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Bines K, Strehlow E, Gray E, Nettnin E, Stoff L, Rafferty MR. Mobility and self-care outcomes in patients with a bariatric comorbidity during inpatient rehabilitation. PM R 2024; 16:426-433. [PMID: 37817058 DOI: 10.1002/pmrj.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/31/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE First, we describe the characteristics and functional outcomes of obese and bariatric patients in an inpatient rehabilitation facility (IRF). Second, we assessed differences in functional outcomes for bariatric, obese, and standard weight body mass index (BMI) groups. Third, we explored whether these characteristics differ between time periods and diagnostic groups. DESIGN A retrospective study comparing electronic medical record data collected in 2016 and 2018, using a repeated cross-sectional cohort design. SETTING IRF. PARTICIPANTS Individuals ≥18 years of age diagnosed with brain injury, medical complexity, general neurology, orthopedic, spinal cord injury (SCI), and stroke. Participants grouped as standard (BMI <30 kg/m2), obese (BMI 30-39 kg/m2), and bariatric (BMI ≥40 kg/m2) weights. (N = 2015 in 2016, N = 2768 in 2018.) INTERVENTIONS: Patients received standard inpatient rehabilitation. In 2018, clinicians had access to new weight-appropriate equipment. MAIN OUTCOME MEASURES Discharge destination; length of stay (LOS) by BMI group and medical diagnoses; item-specific functional independence measure (FIM) change scores. RESULTS Sixty-four percent to 67% of all BMI groups achieved a home discharge. The bariatric BMI group had a longer LOS (21 days) than the standard or obese groups. There was a significant interaction in a linear regression analysis between diagnosis and LOS, where LOS was longer in medically complex patients with bariatric BMI (19.3 days compared to 16.1 days) but shorter in bariatric patients with SCI (20.6 days) compared to standard weight patients (26.2 days). In 2018, the bariatric BMI group had greater average FIM change scores for bathing, lower body dressing, toilet transfers, and bed transfers. CONCLUSIONS Patient BMI is associated with LOS in the IRF, although affected by diagnosis. Patients with higher BMIs can make changes in specific individual motor FIM items. For patients with bariatric BMIs, FIM change scores were higher in 2018, possibly due to the use of equipment and facilities designed for higher weight capacities.
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Affiliation(s)
- Kelcey Bines
- Shirley Ryan Ability Lab, Chicago, United States
| | | | - Elizabeth Gray
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Ella Nettnin
- Shirley Ryan Ability Lab, Chicago, United States
| | - Laura Stoff
- Shirley Ryan Ability Lab, Chicago, United States
| | - Miriam R Rafferty
- Shirley Ryan Ability Lab, Chicago, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, United States
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Cui W, Xu L, Huang L, Tian Y, Yang Y, Li Y, Yu Q. Changes of gut microbiota in patients at different phases of stroke. CNS Neurosci Ther 2023; 29:3416-3429. [PMID: 37309276 PMCID: PMC10580337 DOI: 10.1111/cns.14271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 06/14/2023] Open
Abstract
AIMS Gut dysbiosis appears rapidly after acute stroke and may affect the prognosis, whereas changes in gut microbiota with gradual recovery from stroke are unknown and rarely studied. The purpose of this study is to explore the characteristics of gut microbiota changes over time after stroke. METHODS Stroke patients and healthy subjects were selected to compare the clinical data and gut microbiota of the patient group in two phases with that of healthy subjects and 16S rRNA gene sequencing was used to search the differences of gut microbiota in subjects. RESULTS Compared with the healthy subjects, the subacute patients mainly decreased the abundance of some gut microbial communities, while the decreased communities reduced and more communities increased the abundance in the convalescent patients. The abundance of Lactobacillaceae increased in both phases in patient group, while Butyricimona, Peptostreptococaceae and Romboutsia decreased in both phases. Correlation analysis found that the MMSE scores of patients in the two phases had the greatest correlation with the gut microbiota. CONCLUSION Gut dysbiosis still existed in patients in the subacute phase and convalescent phase, and gradually improved with the recovery of stroke. Gut microbiota may affect the prognosis of stroke by affecting BMI and/or related indicators, and there is a strong correlation between gut microbiota and cognitive function after stroke.
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Affiliation(s)
- Wei Cui
- Department of Rehabilitation MedicineSichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduChina
| | - Li Xu
- Department of Rehabilitation MedicineSichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduChina
| | - Lin Huang
- Department of Rehabilitation MedicineSichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduChina
| | - Yang Tian
- Department of Rehabilitation MedicineSichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduChina
| | - Yan Yang
- Department of Rehabilitation MedicineSichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduChina
| | - Yamei Li
- Department of Rehabilitation MedicineSichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduChina
| | - Qian Yu
- Department of Rehabilitation MedicineSichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduChina
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Influence of Oxidative Stress and Inflammation on Nutritional Status and Neural Plasticity: New Perspectives on Post-Stroke Neurorehabilitative Outcome. Nutrients 2022; 15:nu15010108. [PMID: 36615766 PMCID: PMC9823808 DOI: 10.3390/nu15010108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022] Open
Abstract
Beyond brain deficits caused by strokes, the effectiveness of neurorehabilitation is strongly influenced by the baseline clinical features of stroke patients, including a patient's current nutritional status. Malnutrition, either as a pre-stroke existing condition or occurring because of ischemic injury, predisposes patients to poor rehabilitation outcomes. On the other hand, a proper nutritional status compliant with the specific needs required by the process of brain recovery plays a key role in post-stroke rehabilitative outcome favoring neuroplasticity mechanisms. Oxidative stress and inflammation play a role in stroke-associated malnutrition, as well as in the cascade of ischemic events in the brain area, where ischemic damage leads to neuronal death and brain infarction, and, via cell-to-cell signaling, the alteration of neuroplasticity processes underlying functional recovery induced by multidisciplinary rehabilitative treatment. Nutrition strategies based on food components with oxidative and anti-inflammatory properties may help to reverse or stop malnutrition and may be a prerequisite for supporting the ability of neuronal plasticity to result in satisfactory rehabilitative outcome in stroke patients. To expand nutritional recommendations for functional rehabilitation recovery, studies considering the evolution of nutritional status changes in post-stroke patients over time are required. The assessment of nutritional status must be included as a routine tool in rehabilitation settings for the integrated care of stroke-patients.
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Mehta A, De Paola L, Pana TA, Carter B, Soiza RL, Kafri MW, Potter JF, Mamas MA, Myint PK. The relationship between nutritional status at the time of stroke on adverse outcomes: a systematic review and meta-analysis of prospective cohort studies. Nutr Rev 2022; 80:2275-2287. [PMID: 35640017 PMCID: PMC9647329 DOI: 10.1093/nutrit/nuac034] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
CONTEXT AND OBJECTIVE The impact of existing malnutrition on stroke outcomes is poorly recognised and treated. Evidence was systematically reviewed and quantified by meta-analysis. METHODS MEDLINE, EMBASE and Web of Science were searched from inception to 11 January 2021 and updated in July. Prospective cohort studies, in English, evaluating anthropometric and biomarkers of nutrition on stroke outcomes were included. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network checklist. RESULTS Twenty-six studies (n = 156 249) were eligible (follow-up: One month-14 years). Underweight patients had increased risk of long-term mortality (adjusted hazard ratio = 1.65,1.41-1.95), whilst overweight (0.80,0.74-0.86) and obese patients (0.80,0.75-0.85) had decreased risk compared to normal weight. Odds of mortality decreased in those with high serum albumin (odds ratio = 0.29,0.18-0.48) and increased with low serum albumin (odds ratio = 3.46,1.78-6.74) compared to normal serum albumin (30-35 g/L). Being malnourished compared to well-nourished, as assessed by the Subjective Global Assessment (SGA) or by a combination of anthropometric and biochemical markers increased all-cause mortality (odds ratio = 2.38,1.85-3.06) and poor functional status (adjusted odds ratio = 2.21,1.40-3.49). CONCLUSION Nutritional status at the time of stroke predicts adverse stroke outcomes.
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Affiliation(s)
- Arnav Mehta
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Lorenzo De Paola
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Tiberiu A Pana
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Roy L Soiza
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom
| | - Mohannad W Kafri
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Department of Nutrition & Dietetics, Birzeit University, Birzeit, West Bank, Palestine
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Phyo K Myint
- P. K. Myint, School of Medicine, Medical Sciences and Nutrition Foresterhill, Room 4:013, Polwarth Building, Aberdeen AB25 2ZD, Scotland, UK. E-mail:
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Carretti G, Mirandola D, Maestrini F, Sequi L, Germano S, Muraca MG, Miccinesi G, Manetti M, Marini M. Quality of life improvement in breast cancer survivors affected by upper limb lymphedema through a novel multiperspective physical activity methodology: a monocentric pilot study. Breast Cancer 2022; 29:437-449. [PMID: 35025064 DOI: 10.1007/s12282-021-01322-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Chronic lymphedema causes psychophysical sequelae jeopardizing quality of life (QoL) of breast cancer (BC) survivors, and lack of effective therapies represents a major challenge for healthcare professionals. Structured adapted physical activity (APA) may represent an effective strategy to attenuate cancer treatment-related impairments and improve QoL. Here, we describe the effects of a specific APA intervention based on a novel multiperspective methodology in counteracting lymphedema-related morphofunctional alterations and improving QoL of BC survivors. METHODS BC survivors with chronic moderate/severe lymphedema attending the Cancer Rehabilitation Center in Florence were assessed before and after 8-week APA. The protocol consisted of both APA specialist-supervised and self-leaded sessions using a tailor-designed proprioceptive board. Body mass index, bioimpedance parameters, indirect upper limb volume measurement, and ultrasonography were performed. Wrist flexion/extension and hand strength functional tests were also executed. QoL, depression/anxiety and pain intensity were evaluated by ULL27, HADS, distress thermometer and NRS questionnaires, respectively. RESULTS Although bioimpedance, ultrasound and volumetric measures remained mostly unchanged, wrist mobility, pain perception, depression, and QoL were all significantly ameliorated after APA. CONCLUSIONS Our findings suggest that a multidisciplinary treatment approach involving APA professionals should be employed in the management of BC-related lymphedema to improve patient psychophysical outcomes and QoL.
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Affiliation(s)
- Giuditta Carretti
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Daniela Mirandola
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,The Italian League Against Tumors (LILT), 50126, Florence, Italy
| | | | - Lisa Sequi
- The Italian League Against Tumors (LILT), 50126, Florence, Italy
| | - Sara Germano
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Grazia Muraca
- Oncological Rehabilitation Centre (Ce.Ri.On.), 50139, Florence, Italy.,Oncological Network, Prevention and Research Institute (ISPRO), 50139, Florence, Italy
| | - Guido Miccinesi
- Oncological Network, Prevention and Research Institute (ISPRO), 50139, Florence, Italy
| | - Mirko Manetti
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Mirca Marini
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients-Preliminary Reports. Brain Sci 2021; 11:brainsci11040501. [PMID: 33921075 PMCID: PMC8071377 DOI: 10.3390/brainsci11040501] [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: 03/19/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Rehabilitation-oriented therapy after a stroke must continue in various forms as a life-long effort. Aim: The study investigated the impact of spa rehabilitation on the quality of life and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods: The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients with strokes who participated in a three-week rehabilitation program. Three examinations were performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index. Results: The quality of life was significantly higher in Exam II compared with Exam I (p < 0.001), and improvement was retained at the follow-up. The Barthel scores were higher in Exam II compared with Exam I (79.84 vs. 68.59), while the differences between the scores in Exams II and III were small (p = 0.039). Conclusions: Three-week spa rehabilitation seems to favorably affect the functional efficiency and quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time from stroke onset.
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