins L, Taylor NF, Hogan G, Callisaya ML, Sounthakith V, Snowdon M, Brooks S, Scanlon S, Urmston K, Snowdon DA. Meeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation were positively associated with performance of outdoor community activities 8 weeks after discharge. Disabil Rehabil 2022; 44:6796-6803. [PMID: 34529531 DOI: 10.1080/09638288.2021.1976290] [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: 02/22/2021] [Revised: 08/05/2021] [Accepted: 08/29/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess whether meeting criteria for community ambulation and ambulatory self-confidence on discharge from inpatient rehabilitation are associated with participation in community activities. METHODS Prospective longitudinal observational study design. Participants were assessed within 48-hours of discharge on ability to complete tasks reflective of community ambulation (walking 315 m, ascending/descending three stairs, a ramp, and a street curb and walking at 0.44 m/s) and ambulatory self-confidence. At 8 weeks post-discharge frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Multivariable regression analysis determined factors associated with total and outdoor FAI score. RESULTS Seventy-four of 79 participants were followed up at 8 weeks post-discharge. Meeting all ambulation criteria was positively associated with FAI outdoor score (β = 1.85, 95%CI 0.01-3.69, p = 0.049). Ambulatory self-confidence was positively associated with FAI outdoor score (β = 0.03, 95%CI 0-0.05, p = 0.032) and FAI total score (β = 0.05, 95%CI 0-0.1, p = 0.040). Age (β= -0.22, 95%CI -0.36 to -0.08, p = 0.003) and living alone (β = 3.36, 95%CI 0.10-6.61, p = 0.044) were associated with FAI total score. CONCLUSIONS Capacity to meet ambulation criteria and ambulatory self-confidence are modifiable factors that could be targeted during rehabilitation to improve participation in community activities.Implications for rehabilitationMeeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation are positively associated with performance of outdoor community activities 8 weeks after discharge.Capacity to meet community ambulation criteria and ambulatory confidence may be useful measures for rehabilitation teams to consider when discharging patients home.Meeting ambulation criteria and ambulatory confidence are modifiable factors that could be addressed through targeted therapy to improve community integration following hospitalisation.
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Affiliation(s)
- Leslie Robins
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Georgia Hogan
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
| | | | - Megan Snowdon
- Academic Unit, Peninsula Health, Frankston, Australia
| | - Sarah Brooks
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Sinead Scanlon
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Kim Urmston
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
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Liu T, Jiang Y, Hu J, Li Z, Guo Y, Li X, Xiao J, Yuan L, He G, Zeng W, Kan H, Rong Z, Chen G, Yang J, Wang Y, Ma W. Association of ambient PM 1 with hospital admission and recurrence of stroke in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 828:154131. [PMID: 35219663 DOI: 10.1016/j.scitotenv.2022.154131] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Particulate matter (PM) pollution is a well-known risk factor of stroke. However, little is known about the association between PM1 (aerodynamic diameter ≤ 1.0 μm) and stroke. We estimated the associations of short-term exposure to PM1 with hospital admission and recurrence of stoke in China. METHODS Stroke data were derived from the Chinese Stroke Center Alliance (CASA) program conducted in 1458 hospitals in 292 Chinese cities from 2015 to 2019. Daily air pollution and meteorological data were collected in the cities where studied hospitals were located. Daily PM1 concentration was estimated by a generalized additive model (GAM) using PM2.5 and meteorological variables. A time-stratified case-crossover design was applied to estimate the associations of short-term exposure to PM1 with hospital admission of stroke. A GAM model was used to estimate the association between average PM1 exposure during hospitalization and the recurrence of stroke. RESULTS A total of 989,591 stroke cases were included in the study. Each 10 μg/m3 increase in PM1 (lag06-day) was associated with a 0.53% (95%CI, 0.39%, 0.67%) increment in hospital admission for stroke. The adverse effects of PM1 on ischemic stroke was stronger than on intracerebral hemorrhage. We found the associations were significant in Northeast (0.94%, 95%CI, 0.51%, 1.38%), North (0.47%, 95%CI, 0.20%, 0.75%), Central (0.57%, 95%CI, 0.30%, 0.85%), and East China (0.63%, 95%CI, 0.27%, 0.99%). Of all stroke cases, 62,988 (6.4%) had recurrent stoke attack during their hospitalization. Each 10 μg/m3 increase in PM1 was associated with a 1.64% (95%CI, 1.28%, 2.01%) increment in recurrence of stroke during hospitalization. CONCLUSIONS Short-term exposure to PM1 may increase the risk of incidence and recurrence of stroke in China, and the effects varied across different types of stroke and regions. Geographically targeted strategies and measures are needed to control air pollution for reducing the burden of stroke from PM1.
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Affiliation(s)
- Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Lixia Yuan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Children's Hospital of Fudan University, National Center for Children's Health, Shanghai 200032, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jun Yang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China.
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China.
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Koumo M, Goda A, Maki Y, Yokoyama K, Yamamoto T, Hosokawa T, Katsura J, Yanagibashi K. Indicators Predicting Inpatient Mortality in Post-Stroke Patients Admitted to a Chronic Care Hospital: A Retrospective Pilot Study. Healthcare (Basel) 2022; 10:healthcare10061038. [PMID: 35742088 PMCID: PMC9222313 DOI: 10.3390/healthcare10061038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
Evidence concerning the mortality of post-stroke patients admitted to a chronic-phase hospital seems to be lacking. This pilot study aimed to identify mortality-related clinical variables in the admission of post-stroke patients from a retrospective perspective. A group of 38 non-survival stroke patients and another group of 46 survival stroke patients in a chronic-phase ward of the single center were recruited. Clinical variables including age, sex, stroke type, and Barthel index (BI) score were collected. The difference in the age and BI scores on admission were statistically significant between the two groups (p < 0.01). Polytomous logistic regression analysis revealed that age (odds ratio = 1.09, p = 0.03, and 95% confidence interval: 1.01−1.07), male sex (odds ratio = 5.04, p = 0.01, and 95% confidence interval: 1.39−18.27), and BI scores on admission (odds ratio = 0.90, p = 0.01, and 95% confidence interval: 0.83−0.97) could be prognostic variables. The percentage of correct classification was 83.3%. Age, male sex, and BI scores on admission may be prognostic indicators. The result of this study could lay the groundwork for palliative care for such a clinical population.
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Affiliation(s)
- Masatoshi Koumo
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan
- Correspondence: ; Tel.: +81-(0)75-574-4313
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
- Department of Neurosurgery, Hikone Chuo Hospital, Shiga 522-0054, Japan
| | - Kouta Yokoyama
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Tetsuya Yamamoto
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Tsumugi Hosokawa
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Junichi Katsura
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Ken Yanagibashi
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
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11
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Saumur TM, Gregor S, Xiong Y, Unger J. Quantifying the amount of physical rehabilitation received by individuals living with neurological conditions in the community: a scoping review. BMC Health Serv Res 2022; 22:349. [PMID: 35296315 PMCID: PMC8925183 DOI: 10.1186/s12913-022-07754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Physical rehabilitation is often prescribed immediately following a neurological event or a neurological diagnosis. However, many individuals require physical rehabilitation after hospital discharge. The purpose of this scoping review was to determine the amount of physical rehabilitation that individuals living in the community with neurological conditions receive to understand current global practices and assess gaps in research and service use. Methods This scoping review included observational studies that 1) involved adults living with a neurological condition, and 2) quantified the amount of rehabilitation being received in the community or outpatient hospital setting. Only literature published in English was considered. MEDLINE, EMBASE, AMED, CINAHL, Cochrane Library, and PEDro databases were searched from inception. Two independent reviewers screened titles and abstracts, followed by full texts, and data extraction. Mean annual hours of rehabilitation was estimated based on the amount of rehabilitation reported in the included studies. Results Overall, 18 studies were included after screen 14,698 articles. The estimated mean annual hours of rehabilitation varied greatly (4.9 to 155.1 h), with individuals with spinal cord injury and stroke receiving the greatest number of hours. Participants typically received more physical therapy than occupational therapy (difference range: 1 to 22 h/year). Lastly, only one study included individuals with progressive neurological conditions, highlighting a research gap. Discussion The amount of rehabilitation received by individuals with neurological conditions living in the community varies greatly. With such a wide range of time spent in rehabilitation, it is likely that the amount of rehabilitation being received by most individuals in the community is insufficient to improve function and quality of life. Future work should identify the barriers to accessing rehabilitation resources in the community and how much rehabilitation is needed to observe functional improvements. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07754-4.
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Affiliation(s)
- Tyler M Saumur
- Rehabilitation Sciences Institute, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Sarah Gregor
- Rehabilitation Sciences Institute, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Yijun Xiong
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada
| | - Janelle Unger
- School of Physical Therapy, Western University, London, ON, N6G 1H1, Canada.
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12
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E Wurzinger H, Abzhandadze T, Rafsten L, Sunnerhagen KS. Dependency in Activities of Daily Living During the First Year After Stroke. Front Neurol 2021; 12:736684. [PMID: 34819908 PMCID: PMC8606514 DOI: 10.3389/fneur.2021.736684] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation. Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke. Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed. Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke. Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.
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Affiliation(s)
- Hannah E Wurzinger
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Rafsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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13
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Yun SM, Lee SY, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Oh GJ, Lee YH, Chang WH, Kim YH. Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke. BRAIN & NEUROREHABILITATION 2020; 13:e19. [PMID: 36741795 PMCID: PMC9879371 DOI: 10.12786/bn.2020.13.e19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from -4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.
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Affiliation(s)
- Sang Moon Yun
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University, School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Effects of Age on Long-Term Functional Recovery in Patients with Stroke. ACTA ACUST UNITED AC 2020; 56:medicina56090451. [PMID: 32906615 PMCID: PMC7558871 DOI: 10.3390/medicina56090451] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023]
Abstract
Background and objectives: Age might be a determinant that limits functional recovery in patients with stroke. Here, we investigated the effect of age on functional recovery within 30 months after stroke onset. Materials and Methods: This retrospective longitudinal study enrolled 111 patients with first-ever stroke. Functional recovery was assessed at 2 weeks and at 1, 6, and 30 months after stroke onset using the modified Barthel Index (MBI), modified Rankin Score (mRS), functional ambulation category (FAC), muscle strength, and Mini-Mental State Examination (MMSE). A generalized estimating equation analysis was performed. Results: With the MBI, function improved until 6 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in patients ≥70 years. At 30 months after stroke, there was no significant change of MBI in patients aged <70 years, whereas there was a significant decline in older patients. With the mRS and FAC, function improved until 30 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in older patients. Motor deficit, assessed using the Medical Research Council (MRC), improved significantly until 6 months after stroke onset in patients aged <70 years. There was a significant improvement in cognition (assessed using the MMSE) until 6 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in older patients. Conclusions: Long-term functional recovery occurred for up to 30 months after stroke. Patients aged ≥70 years showed functional decline between 6 and 30 months after onset. These findings could be useful when measuring functional recovery after stroke.
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15
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Shumba J, McLoughlin A, Browne L, Schmid A, Wren MA, Hickey A, Kelly P, Bennett K, Rohde D, Sexton E. Systematic review and meta-analysis of the effect of cognitive impairment on the risk of admission to long-term care after stroke. HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13055.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Admission to long-term care (LTC) post-stroke can be a significant source of costs. Studies evaluating the effect of cognitive impairment (CI) and dementia on risk of LTC admission post-stroke have not been systematically reviewed. The aim of this paper was to conduct a systematic review and meta-analysis of studies of the association between post-stroke CI/dementia and admission to LTC. Patients and methods: PubMed, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for peer-review articles in English published January 2000-June 2018. Included studies were population-based or hospital-based studies assessing the relationship between CI or dementia, and admission to LTC post-stroke. Abstracts were screened, followed by full-text review of potentially relevant articles. Relevant data was extracted using a standard form and the Crowe Critical Appraisal Tool was used for quality appraisal. Results were pooled using random-effects meta-analysis and heterogeneity was assessed using the I² statistic. Results: 18 articles were included in the review and 12 in a meta-analysis. 14/18 studies adjusted for covariates including functional impairment. Increased odds of admission to LTC was associated with post-stroke CI [Odds Ratio (CI 95%): 2.36 (1.18, 4.71), I²=77%] and post-stroke dementia [Odds Ratio (CI 95%): 2.58 (1.38 to 4.82), I²=60%]. Discussion and conclusion: Post-stroke CI and dementia increase odds of admission to LTC post-stroke, independent of functional impairment. This indicates the potential for interventions that reduce post-stroke CI and dementia to also reduce risk of admission to LTC post-stroke, and ultimately costs.
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16
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Functional Performance and Discharge Setting Predict Outcomes 3 Months After Rehabilitation Hospitalization for Stroke. J Stroke Cerebrovasc Dis 2020; 29:104746. [PMID: 32151479 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 01/03/2020] [Accepted: 02/06/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some clinical features of patients after stroke may be modifiable and used to predict outcomes. Identifying these features may allow for refining plans of care and informing estimates of posthospital service needs. The purpose of this study was to identify key factors that predict functional independence and living setting 3 months after rehabilitation hospital discharge by using a large comprehensive national data set of patients with stroke. METHODS The Uniform Data System for Medical Rehabilitation was queried for the records of patients with a diagnosis of stroke who were hospitalized for inpatient rehabilitation from 2005 through 2007. The system includes demographic, administrative, and clinical variables collected at rehabilitation admission, discharge, and 3-month follow-up. Primary outcome measures were the Functional Independence Measure score and living setting 3 months after rehabilitation hospital discharge. RESULTS The sample included 16,346 patients (80% white; 50% women; mean [SD] age, 70.3 [13.1] years; 97% ischemic stroke). The strongest predictors of Functional Independence Measure score and living setting at 3 months were those same factors at rehabilitation discharge, despite considering multiple other predictor variables including age, lesion laterality, initial neurologic impairment, and stroke-related comorbid conditions. CONCLUSIONS These data can inform clinicians, patients with stroke, and their families about what to expect in the months after hospital discharge. The predictive power of these factors, however, was modest, indicating that other factors may influence postacute outcomes. Future predictive modeling may benefit from the inclusion of educational status, socioeconomic factors, and brain imaging to improve predictive power.
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17
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Mutai H, Wakabayashi A, Suzuki A, Furukawa T. Factors Affecting Changes in Social Activities of People with Stroke Living in The Community: Follow-Up 1 to 3 Years after Being Discharged Home. ACTA ACUST UNITED AC 2020. [DOI: 10.11596/asiajot.16.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hitoshi Mutai
- School of Health Sciences, Shinshu University School of Medicine
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18
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Keptner KM, Smyth K, Koroukian S, Schluchter M, Furlan A. Utilization of Rehabilitation Services in Stroke: A Study Utilizing the Health and Retirement Study With Linked Medicare Claims Data. Arch Phys Med Rehabil 2019; 100:2244-2250. [PMID: 31421093 PMCID: PMC7739196 DOI: 10.1016/j.apmr.2019.06.017] [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: 08/07/2018] [Revised: 06/14/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe Medicare fee-for-service beneficiaries who used poststroke rehabilitation services and identified the strongest predictors of utilization after the initial stroke care episode. DESIGN Pooled, cross-sectional design using data from 1998 to 2010 from the Health and Retirement Study (HRS) with linked Medicare claims data. SETTING NA. PARTICIPANTS Stroke survivors who were Medicare fee-for-service beneficiaries and participated in the HRS were included (N=515). MAIN OUTCOME MEASURE Utilization of rehabilitation services up to 10 years poststroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors, and social support. RESULTS Rehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and <16% in years 2, 4, 6, 8, and 10, respectively. Age was the primary factor predicting use of rehabilitation in the first 10 years poststroke (odds ratio: 1.14; P=.001). Recurrent stroke (odds ratio: 1.64; P=.051) was also significantly associated with utilization, whereas unspecified incident stroke at incident trended toward significance (odds ratio: 2.17; P=.077). None of the other factors was a significant predictor of participation in rehabilitation services in this period. CONCLUSION A small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years poststroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.
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Affiliation(s)
- Karen M Keptner
- School of Medicine, Case Western Reserve University, Cleveland, OH.
| | - Kathleen Smyth
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Siran Koroukian
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Mark Schluchter
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Anthony Furlan
- School of Medicine, Case Western Reserve University, Cleveland, OH
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19
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da Silva Rodrigues JC, Luvizutto GJ, da Costa RDM, Prudente RA, da Silva TR, de Souza JT, da Silveira CFDSMP, Rossi DAA, Winckler FC, Modolo GP, Valadão TFC, de Oliveira Antunes LC, Martin LC, Bazan R, Bazan SGZ. Influence of an exercise program on cardiac remodeling and functional capacity in patients with stroke (CRONuS trial): study protocol for a randomized controlled trial. Trials 2019; 20:298. [PMID: 31138281 PMCID: PMC6540544 DOI: 10.1186/s13063-019-3328-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/25/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular rehabilitation is one of the treatment options for post-stroke individuals in order to improve functional independence in activities of daily life and reduce energy expenditure. The aim of this trial is to evaluate the effect of an exercise program on the echocardiographic variables, functional capacity, inflammatory response, neurological status, nutritional status, cardiologic evaluation, and quality of life of patients after stroke. METHODS/DESIGN This is a randomized controlled trial including patients with ischemic stroke in the chronic phase. The patients will be evaluated at the beginning of the study and after 16 weeks. This will include clinical and physical evaluation, 6-min walk test, neurological assessment, nutritional assessment, ambulatory blood pressure monitoring, transthoracic echocardiography, and assessment of the quality of life. The sample size has been determined as 40 patients, who will be divided into two groups: control group (CG; n = 20) and intervention group (IG; n = 20). The CG will undergo conventional physiotherapy for 45 min, three times a week, up to 16 weeks, while the IG will be put on a cardiovascular rehabilitation program consisting of heating, aerobic exercise, and muscle strengthening for 45 min, three times a week, for 16 weeks. The primary endpoint will be functional capacity following a 6-min walk test (delta maxVO2) and morphofunctional echocardiographic variables (indexed left ventricular mass) before and after the intervention. DISCUSSION We expect to observe an improvement in cardiac structural and functional abnormalities in the IG, on echocardiography and biochemical examination, and that the improvement of these parameters after cardiovascular rehabilitation will have a favorable impact on the functional capacity and quality of life of patients after stroke. TRIAL REGISTRATION REBEC, RBR-4wk4b3. Registered on 19 September 2016.
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Affiliation(s)
| | - Gustavo José Luvizutto
- Department of Applied Physiotherapy, Triangulo Mineiro Federal University, Uberaba, Brazil
| | - Rafael Dalle Molle da Costa
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Robson Aparecido Prudente
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Taís Regina da Silva
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Juli Thomaz de Souza
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | | | - Daniele Andreza Antonelli Rossi
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | - Fernanda Cristina Winckler
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Tainá Fabri Carneiro Valadão
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | | | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil.
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20
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Sadighi A, Abedi V, Stanciu A, El Andary N, Banciu M, Holland N, Zand R. Six-Month Outcome of Transient Ischemic Attack and Its Mimics. Front Neurol 2019; 10:294. [PMID: 30972019 PMCID: PMC6445867 DOI: 10.3389/fneur.2019.00294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Although the risk of recurrent cerebral ischemia is higher after a transient ischemic attack (TIA), there is limited data on the outcome of TIA mimics. The goal of this study is to compare the 6-month outcome of patients with negative and positive diffusion-weighted imaging (DWI) TIAs (DWI-neg TIA vs. DWI-pos TIA) and also TIA mimics. Methods: We prospectively studied consecutive patients with an initial diagnosis of TIA in our tertiary stroke centers in a 2-year period. Every included patient had an initial magnetic resonance (MR) with DWI and one-, three-, and six-month follow-up visits. The primary outcome was defined as the composition of intracerebral hemorrhage, ischemic stroke, TIA, coronary artery disease, and death. Results: Out of 269 patients with the initial diagnosis of TIA, 259 patients (mean age 70.5 ± 15.0 [30-100] years old, 56.8% men) were included in the final analysis. Twenty-one (8.1%, 95% confidence interval [CI] 5.1-12.1%) patients had a composite outcome event within the six-month follow-up. Five (23.8%) and 13 (61.9%) composite outcome events occurred in the first 30 and 90 days, respectively. Among patients with DWI-neg TIA, the one- and six-month ischemic stroke rate was 1.5 and 4.6%, respectively. The incidence proportion of composite outcome event was significantly higher among patients who had the diagnosis of DWI-neg TIA compared with those who had the diagnosis of TIA mimics (12.2 vs. 2.1%-relative risk 5.9; 95% CI, 1.4-25.2). In our univariable analysis among patients with DWI-neg TIA and DWI-pos TIA, age (P = 0.017) was the only factor that was significantly associated with the occurrence of the composite outcome. Conclusion: Our study indicated that the overall six-month rate of the composite outcome among patients DWI-neg TIA, DWI-pos TIA, and TIA mimics were 12.2, 9.7, and 2.1%, respectively. Age was the only factor that was significantly associated with the occurrence of the composite outcome.
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Affiliation(s)
- Alireza Sadighi
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
| | - Vida Abedi
- Department of Bioinformatics, Geisinger Medical Center, Danville, PA, United States
| | - Alia Stanciu
- Freeman College of Management, Bucknell University, Lewisburg, PA, United States
| | - Nada El Andary
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
| | - Mihai Banciu
- Freeman College of Management, Bucknell University, Lewisburg, PA, United States
| | - Neil Holland
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
| | - Ramin Zand
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
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Qurat-ul-Ain, Malik AN, Haq U, Ali S. Effect of task specific circuit training on Gait parameters and mobility in stroke survivors. Pak J Med Sci 2018; 34:1300-1303. [PMID: 30344596 PMCID: PMC6191776 DOI: 10.12669/pjms.345.15006] [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: 03/14/2018] [Revised: 03/29/2018] [Accepted: 07/20/2018] [Indexed: 11/19/2022] Open
Abstract
Objective of the study was to investigate effects of task specific circuit gait training to improve gait parameters and mobility among sub-acute and chronic stroke patients. A randomized control trial was conducted on stroke survivors of either gender being capable of standing 10 seconds and having 2-4 score on Rankin Modified Scale. Sample comprised of 30 participants randomly assigned into two groups. Training was given for a session of 40-50 minutes for 3-4 days/week for six weeks. Timed get up and go test (TUG), Cadence, Step Length and Step Width assessed measures of concern. The sample included 16 males and 14 females with mean age of 54.10 ± 10.10 years. After six weeks, significant improvement was recorded in TUG (p=0.014). Cadence (p=0.001), step length (p<0.001) and step width (p=0.009) were also significantly improved. Circuit gait training improves mobility and gait in stroke patients.
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Affiliation(s)
- Qurat-ul-Ain
- Dr. Qurat-ul-Ain, MSNMPT, Department of Physical Therapy, Pakistan Railway Hospital, Riphah International University, Islamabad, Pakistan
| | - Arshad Nawaz Malik
- Dr. Arshad Nawaz Malik, PhD, Department of Physical Therapy, Pakistan Railway Hospital, Riphah International University, Islamabad, Pakistan
| | - Umama Haq
- Dr. Umama Haq, MSNMPT, Department of Physical Therapy, Pakistan Railway Hospital, Riphah International University, Islamabad, Pakistan
| | - Sehrish Ali
- Dr. Sehrish Ali, MSOMPT, Department of Physical Therapy, Pakistan Railway Hospital, Riphah International University, Islamabad, Pakistan
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Zucchella C, Consilvio M, Iacoviello L, Intiso D, Tamburin S, Casale R, Bartolo M. Rehabilitation in oldest-old stroke patients: a comparison within over 65 population. Eur J Phys Rehabil Med 2018; 55:148-155. [PMID: 30160435 DOI: 10.23736/s1973-9087.18.05297-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Considering the demographic trend, characterized by a marked aging due to the increase in life expectancy and the improvement in medical care, in the next future elderly patients will represent the majority of stroke victims with a strong impact on rehabilitative services. AIM To investigate and characterize differences in functional outcome in elderly patients after stroke. DESIGN Observational study. SETTING Post-acute inpatient rehabilitation. POPULATION Subjects aged ≥65 years with acute (i.e. within 30 days from onset) ischemic or hemorrhagic stroke. METHODS At admission, all patients underwent neurological and clinical examination, functional evaluation and laboratory assessment. Comorbidities and clinical complications during hospital stay were recorded. Functional status was evaluated by means of the Functional Independence Measure (FIM) administered at admission and discharge. All patients underwent neuromotor rehabilitation, and speech therapy in case of aphasia, once a day, six days per week. RESULTS The study enrolled 402 patients, who were stratified in three groups according to age: 145 patients in Group 1, the young-old (65-74.9 years, G1), 206 in Group 2, the middle-old (75-84.9 years, G2) and 51 in Group 3, the oldest-old (≥85 years, G3). At discharge, FIM total scores increased significantly for all the groups (P<0.001); however FIM gains, as well as the efficiency parameters derived from FIM were significantly lower in G3 when compared with G1 and G2. G3 showed a significantly higher rate of comorbidities and a higher presence of pressure sores; infections occurred mainly in G2 and G3. Hospitalization was significantly longer for G1 and G2 with respect to G3, while mortality rates were significantly higher in G2 and G3 with respect to G1. The variables that predicted functional outcome were age, previous stroke, stroke severity and functional status at admission. CONCLUSIONS Despite advancing age seems to be associated with a reduced effectiveness of the rehabilitation process and a greater number of complications, intensive rehabilitation can produce significant functional gains for all stroke survivors, regardless of age. CLINICAL REHABILITATION IMPACT Understanding the specificity of this population will offer older subjects targeted interventions and, for health systems, better allocation of resources and the development of more effective approaches.
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Affiliation(s)
| | - Marco Consilvio
- Division of Neurologic, Cardiologic, and Pneumological Rehabilitation, European Institute of Rehabilitation, Isernia, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, NEUROMED Mediterranean Neurological Institute for Research and Care, Pozzilli, Isernia, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Domenico Intiso
- Unit of Physical Medicine and Neurorehabilitation, Casa Sollievo della Sofferenza Institute for Research and Care, San Giovanni Rotondo, Foggia, Italy
| | - Stefano Tamburin
- Unit of Neurology, University Hospital of Verona, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Casale
- Scientific Direction, HABILITA, Zingonia di Ciserano, Bergamo, Italy
| | - Michelangelo Bartolo
- Unit of Neurorehabilitation, Department of Rehabilitation, HABILITA, Zingonia di Ciserano, Bergamo, Italy -
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Malhotra R, Chei CL, Menon EB, Chow WL, Quah S, Chan A, Ajay S, Matchar DB. Trajectories of positive aspects of caregiving among family caregivers of stroke-survivors: the differential impact of stroke-survivor disability. Top Stroke Rehabil 2018; 25:261-268. [DOI: 10.1080/10749357.2018.1455369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Choy-Lye Chei
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | | | - Wai-Leng Chow
- Health Services Research, Eastern Health Alliance, Singapore, Singapore
| | - Stella Quah
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Angelique Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Shweta Ajay
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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24
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Mutai H, Furukawa T, Wakabayashi A, Suzuki A, Hanihara T. Functional outcomes of inpatient rehabilitation in very elderly patients with stroke: differences across three age groups. Top Stroke Rehabil 2018; 25:269-275. [DOI: 10.1080/10749357.2018.1437936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hitoshi Mutai
- School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Rehabilitation, Azumino Red Cross Hospital, Azumino, Japan
| | - Tomomi Furukawa
- Department of Rehabilitation, Azumino Red Cross Hospital, Azumino, Japan
| | - Ayumi Wakabayashi
- Department of Rehabilitation, Azumino Red Cross Hospital, Azumino, Japan
| | - Akihito Suzuki
- Department of Rehabilitation, Azumino Red Cross Hospital, Azumino, Japan
| | - Tokiji Hanihara
- School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan
- Nagano Prefectural Mental Wellness Center, Komagane, Japan
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25
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Hakeem A, Cilingiroglu M, Katramados A, Boudoulas KD, Iliescu C, Gundogdu B, Marmagkiolis K. Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data. Catheter Cardiovasc Interv 2018; 92:1153-1160. [DOI: 10.1002/ccd.27487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/30/2017] [Accepted: 12/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Abdul Hakeem
- Robert Wood Johnson Hospital, Rutgers University; New Brunswick New Jersey
| | - Mehmet Cilingiroglu
- School of Medicine; Arkansas Heart Hospital, Little Rock, AR and Koc University; Istanbul Turkey
| | - Angelos Katramados
- Department of Neurology; Henry Ford Health Sciences Center; Detroit Michigan
| | | | | | - Betul Gundogdu
- Department of Neurology; University of Arkansas for Medical Sciences; Little Rock Arkansas
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Lisabeth LD, Baek J, Morgenstern LB, Zahuranec DB, Case E, Skolarus LE. Prognosis of Midlife Stroke. J Stroke Cerebrovasc Dis 2017; 27:1153-1159. [PMID: 29284570 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To characterize stroke outcomes in a midlife population-based stroke cohort, and to describe comorbidities, quality of care, and risk of recurrence in this age group. MATERIALS AND METHODS Ischemic strokes (ISs) were identified from the population-based Brain Attack Surveillance in Corpus Christi Project (2000-2012). Data were from medical records and patient interviews. Ninety-day outcomes (functional, neurologic, cognitive, quality of life [QOL]), prevalence of comorbidities, quality of care, and 1-year recurrence were estimated for those aged 45-64 (midlife) and compared with those aged ≥65 using sex and race-ethnicity adjusted regression models. RESULTS Of 4858 ISs, 33% occurred in midlife. On average, the midlife group reported some difficulty with function, favorable neurologic and cognitive outcomes, and moderate QOL scores at 90 days. All outcomes except QOL were better in the midlife group. Prevalent comorbidities in midlife were hypertension (74%), diabetes (51%), hyperlipidemia (34%), heart disease (26%), prior stroke/transient ischemic attack (23%), smoking 37%, excess alcohol 10%, and atrial fibrillation 4%. Median body mass index (BMI) was 30 (interquartile range: 26-35). Diabetes, smoking, and alcohol were more prevalent and BMI higher in the midlife group. Quality of stroke care did not differ by age. One-year recurrence in midlife was 8% (95% confidence interval: 6%-9%) and did not differ by age. CONCLUSION While 90-day outcomes were more favorable than in the elderly, midlife stroke survivors faced some disability and did not experience better QOL despite better outcomes. Additional research should identify targets to optimize secondary stroke prevention and improve outcomes in midlife stroke survivors-an understudied group with great potential disability and economic impact.
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Affiliation(s)
- Lynda D Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Stroke Program, University of Michigan, Ann Arbor, Michigan.
| | - Jonggyu Baek
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lewis B Morgenstern
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Stroke Program, University of Michigan, Ann Arbor, Michigan
| | | | - Erin Case
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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Impact of Thyroid Hormone Levels on Functional Outcome in Neurological and Neurosurgical Early Rehabilitation Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4719279. [PMID: 28900623 PMCID: PMC5576392 DOI: 10.1155/2017/4719279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022]
Abstract
Background Neurological and neurosurgical early rehabilitation (NNER) is a specialized treatment option for patients with severe neurological disorders. The present study investigated whether thyroid hormone levels on admission have an impact on the outcome of NNER patients. Method The study included 500 NNER patients who were admitted to the BDH-Clinic Hessisch Oldendorf between 2009 and 2010. Data such as age, sex, diagnoses, comorbidities, Glasgow Coma Scale score, length of stay, and thyroid hormone levels (obtained as part of clinical routine care) were analyzed retrospectively. Improvement in the Early Rehabilitation Barthel Index (ERBI) at the end of the NNER treatment was defined as outcome parameter. Results Most patients made functional progress during treatment, as reflected in significant enhancements of the ERBI. Approximately half of the patients were transferred to further rehabilitation treatment. Young age, early onset of NNER treatment, low functional impairment on admission, and, in particular, low total T3 levels were independently associated with a good outcome. Conclusion Age, severity of disease, and time between injury and admission are known to predict outcome. The present study confirms the influence of these general factors. In addition, an association between thyroid hormones and functional outcome was demonstrated for NNER patients.
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28
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Edwards JD, Kapral MK, Fang J, Swartz RH. Trends in Long-Term Mortality and Morbidity in Patients with No Early Complications after Stroke and Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2017; 26:1641-1645. [PMID: 28506592 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/03/2016] [Accepted: 09/25/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Advances in acute management and secondary prevention have reduced mortality and early recurrent risk after stroke and transient ischemic attack (TIA). However, whether improved outcomes are sustained long term among those without early adverse complications is not clear. We describe trends in long-term mortality and morbidity in patients with ischemic stroke or TIA who are clinically stable at 90 days. METHODS This is a longitudinal cohort registry study (2003-2013) of patients presenting to stroke centers in Ontario, Canada, with a stroke or TIA, with no hospitalization, stroke, myocardial infarction (MI), institutionalization, or death within 90 days (N = 26,698). Primary outcomes were 1-, 3-, and 5-year age-adjusted composite rates of death, stroke or MI, and institutionalization, and secondary analyses evaluated outcomes individually. Trend tests were used to evaluate change over time. RESULTS One-year adjusted composite rates decreased from 9.3% in 2003 to 7.4% in 2012 (trend test P = .02). Significant decreases in 3-year (P < .001) and 5-year (P = .002) composite rates were also observed. Rates of recurrent stroke decreased at 1 and 3 years (P < .01), but not 5 years (P = .21), whereas death rates declined across follow-up times. Conversely, rates of institutionalization increased at 3 and 5 years (P < .01). CONCLUSIONS Long-term mortality and morbidity post stroke and TIA have declined, confirming trends for improved long-term outcomes for patients clinically stable during the initial high-risk period. However, increased long-term rates of institutionalization also suggest that stroke and TIA patients are at risk of long-term functional decline, despite improved clinical outcomes. Further studies evaluating challenges for sustaining functional gains after stroke and TIA are required.
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Affiliation(s)
| | - Moira K Kapral
- Sunnybrook Research Institute, Canada; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine and Women's Health Program, University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jiming Fang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Richard H Swartz
- Sunnybrook Research Institute, Canada; Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.
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29
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Wing JJ, Adar SD, Sánchez BN, Morgenstern LB, Smith MA, Lisabeth LD. Short-term exposures to ambient air pollution and risk of recurrent ischemic stroke. ENVIRONMENTAL RESEARCH 2017; 152:304-307. [PMID: 27829205 PMCID: PMC5135592 DOI: 10.1016/j.envres.2016.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/12/2016] [Accepted: 11/01/2016] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To investigate the association between short-term changes in ambient pollution (particulate matter <2.5µm in aerodynamic diameter (PM2.5) and ozone (O3)) and the risk of recurrent ischemic stroke among individuals living in a bi-ethnic community. METHODS We identified recurrent ischemic stroke cases from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project between 2000 and 2012. Associations between PM2.5 (mean 24-h) and O3 (maximal 8-h) levels, measured on the previous day, and odds of ischemic stroke were assessed using a time-stratified case-crossover design and modeled using conditional logistic regression. RESULTS There were 317 recurrent ischemic strokes after excluding 41 strokes that occurred on days with missing air pollution data. Mean age was 72 years (SD=12) and median time to stroke recurrence was 1.1 years (IQR: 0.2-2.8 years). Median levels of PM2.5 and O3 over the study period were 7.7μg/m3 (IQR: 5.6-10.7μg/m3) and 35.2 ppb (IQR: 25.0-46.1 ppb), respectively. We observed no associations between previous-day PM2.5 and O3 and odds of recurrent stroke (OR=0.95 per 10µg/m3 of PM2.5, 95% CI: 0.71-1.28 and OR=0.97 per 10ppb of O3, 95% CI: 0.87-1.07) after adjusting for ambient temperature and relative humidity. Co-adjustment of both pollutants did not change the results. CONCLUSION We found no evidence of associations between previous-day air pollution levels and recurrent ischemic stroke. Research on the influence of air pollutants on risk of stroke recurrence is still in its infancy, and more research is necessary in studies that are adequately powered to understand the relation.
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Affiliation(s)
- Jeffrey J Wing
- Department of Epidemiology, School of Public Health, University of Michigan, USA.
| | - Sara D Adar
- Department of Epidemiology, School of Public Health, University of Michigan, USA
| | - Brisa N Sánchez
- Department of Biostatistics, School of Public Health, University of Michigan, USA
| | - Lewis B Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Department of Neurology, Stroke Program, University of Michigan, USA
| | - Melinda A Smith
- Department of Neurology, Stroke Program, University of Michigan, USA
| | - Lynda D Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Department of Neurology, Stroke Program, University of Michigan, USA
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Vloothuis JDM, Mulder M, Veerbeek JM, Konijnenbelt M, Visser‐Meily JMA, Ket JCF, Kwakkel G, van Wegen EEH. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev 2016; 12:CD011058. [PMID: 28002636 PMCID: PMC6463929 DOI: 10.1002/14651858.cd011058.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced. OBJECTIVES To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, Issue 10), MEDLINE (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field. SELECTION CRITERIA Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. One review author extracted data, and assessed quality and risk of bias, and a second review author cross-checked these data and assessed quality. We determined the quality of the evidence using GRADE. The small number of included studies limited the pre-planned analyses. MAIN RESULTS We included nine trials about CME, of which six trials with 333 patient-caregiver couples were included in the meta-analysis. The small number of studies, participants, and a variety of outcome measures rendered summarising and combining of data in meta-analysis difficult. In addition, in some studies, CME was the only intervention (CME-core), whereas in other studies, caregivers provided another, existing intervention, such as constraint-induced movement therapy. For trials in the latter category, it was difficult to separate the effects of CME from the effects of the other intervention.We found no significant effect of CME on basic ADL when pooling all trial data post intervention (4 studies; standardised mean difference (SMD) 0.21, 95% confidence interval (CI) -0.02 to 0.44; P = 0.07; moderate-quality evidence) or at follow-up (2 studies; mean difference (MD) 2.69, 95% CI -8.18 to 13.55; P = 0.63; low-quality evidence). In addition, we found no significant effects of CME on extended ADL at post intervention (two studies; SMD 0.07, 95% CI -0.21 to 0.35; P = 0.64; low-quality evidence) or at follow-up (2 studies; SMD 0.11, 95% CI -0.17 to 0.39; P = 0.45; low-quality evidence).Caregiver burden did not increase at the end of the intervention (2 studies; SMD -0.04, 95% CI -0.45 to 0.37; P = 0.86; moderate-quality evidence) or at follow-up (1 study; MD 0.60, 95% CI -0.71 to 1.91; P = 0.37; very low-quality evidence).At the end of intervention, CME significantly improved the secondary outcomes of standing balance (3 studies; SMD 0.53, 95% CI 0.19 to 0.87; P = 0.002; low-quality evidence) and quality of life (1 study; physical functioning: MD 12.40, 95% CI 1.67 to 23.13; P = 0.02; mobility: MD 18.20, 95% CI 7.54 to 28.86; P = 0.0008; general recovery: MD 15.10, 95% CI 8.44 to 21.76; P < 0.00001; very low-quality evidence). At follow-up, we found a significant effect in favour of CME for Six-Minute Walking Test distance (1 study; MD 109.50 m, 95% CI 17.12 to 201.88; P = 0.02; very low-quality evidence). We also found a significant effect in favour of the control group at the end of intervention, regarding performance time on the Wolf Motor Function test (2 studies; MD -1.72, 95% CI -2.23 to -1.21; P < 0.00001; low-quality evidence). We found no significant effects for the other secondary outcomes (i.e. PATIENT motor impairment, upper limb function, mood, fatigue, length of stay and adverse events; caregiver: mood and quality of life).In contrast to the primary analysis, sensitivity analysis of CME-core showed a significant effect of CME on basic ADL post intervention (2 studies; MD 9.45, 95% CI 2.11 to 16.78; P = 0.01; moderate-quality evidence).The methodological quality of the included trials and variability in interventions (e.g. content, timing, and duration), affected the validity and generalisability of these observed results. AUTHORS' CONCLUSIONS There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.
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Affiliation(s)
- Judith DM Vloothuis
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Marijn Mulder
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
| | - Janne M Veerbeek
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
- VU University Medical CenterDepartment of Rehabilitation Medicine, Physical TherapyDe Boelelaan 1118AmsterdamNoor‐HollandNetherlands1007 MB
| | - Manin Konijnenbelt
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Johanna MA Visser‐Meily
- University Medical Center Utrecht and De HoogstraatBrain Center Rudolf MagnusHeidelberglaan 100PO Box 85500UtrechtNetherlands3508 GA
| | - Johannes CF Ket
- Vrije Universiteit AmsterdamMedical LibraryDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam NeurosciencesDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- Amsterdam Neurosciences, VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamPO Box 7057AmsterdamNetherlands1007 MB
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Katz-Leurer M, Carmeli E, Shochina M. The effect of early aerobic training on independence six months post stroke. Clin Rehabil 2016; 17:735-41. [PMID: 14606739 DOI: 10.1191/0269215503cr671oa] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate whether early aerobic training has a beneficial effect on stroke patients' independence in daily and social activities six months after the event. Design: Randomized clinical trial. Setting: Rehabilitation unit. Subjects: Ninety-two patients after a first stroke. Interventions: Forty-six patients participated in an eight-week programme of aerobic training, using a leg cycle ergometer. Main outcome measures: Frenchay Activities Index (FAI) measured twice, at entry to programme (pre-event score) and six months after the onset of the event. Results: Despite the significant improvement of study group patients' functional abilities immediately after the intervention compared with controls, no significant difference was found in FAI mean score between groups six months post event. An interaction effect was noted between event severity, intervention and FAI total score. Mean FAI score declined significantly less in the less severely impaired study group patients. Conclusions: Early, moderately intense aerobic training has no direct impact on independence in daily and social activities as measured by FAI total score six months after a stroke.
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Affiliation(s)
- Michal Katz-Leurer
- Rehabilitation Department, Hadassah University Hospital, Sackler Faculty of Medicine, School of Health Professions, Tel-Aviv University, Ramat-Aviv, Israel.
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Mutai H, Furukawa T, Nakanishi K, Hanihara T. Longitudinal functional changes, depression, and health-related quality of life among stroke survivors living at home after inpatient rehabilitation. Psychogeriatrics 2016; 16:185-90. [PMID: 26179118 DOI: 10.1111/psyg.12137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/09/2015] [Accepted: 05/11/2015] [Indexed: 11/26/2022]
Abstract
AIM This study investigated changes in functional status in home-dwelling stroke survivors 1-3 years after inpatient rehabilitation. It also examined the factors associated with longitudinal functional changes and health-related quality of life. METHODS Survey evaluations were conducted at the homes of 27 stroke survivors. The Functional Independence Measure (FIM), Short Form 36, Frenchay Activities Index, and Hamilton Depression Rating Scale were used to assess functional status, quality of life, social activity, and depression symptoms, respectively. RESULTS From the time of discharge to follow-up (mean: 2.1 ± 0.6 years), total FIM and motor FIM scores were mildly improved, and cognitive FIM score was significantly improved. On the Short Form 36, physical functioning, general health, and vitality scores were lower than norm-based scores. Multiple regression analyses showed a positive association between change in motor FIM score and Frenchay Activities Index score and a negative association between change in cognitive FIM score and elapsed time after discharge. With regard to health-related quality of life, motor FIM score was associated with the physical component summary, whereas age and Hamilton Depression Rating Scale score were associated with the mental component summary. CONCLUSION Social participation was associated with long-term improvement in activities of daily living, indicating that interventions targeting social function are important for maintaining and further improving activities of daily living in stroke survivors. Health-related quality of life was correlated with activities of daily living and depression; therefore, interventions targeting these parameters are important in improving the quality of life of stroke survivors.
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Affiliation(s)
- Hitoshi Mutai
- School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Rehabilitation, Azumino Red Cross Hospital, Azumino, Japan
| | - Tomomi Furukawa
- Department of Rehabilitation, Azumino Red Cross Hospital, Azumino, Japan
| | - Kosuke Nakanishi
- Department of Occupational Therapy, Faculty of Health Science, Health Science University, Fujikawaguchiko, Japan
| | - Tokiji Hanihara
- School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan
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Effects of candesartan in acute stroke on activities of daily living and level of care at 6 months. J Hypertens 2016; 33:1487-91. [PMID: 26039534 DOI: 10.1097/hjh.0000000000000581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Scandinavian Candesartan Acute Stroke Trial (SCAST) indicated that blood pressure-lowering treatment with candesartan in the acute phase of stroke has a negative effect on functional outcome at 6 months, measured by the modified Rankin scale. We wanted to see if similar effects can be observed on activities of daily living and level of care. METHODS SCAST was an international multicentre, randomized and placebo-controlled trial of candesartan in 2029 patients recruited within 30 h of acute ischaemic or haemorrhagic stroke. Treatment lowered blood pressure by 5/2 mmHg from day 2 onwards, and was administered for 7 days. At 6 months, activities of daily living were assessed by the Barthel index, and categorized as 'dependency' (≤55 points), 'assisted dependency' (60-90), or 'independency' (≥95). Level of care was categorized as 'living at own home without public help', 'living at home with public help, or in institution for rehabilitation', or 'living in institution for long or permanent stay'. We used ordinal and binary logistic regression for statistical analysis, and adjusted for predefined key variables. RESULTS Data were available in 1825 patients, of which 1559 (85%) patients had ischaemic and 247 (13%) had haemorrhagic stroke. There were no statistically significant effects of candesartan on the Barthel index or on level of care (adjusted common odds ratio for poor outcome 1.09, 95% confidence interval 0.88-1.35, P = 0.44; and odds ratio 1.05, 95% confidence interval 0.82-1.34, P = 0.69, respectively). In the individual Barthel index domains, there were also no statistically significant differences. CONCLUSION Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months. This result is compatible with the results of the main analysis of the modified Rankin scale, and supports the conclusion that there is no indication for routine blood pressure treatment with candesartan in the acute phase of stroke.
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Kwon SY, Hong SE, Kim EJ, Kim CH, Joa KL, Jung HY. Monitoring of Functioning Status in Subjects With Chronic Stroke in South Korea Using WHODAS II. Ann Rehabil Med 2016; 40:111-9. [PMID: 26949677 PMCID: PMC4775743 DOI: 10.5535/arm.2016.40.1.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/03/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To follow up the long-term functioning in a community through assessing personal background and status based on the International Classification of Functioning, Disability and Health (ICF) after a stroke, by using a Korean version of World Health Organization Disability Assessment Scale II (K-WHODAS II). METHODS We surveyed 146 patients diagnosed at the first-onset of acute stroke and discharged after Inha University Hospital, and 101 patients answered the K-WHODAS II survey. We analyzed the relationship of six functioning domains of K-WHODAS II with K-MMSE (Korean version of Mini-Mental State Examination) and K-MBI (Korean version of Modified Barthel Index) at admission and discharge, and personal background. All subjects were divided into five groups, according to the disease durations, to assess the functional changes and the differences of K-MMSE and K-MBI at the admission and discharge. RESULTS K-MBI and K-MMSE at admission and discharge showed no significant differences in all five groups, respectively (p>0.05), reflecting no baseline disparity for long-term follow-up. All subjects showed positive gains of K-MBI and K-MMSE at discharge (p<0.05). The six functioning domains and total scores of K-WHODAS II had decreasing trends until 3 years after the stroke onset, but rose thereafter. Higher scores of K-MBI and K-MMSE, younger age, women, working status, higher educational level, and living with a partner were correlated with lower scores of K-WHODAS II (p<0.05). CONCLUSION The long-term functioning after stroke was affected not only by cognitive and motor status in hospital, but also by certain kinds of personal background. K-WHODAS II may be used to monitor functioning status in a community and to assess personal backgrounds in subjects with chronic stroke.
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Affiliation(s)
- Su-Yeon Kwon
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sang-Eun Hong
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ee-Jin Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Chang-Hwan Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kyung-Lim Joa
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Han-Young Jung
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
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Meyer S, Verheyden G, Brinkmann N, Dejaeger E, De Weerdt W, Feys H, Gantenbein AR, Jenni W, Laenen A, Lincoln N, Putman K, Schuback B, Schupp W, Thijs V, De Wit L. Functional and motor outcome 5 years after stroke is equivalent to outcome at 2 months: follow-up of the collaborative evaluation of rehabilitation in stroke across Europe. Stroke 2015; 46:1613-9. [PMID: 25953370 DOI: 10.1161/strokeaha.115.009421] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Recovery of patients within the first 6 months after stroke is well documented, but there has been little research on long-term recovery. The aim of this study was to analyze functional and motor recovery between admission to rehabilitation centres and 5 years after stroke. METHODS This follow-up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe study, included patients from 4 European rehabilitation centres. Patients were assessed on admission, at 2 and 6 months, and 5 years after stroke, using the Barthel Index, Rivermead Motor Assessment Gross Function, Leg and Trunk function, and Arm function. Linear mixed models were used, corrected for baseline characteristics. To account for the drop-out during follow-up, the analysis is likelihood-based (assumption of missingness at random). RESULTS A total of 532 patients were included in this study, of which 238 were followed up at 5 years post stroke. Mean age at stroke onset was 69 (±10 SD) years, 53% were men, 84% had ischemic strokes, and 53% had left-sided motor impairment. Linear mixed model analysis revealed a significant deterioration for all 4 outcomes between 6 months and 5 years (P<0.0001). Scores at 2 months were not statistically significant different from scores at 5 years after stroke. Higher age (P<0.0001) and increasing stroke severity on admission (P<0.0001) negatively affected long-term functional and motor recovery. CONCLUSIONS Five-year follow-up revealed deterioration in functional and motor outcome, with a return to the level measured at 2 months. Increasing age and increasing stroke severity negatively affected recovery up to 5 years after stroke.
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Affiliation(s)
- Sarah Meyer
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.).
| | - Geert Verheyden
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Nadine Brinkmann
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Eddy Dejaeger
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Willy De Weerdt
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Hilde Feys
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Andreas R Gantenbein
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Walter Jenni
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Annouschka Laenen
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Nadina Lincoln
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Koen Putman
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Birgit Schuback
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Wilfried Schupp
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Vincent Thijs
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Liesbet De Wit
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
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Hope TMH, Parker Jones 'Ō, Grogan A, Crinion J, Rae J, Ruffle L, Leff AP, Seghier ML, Price CJ, Green DW. Comparing language outcomes in monolingual and bilingual stroke patients. Brain 2015; 138:1070-83. [PMID: 25688076 PMCID: PMC5014078 DOI: 10.1093/brain/awv020] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hope et al. compare language outcomes in monolingual and bilingual stroke patients, and find that prognostic models based on monolingual data alone overestimate language skills in bilingual patients. Both groups seem sensitive to damage in the same brain regions, but bilinguals appear more sensitive to that damage than monolinguals. Post-stroke prognoses are usually inductive, generalizing trends learned from one group of patients, whose outcomes are known, to make predictions for new patients. Research into the recovery of language function is almost exclusively focused on monolingual stroke patients, but bilingualism is the norm in many parts of the world. If bilingual language recruits qualitatively different networks in the brain, prognostic models developed for monolinguals might not generalize well to bilingual stroke patients. Here, we sought to establish how applicable post-stroke prognostic models, trained with monolingual patient data, are to bilingual stroke patients who had been ordinarily resident in the UK for many years. We used an algorithm to extract binary lesion images for each stroke patient, and assessed their language with a standard tool. We used feature selection and cross-validation to find ‘good’ prognostic models for each of 22 different language skills, using monolingual data only (174 patients; 112 males and 62 females; age at stroke: mean = 53.0 years, standard deviation = 12.2 years, range = 17.2–80.1 years; time post-stroke: mean = 55.6 months, standard deviation = 62.6 months, range = 3.1–431.9 months), then made predictions for both monolinguals and bilinguals (33 patients; 18 males and 15 females; age at stroke: mean = 49.0 years, standard deviation = 13.2 years, range = 23.1–77.0 years; time post-stroke: mean = 49.2 months, standard deviation = 55.8 months, range = 3.9–219.9 months) separately, after training with monolingual data only. We measured group differences by comparing prediction error distributions, and used a Bayesian test to search for group differences in terms of lesion-deficit associations in the brain. Our models distinguish better outcomes from worse outcomes equally well within each group, but tended to be over-optimistic when predicting bilingual language outcomes: our bilingual patients tended to have poorer language skills than expected, based on trends learned from monolingual data alone, and this was significant (P < 0.05, corrected for multiple comparisons) in 13/22 language tasks. Both patient groups appeared to be sensitive to damage in the same sets of regions, though the bilinguals were more sensitive than the monolinguals.
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Affiliation(s)
- Thomas M H Hope
- 1 Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - 'Ōiwi Parker Jones
- 1 Wellcome Trust Centre for Neuroimaging, University College London, UK 2 Wolfson College, University of Oxford, UK
| | - Alice Grogan
- 1 Wellcome Trust Centre for Neuroimaging, University College London, UK
| | | | - Johanna Rae
- 1 Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Louise Ruffle
- 1 Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Alex P Leff
- 3 Institute of Cognitive Neuroscience, University College London, UK 4 Department of Brain, Repair and Rehabilitation, Institute of Neurology, University College London, UK
| | - Mohamed L Seghier
- 1 Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Cathy J Price
- 1 Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - David W Green
- 5 Experimental Psychology, University College London, London WC1E 6BT, UK
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Jeon BJ, Kim WH, Park EY. Effect of task-oriented training for people with stroke: a meta-analysis focused on repetitive or circuit training. Top Stroke Rehabil 2015; 22:34-43. [PMID: 25776119 DOI: 10.1179/1074935714z.0000000035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
PURPOSE The current meta-analysis reviewed evidence for effective task-oriented training focused on repetitive or circuit training after stroke. METHOD Searches were conducted of randomized, controlled trials using task-oriented training. The quality of each study was assessed using the Physiotherapy Evidence Database (PEDro) scale. Eleven studies were analyzed regarding the magnitude of effect sizes (ESs) and categorized according to extremities focused upon for training, outcome measures, and study variables. This included duration and frequency of training and stroke stage. RESULTS The PEDro scores ranged from 4 to 8 (median = 7). The overall ES of the 11 studies was large. The effects for lower extremities and both acute/sub-acute and chronic stage stroke were large and significant. Significant effects were also found for gait velocity, gait endurance, balance, timed up and go test, and strength of the lower extremities. There was no significant effect of training focused on upper extremities. Training with a duration of 2 weeks and frequency of 7 days a week had the greatest effects. CONCLUSIONS Task-oriented training interventions are useful for improving muscle strength and gait related activities in both acute/sub-acute and chronic stroke patients. Although this meta-analysis provides evidence of task-oriented training for improving functioning after stroke, further studies are necessary to investigate the effects of training on upper extremities and the overall cost-effectiveness of such training.
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Rollnik JD. Outcome of Early Neurological Rehabilitation Patients Colonized with Extended-Spectrum Beta-Lactamase (ESBL) Producing Bacteria. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojtr.2015.31001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mercer VS, Freburger JK, Yin Z, Preisser JS. Recovery of paretic lower extremity loading ability and physical function in the first six months after stroke. Arch Phys Med Rehabil 2014; 95:1547-55.e4. [PMID: 24755045 DOI: 10.1016/j.apmr.2014.03.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate poststroke recovery of paretic lower extremity loading, walking ability, and self-reported physical function; and to identify subject characteristics associated with recovery. DESIGN Inception cohort study, with testing at monthly intervals from 1 to 6 months poststroke. SETTING Medical center and research laboratory. PARTICIPANTS Volunteer sample of individuals with first-ever, unilateral, noncerebellar stroke (N=33). A total of 78 individuals underwent screening, and 45 were found to be eligible. Of these, 8 declined participation, 2 were excluded because of deteriorating cognitive status, and 2 were lost to follow-up. The remaining 33 individuals enrolled in the study, and 30 (91%) completed the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Outcomes were loading of the paretic lower extremity when standing up from a chair, self-selected gait speed (GS), and Physical Functioning Index. RESULTS Data analyses using linear mixed models indicated that subjects improved over time for all outcomes. Baseline Fugl-Meyer (FM) lower extremity motor scale score was a predictor of immediate poststroke performance for paretic lower extremity loading and self-selected GS, and a predictor of recovery rate for paretic lower extremity loading. Factors identified as having significant effects on performance at 6 months poststroke were baseline FM lower extremity motor scale score for paretic lower extremity loading and self-selected GS and baseline star cancellation score (from the Behavioral Inattention Test) for paretic lower extremity loading. CONCLUSIONS Individuals with better baseline paretic lower extremity motor function have better ability to load that extremity during functional activities and faster walking speeds, and these advantages are still present at 6 months poststroke. Individuals with severe visuospatial neglect demonstrate less ability to load the paretic leg during functional activities at 6 months poststroke.
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Affiliation(s)
- Vicki Stemmons Mercer
- Center for Human Movement Science and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Janet Kues Freburger
- Center for Human Movement Science and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zhaoyu Yin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Rollnik JD. Outcome of MRSA carriers in neurological early rehabilitation. BMC Neurol 2014; 14:34. [PMID: 24555811 PMCID: PMC3932788 DOI: 10.1186/1471-2377-14-34] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colonization with MRSA is believed to have deteriorating effects on neurological rehabilitation patients because MRSA carriers need to be isolated. METHODS Medical records of neurological early rehabilitation patients (most of them after stroke) admitted to a large rehabilitation facility in Northern Germany in 2010 have been carefully reviewed with respect to MRSA status, outcome variables (functional independence), morbidity, and length of stay (LOS). RESULTS 74/569 (13.0%) patients were MRSA positive on admission. MRSA carriers had a significantly longer LOS in early neurological rehabilitation (63.7 (37.1) vs. 25.8 (24.5) days, p < 0.001), worse functional status on admission (Barthel index (BI) 13.6 (9.9) vs. 25.6 (24.1), p < 0.001), worse Glasgow Coma Scale (9.5 (3.2) vs. 12.0 (3.3), p < 0.001), more co-diagnoses (20.5 (5.1) vs. 13.3 (5.5), p < 0.001), and higher Patient Clinical Complexity Levels (PCCL). The outcome was significantly worse among MRSA positive patients (BI 25.5 (21.2) vs. 47.4 (31.0), p < 0.001; Early Rehabilitation Index -47.3 (51.4) vs. -26.0 (35.4), p < 0.001). Isolated patients had slightly less therapy per day (131.6 (16.6) vs. 140.2 (18.7) min/day, p < 0.001), but the overall sum of therapy was significantly larger in the MRSA positive group due to longer LOS. CONCLUSIONS Functional recovery of MRSA carriers in early neurological rehabilitation is worse than in MRSA negative patients. Poorer outcome is not resulting from isolation (less therapy) but from functional status and higher morbidity on admission.
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Affiliation(s)
- Jens D Rollnik
- Institute for Neurorehabilitational Research (InFo), BDH-Clinic Hessisch Oldendorf, Teaching Hospital of Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Greitstr, 18-28, 31840 Hess, Oldendorf, Germany.
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Predictors of Functional Dependency after Stroke in Nigeria. J Stroke Cerebrovasc Dis 2013; 22:e381-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/19/2013] [Accepted: 04/10/2013] [Indexed: 11/18/2022] Open
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De Wit L, Putman K, Devos H, Brinkmann N, Dejaeger E, De Weerdt W, Jenni W, Lincoln N, Schuback B, Schupp W. Long-term prediction of functional outcome after stroke using single items of the Barthel Index at discharge from rehabilitation centre. Disabil Rehabil 2013; 36:353-8. [PMID: 23692390 DOI: 10.3109/09638288.2013.793411] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prognostic value of single items of the Barthel Index (BI) at discharge from rehabilitation, in predicting independence in personal activities of daily living (ADL) (BI score ≥ 95/100) at five years after stroke. METHOD People with stroke were recruited consecutively from four European rehabilitation centres. BI was assessed on discharge and at five years after stroke. Stepwise multivariate logistic regression analysis was used to determine independent predictors of BI score ≥ 95/100 at five years after stroke. Thereupon, percentage chance of reaching BI ≥ 95/100 at five years after stroke was calculated. RESULTS Data were available for 153 patients. Independence in dressing (odds ratio (OR)=5.22, 95% confidence interval (CI)=1.85-14.76, p=0.002) and bathing (OR=8.10, 95% CI=3.40-19.32, p<0.0001) were independent predictors. Independence in both items resulted in 74.1% (57.6-85.8) chance of reaching BI ≥ 95/100 at five years after stroke. Dependence in both items resulted in 6.3% (5.1-7.9) chance. Independence in bathing, but dependence in dressing resulted in 35.4% (30.7-40.4) chance whereas the opposite resulted in 26.1% (20.7-32.3) chance. CONCLUSION Simple assessment of dressing and bathing on discharge from rehabilitation enables therapeutic staff to predict prognosis for long-term independence in personal ADL. This method can be used for early identification of persons with stroke who need intensive follow-up. Implications for Rehabilitation (In)dependence for dressing and bathing at discharge from a rehabilitation centre are significant factors in the prediction of (in)dependence in personal ADL at five years after stroke. This predictive tool can be used for targeting inpatient stroke rehabilitation and early identification of those patients who need intensive follow-up.
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Affiliation(s)
- Liesbet De Wit
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven , Leuven , Belgium
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Konecny P, Elfmark M, Horak S, Pastucha D, Krobot A, Urbanek K, Kanovsky P. Central facial paresis and its impact on mimicry, psyche and quality of life in patients after stroke. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 158:133-7. [PMID: 23558454 DOI: 10.5507/bp.2013.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 11/23/2022] Open
Abstract
AIM Using functional scales and face video analysis, changes in central facial paresis are monitored in patients with stroke after orofacial therapy and correlations between changes in mimicry, mental function and overall quality of life of patients after stroke are made. MATERIALS AND METHODS A prospective randomized study of patients after stroke with facial paresis. The functional status of the experimental group of 50 cases with orofacial regulation therapy and 49 control cases without mimicry therapy is observed after four weeks of rehabilitation. RESULTS Changes in mimicry functions evaluated by the House-Brackmann Grading System (HBGS) clinical range and using 2D video analysis of the distance between the paretic corner of the mouth and earlobe at rest and during smiling were statistically better in the experimental group than in controls. Changes in mental function - depression using Beck Depression Inventory and changes in the quality of life using Bartle index and modified Rankin score (scale) were significantly greater in the experimental group. There was a very close relationship between the changes in mimicry, mental state and overall quality of life according to the Spearman correlative coefficient. CONCLUSION Orofacial rehabilitation therapy for patients with paresis after stroke has a significant influence on the adjustment of mimicry, mental functions and overall quality of life after 4 weeks of treatment.
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Affiliation(s)
- Petr Konecny
- Department of Rehabilitation and Exercise Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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Almenkerk SV, Smalbrugge M, Depla MFIA, Eefsting JA, Hertogh CMPM. What predicts a poor outcome in older stroke survivors? A systematic review of the literature. Disabil Rehabil 2013; 35:1774-82. [DOI: 10.3109/09638288.2012.756941] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mohd Nordin NA, Aziz NA, Alkaff SE, Sulong S, Aljunid S. Rehabilitation for Patients After Stroke in a Tertiary Hospital: is it early and Intensive Enough? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.11.603] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nor Azlin Mohd Nordin
- School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, and
- United Nations University-International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Noor Azah Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sharifa Ezat Alkaff
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Saperi Sulong
- Department of Health Information, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia and
| | - Syed Aljunid
- health economics and
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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Cataldo MC, Calcara ML, Caputo G, Mammina C. Association of total serum cholesterol with functional outcome following home care rehabilitation in Italian patients with stroke. Disabil Health J 2012; 5:111-6. [PMID: 22429545 DOI: 10.1016/j.dhjo.2011.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 11/04/2011] [Accepted: 11/17/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stroke is a disabling disease. In elderly populations, stroke is the third leading cause of death and the primary cause of reduction in or loss of functional ability and personal autonomy. Possible associations between levels of total serum cholesterol (TC) and both incidence of stroke and functional outcomes after rehabilitation are still under study. OBJECTIVE To detect positive and negative prognostic factors associated with functional outcomes in first-time stroke patients admitted to an integrated home care rehabilitative program. METHODS This study enrolled 141 patients with a first-time stroke who were admitted to a home care rehabilitation program. Primary outcome measures were the Barthel activities of daily living (ADL) and mobility indices at the beginning and end of the rehabilitative treatment. The impact of TC and other demographic and clinical variables was analyzed using bivariate and multivariate logistic regression analyses. RESULTS Age and Short Portable Mental Status Questionnaire (SPMSQ) score were negatively associated with functional outcome. In contrast, elevated TC was positively associated with a better home rehabilitative treatment outcome. Barthel index score at admission was negatively associated with outcomes assessed by the Barthel ADL index and age with outcomes assessed by the Barthel mobility index. In a multivariate logistic regression analysis, SPMSQ score and elevated TC were significantly associated with outcome. Specifically, higher SPMSQ scores were negatively associated with better rehabilitative treatment outcomes, whereas elevated TC was positively associated. CONCLUSIONS Elevated TC seems to be associated with better functional outcomes in patients with first-time stroke.
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Affiliation(s)
- Maria Concetta Cataldo
- Geriatric Assessment and Integrated Home Care Unit, District 10, Regional Health Agency 6, Palermo, Italy
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Losoi H, Kettunen JE, Laihosalo M, Ruuskanen EI, Dastidar P, Koivisto AM, Jehkonen M. Predictors of functional outcome after right hemisphere stroke in patients with or without thrombolytic treatment. Neurocase 2012; 18:377-85. [PMID: 22145931 DOI: 10.1080/13554794.2011.608369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to assess the predictors of functional outcome after right hemisphere stroke at 6-month follow up in patients with or without thrombolytic treatment. Thrombolysis did not predict functional outcome in instrumental activities of daily living (IADL). Lower acute phase basic activities of daily living (ADL) measured by the Barthel Index was a statistically significant predictor of IADL when adjusted for age and education (p = .015) and had borderline significance (p = .076) as a predictor of functional outcome when adjusted for severity of stroke at admission. When stroke severity was taken into account also higher age became a statistically significant (p = .039) predictor of functional outcome. The acute phase neuropsychological symptoms predicted the functional outcome in unadjusted analyses but when adjusted for age, education, and severity of stroke no independent association was found.
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Affiliation(s)
- H Losoi
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland.
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Groenewegen JS, de Groot JH, Schouten AC, Maier AB, Arendzen JH, Meskers CGM. Spinal reflex properties in the long term after stroke. J Electromyogr Kinesiol 2011; 22:234-42. [PMID: 22196888 DOI: 10.1016/j.jelekin.2011.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 10/14/2022] Open
Abstract
In the long term after stroke, secondary functional deterioration may be observed while patients also get older. Possible underlying mechanisms are largely unknown. We aimed to assess neuromuscular degeneration represented by alterations in peripheral reflex loop characteristics as a function of follow-up time after stroke, controlled for age. Twenty-one stroke survivors within a small age range (62-67 years) but large variance in follow-up time after stroke (1-15 years) and both five age matched (59-62 years) and young subjects (28-36 years) participated. Short and long latency reflexes evoked by ramp and hold stretches were identified from EMG traces of the m. flexor carpi radialis. Short latency reflex onset time was not enhanced (mean difference 1.6ms compared to age matched controls) and did not relate to follow-up time after stroke (p=0.81). Young controls showed significantly lower reflex delay times (mean difference 7.2ms with respect to older subjects, p=0.009). No evidence was found for peripheral neuromuscular deterioration as a function of follow up time after stroke. Functional deterioration as a result of ageing of stroke patients that may interact with post stroke follow-up time is of further interest.
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Affiliation(s)
- Jan S Groenewegen
- Leiden University Medical Center, Department of Rehabilitation Medicine, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Preyde M, Brassard K. Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2011; 8:445-468. [PMID: 22035470 DOI: 10.1080/15433714.2011.542330] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The current health care system is discharging elderly patients "quicker" and "sicker" from acute care facilities. Consequently, hospital readmission is common; however, readmission may be only one aspect of adverse outcomes of importance to social work discharge planners. The early recognition of risk factors might ensure a successful transition from the hospital to the home. A systematic review was conducted to identify factors associated with adverse outcomes in older patients discharged from hospital to home. Using a content analysis, factors were characterized in five domains: demographic factors, patient characteristics, medical and biological factors, social factors, and discharge factors. The most frequently reported risks were depression, poor cognition, comorbidities, length of hospital stay, prior hospital admission, functional status, patient age, multiple medications, and lack of social support. A systematic search identified four discharge assessment tools for use with the general population of elderly patients. Practice and research implications are offered.
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Affiliation(s)
- Michèle Preyde
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
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Hafsteinsdóttir TB, Vergunst M, Lindeman E, Schuurmans M. Educational needs of patients with a stroke and their caregivers: a systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2011; 85:14-25. [PMID: 20869189 DOI: 10.1016/j.pec.2010.07.046] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To systematically review the research on stroke patients' and caregivers' educational needs. METHODS A search of the literature prior to and including the year January 2009 was conducted using Medline, CINAHL, EMBASE, PsychINFO and the Cochrane Library, yielding 959 articles. Of these, 21 studies were included in the review. RESULTS Stroke patients and caregivers reported many and diverse educational needs, which often were not met. The educational needs of stroke patients and caregivers concerned knowledge about the clinical aspects of stroke, prevention, treatment and functional recovery. The most commonly reported needs of caregivers involved patients' moving and lifting, exercises, psychological changes and nutritional issues. Patients and caregivers wanted information that was tailored to their situation. CONCLUSION Patients and caregivers have many unmet educational needs. The findings call for improved education of patients and caregivers on various issues that are specific to the various recovery phases after stroke. PRACTICE IMPLICATIONS The findings of this review can be used to develop educational interventions for stroke patients and caregivers. Further research is needed to investigate the feasibility and effects of educational interventions and whether they meet the educational needs of patients and caregivers.
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Affiliation(s)
- Thóra B Hafsteinsdóttir
- Department of Rehabilitation, Nursing Science and Sport medicine, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands.
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