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Ko N, Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Chang WH, Lee J, Kim YH. Incidence of Altered Level of Consciousness in Hemorrhagic Stroke Survivors: Associated Factors From a Korean Nationwide Study. Am J Phys Med Rehabil 2024; 103:325-332. [PMID: 37903631 DOI: 10.1097/phm.0000000000002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVE This study aimed to demonstrate the incidence of altered level of consciousness after hemorrhagic stroke and identify factors associated with altered level of consciousness at 3 mos after stroke. DESIGN This study used data from a prospective multicenter cohort study conducted in nine hospitals in Korea and included 1677 patients with first-ever hemorrhagic stroke. Patients were dichotomized into those with and without altered level of consciousness at 3 mos after stroke. Multivariate logistic regression analysis was performed to identify factors associated with subacute to chronic stage altered level of consciousness. RESULTS Among patients with hemorrhagic stroke (age: 20-99 yrs, female 50.21%), the prevalence of altered level of consciousness at admission was 38.58% (25.4% [drowsy], 6.38% [stupor], and 6.8% [coma]) and 17.29% 3 mos after stroke. Multivariate logistic regression analysis revealed that independent factors associated with altered level of consciousness at 3 mos after stroke included late seizure (odds ratio [95% confidence interval], 5.93 [1.78-20.00]), stroke progression (3.84 [1.48-9.64]), craniectomy (2.19 [1.19-4.00]), history of complications (1.74 [1.18-2.55]), age at stroke onset (1.08 [1.07-1.10]), and initial Glasgow Coma Scale score category (0.36 [0.30-0.44]). CONCLUSIONS The factors associated with altered level of consciousness at 3 mos after stroke should be considered when explaining long-term consciousness status and focused management of modifiable factors in acute care hospitals could help ameliorate altered level of consciousness and promote recovery after stroke.
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Affiliation(s)
- Nayeon Ko
- From the Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea (NK, HHL, JL); Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea (MKS); Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (DYK); Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea (Y-IS); Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea (G-JO); Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (Y-SL); Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea (MCJ); Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City, Republic of Korea (SYL); Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea (M-KS); Department of Statistics, Hallym University, Chuncheon, Republic of Korea (JH); Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea (JA); Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (WHC, Y-HK); and Departments of Health Science and Technology, Medical Devices Management and Research, and Digital Healthcare, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (Y-HK)
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Lee JW, Sohn MK, Lee J, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Kim YH, Song MK, Chang WH. Predictors of Burden for First-Ever Stroke Survivor's Long-Term Caregivers: A Study of KOSCO. Medicina (Kaunas) 2024; 60:559. [PMID: 38674206 PMCID: PMC11052313 DOI: 10.3390/medicina60040559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Long-term changes in caregiver burden should be clarified considering that extended post-stroke disability can increase caregiver stress. We assessed long-term changes in caregiver burden severity and its predictors. This study was a retrospective analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Patients with an acute first-ever stroke were enrolled from August 2012 to May 2015. Data were collected at 6 months and 6 years after stroke onset. The caregiver burden was measured with a subjective caregiver burden questionnaire based on the Korean version of the Caregiver Burden Inventory. The caregivers' characteristics and patients' clinical and functional status were also examined at each follow-up. A high caregiver burden, which suggests a risk of burnout, was reported by 37.9% and 51.7% of caregivers at 6 months and 6 years post-stroke, respectively. Both the caregiver burden total score and proportion of caregivers at risk of burnout did not decrease between 6 months and 6 years. The patients' disability (OR = 11.60; 95% CI 1.58-85.08; p = 0.016), caregivers' self-rated stress (OR = 0.03; 95% CI 0.00-0.47; p = 0.013), and caregivers' quality of life (OR = 0.76; 95% CI 0.59-0.99; p = 0.042) were burden predictors at 6 months. At 6 years, only the patients' disability (OR = 5.88; 95% CI 2.19-15.82; p < 0.001) and caregivers' psychosocial stress (OR = 1.26; 95% CI 1.10-1.44; p = 0.001) showed significance. Nearly half of the caregivers were at risk of burnout, which lasted for 6 years after stroke onset. The patients' disability and caregivers' stress were burden predictors in both subacute and chronic phases of stroke. The findings suggest that consistent interventions, such as emotional support or counseling on stress relief strategies for caregivers of stroke survivors, may reduce caregiver burden. Further research is needed to establish specific strategies appropriate for Korean caregivers to alleviate their burden in caring for stroke patients.
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Grants
- 3300-3334-300-260-00, 2013-E33017-00, 2013E-33017-01, 2013E-33017-02, 2016-E33003-00, 2016-E33003-01, 2016-E33003-02, 2019-E3202-00, 2019-E3202-01, 2019-E3202-02, and 2022-11-006 Korea Disease Control and Prevention Agency
- NRF-2022R1A2C1091592 National Research Foundation of Korea
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Affiliation(s)
- Jin-Won Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City 63243, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon 24252, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
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Lee HS, Sohn MK, Lee J, Kim DY, Shin Y, Oh G, Lee Y, Joo MC, Lee SY, Song M, Han J, Ahn J, Kim DH, Kim Y, Chang WH. Long-Term Functional Outcome in Patients With Isolated Thalamic Stroke: The KOSCO Study. J Am Heart Assoc 2024; 13:e032377. [PMID: 38348806 PMCID: PMC11010118 DOI: 10.1161/jaha.123.032377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Information on the long-term prognosis in patients with isolated thalamic stroke is sparse. We report the functional outcomes of patients with thalamic stroke up to 24 months from the KOSCO (Korean Stroke Cohort for Functioning and Rehabilitation) study. METHODS AND RESULTS Isolated thalamic stroke was defined as the presence of lesions solely in the thalamus, excluding cases with lesions in other brain parenchyma areas apart from the thalamus, as identified by brain magnetic resonance imaging or computed tomography scans. The Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and the short version of the Korean Frenchay Aphasia Screening Test were used to assess physical impairment. The Functional Independence Measure and modified Rankin Scale were used to assess functional outcomes. All measurements were conducted up to 24 months poststroke. A total of 297 patients were included, consisting of 235 with ischemic and 62 with hemorrhagic stroke. Except for the Functional Ambulatory Category and Functional Independence Measure, all physical impairments showed significant improvement up to 3 months poststroke (P<0.001) and reached a plateau. The Functional Ambulatory Category and Functional Independence Measure scores continued to improve up to 12 months poststroke (P<0.05) and reached a plateau. At 7 days poststroke, 47.5% of patients had no disability (modified Rankin Scale score<2), whereas at 24 months poststroke, 76.4% of patients had no significant disability. CONCLUSIONS Patients showed rapid recovery from physical impairment up to 3 months poststroke, with additional improvements in ambulatory function and independence observed up to 12 months poststroke. Additionally, relatively favorable long-term functional prognosis at 24 months after onset was demonstrated. These results could provide insights into the proper management regarding functional outcomes of patients with isolated thalamic stroke.
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Affiliation(s)
- Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of MedicineChungnam National UniversityDaejeonRepublic of Korea
| | - Jongmin Lee
- Department of Rehabilitation MedicineKonkuk University School of MedicineSeoulRepublic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Yong‐Il Shin
- Department of Rehabilitation MedicinePusan National University School of Medicine, Pusan National University Yangsan HospitalYangsanRepublic of Korea
| | - Gyung‐Jae Oh
- Department of Preventive MedicineWonkwang University, School of MedicineIksanRepublic of Korea
| | - Yang‐Soo Lee
- Department of Rehabilitation Medicine, School of MedicineKyungpook National University, Kyungpook National University HospitalDaeguRepublic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation MedicineWonkwang University School of MedicineIksanRepublic of Korea
| | - So Young Lee
- Department of Rehabilitation MedicineJeju National University Hospital, Jeju National University School of MedicineJeju CityRepublic of Korea
| | - Min‐Keun Song
- Department of Physical and Rehabilitation MedicineChonnam National University Medical SchoolGwangjuRepublic of Korea
| | - Junhee Han
- Department of StatisticsHallym UniversityChuncheonRepublic of Korea
| | - Jeonghoon Ahn
- Department of Health ConvergenceEwha Womans UniversitySeoulRepublic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Yun‐Hee Kim
- Department of Physical and Rehabilitation MedicineSungkyunkwan University School of MedicineSuwonRepublic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHSTSungkyunkwan UniversitySeoulRepublic of Korea
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Choi JY, Jin LH, Jeon MS, Kim MH, Yang SS, Sohn MK. Training intensity of robot-assisted gait training in children with cerebral palsy. Dev Med Child Neurol 2024. [PMID: 38303153 DOI: 10.1111/dmcn.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/22/2023] [Accepted: 11/17/2023] [Indexed: 02/03/2024]
Abstract
AIM We compared three different intensities of robot-assisted gait training (RAGT) for achieving favourable outcomes in children with cerebral palsy (CP). METHOD This study was conducted using a randomized controlled, single-blind design. Thirty children (19 males and 11 females; mean age 6 years 1 month, SD 2 years) with CP classified in Gross Motor Function Classification System levels II and III were assigned to three different RAGT intensity groups: high-intensity (fastest walking speed and lowest body weight support [BWS]), low-intensity (slowest speed and highest BWS), and comfortable intensity (intermediate speed and intermediate BWS). The RAGT intervention was performed three times a week for 6 weeks. Outcome measures included the 88-item Gross Motor Function Measure, stability index, spatiotemporal parameters of gait analysis, paediatric functional independence measure, and the Canadian Occupational Performance Measure. RESULTS The 88-item Gross Motor Function Measure was significantly improved after training in the high-intensity (D Δ8.3 ± 15.6; E Δ3.8 ± 4.1) and comfortable intensity (D Δ2.9 ± 3.1; E Δ1.2 ± 2.0) groups, whereas gait speed was improved in the comfortable intensity group, without statistically significant group differences. Only the low-intensity group showed improvement on the stability index (Δ -0.6 ± 0.9, p = 0.05). Everyday functional performance significantly improved in all three groups, with the comfortable intensity group showing the greatest improvement. INTERPRETATION Different training intensities produced improvement in different areas; individualized RAGT intensity adjustment is therefore needed based on the rehabilitation goal.
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Affiliation(s)
- Ja Young Choi
- Department of Physical and Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Li Hua Jin
- Department of Physical and Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Soo Jeon
- Department of Physical and Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Department of Rehabilitation Medicine, Deajeon Sejong Chungnam ∙ Nexon Sponsored Public Children's Rehabilitation Hospital, Daejeon, Republic of Korea
| | - Min Hwan Kim
- Department of Physical and Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Shin-Seung Yang
- Department of Physical and Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min Kyun Sohn
- Department of Physical and Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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Kim MS, Min JH, Shin YI, Sohn MK, Lee J, Kim DY, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Kim YH, Ko SH, Chang WH. Predictors of quality of life at 6 months in patients with mild stroke: A prospective observational cohort study. J Stroke Cerebrovasc Dis 2023; 32:107302. [PMID: 37703592 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/04/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES This study aimed to analyze the factors affecting the long-term quality of life of patients with mild stroke and evaluate the differences according to age and sex. MATERIALS AND METHODS The Korean Stroke Cohort for functioning and rehabilitation data was used, and patients with mild stroke with a National Institute of Health Stroke Scale score of < 5 were included. Quality of life after 6 months was analyzed using EuroQol-5 dimensions. Demographic and clinical characteristics were evaluated, and factors affecting the quality of life at 6 months were analyzed. RESULTS Age, current drinking, marital status, length of stay, and modified Rankin Scale, Fugl-Meyer assessment, Functional Independence Measure, and Geriatric Depression Scale scores affected the quality of life at 6 months in patients with mild stroke. Fugl-Meyer assessment score was a predictor for those aged < 65 years, while the functional ambulatory category was a predictor for those aged ≥ 65 years. Predictors of quality of life, excluding alcohol consumption, were comparable between male and female. CONCLUSIONS Among patients aged <65 years, individuals who consumed alcohol, and those who showed better motor function and fewer comorbidities had a higher quality of life. Among patients aged ≥65 years, quality of life was higher in males, younger age, married individuals, those with diabetes, and those with a better walking ability. Among male, individuals who consumed alcohol had a higher quality of life. Rehabilitation treatment should prioritize improving modifiable factors to enhance the quality of life in patients with mild stroke.
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Affiliation(s)
- Mu Su Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Cho HM, Cha S, Sohn MK, Jee S, Chang WK, Kim WS, Paik NJ. Investigation of the efficacy of low-frequency repetitive transcranial magnetic stimulation on upper-limb motor recovery in subacute ischemic stroke without cortical involvement: a protocol paper for a multi-center, double-blind randomized controlled trial. Front Neurol 2023; 14:1216510. [PMID: 37693768 PMCID: PMC10491015 DOI: 10.3389/fneur.2023.1216510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction The incidence of stroke is increasing steadily due to factors such as population aging. Approximately 80% of stroke survivors have motor disorders affecting their daily lives. Repetitive transcranial magnetic stimulation (rTMS) has been reported to maximize functional recovery after stroke along with exercise intervention in upper limb rehabilitation treatment. However, whether rTMS affects the recovery of upper limb function in patients with stroke remains unclear. Therefore, in this trial, we will investigate the efficacy of low-frequency rTMS in patients with subcortical and brainstem ischemic stroke. Methods This study has been designed as a multi-center, double-blind, randomized controlled trial to compare the efficacy of low-frequency rTMS over the contralesional M1 with sham stimulation. Overall, 88 participants will be allocated to the intervention or control group in a 1:1 ratio, with stratification according to their initial upper extremity Fugl-Meyer assessment (UE-FMA) score. The participants will receive either 30 min of real rTMS (intervention group) or sham rTMS (control group), followed by 30 min of occupational therapy for 10 consecutive workdays. All the participants will receive the same amount of rehabilitation therapy throughout the intervention period. Evaluations will be performed at baseline (T0), at the end of treatment (T1), and 4 weeks after the end of treatment (T2), including the box and block test (BBT), UE-FMA, Korean version of the Modified Barthel Index, and NIH Stroke Scale scores, Finger tapping test, Brunnstrom stage, modified Ashworth scale, and grip strength. The primary outcome will be the change in the BBT score between T0 and T2. Conclusion This study will provide evidence on the efficacy of low-frequency rTMS in motor function recovery of the upper limb in patients with subacute, subcortical, and brainstem ischemic stroke. Clinical trial registration ClinicalTrials.gov, identifier [NCT05535504].
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Affiliation(s)
- Hee-Mun Cho
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Lee JI, Han JY, Gwak HB, Moon CW, Sohn MK, Jee S, Kim C. Financial InceNtives for cArdiac rehabilitatioN ComplEtion (FINANCE) (single blind pragmatic RCT). Medicine (Baltimore) 2023; 102:e32936. [PMID: 36827069 DOI: 10.1097/md.0000000000032936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is strongly indicated in patients with acute myocardial infarction (MI), and has been proven to reduce mortality and recurrence and improve patients quality of life. Although clinical guidelines for CR have already been developed domestically and internationally, hospital-based CR remains underutilized. Currently, studies exploring strategies to improve CR participation in South Korea and Asia are limited. OBJECTIVES This study aims to compare the effect of providing CR financial incentives to post-MI patients referred for outpatient CR and to confirm the effect of increasing CR participation and completion rates. METHODS This single-blind, pragmatic, randomized controlled trial will be conducted at 2 tertiary hospitals for CR after acute MI. The control and experimental groups will be randomized, with each group consisting of 24 participants (total of 48 participants) assigned in a 1:1 ratio. The experimental group will receive 4, 7, and 11 USD per completed session of CR during the 1st to 12th, 13 to 24th, and 25th to 36th sessions of CR, respectively, for 3 months after enrollment. Participants who completed the 36 sessions will receive 260 USD incentives. The primary outcomes at 3 months will be used to assess the CR participation rate, as the number of CR sessions completed, and CR completion, as attendance of sessions greater than 50%, thus completion of ≥18 sessions. The outcomes will be used to compare changes in cardiorespiratory function (VO2 max, VO2 at anabolic threshold), the Korean activity scale index, EuroQol 5 dimensions, and the patient health questionnaire at 3 months after discharge and 6 and 12 months after baseline. DISCUSSION Providing financial incentives may confirm the effect of increasing CR on participation and completion rates.
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Affiliation(s)
- Jae In Lee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jae-Young Han
- Department of Physical Medicine and Rehabilitation, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hae-Bin Gwak
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Chang-Won Moon
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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Yun SM, Shin S, Chang WH, Kim DY, Lee J, Sohn MK, Song MK, Shin YI, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Oh GJ, Kim YH. Gender Differences in Mortality and Long-term Functional Outcomes After First-Ever Ischemic Stroke: A Prospective Cohort Study. Int J Stroke 2023:17474930231159779. [PMID: 36786321 DOI: 10.1177/17474930231159779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Although many studies about survival rates and functional outcomes after stroke have been published, studies on gender differences have reported conflicting results. AIMS To determine whether there are differences in mortality and functional outcomes during the first five years after a first-ever ischemic stroke in Korean males and females. METHOD This is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation, a prospective multicenter cohort study. Multifaceted functional assessments were performed repeatedly from 7 days to 60 months after stroke onset to test motor, ambulatory, cognitive, language, and swallowing functions as well as activities of daily living (ADLs) in first-ever stroke patients. Of 10,636 first-ever stroke patients admitted to nine representative hospitals in Korea, 8,210 were ischemic stroke patients included in the mortality analysis. Among them, 6,258 patients provided informed consent and 3,508 completed functional assessments for 60 months. Gender-related differences in five-year mortality and functional recovery were analyzed. RESULT Women showed a significantly higher five-year mortality rate than men after correction for possible covariates (p < 0.05). In terms of functional outcomes, women showed worse ambulatory, cognitive, language, and ADL outcomes than men after adjusting for covariates (all p < 0.05). The five-year recovery pattern differed significantly between genders only for ADL function (β-coefficient estimate=0.34; p = 0.03). CONCLUSION Five-year mortality rate, functional outcomes, and recovery patterns after first-ever ischemic stroke differed significantly by gender. These results suggest the need for gender-specific stroke care and long-term management strategies.
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Affiliation(s)
- Sang Moon Yun
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 36626
| | - Seyoung Shin
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 36626
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 35019
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea 37991
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea 58933
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea 26715
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea 65417
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea 58916
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea 579998
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea 65433
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea 37984
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea 26727
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea 26717
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea 65433
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 35019.,Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
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9
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Kwon BM, Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Chang WH, Lee J, Kim YH. Contributing Factors to the Burden on Primary Family Caregivers of Stroke Survivors in South Korea. Int J Environ Res Public Health 2023; 20:2760. [PMID: 36768126 PMCID: PMC9914967 DOI: 10.3390/ijerph20032760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study is to identify the factors associated with the burden on primary family caregivers of stroke patients at home without care services. For this study, the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data were used. Of the total 8010 caregivers, 1133 family caregiver burden was assessed with the shortened Caregiver Burden Inventory (CBI) 3 months after stroke. Patient and caregiver-related factors affecting the heavier burden of caregivers were identified by comparing the heavier caregiver burden group and the lighter caregiver burden group, which divided according to the CBI scores. The 719 (63.5%) family caregiver cared for patients at home without care services. Logistic regression analysis showed that four or more comorbidities (p = 0.002), neurological impairment at early onset (p < 0.001), dependence on daily life (p < 0.001), aphasia (p = 0.024), and depression(p < 0.001) were associated with a heavier burden of care. According to the shortened CBI, caregivers tended to be concerned more about psychological stress than physical strain. The findings suggest the importance of proactively guiding the emotional support services to caregivers who are at high risk of the heavier burden of patient care.
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Affiliation(s)
- Bo Mi Kwon
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University Yangsan Hospital, Pusan National University, Yangsan-si 50612, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41566, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine l, Jeju-si 63241, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Suwon 06351, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Suwon 06351, Republic of Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Suwon 06351, Republic of Korea
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10
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Choi JE, Kim YW, Jee S, Sohn MK. Clinical characteristics of chronic rhinitis following stroke. Front Neurol 2023; 14:1081390. [PMID: 36756250 PMCID: PMC9901202 DOI: 10.3389/fneur.2023.1081390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Background We previously observed that patients with stroke complained of rhinitis symptoms that developed following the occurrence of stroke. Objectives To investigate the relationship between chronic rhinitis (CR) and stroke. Methods This retrospective study analyzed the medical records and questionnaires of patients with stroke who visited our outpatient clinic from June to December 2020. Stroke lesions were mainly classified as supratentorial, infratentorial, and supra/infratentorial lesions. Supratentorial lesions were further divided into cortex, subcortex, and mixed. Participants were screened for CR and were subsequently divided into the CR and non-CR groups. The Sino-Nasal Outcome Test questionnaire and a questionnaire on autonomic nervous system symptoms were administered to all patients. Results Clinically evaluated indicators were not significantly different between the two groups. The number of patients with lesions in both the cortex and subcortex was significantly higher in the CR group than in the non-CR group. The risk of CR was higher in male patients with stroke than their female counterparts; additionally, the risk of CR was higher in patients with stroke who had both cortical and subcortical lesions, as well as autonomic dysfunction. Conclusions Individuals with subcortical stroke damage had a greater probability of developing CR. The risk was increased in men, as compared with that in women, when autonomic symptoms were present.
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Affiliation(s)
- Jae Eun Choi
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yeong Wook Kim
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea,Chungnam Regional Cardiocerebrovascular Center, Chungnam National University, Daejeon, Republic of Korea,*Correspondence: Sungju Jee ✉
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea,Min Kyun Sohn ✉
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11
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Shin S, Chang WH, Kim DY, Lee J, Sohn MK, Song MK, Shin YI, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Oh GJ, Kim YT, Kim K, Kim YH. Clustering and prediction of long-term functional recovery patterns in first-time stroke patients. Front Neurol 2023; 14:1130236. [PMID: 36970541 PMCID: PMC10031095 DOI: 10.3389/fneur.2023.1130236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives The purpose of this study was to cluster long-term multifaceted functional recovery patterns and to establish prediction models for functional outcome in first-time stroke patients using unsupervised machine learning. Methods This study is an interim analysis of the dataset from the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO), a long-term, prospective, multicenter cohort study of first-time stroke patients. The KOSCO screened 10,636 first-time stroke patients admitted to nine representative hospitals in Korea during a three-year recruitment period, and 7,858 patients agreed to enroll. Early clinical and demographic features of stroke patients and six multifaceted functional assessment scores measured from 7 days to 24 months after stroke onset were used as input variables. K-means clustering analysis was performed, and prediction models were generated and validated using machine learning. Results A total of 5,534 stroke patients (4,388 ischemic and 1,146 hemorrhagic; mean age 63·31 ± 12·86; 3,253 [58.78%] male) completed functional assessments 24 months after stroke onset. Through K-means clustering, ischemic stroke (IS) patients were clustered into five groups and hemorrhagic stroke (HS) patients into four groups. Each cluster had distinct clinical characteristics and functional recovery patterns. The final prediction models for IS and HS patients achieved relatively high prediction accuracies of 0.926 and 0.887, respectively. Conclusions The longitudinal, multi-dimensional, functional assessment data of first-time stroke patients were successfully clustered, and the prediction models showed relatively good accuracies. Early identification and prediction of long-term functional outcomes will help clinicians develop customized treatment strategies.
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Affiliation(s)
- Seyoung Shin
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju-si, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon-si, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Young-Taek Kim
- Department of Preventive Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kwangsu Kim
- College of Computing, Sungkyunkwan University, Suwon-si, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
- *Correspondence: Yun-Hee Kim ;
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12
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Abstract
Cognitive impairment is observed in 12% to 56% of stroke patients, and screening for cognitive impairment is often complex and time-consuming, with results dependent on patient compliance. Therefore, there is a need for an objective method to assess cognitive impairment regardless of patient compliance. Objective evaluation methods include electroencephalogram (EEG) and event-related potential (ERP). This study was conducted to assess intra-tester reliability of resting EEG-based spectral features and auditory/visual P300 latency/amplitude in patients with subacute ischemic stroke. Twenty patients with subacute ischemic stroke were included in the study. The resting EEG and P300 wave using an auditory and visual oddball paradigm were measured at baseline and once again in 24 hours. The following electrode positions (10-20 system) were constantly recorded: F3 (Frontal), Fz, F4, C3 (Central), Cz, C4, P3 (Parietal), Pz, P4. DAR (delta/alpha ratio) and BSI (brain symmetry index) were determined using EEG data. F3 and F4, C3 and C4 and P3 and P4 were switched according to the stroke side and classified as affected hemisphere (AH) and unaffected hemisphere (UH) after the evaluation. In ERP, the amplitude and latency of P300 were obtained. In reliability analysis of EEG-based spectral characteristics, significant reliability was observed for DAR (ICC = 0.447), BSldir (ICC = 0.713) and BSIdirtheta (ICC = 0.724) (Table 4). DAR was showed a poor ICC level, and BSIdir and BSIdirtheta had a moderate ICC level. Visual P300 latency showed excellent intraclass correlation coefficient (ICC) in several montages (PUH = 0.972, Pz = 0.945). In 6 montages, auditory P300 latency was reliable, while in 9 montages, visual P300 latency was reliable. In 4 montages, auditory P300 amplitude was reliable, while visual P300 amplitude was reliable in 7. The visual P300 was more reliable than the auditory P300. The ICC values for P300 latency were greater than those for amplitude. Therefore, when ERP is performed on subacute stroke patients, visual has higher reliability than auditory.
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Affiliation(s)
- Dong Hyuk Yun
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Eun Choi
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
- * Correspondence: Sungju Jee, Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea (e-mail: )
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13
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Kim DH, Moon SJ, Lee J, Cha JK, Kim MH, Park JS, Ban B, Kang J, Kim BJ, Kim WS, Yoon CH, Lee H, Kim S, Kang EK, Her AY, Yoon CW, Rha JH, Woo SI, Lee WK, Jung HY, Lee JH, Park HS, Hwang YH, Kim K, Kim RB, Choi NC, Hwang J, Park HW, Park KS, Yi S, Cho JY, Kim NH, Choi KH, Kim J, Han JY, Choi JC, Kim SY, Choi JH, Kim J, Sohn MK, Choi SW, Shin DI, Lee SY, Bae JW, Lee KS, Bae HJ. Comparison of Factors Associated With Direct Versus Transferred-in Admission to Government-Designated Regional Centers Between Acute Ischemic Stroke and Myocardial Infarction in Korea. J Korean Med Sci 2022; 37:e305. [PMID: 36325609 PMCID: PMC9623032 DOI: 10.3346/jkms.2022.37.e305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. METHODS Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. RESULTS Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. CONCLUSIONS Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.
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Affiliation(s)
- Dae-Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Seok-Joo Moon
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jae-Kwan Cha
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Jong-Sung Park
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Byeolnim Ban
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won-Seok Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang-Hwan Yoon
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heeyoung Lee
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seongheon Kim
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Kyoung Kang
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ae-Young Her
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Cindy W Yoon
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Joung-Ho Rha
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Seong-Ill Woo
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Won Kyung Lee
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Han-Young Jung
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Hun Sik Park
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Yang-Ha Hwang
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Keonyeop Kim
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Rock Bum Kim
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jinyong Hwang
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun-Woong Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Soo Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - SangHak Yi
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Nam-Ho Kim
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Kang-Ho Choi
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Juhan Kim
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae-Young Han
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jay Chol Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Song-Yi Kim
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Joon-Hyouk Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Jei Kim
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Min Kyun Sohn
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Si Wan Choi
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Dong-Ick Shin
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Sang Yeub Lee
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Jang-Whan Bae
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hee-Joon Bae
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Jo YJ, Kim DH, Sohn MK, Lee J, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Chang WH, Kim YH, Kim DY. Clinical Characteristics and Risk Factors of First-Ever Stroke in Young Adults: A Multicenter, Prospective Cohort Study. J Pers Med 2022; 12:jpm12091505. [PMID: 36143290 PMCID: PMC9504439 DOI: 10.3390/jpm12091505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023] Open
Abstract
Stroke in young adults has catastrophic consequences and has increased in prevalence, contrary to the trends of most other diseases. This study aimed to determine the major characteristics and risk factors for stroke in younger adults compared with older adults. From the Korean Stroke Cohort for Functioning and Rehabilitation, 10,584 patients with first-ever stroke between August 2012 and March 2015 were enrolled retrospectively and divided into younger (age ≤ 45) and older groups (age > 45). The clinical characteristics and risk factors of stroke were compared between the younger and older groups. The younger group comprised 915 patients (8.6%). The proportion of hemorrhage strokes in the younger group (42.3%) was significantly higher than in the older group (20.0%) (p < 0.001). Obesity, current smoking, and heavy alcohol consumption were significantly more common risk factors in the younger group than in the older group for all stroke types, whereas hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and coronary heart disease were significantly more frequent in the older group (both p < 0.001). The major risk factors in the younger group may be lifestyle-related. Therefore, increasing awareness of lifestyle-related risk factors may be necessary to prevent stroke in young adults.
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Affiliation(s)
- Yea Jin Jo
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dae Hyun Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejon 34134, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 46241, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan 51538, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41566, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan 51538, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63243, Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Kwangju 61186, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chunchon 24252, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul 03063, Korea
- Correspondence: (Y.-H.K.); (D.Y.K.)
| | - Deog Young Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: (Y.-H.K.); (D.Y.K.)
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15
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Shin S, Lee Y, Chang WH, Sohn MK, Lee J, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Kim YH. Multifaceted Assessment of Functional Outcomes in Survivors of First-time Stroke. JAMA Netw Open 2022; 5:e2233094. [PMID: 36149652 PMCID: PMC9508656 DOI: 10.1001/jamanetworkopen.2022.33094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Because stroke causes diverse functional deficits, understanding the long-term recovery pattern of each functional domain may inform prognosis and therapeutic strategies. OBJECTIVE To observe long-term changes in functional status and residual disability in survivors of first-time stroke. DESIGN, SETTING, AND PARTICIPANTS This cohort study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Between August 2012 and May 2015, 7858 of 10 636 screened patients with first-time strokes from 9 district hospitals in Korea provided informed consent to participate. Data were analyzed from September 2021 through February 2022. EXPOSURE First-time stroke. MAIN OUTCOMES AND MEASURES Study data include multifaceted face-to-face functional assessments obtained at 8 to 9 points until 60 months after stroke onset. The Korean Mini-Mental State Examination (K-MMSE), Fugl-Meyer Assessment, Functional Ambulatory Category, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and Short Korean version of the Frenchay Aphasia Screening Test were performed from 7 days to 60 months after stroke. The Korean Modified Barthel Index was measured from 3 months to 60 months after stroke. RESULTS A total of 4443 patients (2649 men [59.62%]; mean [SD] age 62.13 [12.43] years) who underwent repeated functional assessments for 60 months after stroke (3508 patients with ischemic and 935 patients with hemorrhagic stroke) were included. Overall, functions plateaued between 12 and 18 months after stroke and declined after 30 months; for example, mean (SD) K-MMSE improved from 7 days (22.89 [7.89]) to 12 months (26.03 [5.48]) (P < .001), plateaued until 36 months (26.03 [5.84]), and decreased to 48 months (26.02 [5.82]) (P < .001). Interaction associations were found between time after stroke and age, stroke severity, and stroke type in functional assessment outcomes. For example, mean (SE) FMA for ages 65 years or younger vs older than 65 years was 81.64 (0.63) vs 80.69 (0.68) at 7 days and 91.28 (0.47) vs 88.46 (0.58) at 6 months (P for interaction < .001), and for IS vs HS, it was 84.46 (0.47) vs 69.02 (1.24) at 7 days and 91.20 (0.38) vs 85.51 (0.98) at 6 months (P for interaction < .001). Mean (SE) FMA was 94.39 (0.21) at 7 days and 97.57 (0.14) at 6 months for mild stroke, 44.69 (1.18) at 7 days and 70.43 (1.21) at 6 months for moderate stroke, and 13.22 (0.99) at 7 days and 48.07 (2.62) at 6 months for severe stroke (P for interaction < .001). Factors associated with activities of daily living independence at 60 months included older age (β per 1-year increase = -0.35; standard error [SE], 0.03; P < .001), male sex (β = 2.12; SE, 0.73; P = .004), and hemorrhagic stroke type (β vs ischemic stroke = 2.35; SE, 0.81; P = .004). CONCLUSIONS AND RELEVANCE This study found that long-term recovery patterns in multifaceted functional domains differed from one another and varied by patient age, stroke severity, and stroke type. Understanding the diversity of long-term functional recovery patterns and factors associated with these outcomes in survivors of stroke may help clinicians develop strategies for effective stroke care and rehabilitation.
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Affiliation(s)
- Seyoung Shin
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yaesuel Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Science and Technology, Department of Medical Devices Management and Research, Department of Digital Healthcare, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Abstract
PURPOSE Metatarsal pads are prescribed to decrease forefoot plantar pressure. However, the appropriate metatarsal pad placement location remains a debated issue. We aimed to identify the most effective insole design that reduces forefoot plantar pressure and determine the optimal position for metatarsal pad placement. MATERIALS AND METHODS We recruited 16 healthy adult volunteers, and measured their plantar pressure data during walking while using an in-shoe system. The volunteers were randomly assigned to one of four insole conditions: 1/16-inch insole (i.e., control), 1/4-inch soft plastazote (SP) flat insole, metatarsal pad positioned proximal to the metatarsal head (MTH) on the control insole (P0), and metatarsal pad positioned 10 mm distal from the proximal border of the MTH on the control insole (P10). A masking protocol was created by dividing the forefoot into three subareas, distal to the MTH (dMTH), beneath to the MTH (bMTH), and proximal to the MTH (pMTH). The participants reported their comfort level for each insole using a visual analog scale. RESULTS The SP flat insole and metatarsal pads both had a forefoot plantar pressure-reducing effect and provided insole comfort. Of the three insole designs, the SP flat insole was the most effective. No clear difference existed in efficacy in terms of the location of the metatarsal pad placement. CONCLUSION Considering the possibility of discomfort caused by improper metatarsal pad placement, the SP that increases shock absorption may be more clinically useful.
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Affiliation(s)
- Tae Im Yi
- Rehabilitation Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea.
| | - Eun Chae Lee
- Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Nak Hoon Son
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea.
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Kim MG, Lee SA, Park EJ, Choi MK, Kim JM, Sohn MK, Jee SJ, Kim YW, Son JE, Lee SJ, Hwang KS, Yoo SD. Elastic Dynamic Sling on Subluxation of Hemiplegic Shoulder in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial. Int J Environ Res Public Health 2022; 19:9975. [PMID: 36011613 PMCID: PMC9408021 DOI: 10.3390/ijerph19169975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Background: Shoulder subluxation occurs in 17−64% of hemiplegic patients after stroke and develops mostly during the first three weeks of hemiplegia. A range of shoulder orthoses has been used in rehabilitation to prevent subluxation. However, there is little evidence of their efficacy. AIM: This study aimed to investigate whether there is a difference in the subluxation distance, pain, and functional level of the hemiplegic upper extremity among patients with two different shoulder orthoses. Design: This is a prospective, randomized controlled trial with intention-to-treat analysis. SETTING: Multicenter, rehabilitation medicine department of two university hospitals in South Korea. Population: Forty-one patients with subacute stroke with shoulder subluxation with greater than 0.5 finger width within 4 weeks of stroke were recruited between January 2016 and October 2021. Methods: The experimental group used an elastic dynamic sling while sitting and standing to support the affected arm for eight weeks. The control group used a Bobath sling while sitting and standing. The primary outcome was to assess the distance of the shoulder subluxation on radiography. The secondary outcomes were upper-extremity function, muscle power, activities of daily living, pain and spasticity. Result: The horizontal distance showed significant improvement in the elastic dynamic sling group, but there were no significant differences in the vertical distance between the elastic dynamic and Bobath sling groups. Both groups showed improvements in upper-extremity movements and independence in daily living after 4 and 8 weeks of using shoulder orthoses, and the differences within the groups were significant (p < 0.05). However, there were no significant differences in upper-extremity movements and independence in daily living between the two groups. Conclusions: The subluxation distance showed better results in the elastic dynamic sling, which has both proximal and distal parts, than in the Bobath sling, which holds only the proximal part. Both shoulder orthoses showed improvements in the modified Barthel index, upper-extremity function, and manual muscle testing.
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Affiliation(s)
- Min Gyun Kim
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
- Department of Physical Medicine and Rehabilitation, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Seung Ah Lee
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Min Kyu Choi
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Ji Min Kim
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
| | - Yeong Wook Kim
- Department of Rehabilitation Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Korea
| | - Jung Eun Son
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Seo Jun Lee
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Keum Sun Hwang
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
- Department of Medicine, AgeTech-Service Convergence Major, Kyung Hee University, Seoul 02447, Korea
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18
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Kim C, Kwak HB, Sung J, Han JY, Lee JW, Lee JH, Kim WS, Bang HJ, Baek S, Joa KL, Kim AR, Lee SY, Kim J, Kim CR, Kwon OP, Sohn MK, Moon CW, Lee JI, Jee S. A survey of the perceptions of barriers to and facilitators of cardiac rehabilitation in healthcare providers and policy stakeholders. BMC Health Serv Res 2022; 22:999. [PMID: 35932056 PMCID: PMC9356496 DOI: 10.1186/s12913-022-08298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea. Methods We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed. Results Responses about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, hospitals’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals’ roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies’ roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients’ roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations. Conclusions Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08298-3.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Hae-Bin Kwak
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Young Han
- Department of Physical Medicine and Rehabilitation, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jang Woo Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University, College of Medicine, Cheongju, South Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Kyung Lim Joa
- Department of Physical Medicine and Rehabilitation, Inha University Hospital, Incheon, South Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, South Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine, Wonkwang University Hospital, Wonkwang University Medical School, Iksan, South Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Oh Pum Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Chang-Won Moon
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Jae-In Lee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea.
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19
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Lee EY, Sohn MK, Lee JM, Kim DY, Shin YI, Oh GJ, Lee YS, Lee SY, Song MK, Han JH, Ahn JH, Lee YH, Chang WH, Choi SM, Lee SK, Joo MC, Kim YH. Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure. Int J Environ Res Public Health 2022; 19:9612. [PMID: 35954971 PMCID: PMC9367998 DOI: 10.3390/ijerph19159612] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/26/2022]
Abstract
This study investigated the long-term functional changes in patients with moderate-to-severe ischemic stroke. In addition, we investigated whether there was a difference between the modified Barthel Index (MBI) and Functional Independence Measure (FIM) according to severity. To evaluate the changes in the long-term functional independence of the subjects, six evaluations were conducted over 2 years, and the evaluation was performed using MBI and FIM. A total of 798 participants participated in this study, of which 673 were classified as moderate and 125 as severe. During the first 3 months, the moderate group showed greater recovery than the severe group. The period of significant change in the National Institutes of Health Stroke Scale (NIHSS) score was up to 6 months after onset in the moderate group, and up to 3 months after onset in the severe group. In the severe group, MBI evaluation showed significant changes up to 6 months after onset, whereas FIM showed significant changes up to 18-24 months. Our results showed that functional recovery of patients with ischemic stroke in the 3 months after onset was greater in the moderate group than in the severe group. FIM is more appropriate than MBI for evaluating the functional status of patients with severe stroke.
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Affiliation(s)
- Eun Young Lee
- Department of Rehabilitation Medicine, Institute of Brain Science Research, Wonkwang University School of Medicine, Iksan 54538, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Jong Min Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan 54538, Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41566, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63241, Korea
| | - Min Keun Song
- Department of Physical and Rehabilitation Medicine, Chunnam National University Medical School, Kwangju 61469, Korea
| | - Jun Hee Han
- Department of Statistics, Hallym University, Chuncheon 24252, Korea
| | - Jeong Hoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Young Hoon Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41566, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soo Mi Choi
- Division of Chronic Disease Prevention, Korea Centers for Disease Control and Prevention, Center for Disease, Cheongju 28159, Korea
| | - Seon Kui Lee
- Division of Chronic Disease Prevention, Korea Centers for Disease Control and Prevention, Center for Disease, Cheongju 28159, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan 54538, Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
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Chang WH, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Oh GJ, Lee YS, Joo MC, Han EY, Han J, Kim YH. Erratum: Role of Intensive Inpatient Rehabilitation for Prevention of Disability after Stroke: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. Brain Neurorehabil 2022; 15:e22. [PMID: 36743198 PMCID: PMC9833474 DOI: 10.12786/bn.2022.15.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
[This corrects the article e4 in vol. 9.].
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Affiliation(s)
- Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, Korea
| | - Junhee Han
- Division of Biostatistics, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Department of Medical Device Management & Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
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Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Lee YH, Chang WH, Choi SM, Lee SK, Lee J, Kim YH. Understanding of the Lower Extremity Motor Recovery After First-Ever Ischemic Stroke. Stroke 2022; 53:3164-3172. [PMID: 35713003 DOI: 10.1161/strokeaha.121.038196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to verify the validity of the proportional recovery model for the lower extremity. METHODS We reviewed clinical data of patients enrolled in the Korean Stroke Cohort for Functioning and Rehabilitation between August 2012 and May 2015. Recovery proportion was calculated as the amount of motor recovery over initial motor impairment, measured as the Fugl-Meyer Assessment of Lower Extremity score. We used the logistic regression method to model the probability of achieving the full Fugl-Meyer Assessment of Lower Extremity score, whereby we considered the ceiling effect of the score. To show the difference in the prevalence of achieving the full Fugl-Meyer Assessment of Lower Extremity score between 3 and 6 months poststroke, we constructed a marginal model through the generalized estimating equation method. We also performed the propensity score matching analysis to show the dependency of recovery proportion on the initial motor deficit at 3 and 6 months poststroke. RESULTS We evaluated 1085 patients. The recovery proportions at 3 and 6 months poststroke were 0.67±0.42 and 0.75±0.39, respectively. A 1-unit decrease in the initial neurological impairment and the age at stroke onset increased the probability of achieving the full Fugl-Meyer Assessment of Lower Extremity score, which occurred at both 3 and 6 months poststroke. The prevalence of those who reach full lower limb motor recovery differs significantly between 3 and 6 months poststroke. We also found out that the recovery proportion at both 3 and 6 months poststroke is determined by the initial motor deficits of the lower limb. These results are not consistent with the proportional recovery model. CONCLUSIONS Our results demonstrated that the proportional recovery model for the lower limb is invalid.
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Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea (H.H.L., J.L.)
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, South Korea (M.K.S.)
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y.K.)
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, South Korea (Y.-I.S.)
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (G.-J.O., Y.-H.L.)
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea (Y.-S.L.)
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (M.C.J.)
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, South Korea (S.Y.L.)
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, South Korea (M.K.S.)
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, South Korea (J.H.)
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea (J.A.)
| | - Young-Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (G.-J.O., Y.-H.L.)
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.H.C., Y.-H.K.)
| | - Soo Mi Choi
- Division of Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, South Korea (S.M.C., S.K.L.)
| | - Seon Kui Lee
- Division of Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, South Korea (S.M.C., S.K.L.)
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea (H.H.L., J.L.)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.H.C., Y.-H.K.).,Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.-H.K.)
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22
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Yoon CW, Oh H, Lee J, Rha J, Woo S, Lee WK, Jung H, Ban B, Kang J, Kim BJ, Kim W, Yoon C, Lee H, Kim S, Kim SH, Kang EK, Her A, Cha J, Kim D, Kim M, Lee JH, Park HS, Kim K, Kim RB, Choi N, Hwang J, Park H, Park KS, Yi S, Cho JY, Kim N, Choi K, Kim Y, Kim J, Han J, Choi JC, Kim S, Choi J, Kim J, Jee SJ, Sohn MK, Choi SW, Shin D, Lee SY, Bae J, Lee K, Bae H. Comparisons of Prehospital Delay and Related Factors Between Acute Ischemic Stroke and Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e023214. [PMID: 35491981 PMCID: PMC9238627 DOI: 10.1161/jaha.121.023214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Prehospital delay is an important contributor to poor outcomes in both acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We aimed to compare the prehospital delay and related factors between AIS and AMI.
Methods and Results
We identified patients with AIS and AMI who were admitted to the 11 Korean Regional Cardiocerebrovascular Centers via the emergency room between July 2016 and December 2018. Delayed arrival was defined as a prehospital delay of >3 hours, and the generalized linear mixed‐effects model was applied to explore the effects of potential predictors on delayed arrival. This study included 17 895 and 8322 patients with AIS and AMI, respectively. The median value of prehospital delay was 6.05 hours in AIS and 3.00 hours in AMI. The use of emergency medical services was the key determinant of delayed arrival in both groups. Previous history, 1‐person household, weekday presentation, and interhospital transfer had higher odds of delayed arrival in both groups. Age and sex had no or minimal effects on delayed arrival in AIS; however, age and female sex were associated with higher odds of delayed arrival in AMI. More severe symptoms had lower odds of delayed arrival in AIS, whereas no significant effect was observed in AMI. Off‐hour presentation had higher and prehospital awareness had lower odds of delayed arrival; however, the magnitude of their effects differed quantitatively between AIS and AMI.
Conclusions
The effects of some nonmodifiable and modifiable factors on prehospital delay differed between AIS and AMI. A differentiated strategy might be required to reduce prehospital delay.
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23
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Jee S, Jeong M, Paik NJ, Kim WS, Shin YI, Ko SH, Kwon IS, Choi BM, Jung Y, Chang W, Sohn MK. Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:755316. [PMID: 35370909 PMCID: PMC8965290 DOI: 10.3389/fneur.2022.755316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the available evidence on early supported discharge (ESD) and transitional care (TC) delivery service in patients with cerebrovascular disease. Methods A systematic literature search was conducted to collect all available evidence on the use of ESD and TC services. We included cluster-randomized pragmatic trials or randomized controlled trials (RCTs) that recruited patients with stroke or transient ischemic attack to receive either conventional care or any care service intervention that included rehabilitation or support provided by professional medical personnel with the aim of accelerating and supporting home discharge. Relevant data were electronically searched through international databases (Cochrane Library, EMBASE, and PubMed) and incorporated into a summary grid to investigate research outcomes and provide a narrative synthesis. Furthermore, we compared the outcomes in terms of length of hospital stay, patient and caregiver outcomes, and mortality through meta-analysis. Results We identified and included a total of 20 publications of various original randomized studies. There were 18 studies conducted in western countries and 2 in eastern countries. The meta-analysis revealed a tendency that ESD or TC could decrease the length of hospital stay more than the usual care [standardized mean difference (SMD) -0.13; 95% confidence interval (CI) -0.31 to 0.04 days; P = 0.14]. Moreover, there was a tendency that ESD resulted in better activities of daily living (ADL) than usual care (SMD 0.29; 95% CI -0.04 to 0.61; P = 0.08). Patient outcome based on modified Rankin scale (mRS) score (SMD -0.11; 95% CI -0.38 to 0.17; P = 0.45] and mortality (odds ratio 0.80; 95% CI 0.56-1.17; P = 0.25) did not reveal any significant difference. The Caregiver Strain Index revealed no difference. Conclusion We did not find a large effect size for the use of TC and ESD. When implementing the TC and ESD model from western to Asian countries, services should be prepared and implemented in accordance with national medical rehabilitation pathways for cerebrovascular disease.
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Affiliation(s)
- Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
| | - Minah Jeong
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Bo Mi Choi
- Department of Public Health and Medical Services, Chungnam National University Hospital, Daejeon, South Korea
| | - Yunsun Jung
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Wonkee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
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Kim KT, Chang WK, Jung YS, Jee S, Sohn MK, Ko SH, Shin YI, Leigh JH, Kim WS, Paik NJ. Unmet Needs for Rehabilitative Management in Common Health-Related Problems Negatively Impact the Quality of Life of Community-Dwelling Stroke Survivors. Front Neurol 2022; 12:758536. [PMID: 35002922 PMCID: PMC8733320 DOI: 10.3389/fneur.2021.758536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/07/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose: Community-dwelling stroke survivors have various unmet needs for rehabilitative management, but there is a lack of in-depth investigations on common health problems after stroke. Moreover, the association between unmet needs and health-related quality of life (HRQoL) has not been thoroughly investigated. This study aimed to investigate the unmet needs for rehabilitative management in common problems after stroke and their associations with HRQoL among community-dwelling stroke survivors. Methods: A face-to-face cross-sectional survey was conducted among community-dwelling stroke survivors visiting outpatient clinics of rehabilitation departments between June and October 2020 in three university-affiliated hospitals. Unmet needs for common problems after stroke were assessed across eight domains based on the post-stroke checklist: spasticity, dysphagia, communication, cognition, ambulation, pain/discomfort, anxiety/depression, and self-care. HRQoL was measured using the EuroQoL-5D three level (EQ-5D). The prevalence of unmet needs for rehabilitative management and their associations with the EQ-5D index were analyzed. Results: Among the 239 participants who responded to the survey, 63% (n = 150) were men. The mean age was 63 ± 13 years, and the mean duration of stroke onset was 55.6 months. Overall, 49% reported at least one unmet need, and the most frequently reported unmet needs were anxiety/depression (20.9%), self-care (20.9%), and pain/discomfort (18.0%). The highest proportion of unmet needs was in the anxiety/depression, communication, and cognition domains. Patients with unmet needs for cognition and pain/discomfort showed a significantly lower EQ-5D index, even after adjusting for age, sex, and modified Rankin scale scores. The total number of unmet needs was significantly correlated with a lower EQ-5D index (Pearson's r = -0.329, p < 0.001) in the multivariate linear regression model. Conclusions: Unmet rehabilitative needs are prevalent among community-dwelling stroke survivors, and the proportion of unmet needs was high among non-physical domains such as anxiety/depression. The number of unmet needs is an independent negative predictor of HRQoL. Systematic approaches to identify unmet needs and provide appropriate rehabilitative management are required in long-term stroke survivors.
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Affiliation(s)
- Kyoung Tae Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.,Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yun-Sun Jung
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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25
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Yoon JA, Shin YI, Kim DY, Sohn MK, Lee J, Lee SG, Lee YS, Han EY, Joo MC, Oh GJ, Park M, Chang WH, Kim YH. Post-stroke Hyperglycemia in Non-diabetic Ischemic Stroke is Related With Worse Functional Outcome: A Cohort Study. Ann Rehabil Med 2021; 45:359-367. [PMID: 34743479 PMCID: PMC8572995 DOI: 10.5535/arm.21124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/23/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate long-term and serial functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia. METHODS The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a large, multi-center, prospective cohort study of stroke patients admitted to participating hospitals in nine areas of Korea. From KOSCO, ischemic stroke patients without diabetes were recruited and divided into two groups: patients without diabetes without (n=779) and with post-stroke hyperglycemia (n=223). Post-stroke hyperglycemia was defined as a glucose level >8 mmol/L. Functional assessments were performed 7 days and 3, 6, and 12 months after stroke onset. RESULTS There were no significant differences in baseline characteristics between the groups, except in the age of onset and smoking. Analysis of the linear correlation between the initial National Institutes of Health Stroke Scale (NIHSS) score and glucose level showed no significant difference. Among our functional assessments, NIHSS, Fugl-Meyer Assessment (affected side), Functional Ambulatory Category, modified Rankin Scale, and Korean Mini-Mental State Examination (K-MMSE) showed statistically significant improvements in each group. All functional improvements except K-MMSE were significantly higher in patients without post-stroke hyperglycemia at 7 days and 3, 6, and 12 months. CONCLUSION The glucose level of ischemic stroke patients without diabetes had no significant correlation with the initial NIHSS score. The long-term effects of stress hyperglycemia showed worse functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.
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Affiliation(s)
- Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju University College of Medicine, Jeju, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Gyung-Jae Oh
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Minsu Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chang WK, Kim WS, Sohn MK, Jee S, Shin YI, Ko SH, Ock M, Kim HJ, Paik NJ. Korean Model for Post-acute Comprehensive rehabilitation (KOMPACT): The Study Protocol for a Pragmatic Multicenter Randomized Controlled Study on Early Supported Discharge. Front Neurol 2021; 12:710640. [PMID: 34566853 PMCID: PMC8455937 DOI: 10.3389/fneur.2021.710640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Early supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients' discharge to home. Previous studies have demonstrated that ESD provides equivalent patient and caregiver outcomes with superior cost-effectiveness compared to conventional rehabilitation (CR). This study intends to examine the feasibility of ESD in Korea. Methods and Analysis: This study is designed as a multicenter assessor-blinded, randomized controlled trial. Ninety post-acute stroke patients with mild to moderate disability (modified Rankin Scale 1–3) will be recruited from three university hospitals (30 patients per hospital) in Korea and allocated to either the ESD group or the CR group in a 1:1 ratio. Patients in the ESD group will receive individualized discharge planning and goal setting, a 4-week home-based rehabilitation program, and liaison service to community-based resources by a multidisciplinary team. Patients in the CR group will receive rehabilitation practices according to their current hospital policy. Outcomes: The primary outcome is the Korean version of the modified Barthel Index, and the primary endpoint was post-onset 3 months. Clinical outcomes, patient/caregiver reported outcomes, and socioeconomic outcomes will be measured at baseline, 1 month after discharge, 2 months after discharge, and 3 months after onset. Discussion: The efficacy and cost-effectiveness of ESD can vary according to the healthcare system and sociocultural aspects. To establish ESD as an alternative transitional care model for post-acute stroke patients in Korea, its feasibility needs to be examined in prior. This study will add evidence on the applicability of ESD in Korea. Ethical Considerations: The study protocol was reviewed and approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB number B-2012/654-308). The study protocol was registered at ClinicalTrials.gov (Identifier NCT04720820). Disseminations will include submission to peer-reviewed journals and presentations at conferences.
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Affiliation(s)
- Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Ko N, Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Lee YH, Chang WH, Choi SM, Lee SK, Lee J, Kim YH. Status of dysphagia after ischemic stroke: A Korean nationwide study. Arch Phys Med Rehabil 2021; 102:2343-2352.e3. [PMID: 34348122 DOI: 10.1016/j.apmr.2021.07.788] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence of dysphagia after ischemic stroke and determine factors affecting the presence of dysphagia. DESIGN Retrospective case-control study. This was an interim analysis of a prospective multicenter Korean stroke cohort. SETTING Acute care university hospitals. PARTICIPANTS Patients (N=6000) with first-ever acute ischemic stroke. Patients were divided into two groups according to the presence or absence of dysphagia confirmed at 7 days after onset using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, which was determined after conducting screening or standardized tests. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Age at stroke onset, body mass index (BMI), premorbid modified Rankin Scale (mRS), brainstem lesions, National Institutes of Health Stroke Scale (NIHSS), post-stroke mRS, and ASHA-NOMS swallowing level at post-stroke day 7 were evaluated. RESULTS Among ischemic stroke patients, 32.3% (N=1940) had dysphagia at 7 days after stroke onset. At discharge, 80.5% (N=1561) still had dysphagia. The prediction model for the presence of dysphagia identified age at onset, underweight (BMI < 18.5 kg/m2), premorbid mRS, brainstem lesions, and NIHSS as independent predictors. The odds ratio (OR) for the presence of dysphagia significantly increased with underweight (OR [95% confidence interval]: 1.6684 [1.27-2.20]), increased age at onset (1.0318 [1.03-1.04]), premorbid mRS (1.1832 [1.13-1.24]), brainstem lesions (1.6494 [1.39-1.96]), and NIHSS (1.2073 [1.19-1.23]). CONCLUSIONS The incidence of dysphagia after ischemic stroke was 32.3%. The prediction model for the presence of dysphagia identified age, low BMI, premorbid disabilities, brainstem lesions, and NIHSS as predictive factors.
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Affiliation(s)
- Nayeon Ko
- Department of Rehabilitation Medicine, Konkuk University School of Medicine
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School
| | - Junhee Han
- Department of Statistics, Hallym University
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University
| | - Young-Hoon Lee
- Department of Preventive Medicine, Wonkwang University, School of Medicine
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Soo Mi Choi
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease
| | - Seon Kui Lee
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine.
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University.
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28
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Lee HH, Kim DY, Sohn MK, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Chang WH, Kim I, Mi Choi S, Lee J, Kim YH. Revisiting the Proportional Recovery Model in View of the Ceiling Effect of Fugl-Meyer Assessment. Stroke 2021; 52:3167-3175. [PMID: 34134508 DOI: 10.1161/strokeaha.120.032409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to verify the validity of the proportional recovery model in view of the ceiling effect of the Fugl-Meyer Assessment. METHODS We reviewed the medical records of patients enrolled in the Korean Stroke Cohort for Functioning and Rehabilitation between August 2012 and May 2015. Recovery proportion was defined as the actual change in Fugl-Meyer Assessment score of the upper extremity between 7 days and 6 months poststroke, relative to the initial neurological impairment. We then used logistic regression to identify clinical factors attributable to a ceiling effect of the Fugl-Meyer Assessment score of the upper extremity and propensity score matching to verify the validity of the proportional recovery rule. RESULTS We screened 10 636 patients and analyzed 849 patients (mean age, 65.4±11.9 years; female, 320 [37.7%]) with first-ever ischemic stroke. We found, through logistic regression analysis, that a one-unit increase in the initial neurological impairment and the age at stroke onset affected the odds ratio (1.0386 and 0.9736, respectively) of achieving the full Fugl-Meyer Assessment score of the upper limb at 6 months poststroke. We also demonstrated, through propensity score matching, that the difference in initial neurological impairment of the upper extremity resulted in discrepancy of the recovery proportion (0.92±0.20 [0-1] versus 0.81±0.31 [0-1], P<0.001). CONCLUSIONS We demonstrated that the ceiling effect of the Fugl-Meyer Assessment score of the upper extremity is pronounced in patients with mild initial motor deficits of the upper extremity and that the recovery proportion varies according to the initial motor deficit of the upper limb using logistic regression analysis and propensity score matching, respectively. These results suggest that the proportional recovery model is not valid.
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Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea (H.H.L., J.L.)
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y.K.)
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, South Korea (M.K.S.)
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, South Korea (Y.-I.S.)
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (G.-J.O.)
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea (Y.-S.L.)
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (M.C.J.)
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, South Korea (S.Y.L.)
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, South Korea (J.H.)
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea (J.A.)
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.H.C., Y.-H.K.)
| | - Ilyoel Kim
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease (I.K., S.M.C.)
| | - Soo Mi Choi
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease (I.K., S.M.C.)
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea (H.H.L., J.L.)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.H.C., Y.-H.K.).,Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.-H.K.)
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29
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Chang WH, Lee J, Shin YI, Ko MH, Kim DY, Sohn MK, Kim J, Kim YH. Cerebrolysin Combined with Rehabilitation Enhances Motor Recovery and Prevents Neural Network Degeneration in Ischemic Stroke Patients with Severe Motor Deficits. J Pers Med 2021; 11:jpm11060545. [PMID: 34208352 PMCID: PMC8231166 DOI: 10.3390/jpm11060545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to evaluate whether Cerebrolysin combined with rehabilitation therapy supports additional motor recovery in stroke patients with severe motor impairment. This study analyzed the combined data from the two phase IV prospective, multicenter, randomized, double-blind, placebo-controlled trials. Stroke patients were included within seven days after stroke onset and were randomized to receive a 21-day treatment course of either Cerebrolysin or placebo with standardized rehabilitation therapy. Assessments were performed at baseline, immediately after the treatment course, and 90 days after stroke onset. The plasticity of the motor system was assessed by diffusion tensor imaging and resting state fMRI. In total, 110 stroke patients were included for the full analysis set (Cerebrolysin n = 59, placebo n = 51). Both groups showed significant motor recovery over time. Repeated-measures analysis of varianceshowed a significant interaction between time and type of intervention as measured by the Fugl–Meyer Assessment (p < 0.05). The Cerebrolysin group demonstrated less degenerative changes in the major motor-related white matter tracts over time than the placebo group. In conclusion, Cerebrolysin treatment as an add-on to a rehabilitation program is a promising pharmacologic approach that is worth considering in order to enhance motor recovery in ischemic stroke patients with severe motor impairment.
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Affiliation(s)
- Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (W.H.C.); (J.L.)
| | - Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (W.H.C.); (J.L.)
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea;
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea;
| | - Jinuk Kim
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Korea;
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (W.H.C.); (J.L.)
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Korea;
- Correspondence: ; Tel.: +82-2-3410-2824
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Song R, Park M, Jang T, Oh J, Sohn MK. Effects of a Tai Chi-Based Stroke Rehabilitation Program on Symptom Clusters, Physical and Cognitive Functions, and Quality of Life: A Randomized Feasibility Study. Int J Environ Res Public Health 2021; 18:ijerph18105453. [PMID: 34065178 PMCID: PMC8160714 DOI: 10.3390/ijerph18105453] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Stroke survivors suffer from disease-associated symptoms. Tai Chi can be a beneficial approach to provide an adapted form of intervention to manage their symptoms. The study aimed to determine the effects of a Tai Chi-based stroke rehabilitation program on symptom clusters, physical and cognitive functions, and stroke-specific quality of life among stroke survivors in Korea. Thirty-four stroke survivors were randomly assigned to receive either the Tai Chi-based program or the stroke-symptom management program. The feasibility of the program and its effects on the outcomes were assessed at baseline, 3 months, and 6 months. Repeated measures ANOVA showed that most symptoms improved in both groups during the 6-month period, but swallowing-related symptoms improved significantly in the Tai Chi group. Based on the interaction effect, Tai Chi was more effective on flexor muscle strength, ambulation, and activities of daily living and cognitive function over 6 months than their counterparts. Among SS-QOL dimensions, the Tai Chi group showed significant improvements in the thinking and self-care dimensions. The Tai Chi-based stroke rehabilitation program was feasible and safely applicable to stroke survivors in the community settings. This program could improve symptoms, physical and cognitive function, leading to improvements in the self-care dimension of the SS-QOL among stroke survivors.
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Affiliation(s)
- Rhayun Song
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (R.S.); (J.O.)
| | - Moonkyoung Park
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (R.S.); (J.O.)
- Correspondence: ; Tel.: +82-42-580-8325
| | - Taejeong Jang
- College of Nursing, Woosuk University, Wanju 55338, Korea;
| | - Jiwon Oh
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (R.S.); (J.O.)
| | - Min Kyun Sohn
- College of Medicine, Chungnam National University, Daejeon 35015, Korea;
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Cha E, Kim J, Sohn MK, Lee BS, Jung SS, Lee S, Lee I. Perceptions on good-life, good-death, and advance care planning in Koreans with non-cancerous chronic diseases. J Adv Nurs 2020; 77:889-898. [PMID: 33222194 DOI: 10.1111/jan.14633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/08/2020] [Accepted: 10/23/2020] [Indexed: 12/01/2022]
Abstract
AIMS This study explored perceptions on a good-life, good-death, and advance care planning in Koreans with non-cancerous chronic diseases with the goal to develop a culture-specific advance care planning intervention in this population. DESIGN A qualitative descriptive design was used. METHODS Data collections were conducted between September 2017 - June 2018. Twenty-nine patients aged 41-82 years (85.8% men) participated in the interviews lasting 40-60 min. The verbatim transcriptions of the semi-structured interview data were analysed using conventional content analysis. RESULTS Good-life was described as 'present with physical and financial independence,' 'not burdensome to the family,' 'completed life responsibility', and 'helping others.' Some participants described good-death as 'prepared death' while others considered it as 'sudden death during sleep.' All participants wanted to have a painless death and not burden the family. Advance care planning was a new concept to many participants. It was likened to 'insurance.' Some participants believed that decision-making on life-sustaining treatment should be done by their family, not themselves, because of economic or emotional distress. Some participants wanted to discuss medical and non-medical care services to reduce the burden on self and family. CONCLUSION Family is key when it comes to the meaning of good-life and good-death. Cultural adaptation is necessary to meet the advance care planning needs of Koreans with non-cancerous chronic diseases. IMPACT Successfully implementing advance care planning in Koreans with non-cancerous chronic diseases depends on how it is adapted to the disease-specific characteristics compared with cancer, and the cultural norms and social context. Nurses need to be prepared to offer advance care planning to persons with non-cancerous chronic diseases based on a keen sense of and empathetic cultural competence.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - JinShil Kim
- College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Min Kyun Sohn
- College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Byung Seok Lee
- College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sung Soo Jung
- College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - SoJung Lee
- Department of Nursing, Korean Bible University, Seoul, Republic of Korea
| | - Insil Lee
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
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Yun SM, Lee SY, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Oh GJ, Lee YH, Chang WH, Kim YH. Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke. Brain Neurorehabil 2020; 13:e19. [PMID: 36741795 PMCID: PMC9879371 DOI: 10.12786/bn.2020.13.e19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from -4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.
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Affiliation(s)
- Sang Moon Yun
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University, School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim H, Lee M, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Chang WH, Choi JY, Kang SH, Lee DH, Kim YT, Choi MT, Kim YH. Simultaneous Clustering and Classification of Function Recovery Patterns of Ischemic Stroke. j med imaging hlth inform 2020. [DOI: 10.1166/jmihi.2020.3061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper shows the simultaneous clustering and classification that is done in order to discover internal grouping on an unlabeled data set. Moreover, it simultaneously classifies the data using clusters discovered as class labels. During the simultaneous clustering and classification,
silhouette and F1 scores were calculated for clustering and classification, respectively, according to the number of clusters in order to find an optimal number of clusters that guarantee the desired level of classification performance. In this study, we applied this approach
to the data set of Ischemic stroke patients in order to discover function recovery patterns where clear diagnoses do not exist. In addition, we have developed a classifier that predicts the type of function recovery for new patients with early clinical test scores in clinically meaningful
levels of accuracy. This classifier can be a helpful tool for clinicians in the rehabilitation field.
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Affiliation(s)
- Hyungtai Kim
- SKKU Advanced Institute of Nano Technology, Sungkyunkwan University, 16419, Republic of Korea
| | - Minhee Lee
- Department of Mechanical Engineering, Sungkyunkwan University, 16419, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, 35515, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, 05030, Republic of Korea
| | - Deog Yung Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 03722, Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, 61469, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, 50612, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, 54538, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, 41944, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, 54538, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, 63241, Republic of Korea
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, 24252, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, 03760, Republic of Korea
| | - Won Hyuk Chang
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease, 28159, Republic of Korea
| | - Ji Yoo Choi
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease, 28159, Republic of Korea
| | - Sung Hyun Kang
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease, 28159, Republic of Korea
| | - Dong Han Lee
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease, 28159, Republic of Korea
| | - Young Taek Kim
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Control, Center for Disease Prevention, 28159, Republic of Korea
| | - Mun-Taek Choi
- Department of Mechanical Engineering, Sungkyunkwan University, 16419, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06315, Republic of Korea
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Kim DY, Oh HM, Bok SK, Chang WH, Choi Y, Chun MH, Han SJ, Han TR, Jee S, Jung SH, Jung HY, Jung TD, Kim MW, Kim EJ, Kim HS, Kim YH, Kim Y, Kim DY, Kim DY, Kim DK, Ko SH, Ko MH, Lee JK, Lee J, Lee SJ, Lee SG, Lim SH, Oh BM, Paik NJ, Park KD, Park SW, Park GY, Park JH, Park YG, Pyun SB, Ryu B, Seo HG, Shin YI, Sohn MK, Yang SN, Don Yoo S, Yoo WK. KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease. Brain Neurorehabil 2020; 13:e17. [PMID: 36744191 PMCID: PMC9879460 DOI: 10.12786/bn.2020.13.e17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022] Open
Abstract
Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.
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Affiliation(s)
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongmin Choi
- Department of Rehabilitation Medicine, School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Tai-Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Young Jung
- Department of Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hyoung Seop Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongwook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Sam-Gyu Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byungju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University, College of Medicine, Seoul, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine & Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
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Ko H, Kim H, Kim Y, Sohn MK, Jee S. Dose-Response Effect of Daily Rehabilitation Time on Functional Gain in Stroke Patients. Ann Rehabil Med 2020; 44:101-108. [PMID: 32392648 PMCID: PMC7214137 DOI: 10.5535/arm.2020.44.2.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/01/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To demonstrate the effect of daily treatment time on recovery of functional outcomes and how each type of rehabilitation treatment influences the improvement of subgroups of functional outcomes in stroke patients. METHODS We conducted a retrospective study in 168 patients who were admitted to the Department of Rehabilitation Medicine between 2015 and 2016. Patients who experienced their first-ever stroke and unilateral lesions were included. All patients underwent conventional rehabilitation treatment, and each treatment was administered one to two times a day depending on individual and treatment room schedules. Based on the mean daily treatment time, patients were divided into two groups: a high-amount group (n=54) and low-amount group (n=114). Outcomes were measured through the Korean version of Modified Barthel Index (MBI), FuglMeyer Assessment of the upper extremity, Trunk Impairment Scale (TIS), and Berg Balance Scale (BBS) scores on admission and at discharge. RESULTS The functional change and scores at discharge of MBI, TIS, and BBS were greater in the high-amount group than in the low-amount group. Among various types of rehabilitation treatments, occupational therapy training showed significant correlation with MBI, TIS, and BBS gain from admission to discharge. CONCLUSION The amount of daily mean treatment in post-stroke patients plays an important role in recovery. Mean daily rehabilitation treatment time seems to correlate with improved balance and basic activities of daily living after stroke.
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Affiliation(s)
- Hanbit Ko
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Medical Rehabilitation Center, Chungnam National University Hospital, Daejeon, Korea
| | - Howook Kim
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Medical Rehabilitation Center, Chungnam National University Hospital, Daejeon, Korea
| | - Yeongwook Kim
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Medical Rehabilitation Center, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Medical Rehabilitation Center, Chungnam National University Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.,Daejeon-Chungcheong Regional Medical Rehabilitation Center, Chungnam National University Hospital, Daejeon, Korea
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Im S, Lim DY, Sohn MK, Kim Y. Frequency of and Reasons for Unplanned Transfers From the Inpatient Rehabilitation Facility in a Tertiary Hospital. Ann Rehabil Med 2020; 44:151-157. [PMID: 32392654 PMCID: PMC7214139 DOI: 10.5535/arm.2020.44.2.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To characterize the patients in the inpatient rehabilitation facility who were transferred to acute care facilities and identify the frequency of and reasons for the unplanned transfer. METHODS Medical records of patients admitted to the inpatient rehabilitation facility from October 2017 to December 2018 were reviewed. Patients were categorized according to their diagnoses. The included patients were divided into the unplanned transfer and control groups based on whether they required to transfer to another department for acute care before completing an uninterrupted rehabilitation course. The groups were compared in terms of sex, age, length of stay, admission sources, and disease groups. The reasons for unplanned transfers were classified based on medical or surgical conditions. RESULTS Of the 1,378 patients were admitted to the inpatient rehabilitation facility, 1,301 satisfied inclusion criteria. Among them, 121 (9.3%) were unexpectedly transferred to the medical or surgical department. The unplanned transfer group had a higher age (69.54±12.53 vs. 64.39±15.32 years; p=0.001) and longer length of stay (85.69±66.08 vs. 37.81±31.13 days; p<0.001) than the control group. The top 3 reasons for unplanned transfers were infectious disease, cardiopulmonary disease, and orthopedic problem. CONCLUSION The unplanned transfer group had a significantly higher age and longer length of stay. The most common reason for the unplanned transfer was infectious disease. However, the proportions of those with orthopedic and neurological problems were relatively high. Therefore, further studies of these patient populations may help organize systematic strategies that are needed to reduce unplanned transfers to acute facilities for patients in rehabilitation facilities.
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Affiliation(s)
- Soobin Im
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Da Young Lim
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yeongwook Kim
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
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Lee SY, Kim DY, Sohn MK, Lee J, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YH, Lee YS, Joo MC, Lee SY, Ahn J, Chang WH, Choi JY, Kang SH, Kim IY, Han J, Kim YH. Determining the cut-off score for the Modified Barthel Index and the Modified Rankin Scale for assessment of functional independence and residual disability after stroke. PLoS One 2020; 15:e0226324. [PMID: 31995563 PMCID: PMC6988933 DOI: 10.1371/journal.pone.0226324] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 11/25/2019] [Indexed: 11/25/2022] Open
Abstract
Assessment of functional independence and residual disability is very important for measuring treatment outcome after stroke. The modified Rankin Scale (mRS) and the modified Barthel Index (MBI) are commonly used scales to measure disability or dependence in activities of daily living (ADL) of stroke survivors. Lack of consensus regarding MBI score categories has caused confusion in interpreting stroke outcomes. The purpose of this study was to identify the optimal corresponding MBI and modified Rankin scale (mRS) grades for categorization of MBI. The Korean versions of the MBI (K-MBI) and mRS were collected from 5,759 stroke patients at 3 months after onset of stroke. The sensitivity and specificity were calculated at K-MBI score cutoffs for each mRS grade to obtain optimally corresponding K-MBI scores and mRS grades. We also plotted receiver operating characteristic (ROC) curves of sensitivity and specificity and determined the area under the curve (AUC). The K-MBI cutoff points with the highest sum of sensitivity and specificity were 100 (sensitivity 0.940; specificity 0.612), 98 (sensitivity 0.904; specificity 0.838), 94 (sensitivity 0.885; specificity 0.937), 78 (sensitivity 0.946; specificity, 0.973), and 55 (sensitivity 937; specificity 0.986) for mRS grades 0, 1, 2, 3, and 4, respectively. From this result, the K-MBI cutoff score range for each mRS grade can be obtained. For mRS grade 0, the K-MBI cutoff score is 100, indicating no associated score range. For mRS grades 1, 2, 3, 4, and 5, the K-MBI score ranges is from 99 to 98, 97 to 94, 93 to 78, 77 to 55, and under 54, respectively.The AUC for the ROC curve was 0.791 for mRS grade 0, 0.919 for mRS grade 1, 0.970 for mRS grade 2, 0.0 for mRS grade 3, and 0.991 for mRS grade 4. The K-MBI cutoff score ranges for representing mRS grades were variable; mRS grades 0, 1, and 2 had narrow K-MBI score ranges, while mRS grades 3, 4, and 5 exhibited broad K-MBI score ranges. mRS grade seemed to sensitively differentiate mild residual disability of stroke survivors, whereas K-MBI provided more specific information of the functional status of stroke survivors with moderate to severe residual impairment.
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Affiliation(s)
- Seung Yeol Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Young Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University, School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, University of Jeju College of Medicine, Jeju, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yoo Choi
- Division of Chronic Disease Prevention, Korea Center for Disease Control and Prevention, Osong, Republic of Korea
| | - Sung Hyun Kang
- Division of Chronic Disease Prevention, Korea Center for Disease Control and Prevention, Osong, Republic of Korea
| | - Il Yoel Kim
- Division of Chronic Disease Prevention, Korea Center for Disease Control and Prevention, Osong, Republic of Korea
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, Republic of Korea
- * E-mail: (YHK); (JH)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Departmen of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- * E-mail: (YHK); (JH)
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Kim MS, Joo MC, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YS, Han EY, Han J, Ahn J, Chang WH, Kim YH, Choi JY, Hyun Kang S, Kim YT. Development and validation of a prediction model for home discharge in patients with moderate stroke: The Korean stroke cohort for functioning and rehabilitation study. Top Stroke Rehabil 2020; 27:453-461. [PMID: 31941411 DOI: 10.1080/10749357.2019.1711338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous studies have investigated the predictors for home discharge without considering stroke severity. OBJECTIVES To develop a practical assessment tool that predicts home discharge for moderate stroke patients after subacute rehabilitation therapy in the tertiary hospitals. METHODS Stroke patients with National Institutes of Health Stroke Scale scores of 6 to 13 were included in this prospective cohort study. Various demographic, clinical, and functional factors were analyzed as potential predictive factors. A weighted scoring model was developed through the following three-step process: 1) selection of the factors by logistic regression analyses, 2) development of a weighted scoring model, and 3) validation of the generalizability of the model. RESULTS The home discharge rate was 51% (n = 372), and the overall mean length of stay of hospitalization was 32.5 days. 1) The Cognitive Functional Independence Measure, 2) the Functional Ambulation Categories, 3) the modified Charlson Comorbidity Index, and 4) marital status were independent predictors of home discharge. The coefficient value for marital status was adjusted to 1 in the scoring system, and the values of the other parameters were proportionally converted to the nearest integer. Possible total scores ranged from 0 to 13 in the model, with a higher score indicating a higher probability of home discharge. With a cutoff point of 7, this model showed 87.0% sensitivity and 86.2% specificity (area under the curve = 0.90). CONCLUSIONS This novel assessment tool can be useful in predicting home discharge after subacute rehabilitation of moderate stroke patients.
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Affiliation(s)
- Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine , Iksan, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine , Iksan, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University , Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine , Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School , Gwangju, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital , Busan, Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital , Busan, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine , Iksan, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital , Daegu, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine , Jeju, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University , Chuncheon, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University , Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Ji Yoo Choi
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention,Center for Disease
| | - Sung Hyun Kang
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention,Center for Disease
| | - Young Taek Kim
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention,Center for Disease
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Shin M, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Oh GJ, Lee YS, Joo MC, Han EY, Han J, Ahn J, Chang WH, Shin MA, Choi JY, Kang SH, Kim Y, Kim YH. Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke: The KOSCO Study. Stroke 2019; 51:99-107. [PMID: 31822247 PMCID: PMC6924936 DOI: 10.1161/strokeaha.119.026829] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text. The theory of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neuropathology. This study investigated whether CR has a modulating effect on cognitive impairment and recovery after stroke.
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Affiliation(s)
- Minyoung Shin
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.S., W.H.C., M.A.S., Y.-H.K.).,Department of Counseling Psychology, Yongmoon Graduate School of Counseling Psychology, Seoul, Republic of Korea (M.S.)
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea (M.K.S.)
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea (J.L.)
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (D.Y.K.)
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Kwangju, Republic of Korea (S.-G.L.)
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Republic of Korea (Y.-I.S.)
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea (G.-J.O.)
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea (Y.-S.L.)
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea (M.C.J.)
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Republic of Korea (E.Y.H.)
| | | | - Jeonghoon Ahn
- Department of Statistics, Hallym University, Chuncheon, Republic of Korea (J.A.).,Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea (J.A,)
| | - Won Hyuk Chang
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.S., W.H.C., M.A.S., Y.-H.K.)
| | - Min A Shin
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.S., W.H.C., M.A.S., Y.-H.K.)
| | - Ji Yoo Choi
- Division of Chronic Disease Prevention, Center for Disease Prevention, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea (J.Y.C., S.H.K.)
| | - Sung Hyun Kang
- Division of Chronic Disease Prevention, Center for Disease Prevention, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea (J.Y.C., S.H.K.)
| | - Youngtaek Kim
- Public Health Medical Service, Chungnam National University Hospital, Daejeon, Republic of Korea (Y.K.)
| | - Yun-Hee Kim
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.S., W.H.C., M.A.S., Y.-H.K.).,Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (Y.-H.K.)
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40
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Kim SH, Shin YI, Kim SC, Ko SH, Kim DY, Lee J, Sohn MK, Lee SG, Oh GJ, Lee YS, Joo MC, Han EY, Han J, Chang WH, Min JH, Kim YH. Factors Associated to Returning Home in the First Year after Stroke. Brain Neurorehabil 2019; 13:e1. [PMID: 36744270 PMCID: PMC9879522 DOI: 10.12786/bn.2020.13.e1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/02/2019] [Accepted: 09/12/2019] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the 'Return home' group and 99 subjects in the 'Rehabilitation hospitalization' group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.
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Affiliation(s)
- Seung Han Kim
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Chan Kim
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Hwa Ko
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Deog Young Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim YW, Sohn MK. Effects of rTMS on cognition and functional connectivity in subacute stroke patients. IBRO Rep 2019. [DOI: 10.1016/j.ibror.2019.07.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Han J, Lee HI, Shin YI, Son JH, Kim SY, Kim DY, Sohn MK, Lee J, Lee SG, Oh GJ, Lee YS, Joo MC, Han EY, Chang WH, Kim YH. Factors influencing return to work after stroke: the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. BMJ Open 2019; 9:e028673. [PMID: 31300502 PMCID: PMC6629413 DOI: 10.1136/bmjopen-2018-028673] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the rate of return to work and identify key factors associated with return to work between 3 months and 2 years after stroke. DESIGN Prospective cohort study. SETTING The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) in Korea. PARTICIPANTS A total of 193 persons with first-ever stroke who reported working status at 3 months after stroke. OUTCOME MEASURES Data on baseline characteristics were collected from medical records. Functional assessments were performed using the National Institutes of Health Stroke Scale, the modified Rankin Scale, the Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the Korean version of the Frenchay Aphasia Screening Test, the American Speech-Language-Hearing Association National Outcomes Measurement System, the Korean-Modified Barthel Index, the Geriatric Depression Scale-Short Form and the EuroQol-5 dimensions. An enumeration survey included the Reintegration to Normal Living Index, the Psychosocial Well-being Index-Short Form (, the Family Support Index and the Caregivers Burden Index. RESULTS Overall, 145 (75.1%) patients who had a stroke in the "Continuously-Employed" group and 48 (24.9%) in the "Employed-Unemployed" group returned to work between 3 months and 2 years after stroke. Multivariate logistic analysis demonstrated that in patients who had a stroke, characteristics such as age, PWI-SF Score, and caregiver characteristics, including age, sex (female) and living arrangements, were significantly associated with return to work between 3 months and 2 years after stroke. CONCLUSION Age and PWI-SF Score of patients who had a stroke, as well as the age, sex and living arrangements of caregivers, are key factors influencing the return to work after stroke. TRIAL REGISTRATION NUMBER NCT03402451.
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Affiliation(s)
- Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, The Republic of Korea
| | - Hae In Lee
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Ju Hyun Son
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, The Republic of Korea
| | - Min Kyun Sohn
- School of Medicine, Department of Rehabilitation Medicine, Chungnam National University, Daejeon, The Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, The Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, The Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, The Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, School of Medicine, Jeju National University, Jeju, The Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
- Department of Health Sciences and Technology,Department of Medical Device Management & Research, Department of DigitalHealth, SAIHST, Sungkyunkwan University, Seoul, The Republic of Korea
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Kim MS, Joo MC, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YS, Han EY, Han J, Ahn J, Chang WH, Kim YH. Erratum to: Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study. J Clin Neurol 2019; 15:427. [PMID: 31286724 PMCID: PMC6620457 DOI: 10.3988/jcn.2019.15.3.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
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Nam S, Sohn MK, Kim HA, Kong HJ, Jung IY. Development of Artificial Intelligence to Support Needle Electromyography Diagnostic Analysis. Healthc Inform Res 2019; 25:131-138. [PMID: 31131148 PMCID: PMC6517633 DOI: 10.4258/hir.2019.25.2.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives This study proposes a method for classifying three types of resting membrane potential signals obtained as images through diagnostic needle electromyography (EMG) using TensorFlow-Slim and Python to implement an artificial-intelligence-based image recognition scheme. Methods Waveform images of an abnormal resting membrane potential generated by diagnostic needle EMG were classified into three types-positive sharp waves (PSW), fibrillations (Fibs), and Others-using the TensorFlow-Slim image classification model library. A total of 4,015 raw waveform data instances were reviewed, with 8,576 waveform images subsequently collected for training. Images were learned repeatedly through a convolutional neural network. Each selected waveform image was classified into one of the aforementioned categories according to the learned results. Results The classification model, Inception v4, was used to divide waveform images into three categories (accuracy = 93.8%, precision = 99.5%, recall = 90.8%). This was done by applying the pretrained Inception v4 model to a fine-tuning method. The image recognition model was created for training using various types of image-based medical data. Conclusions The TensorFlow-Slim library can be used to train and recognize image data, such as EMG waveforms, through simple coding rather than by applying TensorFlow. It is expected that a convolutional neural network can be applied to image data such as the waveforms of electrophysiological signals in a body based on this study.
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Affiliation(s)
- Sangwoo Nam
- Department of Biomedical Engineering, Chungnam National University Graduade School, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyun Ah Kim
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, Chungnam National University College of Medicine, Daejeon, Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Kang SH, Kim JS, Joo JS, Eun HS, Lee ES, Moon HS, Kim SH, Sung JK, Lee BS, Jeong HY, Kim Y, Sohn MK, Jee S. Efficacy of Early Endoscopic Intervention for Restoring Normal Swallowing Function in Patients with Lateral Medullary Infarction. Toxins (Basel) 2019; 11:toxins11030144. [PMID: 30836597 PMCID: PMC6468434 DOI: 10.3390/toxins11030144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 11/16/2022] Open
Abstract
Dysphagia is considered to be a significant barrier for recovery after lateral medullary infarction (LMI). However, there is still no gold standard treatment for dysphagia. The aim of this study was to explore an effect of an early treatment options for swallowing dysfunction after acute LMI. Medical records of acute LMI patients who had been admitted to the department of rehabilitation medicine from January 2014 to December 2017 were reviewed retrospectively. We compared the clinical efficacy of conventional dysphagia rehabilitation to early endoscopic intervention using either botulinum toxin injection into cricopharyngeal muscle or endoscopic balloon dilatation of the muscle. Outcomes, such as duration of parental feeding, albumin level at diet transition to enteral feeding, and complications, were analyzed. A total of 18 patients with LMI were included. While eight patients (8/9, 88.89%) in the endoscopic group were capable of orally ingesting their diet after intervention, the conversion from tube feeding to an oral diet was possible in only five patients (5/9, 55.56%) of the conventional group during hospitalization. However, the difference between the two groups was not significant (p-value ≤ 0.147, chi-square test). Only the final dietary level at the time of discharge was higher level in endoscopic group. The conversion interval from tube feeding to oral diet was also comparable between groups. There was no re-conversion from the oral diet to tube feeding in patients of either group during the median follow-up period of 20 months. Early endoscopic intervention may be a better option for dysphagia with LMI, compared to conventional dysphagia rehabilitation. However, a larger and prospective trial may be needed to confirm our observations.
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Affiliation(s)
- Sun Hyung Kang
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Ju Seok Kim
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Jong Seok Joo
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Hyuk Soo Eun
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Eaum Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Hee Seok Moon
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Seok Hyun Kim
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Jae Kyu Sung
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Byung Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Hyun Yong Jeong
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Yeongwook Kim
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon 35015, Korea.
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon 35015, Korea.
| | - Sungju Jee
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon 35015, Korea.
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Shin M, Chang WH, Kim DY, Sohn MK, Lee J, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YS, Joo MC, Han EY, Han JH, Ahn J, Choi YJ, Kang SH, Lee KH, Kim YT, Shin M, Kim YH. Abstract WP198: Sex Differences of Functional Recovery Pattern After the First-ever Stroke in Korea: The KOSCO Study. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
The objective of this study was to investigate differences of functional recovery pattern and the factors associated with recovery pattern between male and female stroke patients.
Methods:
This study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) designed as 10 years long-term follow-up study of stroke patients. We analyzed serial data up to 24 months of multi-facet functional assessments such as Korean-Modified Barthel Index (K-MBI), Fugl-Meyer Assessment (FMA), Functional ambulation classification (FAC), American Speech-Language-Hearing Association-National Outcomes Measurement System (ASHA-NOMS), Korean version of Frenchay Aphasia Screening Test (K-FAST) to identify sex-specific differences after adjustments for difference with age, type of stroke, premorbid functional level, degree of comorbidity, and multi-facet functional levels at 7 day after stroke.
Results:
Out of total 10,636 stroke patients (6,043 male and 4,593 female), female patients showed significantly older age, lower education level, lower body mass index, worse premorbid functional level, higher co-morbidity and more severe initial severity assessed by NIHSS compared with male stroke patients (p<0.05, Table 1). Even after multiple adjustments for differences, multi-facet functional outcomes were more severe in female stroke patients such as lower FMA, K-FAST, and FAC at 7 day; lower K-MBI, K-FAST, and FAC at 3, 12, and 24 months; lower ASHA-NOMS at 24 months (p<0.05, Table 2).
Conclusion:
The results of this study could provide more specific information for establishing the stroke rehabilitation strategy according to sex.
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Affiliation(s)
- Mina Shin
- Dept of Physical and Rehabilitation Medicine, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Won Hyuk Chang
- Dept of Physical and Rehabilitation Medicine, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Deog Yung Kim
- Dept and Rsch Institute of Rehabilitation Medicine, Yonsei Univ of College of Medicine, Seoul, Korea, Republic of
| | - Min Kyun Sohn
- Dept of Rehabilitation Medicine, Chungnam National Univ Sch of Medicine, Chungnam, Korea, Republic of
| | - Jongmin Lee
- Dept of Rehabilitation Medicine, Konkuk Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Sam-Gyu Lee
- Dept of Physical and Rehabilitation Medicine, Chonnam National Univ Med Sch, Chonnam, Korea, Republic of
| | - Yong-il Shin
- Dept of Rehabilitation Medicine, Pusan National Univ Sch of Medicine, Pusan, Korea, Republic of
| | - Soo-Yeon Kim
- Dept of Rehabilitation Medicine, Pusan National Univ Sch of Medicine, Pusan, Korea, Republic of
| | - Gyung-Jae Oh
- Dept of Preventive Medicine, Wonkwang Univ, Sch of Medicine, Chunbuk, Korea, Republic of
| | - Yang-Soo Lee
- Dept of Rehabilitation Medicine, Kyungpook National Univ Hosp, Kyungpook, Korea, Republic of
| | - Min Cheol Joo
- Dept of Rehabilitation Medicine, Wonkwang Univesity Sch of Medicine, chunbuk, Korea, Republic of
| | - Eun Young Han
- Dept of Rehabilitation Medicine, Jeju National Univ Hosp, Jeju, Korea, Republic of
| | - Jun Hee Han
- Dept of Statistics, Hanllym Univ, Gangwon-do Province, Korea, Republic of
| | - Jeounghoon Ahn
- Dept of Health Convergence, Ewha Womans Univ, Seoul, Korea, Republic of
| | - Yong-Joo Choi
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Prevention, Cntr for Disease, Chungbuk, Korea, Republic of
| | - Sung Hyun Kang
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Prevention, Cntr for Disease, Chungbuk, Korea, Republic of
| | - Kang Hee Lee
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Prevention, Cntr for Disease, Chungbuk, Korea, Republic of
| | - Young Taek Kim
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Control, Cntr for Disease Prevention, Chungbuk, Korea, Republic of
| | - Minyoung Shin
- Dept of Physical and Rehabilitation Medicine, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Yun-Hee Kim
- Dept of Physical and Rehabilitation Medicine, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
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Chang WH, Shin M, Shin YI, Sohn MK, Lee J, Kim DY, Lee SG, Kim SY, Oh GJ, Lee YS, Joo MC, Han EY, Han JH, Ahn J, Lee KH, Kang SH, Choi YJ, Kim YT, Choi MT, Kim YH. Abstract TP174: Clustering and Predicting Functional Recovery Patterns of the First-ever Ischemic Stroke Using Artificial Intelligence: The KOSCO Study. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
The objective of this study was to apply the clustering approach of multi-facet functional recovery pattern with big data of in the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) using artificial intelligence, and to provide valuable prediction models for clinically use.
Methods:
This study was an interim analysis of the KOSCO designed as 10 years long-term follow-up study of stroke patients. We analyzed data of participants who completed functional assessments from 7 days to 12 months after ischemic stroke onset. Functional assessments included Korean modified Barthel Index (K-MBI), Korean Mini-Mental State Examination (K-MMSE), Fugl-Meyer Assessment (FMA), Functional Ambulatory Category (FAC), the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA-NOMS), and Short Korean Version of Frenchay Aphasia Screening Test (Short K-FAST). The cluster analysis using artificial intelligence was performed for multi-facet functional recovery patterns of independency, motor, ambulation, cognition, language, and swallowing functions. After the cluster analysis, a group of rehabilitation specialists reviewed the clinical meaningfulness with clustered population, whether the groups had high homogeneity and representativeness of the clinical stroke recovery patterns. After these clustering approaches, a prediction model using machine learning was performed. The accuracy of classification of this prediction model was evaluated by comparing how much the prediction was equivalent to the actual clustering result.
Results:
After the machine learning in supervised manners on artificial intelligence, recovery patterns after stroke could be classified into ten groups. Each group showed a different multi-facet functional recovery pattern from 7 day to 12 months, and this clustering showed a clinically acceptance. In addition, the accuracy in classification with clinical characteristics at 7 days showed more than 73.0%.
Conclusion:
The results of this study demonstrated the potentials of the clustering and predicting functional recovery patterns of stroke patients using artificial intelligence.
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Affiliation(s)
- Won Hyuk Chang
- Dept of Physical and Rehabilitation Medicine, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, seoul, Korea, Republic of
| | - Mina Shin
- Dept of Physical and Rehabilitation Medicine, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, seoul, Korea, Republic of
| | - Yong-il Shin
- Dept of Rehabilitation Medicine, Pusan National Univ Sch of Medicine, Pusan, Korea, Republic of
| | - Min Kyun Sohn
- Dept of Rehabilitation Medicine, Chungnam National Univ Sch of Medicine, Chungnam, Korea, Republic of
| | - Jongmin Lee
- Dept of Rehabilitation Medicine, Konkuk Univ Sch of Medicine, seoul, Korea, Republic of
| | - Deog Yung Kim
- Dept and Rsch Institute of Rehabilitation Medicine, Yonsei Univ of College of Medicine, seoul, Korea, Republic of
| | - Sam-Gyu Lee
- Dept of Physical and Rehabilitation Medicine, Chonnam National Univ Med Sch, Chonnam, Korea, Republic of
| | - Soo-Yeon Kim
- Dept of Physical and Rehabilitation Medicine, Pusan National Univ Sch of Medicine, Pusan, Korea, Republic of
| | - Gyung-Jae Oh
- Dept of Preventive Medicine, Wonkwang Univesity Sch of Medicine, Chunbuk, Korea, Republic of
| | - Yang-Soo Lee
- Dept of Rehabilitation Medicine, Kyungpook National Univ Hosp, Kyungpook, Korea, Republic of
| | - Min Cheol Joo
- Dept of Rehabilitation Medicine, Wonkwang Univesity Sch of Medicine, Chunbuk, Korea, Republic of
| | - Eun Young Han
- Dept of Rehabilitation Medicine, Jeju National Univ Hosp, Jeju, Korea, Republic of
| | - Jun Hee Han
- Dept of Statistics, Hanllym Univ, Gangwon-do Province, Korea, Republic of
| | - Jeounghoon Ahn
- Dept of Health Convergence, Ewha Womans Univ, seoul, Korea, Republic of
| | - Kang Hee Lee
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Prevention, Cntr for Disease, Chungbuk, Korea, Republic of
| | - Sung Hyun Kang
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Prevention, Cntr for Disease, Chungbuk, Korea, Republic of
| | - Yong-Joo Choi
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Prevention, Cntr for Disease, Chungbuk, Korea, Republic of
| | - Young Taek Kim
- Korea Cntrs for Disease Control and Prevention, Div of Chronic Disease Control, Cntr for Disease Prevention, Chungbuk, Korea, Republic of
| | - Mon-Taek Choi
- Sch of Mechanical Engineering, Sungkyunkwan Univ, seoul, Korea, Republic of
| | - Yun-Hee Kim
- Dept of Physical and Rehabilitation Medicine, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, seoul, Korea, Republic of
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Kim MS, Joo MC, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YS, Han EY, Han J, Ahn J, Chang WH, Kim YH. Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study. J Clin Neurol 2019; 15:54-61. [PMID: 30618217 PMCID: PMC6325355 DOI: 10.3988/jcn.2019.15.1.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Few studies have investigated the relationship between the specific functional factors potentially associated with functional level and stroke recurrence. We conducted a study of patients with noncardioembolic ischemic stroke (NCIS) to determine the functional factors affecting recurrence within the first year. Methods In total, 568 first-ever NCIS patients (age=65.1±17.4 years, mean±SD) were analyzed in a multicenter, prospective cohort study registered from August 2012. Demographic characteristics, past medical history, comorbidities, laboratory data, stroke features in neuroimaging, acute treatments, and medications at discharge were assessed. Functional factors reflecting gross functional impairment, ambulatory function, motor function, activities of daily living, cognition, language ability, swallowing function, mood, and quality of life were comprehensively evaluated in face-to-face assessments using standardized tools at the time of discharge. Results The cumulative incidence of stroke recurrence in NCIS was 6.0% (n=34) at 1 year. The period from admission to discharge was 34.4±7.0 days. The independent predictors of stroke recurrence within 1 year in multivariate Cox proportional-hazards regression analyses were 1) age [per-year hazard ratio (HR)=1.04, 95% confidence interval (CI)=0.97–1.06, p=0.048], 2) Charlson Comorbidity Index higher than 2 (HR=1.72, 95% CI=1.26–2.22, p=0.016), 3) modified Rankin Scale score of 3 or more at discharge (HR=1.56, 95% CI=1.22–1.94, p=0.032), and 4) Functional Ambulation Category of 3 or less at discharge (HR=2.56, 95% CI=1.84–3.31, p=0.008). Conclusions In addition to patient age, moderate-to-severe functional impairment requiring the help of others (especially for ambulation) at the time of discharge and the severity of comorbidity were independent predictors of stroke recurrence within 1 year of the first NCIS.
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Affiliation(s)
- Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea.
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lee KH, Sohn MK, Jeong HS, Song HJ, Kim J, Kwon HJ, Koh HS, Jee S. The Effect of Inter-Departmental Stroke Meetings on Rehabilitation in a Comprehensive Cerebrovascular Center. J Korean Med Sci 2018; 33:e85. [PMID: 29495135 PMCID: PMC5835584 DOI: 10.3346/jkms.2018.33.e85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stroke is the number one cause of adulthood disability in Korea. Rehabilitation after stroke can minimize functional disability, enhance recovery toward independence, and optimize community reintegration. The inter-departmental stroke meeting (IDSM) is a potential method to improve rehabilitation outcomes in patients with stroke. We aimed to analyze the effect of IDSM on rehabilitation after acute ischemic stroke management. METHODS Medical records of 753 patients with acute ischemic stroke admitted to the neurology department of our medical center between January and December 2014 were reviewed retrospectively. In May 2014, weekly IDSMs were initiated. All physicians responsible for the patient's care reviewed patient treatment, methods of secondary prevention, and future rehabilitation plans. RESULTS The transfer rate significantly increased after initiation of IDSM (phase 2, 3) and the length of stay (LOS) before transfer to the rehabilitation department decreased significantly from 9.68 ± 8.50 days to 5.75 ± 2.12 days. There was a reduction in the total LOS from 52 ± 28.57 days to 35 ± 27.21 days after IDSMs were introduced. In non-transferred patients also, the total LOS reduced significantly. The transfer rate increased significantly and the LOS before transfer to the rehabilitation department decreased significantly after implementation of IDSM in a subgroup of patients with moderate to severe stroke. CONCLUSION The introduction of IDSM was significantly correlated with improvements in transfer rates and reduction of LOS in hospital. This finding shows that IDSMs are an important intervention to improve therapeutic progress and outcomes for patients with stroke.
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Affiliation(s)
- Kyu Ho Lee
- Department of Rehabilitation Medicine, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hye Seon Jeong
- Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hee Jung Song
- Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Jei Kim
- Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hyon Jo Kwon
- Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hyeon Song Koh
- Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.
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50
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Park SH, Sohn MK, Jee S, Yang SS. The Characteristics of Cognitive Impairment and Their Effects on Functional Outcome After Inpatient Rehabilitation in Subacute Stroke Patients. Ann Rehabil Med 2017; 41:734-742. [PMID: 29201811 PMCID: PMC5698659 DOI: 10.5535/arm.2017.41.5.734] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/28/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To determine the frequency and characteristics of vascular cognitive impairment (VCI) in patients with subacute stroke who underwent inpatient rehabilitation and to analyze whether cognitive function can predict functional assessments after rehabilitation. Methods We retrospectively reviewed the medical records of patients who were admitted to our rehabilitation center after experiencing a stroke between October 2014 and September 2015. We analyzed the data from 104 patients who completed neuropsychological assessments within 3 months after onset of a stroke. Results Cognitive impairment was present in 86 out of 104 patients (82.6%). The most common impairment was in visuospatial function (65, 62.5%) followed by executive function (63, 60.5%), memory (62, 59.6%), and language function (34, 32.6%). Patients with impairment in the visuospatial and executive domains had poor scores of functional assessments at both admission and discharge (p<0.05). A multivariate analysis revealed that age (β=−0.173) and the scores on the modified Rankin Scale (β=−0.178), Korean version of the Modified Barthel Index (K-MBI) (β=0.489) at admission, and Trail-Making Test A (TMT-A) (β=0.228) were related to the final K-MBI score at discharge (adjusted R2=0.646). Conclusion In our study, VCI was highly prevalent in patients with stroke. TMT-A scores were highly predictive of their final K-MBI score. Collectively, our results suggest that post-stroke executive dysfunction is a significant and independent predictor of functional outcome.
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Affiliation(s)
- Soo Ho Park
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine and Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine and Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine and Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Shin Seung Yang
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine and Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
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