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Predictors of home discharge after mechanical thrombectomy in patients with acute ischemic stroke: Usefulness of National Institutes of Health Stroke Scale sub-items assessed 24 h postoperatively. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
BACKGROUND Spontaneous recovery of visual loss resulting from injury to the brain is variable. A variety of traditional rehabilitative strategies, including the use of prisms or compensatory saccadic eye movements, have been used successfully to improve visual function and quality-of-life for patients with homonymous hemianopia. More recently, repetitive visual stimulation of the blind area has been reported to be of benefit in expanding the field of vision. EVIDENCE ACQUISITION We performed a literature review with main focus on clinical studies spanning from 1963 to 2016, including 52 peer-reviewed articles, relevant cross-referenced citations, editorials, and reviews. RESULTS Repetitive visual stimulation is reported to expand the visual field, although the interpretation of results is confounded by a variety of methodological factors and conflicting outcomes from different research groups. Many studies used subjective assessments of vision and did not include a sufficient number of subjects or controls. CONCLUSIONS The available clinical evidence does not strongly support claims of visual restoration using repetitive visual stimulation beyond the time that spontaneous visual recovery might occur. This lack of firm supportive evidence does not preclude the potential of real benefit demonstrated in laboratories. Additional well-designed clinical studies with adequate controls and methods to record ocular fixation are needed.
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Meijer R, van Limbeek J, Peusens G, Rulkens M, Dankoor K, Vermeulen M, de Haan RJ. The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study. Clin Rehabil 2016; 19:770-8. [PMID: 16250197 DOI: 10.1191/0269215505cr875oa] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit. Methods: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and social subdomains, were scored and analysed by binary logistic regression analysis. The outcome of the research consisted of the various discharge destinations. Results: The overall predictive value of the discharge model is high (91%). Factors predictive of a poor discharge outcome are a low Barthel Index score (odds ratio (OR) 0.78 per point increase; p < 0.001), a poor sitting balance (OR 5.96; p < 0.001), a depression (OR 7.23; p < 0.001), poststroke cognitive disability (OR 3.51; p = 0.007) and older age (OR 1.05 per point increase; p = 0.008). If present, a personality disorder, premorbid cognitive disability and premorbid functional disability all show a tendency towards poor discharge outcome, but these factors did not reach statistical significance in this study, possibly due to their low prevalence. Readiness of the family circle to provide support was only significant in the univariate analysis. Conclusions: Somatic, biological and psychological factors predict the discharge outcome. Functional and cognitive factors play a decisive role in the future ability to live independently after a stroke. The prognostic importance of social factors could not be demonstrated. Urinary incontinence did not emerge as a prognostic factor. This is in contrast to scientific findings till now, but in accordance with clinical experience.
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Affiliation(s)
- R Meijer
- Department of Neurological Rehabilitation, Rehabilitation Centre Groot Klimmendaal, P.O. Box 9044, 6800 GG Arnhem, The Netherlands.
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Kalichman L, Alperovitch-Najenson D, Treger I. The impact of patient's weight on post-stroke rehabilitation. Disabil Rehabil 2016; 38:1684-90. [DOI: 10.3109/09638288.2015.1107640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Woodhead ZVJ, Ong YH, Leff AP. Web-based therapy for hemianopic alexia is syndrome-specific. ACTA ACUST UNITED AC 2015. [DOI: 10.1136/bmjinnov-2015-000041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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de Haan GA, Heutink J, Melis-Dankers BJM, Tucha O, Brouwer WH. Spontaneous recovery and treatment effects in patients with homonymous visual field defects: a meta-analysis of existing literature in terms of the ICF framework. Surv Ophthalmol 2013; 59:77-96. [PMID: 24112548 DOI: 10.1016/j.survophthal.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 02/08/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022]
Abstract
Homonymous visual field defects (HVFDs) are a common consequence of posterior brain injury. Most patients do not recover spontaneously and require rehabiliation. To determine whether a certain intervention may help an individual patient, it is necessary to predict the patient's level of functioning and the effect of specific training. We provide an overview of both the existing literature on HVFDs in terms of the International Classification of Functioning, Disability, and Health (ICF) components and the variables predicting the functioning of HVFD patients or the effect of treatment. We systematically analyzed 221 publications on HVFD. All variables included in these articles were classified according to the ICF, as developed by the World Health Organization, and checked for their predictive value. We found that ICF helps to clarify the scope of the existing literature and provides a framework for designing future studies, which should consider including more outcome measures related to Activities and Participation. Although several factors have been described that predict HVFD patients' level of functioning or the effects of training, additional research is necessary to identify more.
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Affiliation(s)
- Gera A de Haan
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands; Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands.
| | - Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands; Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Bart J M Melis-Dankers
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Wiebo H Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
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Portacolone E. The notion of precariousness among older adults living alone in the U.S. J Aging Stud 2013; 27:166-74. [DOI: 10.1016/j.jaging.2013.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 12/25/2012] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
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Jacquin-Courtois S, Bays PM, Salemme R, Leff AP, Husain M. Rapid compensation of visual search strategy in patients with chronic visual field defects. Cortex 2012; 49:994-1000. [PMID: 22626007 DOI: 10.1016/j.cortex.2012.03.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 03/07/2012] [Accepted: 03/28/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to test the effect and specificity of a novel, compensatory eye movement training therapy designed to improve visual search performance in patients with homonymous visual field defects. METHODS Seven patients with chronic homonymous visual field defects and six healthy control subjects were tested. All subjects completed the single training period (300 trials). Subjects were assessed on three different saccadic tasks (a visual search task, a rapid scanning task and a reading task) which were evaluated at three time points on the same day: two before and one after the training period. The computer-based training consisted of a novel ramp-step search paradigm that required subjects to pursue a stimulus (ramp phase) and then saccade to find its location when it suddenly jumped (step phase). RESULTS Pre-therapy we confirmed that patients differed from controls on the visual search task. Post-training we demonstrated a clear improvement in terms of reaction time required to complete the visual search. This effect was confined to: (1) the patient group only; (2) targets presented to the blind visual field of the patients only; (3) the visual search task only and not the rapid scanning or reading task. CONCLUSION These results demonstrate that rapid, compensatory changes can occur in patients with visual field defects that impact on their ability to carry out efficient visual search. We plan to translate this therapy, along with appropriate testing materials, in a free-to-use, internet-based application based on this intervention.
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Affiliation(s)
- Sophie Jacquin-Courtois
- Service de Rééducation Neurologique, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Plateforme Mouvement et Handicap, Saint Genis Laval, France.
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ITO I, SATO H, HAMADA K, SHINDO N. Social Factors influenced the Discharge Destination and Length of Hospital Stay of Stroke Patients after Rehabilitation. ACTA ACUST UNITED AC 2011. [DOI: 10.2490/jjrmc.48.561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Farner L, Wagle J, Engedal K, Flekkøy KM, Wyller TB, Fure B. Depressive symptoms in stroke patients: a 13 month follow-up study of patients referred to a rehabilitation unit. J Affect Disord 2010; 127:211-8. [PMID: 20933286 DOI: 10.1016/j.jad.2010.05.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 05/25/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although depression is known to be frequently associated with stroke, it is nonetheless underdiagnosed and under-treated in this patient population. Its effect on outcome for stroke patients is thought to be substantial, but prediction is complicated by other pre- and post stroke factors. The aims of this study was to describe changes in depressive symptoms in elderly stroke patients across a timespan of one year, to examine risk factor for such changes and to explore whether depressive symptoms have any independent impact upon one year mortality and nursing home placement. METHODS 194 patients diagnosed with an ischaemic or hemorrhagic stroke was recruited from the Stroke Rehabilitation Unit, Ullevaal University Hospital, Oslo, Norway during the period between March 2005 and August 2006 and followed up for a period of 13 months. Pre-stroke assessment was accomplished by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Frenchay Activities Index (FAI), the Barthel ADL Index and patient's medical history. Post-stroke assessment at inclusion and follow-up examination was performed with the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Star Cancellation Test, the Barthel ADL Index, the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Information was collected from the patients' records. RESULTS Institutionalization at 13 months was predicted by more depression (MADRS) and cognitive impairment (RBANS) at baseline, together with lower pre-stroke social activity levels (FAI). Two factors predicted death at 13 months: Cognitive impairment (MMSE) and greater age. The prevalence of depression was relatively unchanged from baseline (56%) to 13 month follow-up (48%). Among the patients who were depressed at baseline 55% still had MADRS score above six (persistent depression) at 13 months, while 35% in the non-depressed group at baseline had developed depression (incident depression). Persistent depression was significantly predicted by lower pre-stroke social activity levels (FAI) together with a more severe stroke (NIHSS) and worse overall function (mRS) at baseline. Incident depression was predicted by receipt of municipal home help before the stroke and a lower score on the delayed memory tasks on RBANS at baseline.
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Affiliation(s)
- Lasse Farner
- Norwegian Centre for Ageing and Health, Vestfold Mental Health Care Trust, Norway.
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Hoffmann T, McKenna K. Prediction of Outcome After Stroke. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v19n01_04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marom B, Jarus T, Josman N. The Relationship Between the Assessment of Motor and Process Skills (AMPS) and the Large Allen Cognitive Level (LACL)Test in Clients with Stroke. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v24n04_03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW Homonymous hemianopia is the commonest form of acquired homonymous visual field defect; the usual causes are stroke, head injury and intracranial tumours. This impairment can affect a variety of cognitive visual functions, including visual search, safe navigation through changing environments and reading. A number of rehabilitative techniques have been tried with varying degrees of success. They broadly fall into three main groups: optical therapies, in which the damaged visual field is brought into view by the use of optical devices; eye movement-based therapies, in which the damaged visual field is more effectively sampled with compensatory or adaptive eye movements; and visual field restitution therapies, in which vision in the damaged field is itself improved. These techniques all rely on mass practice. This review provides an up-to-date summary of these approaches. RECENT FINDINGS All of the three main approaches to rehabilitation of homonymous visual field defect have been pursued in recent years and all appear capable of providing a moderate amount of 'real-world' improvement to patients. Controversy still reigns over the mechanism of action of all but the optical methods. Patients have to practice for many hours to feel the benefit of all of these techniques, with the eye movement-based therapies requiring the least amount of exposure. SUMMARY The evidence base for these types of behavioural therapy is getting stronger all the time. Future studies that take on the difficult task of controlling for placebo effects will allow patients' subjective ratings of success to be used as a convincing outcome measure. Without doubt, the literature would also benefit from bigger studies that include more patients; however, one could argue that given the clear negative effect that homonymous visual field defect has on patients' lives, these therapies should be more widely available already.
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Brauer SG, Bew PG, Kuys SS, Lynch MR, Morrison G. Prediction of Discharge Destination After Stroke Using the Motor Assessment Scale on Admission: A Prospective, Multisite Study. Arch Phys Med Rehabil 2008; 89:1061-5. [DOI: 10.1016/j.apmr.2007.10.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 10/02/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
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Marengoni A, Agüero-Torres H, Timpini A, Cossi S, Fratiglioni L. Rehabilitation and Nursing Home Admission after Hospitalization in Acute Geriatric Patients. J Am Med Dir Assoc 2008; 9:265-70. [DOI: 10.1016/j.jamda.2008.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
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Kalichman L, Rodrigues B, Gurvich D, Israelov Z, Spivak E. Impact of Patient's Weight on Stroke Rehabilitation Results. Am J Phys Med Rehabil 2007; 86:650-5. [PMID: 17667195 DOI: 10.1097/phm.0b013e318115f41b] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the influence of patient's weight on rehabilitation results after first stroke. DESIGN Retrospective, comparative study. The sample comprised 84 males and females, first-time stroke patients, who had been hospitalized in the department of rehabilitation at the Hartzfeld Geriatric Hospital, Gedera, Israel for a full 3 mos and who, on admission, had scored between 40 and 60 on the total Functional Improvement Measure (FIM) test. We evaluated the difference in total FIM improvement between normal-weight, overweight, and obese patients. RESULTS The relative improvement of FIM score was significantly higher in normal-weight patients than in overweight patients, and improvement in overweight patients was significantly higher than in obese ones. We also found a statistically significant negative correlation (r = -0.27, P = 0.014) between relative improvement of FIM score and body mass index (BMI) in the total sample. CONCLUSIONS Our study revealed that during the first 12 wks, rehabilitation is statistically significantly less effective in overweight and, particularly, in obese patients (evaluated by BMI). We also found a statistically significant negative association between the individual's BMI and relative improvement of the FIM score, representing the functional status of the stroke patient.
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Affiliation(s)
- Leonid Kalichman
- Department of Rehabilitation, Hartzfeld Geriatric Hospital, Gedera, Israel
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Agarwal V, McRae MP, Bhardwaj A, Teasell RW. A model to aid in the prediction of discharge location for stroke rehabilitation patients11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1703-9. [PMID: 14639573 DOI: 10.1053/s0003-9993(03)00362-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine which demographic and medical factors recorded on admission to a rehabilitation unit best predict discharge accommodation outcomes. DESIGN Retrospective chart review. SETTING Inpatient rehabilitation unit in an academic hospital in southwestern Ontario, Canada. PARTICIPANTS One hundred four stroke patients (54 women, 50 men; mean age, 72.0y) admitted to the rehabilitation unit over a 4-year period. INTERVENTIONS All patients underwent evaluations by the physical therapy, occupational therapy, social work, speech pathology, and psychology departments. Patients were divided into 2 groups: (1) no change in premorbid accommodation and (2) change in premorbid accommodation. MAIN OUTCOME MEASURES Demographic, clinical, and housing information (premorbid, discharge) and functional data (FIM trade mark instrument, Chedoke-McMaster Stroke Assessment [CMSA] Impairment Inventory, Berg Balance Scale [BBS]) were recorded for each patient. RESULTS Of 104 patients, 24 were discharged with a change in premorbid accommodation. Change in discharge location was significantly associated with age, gender, and the presence of premorbid social support (P<.01), but not with type of premorbid living arrangement. Statistically significant differences were noted between total FIM scores (P<.001), BBS scores (P<.001), and the postural component of the CMSA Impairment Inventory (P<.03). A logistic regression model, predicting 67% of the variance, was created to predict discharge accommodations. CONCLUSIONS Patients admitted to the rehabilitation unit can be scored to obtain their predicted chance of being discharged with a change from their premorbid accommodations. The equation is relatively easy to calculate and is based on data that are commonly collected in rehabilitation.
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Affiliation(s)
- Vikas Agarwal
- Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph's Health Care, London, Ontario, Canada
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Meijer R, Ihnenfeldt DS, van Limbeek J, Vermeulen M, de Haan RJ. Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature. Clin Rehabil 2003; 17:512-20. [PMID: 12952157 DOI: 10.1191/0269215503cr644oa] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify evidence-based prognostic factors in the subacute phase after a stroke for future residence at six months to one year post stroke. DESIGN Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, PsycLIT and Sociological Abstracts. (2) Reference lists, personal archives and consultation of experts in the field. (3) Guidelines. METHODS Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for future residence; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration. RESULTS From 1027 potentially relevant studies 10 studies involving a total of 3564 patients met the inclusion criteria. No prognostic factor was identified in at least two level A (i.e., a good level of scientific evidence according to the methodological score) studies, our standard for scientific proof. The following factors were found in at least one level A study: low initial ADL functioning, high age, cognitive disturbance, paresis of arm and leg, not alert as initial level of consciousness, old hemiplegia, homonymous hemianopia, visual extinction, constructional apraxia, no transfer to the stroke unit, nonlacunar stroke type, visuospatial construction problems, urinary incontinence and female gender. CONCLUSIONS At present there is insufficient evidence concerning possible predictors in the subacute stage of stroke to make an evidence-based prediction of the future residence. In the scientific research until now social factors and their contribution to the possibility of living independently have not been investigated, or at least less well. None of the studies in this review described a conceptual framework as basis for the choice of the examined prognostic factors.
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Affiliation(s)
- R Meijer
- Department of Rehabilitation Medicine, Academic Medical Center Amsterdam, The Netherlands.
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McKenna K, Tooth L, Strong J, Ottenbacher K, Connell J, Cleary M. Predicting discharge outcomes for stroke patients in Australia. Am J Phys Med Rehabil 2002; 81:47-56. [PMID: 11807333 DOI: 10.1097/00002060-200201000-00009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to describe discharge outcomes and explore their correlates for patients rehabilitated after stroke at an Australian hospital from 1993 to 1998. DESIGN Data on length of stay, discharge functional status, and discharge destination were retrospectively obtained from medical records. Patients' actual rehabilitation length of stay was compared with the Australian National Sub-Acute and Non-Acute Patient predicted length of stay. The change in length of stay over the 5-yr period from 1993 to 1998 was documented. RESULTS Patients' mean converted motor FIM scores improved from 53.1 at admission to 74.1 at discharge. Lower admission-converted motor FIM scores were related to longer length of stay, lower discharge-converted motor FIM scores, and the need for a change in living situation on discharge. CONCLUSION The results of this study provide Australian data on discharge outcomes after stroke to assist in the planning and delivery of appropriate interventions to individual patients during rehabilitation.
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Affiliation(s)
- Kryss McKenna
- Department of Occupational Therapy, University of Queensland, Brisbane, Queensland 4072, Australia
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Lichtenberg PA, MacNeill SE, Mast BT. Environmental press and adaptation to disability in hospitalized live-alone older adults. THE GERONTOLOGIST 2000; 40:549-56. [PMID: 11037933 DOI: 10.1093/geront/40.5.549] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study examined the ability of personal competency variables at the time of hospital discharge to predict primary instrumental activities of daily living (IADLs) and secondary outcomes (living arrangements) in a sample of 194 urban, live-alone, older adults who had a new onset disability. DESIGN AND METHODS Consecutively admitted medical rehabilitation patients, 72% women and 85% African American, participated in the study. Using path analysis, three of the four competency variables collected at the time of hospitalization (cognition, medical burden, activities of daily living) predicted IADLs at 3 and 6 months after hospitalization (e.g., cooking, telephone use, money management). IADLs, in turn, predicted living arrangements at 3 and at 6 months after hospitalization. RESULTS The findings provided strong support for the importance of assessing a broad range of competency variables when investigating adaptation to disability. IMPLICATIONS The increased understanding of adaptation in live-alone older adults with a new-onset disability is particularly timely given the increase in live-alone older adults and the dire consequences associated with change in living arrangement (i.e., mortality and morbidity) in this group.
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Affiliation(s)
- P A Lichtenberg
- Wayne State University, Institute of Gerontology, Detroit, MI 48202, USA.
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Bond J, Gregson B, Smith M, Lecouturier J, Rousseau N, Rodgers H. Predicting place of discharge from hospital for patients with a stroke or hip fracture on admission. J Health Serv Res Policy 2000; 5:133-9. [PMID: 11183623 DOI: 10.1177/135581960000500303] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the predictive power of patient and service characteristics on place of discharge following hospital admission for an acute stroke and for hip fracture. METHODS Prospective cohort of 440 acute stroke and 572 hip fracture patients aged 65 years or over admitted from home to six district general hospitals and associated community hospitals, three in the North and three in the South of England. RESULTS Age, marital status, living arrangements, mental health status at admission, pre-admission self-rated disability, pre-admission use of home-care services, post-admission staff assessments of functional dependency as measured by Barthel Index and of confusion as measured by the modified Crichton Royal Behavioural Rating Scale and nursing staffs' expectation of place of discharge are all significantly related to place of discharge for stroke and hip fracture participants. Logistic regression correctly predicted discharge destination for 87% of stroke patients from data available at time of admission and 83% of hip fracture patients. Of the 30% of stroke patients discharged to an institution, the model correctly predicted 73%. However, of the 19% of hip fracture patients discharged to an institution, only 28% were correctly predicted. CONCLUSIONS Data about older patients admitted to hospital with an acute condition should be routinely collected by hospital staff to inform clinical management and to permit risk-adjusted audit.
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Affiliation(s)
- J Bond
- Centre for Health Services Research, Institute for the Health of the Elderly, University of Newcastle upon Tyne, UK
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Puckree T, Chetty TP, Ramlakan S, Simelane TV, Lin J. An evaluation of the functional status of the residents of a geriatric residential facility in South Africa. Disabil Rehabil 1997; 19:552-5. [PMID: 9442994 DOI: 10.3109/09638289709166049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An increase in dependent elderly people together with a change in social structure from extended to nuclear families is resulting in institutionalization of the elderly. Since training of health care personnel is not keeping pace with the demands for health care, many institutions for the elderly are forced to function without the necessary health personnel. The purpose of the present study was to examine the functional status of the residents of one geriatric facility without health care personnel in Durban, South Africa. Functional status of each of the 101 residents was assessed using the Barthel Index. The results show that although overall Barthel Index scores showed that ageing or pathology did not influence numbers of functional elderly, individual analysis of items indicated that the majority of the residents could not perform basic functional tasks like feeding, bathing and climbing stairs.
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Affiliation(s)
- T Puckree
- Department of Physiotherapy, University of Durban-Westville, South Africa
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MacNeill SE, Lichtenberg PA. Home alone: the role of cognition in return to independent living. Arch Phys Med Rehabil 1997; 78:755-8. [PMID: 9228880 DOI: 10.1016/s0003-9993(97)90085-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify unique predictors of the ability to return to living alone in geriatric patients undergoing medical rehabilitation. DESIGN Of 900 consecutive geriatric patients entering medical rehabilitation, 372 were identified as living alone before admission. Data were collected on functional status, cognition, demographics, and discharge disposition. SETTING A freestanding medical rehabilitation facility. All patients were admitted to a geriatric rehabilitation unit. PATIENTS Patients aged 60 to 99, identified as having lived alone before admission, were included. As standard procedure, patients underwent functional and cognitive assessment, and medical records were reviewed. MAIN OUTCOME MEASURE Logistic regression analysis was used to evaluate predictors of discharge disposition, including demographic variables, medical burden, the Functional Independence Measure (FIM), and the Dementia Rating Scale (DRS). RESULTS Both the FIM and DRS provided significant and unique variance in prediction of discharge disposition. Patients discharged home alone performed similarly to those discharged with supervision on FIM motor items but higher on FIM social cognition items, emphasizing the strong role of cognition in discharge disposition. Patients discharged home alone scored above suggested cutoff scores on the DRS, indicating generally intact cognitive functioning, whereas those discharged with supervision scored below suggested cutoffs. CONCLUSION Results emphasize the importance of cognition in the ability to return to completely independent living after medical rehabilitation in geriatric patients.
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Affiliation(s)
- S E MacNeill
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, USA
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