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Acero-Garces D, Zuluaga-Lotero D, Ortiz-Muñoz D, Arango GP, Moyano M, Vargas-Manotas J, Rojas CA, Urrego J, Rojas JP, Rosso F, Ramos-Burbano GE, Llanos MD, Lizarazo J, Lopez-Gonzalez R, Jimenez-Arango JA, Benavides-Melo J, Martinez-Villota VA, Gonzalez G, Dominguez-Penuela SC, Quintero JA, Luque KA, Ruiz AM, Claros K, Osorio L, Pardo CA, Parra B. Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic. J Neurol Sci 2024; 463:123140. [PMID: 39047509 PMCID: PMC11338696 DOI: 10.1016/j.jns.2024.123140] [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: 01/30/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.
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Affiliation(s)
| | | | | | - Gloria P Arango
- Universidad Del Valle, School of Human Rehabilitation, Faculty of Health, Cali, Colombia
| | - Martha Moyano
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - José Vargas-Manotas
- Universidad Simón Bolívar, Barranquilla, Colombia; La Misericordia Clínica Internacional, Barranquilla, Colombia
| | - Christian A Rojas
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia; Clinica Imbanaco, Department of Pediatrics, Cali, Colombia
| | - Jonathan Urrego
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia
| | - Juan P Rojas
- Fundación Clínica Infantil Club Noel, Department of Pediatrics, Cali, Colombia; Universidad Libre seccional Cali, Cali, Colombia
| | - Fernando Rosso
- Fundación Valle del Lili, Department of Internal Medicine, Cali, Colombia; Universidad ICESI, Cali, Colombia
| | - Gustavo E Ramos-Burbano
- Universidad del Valle, School of Medicine, Cali, Colombia; Clinica Rey David, Cali, Colombia
| | | | - Jairo Lizarazo
- Hospital Universitario Erasmo Meoz, Cúcuta, Colombia; Universidad de Pamplona, Cúcuta, Colombia
| | | | | | | | | | - Guillermo Gonzalez
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia; Universidad Surcolombiana, Neiva, Colombia
| | | | - Jaime A Quintero
- Universidad del Valle, Department of Microbiology, Cali, Colombia
| | | | | | - Katherinne Claros
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia
| | - Lyda Osorio
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - Carlos A Pardo
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, MD, USA.
| | - Beatriz Parra
- Universidad del Valle, Department of Microbiology, Cali, Colombia
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Ariana GM. Chronic inflammatory demyelinating polyneuropathy. A case description. Clin Case Rep 2024; 12:e9217. [PMID: 39104739 PMCID: PMC11298991 DOI: 10.1002/ccr3.9217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 08/07/2024] Open
Abstract
Patients affected by chronic inflammatory demyelinating polyradiculoneuropathy require close follow up due to the neuronal demyelination along with axonal degeneration associated with the disease process, giving the opportunity to the medical team of adequating therapeutics and other medical interventions, according to the evolution of the symptoms, to prevent irreversible axonal degeneration.
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Almeida MP, Machado Vaz I, Winck JC, Marques A. Inpatient rehabilitation of a person with Guillain-Barré syndrome associated with COVID-19 infection: An expert interdisciplinary approach to a case study. Physiother Theory Pract 2023; 39:2479-2489. [PMID: 35521973 DOI: 10.1080/09593985.2022.2072252] [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: 11/08/2021] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Several cases of Guillain-Barré Syndrome (GBS) associated with a COVID-19 infection have been recently reported. Rehabilitation might be a key player in the recovery of these highly complex patients however, results are yet unknown. This case report aimed to describe the effects of an inpatient rehabilitation program, with an interdisciplinary team approach, in a patient with GBS in the context of a COVID-19 infection. CASE DESCRIPTION A 58-year-old man with GBS after COVID-19 started an inpatient rehabilitation program focused on reducing dyspnea and fatigue symptoms; improving muscle strength, balance, aerobic and functional training; practicing activities of daily living and energy conservation techniques; swallowing training; emotional support and patient and family education about daily routines. An expert interdisciplinary team delivered the intervention, approximately 5 h/day, 5 days/week for 6 weeks. OUTCOMES Improvements were observed in dyspnea, fatigue, nocturnal ventilation, muscle strength, balance, walking capacity, functional status, and swallowing function. CONCLUSION This clinical case report illustrates the impact of a tailored and interdisciplinary rehabilitation program, on promoting recovery in multiple health domains of a patient with GBS associated with COVID-19 infection. Our experience might be useful to guide other inpatient rehabilitation programs to successfully manage these highly complex patients.
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Affiliation(s)
- Miguel P Almeida
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Respiratory Research and Rehabilitation Laboratory (Lab3r), School of Health Sciences (ESSUA) and Institute of Biomedicine (IBiMED), University of Aveiro, Aveiro, Portugal
| | - Inês Machado Vaz
- Serviço de Medicina Física e de Reabilitação - Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal
| | - João Carlos Winck
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3r), School of Health Sciences (ESSUA) and Institute of Biomedicine (IBiMED), University of Aveiro, Aveiro, Portugal
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Andrews AW, Bohannon RW. Improvements and Residual Limitations Experienced by Patients With Guillain-Barré Syndrome Undergoing Inpatient Rehabilitation. Am J Phys Med Rehabil 2023; 102:541-544. [PMID: 36897800 DOI: 10.1097/phm.0000000000002230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
ABSTRACT The purposes of this study were to (1) describe the level of functional independence of patients with Guillain-Barré syndrome before and after inpatient rehabilitation, (2) determine whether the level of functional independence increased in each functional domain during inpatient rehabilitation, and (3) determine whether independence at the end of inpatient rehabilitation differed significantly between domains. Data from patients with Guillain-Barré syndrome discharged from inpatient rehabilitation settings in 2019 were obtained from the Uniform Data System for Medical Rehabilitation database. The primary variables analyzed were paired, dichotomous variables of the number of patients who achieved full independence in the admission and discharge scores for the activities that comprise the domains, subscales, and total of the Functional Independence Measure. All patients admitted to inpatient rehabilitation required assistance with at least one if not several domains of function, motor, as well as cognitive. By the end of the inpatient rehabilitation stay, for each domain of function, significantly more patients were independent ( P < 0.0001). Independence at the end of inpatient rehabilitation differed significantly between domains ( P < 0.0001); more patients achieved independence in the communication (87.5%) and social cognition (74.8%) domains while fewer patients achieved independence in the self-care (35.9%), transfers (34.2%), and locomotion domains (24.7%).
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Affiliation(s)
- Addison Williams Andrews
- From the Department of Physical Therapy Education, Elon University, Elon, North Carolina (AWA); and Physical Therapy Consultants, Fuquay-Varina, North Carolina (RWB)
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Kushner DS, Johnson-Greene D, Felix ER, Miller C, Cordero MK, Thomashaw SA. Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients. PLoS One 2023; 18:e0286296. [PMID: 37228065 DOI: 10.1371/journal.pone.0286296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge destinations following inpatient-rehabilitation (IR) in this patient population, thus this study. OBJECTIVES To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients. METHODS Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination. RESULTS 81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001). CONCLUSIONS Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination.
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Affiliation(s)
- David S Kushner
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Doug Johnson-Greene
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Elizabeth R Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Cheryl Miller
- Therapy Operations, Encompass Health Corporation, Birmingham, Alabama, United States of America
| | - Maite K Cordero
- Therapy Operations, Encompass Health Corporation, Birmingham, Alabama, United States of America
| | - Stacy A Thomashaw
- Therapy Operations, Encompass Health Corporation, Birmingham, Alabama, United States of America
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Ability Realization Improves During Inpatient Rehabilitation for Guillain-Barré Syndrome. Am J Phys Med Rehabil 2022; 101:954-959. [PMID: 34954739 DOI: 10.1097/phm.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to investigate improvement in ability realization and additional long-term outcomes, during and after inpatient rehabilitation for Guillain-Barré syndrome. DESIGN This is a retrospective, longitudinal cohort study, in which outcomes were examined using validated scales, for 47 inpatients with Guillain-Barré syndrome. RESULTS Scores improved from 65 on the American Spinal Injury Association Motor Score and 50 on the Spinal Cord Independence Measure, at admission to inpatient rehabilitation, to 81 and 80 at discharge, and to 92 and 95 at the end of 7.5 yrs, on average, at the follow-up ( P = 0.001). The mean Spinal Cord Independence Measure/American Spinal Injury Association Motor Score ratio, which reflects the ability realization, increased during rehabilitation from 50/65 to 80/81 ( P = 0.001), and tended to increase further at follow-up to 95/92 ( P = 0.228). At follow-up, pain did not correlate, and fatigue showed a weak correlation with the American Spinal Injury Association Motor Score, Spinal Cord Independence Measure, and the Adult Subjective Assessment of Participation ( r = -0.363, P = 0.012; r = -0.362, P = 0.012; r = -0.392, P = 0.006). CONCLUSIONS Ability realization improved during inpatient rehabilitation for Guillain-Barré syndrome and remained high after discharge, suggesting a likely contribution of rehabilitation to the functional outcome, beyond the contribution of neurological recovery. Despite residual fatigue and pain, there was only minor or no effect on daily function or participation.
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7
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Kim JW, Kim YG, Park YC, Choi S, Lee S, Min HJ, Kim MJ. Guillain-Barre Syndrome After Two COVID-19 Vaccinations: Two Case Reports With Follow-up Electrodiagnostic Study. J Korean Med Sci 2022; 37:e58. [PMID: 35191234 PMCID: PMC8860773 DOI: 10.3346/jkms.2022.37.e58] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/17/2022] [Indexed: 11/20/2022] Open
Abstract
Guillain-Barre syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy and commonly occurs after a preceding infection or immunization sequalae. Following the severe acute respiratory syndrome-coronavirus-2 virus pandemic with co-introduction of massive vaccinations, several GBS cases associated with coronavirus disease 2019 (COVID-19) infection per se or after vaccination for COVID-19 were reported internationally. Herein, we report two cases of Korean GBS presenting with tetraplegia after two different COVID-19 vaccinations (42-year old man by AstraZeneca and 48-year woman by Pfizer vaccines) within four weeks after vaccination. The patients were diagnosed with clinical examination, serial electromyography, and compatible laboratory results and improved after comprehensive rehabilitative treatment and intravenous immunoglobulin therapy. Furthermore, we performed an electrodiagnostic follow-up study of each case to examine their unique characteristics.
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Affiliation(s)
- Jun Woo Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Gyun Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yu Chan Park
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Saemi Choi
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Sanggon Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Hye Joon Min
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Siriwardena AN, Akanuwe JNA, Botan V, Laparidou D, Curtis F, Jackson J, Asghar ZB, Hodgson TL. Patient-reported symptoms and experience following Guillain-Barré syndrome and related conditions: Questionnaire development and validation. Health Expect 2021; 25:223-231. [PMID: 34597442 PMCID: PMC8849366 DOI: 10.1111/hex.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Guillain‐Barré syndrome (GBS) is a rare inflammatory peripheral nerve disorder with variable recovery. Evidence is lacking on experiences of people with GBS and measurement of these experiences. Objective We aimed to develop and validate an instrument to measure experiences of people with GBS. Design We used a cross‐sectional design and online self‐administered questionnaire survey. Question domains, based on a previous systematic review and qualitative study, covered experiences of GBS, symptom severity at each stage, healthcare and factors supporting or hindering recovery. Descriptive, exploratory factor and reliability analyses and multivariable regression analysis were used to investigate the relationships between variables of interest, explore questionnaire reliability and validity and identify factors predicting recovery. Setting and Participants People with a previous diagnosis of GBS were recruited through a social media advert. Results A total of 291 responders, of different sexes, and marital statuses, were included, with most diagnosed between 2015 and 2019. Factor analysis showed four scales: symptoms, information provided, factors affecting recovery and care received. Positive social interactions, physical activity including physiotherapy and movement, changes made at home and immunoglobulin treatment were important for recovery. Multivariable models showed that immunoglobulin and/or plasma exchange were significant predictors of recovery. Employment and recovery factors (positive interactions, work support and changes at work or home, physical activity and therapy), though associated with recovery, did not reach statistical significance. Conclusion The questionnaire demonstrated good internal reliability of scales and subscales and construct validity for people following GBS. Patient Contribution Patients were involved in developing and piloting the questionnaire.
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Affiliation(s)
| | - Joseph N A Akanuwe
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Vanessa Botan
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Despina Laparidou
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Ffion Curtis
- Centre for Ethnic Health Research, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Jennifer Jackson
- Community Orgnisation Group, Lincoln International Business School, University of Lincoln, Lincoln, UK
| | - Zahid B Asghar
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Timothy L Hodgson
- Perception Action Cognition, School of Psychology, University of Lincoln, Lincoln, UK
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Ng AH, Molinares DM, Guo Y, Fu J, Bruera E. Functional Impairments and Rehabilitation Outcomes of Patients With Immunotherapy-Induced Acute Inflammatory Demyelinating Polyradiculoneuropathy, Myasthenia Gravis, and Myositis. Am J Phys Med Rehabil 2021; 100:1015-1019. [PMID: 33886237 DOI: 10.1097/phm.0000000000001764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Immunotherapy has led to a higher survival rate among different oncological disease groups but also associated with adverse-related events in multiple organ systems. Immunotherapy-related musculoskeletal weakness often results in a loss of cancer survivors' physical function, ultimately impacting their independence and quality of life. This is a retrospective study of 24 cancer patients who were treated with immunotherapy either alone or in conjunction with other oncological treatments. Twelve subjects (50%) were found to have acute inflammatory demyelinating polyradiculopathy/Guillain-Barré syndrome, six (25%) myositis, two (8%) myasthenia gravis, two (8%) diagnosis of myositis/myasthenia gravis, and one (4%) Guillain-Barré syndrome/myasthenia gravis combination. Physical therapy was provided in 91.7% of the cases, and physiatrist was involved in 54% of the cases. Almost half (45%) were discharged home, six (25%) to acute inpatient rehabilitation, two (8%) to subacute rehabilitation, three (12.5%) to hospice, and two (8%) died. The average length of hospital stay was 30 days, and eight patients (33%) readmitted within 3 mos. Our findings highlight the severity of functional impairments and the need for early rehabilitation interventions.
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Affiliation(s)
- Amy H Ng
- From the Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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10
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Bondi M, Engel-Haber E, Wolff J, Grosman-Rimon L, Bloch A, Zeilig G. Functional outcomes following inpatient rehabilitation of Guillain-Barré syndrome patients: Intravenous immunoglobulins versus plasma exchange. NeuroRehabilitation 2021; 48:543-551. [PMID: 34024788 DOI: 10.3233/nre-201640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment with either Intravenous immunoglobulin (IVIg) or plasma exchange (PE) in patients with Guillain-Barré Syndrome (GBS) showed equivalent efficacy as attested by a commonly used disability scale. However, it has been suggested that this scale may not be sensitive enough to detect subtle functional changes between the two treatments since it mainly focuses on walking capability and respiratory function. OBJECTIVE To evaluate functional outcomes following treatment with IVIg or PE using comprehensive scales that incorporate parameters of basic activities of daily living. METHODS A retrospective cohort study was conducted between 2007 and 2013 in an inpatient neurologic rehabilitation department. The study group included 70 individuals with GBS: 39 were treated with PE and 31 with IVIg. A comparison of functional outcomes was performed using Functional Independence Measure (FIM), rehabilitation efficiency (REy), rehabilitation effectiveness (REs), and the GBS disability scale (GDS). RESULTS Both treatments had a comparable effect on the various functional outcomes. Patients showed a significant increase in total FIM scores (30 points on average) during rehabilitation mainly as a result of an increase in motor sub-scores. A mean improvement of 1.23 (SD 0.9) in GDS was also observed. On average, individuals with GBS spent 20 days combined in the acute departments and 61 days in the rehabilitation department, with length of stay being similar for both treatments. CONCLUSIONS IVIg and PE treatments have similar basic activities of daily living (ADL) functional outcomes. Nevertheless, due to the different mechanism of actions of these treatments and the multitude of GBS variants, it is possible that further comprehensive assessment tools may demonstrate differences in activity and participation of individuals with GBS.
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Affiliation(s)
- Moshe Bondi
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Einat Engel-Haber
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Julie Wolff
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Liza Grosman-Rimon
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.,The Academic College at Wingate, Wingate Institute, Netanya, Israel
| | - Ayala Bloch
- Department of Behavioral Sciences, Ariel University, Ariel, Israel.,The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,School of health professions, Ono academic college, Kiryat Ono, Israel
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11
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Querol L, Crabtree M, Herepath M, Priedane E, Viejo Viejo I, Agush S, Sommerer P. Systematic literature review of burden of illness in chronic inflammatory demyelinating polyneuropathy (CIDP). J Neurol 2020; 268:3706-3716. [PMID: 32583051 PMCID: PMC8463372 DOI: 10.1007/s00415-020-09998-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022]
Abstract
Background Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare neurological disorder characterised by muscle weakness and impaired sensory function. The present study provides a comprehensive literature review of the burden of illness of CIDP. Methods Systematic literature search of PubMed, Embase, and key conferences in May 2019. Search terms identified studies on the epidemiology, humanistic burden, current treatment, and economic burden of CIDP published since 2009 in English. Results Forty-five full texts and nineteen conference proceedings were identified on the epidemiology (n = 9), humanistic burden (n = 7), current treatment (n = 40), and economic burden (n = 8) of CIDP. Epidemiological studies showed incidence and prevalence of 0.2–1.6 and 0.8–8.9 per 100,000, respectively, depending on geography and diagnostic criteria. Humanistic burden studies revealed that patients experienced physical and psychosocial burden, including impaired physical function, pain and depression. Publications on current treatments reported on six main types of therapy: intravenous immunoglobulins, subcutaneous immunoglobulins, corticosteroids, plasma exchange, immunosuppressants, and immunomodulators. Treatments may be burdensome, due to adverse events and reduced independence caused by treatment administration setting. In Germany, UK, France, and the US, CIDP economic burden was driven by direct costs of treatment and hospitalisation. CIDP was associated with indirect costs driven by impaired productivity. Conclusions This first systematic review of CIDP burden of illness demonstrates the high physical and psychosocial burden of this rare disease. Future research is required to fully characterise the burden of CIDP, and to understand how appropriate treatment can mitigate burden for patients and healthcare systems. Electronic supplementary material The online version of this article (10.1007/s00415-020-09998-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis Querol
- Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain.
| | | | - M Herepath
- Optimal Access Life Science Consulting Limited, Swansea, UK
| | | | | | - S Agush
- Huron Consulting Group, London, UK
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12
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Improvement During Inpatient Rehabilitation Among Older Adults With Guillain-Barré Syndrome, Multiple Sclerosis, Parkinson Disease, and Stroke. Am J Phys Med Rehabil 2019; 97:879-884. [PMID: 29952780 DOI: 10.1097/phm.0000000000000991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to quantify the improvement in independence experienced by patients with the following diagnoses: Guillain-Barré syndrome, multiple sclerosis, Parkinson disease, and stroke after inpatient rehabilitation. DESIGN Subjects who were admitted to inpatient rehabilitation hospitals in 2012-2013 with an incident diagnosis of the following: Guillain-Barré syndrome (n = 1079), multiple sclerosis (n = 1438), Parkinson disease (n = 11,834), or stroke (n = 131,313), were included. The main outcome measure was improvement in Functional Independence Measure scores on self-care, mobility, and cognition during inpatient rehabilitation. We estimated percent improvement from a linear mixed-effects model adjusted for patients' age, sex, race/ethnicity, comorbidity count, diagnostic group (Guillain-Barré syndrome, multiple sclerosis, Parkinson disease, and stroke), and admission score. RESULTS All patient diagnostic groups receiving inpatient rehabilitation improved across all three domains. The largest adjusted percent improvements were observed in the mobility domain and the smallest in the cognition domain for all groups. Percent improvement in mobility ranged from 84.9% (multiple sclerosis) to 144.0% (Guillain-Barré syndrome), self-care from 49.5% (multiple sclerosis) to 84.1% (Guillain-Barré syndrome), and cognition from 34.0% (Parkinson disease) to 51.7% (Guillain-Barré syndrome). Patients with Guillain-Barré syndrome demonstrated the greatest percent improvement across all three domains. CONCLUSIONS Patients with Guillain-Barré syndrome, multiple sclerosis, Parkinson disease, and stroke should improve during inpatient rehabilitation but anticipated outcomes for patients with Guillain-Barré syndrome should be even higher.
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Hojan K, Wruk B, Tymińska A, Kurnatowski J, Norman H. Comprehensive rehabilitation treatment for pregnant women with Guillain-Barré syndrome - a case report. REHABILITACJA MEDYCZNA 2019. [DOI: 10.5604/01.3001.0013.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute demyelinating poliradioculopathy and autoimmune condition, with a fast rapid natural course, and with high disability and usually episodic immune treatment. Clinical features include areflexia, limb weakness and uncommonly, sensory loss proceeding to neuromuscular paralysis involving bulbar, facial and respiratory function with maximum severity of symptoms atin 2-4 weeks. The eEtiology of GBS is not incompletely understood, however, prognosis is usually good with early detection and prompt treatment. In thise paper, we present a unique case of comprehensive rehabilitation treatment for a pregnant woman with GBS atin the 8th week of pregnancy. On the basis of this case report, we discuss possible and safe rehabilitation treatment for women in the first trimester of pregnancy, with significantly weakened muscle strength, after stabilizsation of vital signs and immunotherapy. The paper describes comprehensive care provided to the pregnant woman with teraplegia, hyperstesia and dysphagia after stabiliszation of vital signs, which was conducted until delivery atin the 39th week of pregnancy.
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Affiliation(s)
- Katarzyna Hojan
- Oddział Rehabilitacji Neurologicznej, Bonifraterskie Centrum Rehabilitacji, Piaski / Neurorehabilitation Unit at Bonifratres Rehabilitation Centre, Piaski, Poland Oddział Rehabilitacji, Wielkopolskie Centrum Onkologii, Pozna / Department of Rehabilitation at the Greater Poland Cancer Centre, Poznan, Poland
| | - Berenika Wruk
- Oddział Rehabilitacji Neurologicznej, Bonifraterskie Centrum Rehabilitacji, Piaski / Neurorehabilitation Unit at Bonifratres Rehabilitation Centre, Piaski, Poland
| | - Anna Tymińska
- Oddział Rehabilitacji Neurologicznej, Bonifraterskie Centrum Rehabilitacji, Piaski / Neurorehabilitation Unit at Bonifratres Rehabilitation Centre, Piaski, Poland
| | - Jan Kurnatowski
- Oddział Rehabilitacji Neurologicznej, Bonifraterskie Centrum Rehabilitacji, Piaski / Neurorehabilitation Unit at Bonifratres Rehabilitation Centre, Piaski, Poland
| | - Hanna Norman
- Oddział Rehabilitacji Neurologicznej, Bonifraterskie Centrum Rehabilitacji, Piaski / Neurorehabilitation Unit at Bonifratres Rehabilitation Centre, Piaski, Poland
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Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculopathy resulting in severe impairments of many body structures and functions with consequent limitations of activities and participation. The aim of our study was to evaluate rehabilitation outcome in these patients. Forty-five (20 women, 25 men) with GBS patients who had completed primary comprehensive rehabilitation were included in the study. Medical Research Council Scale for Muscle Strength was used for assessment of lower-limb function. Patients' activities were assessed using the Functional Independence Measure and two walking tests (6 min and 10 m). The patients were also described using an adapted International Classification of Functioning, Disability and Health checklist. Assessment was performed at admission and at discharge. Clinically important and statistically significant improvements were found in all outcome measures. Strong and significant correlations were found between the outcome measures. International Classification of Functioning, Disability and Health coding also clearly reflected the progress. Improvement in patients' activities increased statistically significantly with time for up to 3 months of rehabilitation. The outcome was not related to the time interval from establishing the diagnosis to the start of rehabilitation. Hence, multidisciplinary care for GBS patients is effective, because clinically important and statistically significant improvements regarding body functions and activities are achieved during relatively short inpatient rehabilitation.
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Rougé A, Lemarié J, Gibot S, Bollaert PE. Long-term impact after fulminant Guillain-Barré syndrome, case report and literature review. Int Med Case Rep J 2016; 9:357-363. [PMID: 27853394 PMCID: PMC5106230 DOI: 10.2147/imcrj.s112050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 47-year-old man was admitted to the intensive care unit a few hours after presenting to emergency department with acute diplopia and dysphonia. Swallowing disorders and respiratory muscular weakness quickly required invasive ventilation. On day 3, the patient was in a “brain-death”-like state with deep coma and absent brainstem reflexes. Electroencephalogram ruled out brain death diagnosis as a paradoxical sleep trace was recorded. Cerebrospinal fluid analysis, electrophysiologic studies, and a recent history of diarrhea led to the diagnosis of Campylobacter jejuni-related fulminant Guillain-Barré syndrome (GBS) mimicking brain death. The outcome was favorable after long Intensive Care Unit and inpatient rehabilitation stays, despite persistent disability at 9 years follow-up. This case and the associated literature review of 34 previously reported fulminant GBS patients emphasize the importance of electrophysiological investigations during clinical brain-death states with no definite cause. Fulminant GBS has a worse outcome than “standard” GBS with higher rates of severe disability (about 50%). Long-term physiotherapy and specific rehabilitation programs appear essential to improve recovery.
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Affiliation(s)
- Alain Rougé
- Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Jérémie Lemarié
- Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Sébastien Gibot
- Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Pierre Edouard Bollaert
- Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France
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Turner-Stokes L, Vanderstay R, Stevermuer T, Simmonds F, Khan F, Eagar K. Comparison of Rehabilitation Outcomes for Long Term Neurological Conditions: A Cohort Analysis of the Australian Rehabilitation Outcomes Centre Dataset for Adults of Working Age. PLoS One 2015; 10:e0132275. [PMID: 26167877 PMCID: PMC4500577 DOI: 10.1371/journal.pone.0132275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/11/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe and compare outcomes from in-patient rehabilitation (IPR) in working-aged adults across different groups of long-term neurological conditions, as defined by the UK National Service Framework. DESIGN Analysis of a large Australian prospectively collected dataset for completed IPR episodes (n = 28,596) from 2003-2012. METHODS De-identified data for adults (16-65 years) with specified neurological impairment codes were extracted, cleaned and divided into 'Sudden-onset' conditions: (Stroke (n = 12527), brain injury (n = 7565), spinal cord injury (SCI) (n = 3753), Guillain-Barré syndrome (GBS) (n = 805)) and 'Progressive/stable' conditions (Progressive (n = 3750) and Cerebral palsy (n = 196)). Key outcomes included Functional Independence Measure (FIM) scores, length of stay (LOS), and discharge destination. RESULTS Mean LOS ranged from 21-57 days with significant group differences in gender, source of admission and discharge destination. All six groups showed significant change (p<0.001) between admission and discharge that was likely to be clinically important across a range of items. Significant between-group differences were observed for FIM Motor and Cognitive change scores (Kruskal-Wallis p<0.001), and item-by-item analysis confirmed distinct patterns for each of the six groups. SCI and GBS patients were generally at the ceiling of the cognitive subscale. The 'Progressive/stable' conditions made smaller improvements in FIM score than the 'Sudden-onset conditions', but also had shorter LOS. CONCLUSION All groups made gains in independence during admission, although pattern of change varied between conditions, and ceiling effects were observed in the FIM-cognitive subscale. Relative cost-efficiency between groups can only be indirectly inferred. Limitations of the current dataset are discussed, together with opportunities for expansion and further development.
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Affiliation(s)
- Lynne Turner-Stokes
- King’s College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- * E-mail:
| | - Roxana Vanderstay
- King’s College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Tara Stevermuer
- University of Wollongong, Australasian Rehabilitation Outcomes Centre / Australian Health Services Research Institute, Wollongong, Australia
| | - Frances Simmonds
- University of Wollongong, Australasian Rehabilitation Outcomes Centre / Australian Health Services Research Institute, Wollongong, Australia
| | - Fary Khan
- University of Melbourne and Royal Melbourne Hospital, Department of Rehabilitation, Melbourne, Australia
| | - Kathy Eagar
- University of Wollongong, Australasian Rehabilitation Outcomes Centre / Australian Health Services Research Institute, Wollongong, Australia
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