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Braga MAF, Faria-Fortini I, Soares CLDA, Rodrigues NAG, Sant Anna RV, Faria CDCDM. Acute clinical outcomes predict both generic and specific health-related quality of life six and 12 months after stroke: A one-year prospective study developed in a middle-income country. J Stroke Cerebrovasc Dis 2024; 33:107777. [PMID: 38795794 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107777] [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: 10/20/2023] [Revised: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVE To identify acute predictors of generic and specific health-related quality of life (HRQoL) six and 12 months after stroke in individuals from a middle-income country. MATERIAL AND METHODS This was a prospective study. The dependent outcomes assessed during six and 12 months after stroke included both generic and specific HRQoL (Short Form Health Survey-36 [SF-36] and stroke-specific quality of life [SSQOL]). The predictors were age, sex, education level, length of hospital stay, current living arrangement, stroke severity, functional independence, and motor impairment. RESULTS 122 (59.9±14 years) and 103 (59.8±14.71 years) individuals were evaluated six and 12 months after stroke, respectively. Functional independence and sex were significant acute predictors of both generic and specific HRQoL. Functional independence was the strongest predictor (0.149≤R2≤0.262; 20.01≤F≤43.96, p<0.001), except for generic HRQoL at 12 months, where sex was the strongest predictor (R2=0.14; F=17.97, p<0.001). CONCLUSION Generic and specific HRQoL in chronic individuals six and 12 months after stroke, from a middle-income country, can be predicted based on functional independence, the strongest predictor, assessed in the acute phase, except for generic HRQoL at 12 months. Functional independence can be modified by rehabilitation strategies and thus should be considered for HRQoL prognoses at chronic phase.
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Affiliation(s)
- Marcela Aline Fernandes Braga
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Graduate Program in Occupation Studies of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, (MG), Brazil
| | - Carolina Luísa de Almeida Soares
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Physiotherapy graduation in Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | | | - Romeu Vale Sant Anna
- Neurologist, coordinator of the stroke unit at the public hospital Risoleta Tolentino Neves, Belo Horizonte, (MG), Brazil
| | - Christina Danielli Coelho de Morais Faria
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Department of Physical Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil.
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Xue K, Li W, Liu F, Liu X, Wong J, Zhou M, Cai C, Long J, Li J, Zhang Z, Hou W, Nie G, Wang Y. Evaluation of activities of daily living using an electronic version of the Longshi Scale in patients with stroke: reliability, consistency, and preference. BMC Med Inform Decis Mak 2024; 24:125. [PMID: 38750562 PMCID: PMC11094909 DOI: 10.1186/s12911-024-02508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The Longshi Scale is a pictorial assessment tool for evaluating activities of daily living (ADL) in patients with stroke. The paper-based version presents challenges; thus, the WeChat version was created to enhance accessibility. Herein, we aimed to validate the inter-rater and test-retest reliabilities of the WeChat version of the Longshi Scale and explore its potential clinical applications. METHODS We recruited 115 patients with stroke in the study. The ADL results of each patient were assessed using both the WeChat and paper-based version of the Longshi Scale; each evaluation was conducted by 28 health professionals and 115 caregivers separately. To explore the test-retest reliability of the WeChat version, 22 patients were randomly selected and re-evaluated by health professionals using the WeChat version. All evaluation criteria were recorded, and all evaluators were surveyed to indicate their preference between the two versions. RESULTS Consistency between WeChat and the paper-based Longshi Scale was high for ADL scores by health professionals (ICC2,1 = 0.803-0.988) and caregivers (ICC2,1 = 0.845-0.983), as well as for degrees of disability (κw = 0.870 by professionals; κw = 0.800 by caregivers). Bland-Altman analysis showed no significant discrepancies. The WeChat version exhibited good test-retest reliability (κw = 0.880). The WeChat version showed similar inter-rater reliability in terms of the ADL score evaluated using the paper-based version (ICC2,1 = 0.781-0.941). The time to complete assessments did not differ significantly, although the WeChat version had a shorter information entry time (P < 0.001, 95% confidence interval: -43.463 to -15.488). Health professionals favored the WeChat version (53.6%), whereas caregivers had no significant preference. CONCLUSIONS The WeChat version of the Longshi Scale is reliable and serves as a suitable alternative for health professionals and caregivers to assess ADL levels in patients with stroke. The WeChat version of the Longshi Scale is considered user-friendly by health professionals, although it is not preferred by caregivers. TRIAL REGISTRATION This study was approved by the Ethics Committee of the Second People's Hospital of Shenzhen (approval number: 20210812003-FS01) and registered on the Clinical Trial Register Center website: clinicaltrials.gov on January 31, 2022 (registration no.: NCT05214638).
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Affiliation(s)
- Kaiwen Xue
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Weihao Li
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Fang Liu
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Xiangxiang Liu
- National Clinical Research Center for Infectious Disease of Shenzhen; Shenzhen Third People's Hospital, Shenzhen, China
| | - John Wong
- School of Nursing and Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Mingchao Zhou
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Chunli Cai
- Operation Department, Shenzhen Yilanda Technology Co. Ltd., Shenzhen, China
| | - Jianjun Long
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Jiehui Li
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Zeyu Zhang
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Weilin Hou
- Department of Rehabilitation, Changzhou Hospital of Traditional Chinese Medicine, Jiangsu, China.
| | - Guohui Nie
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China.
| | - Yulong Wang
- Department of Rehabilitation, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China.
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Zhang W, Mei Z, Feng Z, Li B. Effects of a nurse-led eHealth programme on functional outcomes and quality of life of patients with stroke: a pooled analysis of randomized controlled trials. Front Public Health 2024; 12:1395270. [PMID: 38737865 PMCID: PMC11082325 DOI: 10.3389/fpubh.2024.1395270] [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: 03/03/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Background Stroke remains a leading cause of disability worldwide. Nurse-led eHealth programs have emerged as a potentially effective strategy to improve functional outcomes and quality of life in stroke survivors. However, the variability of study designs and outcomes measured across trials necessitates a pooled analysis to comprehensively assess the efficacy of these interventions. This protocol outlines the methodology for a pooled analysis that aims to synthesize evidence from randomized controlled trials (RCTs) evaluating nurse-led eHealth interventions for stroke patients. Methods and analysis This pooled analysis will be conducted according to the PRISMA guidelines. We will include RCTs that evaluate nurse-led eHealth programs and report on functional outcomes or quality of life in stroke patients. Comprehensive searches of electronic databases including Pubmed, EMBASE, the Cochrane Library, CINAHL, and PsycINFO will be conducted with a predefined search strategy. Study selection will involve screening titles and abstracts, followed by full-text review using explicit inclusion and exclusion criteria. Data extraction will be undertaken independently by two reviewers. The risk of bias will be assessed through the Cochrane Risk of Bias tool. Additionally, the quality of evidence for each outcome will be evaluated using the GRADE approach. Meta-analyses will be performed using random-effects models, and heterogeneity will be quantified using the I2 statistic. Subgroup and sensitivity analyses will explore potential sources of heterogeneity. Discussion and conclusions This pooled analysis is poised to provide a nuanced understanding of the effectiveness of nurse-led eHealth programs in stroke rehabilitation, leveraging a thorough methodological framework and GRADE tool to ensure robustness and reliability of evidence. The investigation anticipates diverse improvements in patient outcomes, underscoring the potential of personalized, accessible eHealth interventions to enhance patient engagement and treatment adherence. Despite the challenges posed by the heterogeneity of interventions and rapid technological advancements, the findings stand to influence clinical pathways by integrating eHealth into standard care, if substantiated by the evidence. Our study's depth and methodological rigor possess the potential to initiate changes in healthcare policy, advocating for the adoption of eHealth and subsequent investigations into its cost-efficiency. Ultimately, we aim to contribute rich, evidence-based insights into the burgeoning field of digital health, offering a foundational assessment of its applications in stroke care. Our data is expected to have a lasting impact, not only guiding immediate clinical decisions but also shaping the trajectory of future healthcare strategies in stroke recovery. Systematic review registration Identifier (CRD42024520100: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=520100).
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Affiliation(s)
- Wei Zhang
- Department of Neurology, Xinxiang Central Hospital, The Fourth Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Zaibang Feng
- Department of Rehabilitation Medicine and Physiotherapy, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Bin Li
- Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Zhou J, Zha F, Liu F, Wan L, Zhou M, Long J, Chen M, Xue K, Wang Y. Reliability and validity of a graphical computerized adaptive test Longshi scale for rapid assessment of activities of daily living in stroke survivors. Sci Rep 2024; 14:7625. [PMID: 38561344 PMCID: PMC10985115 DOI: 10.1038/s41598-024-57671-1] [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: 10/09/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Stroke survivors frequently experience difficulties in daily activities, such as bathing, feeding, and mobility. This study aimed to evaluate the reliability and validity of a computer-adaptive test-Longshi scale (CAT-LS) for assessing activities of daily living (ADL) in stroke survivors. This cross-sectional study collected data using an electronic application. The ADL function of stroke survivors in rehabilitation departments of hospitals was assessed using both the CAT-LS and BI. Correlations between the CAT-LS and Barthel index (BI) and concurrent validity were evaluated using Pearson's correlation test and multiple linear regression. Interrater reliability was evaluated using the intraclass correlation coefficient based on a two-way random effect. The internal consistency of the CAT-LS was assessed using Cronbach's coefficient (α) and corrected item-total correlations. Overall, 103 medical institutions in China were used in this study. In total, 7151 patients with stroke were included in this study. The CAT-LS classified patients into three ADL groups (bedridden, domestic, and community) with significantly different BI scores (P < 0.05). The CAT-LS results obtained using the decision-tree scoring model were consistent with the scores for each BI item. A strong correlation was observed between CAT-LS and BI (Pearson's r: 0.6-0.894, P < 0.001). The CAT-LS demonstrated good internal consistency (Cronbach's α, 0.803-0.894) and interrater reliability (ICC, 0.928-0.979). CAT-LS is time-efficient and requires < 1 min to administer. The CAT-LS is a reliable and valid tool for assessing ADL function in stroke survivors and can provide rapid and accurate assessments that reduce the burden on healthcare professionals. Further validation of this tool in other populations and settings is necessary.Study registration number: No.: ChiCTR2000034067; http://www.chictr.org.cn/showproj.aspx?proj=54770 .
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Affiliation(s)
- Jing Zhou
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
- Department of Neurology, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Biological Science, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Fubing Zha
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Fang Liu
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Li Wan
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Mingchao Zhou
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Jianjun Long
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Miaoling Chen
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Kaiwen Xue
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China.
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Yan J, Zhang Q, Zhou J, Zha F, Gao Y, Li D, Zhou M, Zhao J, Feng J, Ye L, Wang Y. Inverted U-shaped relationship between Barthel Index Score and falls in Chinese non-bedridden patients: a cross-sectional study. Top Stroke Rehabil 2024:1-11. [PMID: 38402602 DOI: 10.1080/10749357.2024.2318089] [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: 06/02/2023] [Accepted: 02/04/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Performing activities of daily living comprise an important risk factor for falls among non-bedridden stroke inpatients in rehabilitation departments. OBJECTIVES To explore the correlation between Barthel Index score and the occurrence of falls in non-bedridden stroke rehabilitation inpatients. METHODS In this cross-sectional study, information of patients grouped as non-bedridden patients by the Longshi Scale was collected. RESULTS A total of 3097 patients were included in this study, with a fall incidence of 10.43%. After adjusting covariates, the total score of Barthel Index and falls in non-bedridden inpatients after stroke presented an inverted U-shaped curve relationship, in which inflection point was 60. The effect sizes on the left and right sides of infection point were 1.02 (95%CI 1.00-1.04) and 0.97 (95%CI 0.96-0.99), respectively. CONCLUSIONS Non-bedridden stroke patients with moderate activities of daily living (ADL) capacity may be at particularly increased risk of falls in rehabilitation departments.
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Affiliation(s)
- Jie Yan
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Qingfang Zhang
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
- Department of Rehabilitation, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jing Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Fubing Zha
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yan Gao
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Dongxia Li
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Mingchao Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Jingpu Zhao
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Jun Feng
- Department of Rehabilitation, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Liang Ye
- Department of Rehabilitation, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Yulong Wang
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
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Gyabaah S, Adu-Boakye Y, Sarfo-Kantanka O, Gyan KF, Kokuro C, Agyei M, Akassi J, Tawiah P, Norman B, Ovbiagele B, Sarfo FS. Frequency & factors associated with elevated lipoprotein-a among Ghanaian stroke survivors. J Neurol Sci 2024; 456:122839. [PMID: 38103418 DOI: 10.1016/j.jns.2023.122839] [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: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Indigenous Africans are genetically predisposed to elevated lipoprotein-a (Lp(a)), a veritable risk factor for ischemic stroke. Recent studies have demonstrated the promising efficacy of therapeutic interventions for addressing elevated Lp(a) among patients at high risk of atherosclerotic cardiovascular events. It is important to assess the burden of elevated Lp(a) among stroke survivors of African ancestry aimed at addressing potential unmet therapeutic gaps for optimal secondary prevention. PURPOSE To assess the frequency of elevated lipoprotein-a among Ghanaian stroke survivors and factors associated with it. METHODS A prospective study conducted at the Neurology clinic of the Komfo Anokye Teaching Hospital among ischemic stroke survivors aged ≥18 years. Serum lipoprotein-a concentrations were measured using ELISA kits. A multivariate regression analysis was fitted to identify factors independently associated with elevated lipoprotein-a concentration > 30 mg/dl. RESULTS Among 116 stroke survivors, 35 (30.2%) had elevated Lp(a). The adjusted odds ratio (95% CI) of factors associated with elevated Lp(a) were female sex 3.09 (1.05-9.12), p = 0.04, diabetes mellitus 3.52 (1.32-9.40), p = 0.01, urban dwelling 4.64 (1.61-13.39), p = 0.005 and total cholesterol 1.85 (1.28-2.67), p = 0.001. Whereas the LDL cholesterol significantly decreased from baseline to month 12 among a subset of participants, the Lp(a) levels significantly increased from a baseline value of 29.38 ± 15.32 mg/dl to 40.97 ± 29.72 mg/dl, p = 0.032. CONCLUSION Approximately 1 in 3 Ghanaian ischemic stroke survivors harbor an elevated Lp(a) associated with female sex, urban residence, diabetes mellitus and raised cholesterol. This burden highlights an unmet therapeutic gap in secondary risk reduction in this resource-limited setting.
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Affiliation(s)
| | - Yaw Adu-Boakye
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Osei Sarfo-Kantanka
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Collins Kokuro
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Martin Agyei
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - John Akassi
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Phyllis Tawiah
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Betty Norman
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Fred Stephen Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
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Huang W, Zhang M, Wang W, Luo F, Li J, Zhang Y, Lin J, Zou X, Cai G. Neuronavigation-assisted microsurgical clipping of pericallosal aneurysms: A single-center retrospective study. Clin Neurol Neurosurg 2023; 233:107905. [PMID: 37515855 DOI: 10.1016/j.clineuro.2023.107905] [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: 05/17/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
Surgical clipping of pericallosal artery aneurysm is technically challenging since it is fragile and tends to rupture accidentally during the operation. This study was aimed to evaluate the efficacy and safety of MRI-neuronavigation-assisted microsurgery for pericallosal artery aneurysm clipping. Forty patients diagnosed with pericallosal artery aneurysms who underwent craniotomy clipping were enrolled. Among these patients, 18 cases accepted routine surgical approaches, while another 22 cases accepted MRI-neuronavigation-assisted microsurgery. Design of craniotomy, operation pathway, operation duration, intraoperative cerebral protection and superior drainage vein protection were analyzed retrospectively. All the 40 cases underwent aneurysm clipping by pre-coronal inter-hemispheric approach, and all aneurysms were clipped completely confirmed by postoperative CTA or DSA. During the operations, MRI-neuronavigation provided precise spatial configuration of pericallosal artery aneurysms, and allowed accurate and real-time identification for the adjacent arteries and brain structures, and no aneurysms ruptured accidentally during the operations. Functional cortex and draining veins were protected well. Compared with routine surgical approaches, the MRI-neuronavigation-assisted microsurgery showed less operation duration, few adverse events induced by accurate location for aneurysm and less invasion to draining veins. Therefore, MRI-neuronavigation-assisted microsurgery could precisely locate the pericallosal artery aneurysm, optimize surgical approaches, and help to cerebral protection. It is expected to reduce the surgical risk and improve the precision and security, can be regarded as an effective technology in the clipping of pericallosal artery aneurysms.
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Affiliation(s)
- Wei Huang
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China
| | - Mingsheng Zhang
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China
| | - Wenhao Wang
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China.
| | - Fei Luo
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China.
| | - Jun Li
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China
| | - Yuan Zhang
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China
| | - Junming Lin
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China
| | - Xiaojun Zou
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China
| | - Genping Cai
- Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China
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Zhou M, Zha F, Liu F, Zhou J, Liu X, Li J, Yang Q, Zhang Z, Xiong F, Hou D, Weng H, Wang Y. Long-term care status for the elderly with different levels of physical ability: a cross-sectional survey in first-tier cities of China. BMC Health Serv Res 2023; 23:953. [PMID: 37674190 PMCID: PMC10481569 DOI: 10.1186/s12913-023-09987-3] [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: 01/05/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Long term care (LTC) services for functionally impaired senior citizens are crucial for addressing the challenges of aging. However, research on eligibility criteria and coverage of LTC in China is lacking. Our objective is to assess the current status of LTC and explore eligibility criteria and coverage for the elderly. METHODS This is a cross-sectional study conducted in two first-tier cities in China. Residents aged 65 or over were recruited from a nursing home and four primary hospitals. Participants were divided into three groups (bedridden, domestic, and community), then six grades (grade one to six) according to the Longshi Scale, and their functional ability was assessed using the Modified Barthel Index. Information such as diseases, complications, and daily care needs were collected. Nursing staff were invited to indicate patients' needs for care. A one-way ANOVA test, Kruskal Wallis H test and Mann-Whitney U test were used to explore the differences of variables in three Longshi groups or Longshi grades. RESULTS Among all 1157 participants, with an average age of 80.54, 69.3% were in the bedridden group. The most common diagnosis was stroke (71.4%), with the most prevalent complication being pulmonary infection (25.2%). In the nursing assessment, basic health care, disease care, activity care, complication prevention care and psychosocial care were summarized as the five main aspects of LTC for the elderly. Feeding, bathing, drinking, bowel management and bladder management were identified as the basic care which fulfills participants' basic physical needs in each Longshi group. Mouth care, artificial airway management, and body reposition, which can prevent immobility complications, were highly demanded by bedridden elderly. CONCLUSIONS The elderly in grade one to three are the ones in need of LTC most. The content of LTC for elderly should include basic care which fulfills their basic physical needs and complication care which can prevent immobility complications. The evidence of this research may contribute to the design of LTC in China. TRIAL REGISTRATION The study design was registered in the Chinese Clinical Trial Registry (ChiCTR-2000034067, Registered 22 Jun 2020, http://www.chictr.org.cn/showproj.aspx?proj=54770 ).
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Affiliation(s)
- Mingchao Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Fubing Zha
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Fang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Jing Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Xiangxiang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Jiehui Li
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qingqing Yang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zeyu Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Feng Xiong
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Dianrui Hou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Hongyun Weng
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Yulong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China.
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9
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Zhu W, Deng S, Jiang H, Zhang J, Li B, Jia Q, Meng Z. Assessment of corticospinal tract remodeling based on diffusion tensor imaging in the treatment of motor dysfunction after ischemic stroke by acupuncture: A meta-analysis. Medicine (Baltimore) 2023; 102:e34618. [PMID: 37565876 PMCID: PMC10419801 DOI: 10.1097/md.0000000000034618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND To investigate the efficacy of acupuncture in improving motor dysfunction after ischemic stroke (IS) and to investigate the effect of acupuncture on corticospinal tract (CST) remodeling using diffusion tensor imaging. METHODS Published literature on the effect of acupuncture on CST remodeling after IS using diffusion tensor imaging in the form of randomized controlled trials (RCTs) were systematically retrieved and screened from Cochrane Library, Web of Science, PubMed, Embase, CNKI, CBM, VIP, and Wanfang databases from inception to December 2022. The methodological quality of the included studies was critically and independently evaluated by 2 reviewers using the Cochrane Risk of Bias Assessment Tool for RCTs. The correlated data were extracted using the pre-designed form, and all analyses were performed using Reviewer Manager version 5.4. RESULTS Eleven eligible RCTs involving 459 patients were eventually included. The combined evidence results showed that the acupuncture group significantly improved patients' National Institute of Health stroke scale, Fugl-Meyer Assessment Scale, and Barthel index compared with conventional medical treatment. The acupuncture group significantly promoted remodeling of the CST, as reflected by an increase in fractional anisotropy (FA) throughout the CST [MD = 0.04, 95% CI (0.02, 0.07), P = .001], and in addition, subgroup analysis showed that the acupuncture group significantly improved FA in the infarct area compared with conventional medical treatment at around 4 weeks [MD = 0.04, 95% CI (0.02, 0.06), P = .0002] and FA of the affected cerebral peduncle [MD = 0.03, 95% CI (0.00, 0.07), P = .02]. Also, compared with conventional medical treatment, the acupuncture group significantly increased average diffusion coefficient of the affected cerebral peduncle [MD = -0.21, 95% CI (-0.28, -0.13), P < .00001]. CONCLUSION The results of the meta-analysis suggest that acupuncture therapy can improve the clinical manifestations of motor dysfunction in patients after IS and advance a possibly beneficial effect on CST remodeling. However, due to the number and quality of eligible studies, these findings need to be further validated in more standardized, rigorous, high-quality clinical trials.
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Affiliation(s)
- Weiming Zhu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shizhe Deng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hailun Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jieying Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Boxuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qingqing Jia
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhihong Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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10
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Onishi R, Hatakeyama Y, Hirata K, Matsumoto K, Seto K, Wu Y, Kitazawa T, Hasegawa T. Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan. BMC Geriatr 2023; 23:235. [PMID: 37072735 PMCID: PMC10114477 DOI: 10.1186/s12877-023-03957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Maintenance of activities of daily living (ADL) during acute hospitalization is an important treatment goal, especially for elderly inpatients with diseases that often leave disabilities, such as cerebral infarction. However, studies assessing risk-adjusted ADL changes are limited. In this study, we developed and calculated a hospital standardized ADL ratio (HSAR) using Japanese administrative claims data to measure the quality of hospitalization care for patients with cerebral infarction. METHODS This study was designed as a retrospective observational study using the Japanese administrative claim data from 2012 to 2019. The data of all hospital admissions with a primary diagnosis of cerebral infarction (ICD-10, I63) were used. The HSAR was defined as the ratio of the observed number of ADL maintenance patients to the expected number of ADL maintenance patients multiplied by 100, and ratio of ADL maintenance patients was risk-adjusted using multivariable logistic regression analyses. The c-statistic was used to evaluate the predictive accuracy of the logistic models. Changes in HSARs in each consecutive period were assessed using Spearman's correlation coefficient. RESULTS A total of 36,401 patients from 22 hospitals were included in this study. All variables used in the analyses were associated with ADL maintenance, and evaluations using the HSAR model showed predictive ability with c-statistics (area under the curve, 0.89; 95% confidence interval, 0.88-0.89). CONCLUSIONS The findings indicated a need to support hospitals with a low HSAR because hospitals with high/low HSAR were likely to produce the same results in the subsequent periods. HSAR can be used as a new quality indicator of in-hospital care and may contribute to the assessment and improvement of the quality of care.
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Affiliation(s)
- Ryo Onishi
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Yosuke Hatakeyama
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Koki Hirata
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Kunichika Matsumoto
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Kanako Seto
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan
| | - Yinghui Wu
- School of Nursing, Shanghai Jiao Tong University, 800 Dongchuan RD, Minhang District, Shanghai, 200240, China
| | - Takefumi Kitazawa
- Department of Nursing, Faculty of Health Sciences, Tokyo Kasei University, 2-15-1, Inariyama, Sayama, 350-1398, Japan
| | - Tomonori Hasegawa
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-Ku, Tokyo, 143-8540, Japan.
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11
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Li D, Zha F, Wang Y. Association Between Falling and Activities of Daily Living Measured by the Longshi Scale in Patients Poststroke: A Cross-sectional Study. J Nurs Care Qual 2023; 38:E25-E31. [PMID: 36729956 DOI: 10.1097/ncq.0000000000000679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Activities of daily living comprise an important risk factor for falls among patients who have suffered a stroke. PURPOSE To investigate the incidence of falls in patients with stroke, categorized by their Longshi grades (bedridden, domestic, community), and to explore their risk factors for falls. METHODS A cross-sectional descriptive design was used. Patients completed a survey during face-to-face interviews. RESULTS Of the 869 participants, 15.7% experienced a fall. Those in the domestic Longshi group had the highest rate of falls. Approximately 30% experienced either a moderate or severe injury as a result of falling. In addition, being older than 70 years was significantly correlated with fall risk. Intermediate Longshi grades, from moderately dependent to slightly dependent, were also positively correlated with falls. CONCLUSION Patients with stroke in the domestic Longshi group have a higher rate of falls. The risk of falling increased significantly in those with intermediate Longshi grades.
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Affiliation(s)
- Dongxia Li
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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12
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Liu X, Gao Y, Zhao J, Zhou M, Wan L, Nie G, Wang Y. Reliability of pictorial Longshi Scale for informal caregivers to evaluate the functional independence and disability. Nurs Open 2022; 10:1852-1862. [PMID: 36336801 PMCID: PMC9912417 DOI: 10.1002/nop2.1448] [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: 02/07/2022] [Revised: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
AIM The pictorial Longshi Scale was designed to assess patients' functional ability in the Chinese context, which is gradually used by some informal caregivers. However, its reliability compared with healthcare professionals has not been examined. DESIGN A multi-centre cross-sectional study conducted in 24 Chinese hospitals. METHODS We recruited patients undergoing rehabilitation treatment and informal caregiver dyads. Informal caregivers and healthcare professionals evaluated patients' functional ability using the Longshi Scale according to three levels (bedridden, domestic and community). The Kappa coefficient and McNemar-Bowker test were used to examine the consistency and accuracy between the two parallel assessments. RESULTS This study involved 947 patients (mean age: 46.07 ± 11.72 years) and informal caregiver dyads (64.86 ± 12.94 years). Most patients were males (66.3%), while most caregivers were females (60.7%). Over 70% of patients and caregiver dyads had a secondary-school education and lower. Around 90% of caregivers were relatives (spouse, 42.8%; offspring, 20.7%; siblings: 13.3%; parent, 12.0%) of patients. The agreement in sub-levels of the Longshi Scale between caregivers and healthcare professionals ranges from 73%-89%, and the corresponding Kappa coefficients range from 0.504-0.786. Caregivers were more likely to assign fewer patients to the bedridden group and more to the domestic group than healthcare professionals. The subgroup analysis by education level indicated that the difference in assigning patients into three degrees of functional disability was only significant in those with primary-school education, while non-significant in those with secondary-school education and higher. CONCLUSION The evaluation outcomes of functional ability using the Longshi Scale are similar between informal caregivers and healthcare professionals. However, informal caregivers' education level is a dominant factor in affecting the assessment accuracy compared with healthcare professionals. Informal caregivers with a secondary-school education and higher are supported to evaluate patients' functional ability independently.
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Affiliation(s)
- Xiangxiang Liu
- Department of RehabilitationThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenChina
| | - Yan Gao
- Department of RehabilitationThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenChina
| | - Jingpu Zhao
- Department of RehabilitationThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenChina
| | - Mingchao Zhou
- Department of RehabilitationThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenChina
| | - Li Wan
- Department of RehabilitationThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenChina
| | - Guohui Nie
- Department of RehabilitationThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenChina
| | - Yulong Wang
- Department of RehabilitationThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenChina
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Zhou J, Liu F, Zhou M, Long J, Zha F, Chen M, Li J, Yang Q, Zhang Z, Wang Y. Functional status and its related factors among stroke survivors in rehabilitation departments of hospitals in Shenzhen, China: a cross-sectional study. BMC Neurol 2022; 22:173. [PMID: 35546388 PMCID: PMC9092870 DOI: 10.1186/s12883-022-02696-0] [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: 12/28/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many stroke survivors have multiple chronic diseases and complications coupled with various other factors which may affect their functional status. We aimed to investigate the factors associated with poor functional status in hospitalized patients with stroke in Shenzhen, China. Methods In this cross-sectional study, four urban hospitals were selected using convenient sampling, and all stroke patients in these four hospitals were included using cluster sampling. The functional status of stroke survivors was evaluated using Longshi Scale. Explanatory variables (factors affecting functional status comprising age, sex, body mass index, smoking, alcohol consumption, complications, and chronic conditions) were collected. Ordinal logistic regression was used to examine which factors were associated with poor functional status. Results Stroke survivors with poor functional status accounted for 72.14% and were categorised as the bedridden group based on Longshi scale, 21.67% of patients with moderate functional limitation were categorised as the domestic group, and 6.19% of the patients with mild functional restriction were categorised as the community group. The highest dependence scores were noted for feeding (73.39%), bowel and bladder management (69.74%) and entertainment (69.53%) among the bedridden group, and housework (74.29%) among the domestic group. In the adjusted model, the odds of poor functional status were higher among stroke patients with older age (odds ratio [OR] = 2.39, 95% CI: 1.55–3.80), female sex (OR = 1.73, 95% CI: 1.08–2.77), duration of stroke more than 12 months (OR = 1.94, 95% CI: 1.28–2.95), with pulmonary infection (OR = 10.91, 95% CI: 5.81–20.50), and with deep venous thrombosis (OR = 3.00, 95% CI: 1.28–7.04). Conclusions Older adults (age ≥ 60 years) and women were more likely to exhibit poor functional status post-stroke. Pulmonary infection and deep venous thrombosis were related to an increased risk of being dependent on activities of daily living. Therefore, clinical and rehabilitation interventions aimed at preventing or treating these common complications should be addressed to deal with subsequent dysfunction post-stroke. Since all data were obtained in metropolitan areas where the economy is well developed, future studies should be conducted in rural areas and economically less developed cities. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02696-0.
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Affiliation(s)
- Jing Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Fang Liu
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Mingchao Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jianjun Long
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Fubing Zha
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Miaoling Chen
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jiehui Li
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Qingqing Yang
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Zeyu Zhang
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Yulong Wang
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China.
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Liu X, Zhou M, Zhao J, Gao Y, Wang Y, Zhou J, Wan L, Nie G, Wang Y. Functional Independence and Disability Evaluation in Stroke Patients: Optimal Cutoff Scores for a Pictorial-Based Longshi Scale, Barthel Index, and Modified Rankin Scale. Front Neurol 2022; 13:710852. [PMID: 35222236 PMCID: PMC8866832 DOI: 10.3389/fneur.2022.710852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The modified Rankin Scale (mRS) and Barthel Index (BI) are widely used to measure functional outcomes worldwide. The Longshi Scale (LS), a novel pictorial-based instrument, was designed to improve the simplicity and convenience of measuring functional outcomes in the Chinese context. However, the disagreements in functional outcomes assessed by the mRS, BI, and LS are misleading, particularly in stroke patients. This study aimed to identify the optimal cutoff scores of LS and BI according to the mRS in Chinese stroke patients with different levels of functional disability. Methods The mRS, BI, and LS were applied to evaluate functional independence and disability in 7364 stroke patients in a multi-center cross-sectional study. Stroke patients were categorized into bedridden, domestic, and community groups in advance using the LS, indicating severe, moderate, and mild functional disability, respectively. The optimal cut-off scores of the LS and BI according to the mRS were identified via sensitivity, specificity, and Youden's index and stratified by different levels of functional disability determined by LS. We also plotted the receiver operator characteristic (ROC) curves of sensitivity and specificity and determined the area under the curve (AUC). Results In the bedridden group, LS and BI cutoff scores with the highest Youden's index were 5 and 10 for mRS 4, and the AUCs for the ROC curve were 0.848 and 0.863 for mRS 4. In the domestic group, LS and BI cutoff scores with the highest Youden's index were 5 and 65 for mRS 3, and the AUCs for the ROC curve were 0.796 and 0.826 for mRS 3. In the community group, LS cutoff scores with the highest sum of sensitivity and specificity were 9, 9, and 8 for mRS grades 0, 1, and 2, respectively, while the BI cutoff scores with the highest sum of sensitivity and specificity were 100, 100, and 95, respectively, while the AUCs for the ROC curve were 0.697 and 0.735 for mRS 2, 0.694 and 0.716 for mRS 1, and 0.628, and 0.660 for mRS 0. Conclusions The mRS is more precise to determine mild functional disability, whereas BI can provide more specific information on moderate and severe levels in stroke patients. Although LS was a less precise was to determine moderate and severe levels than BI, it is much simpler and more convenient to be applied to a large-scale population.
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Affiliation(s)
- Xiangxiang Liu
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
| | - Mingchao Zhou
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jingpu Zhao
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yan Gao
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yao Wang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
| | - Jing Zhou
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Li Wan
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Guohui Nie
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
- Guohui Nie
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
- *Correspondence: Yulong Wang
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