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Zhang J, Shen Z, Tong X, Sun X, Yao N. Availability of family care resources, bathing assistance and toileting assistance among older adults with functional limitations: an evidence-based study from China. BMC Geriatr 2024; 24:419. [PMID: 38730380 PMCID: PMC11088109 DOI: 10.1186/s12877-024-05047-5] [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: 12/09/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND An aging population has contributed to an increasing prevalence of functional limitations among older adults. Family support plays a crucial role in toileting and bathing assistance. Yet, the relationship between availability of family care resources and such actual assistance remains insufficiently explored. Our study aims to describe availability of family care resources and identify the association between availability of family care resources and toileting assistance or bathing assistance. METHODS This study employed a cross-sectional analysis of data from the 2018 National Survey of the China Health and Retirement Longitudinal Study (CHARLS). The availability of family care resources was assessed using measurements of spouse availability, adult child availability, and living arrangement. Bathing assistance and toileting assistance were measured based on self-reported receipt of such assistance. Descriptive statistics were used to depict the overall and subgroup situation of availability of family care resources. Multivariable logistic models were employed to investigate the relationship between availability of family care resources and the receipt of toileting assistance or bathing assistance. RESULTS Among the sample of older adults with functional limitations, 69% had a spouse, 63% had at least one adult child, and 80% resided with family members. Among those with bathing disability, 13% reported lacking bathing assistance, and among those with toileting disability, 54% reported lacking toileting assistance. Participants with 1-2 adult children had lower odds of receiving toileting assistance (OR: 0.28, 95% CI: 0.09, 0.91, p= 0.034) compared to those with three or more adult children. Spouse availability and living arrangement did not exhibit statistically significant associations with toileting assistance. Participants without a spouse had lower odds of receiving bathing assistance (OR: 0.27, 95% CI: 0.09-0.78, p= 0.016) in comparison to those with a spouse; however, adult child availability and living arrangement did not display statistically significant associations with bathing assistance. CONCLUSION The present findings suggest a gap in family commitment when it comes to assisting older adults with functional limitations in bathing/toileting. To address this, policymakers are encouraged to prioritize the implementation of proactive mechanisms for identifying family caregivers, alongside incentives to enhance their engagement in practical caregiving activities. Furthermore, it is crucial to emphasize the prioritization of affordable and easily accessible formal toileting/bathing assistance options for older adults who lack sufficient family care resources.
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Affiliation(s)
- Jinxin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, Shandong, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Zi Shen
- Zibo First Hospital, Zibo, Shandong, 255200, China
| | - Xiyang Tong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, Shandong, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, Shandong, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
| | - Nengliang Yao
- Home Centered Care Institute, Schaumburg, IL, USA
- University of Virginia, Charlottesville, VA, USA
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Cheng CJ, Yu HB. Global trends and development of acupuncture for stroke: A review and bibliometric analysis. Medicine (Baltimore) 2024; 103:e36984. [PMID: 38241541 PMCID: PMC10798747 DOI: 10.1097/md.0000000000036984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024] Open
Abstract
The objective of this review is to elaborate on the status, hotspots, and trends of researches on acupuncture for stroke over the past 26 years. Publications about acupuncture for stroke were downloaded from the Web of Science Core Collection, and these papers were published up to December 31, 2022. A bibliometric analysis of acupuncture for stroke was conducted by CiteSpace (6.2.R4) and VOSviewer (1.6.17). In this study, VOSviewer was used for visual analysis of countries, institutions, authors, journals, keywords, and co-cited references. CiteSpace was used to draw a keyword burst map and a co-cited reference burst map. A total of 534 papers were obtained from the Web of Science Core Collection. The number of papers per year showed a rapid upward trend. The most productive country and institution in this field were China (452) and the Fujian University of Traditional Chinese Medicine (43), respectively. Tao Jing had the highest number of articles (34), and EZ Longa was the most popular author (129 co-citations). Neural Regeneration Research (51) was the most productive journal, and Stroke (1346) was the most co-cited journal. An paper written by EZ Longa was the most influential reference, with the highest citation count. The hotspots and frontiers of this area of research were focused on the mechanisms of acupuncture, especially its neural regenerative or neuroprotective effects. This study used CiteSpace and VOSviewer for bibliometric analysis to provide researchers with information on the research status, hotspots, and trends in acupuncture for stroke research over the past 26 years.
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Affiliation(s)
- Chang-Jiang Cheng
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hai-Bo Yu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Taroza S, Burkauskas J, Mickuviene N, Kazukauskiene N, Podlipskyte A. Psychometrics and validation of the EQ-5D-5L instrument in individuals with ischemic stroke in Lithuania. Front Psychol 2023; 14:1284859. [PMID: 38125861 PMCID: PMC10731357 DOI: 10.3389/fpsyg.2023.1284859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background Experiencing stroke is associated with deterioration in health-related quality of life (HRQL). One of the generic tools used for HRQL assessment is the EuroQol instrument of five dimensions and five levels (EQ-5D-5L), which has not yet been validated in Lithuania. This study aimed to evaluate validity, reliability, and factor structure of the EQ-5D-5L instrument in a sample of Lithuanian individuals at the end of the first week after experiencing ischemic stroke (IS). Methods The study had a cross-sectional design, including 134 individuals [61.9% men and 38.1% women; median (IQR) age was 66 years (59-73) years, in the final analysis]. Alongside the EQ-5D-5L, psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Assessment-7 (GAD-7); neurological impairment with the National Institutes of Health Stroke Scale (NIHSS); and functional independence with the Barthel index (BI). Confirmatory factor analysis (CFA) was performed for validation of the factor structure. Results The internal consistency of the EQ-5D-5L instrument was 0.81. A significant ceiling effect (17.2%) of the descriptive part of the EQ-5D-5L was detected. The convergent validity of the EQ-5D-5L descriptive system was confirmed, with significant correlations with the other scales used, except for the visual analog scale. The two-factor ("physical" and "emotional") model was confirmed by CFA, with acceptable fit [root mean square error of approximation (RMSEA) = 0.045, RMSEA 90% CI = 0.000-0.145; comparative fit indices (CFI) = 0.996; non-normal fit index (NFI) = 0.983; Tucker-Lewis Index (TLI) = 0.936; χ2/df = 1.27)]. Conclusion This study provides information on the psychometric properties of the EQ-5D-5L instrument in Lithuanian individuals, showing that the EQ-5D-5L descriptive system is a reliable and valid tool for HRQL assessment. The Lithuanian version of the descriptive part of the EQ-5D-5L instrument is best expressed as a two-factor model, estimating the physical and emotional dimensions of HRQL in individuals who have experienced IS.
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Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
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Mazwi N, Lissak I, Wongtangman K, Platzbecker K, Albrecht L, Teja B, Xu X, Morteo NM, Sparling T, Latronico N, Barbieri S, Blobner M, Schaller SJ, Eikermann M. Effects of mobility dose on discharge disposition in critically ill stroke patients. PM R 2023; 15:1547-1556. [PMID: 37448373 DOI: 10.1002/pmrj.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/14/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Mobilization in the intensive care unit (ICU) has the potential to improve patient outcomes following acute stroke. The optimal duration and intensity of mobilization for patients with hemorrhagic or ischemic stroke in the ICU remain unclear. OBJECTIVE To assess the effect of mobilization dose in the ICU on adverse discharge disposition in patients after stroke. DESIGN This is an international, prospective, observational cohort study of critically ill stroke patients (November 2017-September 2019). Duration and intensity of mobilization was quantified daily by the mobilization quantification score (MQS). SETTING Patients requiring ICU-level care were enrolled within 48 hours of admission at four separate academic medical centers (two in Europe, two in the United States). PARTICIPANTS Participants included individuals (>18 years old) admitted to an ICU within 48 hours of ischemic or hemorrhagic stroke onset who were functionally independent at baseline. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The primary outcome was adverse discharge disposition. RESULTS Of the patients screened, 163 were eligible for inclusion in the study. One patient was subsequently excluded due to insufficient data collection (n = 162). The dose of mobilization varied greatly between centers and patients, which could not be explained by patients' comorbidities or disease severity. High dose of mobilization (mean MQS > 7.3) was associated with a lower likelihood of adverse discharge (adjusted odds ratio, [aOR]: 0.14; 95% confidence interval [CI]: 0.06-0.31; p < .01). CONCLUSION The increased use of mobilization acutely in the ICU setting may improve patient outcomes.
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Affiliation(s)
- Nicole Mazwi
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - India Lissak
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karuna Wongtangman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Katharina Platzbecker
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Lea Albrecht
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bijan Teja
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Anesthesiology and Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole M Morteo
- Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tawnee Sparling
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Silvia Barbieri
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Manfred Blobner
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
- University of Ulm, Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ulm, Germany
| | - Stefan J Schaller
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care, Berlin, Germany
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Montefiore Medical Center, Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA
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Sun YA, Kalpakavadi S, Prior S, Thrift AG, Waddingham S, Phan H, Gall SL. Socioeconomic status and health-related quality of life after stroke: a systematic review and meta-analysis. Health Qual Life Outcomes 2023; 21:115. [PMID: 37875951 PMCID: PMC10599023 DOI: 10.1186/s12955-023-02194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) is associated with stroke occurrence and survival following stroke but its association with health-related quality of life (HRQoL) following stroke remains uncertain. We performed a systematic review and meta-analysis to examine the association between SES and HRQoL after stroke. METHODS PubMed, SCOPUS, EMBASE, and Web of Science were searched to identify relevant cohort and case-control studies between January 2000 and May 2022. Two authors screened titles, abstracts and full text articles. One author extracted data from all included studies. Meta-analyses were performed for studies with comparable measurements of SES and HRQoL. Random effects models were used to estimate pooled summary standardised mean differences in HRQoL by SES. RESULTS Out of 1,876 citations, 39 studies incorporated measurement of overall HRQoL following stroke and were included in the systematic review, with 17 studies included in the meta-analyses. Overall, reports including education, income, occupation and work status effects on HRQoL after stroke were inconsistent among all included 39 studies. In the global meta-analysis of 17 studies, HRQoL among survivors of stroke was lower in the low SES group than in the high SES group (standardised mean difference (SMD) -0.36, 95% CI -0.52, -0.20, p < 0.0001). When using education and income indicators separately, summary effects were similar to those of the global analysis (low versus high education SMD -0.38, 95% CI -0.57, -0.18, p < 0.0001; low versus high income SMD -0.39, 95% CI -0.59, -0.19, p < 0.0001). CONCLUSIONS Across all SES indicators, people with stroke who have lower SES have poorer overall HRQoL than those with higher SES. Accessibility and affordability of poststroke support services should be taken into consideration when planning and delivering services to people with low SES.
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Affiliation(s)
- Yichao A Sun
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Serah Kalpakavadi
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Sarah Prior
- Tasmanian School of Medicine, Rural Clinical School, University of Tasmania, Burnie, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | | | - Hoang Phan
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
- Menzies School for Health Research, Charles Darwin University, Casuarina, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
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Sun YA, Phan H, Buscot MJ, Thrift AG, Gall S. Area-level and individual-level socio-economic differences in health-related quality of life trajectories: Results from a 10-year longitudinal stroke study. J Stroke Cerebrovasc Dis 2023; 32:107188. [PMID: 37216749 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND We examined area-level (aSES) and individual-level (iSES) socio-economic status on trajectories of HRQoL to 10 years following stroke. METHODS Participants with strokes between 1/5/1996 and 30/4/1999 completed the Assessment of Quality of Life instrument (AQoL, range: -0.04 [worse than death] to 0 [death] to 1 [full health]) at ≥one of 3month, 6-month, 1-year, 2-year, 3-year, 4-year, 5-year, 7-year and 10-year interviews after stroke. Sociodemographic and health information were collected at baseline. We derived aSES from postcode using the Australian Socio-Economic Indexes For Area (2006) (categories: high, medium, low), and iSES from lifetime occupation (categories: non-manual, manual). Multivariable linear mixed effects modelling was used to estimate trajectories of HRQoL over 10 years, by aSES and iSES, adjusting for age, sex, cardiovascular disease, smoking, diabetes, stroke severity, stroke type, and the time influence on age and health conditions. RESULTS Of 1,686 participants enrolled, we excluded 239 with 'possible' stroke and 284 with missing iSES. Among the remaining 1,163 participants, 1,123 (96.6%) had AQoL assessed at ≥3 timepoints. In multivariable analysis, over time, people in the medium aSES group had mean 0.02 (95% CI -0.06, 0.02) greater reduction in AQoL score, and people in the low aSES group had mean 0.04 (95% CI, -0.07, -0.001) greater reduction, than those in the high aSES group. Manual workers had an average 0.04 (95% CI, -0.07, -0.01) greater reduction in AQoL score over time than non-manual workers. CONCLUSIONS Over time, HRQoL declines in all people with stroke, declining most rapidly in lower SES groups.
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Affiliation(s)
- Yichao A Sun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia
| | - Hoang Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic., Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic., Australia.
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Higashi Y, Kaneda T, Yuri Y, Horimoto T, Somei Y, Hirayama K. Development of toileting behaviour evaluation for Japanese older patients using wheelchairs in a hospital setting: a validation study. BMC Geriatr 2023; 23:353. [PMID: 37280510 DOI: 10.1186/s12877-023-04069-9] [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: 12/01/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Ageing limits the activities of daily living (ADLs). Among ADLs, a lack of toileting independence causes a decline in the quality of life, mental health, and social participation. Therefore, occupational therapists spend considerable time assessing toileting disability based on various assessment methods for toileting behaviour. However, these assessment methods have issues with the grading levels, number of items, and diseases covered, and they fail to evaluate toileting behaviour accurately and sensitively. Hence, this study developed a Toileting Behaviour Evaluation (TBE) on a 6-point ordinal scale for patients using wheelchairs, with 22 activity components for various diseases. METHODS This study examined the reliability and validity of the TBE in acute and subacute hospitals in Japan. To this end, two occupational therapists assessed 50 patients for inter-rater reliability at different times and one assessed them twice within 7-10 days for intra-rater reliability using the TBE. Furthermore, occupational therapists assessed 100 patients for internal consistency using the TBE and for concurrent validity using the TBE and Functional Independence Measure (FIM). The patients had been diagnosed with various diseases. This study used the weighted kappa coefficient for statistical analysis of the inter-rater and intra-rater reliability, Cronbach's alpha coefficient for internal consistency, and Spearman's rank correlation coefficient for concurrent validity. We performed all statistical analyses using the IBM SPSS Statistics ver. 25 for Windows. All P-values < 0.05 were considered statistically significant. RESULTS The minimum weighted kappa coefficients for the inter-rater and intra-rater reliability for each item were 0.67 and 0.79, respectively. Cronbach's alpha was 0.98 for the 22 items. The Spearman's rank correlation coefficient between the mean scores on the TBE and FIM for toilet-related items was 0.74 (P < .01). CONCLUSIONS The TBE demonstrated good reliability and validity. This means that therapists can use it to identify impaired toileting behaviour. However, the relationship between impairments and each item of toileting behaviour should be explored in future studies. Additionally, studies should examine the creation of a specific index of functions of independence in each toileting behaviour.
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Affiliation(s)
- Yasuhiro Higashi
- Faculty of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16, Nankokita, Suminoe, Osaka, 559-8611, Japan.
- Department of Rehabilitation, Kansai Rehabilitation Hospital, 3-11-1, Sakuranocho, 560-0054, Toyonaka, Osaka, Japan.
| | - Toshikatsu Kaneda
- Faculty of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16, Nankokita, Suminoe, Osaka, 559-8611, Japan
- Department of Rehabilitation, Kansai Rehabilitation Hospital, 3-11-1, Sakuranocho, 560-0054, Toyonaka, Osaka, Japan
| | - Yoshimi Yuri
- Faculty of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16, Nankokita, Suminoe, Osaka, 559-8611, Japan
| | - Takumi Horimoto
- Department of Rehabilitation, Osaka General Hospital of West Japan Railway Company, 1-2-22, Matsuzakicho, 545-0053, Abeno, Osaka, Japan
| | - Yuta Somei
- Department of Rehabilitation, Kansai Rehabilitation Hospital, 3-11-1, Sakuranocho, 560-0054, Toyonaka, Osaka, Japan
| | - Kimiaki Hirayama
- Department of Rehabilitation, Kiba Hospital, 4-2-8, Iwatacho, 578-0941, Higashiosaka, Osaka, Japan
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Smits GHJM, van Doorn S, Bots ML, Hollander M. Cardiovascular risk reduction with integrated care: results of 8 years follow up. BMC PRIMARY CARE 2023; 24:66. [PMID: 36890432 PMCID: PMC9996931 DOI: 10.1186/s12875-023-02010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Care groups organize integrated cardiovascular risk management programs in primary care for high risk patients. Results of long term cardiovascular risk management are scarce. The aim was to describe changes in low density lipoprotein cholesterol, systolic blood pressure and smoking between 2011 and 2018 in patients participating in an integrated program for cardiovascular risk management organized by a care group in the Netherlands. AIM To explore whether long-term participation in an integrated cardiovascular risk management program could lead to the improvement of 3 important risk factors for cardiovascular disease. METHODS A protocol was developed for delegated practice nurse activities. A multidisciplinary data registry was used for uniform registration. The care group organized annual education for general practitioners and practice nurses on cardiovascular topics and regular meetings for practice nurses only to discuss complex patient cases and implementation issues. From 2015 onwards, the care group started with practice visitations to discuss performance and support practices with organizing integrated care. RESULTS In patients eligible for primary prevention as well as for secondary prevention similar trends were observed: lipid modifying and blood pressure lowering medication increased, mean low density lipoprotein cholesterol and mean systolic blood pressure decreased, patients on target for low density lipoprotein cholesterol and systolic blood pressure increased and the proportion of non-smokers with both low density lipoprotein cholesterol and systolic blood pressure on target increased. Improved registration between 2011 and 2013 was partly responsible for the sharp increase of patients on target for low density lipoprotein cholesterol and systolic blood pressure. CONCLUSION In patients participating in an integrated cardiovascular risk management program, we saw annual improvements in 3 important cardiovascular risk factors between 2011 and 2018.
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Affiliation(s)
- Geert H. J. M. Smits
- grid.5477.10000000120346234Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Primary Care Group PoZoB, Bolwerk 10-14, 5509 MH Veldhoven, The Netherlands
| | - Sander van Doorn
- grid.5477.10000000120346234Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L. Bots
- grid.5477.10000000120346234Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monika Hollander
- grid.5477.10000000120346234Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1278] [Impact Index Per Article: 1278.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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'Quality of life at 90 days after stroke and its correlation to activities of daily living': A prospective cohort study. J Stroke Cerebrovasc Dis 2022; 31:106806. [PMID: 36191565 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The main goal of stroke rehabilitation is to improve the health-related quality of life (HRQoL). In developed countries, several studies evaluating the HRQoL among stroke survivors have been conducted. In India, HRQoL related to stroke as an important health care issue has not received sufficient attention. The study was conducted to encourage the professionals to use stroke-specific HRQoL scales in clinical practice as one of the measures of stroke outcome. OBJECTIVES To study the correlation between activities of daily living (ADLs) and HRQoL at 90 days following an acute stroke. METHODS In this prospective study, functional independence of patients admitted with stroke were measured using Barthel Index (BI). At 90 days post-stroke patients were assessed using two questionnaires. RESULTS Significant improvement in BI total and domains scores at 90 days (p < .001) were seen. At follow-up, Stroke Specific Quality of Life Scale-12 (SS-QoL-12) score for 59 patients was 48 (high QoL). Individuals scored lowest for psychosocial subscale of HRQoL compared to physical subscale. All items and the total score of the BI showed a significant positive partial correlation (p< .001) with the HRQoL total score. The self-care domain of BI showed the highest correlation with QoL total score at 0.88. CONCLUSIONS Patient dependent in ADL constantly scored less in all QoL domains. The psychosocial QoL was found to be most affected even in the presence of complete functional independence paving way for further studies on factors that impact psychosocial QoL of stroke survivors.
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Yorozuya K, Kubo Y, Narita R, Kondo T. Association between toileting independence and higher brain functions in post-stroke inpatients: A cross-sectional study. J Stroke Cerebrovasc Dis 2022; 31:106524. [PMID: 35490469 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106524] [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: 11/28/2021] [Revised: 03/25/2022] [Accepted: 04/17/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to cross-sectionally examine and clarify the types of higher brain functions associated with toileting independence in post-stroke inpatients. MATERIALS AND METHODS From November 2017 to October 2020, 51 participants were selected from a database of post-stroke inpatients in a Japanese hospital; the selected participants had missing data. The objective variable was the independence of toileting and toilet transfer in the Functional Independence Measure; independence was set at 6 points or more. The covariates were age, sex, and Berg balance scale score; the explanatory variables were higher brain functions of four items (forward digit span, visual cancelation task [VCT] correctness rate, symbol digit modalities test score, and Kohs block design test score). Logistic regression analysis was performed using multiple imputation and Bayesian modeling. RESULTS VCT correctness rate was significantly associated with toileting independence in the best model selected (odds ratio 1.16; 95% credible interval 1.02, 1.49). CONCLUSION Selective attention (assessed by VCT correctness rate) may be associated with, and predict, toileting independence in post-stroke inpatients.
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Affiliation(s)
- Kyosuke Yorozuya
- Faculty of Care and Rehabilitation, Seijoh University, Tokai, Japan.
| | - Yuta Kubo
- Faculty of Care and Rehabilitation, Seijoh University, Tokai, Japan.
| | - Rikiya Narita
- Rehabilitation unit, Azuma Rehabilitation Hospital, Nagoya, Japan.
| | - Taiga Kondo
- Rehabilitation unit, Azuma Rehabilitation Hospital, Nagoya, Japan.
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Wei C, Yu X, Wang L, Jiang J, Dai Q, Kang Y, Li J, Chen X. Can hyperuricemia predict the progression risk of cerebral small vessel disease? Neurol Res 2022; 44:910-917. [PMID: 35475780 DOI: 10.1080/01616412.2022.2067707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Uric acid (UA) may play a crucial role in the process of cerebral small vessel disease (SVD), but few follow-up studies have focused on the effect of UA in the progression of SVD. The present study aimed to ascertain whether serum UA levels are associated with the risk of SVD progression. METHODS We performed an observational clinical study in adults older than 45 years with cranial magnetic resonance imaging (MRI) from 30 October 2015, to 28 January 2021. The patients were divided into two groups according to whether their total burden of SVD scores increased or not during the follow-up: SVD progression (increased by at least one point) and without SVD progression (increased 0 points). Cox regression and Kaplan-Meier survival analyses were used for univariate analysis between groups to identify the risk factors for SVD progression. RESULTS Ultimately, 261 eligible patients were included in the final analysis. Of the 261 eligible patients, 73 were included in the SVD progression group, and 188 were included in the group without SVD progression. Correlation analysis found that the levels of UA and the ratio of hyperuricemia (HUA) showed statistically significant correlations with SVD progression risk (r = 0.197 and Crammer's V = 0.213, respectively, P < 0.01). Cox regression and Kaplan-Meier survival analyses showed that after adjustment for covariates, HUA was an independent risk factor for the incidence of SVD progression. The risk of SVD progression in patients with HUA was higher than that in those without HUA (HR (95% CI), 1.77 (1.03-3.05), P < 0.05). CONCLUSIONS High serum UA levels are independently related to the risk of SVD progression, thus highlighting not only the influence of traditional risk factors such as hypertension and age on SVD but also the UA levels of patients for individualized treatment.
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Affiliation(s)
- Cunsheng Wei
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaorong Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yue Kang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Developing a Clinical Prediction Rule for Gait Independence at Discharge in Patients with Stroke: A Decision-Tree Algorithm Analysis. J Stroke Cerebrovasc Dis 2022; 31:106441. [PMID: 35305537 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/19/2022] [Accepted: 02/26/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To develop a clinical prediction rule (CPR) for gait independence at discharge in patients with stroke, using the decision-tree algorithm and to investigate the usefulness of CPR at admission to the rehabilitation ward. MATERIALS AND METHODS We included 181 subjects with stroke during the postacute phase. The Chi-squared automatic interaction detection analysis method with 10-fold cross-validation was used to develop two CPRs; CPR 1 using easily obtainable data available at admission; CPR 2 using easily obtainable data available 1 month after admission, for prediction of gait independence at discharge. RESULTS The degree of independence of toileting was extracted as a first node in the development of two CPRs to predict gait independence at discharge. CPR 1 included the presence of delirium. CPR 2 included problem-solving abilities. The accuracy and area under the curve of CPR 1 were 84.5% and 0.911, respectively; those of CPR 2 were 89.0% and 0.958, respectively. CONCLUSIONS Toileting independence is a key factor in predicting the gait independence for the discharge of patients with stroke during the postacute phase. Early intervention, during the acute phase, for delirium and cognitive decline, as well as for toileting, increases the possibility of gait independence at discharge.
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2480] [Impact Index Per Article: 1240.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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15
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Yu X, Yu Y, Wei C, Wang L, Jiang J, Zhang R, Dai Q, Kang Y, Chen X. Association between small dense low-density lipoprotein cholesterol and neuroimaging markers of cerebral small vessel disease in middle-aged and elderly Chinese populations. BMC Neurol 2021; 21:436. [PMID: 34753453 PMCID: PMC8576978 DOI: 10.1186/s12883-021-02472-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral small vascular disease (CSVD) is one of the leading causes of death in the aged population and is closely related to abnormalities in low-density lipoprotein cholesterol (LDL-C). Our study aims to clarify the relationship between small and dense low-density lipoprotein cholesterol (sdLDL-C) (a subcomponent of LDL-C) and neuroimaging markers of CSVD. METHODS In total, 1211 Chinese adults aged ≥45 years with cranial magnetic resonance imaging (MRI) were recruited in this retrospective study from January 2018 to May 2021. Serum lipids and other baseline characteristics were investigated in relation to the occurrence of CSVD. A logistic regression model was performed to analyze the relationships between LDL subtypes and CSVD risk, and the Pearson correlation coefficient was used to analyze the correlation between clinical characteristics and CSVD risk. ROC curves and AUCs were created and depicted to predict the best cutoff value of LDL-C subtypes for CSVD risk. Based on these data, we performed comprehensive analyses to investigate the risk factors for CSVD. RESULTS Ultimately, 623 eligible patients were included in the present study. Of the 623 eligible patients, 487 were included in the CSVD group, and 136 were included in the group without CSVD (control group). We adjusted for confounders in the multivariate logistic regression model, and LDL-C3 was still higher in the CSVD patients than in the group of those without CSVD (OR (95% CI), 1.22(1.08-1.38), P < 0.05). Pearson correlation showed that there was a positive correlation between the levels of LDL-C3, LDL-C4, LDL-C5, glucose, age, hypertension, previous ischemic stroke and CSVD risk (r > 0.15, P < 0.01). Moreover, the best cutoff value of LDL-C3 to predict CSVD was 9.5 mg/dL with 68.4% sensitivity and 72.8% specificity, and the best cutoff value of LDL-C4 to predict CSVD was 5.5 mg/dL with 50.5% sensitivity and 90.4% specificity. CONCLUSION The results indicate that LDL-C3 is an independent risk factor for CSVD. A new prediction model based on LDL-C3 and LDL-C4 can help clinicians identify high-risk CSVD, even in people with normal LDL-C levels. The levels of sdLDL-C should be considered in the assessment and management of CSVD.
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Affiliation(s)
- Xiaorong Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yanhua Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Cunsheng Wei
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Rui Zhang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yue Kang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
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Health-related quality of life after first-ever acute ischemic stroke: associations with cardiovascular health metrics. Qual Life Res 2021; 30:2907-2917. [PMID: 33932220 DOI: 10.1007/s11136-021-02853-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the associations between cardiovascular health (CVH) metrics and health-related quality of life (HRQL) among patients with ischemic stroke in China, and further explore the role of physical and cognitive function in their associations. METHODS This hospital-based study included 1714 patients with first-ever acute ischemic stroke (age ≥ 40 years; 36.7% women) who were admitted to two university hospitals in Shandong, China. We collected information on seven CVH metrics (smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting blood glucose) through interviews, clinical examinations, and laboratory tests. EQ-5D-3L was used to assess HRQL. Cognitive and physical functioning was assessed by the Montreal Cognitive Assessment test and Barthel index, respectively. Data were analyzed using the general linear regression models. RESULTS The average score (SD) was 0.746 (0.23) for HRQL index and 72.7 (15.8) for self-rated health. Optimal levels of four individual CVH metric components (diet, physical activity, blood pressure, and blood glucose) and a higher composite CVH score were significantly associated with a greater HRQL index and better self-rated health (p < 0.05 for all). Physical dependence and cognitive impairment were associated with a lower HRQL index and poorer self-rated health status (p < 0.001). Furthermore, the relationships between CVH metrics and HRQL index varied by functional status, such that their associations were statistically significant only among people who had physical dependence or cognitive impairment. CONCLUSION Achieving a better cardiovascular health profile is associated with better quality of life among ischemic stroke survivors, primarily in those with physical or cognitive impairment.
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Schäfer SK, Fleischmann R, von Sarnowski B, Bläsing D, Flöel A, Wurm S. Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study. BMJ Open 2021; 11:e049944. [PMID: 34187831 PMCID: PMC8245451 DOI: 10.1136/bmjopen-2021-049944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Stroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke. METHODS AND ANALYSIS The study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1-5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models. ETHICS AND DISSEMINATION The study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives. TRIAL REGISTRATION NUMBER NCT04704635.
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Affiliation(s)
- Sarah K Schäfer
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | - Dominic Bläsing
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases, Greifswald, Germany
| | - Susanne Wurm
- Institute for Community Medicine, Department of Social Medicine and Prevention, University of Greifswald Faculty of Medicine, Greifswald, Germany
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Iwata K, Koyama S, Yamazaki T, Kimura K, Sakurai H, Kanada Y. Effect of residual lower-extremity function on strategies and execution time for raising and lowering trousers in patients with hemiparetic stroke: a cross-sectional study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims There are no established methods for patients with hemiparetic stroke to practice the raising and lowering of trousers. The aim of this study was to investigate the use of different strategies by patients with hemiparetic stroke for lowering and raising trousers by using the non-paretic upper limb in the standing position, based on residual motor function in the paretic lower limb. Methods A total of 28 patients with hemiparetic stroke were included in the study (n=10, 12, and 6 with lower-limb Brunnstrom stages III, IV and V respectively). Endpoints were execution time and frequency of changing the manipulation region. Results Lower-limb Brunnstrom stages III, IV and V were associated with execution times of 24.1 ± 11.1, 18.1 ± 6.5 and 16.9 ± 9.6 seconds respectively, and the mean frequency of manipulation of trousers on the posterior paretic side was significantly lower than those of the anterior paretic, anterior non-paretic, and posterior non-paretic sides in all patients (P<0.05). Conclusions Motor function of the paretic lower limb did not affect the strategies used for lowering and raising trousers with the non-paretic upper limb. Manipulation of trousers on the posterior paretic side was especially difficult.
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Affiliation(s)
- Kenji Iwata
- Rehabilitation, Medical Corporation Shoutokukai Hananooka Hospital, Matsusaka, Japan
| | - Soichiro Koyama
- School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Toshihiro Yamazaki
- Department of Rehabilitation, Shizuoka Saiseikai General Hospital, Sizuoka, Japan
| | - Keisuke Kimura
- Rehabilitation, Medical Corporation Shoutokukai Hananooka Hospital, Matsusaka, Japan
| | - Hiroaki Sakurai
- School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoshikiyo Kanada
- School of Health Sciences, Fujita Health University, Toyoake, Japan
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3095] [Impact Index Per Article: 1031.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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21
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Odetunde MO, Odole AC, Odunaiya NA, Odetunde NA, Okoye EC, Mbada CE, Umunnah JO, Akinpelu AO. Cross-cultural adaptation and validation of the Igbo language version of the stroke-specific quality of life scale 2.0. Pan Afr Med J 2021; 37:111. [PMID: 33425144 PMCID: PMC7755362 DOI: 10.11604/pamj.2020.37.111.19557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/02/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction availability of the Stroke-Specific Quality of Life scale 2.0 (SS-QoL(E)) in Yoruba and Hausa, two of the three major indigenous languages in Nigeria have the potential to promote its uptake among these population, however, its non-availability in the Igbo languages makes its use restrictive among the south-eastern Nigerians. This study was aimed at cross-culturally adapting and assessing validity and reliability of the Igbo version of the SS-QoL. Methods the SS-QoL(E) was cross-culturally adapted to Igbo following the American Association of Orthopaedic Surgeons’ guideline. This involved forward and back-translations, expert committee review, pretesting and cognitive debriefing interview to produce the final Igbo version, SS-QoL(I). The validity and reliability test involved 50 consenting Igbo stroke survivors. The construct validity was assessed by administering SS-QoL(E) and SS-QoL(I) on all 50 respondents, while SS-QoL(I) was re-administered at 7-day interval to assess test-retest reliability. Each scale was administered in random order. Data were analysed using Spearman’s correlation, Wilcoxon’s signed-rank test, Cronbach’s alpha, Intra-class Correlation Coefficient (ICC), independent t-test and one-way ANOVA at p<0.05. Results respondents’ domains scores on SS-QoL(E) and SS-QoL(I) did not differ significantly except in mobility and work (r=0.58 to 0.87; p=0.001). Cronbach’s alpha was 0.69 to 0.87 for domains scores. The ICC ranged from 0.48 to 0.84, while no significant differences was found across different age groups or gender for the domains or overall scores of SS-QoL(I). Conclusion the Igbo version of the SS-QoL has limited alterations from the original version and has moderate to excellent validity and reliability values.
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Affiliation(s)
| | | | - Nse Ayooluwa Odunaiya
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | | | - Joseph Onuwa Umunnah
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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Determinants of Long-Term Health-Related Quality of Life in Young Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2020; 30:105499. [PMID: 33271487 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/22/2020] [Accepted: 11/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to assess long-term, health-related quality of life (HRQOL) in a young ischemic stroke cohort, and to identify factors associated with poor HRQOL. MATERIALS AND METHODS We conducted a survey with ischemic stroke survivors in Estonia aged 18-54 years at the time of stroke, measuring HRQOL with the three-level version of the five-dimension EuroQol (EQ-5D-3L). The control group comprised the participants of the Health Behavior among Estonian Adult Population study. A tobit regression model with a backward stepwise analysis was used to identify factors associated with low EQ-5D-3L utility scores. RESULTS In total, 352 patients with a mean follow-up time from the qualifying event of 5.7 years and 2304 controls were included. The mean EQ-5D-3L utility score in stroke survivors was significantly lower compared with that in the general population (0.71 vs. 0.87, respectively, p<0.001). However, the subgroup with excellent functional outcome had a significantly higher mean EQ-5D-3L utility score compared with non-stroke counterparts (0.91 v 0.87, respectively, p<0.001). The largest differences between stroke survivors and the general population were in the physical domains. Coronary heart disease at the index event, and higher follow-up duration, functional disability, depressive symptoms, recurrent stroke, and not being fully employed at follow-up, were independently associated with lower HRQOL. CONCLUSION Young ischemic stroke survivors have long-term decreased HRQOL, except for those with excellent functional recovery. Our results prioritize motor rehabilitation and highlight the importance of secondary prevention, treatment of depression, and career counselling as potential ways of increasing HRQOL.
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Chen X, Delcourt C, Sun L, Zhou Z, Yoshimura S, You S, Malavera A, Torii-Yoshimura T, Carcel C, Arima H, Hackett ML, Robinson T, Song L, Wang X, Lindley RI, Chalmers J, Anderson CS. Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm. Cerebrovasc Dis 2020; 49:427-436. [PMID: 32702699 DOI: 10.1159/000509226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). METHODS ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly divided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years; 38.4% female; 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24-2.29) and deep (OR 1.50, 95% CI: 1.03-2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty - atrophy, white matter change, and old infarcts - were significantly associated with adverse physical but not emotional HRQoL domains. CONCLUSIONS In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.
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Affiliation(s)
- Xiaoying Chen
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Candice Delcourt
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lingli Sun
- The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Zien Zhou
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sohei Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Alejandra Malavera
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Takako Torii-Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Lili Song
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia, .,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia, .,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, .,The George Institute China at Peking University Health Science Centre, Beijing, China, .,Heart Health Research Center, Beijing, China,
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24
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4842] [Impact Index Per Article: 1210.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Molchanova EE, Drobyshev VA. [Acupuncture as a factor of correction of «final points» and improving the quality of life at the stage of rehabilitation of patients with ischemic stroke]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2020; 97:11-16. [PMID: 32687295 DOI: 10.17116/kurort20209704111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED All parameters of the quality of life of patients after cerebral stroke are reduced. There is relatively little information about the impact of stroke and the features of rehabilitation technologies in the acute period on the quality of life of patients in the period of residual events. AIM The study of quality of life indicators for patients who have suffered an ischemic stroke after three years from the onset of the condition, as well as the incidence of recurrent strokes and mortality in the residual period, depending on the rehabilitation methods in the acute period. MATERIAL AND METHODS In order to identify the frequency of recurrent strokes and the mortality rate in the post-stroke period, a three-year prospective observation of 330 patients (220 patients of the main group, whose early rehabilitation was optimized using various methods of reflexotherapy, and 110 patients of the comparison group who underwent traditional pharmacotherapy in combination with physiotherapy and Exercise therapy) was performed. To study the quality of life (using the MOS SF-36 questionnaire), 140 people from the main group and 40 from the comparison group were selected by random sampling. RESULTS The main group showed a lower incidence of recurrent stroke episodes (3.2%) and mortality (1.8%) compared with the comparison group (12.7 and 13.6%, respectively). Comparison of quality of life indicators in the studied groups revealed higher values for all subscales of the MOS SF-36 questionnaire in the group of patients who received reflexotherapy in the acute period of ischemic stroke, and for several subscales, the differences were statistically significant: in the acute period, by subscales RP (p<0.05), GH (p<0.05), VT (p<0.05), SF (p<0.05), RE (p<0.05), MH (p<0.05), after three years - by subscales PF (p<0.05), GH (p<0.05), VT (p<0.01) and MH (p<0.05). CONCLUSIONS Thus, optimization of early rehabilitation by including from the first days reflexotherapy methods helps to improve the indicators of both the physical and mental components of the patients' health not only in the acute but also in the long term, and also helps to reduce the frequency of repeated strokes and the mortality rate in the post-stroke period.
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Affiliation(s)
- E E Molchanova
- Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russia
| | - V A Drobyshev
- Novosibirsk State Medical University of the Ministry of Health of Russia, Novosibirsk, Russia
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26
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Chen X, Wang X, Delcourt C, Li J, Arima H, Hackett ML, Robinson T, Lavados PM, Lindley RI, Chalmers J, Anderson CS. Ethnicity and Other Determinants of Quality of Functional Outcome in Acute Ischemic Stroke: The ENCHANTED Trial. Stroke 2019; 51:588-593. [PMID: 31822251 DOI: 10.1161/strokeaha.119.027639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Patient-centered outcomes are important. We aimed to determine predictors of health-related quality of life (HRQoL) and develop utility-weighted modified Rankin Scale (mRS) scores in thrombolyzed acute ischemic stroke patients from both arms of ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods- ENCHANTED was an international quasi-factorial clinical trial of different doses of intravenous alteplase and intensities of blood pressure control in acute ischemic stroke patients, with outcomes on the 5-Dimensional European Quality of Life Scale and mRS assessed at 90 days post-randomization. Logistic regression models were used to identify baseline predictors of poor HRQoL (≤mean 5-Dimensional European Quality of Life Scale utility scores). Ordinary least squares regression derived utility-weighted mRS scores. Results- In 4016 acute ischemic stroke patients with complete 5-Dimensional European Quality of Life Scale and mRS data, independent predictors of poor HRQoL were older age (odds ratio, 1.19 [95% CI, 1.12-1.27], per 10-year increase), non-Asian ethnicity (1.91 [1.61-2.27]), greater stroke severity on the National Institutes of Health Stroke Scale (1.11 [1.09-1.12]), diabetes mellitus (1.41 [1.18-1.69]), premorbid disability (mRS score 1 versus 0; 1.62 [1.33-1.97]), large vessel atheromatous pathogenesis (1.32 [1.12-1.54]), and proxy respondent (2.35 [2.01-2.74]). Sensitivity analyses indicate the ethnicity influence on HRQoL was driven by the high proportion of Chinese (62.9% of Asian) participants with better HRQoL compared with non-Chinese or other Asian groups. Derived utility values across mRS scores 0 to 5 were 0.977, 0.885, 0.748, 0.576, 0.194, and -0.174, respectively. Correlations between mRS and 5-Dimensional European Quality of Life Scale scores were stronger in Asians. Conclusions- HRQoL is worse after thrombolyzed acute ischemic stroke in the elderly, non-Asians, with greater initial severity, diabetes mellitus, premorbid disability, due to large vessel atheroma, and proxy assessment. The broader significance of better HRQoL in Asians is tempered by Chinese participants dominating analyses. From utility-weighted mRS scores indicating the greatest steps in mRS scores are between 5 and 3, treatments to avoid major disability provide the greatest benefits for patients. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01422616.
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Affiliation(s)
- Xiaoying Chen
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.).,Faculty of Medicine and Health (X.C., C.D., M.L.H.), University of Sydney, NSW, Australia
| | - Xia Wang
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.)
| | - Candice Delcourt
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.).,Faculty of Medicine and Health (X.C., C.D., M.L.H.), University of Sydney, NSW, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.D., C.S.A.)
| | - Jingwei Li
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.).,Department of Cardiology, People's Liberation Army General Hospital, Beijing, China (J.L.).,Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China (J.L.)
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health (H.A.), Fukuoka University, Japan
| | - Maree L Hackett
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.).,Faculty of Medicine and Health (X.C., C.D., M.L.H.), University of Sydney, NSW, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, United Kingdom (M.L.H.)
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (T.R.).,NIHR Biomedical Research Centre, Leicester, United Kingdom (T.R.)
| | - Pablo M Lavados
- Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago (P.M.L.).,Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile (P.M.L.)
| | - Richard I Lindley
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.).,Westmead Clinical School (R.I.L.), University of Sydney, NSW, Australia
| | - John Chalmers
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.)
| | - Craig S Anderson
- From the George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.C., X.W., C.D., J.L., M.L.H., R.I.L., J.C., C.S.A.).,Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.D., C.S.A.).,The George Institute China at Peking University Health Science Centre, Beijing (C.S.A.).,Heart Health Research Center, Beijing, China (C.S.A.)
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27
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5333] [Impact Index Per Article: 1066.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Chakrabarty M, Pflieger EM, Cardillo E, Chatterjee A. Effects of Chronic Brain Injury on Quality of Life: A Study in Patients With Left- or Right-Sided Lesion. Arch Rehabil Res Clin Transl 2019; 2:100031. [PMID: 33543061 PMCID: PMC7853383 DOI: 10.1016/j.arrct.2019.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives To test the hypothesis that quality of life (QOL) is made up of different components, and each of these has different anatomic and demographic contributors. Design Questionnaire-based study. Setting Center for Cognitive Neuroscience, University of Pennsylvania. Participants People with chronic brain injury (N=52) volunteered for the study. After excluding patients with severe communication deficits, bilateral lesions, and incomplete data, 42 patients with focal lesions were included in the final study: 22 patients with left hemisphere injury (LHI) (9 women and 13 men; mean age ± SD, 60.6±11.2y [range: 36-83]; mean chronicity ± SD, 11.5±4.2y) and 20 patients with right hemisphere injury [RHI] (16 women and 4 men; mean age ± SD [62.7±12.8y] [range: 31-79]; mean chronicity ± SD 10.1±4.3y). Interventions Not applicable. Main Outcome Measures We administered the RAND36-Item Health Survey (RAND-Version-1.0), Stroke Impact Scale (version 3.0), Positive Affect and Negative Affect Scale, and Distress Thermometer to measure QOL in LHI and RHI patients. Exploratory factor analysis with principal component method reduced these measures to 5 factors, roughly categorized as-(1) physical functioning; (2) general health; (3) emotional health; (4) social functioning; and (5) cognitive functioning. Exploratory analyses attempted to relate these factor scores to demographic variables, neuroanatomical data, and neuropsychological measures. Results Physical functioning was the biggest contributor to reduced QOL, explaining 32.5%, of the variance. Older age, less education, and larger lesion size predicted poorer physical functioning (P<.001). Age also affected emotional health. (P=.019). Younger patients reported poorer emotional health than older patients. LHI patients reported less satisfaction with their cognitive functioning (P=.009) and RHI patients with their physical functioning (P=.06). Exploratory neuroanatomical analyses hinted at brain areas that may be associated with the perception of disability in each QOL component. Conclusions QOL is composed of 5 components. Clinical and demographic factors appear to differentially affect these aspects of patients' perceived QOL, providing hypotheses for further testing and suggesting potential relations for therapeutic interventions to consider.
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Affiliation(s)
- Madhushree Chakrabarty
- Center for Cognitive Neuroscience and Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
- Corresponding author Madhushree Chakrabarty, PhD, 126, Jodhpur Park, Kolkata 68, West Bengal, India.
| | | | - Eileen Cardillo
- Center for Cognitive Neuroscience and Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjan Chatterjee
- Center for Cognitive Neuroscience and Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Conroy SS, Wittenberg GF, Krebs HI, Zhan M, Bever CT, Whitall J. Robot-Assisted Arm Training in Chronic Stroke: Addition of Transition-to-Task Practice. Neurorehabil Neural Repair 2019; 33:751-761. [PMID: 31328671 DOI: 10.1177/1545968319862558] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Robot-assisted therapy provides high-intensity arm rehabilitation that can significantly reduce stroke-related upper extremity (UE) deficits. Motor improvement has been shown at the joints trained, but generalization to real-world function has not been profound. Objective. To investigate the efficacy of robot-assisted therapy combined with therapist-assisted task training versus robot-assisted therapy alone on motor outcomes and use in participants with moderate to severe chronic stroke-related arm disability. Methods. This was a single-blind randomized controlled trial of two 12-week robot-assisted interventions; 45 participants were stratified by Fugl-Meyer (FMA) impairment (mean 21 ± 1.36) to 60 minutes of robot therapy (RT; n = 22) or 45 minutes of RT combined with 15 minutes therapist-assisted transition-to-task training (TTT; n = 23). The primary outcome was the mean FMA change at week 12 using a linear mixed-model analysis. A subanalysis included the Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS), with significance P <.05. Results. There was no significant 12-week difference in FMA change between groups, and mean FMA gains were 2.87 ± 0.70 and 4.81 ± 0.68 for RT and TTT, respectively. TTT had greater 12-week secondary outcome improvements in the log WMFT (-0.52 ± 0.06 vs -0.18 ± 0.06; P = .01) and SIS hand (20.52 ± 2.94 vs 8.27 ± 3.03; P = .03). Conclusion. Chronic UE motor deficits are responsive to intensive robot-assisted therapy of 45 or 60 minutes per session duration. The replacement of part of the robotic training with nonrobotic tasks did not reduce treatment effect and may benefit stroke-affected hand use and motor task performance.
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Affiliation(s)
| | - George F Wittenberg
- 2 University of Maryland School of Medicine, Baltimore, MD, USA.,3 VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Min Zhan
- 2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher T Bever
- 1 Baltimore VA Medical Center, Baltimore, MD, USA.,2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jill Whitall
- 2 University of Maryland School of Medicine, Baltimore, MD, USA
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30
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Zheng S, Yao B. Impact of risk factors for recurrence after the first ischemic stroke in adults: A systematic review and meta-analysis. J Clin Neurosci 2019; 60:24-30. [DOI: 10.1016/j.jocn.2018.10.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022]
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31
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Odetunde MO, Akinpelu AO, Odole AC. Cross-cultural adaptatiion and validation of the stroke specific quality of life 2.0 scale into Hausa language. J Patient Rep Outcomes 2018; 2:63. [PMID: 30574661 PMCID: PMC6301903 DOI: 10.1186/s41687-018-0082-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Stroke Specific Quality of Life 2.0 (SS-QoL 2.0) is a widely used scale that has been cross-culturally adapted to many languages including Yoruba, one of the three major Nigerian languages. Non-availability of SS-QoL 2.0 in Hausa, the indigenous language of Northern Nigeria has restricted its use in Hausa stroke-survivors (SSV). This study was aimed at cross-culturally adapting SS-QoL 2.0 to Hausa and assessing validity and reliability of the Hausa version. The English version of SS-QoL 2.0 was cross-culturally adapted to Hausa following the American Association of Orthopaedic Surgeons' guideline. A final Hausa version (FHV) was produced through forward and back-translations, expert committee review, pretesting and cognitive debriefing interview. The FHV was investigated for test-retest reliability, internal consistency, convergent, construct and known-group validity on 86 consenting Hausa SSV. Hausa version of WHOQoL-BREF was used to assess convergent validity (n = 57) while English versions of SS-QoL was used to assess construct validity (n = 51) of FHV. The FHV was re-administered on 53 of the participants at 7-day interval to assess test-retest reliability. Each scale was administered in random order to eliminate bias. Data were analysed using Spearman correlation, Cronbach's alpha, Intra-class Correlation Coefficient (ICC), Independent t-test and One-way ANOVA at p < 0.05. RESULTS The SS-QoL 2.0 was successfully cross-culturally adapted to Hausa. Participants' mean overall score on SS-QoL 2.0 (145.30 ± 39.78) did not differ significantly from that of FHV (150.41 ± 40.45) p = 0.28. The mean domains score did not differ significantly except in self-care and work domains. There were weak to good correlations for 6 out of 8 similar domains on Hausa versions of SS-QoL and WHOQoL-BREF (r = 0.21-0.61; p = 0.001-0.006); and good to excellent correlations between Hausa and English versions of SS-QoL (r = 0.70-0.92; p = 0.001). The FHV showed high to excellent test-retest reliability (ICC = 0.86-0.99) and acceptable to excellent internal consistency (Cronbach's α = 0.71-0.90). No significant gender differences were demonstrated for any domains of FHV and for most domains across age groups. CONCLUSION The FHV is valid and reliable. The scale is recommended for assessing health-related quality of life among Hausa stroke survivors.
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Affiliation(s)
- Marufat O. Odetunde
- Department of Physiotherapy, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Aderonke O. Akinpelu
- Department of Physiotherapy, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Adesola C. Odole
- Department of Physiotherapy, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
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Kawanabe E, Suzuki M, Tanaka S, Sasaki S, Hamaguchi T. Impairment in toileting behavior after a stroke. Geriatr Gerontol Int 2018; 18:1166-1172. [PMID: 29770543 DOI: 10.1111/ggi.13435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/13/2018] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Abstract
AIM Dependence for toileting is the most problematic aspect for patients after a stroke. However, the relative difficulty of each component of toileting and the predictors for independent performance of these activities are unknown. We investigated these issues in stroke patients using Boltzmann sigmoid and generalized linear modeling. METHODS We carried out a cross-sectional correlation study, including 107 adult inpatients, hospitalized for a stroke. We assessed the activity components of toileting, as well as evaluated physical impairment using the Fugl-Meyer Assessment, impairments in balance using the Berg Balance Scale, cognitive impairments using the Mini-Mental State Examination and the presence or absence of unilateral spatial neglect or aphasia. RESULTS Boltzmann sigmoid modeling showed that the total scores required to obtain a response at 50% of the maximal value for the required components of toileting ranged between 2.691 and 34.962 points, for the components of "wearing pants" and "cutting the toilet paper," respectively. A generalized linear model showed that the Berg Balance Scale score was a significant predictor for independent performance on most component activities of toileting. CONCLUSIONS The component of toileting that was easiest to carry out was cutting the toilet paper, and the most difficult was wearing pants. Balance impairment was an independent predictor of independent toileting after stroke. This detailed toileting assessment enabled us to document the most difficult components of toileting, and to assess the motor and process skills required for independent toileting. Geriatr Gerontol Int 2018; 18: 1166-1172.
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Affiliation(s)
- Eri Kawanabe
- Department of Rehabilitation, Hamareha Home-visit Rehabilitation Station, Kanagawa, Japan
| | - Makoto Suzuki
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shotaro Sasaki
- Department of Rehabilitation, St. Marianna University, Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Toyohiro Hamaguchi
- School of Health Sciences, Saitama Prefectural University, Saitama, Japan
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Alcusky M, Lapane KL. Treatment of atrial fibrillation in nursing homes: A place for direct acting oral anticoagulants? THE JOURNAL OF NURSING HOME RESEARCH SCIENCES 2018; 4:15-19. [PMID: 31549021 PMCID: PMC6756768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Atrial fibrillation affects ~1 in 6 long-term nursing home residents. After an ischemic stroke hospitalization, ~2/3 of nursing home residents receive skilled nursing care and functional independence continues to decline, a process often complicated by rehospitalization and stroke recurrence. Due to advanced age and multimorbidity, anticoagulation is indicated for essentially all nursing home residents with atrial fibrillation. Yet as the severity of cognitive and/or functional deficits increases, the net clinical benefit of anticoagulation becomes less certain. Therefore, nursing home residents are most likely to be in need of supportive clinical evidence regarding anticoagulation, but least likely to have risk/benefit information from trials. Approximately half of US nursing home residents with atrial fibrillation have been treated with warfarin historically. Trial evidence in ambulatory older adults supports a large relative risk reduction (~50%) for stroke with warfarin versus aspirin and generally comparable bleeding risk. However, nursing home residents have a complex confluence of multimorbidity and polypharmacy that distinguishes them from healthier, non-institutionalized trial populations. Exemplifying this distinction, maintaining nursing home residents treated with warfarin within the therapeutic range has been a challenge historically, increasing the risk of adverse events. The direct acting oral anticoagulants may be a preferred therapeutic option for an indeterminate fraction of nursing home residents with atrial fibrillation. A review of the literature on anticoagulant use in nursing homes underscores the need for evidence on the effectiveness and safety of the direct acting oral anticoagulants specific to clinically complex older adults.
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Affiliation(s)
- Matthew Alcusky
- Post-doctoral fellow, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, , ,
| | - Kate L Lapane
- Associate Dean, Clinical and Population Health Research, Professor-Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, , ,
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Wang R, Langhammer B. Predictors of quality of life for chronic stroke survivors in relation to cultural differences: a literature review. Scand J Caring Sci 2017; 32:502-514. [DOI: 10.1111/scs.12533] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Rongrong Wang
- Department of Physiotherapy; Faculty of Health; Oslo and Akershus University College; Oslo Norway
- Neurorehabilitation Department; China Rehabilitation Research Center; Beijing China
| | - Birgitta Langhammer
- Department of Physiotherapy; Faculty of Health; Oslo and Akershus University College; Oslo Norway
- Sunnaas Rehabilitation Hospital; Oslo Norway
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Goldfinger JZ, Preiss LR, Devereux RB, Roman MJ, Hendershot TP, Kroner BL, Eagle KA. Marfan Syndrome and Quality of Life in the GenTAC Registry. J Am Coll Cardiol 2017; 69:2821-2830. [PMID: 28595698 PMCID: PMC5519341 DOI: 10.1016/j.jacc.2017.04.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous small studies suggested reduced quality of life (QOL) for people with Marfan syndrome (MFS) compared with those without MFS. The national registry of GenTAC (Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) is a longitudinal observational cohort study of patients with conditions that predispose to thoracic aortic aneurysms and dissections, including MFS. At the time of registry enrollment, GenTAC study participants are asked to complete questionnaires about demographics, medical history, health habits, and QOL. OBJECTIVES This study assessed QOL in GenTAC participants with MFS and identify associated factors using self-reported data. METHODS QOL was assessed using the 4 subscales of the Physical Component Summary (PCS) of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36): physical functioning; role limitations due to physical health; bodily pain; and general health. We studied the association of QOL with self-reported demographics, health behaviors, physical impairments, surgeries, comorbid medical conditions, medications, and MFS severity. RESULTS In the GenTAC registry, 389 adults with MFS completed the SF-36. Mean age was 41 years, 51% were men, 92% were white, and 65% were college graduates. The mean PCS composite score was 42.3. In bivariate analysis, predictors of better QOL included college education, marital status, higher household income, private health insurance, full-time employment, moderate alcohol use, fewer prior surgeries, fewer comorbid conditions, absence of depression, and less severe MFS manifestations. In a multivariable analysis, insurance status and employment remained significant predictors of QOL. CONCLUSIONS In a large cohort of patients with MFS in the GenTAC registry, health-related QOL was below the population norm. Better QOL was independently associated with socioeconomic factors, not factors related to general health or MFS severity.
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Affiliation(s)
- Judith Z Goldfinger
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Liliana R Preiss
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Rockville, Maryland
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Tabitha P Hendershot
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Rockville, Maryland
| | - Barbara L Kroner
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Rockville, Maryland
| | - Kim A Eagle
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan
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Shahid H, Sebastian R, Schnur TT, Hanayik T, Wright A, Tippett DC, Fridriksson J, Rorden C, Hillis AE. Important considerations in lesion-symptom mapping: Illustrations from studies of word comprehension. Hum Brain Mapp 2017; 38:2990-3000. [PMID: 28317276 PMCID: PMC5426992 DOI: 10.1002/hbm.23567] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 11/06/2022] Open
Abstract
Lesion-symptom mapping is an important method of identifying networks of brain regions critical for functions. However, results might be influenced substantially by the imaging modality and timing of assessment. We tested the hypothesis that brain regions found to be associated with acute language deficits depend on (1) timing of behavioral measurement, (2) imaging sequences utilized to define the "lesion" (structural abnormality only or structural plus perfusion abnormality), and (3) power of the study. We studied 191 individuals with acute left hemisphere stroke with MRI and language testing to identify areas critical for spoken word comprehension. We use the data from this study to examine the potential impact of these three variables on lesion-symptom mapping. We found that only the combination of structural and perfusion imaging within 48 h of onset identified areas where more abnormal voxels was associated with more severe acute deficits, after controlling for lesion volume and multiple comparisons. The critical area identified with this methodology was the left posterior superior temporal gyrus, consistent with other methods that have identified an important role of this area in spoken word comprehension. Results have implications for interpretation of other lesion-symptom mapping studies, as well as for understanding areas critical for auditory word comprehension in the healthy brain. We propose that lesion-symptom mapping at the acute stage of stroke addresses a different sort of question about brain-behavior relationships than lesion-symptom mapping at the chronic stage, but that timing of behavioral measurement and imaging modalities should be considered in either case. Hum Brain Mapp 38:2990-3000, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Hinna Shahid
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMaryland21287
| | - Rajani Sebastian
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMaryland21287
| | - Tatiana T. Schnur
- Department of NeurosurgeryBaylor College of MedicineHoustonTexas77030
| | | | - Amy Wright
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMaryland21287
| | - Donna C. Tippett
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMaryland21287
- Department of Physical Medicine & RehabilitationJohns Hopkins University School of MedicineBaltimoreMaryland21287
- Department of Otolaryngology & Head & Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMaryland21287
| | | | - Chris Rorden
- University of South CarolinaColumbiaSouth Carolina29208
| | - Argye E. Hillis
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMaryland21287
- Department of Physical Medicine & RehabilitationJohns Hopkins University School of MedicineBaltimoreMaryland21287
- Department of Cognitive ScienceJohns Hopkins UniversityBaltimoreMaryland21218
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Tse T, Binte Yusoff SZ, Churilov L, Ma H, Davis S, Donnan GA, Carey LM. Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort. Top Stroke Rehabil 2017; 24:405-414. [PMID: 28438076 DOI: 10.1080/10749357.2017.1318339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a relative lack of longitudinal studies investigating stroke-specific outcomes and quality of life (QOL). This study aimed to identify which factors (level of disability, cognitive functioning, depressive symptoms, physical activity, and work and social engagement) were independently associated with each stroke-specific domain of QOL, adjusting for age and gender, at 3 months and 12 months post-stroke in an Australian cohort. METHOD Survivors of ischemic stroke were recruited from 18 sites of the STroke imAging pRevention and Treatment (START) longitudinal cohort study. Survivors were assessed at 3 months (n = 185) and 12 months (n = 170) post-stroke using the Stroke Impact Scale (SIS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Montgomery-Asberg Depression Rating Scale, Rapid Assessment of Physical Activity, and Work and Social Adjustment Scale (WSAS). RESULTS WSAS was independently associated with the SIS domains of: Physical Composite function; Participation; and Perceived Recovery at 3 months and 12 months and SIS domain of Emotion at 12 months post-stroke. The presence of depressive symptoms was independently associated with the SIS domains of: Memory and Thinking; and Emotion at 3 months. At 12 months post-stroke, mRS was independently associated with SIS domain of Physical Composite function and MoCA with SIS domain of Communication. CONCLUSION Engaging in work and social activities is an important factor associated with stroke-specific domains of QOL over time. It is recommended that services focus on improving work and social engagement given their importance related to QOL in the first year of recovery post-stroke. Identifying and treating those with depressive symptoms may enhance QOL in the early months post-stroke. TRIAL REGISTRATION START-PrePARE Australian New Zealand Clinical Trials, www.anzctr.org.au , Registry number: ACTRN12610000987066. EXTEND ClinicalTrial.gov identifier: NCT00887328.
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Affiliation(s)
- Tamara Tse
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,b Neurorehabilitation and Recovery, Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
| | - Siti Zubaidah Binte Yusoff
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,c Ang Mo Kio - Thye Hua Kwan Hospital , Ang Mo Kio , Singapore
| | - Leonid Churilov
- d Statistics and Decision Analysis Academic Platform , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,e School of Mathematical and Geospatial Sciences , RMIT University , Melbourne , Australia
| | - Henry Ma
- f Department of Medicine, Stroke Unit, Monash Health , Monash University , Clayton , Australia.,g The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
| | - Stephen Davis
- h Department of Medicine, Melbourne Brain Centre , Royal Melbourne Hospital, University of Melbourne , Parkville , Australia
| | - Geoffrey Alan Donnan
- g The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,i Florey Department of Neuroscience and Mental Health , The University of Melbourne , Parkville , Australia
| | - Leeanne M Carey
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,b Neurorehabilitation and Recovery, Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
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Balakrishnan R, Kaplan B, Negron R, Fei K, Goldfinger JZ, Horowitz CR. Life after Stroke in an Urban Minority Population: A Photovoice Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030293. [PMID: 28287467 PMCID: PMC5369129 DOI: 10.3390/ijerph14030293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 12/15/2022]
Abstract
Stroke is a leading cause of disability in the United States and disproportionately affects minority populations. We sought to explore the quality of life in urban, minority stroke survivors through their own photos and narratives. Using the Photovoice method, seventeen stroke survivors were instructed to take pictures reflecting their experience living with and recovering from stroke. Key photographs were discussed in detail; participants brainstormed ways to improve their lives and presented their work in clinical and community sites. Group discussions were recorded, transcribed, and coded transcripts were reviewed with written narratives to identify themes. Participants conveyed recovery from stroke in three stages: learning to navigate the initial physical and emotional impact of the stroke; coping with newfound physical and emotional barriers; and long-term adaptation to physical impairment and/or chronic disease. Participants navigated this stage-based model to varying degrees of success and identified barriers and facilitators to this process. Barriers included limited access for disabled and limited healthy food choices unique to the urban setting; facilitators included presence of social support and community engagement. Using Photovoice, diverse stroke survivors were able to identify common challenges in adapting to life after stroke and important factors for recovery of quality of life.
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Affiliation(s)
- Revathi Balakrishnan
- Division of Cardiology, New York University School of Medicine, 462 1st Avenue NBV 17S5, New York, NY 10016, USA.
| | - Benjamin Kaplan
- University of North Carolina School of Medicine, 321 S Columbia St, Chapel Hill, NC 27516, USA.
| | - Rennie Negron
- Yale Institute for Network Science, Department of Sociology, Yale University, 17 Hillhouse Avenue, New Haven, CT 06520, USA.
| | - Kezhen Fei
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY 10029, USA.
| | - Judith Z Goldfinger
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Carol R Horowitz
- Center of Health Equity and Community Engaged Research at Mount Sinai, Department of Population Health Science and Policy, Icahn School at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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Luan Erfe B, Siddiqui KA, Schwamm LH, Mejia NI. Relationship Between Language Preference and Intravenous Thrombolysis Among Acute Ischemic Stroke Patients. J Am Heart Assoc 2016; 5:e003782. [PMID: 27881425 PMCID: PMC5210419 DOI: 10.1161/jaha.116.003782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/06/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Approximately 20% of the US population primarily speaks a language other than English at home. Yet the effect of language preference on treatment of acute ischemic stroke (AIS) patients remains unknown. We aimed to evaluate the influence of language preference on AIS patients' receipt of intravenous (IV) thrombolysis. METHODS AND RESULTS We analyzed data from 3894 AIS patients who participated in the American Heart Association "Get With The Guidelines®-Stroke" program at our hospital from January 1, 2003 to April 30, 2014. Information included patients' language in which they preferred to receive medical care. We used descriptive statistics and stepwise logistic regression models to examine associations between patients' language preference and receipt of IV thrombolysis, adjusting for relevant covariates. A total of 306/3295 (9.3%) AIS patients preferred to speak a non-English language and represented 25 different languages. Multivariable analyses adjusting for other socioeconomic factors showed that non-English-preferring patients were more likely than English-preferring patients to receive IV thrombolysis (OR=1.64; CI=1.09-2.48; P=0.02). However, in models that also included age, sex, and initial NIH Stroke Scale, patients' language preference was no longer significant (OR 1.38; CI=0.88-2.15; P=0.16), but NIH Stroke Scale was strongly associated with receiving IV thrombolysis (OR=1.15 per point; CI=1.13-1.16; P<0.0001). CONCLUSIONS Contrary to our hypothesis, non-English-preferring was not associated with lower rates of IV thrombolysis among AIS patients once initial stroke severity was accounted for.
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Affiliation(s)
| | | | - Lee H Schwamm
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | - Nicte I Mejia
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
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Long-Term Treatment with Citicoline Prevents Cognitive Decline and Predicts a Better Quality of Life after a First Ischemic Stroke. Int J Mol Sci 2016; 17:390. [PMID: 26999113 PMCID: PMC4813246 DOI: 10.3390/ijms17030390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/02/2022] Open
Abstract
Stroke, as the leading cause of physical disability and cognitive impairment, has a very significant impact on patients’ quality of life (QoL). The objective of this study is to know the effect of citicoline treatment in Qol and cognitive performance in the long-term in patients with a first ischemic stroke. This is an open-label, randomized, parallel study of citicoline vs. usual treatment. All subjects were selected 6 weeks after suffering a first ischemic stroke and randomized into parallel arms. Neuropsychological evaluation was performed at 1 month, 6 months, 1 year and 2 years after stroke, and QoL was measured using the EuroQoL-5D questionnaire at 2 years. 163 patients were followed during 2 years. The mean age was 67.5 years-old, and 50.9% were women. Age and absence of citicoline treatment were independent predictors of both utility and poor quality of life. Patients with cognitive impairment had a poorer QoL at 2 years (0.55 vs. 0.66 in utility, p = 0.015). Citicoline treatment improved significantly cognitive status during follow-up (p = 0.005). In conclusion, treatment with long-term citicoline is associated with a better QoL and improves cognitive status 2 years after a first ischemic stroke.
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Reeves SL, Brown DL, Baek J, Wing JJ, Morgenstern LB, Lisabeth LD. Ethnic Differences in Poststroke Quality of Life in the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Stroke 2015; 46:2896-901. [PMID: 26286542 DOI: 10.1161/strokeaha.115.010328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Mexican Americans (MAs) have an increased risk of stroke and experience worse poststroke disability than non-Hispanic whites, which may translate into worse poststroke quality of life (QOL). We assessed ethnic differences in poststroke QOL, as well as potential modification of associations by age, sex, and initial stroke severity. METHODS Ischemic stroke survivors were identified through the biethnic, population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from medical records, baseline interviews, and 90-day poststroke interviews. Poststroke QOL was measured at ≈90 days by the validated short-form stroke-specific QOL in 3 domains: overall, physical, and psychosocial (range, 0-5; higher scores represent better QOL). Tobit regression was used to model associations between ethnicity and poststroke QOL scores, adjusted for demographics, clinical characteristics, and prestroke cognition and function. RESULTS Among 290 eligible stroke survivors (66% MA, 34% non-Hispanic whites, median age=69 years), median scores for overall, physical, and psychosocial poststroke QOL were 3.3, 3.8, and 2.7, respectively. Poststroke QOL was lower for MAs than non-Hispanic whites both overall (mean difference, -0.30; 95% confidence interval, -0.59, -0.01) and in the physical domain (mean difference, -0.47; 95% confidence interval, -0.81, -0.14) after multivariable adjustment. No ethnic difference was found in the psychosocial domain. Age modified the associations between ethnicity and poststroke QOL such that differences were present in older but not in younger ages. CONCLUSIONS Disparities exist in poststroke QOL for MAs and seem to be driven by differences in older stroke patients. Targeted interventions to improve outcomes among MA stroke survivors are urgently needed.
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Affiliation(s)
- Sarah L Reeves
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.).
| | - Devin L Brown
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Jonggyu Baek
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Jeffrey J Wing
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Lewis B Morgenstern
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Lynda D Lisabeth
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
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Okita Y, Narita Y, Miyahara R, Miyakita Y, Ohno M, Shibui S. Health-related quality of life in long-term survivors with Grade II gliomas: the contribution of disease recurrence and Karnofsky Performance Status. Jpn J Clin Oncol 2015; 45:906-13. [DOI: 10.1093/jjco/hyv115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/30/2015] [Indexed: 11/13/2022] Open
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Strambo D, Zambon AA, Roveri L, Giacalone G, Di Maggio G, Peruzzotti-Jametti L, La Gioia S, Galantucci S, Comi G, Sessa M. Defining minor symptoms in acute ischemic stroke. Cerebrovasc Dis 2015; 39:209-15. [PMID: 25791530 DOI: 10.1159/000375151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 01/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thrombolysis is often withheld from acute ischemic stroke patients presenting with mild symptoms; however, up to 40% of these patients end up with a poor outcome when left untreated. Since there is lack of consensus on the definition of minor symptoms, we aimed at addressing this issue by looking for features that would better predict functional outcomes at 3 months. METHODS Among all acute ischemic stroke patients admitted to our Stroke Unit (n = 1,229), we selected a cohort of patients who arrived within 24 hours from symptoms onset, with baseline NIHSS ≤6, not treated with thrombolysis (n = 304). Epidemiological data, comorbidities, radiological features and clinical presentation (NIHSS items) were collected to identify predictors of outcome. Our cohort was tested against minor stroke definitions selected from the literature and a newly proposed one. RESULTS Three months after stroke onset, 97 patients (31.9%) had mRS ≥ 2. Independent predictors of poor outcome were age (OR 0.97 [95% CI 0.95-9.99]) and baseline NIHSS score (OR 0.79 [95% CI 0.67-0.94]), while cardioembolic aetiology was negatively associated (OR 3.29 [95% CI 1.51-7.14]). Items of NIHSS associated with poor outcome were impairment of right motor arm (OR 0.49 [95% CI 0.27-0.91]) or the involvement of any of the motor items (OR 0.69 [95% CI 0.48-0.99]). The definition of minor stroke as NIHSS ≤3 and the new proposed definition had the highest sensitivity and accuracy and were independent predictors of outcome. CONCLUSIONS Our study confirmed that in spite of a low NIHSS score, one third of patients had poor outcome. As already described, age and NIHSS score remained independent predictors of poor outcome even in mild stroke. Also, motor impairment appeared a major determinant of poor outcome. The new proposed definition of minor stroke featured the NIHSS score and the NIHSS items that better predicted functional outcome. Awareness that even minor stroke can yield to poor outcome should sensitize patients to arrive early to the ED and neurologists to administer rt-PA.
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Affiliation(s)
- Davide Strambo
- San Raffaele Scientific Institute-Institute of Experimental Neurology, Stroke Unit-Department of Neurology and Neurophysiology, Milan, Italy
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Rowlands D, Sugahara K, Kwok JCF. Glycosaminoglycans and glycomimetics in the central nervous system. Molecules 2015; 20:3527-48. [PMID: 25706756 PMCID: PMC6272379 DOI: 10.3390/molecules20033527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/09/2015] [Accepted: 02/13/2015] [Indexed: 01/05/2023] Open
Abstract
With recent advances in the construction of synthetic glycans, selective targeting of the extracellular matrix (ECM) as a potential treatment for a wide range of diseases has become increasingly popular. The use of compounds that mimic the structure or bioactive function of carbohydrate structures has been termed glycomimetics. These compounds are mostly synthetic glycans or glycan-binding constructs which manipulate cellular interactions. Glycosaminoglycans (GAGs) are major components of the ECM and exist as a diverse array of differentially sulphated disaccharide units. In the central nervous system (CNS), they are expressed by both neurons and glia and are crucial for brain development and brain homeostasis. The inherent diversity of GAGs make them an essential biological tool for regulating a complex range of cellular processes such as plasticity, cell interactions and inflammation. They are also involved in the pathologies of various neurological disorders, such as glial scar formation and psychiatric illnesses. It is this diversity of functions and potential for selective interventions which makes GAGs a tempting target. In this review, we shall describe the molecular make-up of GAGs and their incorporation into the ECM of the CNS. We shall highlight the different glycomimetic strategies that are currently being used in the nervous system. Finally, we shall discuss some possible targets in neurological disorders that may be addressed using glycomimetics.
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Affiliation(s)
- Dáire Rowlands
- John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK.
| | - Kazuyuki Sugahara
- Proteoglycan Signaling and Therapeutics Research Group, Graduate School of Life Science, Faculty of Advanced Life Science, Hokkaido University, Sapporo 001-0021, Japan.
| | - Jessica C F Kwok
- John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK.
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46
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Pulman J, Buckley E. Assessing the Efficacy of Different Upper Limb Hemiparesis Interventions on Improving Health-Related Quality of Life in Stroke Patients: A Systematic Review. Top Stroke Rehabil 2015; 20:171-88. [DOI: 10.1310/tsr2002-171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wang YL, Pan YS, Zhao XQ, Wang D, Johnston SC, Liu LP, Meng X, Wang AX, Wang CX, Wang YJ. Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neurosci Ther 2014; 20:1029-35. [PMID: 25307297 DOI: 10.1111/cns.12329] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/27/2022] Open
Abstract
AIMS To examine the health-related quality of life (HRQOL) in patients with transient ischemic attack (TIA) or minor stroke and assess the impact of recurrent stroke on HRQOL. METHODS Health-related quality of life data on patients participated in the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial were analyzed. The available 90-day EuroQoL data (EQ-5D) were used to calculate EQ-5D index score. Poor HRQOL was defined as an EQ-5D index score ≤0.5. The characteristics of HRQOL and factors predicting poor HRQOL in these patients were then explored. RESULTS Among the total 5170 patients enrolled, 90-day HRQOL data were obtained from 5104 patients for analysis. The mean EQ-5D index score at day 90 was 0.88 ± 0.21 for all patients, but only 0.42 ± 0.35 for those with recurrent strokes. Poor 90-day HRQOL was found in 294 (5.8%) patients. Patients with poor HRQOL had more strokes during follow-up than patients with good HRQOL (94.9 vs. 4.7%, P < 0.001). Age, history of hypertension and diabetes, and NIHSS at baseline were independent risk factors for predicting poor HRQOL. Stroke recurrence, NIHSS at baseline, age, and minor stroke on admission became independent risk factors once stroke recurrence was added into the model. CONCLUSIONS Stroke recurrence was associated with poor HRQOL in patients with TIA or minor strokes. Interventions focusing on controlling risk factors and prevention of worsening of neurological function may prevent poor HRQOL in these patients.
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Affiliation(s)
- Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
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48
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Lopez-Espuela F, Zamorano JDP, Ramírez-Moreno JM, Jiménez-Caballero PE, Portilla-Cuenca JC, Lavado-García JM, Casado-Naranjo I. Determinants of Quality of Life in Stroke Survivors After 6 Months, from a Comprehensive Stroke Unit. Biol Res Nurs 2014; 17:461-8. [DOI: 10.1177/1099800414553658] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In the social model of stroke, health-related quality of life (HRQoL) is the result of interplay among stroke severity, social support, and health-promoting behaviors. Our objective was to identify determinants of HRQoL in stroke survivors. Methods: Ischemic stroke patients were evaluated at 6 months with the Short Form 12 Health Survey, including physical component survey (PCS) and mental health component survey (MCS) summary scores. Multivariate stepwise regression analyses determined independent predictors of scores. Models included age, gender, socioeconomic class, education, residential environment, social support, previous comorbidity (Charlson Index), previous stroke, side of stroke, National Institutes of Health Stroke Scale (NIHSS) score at admission, Barthel Index (BI) and modified Rankin Scale (mRS) scores at discharge, and length of stay. Results: A total of 131 patients participated (mean age 70.1, SD = 12.5; 62.6% males). In all, 33.6% had a BI score <90 and an mRS score >2 (poor outcome). The mean ( SD) PCS score was 39.46 (9.3) and mean ( SD) MCS score was 34.86 (10.1). Lower PCS score was associated with female sex (β = 0.204, p = .009), poor social support (β = −0.225, p = .003), and poor Charlson Index (β = −0.162, p = .032) and BI scores (β = 0.384, p < .0001). Lower MCS score was associated with female sex (β = 0.162, p = .062) and poor NIHSS (β = −0.265, p = .019) and BI scores (β = 0.203, p < .071). Conclusion: Stroke severity, disability, gender, social support, and previous stroke have significant impacts on the physical and mental domains of generic HRQoL.
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Affiliation(s)
- Fidel Lopez-Espuela
- Psychologist and Research Nurse, Stroke Unit, Hospital San Pedro de Alcantara, Caceres, Spain
| | | | | | | | - Juan Carlos Portilla-Cuenca
- Department of Neurology, Stroke Unit, Department of Neurology, Hospital San Pedro de Alcántara, Caceres, Spain
| | | | - Ignacio Casado-Naranjo
- Department of Neurology, Stroke Unit, Department of Neurology, Hospital San Pedro de Alcántara, Caceres, Spain
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49
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Jönsson AC, Delavaran H, Iwarsson S, Ståhl A, Norrving B, Lindgren A. Functional Status and Patient-Reported Outcome 10 Years After Stroke. Stroke 2014; 45:1784-90. [DOI: 10.1161/strokeaha.114.005164] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ann-Cathrin Jönsson
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Hossein Delavaran
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Susanne Iwarsson
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Agneta Ståhl
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Bo Norrving
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Arne Lindgren
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
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50
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Dhamoon MS, McClure LA, White CL, Lau H, Benavente O, Elkind MSV. Quality of life after lacunar stroke: the Secondary Prevention of Small Subcortical Strokes study. J Stroke Cerebrovasc Dis 2014; 23:1131-7. [PMID: 24177006 PMCID: PMC4002657 DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/30/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We sought to describe the course and predictors of quality of life (QOL) after lacunar stroke. We hypothesized that there is a decline in QOL after recovery from lacunar stroke. METHODS The Secondary Prevention of Small Subcortical Strokes is a clinical trial in lacunar stroke patients with annual assessments of QOL with the stroke-specific QOL score. The overall score was used and analyzed as a continuous variable (range 0-5). We fit linear mixed models to assess the trend in QOL over time, assuming linearity of time, and adjusted for demographics, medical risk factors, cognitive factors, and functional status in univariable and multivariable models. RESULTS Among 2870 participants, mean age was 63.4 years (SD 10.7), 63% were men, 51% White, 32% Hispanic, 36% had college education, 36% had diabetes, 89% had hypertension, and 10% had prior stroke. Mean poststroke Barthel Index (BI) score was 95.4 (assessed on average 6 months after stroke). In the final multivariable model, there was an average increase in QOL of .6% per year, and factors associated with decline in QOL over time included age (-.0003 per year, P < .0001), any college education (-.0013 per year, .01), prior stroke (-.004 per year, P < .0001), and BI (-.0002 per year, P < .0001). CONCLUSIONS In this clinical trial of lacunar stroke patients, there was a slight annual increase in QOL overall, and age, level of education, and prior stroke were associated with changes in QOL over time. Multiple strokes may cause decline in QOL over time in the absence of recurrent events.
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Affiliation(s)
- Mandip S Dhamoon
- Department of Neurology, Mount Sinai School of Medicine, New York, New York.
| | - Leslie A McClure
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carole L White
- School of Nursing, University of Texas Health Sciences Center, San Antonio, Texas
| | - Helena Lau
- Boston University, Boston, Massachusetts
| | - Oscar Benavente
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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