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Silva AC, Menezes KKP, Scianni AA, Avelino PR, Faria CDCDM. Predictors of health-related quality of life one year after stroke: a systematic review with meta-analysis. Int J Rehabil Res 2024; 47:53-63. [PMID: 38578257 DOI: 10.1097/mrr.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The objective was to investigate, through a systematic review, which independent variables predict health-related quality of life (HRQoL) one year after stroke. Searches were conducted in LILACS, MEDLINE, Scielo, Web of Science, and PEDro. The inclusion criteria were observational longitudinal studies, which included at least one independent variable measured at baseline, as a potential predictor of HRQoL measured 12 months after stroke. The predictors of interest were variables across all domains of the International Classification of Function, Disability and Health. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A total of 17 papers were included, involving 8338 participants, and 10 possible predictors of the HRQoL one year after stroke. The meta-analysis was performed for six of them (cognition, depression, neurological deficit, stroke severity, motor impairment, and limitation in activities of daily living), and significant results were found only for limitation in activities of daily living (odds ratio, 1.30 [95% confidence interval, 1.09-1.57]; I2 = 72%; P < 0.01). The descriptive analysis of the remaining four predictors suggested a significant predictive value of balance and functional independence, whereas the results for trunk control were not significant and for social participation were unclear. In conclusion, individuals within the first 11.5 weeks after stroke with lower limitation in activities of daily living, higher functional independence, and better balance, are more likely to have a higher HRQoL one year after stroke. Thus, these predictors, all modifiable factors, need to be targeted during acute rehabilitation.
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Affiliation(s)
- Aryane Caroline Silva
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Kim H, Lee C, Kim N, Chung E, Jeon H, Shin S, Kim M. Early functional factors for predicting outcome of independence in daily living after stroke: a decision tree analysis. J Rehabil Med 2024; 56:jrm35095. [PMID: 38712968 DOI: 10.2340/jrm.v56.35095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/20/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the predictive functional factors influencing the acquisition of basic activities of daily living performance abilities during the early stages of stroke rehabilitation using classification and regression analysis trees. METHODS The clinical data of 289 stroke patients who underwent rehabilitation during hospitalization (164 males; mean age: 62.2 ± 13.9 years) were retrospectively collected and analysed. The follow-up period between admission and discharge was approximately 6 weeks. Medical records, including demographic characteristics and various functional assessments with item scores, were extracted. The modified Barthel Index on discharge served as the target outcome for analysis. A "good outcome" was defined as a modified Barthel Index score ≥ 75 on discharge, while a modified Barthel Index score < 75 was classified as a "poor outcome." RESULTS Two classification and regression analysis tree models were developed. The first model, predicting activities of daily living outcomes based on early motor functions, achieved an accuracy of 92.4%. Among patients with a "good outcome", 70.9% exhibited (i) ≥ 4 points in the "sitting-to-standing" category in the motor assessment scale and (ii) 32 points on the Berg Balance Scale score. The second model, predicting activities of daily living outcome based on early cognitive functions, achieved an accuracy of 82.7%. Within the "poor outcome" group, 52.2% had (i) ≤ 21 points in the "visuomotor organization" category of Lowenstein Occupational Therapy Cognitive Assessment, (ii) ≤ 1 point in the "time orientation" category of the Mini Mental State Examination. CONCLUSION The ability to perform "sitting-to-standing" and visuomotor organization functions at the beginning of rehabilitation emerged as the most significant predictors for achieving successful basic activities of daily living on discharge after stroke.
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Affiliation(s)
- Heegoo Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Chanmi Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Nayeong Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Eunhye Chung
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - HyeongMin Jeon
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Seyoung Shin
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea; Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Digital Therapeutics Research Team, CHA Future Medicine Research Institute, Seongnam, Republic of Korea; Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, Republic of Korea.
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Cruickshank A, Brooks ED, Sperling C, Nelson MLA, Singh H. Exploring the experiences of adults with stroke in virtual community-based stroke programs: a qualitative descriptive study. BMC Health Serv Res 2024; 24:600. [PMID: 38715062 PMCID: PMC11077787 DOI: 10.1186/s12913-024-11043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Stroke is among the top contributors to disability and can impact an individual's cognition, physical functioning, and mental health. Since the COVID-19 pandemic, several community-based organizations have started delivering stroke programs virtually. However, participants' experiences in these programs remain understudied, and evidence-based guidelines to inform and optimize virtual stroke program development and delivery are lacking. Thus, this study aimed to describe the perspectives and experiences of individuals with stroke who participated in virtual community-based organization stroke programs, including perceived access and participation facilitators and barriers and suggestions for improving these programs. METHODS A qualitative descriptive design was used to gather participant experiences through semi-structured interviews. Audio-recorded interviews were conducted on Zoom and transcribed verbatim. Adult participants who had experienced a stroke and attended at least one Canadian virtual community-based organization stroke program were recruited. Data were analyzed using inductive thematic analysis. RESULTS Twelve participants (32-69 years, 2-23 years post-stroke, eight women and four men) participated in this study. Five themes were identified: (1) motives to join virtual community-based organization stroke programs, including gaining peer connections, knowledge and information; (2) perceived barriers to accessing and participating in virtual community-based organization stroke programs, including technology inequities, difficulties navigating technology, and inadequate facilitation; (3) perceived facilitators to accessing and participating in virtual community-based organization stroke programs, including remote access, virtual platform features and program leader characteristics/skills; (4) unmet needs during virtual community-based organization stroke programs, including in-person connection and individualized support; and (5) suggestions and preferences for improving virtual community-based organization stroke programs, including program facilitation, content and format. CONCLUSIONS Study findings highlight opportunities to improve virtual community-based organization stroke programs to optimize participant experiences and outcomes. Addressing the barriers and suggestions identified in this study may improve virtual community-based organization stroke programs' access and quality.
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Affiliation(s)
- Amy Cruickshank
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Emma D'Andrea Brooks
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Christina Sperling
- March of Dimes Canada, 202-885 Don Mills Rd., Toronto, ON, M3C 1V9, Canada
| | - Michelle LA Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Dr, Toronto, ON, M4G 3V9, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
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Ribeiro Batista L, Silva SLAD, Cunha Polese J, Silva AC, Teixeira-Salmela LF, Faria CDCDM, Faria-Fortini I. Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke. Disabil Rehabil 2024:1-7. [PMID: 38318868 DOI: 10.1080/09638288.2024.2313124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. MATERIALS AND METHODS 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. RESULTS Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). CONCLUSIONS Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.
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Affiliation(s)
- Ludmilla Ribeiro Batista
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Janaine Cunha Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Aryane Carolina Silva
- Graduate Program in Rehabilitation Sicences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Ansong R, Gazarian P. Healthcare self-management support of stroke patients after discharge: A conceptual analysis using Rodger's evolutionary approach. J Adv Nurs 2024. [PMID: 38297450 DOI: 10.1111/jan.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/26/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
AIM(S) To explore the meaning of healthcare self-management support for post-discharged stroke patients. METHOD Rodgers' evolutionary approach was used to identify antecedents, attributes, related terms, surrogate terms and consequences. DATA SOURCE Literature from 2012 to 2022 was searched from MEDLINE, CINAHL, PsycINFO and Google Scholar. RESULTS Three antecedents preceded healthcare self-management support for post-discharged stroke patients: loss of inpatient support, preparedness for self-management and presence of self-management support. Healthcare self-management support for post-discharged stroke patients was defined by eight attributes: pre-discharge assessment and planning; provision of continuous education and training; collaborative goal-setting; reinforcement and documentation of vital information; coordination of post-discharge care; provision of rehabilitation support and promoting community reintegration; provision of counselling support; and using clear communication, patient empowerment and promoting self-efficacy. The identified consequences of the concept were as follows: improved patient outcomes; improved life quality; decreased healthcare cost; decreased re-admission rate and inpatient care burden; and decreased complication rate. CONCLUSION Healthcare self-management support for post-discharged stroke patients is an emerging concept that can help to significantly improve stroke patients' health outcomes and life quality. However, its applicability is uncertain considering the workload, time and resources available to healthcare professionals. There is a need for future studies to focus on the feasibility and applicability of this concept in clinical practice and to identify any challenges healthcare providers may have in supporting stroke patients after discharge. IMPACT This concept analysis brings clarity to the concept of healthcare self-management support of post-discharged stroke patients and distinguishes it from other self-management supports. It provides an opportunity for further studies and a pathway for generalized healthcare self-management support for stroke patients after discharge to improve health outcomes and quality of life. NO PATIENT OR PUBLIC CONTRIBUTION No patients, service users, caregivers or members of the public were involved in conducting this concept analysis.
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Affiliation(s)
- Rockson Ansong
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Priscilla Gazarian
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
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Abdullahi A, Wong TW, Ng SS. Prevalence and risks factors of caregiving-related low back pain among caregivers of stroke survivors: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2023; 59:682-688. [PMID: 37851375 PMCID: PMC10795072 DOI: 10.23736/s1973-9087.23.07970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Stroke causes disability that makes its survivors depend on caregivers for help. The caregivers offer help during lifting and transferring patients from one place to another. However, such activities result in the caregivers sustaining musculoskeletal injuries such as the low back pain (LBP). The aim of this study was to carry out a systematic review and meta-analysis to determine the prevalence of LBP and its risk factors among these caregivers. EVIDENCE ACQUISITION PubMED, Embase, Web of Science (WoS) and CINAHL were searched until January 2023, and cross-sectional studies were included. Data on prevalence of LBP due to caregiving activities and participants' characteristics such as sex and nature of caregiving were extracted. EVIDENCE SYNTHESIS Risks of bias of the included studies were assessed using Agency for healthcare Research and Quality (AHRQ) tool. The data were analyzed using both narrative and quantitative syntheses. In the quantitative synthesis, random effect model meta-analysis of the prevalence and odd of developing LBP between men and women; and between partial and complete caregivers was used. Fives studies (N.=644) were included. The results showed that the prevalence of LBP was 53.9%, with 96% CI from 50.0% to 57.8%. In addition, there was no statistically significant difference in the risk of developing LBP between men and women (OR=1.58, 95% CI=0.27 to 9.27, P=0.61); and between partial and complete caregivers (OR=1.33, 95% CI=0.32 to 5.61, P=0.70). CONCLUSIONS About half of caregivers of stroke survivors may experience LBP. Therefore, this should be considered during rehabilitation.
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Affiliation(s)
- Auwal Abdullahi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Thomson W Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Shamay S Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China -
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Vázquez Martínez VH, Martínez Bautista H, Loera Morales JI, Ruiz Carrizales DA. [Risk factors for disability in patients with stroke in northeastern Mexico: A retrospective cross-sectional study]. Aten Primaria 2023; 55:102779. [PMID: 37804803 PMCID: PMC10560769 DOI: 10.1016/j.aprim.2023.102779] [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: 06/23/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE To determine the risk factors associated with disability in patients who had a stroke in northeastern Mexico. DESIGN This was an observational, retrospective, cross-sectional study. SITE: Conducted at the Family Medicine Unit No. 33 of the Mexican Institute of Social Security in Reynosa, Tamaulipas, Mexico. PARTICIPANTS One hundred and ninety-eight males and 146 females, above 18 years old, beneficiaries of the Mexican Institute of Social Security with a diagnosis of stroke between 2018 and 2021. INTERVENTIONS The Barthel index that assesses the degree of dependence to perform basic activities of daily living was applied to the participants and sociodemographic, biological and anthropometric variables were collected from the digital medical record. MAIN MEASURES A univariate, correlational and ordinal logistic regression statistical analysis was performed between independent and dependent variables to obtain measures of frequency, percentages, and associated risks. RESULTS The risk factors associated with disability were age (OR 1.03, CI 1.01-1.05), overweight (OR 1.81, CI 1.03-3.1), obesity grade I (OR 2.74, CI 1.46-5.1), obesity grade II (OR 4.38, CI 1.44-13), obesity grade III (OR 9.99, CI 2.12-47); type of stroke: ischemic (OR 4.60, CI 2.6-8) or thrombotic (OR 4.95, CI 1.57-15). The number of comorbidities was associated with disability when having one comorbidity (OR 2.80, CI 1.22-6.4), two comorbidities (OR 3.43, CI 1.37-8.5), three comorbidities (OR 2.71, CI 1.01-7.3), and with five comorbidities (OR 3.17, CI 1.01-9.9). CONCLUSIONS The risk factors found for disability were age, overweight, obesity, and type of ischemic and thrombotic stroke. Being cared for by a relative and/or spouse reduces the probability of disability.
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Affiliation(s)
| | | | - Jesús Iii Loera Morales
- Unidad de Medicina Familiar número 33, Instituto Mexicano del Seguro Social (IMSS), Tamaulipas, México
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Abdullahi A, Wong TWL, Ng SSM. Effects and safety of vagus nerve stimulation on upper limb function in patients with stroke: a systematic review and meta-analysis. Sci Rep 2023; 13:15415. [PMID: 37723225 PMCID: PMC10507009 DOI: 10.1038/s41598-023-42077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
Vagus nerve stimulation (VNS) is used to deliver electric current to stimulate the vagus nerve. The aim of this study is to carry out a systematic review and meta-analysis to determine its effects on motor function in patients with stroke. PubMED, Embase, Web of Science (WoS), and Scopus were searched. Data on time since stroke, and mean scores and standard deviation on outcomes such as level of impairment and motor function were extracted. The results showed that invasive (MD 2.66, 95% CI 1.19-4.13, P = 0.0004) and non-invasive (MD 24.16, 95% CI 23.56-24.75, P = 0.00001) VNS are superior at improving level of motor impairment than the control post intervention and at follow-up respectively. Similarly, VNS improved motor function post intervention (MD 0.28, 95% CI 0.15-0.41, P < 0.0001); and there was no significant difference in adverse events between invasive VNS and control (OR 2.15, 95% CI 0.97-4.74, P = 0.06), and between non-invasive VNS and control (OR 4.54, 95% CI 0.48-42.97, P = 0.19). VNS can be used to improve motor function in patients with stroke.
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Affiliation(s)
- Auwal Abdullahi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region, China
| | - Thomson W L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region, China
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region, China.
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Dąbrowská M, Pastucha D, Janura M, Tomášková H, Honzíková L, Baníková Š, Filip M, Fiedorová I. Effect of Virtual Reality Therapy on Quality of Life and Self-Sufficiency in Post-Stroke Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1669. [PMID: 37763788 PMCID: PMC10536396 DOI: 10.3390/medicina59091669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The consequences of stroke have a significant impact on self-sufficiency and health-related quality of life (HRQoL). Virtual reality (VR)-based rehabilitation has the potential to impact these modalities, but information on timing, volume, and intensity is not yet available. The aim of this randomized controlled trial (1:1) was to evaluate the impact of conventional rehabilitation combined with VR on self-care and domains of HRQoL in patients ≤6 months post-stroke. Materials and Methods: The intervention group completed a total of 270 min of conventional VR + rehabilitation sessions. The control group underwent conventional rehabilitation only. Primary assessments with the WHO disability assessment schedule 2.0 (WHODAS 2) questionnaire were conducted before rehabilitation (T0), after completion of the intervention (T1), and at the 4-week follow-up (T2); secondary outcomes included self-sufficiency and balance assessments. Results: Fifty patients completed the study (mean age 61.2 ± 9.0 years, time since stroke 114.3 ± 39.4 days). There were no statistically significant differences between the groups in WHODAS 2, self-sufficiency, and balance scores (p > 0.05). Conclusions: In the experimental group, there was a statistically significant difference in WHODAS 2, assessment of self-sufficiency, and balance scores before and after therapy (p < 0.05). VR appears to be a suitable tool to supplement and modify rehabilitation in patients after stroke.
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Affiliation(s)
- Marcela Dąbrowská
- Department of Epidemiology and Public Health Protection, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic;
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
| | - Dalibor Pastucha
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Department of Rehabilitation and Sports Medicine, University Hospital of Ostrava, 708 52 Ostrava, Czech Republic
| | - Miroslav Janura
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Faculty of Physical Culture, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
| | - Hana Tomášková
- Department of Epidemiology and Public Health Protection, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic;
| | - Lucie Honzíková
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
| | - Šárka Baníková
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Department of Rehabilitation and Sports Medicine, University Hospital of Ostrava, 708 52 Ostrava, Czech Republic
| | - Michal Filip
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
| | - Iva Fiedorová
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Department of Rehabilitation and Sports Medicine, University Hospital of Ostrava, 708 52 Ostrava, Czech Republic
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Chen X, Liu F, Lyu Z, Xiu H, Hou Y, Tu S. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) impacts activities of daily living of patients with post-stroke cognitive impairment: a systematic review and meta-analysis. Neurol Sci 2023:10.1007/s10072-023-06779-9. [PMID: 37012519 DOI: 10.1007/s10072-023-06779-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To systematically evaluate the impact of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on activities of daily living (ADLs) of patients with post-stroke cognitive impairment (PSCI). DATA SOURCES Relevant studies published as of November 2022 (English and Chinese) were searched in Web of Science, PubMed, Embase, Cochrane Library, OVID, China Science and Technology Journal Database (VIP), Wanfang, Chinese National Knowledge Infrastructure (CNKI), and SinoMed databases. REVIEW METHODS Randomized controlled trials (RCTs) that used HF-rTMS for the treatment of ADLs in patients with PSCI were included in this meta-analysis. Two reviewers independently screened literature, extracted the data, evaluated the risk of bias using the Cochrane Risk of Bias Tool, and cross-checked. RESULTS Forty-one RCTs involving 2855 patients with PSCI were included. In 30 RCTs, the experimental group received HF-rTMS in addition to the interventions used in the control group. In 11 RCTs, the experimental group received HF-rTMS while the control group received sham-rTMS. Barthel Index (BI), Modified Barthel Index (MBI), and Functional Independence Measure (FIM) were higher in the HF-rTMS group than in the control group, whereas scores of Blessed Behavior Scale was lower in the HF-rTMS group than in the control group. All P < 0.05. In 36 studies, the stimulation sites were on the dorsolateral prefrontal cortex (DLPFC). CONCLUSION HF-rTMS can ameliorate ADLs of patients with PSCI and has a better rehabilitation effect on PSCI.
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Affiliation(s)
- Xin Chen
- Nursing College, Fujian University of Traditional Chinese Medicine, No.1 Qiu Yang Road, Shangjie, Minhou, Fuzhou, Fujian, 350122, People's Republic of China
| | - Fang Liu
- Nursing College, Fujian University of Traditional Chinese Medicine, No.1 Qiu Yang Road, Shangjie, Minhou, Fuzhou, Fujian, 350122, People's Republic of China.
| | - Zecai Lyu
- Nursing College, Fujian University of Traditional Chinese Medicine, No.1 Qiu Yang Road, Shangjie, Minhou, Fuzhou, Fujian, 350122, People's Republic of China
| | - Huoqin Xiu
- Nursing College, Fujian University of Traditional Chinese Medicine, No.1 Qiu Yang Road, Shangjie, Minhou, Fuzhou, Fujian, 350122, People's Republic of China
| | - Yufei Hou
- Nursing College, Fujian University of Traditional Chinese Medicine, No.1 Qiu Yang Road, Shangjie, Minhou, Fuzhou, Fujian, 350122, People's Republic of China
| | - Shuzhen Tu
- Nursing College, Fujian University of Traditional Chinese Medicine, No.1 Qiu Yang Road, Shangjie, Minhou, Fuzhou, Fujian, 350122, People's Republic of China
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Susts J, Reinholdsson M, Sunnerhagen KS, Abzhandadze T. Physical inactivity before stroke is associated with dependency in basic activities of daily living 3 months after stroke. Front Neurol 2023; 14:1094232. [PMID: 36824422 PMCID: PMC9942155 DOI: 10.3389/fneur.2023.1094232] [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: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Background Physical inactivity is a leading risk factor for non-communicable diseases, including stroke. Moreover, physical inactivity before stroke is associated with stroke severity, which, in turn, can cause disability. However, it remains unclear whether physical inactivity before stroke is associated with dependency in basic activities of daily living (ADL). Aim The aim of this study was to evaluate whether physical inactivity before stroke influences ADL dependency 3 months after stroke. Methods This longitudinal study was based on data from three Swedish registries. Patients with acute stroke who were admitted to the Sahlgrenska University Hospital between 9 November 2014 and 30 June 2019 were included in the study. Baseline data were collected from the three stroke units, and self-reported questionnaires were used to collect 3-month follow-up data. Physical inactivity before stroke was the primary independent variable that was self-reported using the Saltin-Grimby physical activity level scale. ADL dependency was a composite measure of three tasks: mobility, dressing, and toilet use. A binary logistic regression analysis was used to explain the association between physical inactivity before stroke and basic ADL 3 months after stroke. Results In total, 3,472 patients were included in the study. The median age was 75 years, 49% of the patients were physically inactive before stroke, and 75% had a mild stroke. ADL dependency at follow-up was reported to be 32%. Physically inactive patients, compared with physically active patients, had 2.35 times higher odds for ADL dependency 3 months after stroke (odds ratio 2.30 [95% CI 1.89 - 2.80]). The model correctly classified 84% of the patients (the area under the receiver operating characteristic curve was 0.84 [95% CI, 0.83 - 0.86]). Conclusion The findings of this study suggest that physical inactivity before stroke is associated with dependency in basic ADL 3 months after stroke. In addition, older age, female sex, pre-stroke living conditions, need for help, previous stroke, and admission stroke severity are significant contributors to dependency.
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Affiliation(s)
- Jevgenijs Susts
- Department of Education and Science, National Rehabilitation Center “Vaivari”, Jurmala, Latvia,Faculty of Residency, Riga Stradins University, Riga, Latvia
| | - Malin Reinholdsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden,Rehabilitation Medicine, Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden,*Correspondence: Tamar Abzhandadze ✉
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Langton-Frost N, Orient S, Adeyemo J, Bahouth MN, Daley K, Ye B, Lavezza A, Pruski A. Development and Implementation of a New Model of Care for Patients With Stroke, Acute Hospital Rehabilitation Intensive SErvices: Leveraging a Multidisciplinary Rehabilitation Team. Am J Phys Med Rehabil 2023; 102:S13-S18. [PMID: 36634325 DOI: 10.1097/phm.0000000000002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT The optimal timing and intensity of early rehabilitation remain uncertain. The literature has stated that too early high-intensity mobility within 24 hours can result in poor outcomes as compared with the 24- to 48-hour poststroke (Stroke 2012;43:2389-94. Stroke 2004;35:1005-9). However, few studies have shown that mobilizing patients a few times per day can have positive results (Stroke 2004;35:1005-9. Cerebrovasc Dis 2010;29:352-60). In addition to mobility impairments, many patients after stroke have dysphagia, aphasia, and cognitive-linguistic deficits. To date, there is limited literature on early rehabilitation in these areas. Here, we describe a program of enhanced rehabilitation in the acute care hospital. In this enhanced model of care, our team delivers up to six sessions of therapy per day focused on the patient's deficits. A patient can receive up to two sessions of each discipline daily to include physical therapy, occupational therapy, and speech language pathology. The model emphasizes team collaboration between therapy disciplines, physiatry, nursing, and neurology accomplished through a daily therapy schedule, rehabilitation huddle, and direct communication before and after therapy sessions. With this model, we aim to enhance coordination of care resulting in improved patient satisfaction and, ultimately, recovery.
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Affiliation(s)
- Nicole Langton-Frost
- From the Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland (NL-F, SO, JA, KD, BY, AL); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland (MNB); and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (AP)
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Huang M, Xu S, Zhou M, Luo J, Zha F, Shan L, Yang Q, Zhou B, Wang Y. Lysophosphatidylcholines and phosphatidylcholines as biomarkers for stroke recovery. Front Neurol 2022; 13:1047101. [PMID: 36588912 PMCID: PMC9797831 DOI: 10.3389/fneur.2022.1047101] [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: 09/17/2022] [Accepted: 11/29/2022] [Indexed: 12/16/2022] Open
Abstract
Stroke is a serious global public health issue, associated with severe disability and high mortality rates. Its early detection is challenging, and no effective biomarkers are available. To obtain a better understanding of stroke prevention, management, and recovery, we conducted lipidomic analyses to characterize plasma metabolic features. Lipid species were measured using an untargeted lipidomic analysis with liquid chromatography-tandem mass spectrometry. Sixty participants were recruited in this cohort study, including 20 healthy individuals and 40 patients with stroke. To investigate the association between lipids related to long-term functional recovery in stroke patients. The primary independent variable was activities of daily living (ADL) dependency upon admission to the stroke unit and at the 3-month follow-up appointment. ADL dependency was assessed using the Barthel Index. Eleven significantly altered lipid species between the stroke and healthy groups were detected and displayed in a hierarchically clustered heatmap. Acyl carnitine, triacylglycerol, and ceramides were detected as potential lipid markers. Regarding the association between lipid profiles and functional status of patients with stroke the results indicated, lysophosphatidylcholines (LPC) and phosphatidylcholines were closely associated with stroke recovery. LPC may contribute positively role in patient's rehabilitation process via an anti-inflammatory mechanism. Appropriate management or intervention for lipid levels is expected to lead to better clinical outcomes.
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Affiliation(s)
- Meiling Huang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Shaohang Xu
- Deepxomics., Ltd., Shenzhen, Guangdong, China
| | - Mingchao Zhou
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jiao Luo
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong, China
| | - Fubing Zha
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Linlin Shan
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Qingqing Yang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Baojin Zhou
- Deepxomics., Ltd., Shenzhen, Guangdong, China,Baojin Zhou
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China,*Correspondence: Yulong Wang
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