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Woodfin S, Hall S, Ramerth A, Chapple B, Fausnacht D, Moore W, Alkhalidy H, Liu D. Potential Application of Plant-Derived Compounds in Multiple Sclerosis Management. Nutrients 2024; 16:2996. [PMID: 39275311 PMCID: PMC11397714 DOI: 10.3390/nu16172996] [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: 07/30/2024] [Revised: 08/23/2024] [Accepted: 08/29/2024] [Indexed: 09/16/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by inflammation, demyelination, and neurodegeneration, resulting in significant disability and reduced quality of life. Current therapeutic strategies primarily target immune dysregulation, but limitations in efficacy and tolerability highlight the need for alternative treatments. Plant-derived compounds, including alkaloids, phenylpropanoids, and terpenoids, have demonstrated anti-inflammatory effects in both preclinical and clinical studies. By modulating immune responses and promoting neuroregeneration, these compounds offer potential as novel adjunctive therapies for MS. This review provides insights into the molecular and cellular basis of MS pathogenesis, emphasizing the role of inflammation in disease progression. It critically evaluates emerging evidence supporting the use of plant-derived compounds to attenuate inflammation and MS symptomology. In addition, we provide a comprehensive source of information detailing the known mechanisms of action and assessing the clinical potential of plant-derived compounds in the context of MS pathogenesis, with a focus on their anti-inflammatory and neuroprotective properties.
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Affiliation(s)
- Seth Woodfin
- Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA 24515, USA
| | - Sierra Hall
- Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA 24515, USA
| | - Alexis Ramerth
- Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA 24515, USA
| | - Brooke Chapple
- Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA 24515, USA
| | - Dane Fausnacht
- Department of Biology, School of Sciences and Agriculture, Ferrum College, Ferrum, VA 24088, USA
| | - William Moore
- Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA 24515, USA
| | - Hana Alkhalidy
- Department of Human Nutrition, Foods and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA 24061, USA
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Dongmin Liu
- Department of Human Nutrition, Foods and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA 24061, USA
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Zaidi DA, Yaqoob E, Chaurasia B, Javed S. Addressing stroke care deficiencies in Pakistan: a call for nationwide reforms and strategic initiatives. Neurosurg Rev 2024; 47:396. [PMID: 39093320 DOI: 10.1007/s10143-024-02648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Dua Abbas Zaidi
- Violence, Injury Prevention & Disability Unit, Health Services Academy, Islamabad, Pakistan
| | - Eesha Yaqoob
- Violence, Injury Prevention & Disability Unit, Health Services Academy, Islamabad, Pakistan
- Ministry of National Health Services Regulations and Coordination, Government of Pakistan, Islamabad, Pakistan
| | | | - Saad Javed
- Violence, Injury Prevention & Disability Unit, Health Services Academy, Islamabad, Pakistan
- Ministry of National Health Services Regulations and Coordination, Government of Pakistan, Islamabad, Pakistan
- Registrar Neurosurgery, Brain Surgery Hospital, Research Fellow at Violence, Injury Prevention and Disability Unit, Health Services Academy, Ministry of National Health Services, Regulations … Coordination, Islamabad, Pakistan
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Stanik M, Hass Z, Kong N. Seizure prediction in stroke survivors who experienced an infection at skilled nursing facilities-a machine learning approach. Front Physiol 2024; 15:1399374. [PMID: 38872836 PMCID: PMC11169844 DOI: 10.3389/fphys.2024.1399374] [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: 03/11/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background Infections and seizures are some of the most common complications in stroke survivors. Infections are the most common risk factor for seizures and stroke survivors that experience an infection are at greater risk of experiencing seizures. A predictive model to determine which stroke survivors are at the greatest risk for a seizure after an infection can be used to help providers focus on prevention of seizures in higher risk residents that experience an infection. Methods A predictive model was generated from a retrospective study of the Long-Term Care Minimum Data Set (MDS) 3.0 (2014-2018, n = 262,301). Techniques included three data balancing methods (SMOTE for up sampling, ENN for down sampling, and SMOTEENN for up and down sampling) and three feature selection methods (LASSO, Recursive Feature Elimination, and Principal Component Analysis). One balancing and one feature selection technique was applied, and the resulting dataset was then trained on four machine learning models (Logistic Regression, Random Forest, XGBoost, and Neural Network). Model performance was evaluated with AUC and accuracy, and interpretation used SHapley Additive exPlanations. Results Using data balancing methods improved the prediction performances of the machine learning models, but feature selection did not remove any features and did not affect performance. With all models having a high accuracy (76.5%-99.9%), interpretation on all four models yielded the most holistic view. SHAP values indicated that therapy (speech, physical, occupational, and respiratory), independence (activities of daily living for walking, mobility, eating, dressing, and toilet use), and mood (severity score, anti-anxiety medications, antidepressants, and antipsychotics) features contributed the most. Meaning, stroke survivors who received fewer therapy hours, were less independent, had a worse overall mood were at a greater risk of having a seizure after an infection. Conclusion The development of a tool to predict seizure following an infection in stroke survivors can be interpreted by providers to guide treatment and prevent complications long term. This promotes individualized treatment plans that can increase the quality of resident care.
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Affiliation(s)
- Madeleine Stanik
- Purdue University, Department of Engineering, Weldon School of Biomedical Engineering, West Lafayette, IN, United States
| | - Zachary Hass
- Purdue University, Schools of Industrial Engineering and Nursing, West Lafayette, IN, United States
| | - Nan Kong
- Purdue University, Department of Engineering, Weldon School of Biomedical Engineering, West Lafayette, IN, United States
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Kintrilis N, Kontaxakis A, Philippou A. EFFECT OF RESISTANCE TRAINING THROUGH IN-PERSON AND TELECONFERENCING SESSIONS IN REHABILITATION OF ACUTE STROKE PATIENTS. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2024; 7:18647. [PMID: 38328738 PMCID: PMC10847974 DOI: 10.2340/jrmcc.v7.18647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
Objective To determine whether application of a strength training regimen yields measurable results on stroke survivors and compare different methods for the proposed intervention. Design Patients and Methods Ninety stroke patients were recruited from the neurological clinic of a local third-level clinic. Sixty patients participated in a strength training regimen with trainings taking place 3 times a week for 12 weeks with the use of resistance bands. Thirty of these patients were given face-to-face sessions and 30 patients were given trainings through an on-line platform. The last 30 patients who comprised the control group only followed usual care after the stroke. Results The applied strength regimen had a statistically significant effect on Visual Analog Scale scores of stroke patients who received it (p = 0.009), as well as in the teleconferencing group (p = 0.004). The measured arteriovenous oxygen difference was elevated for stroke patients who received the intervention as a whole (p = 0.007). Patients who were trained in person and the ones who were trained via teleconferencing yielded similar results as evaluated through the VAS index. Discussion and Conclusion Administration of strength training 3 times weekly for 12 weeks to stroke patients yielded measurable results in terms of general function and quality of life.
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Affiliation(s)
- Nikolaos Kintrilis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kontaxakis
- Physical and Rehabilitation Medicine Department, 414 Military Hospital of Special Diseases, Penteli, Greece
| | - Anastasios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abd El-Kafy EM, Alayat MS, Alwhaibi RM, Basuodan RM. Spiral strapping for improving upper extremity motor functions in individuals with stroke: A randomized controlled trial. Prosthet Orthot Int 2024:00006479-990000000-00208. [PMID: 38170804 DOI: 10.1097/pxr.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The rehabilitation process for the upper extremities of individuals with stroke requires therapists to use splints for supportive and corrective purposes. The aim of this study was to assess the effectiveness of spiral strapping in inhibiting spasticity and improving the upper extremity motor functions of individuals with chronic stroke. METHODS Forty Saudi individuals aged 50-60 years with chronic stroke participated in this study. Their degrees of spasticity according to the Modified Ashworth Scale ranged across grades 1, 1+, and 2. Participants were randomly assigned to experimental and control groups. Participants in both groups received 1 h of conventional physical therapy for 3 d/wk to improve the motor functions of their upper extremities. In addition, participants in the experimental group wore an upper-limb spiral strapping with a hand splint 10 h/d for 6 d/wk. The treatment program for both groups was delivered for 4 weeks. Changes in the scores of Action Research Arm Test for elbow joint spasticity, active range of motion of the shoulder, elbow, and forearm joints, and hand grip strength were evaluated before and after treatment in both groups. RESULTS Significant improvements in all measured variables after treatment were reported in both groups, except for elbow joint spasticity in the control group. The experimental group showed significant post-treatment improvement in the scores for all measured variables compared with the control group. CONCLUSIONS Spiral strapping was beneficial in inhibiting mild degrees of spasticity and improving the motor functions of the upper extremities of stroke patients.
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Affiliation(s)
- Ehab Mohamed Abd El-Kafy
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mohamad Salaheldien Alayat
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Reem M Alwhaibi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem M Basuodan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Temehy B, Soundy A, Sahely A, Palejwala Y, Heath J, Rosewilliam S. Exploring the needs of stroke patients after discharge from rehabilitation centres in Saudi Arabian communities: An IPA qualitative exploratory study design. PLoS One 2023; 18:e0291263. [PMID: 37682983 PMCID: PMC10490873 DOI: 10.1371/journal.pone.0291263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
There are about 29 strokes per 100,000 people, annually, in the Kingdom of Saudi Arabia (KSA). These patients require long-term rehabilitation services to enhance recovery and independence in the community. Currently there are limited long-term rehabilitation services in KSA and research is needed to establish pathways for provision of community-based rehabilitation (CBR). To develop effective new CBR models, understanding the experiences and needs of stroke patients in KSA who have undergone poststroke care services is essential. This study aims to gain insight into stroke patients' needs after their discharge from rehabilitation centres in Saudi Arabia. An interpretive phenomenological analysis (IPA) study was undertaken using semi-structured interviews. Participants were eligible if they had a stroke, completed their in-hospital rehabilitation sessions and had been discharged within the past three years. Semi-structured interviews were conducted using interview guides. Transcripts were translated and analysed using interpretive phenomenological analysis. Twenty-four (15 males and 9 females) participants were recruited from two hospitals in KSA. The key findings suggested that patients experienced limited community rehabilitation services postdischarge unless they were financially able to pay for private therapy. Coping barriers including Medical, Psychological, Social, and Financial and facilitators including Faith, Recovery, Social support and leisure were identified. Participants suggested strategies to improve services within hospital and community for rehabilitation, needs of staff, access to services and ongoing care. Further work is required to develop, implement and evaluate a community rehabilitation intervention that includes education, and self-management elements to support stroke survivors in the community in KSA.
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Affiliation(s)
- Basema Temehy
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrew Soundy
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ahmad Sahely
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Yasmin Palejwala
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Heath
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sheeba Rosewilliam
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Alkhamis FA, Alabdali MM, Alsulaiman AA, Alamri AS, Alali R, Akhtar MS, Alsalman SA, Cyrus C, Albakr AI, Alduhalan AS, Gandla D, Al-Romaih K, Abouelhoda M, Loza BL, Keating B, Al-Ali AK. Whole-exome sequencing analyses in a Saudi Ischemic Stroke Cohort reveal association signals, and shows polygenic risk scores are related to Modified Rankin Scale Risk. Funct Integr Genomics 2023; 23:102. [PMID: 36973604 PMCID: PMC10042957 DOI: 10.1007/s10142-023-01039-7] [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: 02/09/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
Ischemic stroke represents a significant societal burden across the globe. Rare high penetrant monogenic variants and less pathogenic common single nucleotide polymorphisms (SNPs) have been described as being associated with risk of diseases. Genetic studies in Saudi Arabian patients offer a greater opportunity to detect rare high penetrant mutations enriched in these consanguineous populations. We performed whole exome sequencing on 387 ischemic stroke subjects from Saudi Arabian hospital networks with up to 20,230 controls from the Saudi Human Genome Project and performed gene burden analyses of variants in 177 a priori loci derived from knowledge-driven curation of monogenic and genome-wide association studies of stroke. Using gene-burden analyses, we observed significant associations in numerous loci under autosomal dominant and/or recessive modelling. Stroke subjects with modified Rankin Scale (mRSs) above 3 were found to carry greater cumulative polygenic risk score (PRS) from rare variants in stroke genes (standardized PRS mean > 0) compared to the population average (standardized PRS mean = 0). However, patients with mRS of 3 or lower had lower cumulative genetic risk from rare variants in stroke genes (OR (95%CI) = 1.79 (1.29-2.49), p = 0.0005), with the means of standardized PRS at or lower than 0. In conclusion, gene burden testing in Saudi stroke populations reveals a number of statistically significant signals under different disease inheritance models. However, interestingly, stroke subjects with mRS of 3 or lower had lower cumulative genetic risk from rare variants in stroke genes and therefore, determining the potential mRS cutoffs to use for clinical significance may allow risk stratification of this population.
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Affiliation(s)
- Fahad A Alkhamis
- Department of Neurology, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Majed M Alabdali
- Department of Neurology, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Abdulla A Alsulaiman
- Department of Neurology, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Abdullah S Alamri
- Department of Neurology, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Rudaynah Alali
- Department of Internal Medicine, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Mohammed S Akhtar
- Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Sadiq A Alsalman
- Department of Neurology, King Fahd Hospital, Alhafof, Saudi Arabia
| | - Cyril Cyrus
- Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Aishah I Albakr
- Department of Neurology, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Anas S Alduhalan
- Department of Neurology, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Divya Gandla
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | | | | | - Bao-Li Loza
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Brendan Keating
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Amein K Al-Ali
- Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia.
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Kourtidou-Papadeli C, Frantzidis C, Machairas I, Giantsios C, Dermitzakis E, Kantouris N, Konstantinids E, Bamidis P, Vernikos J. Rehabilitation assisted by Space technology-A SAHC approach in immobilized patients-A case of stroke. Front Physiol 2023; 13:1024389. [PMID: 36741804 PMCID: PMC9890276 DOI: 10.3389/fphys.2022.1024389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction: The idea behind the presentation of this case relates to utilizing space technology in earth applications with mutual benefit for both patients confined to bed and astronauts. Deconditioning and the progressiveness of skeletal muscle loss in the absence of adequate gravity stimulus have been of physiological concern. A robust countermeasure to muscle disuse is still a challenge for both immobilized patients and astronauts in long duration space missions. Researchers in the space medicine field concluded that artificial gravity (AG) produced by short-radius centrifugation on a passive movement therapy device, combined with exercise, has been a robust multi-system countermeasure as it re-introduces an acceleration field and gravity load. Methods: A short-arm human centrifuge (SAHC) alone or combined with exercise was evaluated as a novel, artificial gravity device for an effective rehabilitation strategy in the case of a stroke patient with disability. The results reveal valuable information on an individualized rehabilitation strategy against physiological deconditioning. A 73-year-old woman was suddenly unable to speak, follow directions or move her left arm and leg. She could not walk, and self-care tasks required maximal assistance. Her condition was getting worse over the years, also she was receiving conventional rehabilitation treatment. Intermittent short-arm human centrifuge individualized protocols were applied for 5 months, three times a week, 60 treatments in total. Results: It resulted in significant improvement in her gait, decreased atrophy with less spasticity on the left body side, and ability to walk at least 100 m with a cane. Balance and muscle strength were improved significantly. Cardiovascular parameters improved responding to adaptations to aerobic exercise. Electroencephalography (EEG) showed brain reorganization/plasticity evidenced through functional connectivity alterations and activation in the cortical regions, especially of the precentral and postcentral gyrus. Stroke immobility-related disability was also improved. Discussion: These alterations were attributed to the short-arm human centrifuge intervention. This case study provides novel evidence supporting the use of the short-arm human centrifuge as a promising therapeutic strategy in patients with restricted mobility, with application to astronauts with long-term muscle disuse in space.
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Affiliation(s)
- Chrysoula Kourtidou-Papadeli
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- Aeromedical Center of Thessaloniki (AeMC), Kalamaria, Greece
| | - Christos Frantzidis
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- School of Computer Science, University of Lincoln, Lincoln, United Kingdom
| | - Ilias Machairas
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Giantsios
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Dermitzakis
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- Aeromedical Center of Thessaloniki (AeMC), Kalamaria, Greece
| | - Nikolaos Kantouris
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
| | | | - Panagiotis Bamidis
- Laboratory of Medical Physics, Biomedical Engineering & Aerospace Neuroscience (BEAN), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
| | - Joan Vernikos
- Greek Aerospace Medical Association and Space Research (GASMA-SR), Thessaloniki, Greece
- Thirdage LLC., New York, NY, United States
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Wanni Arachchige PR, Karunarathna S, Meidian AC, Ueda R, Uchida W, Senoo A. Structural connectivity changes in the motor execution network after stroke rehabilitation. Restor Neurol Neurosci 2021; 39:237-245. [PMID: 34275914 PMCID: PMC8543268 DOI: 10.3233/rnn-211148] [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] [Indexed: 11/29/2022]
Abstract
Background: Although quite a very few studies have tested structural connectivity changes following an intervention, it reflects only selected key brain regions in the motor network. Thus, the understanding of structural connectivity changes related to the motor recovery process remains unclear. Objective: This study investigated structural connectivity changes of the motor execution network following a combined intervention of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) after a stroke using graph theory approach. Methods: Fifty-six stroke patients underwent Fugl-Meyer Assessment (FMA), Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS), diffusion tensor imaging (DTI), and T1 weighted imaging before and after the intervention. We examined graph theory measures related to twenty brain regions using structural connectomes. Results: The ipsilesional and contralesional hemisphere showed structural connectivity changes post-intervention after stroke. We found significantly increased regional centralities and nodal efficiency within the frontal pole and decreased degree centrality and nodal efficiency in the ipsilesional thalamus. Correlations were found between network measures and clinical assessments in the cuneus, postcentral gyrus, precentral gyrus, and putamen of the ipsilesional hemisphere. The contralesional areas such as the caudate, cerebellum, and frontal pole also showed significant correlations. Conclusions: This study was helpful to expand the understanding of structural connectivity changes in both hemispheric networks during the motor recovery process following LF-rTMS and intensive OT after stroke.
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Affiliation(s)
| | - Sadhani Karunarathna
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Department of Radiography/Radiotherapy, Faculty of Allied Health Sciences, University of Peradeniya
| | - Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Wataru Uchida
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Atsushi Senoo
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients-Preliminary Reports. Brain Sci 2021; 11:brainsci11040501. [PMID: 33921075 PMCID: PMC8071377 DOI: 10.3390/brainsci11040501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Rehabilitation-oriented therapy after a stroke must continue in various forms as a life-long effort. Aim: The study investigated the impact of spa rehabilitation on the quality of life and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods: The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients with strokes who participated in a three-week rehabilitation program. Three examinations were performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index. Results: The quality of life was significantly higher in Exam II compared with Exam I (p < 0.001), and improvement was retained at the follow-up. The Barthel scores were higher in Exam II compared with Exam I (79.84 vs. 68.59), while the differences between the scores in Exams II and III were small (p = 0.039). Conclusions: Three-week spa rehabilitation seems to favorably affect the functional efficiency and quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time from stroke onset.
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Almosallam A, Qureshi AZ, Ullah S, Alibrahim A. Return to driving post stroke; patients' perspectives and challenges in Saudi Arabia. Top Stroke Rehabil 2021; 29:192-200. [PMID: 33775236 DOI: 10.1080/10749357.2021.1905201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BackgroundReturning to driving remains one of the most important goals for stroke survivors. In Saudi Arabia, there are no structured processes to address the issue of return to driving in individuals with disabilities. There are increasing rates of strokes in the country and road traffic accidents are the highest in the region. Returning to driving among male stroke survivors in Saudi Arabia is of particular importance due to socio-economic and cultural reasons.AimsThe study aims to explore the factors involved in return to driving among stroke survivors in Saudi population.MethodsThis cross-sectional study was carried out on 100 male stroke survivors who had completed an inpatient rehabilitation program and had at least one follow-up assessment three months post-discharge. Information was collected regarding demographics, stroke characteristics, and factors related to pre and post-stroke driving. Data were analyzed using SPSS.ResultsMajority (60%) of patients were 51 years of age and above. Most commonly reported stroke impairments were weakness and spasticity with majority of participants having right-sided body involvement. Out of 94 stroke survivors who were driving prior to stroke, only 7 resumed driving. None of the stroke survivors who returned to driving reported receiving any formal driving assessment. Only one patient who reported being aware of the need of driving assessment did not resume driving after stroke.ConclusionsThere is a dire need to increase awareness and to develop a structured integrated system in Saudi Arabia to facilitate stroke survivors to return to driving.
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Affiliation(s)
| | - Ahmad Zaheer Qureshi
- Department of Physical Medicine & RehabilitationKing Fahad Medical City,Ryiadh,Saudi Arabia
| | - Sami Ullah
- Department of Physical Medicine & RehabilitationKing Fahad Medical City,Ryiadh,Saudi Arabia
| | - Abdullah Alibrahim
- Department of Comprehensive Rehabilitation CareKing Fahad Medical City,Riyadh,Saudi Arabia
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Moftah E, Vennu V, Abdulrahman TA, Alnahdi AH, Balubaid H, Alghamdi G, Alonazi S, Abunassif S, Bindawas SM. Association of affected lower limb flexor muscle strength with swing phase duration and gait speed in elderly post-stroke patients. NeuroRehabilitation 2020; 47:443-450. [PMID: 33136075 DOI: 10.3233/nre-203150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although several studies have shown an association of muscle weakness with gait speed (GS), no study has explored the relationship of muscle strength with swing phase duration and GS after stroke among the elderly in Saudi Arabia. OBJECTIVE To examine the association of affected ankle dorsiflexor and hip flexor muscle strength with swing phase duration and GS in the elderly with different stroke chronicity. METHODS In this cross-sectional study, we included a total of 60 post-stroke patients aged ≥55 years who were admitted in neurorehabilitation units between May 2017 and August 2018. Linear regression was employed to examine the association of muscle strength (measured using a handheld dynamometer) with swing phase duration and GS (both measured using the computerized Zebris-Mat). RESULTS The chronicity of the stroke was negatively associated (p < 0.05) with swing phase duration. The ankle dorsiflexor muscle strength was significantly associated with GS (β= 0.656, p = 0.041). In contrast, hip flexor muscle strength was significantly associated with GS (β= 0.574, p < 0.0001) even after adjusting for stroke chronicity (β= 0.561, p < 0.0001). CONCLUSIONS Stroke chronicity was the predictor that reduced swing phase duration. The ankle dorsiflexor muscle strength was associated with GS. However, the hip flexor muscle strength was associated with GS even after adjusting for stroke chronicity.
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Affiliation(s)
- Emad Moftah
- Rehabilitation Services Department, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Tariq A Abdulrahman
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali H Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hashim Balubaid
- King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,Division of Geriatric Medicine, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ghalib Alghamdi
- Rehabilitation Services Department, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,Occupational Therapy Department, College of Applied Medical Science, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sultana Alonazi
- Rehabilitation Services Department, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sondos Abunassif
- Rehabilitation Services Department, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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13
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Alsufyani AM. Role of Treatment Theory and Enablement Theory for Restoring Health and Rehabilitation in Saudi Arabia. Cureus 2020; 12:e9180. [PMID: 32802615 PMCID: PMC7425820 DOI: 10.7759/cureus.9180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 11/05/2022] Open
Abstract
Several challenges are involved in providing the appropriate treatment during the process of a patient's rehabilitation. Studies conducted in relation to the rehabilitation issues are ineffective in providing useful developments in the provided treatments. Most of the studies lack the utilization of theoretical framework which ultimately proposed weak findings. This study aimed to provide a theoretical framework in relation to the treatment theory as well as the enablement theory along with their effectiveness in improving rehabilitation treatments. The study involves a thorough review undertaking of published articles from 2014 to 2019 that were based on the rehabilitation and other health restoration measures through PubMed and Medline databases. Findings of the study were proposed in the form of a theoretical framework of treatment and the enablement theory. For rehabilitation and clinical researches, it is recommended to use treatment theory and enablement theory to propose unique results that may contribute to the improved healthcare treatment.
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14
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Bindawas SM, Mawajdeh HM, Vennu VS, Alhaidary HM. Functional recovery differences after stroke rehabilitation in patients with uni- or bilateral hemiparesis. ACTA ACUST UNITED AC 2019; 22:186-191. [PMID: 28678212 PMCID: PMC5946362 DOI: 10.17712/nsj.2017.3.20170010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the functional recovery differences after stroke rehabilitation in patients with uni- or bilateral hemiparesis. METHODS In this retrospective study, we included data from the medical record of all 383 patients with uni- or bilateral hemiparesis after stroke who were admitted to King Fahad Medical City-Rehabilitation Hospital between 2008 and 2014 in Riyadh, Kingdom of Saudi Arabia. According to the site of hemiparesis, we classified patients into 3 groups: right hemiparesis (n=208), left hemiparesis (n=157), and bilateral hemipareses (n=18). The patients (n=49) who did not have either site of hemiparesis were excluded. The Functional Independence Measures (FIM) instrument was used to assess the score at admission and discharge. A post hoc test was conducted to examine the functional recovery differences between groups. Multiple regression analyses were used to confirm the findings. RESULTS Amongst the three groups, there were significant (p<0.05) differences in the total-FIM score as well as motor- and cognitive-FIM sub-scores between admission and discharge of stroke rehabilitation. The differences were significantly greater in the bilateral hemipareses group than in either unilateral hemiparesis group. Multiple regression analyses also confirmed that the site of hemiparesis significantly (p<0.05) differs in the total-FIM score as well as motor-FIM and cognitive-FIM sub-scores. CONCLUSION Our results demonstrate that differences in functional recovery after stroke rehabilitation may be influenced by the site of hemiparesis after stroke.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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15
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Al-Senani F, Al-Johani M, Salawati M, ElSheikh S, AlQahtani M, Muthana J, AlZahrani S, Shore J, Taylor M, Ravest VS, Eggington S, Cuche M, Davies H, Lobotesis K, Saver JL. A national economic and clinical model for ischemic stroke care development in Saudi Arabia: A call for change. Int J Stroke 2019; 14:835-842. [PMID: 31122171 PMCID: PMC6823921 DOI: 10.1177/1747493019851284] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stroke is a significant burden in Saudi Arabia and the Saudi Ministry of Health's stroke committee has identified an urgent need to improve care. AIM The purpose of this study was to undertake a health-economic analysis to quantify the impact of developing stroke care in the country. METHODS An economic model was developed to assess the costs and clinical outcomes associated with an ischemic stroke care development program compared with current stroke care. Based on Saudi epidemiological data, cohorts of ischemic stroke patients enter the model each year for the first 10 years based on increasing incidence. Four treatment options were modeled including reperfusion and non-reperfusion treatments. The development scenario estimates the impact of gradually increasing uptake of more effective treatments over 10 years. Changes in the stroke care organization are considered along with resources required to increase capacity, allowing more patients to be admitted to stroke hospitals and access effective treatments. RESULTS The stroke care development program is associated with an increase in functionally independent patients and a decrease in disabling strokes compared with current stroke care. Additionally, the development program is associated with estimated cost savings of $602 million over 15 years ($255 million direct costs, $348 million indirect costs). CONCLUSIONS The model predicts that the stroke care development program is associated with improved patient outcomes and lower overall costs compared with the current stroke care program.
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Affiliation(s)
- Fahmi Al-Senani
- Department of Neurology, King Fahad Medical City, National Neurosciences Institute, Riyadh, Saudi Arabia
| | - Mohammed Al-Johani
- Department of Neurology, King Fahad Medical City, National Neurosciences Institute, Riyadh, Saudi Arabia
| | - Mohammad Salawati
- Department of Neurology, King Fahad Medical City, National Neurosciences Institute, Riyadh, Saudi Arabia
| | - Souda ElSheikh
- Department of Neurology, King Fahad Medical City, National Neurosciences Institute, Riyadh, Saudi Arabia
| | - Maha AlQahtani
- Department of Neurology, King Fahad Medical City, National Neurosciences Institute, Riyadh, Saudi Arabia
| | - Jamal Muthana
- Department of Neurology, King Fahad Medical City, National Neurosciences Institute, Riyadh, Saudi Arabia
| | - Saeed AlZahrani
- King Fahad Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Judith Shore
- York Health Economics Consortium, University of York, York, UK
| | - Matthew Taylor
- York Health Economics Consortium, University of York, York, UK
| | | | - Simon Eggington
- Medtronic International Trading Sárl, Tolochenaz, Switzerland
| | - Matthieu Cuche
- Medtronic International Trading Sárl, Tolochenaz, Switzerland
| | - Heather Davies
- York Health Economics Consortium, University of York, York, UK
| | - Kyriakos Lobotesis
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Abstract
INTRODUCTION Cerebrolysin is a neuropeptide preparation with neurotrophic effects and promotes recovery after brain injury. Its preclinical profile promises wide applications due to its multi-target effects. Currently, Cerebrolysin is used for treatment of cerebral ischemia and neurodegeneration. Areas covered: In stroke, earlier clinical trials with Cerebrolysin were performed mostly in mildly affected stroke populations, which usually have a favorable prognosis. Due to this selection, a floor or ceiling effect of recovery measures in the mild cases may have prevented to show a clear benefit between treatment groups. In contrast, subgroup analyses of more severely affected patients reveal a strikingly positive effect for enhanced recovery. Based on the findings from several studies, it became evident that the effect size of Cerebrolysin was increasing with stroke severity. Other controlled studies showed that Cerebrolysin can be safely used in combination with thrombolysis. More recently, Cerebrolysin has been tested not only for neuroprotection but also for its neurorecovery potential and also showed efficacy in patients with moderate to severe strokes. Expert commentary: Cerebrolysin shows a benefit mostly in moderate to severe ischemic stroke patients and an overall significant effect for functional recovery when combined with neurorehabilitation versus neurorehabilitation alone. This gives lead to the planning of a more rigorous study design in the future.
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Affiliation(s)
- Michael Brainin
- a Department of Neurosciences and Preventive Medicine , Danube University Krems , Krems , Austria
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17
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Bindawas SM, Vennu V. The National and Regional Prevalence Rates of Disability, Type, of Disability and Severity in Saudi Arabia-Analysis of 2016 Demographic Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030419. [PMID: 29495546 PMCID: PMC5876964 DOI: 10.3390/ijerph15030419] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 01/09/2023]
Abstract
The prevalence of disability varies between countries ranging from less than 1% to up to 30% in some countries, thus, the estimated global disability prevalence is about 15%. However, it is unknown what the current estimate of disability and its types and severity are in Saudi Arabia. Thus, the objective of this study is to estimate national and regional prevalence rates of any disability, types of disability, and their severity among Saudi populations. Data on disability status were extracted from the national demographic survey conducted in 2016 as reported by the General Authority for Statistics, Saudi Arabia (N = 20,064,970). Prevalence rates per a population of 100,000 of any disability, type of disability, and its severity were calculated at the national level and in all 13 regions. Out of 20,064,970 Saudi citizens surveyed, 667,280 citizens reported disabilities, accounting for a prevalence rate of 3326 per a population of 100,000 (3.3%). Individuals aged 60 years and above (11,014) and males (3818) had a higher prevalence rate of disability compared with females (2813). The Tabuk region has the highest rate of reported disability, at 4.3%. The prevalence rates of extreme disabilities in mobility and sight were higher in Madinah (57,343) and Northern border (41,236) regions, respectively. In Saudi Arabia, more than half a million Saudi citizens (1 out of every 30 individuals) reported the presence of disability during the year 2016. A higher prevalence rate of disability was seen among those aged 60 years and above, and males. Targeted efforts are required at the national and regional levels to expand and improve rehabilitation and social services for all people with disabilities.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh-11433, Saudi Arabia.
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh-11433, Saudi Arabia.
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18
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Bindawas SM, Vennu V, Mawajdeh H, Alhaidary HM, Moftah E. Length of Stay and Functional Outcomes Among Patients with Stroke Discharged from an Inpatient Rehabilitation Facility in Saudi Arabia. Med Sci Monit 2018; 24:207-214. [PMID: 29321468 PMCID: PMC5772339 DOI: 10.12659/msm.907452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In many countries, the length of stay (LOS) for inpatient rehabilitation following stroke has gradually decreased. It is unclear whether this trend is associated with differences in functional outcomes, especially in developing countries. This study aimed to examine associations between LOS and functional outcomes among patients with stroke discharged from an inpatient rehabilitation facility in Saudi Arabia. Material/Methods This retrospective study included all patients (N=409) aged ≥18 years who were admitted to an inpatient rehabilitation for stroke during 2008–2014. There were no deaths in the cohort during the study period. Patients were divided into 4 groups according to days of rehabilitation: ≤30 days (n=114), 31–60 days (n=199), 61–90 days (n=72), and >90 days (n=24). Multivariate regression analyses were used to evaluate functional outcomes using the functional independence measure (FIM). Results The fully adjusted model showed that higher total and subscale FIM scores were significantly associated with a LOS ≤30 days (total β: 18.2, standard error [SE]=4.43, P≤0.0001; motor-FIM: β=13.9, SE=3.70, P=0.0002; cognitive-FIM: β=4.3, SE=1.29, P=0.001), and 31–60 days (total β: 11.3, SE=4.07, P=0.005; motor-FIM: β=8.8, SE=3.40, P=0.009; cognitive-FIM: β=2.4, SE=1.19, P=0.038) compared with >90 days. Conclusions A short or intermediate LOS is not necessarily associated with worse outcomes, assuming adequate care is provided.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hussam Mawajdeh
- Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Emad Moftah
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Rehabilitation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Bindawas SM, Vennu V, Mawajdeh H, Alhaidary H. Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia. Clin Interv Aging 2017; 12:1791-1797. [PMID: 29123384 PMCID: PMC5661488 DOI: 10.2147/cia.s145402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Among various risk factors, age has been identified as a nonmodifiable risk factor for stroke that influences functional outcomes after inpatient stroke rehabilitation in the developed world as well as in Saudi Arabia (SA). The demand for inpatient stroke rehabilitation services increases with population aging and stroke incidence; however, these services are limited in SA. Objective To examine functional outcomes by age after inpatient stroke rehabilitation in SA. Patients and methods Data from 418 patients with stroke who underwent inpatient stroke rehabilitation at the King Fahad Medical City-Rehabilitation Hospital, Riyadh, SA, between November 2008 and December 2014 were collected from electronic medical records. According to the patients’ age, we classified participants into two groups: adults, aged <65 years (n=255), and older adults, aged ≥65 years (n=163). All patients’ functional statuses at admission and discharge from inpatient stroke rehabilitation were assessed using the functional independence measure (FIM) scale. Results The mean age was 59.9 years (SD =9.4). Older adults had significantly smaller changes in functional outcome from admission to discharge on both the total FIM (23 [SD =15.9]) and the motor FIM (21 [SD =15.4]), and they were significantly less independent (36%) compared to adults. In the adjusted models, older adults had significantly lower scores than adults, by 11 points (p<0.0001) for the total FIM score and by 10 points (p<0.0001) for the motor FIM subscale score. There was no significant change with age in the cognitive FIM subscale score. Conclusion After inpatient stroke rehabilitation, older adults had limited functional outcomes or were less independent than adults. However, the clinical relevance of this finding is questionable, so there is currently no justification to deny patients access to intensive stroke rehabilitation solely because of advanced age. Future large-scale research is needed to confirm rehabilitation outcomes by including confounders such as social support, socioeconomics, comorbidities, and the patient’s opinion after rehabilitation.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, King Saud University, Riyadh
| | - Vishal Vennu
- Department of Rehabilitation Sciences, King Saud University, Riyadh
| | - Hussam Mawajdeh
- Comprehensive Rehabilitation Care Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hisham Alhaidary
- Comprehensive Rehabilitation Care Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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