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Acero-Garces D, Zuluaga-Lotero D, Ortiz-Muñoz D, Arango GP, Moyano M, Vargas-Manotas J, Rojas CA, Urrego J, Rojas JP, Rosso F, Ramos-Burbano GE, Llanos MD, Lizarazo J, Lopez-Gonzalez R, Jimenez-Arango JA, Benavides-Melo J, Martinez-Villota VA, Gonzalez G, Dominguez-Penuela SC, Quintero JA, Luque KA, Ruiz AM, Claros K, Osorio L, Pardo CA, Parra B. Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic. J Neurol Sci 2024; 463:123140. [PMID: 39047509 PMCID: PMC11338696 DOI: 10.1016/j.jns.2024.123140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.
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Affiliation(s)
| | | | | | - Gloria P Arango
- Universidad Del Valle, School of Human Rehabilitation, Faculty of Health, Cali, Colombia
| | - Martha Moyano
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - José Vargas-Manotas
- Universidad Simón Bolívar, Barranquilla, Colombia; La Misericordia Clínica Internacional, Barranquilla, Colombia
| | - Christian A Rojas
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia; Clinica Imbanaco, Department of Pediatrics, Cali, Colombia
| | - Jonathan Urrego
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia
| | - Juan P Rojas
- Fundación Clínica Infantil Club Noel, Department of Pediatrics, Cali, Colombia; Universidad Libre seccional Cali, Cali, Colombia
| | - Fernando Rosso
- Fundación Valle del Lili, Department of Internal Medicine, Cali, Colombia; Universidad ICESI, Cali, Colombia
| | - Gustavo E Ramos-Burbano
- Universidad del Valle, School of Medicine, Cali, Colombia; Clinica Rey David, Cali, Colombia
| | | | - Jairo Lizarazo
- Hospital Universitario Erasmo Meoz, Cúcuta, Colombia; Universidad de Pamplona, Cúcuta, Colombia
| | | | | | | | | | - Guillermo Gonzalez
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia; Universidad Surcolombiana, Neiva, Colombia
| | | | - Jaime A Quintero
- Universidad del Valle, Department of Microbiology, Cali, Colombia
| | | | | | - Katherinne Claros
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia
| | - Lyda Osorio
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - Carlos A Pardo
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, MD, USA.
| | - Beatriz Parra
- Universidad del Valle, Department of Microbiology, Cali, Colombia
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Ribeiro Batista L, Silva SLAD, Cunha Polese J, Silva AC, Teixeira-Salmela LF, Faria CDCDM, Faria-Fortini I. Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke. Disabil Rehabil 2024:1-7. [PMID: 38318868 DOI: 10.1080/09638288.2024.2313124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. MATERIALS AND METHODS 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. RESULTS Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). CONCLUSIONS Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.
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Affiliation(s)
- Ludmilla Ribeiro Batista
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Janaine Cunha Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Aryane Carolina Silva
- Graduate Program in Rehabilitation Sicences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Tseng YT, Han DS, Lai JCY, Wang CH, Wang TG, Chen HH. The Influence of Hemoglobin and Swallowing Ability on Daily Living Activities After Hospital Discharge in Taiwanese Stroke Patients: A Longitudinal Study. Arch Phys Med Rehabil 2023; 104:1638-1645. [PMID: 37286069 DOI: 10.1016/j.apmr.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to examine the mediating effect of swallowing ability on hemoglobin levels and activities of daily living (ADL). DESIGN Prospective longitudinal study. SETTING Two rehabilitation wards in a national referral center for Northern Taiwan, followed by discharge. PARTICIPANTS 101 participants were admitted for first or recurrent infarction or hemorrhagic stroke and transferred to the rehabilitation ward of a medical center (N=101). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Hemoglobin data were collected from medical records. Swallowing ability and ADL were measured using the Functional Oral Intake Scale and Barthel Index, respectively, with higher scores indicating better functioning. RESULTS Mediation analysis performed using path analysis illustrated that hemoglobin at the time of transfer to the rehabilitation ward had a direct and positive effect on swallowing ability at 1-3 days before discharge (path coefficient=0.21, 95% confidence interval [CI]: 0.04-0.35, P=.018), and swallowing ability at 1-3 days before discharge had a direct and positive effect on ADL at 1 month after discharge (path coefficient=0.36, 95% CI: 0.13-0.57, P=.002). Hemoglobin level at the time of transfer to the rehabilitation ward did not directly influence ADL 1 month after discharge (path coefficient=0.12, 95% CI: -0.05-0.28, P=.166). These results indicate that swallowing ability substantially mediates the relation between previous hemoglobin levels and subsequent ADL. CONCLUSION Low hemoglobin levels and poor swallowing ability should be concurrently addressed to improve ADL performance.
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Affiliation(s)
- Ying-Tzu Tseng
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, Taipei City, Taiwan; Department of Physical Medicine and rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jerry Cheng-Yen Lai
- Department of Medical Research, Taitung MacKay Memorial Hospital, Taitung City, Taiwan; College of Science and Engineering, National Taitung University, Taitung City, Taiwan
| | - Chien-Hui Wang
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hung-Hui Chen
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan; School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan.
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Hanson S, Lassen A, Nielsen D, Ryg J, Forero R, Brabrand M. Resuscitation Preferences of Older Acutely Admitted Medical and Mentally Competent Patients with One and Six Months Follow-up. Resuscitation 2023:109836. [PMID: 37196801 DOI: 10.1016/j.resuscitation.2023.109836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
AIM Determining patients' cardiopulmonary resuscitation (CPR) preferences in the emergency department (ED) is common practice but the stability of these preferences and their recollection by patients has been questioned. Therefore, this study assessed the stability and recall of CPR preferences of older patients at and following ED discharge. METHODS This survey-based cohort study was conducted between February and September 2020 at three EDs in Denmark. It consecutively asked mentally competent patients aged 65 years or older who were admitted to hospital through the ED and then one and six months later "In your current state of health, do you wish that physicians should try to intervene if your heart stops beating?" Possible responses were confined to "definitely yes", "definitely no", "uncertain", and "prefer not to answer". RESULTS In total, 3688 patients admitted to hospital via the ED patients were screened, 1766 were eligible and 491 (27.8%) were included: median age was 76 (IQR 71-82) years, and 257 (52.3%) were men. One third of patients who expressed definite yes or no preferences in ED had changed their preference at one month follow-up. Only 90 (27.4%) and 94 (35.7%) patients recalled their preferences at one and six months follow-up, respectively. CONCLUSION and Relevance In this study, one-in-three older ED patients who initially expressed definite resuscitation preferences had changed their minds at one month follow-up. Preferences were more stable at six months but only a minority were able to recall their preferences.
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Affiliation(s)
- Stine Hanson
- Department of Regional Health Research, Center-Esbjerg, University of Southern Denmark.
| | - Annmarie Lassen
- Department of Emergency Medicine, Odense University Hospital, Denmark, Institute of Clinical Research, University of Southern Denmark
| | - Dorthe Nielsen
- Family focused healthcare research Centre, Odense University Hospital; Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark
| | - Roberto Forero
- Simpson Centre for Health Services Research, School of Clinical Medicine, UNSW Medicine & Health, SWS Clinical Campuses, Liverpool Hospital, UNSW, Sydney and Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool BC, 1871, NSW, Australia
| | - Mikkel Brabrand
- Department of Emergency, Medicine, Hospital of South West Jutland, Denmark, University of Southern Denmark, Institute of Regional Health Research, Center-Esbjerg, University of Southern Denmark
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Brito SAFD, Scianni AA, Peniche PDC, Faria CDCDM. Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist. Clin Rehabil 2023; 37:415-435. [PMID: 36448251 DOI: 10.1177/02692155221129834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. DESIGN Systematic review. SUBJECTS Individuals with neurological conditions. INTERVENTION Not applicable. MAIN MEASURES The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. RESULTS From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as "sufficient" in a study with appropriate methodological quality ("very good" or "adequate"). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. CONCLUSION The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. REGISTRATION NUMBER CRD42021257662.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula da Cruz Peniche
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Aguilar-Zafra S, del Corral T, Valera-Calero JA, Martín-Casas P, Plaza-Manzano G, López-de-Uralde-Villanueva I. Development of the Web-Based Spanish Version of the Barthel Index in Patients with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13965. [PMID: 36360845 PMCID: PMC9657693 DOI: 10.3390/ijerph192113965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND The aims of this study were to develop a web-based Spanish form of the Barthel index (BI), to evaluate its psychometric properties and stability over time (test-retest), and to determine minimal detectable change (MDC) in patients with multiple sclerosis (MS). METHODS Participants answered the BI on two forms (web-based and face-to-face interview), 7-10 days apart. The internal consistency was evaluated using Cronbach's alpha, and intraclass correlation (ICC) and kappa (κ) coefficients were used to investigate the agreement between both forms. RESULTS 143 participants were included. The Spanish web-based form of the BI showed excellent agreement between both forms for each item (κ = 0.86 (0.79 to 0.92), and for total score (κ = 0.87 (0.81 to 0.93); ICC = 0.99 (0.98 to 0.99). The internal consistency was good-excellent (Cronbach's alpha = 0.89 (0.86-0.91)). The stability over time was adequate, the agreement of each item was κ = 0.63 (0.52-0.74)), and for total score (ICC = 0.97), determining a MDC95 of 12.09 points. CONCLUSIONS The Spanish web-based form of the BI is a valid and reliable tool to assess functionality and can be applied in both formats in patients with MS. A total score difference of more than 12 points was found to indicate a deterioration or improvement in the patient's functionality.
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Affiliation(s)
- Sandra Aguilar-Zafra
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Téxum S.L Physiotherapy Center, 28821 Madrid, Spain
| | - Tamara del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physical Therapy, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Cinone N, Santoro L, Spina S, Facciorusso S, Battaglia M, Baricich A, Marcogiuseppe P, Santamato A. Reasons and Determinants of BoNT-A Treatment Discontinuation in Patients Living with Spasticity: A 10-Year Retrospective Analysis. Toxins (Basel) 2022; 14:675. [PMID: 36287945 PMCID: PMC9609474 DOI: 10.3390/toxins14100675] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the reasons and determinants of BoNT-A discontinuation in patients with stroke, multiple sclerosis, spinal cord injury, and traumatic brain injury. METHODS It is a retrospective study of 56 discontinuer patients treated with botulinum toxin between January 2011 and December 2021. Discontinuation rates and their predictors were estimated using Kaplan-Meier, Log rank test, and Cox's regression method of analyses. RESULTS The mean age was 56.54 years, 53.57% were affected by post-stroke spasticity, 17.86% by spinal cord injury, 12.5% and 16.07% by traumatic brain injury and multiple sclerosis, respectively. The median discontinuation time was 5 months. The main reason for discontinuation were logistic problems (37%) and orthopedic surgeries or intrathecal baclofen (27%). Discontinuers were more likely to have severe spasticity (R = 1.785), have no pain (HR = 1.320), no access to rehabilitation services (HR = 1.402), and have cognitive impairment (HR = 1.403). CONCLUSIONS The main reasons for discontinuation are related to logistic issues (due to distance or the absence of an adequate caregiver) and surgical interventions for spasticity, including intrathecal baclofen. It is crucial to identify possible predictors of discontinuation to improve the effectiveness of a multidisciplinary management. The study confirms the crucial role of rehabilitation and caregivers in achieving better long-term outcomes.
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Affiliation(s)
- Nicoletta Cinone
- Spasticity and Movement Disorder Unit, Physical Medicine and Rehabilitation, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Luigi Santoro
- Spasticity and Movement Disorder Unit, Physical Medicine and Rehabilitation, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Stefania Spina
- Spasticity and Movement Disorder Unit, Physical Medicine and Rehabilitation, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Salvatore Facciorusso
- Villa Beretta Rehabilitation Center, Valduce Hospital, Via Nazario Sauro 17, 23845 Costa Masnaga, Italy
| | - Marco Battaglia
- Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, viale Piazza d’armi 1, 28100 Novara, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, viale Piazza d’armi 1, 28100 Novara, Italy
| | - Pasqua Marcogiuseppe
- Spasticity and Movement Disorder Unit, Physical Medicine and Rehabilitation, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Andrea Santamato
- Spasticity and Movement Disorder Unit, Physical Medicine and Rehabilitation, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
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Wu ZY, Wang YQ, Wen XP, Wang MY, Wang LN, Lu LM, Li KB. Does noninvasive cerebellar stimulation improve the balance and walking function of patients with stroke: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e30302. [PMID: 36086722 PMCID: PMC10980459 DOI: 10.1097/md.0000000000030302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Investigating the efficacy and safety of noninvasive cerebellar stimulation in improving the balance and walking function of patients with stroke. METHODS We searched 7 databases for randomized controlled trials (RCTs) related to noninvasive cerebellar stimulation in the treatment of stroke. The Berg Balance Scale (BBS), 6-minute walk test (6MWT), and Barthel Index (BI) were used as the outcome indexes to evaluate balance, walking and activities of daily living (ADL). The quality of the research was evaluated using the Cochrane Risk of Bias Tool. A meta-analysis was performed to evaluate the difference between the noninvasive cerebellar stimulation and control groups. Heterogeneity tests were performed to assess differences in treatment effects across noninvasive cerebellar stimulation modalities. A sensitivity analysis was performed to evaluate the robustness of the results. RESULTS Seven studies were included, and 5 articles (71.43%) were rated as having a low risk of bias. Among the primary outcome indicators, 4 of the 7 articles were combined into the fixed effect model (I2 = 38%, P = .18). Compared with the control group, noninvasive cerebellar stimulation improved the BBS score, and the difference was statistically significant (mean difference [MD]: 3.00, 95% confidence interval [CI]: 1.10-5.40, P = .03); the sensitivity analysis showed that the statistical model was still stable after sequentially eliminating each article. Compared with the control group, noninvasive cerebellar stimulation improved the 6MWT results of patients with stroke (MD: 25.29, 95% CI: 4.86-45.73, P = .02). However, noninvasive cerebellar stimulation did not improve the BI (MD: 15.61, 95% CI: -7.91 to 39.13, P = .19). No safety problems or adverse reactions to noninvasive cerebellar stimulation were observed. CONCLUSIONS Noninvasive cerebellar stimulation improves balance and walking function of patients with stroke, but its effect on ADL is uncertain. Due to the methodological weaknesses in the included trials, more RCTs are needed to confirm our conclusions.
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Affiliation(s)
- Zhi-Yuan Wu
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yi-Qiao Wang
- Evidence-based Medicine and Data Science Centre, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Peng Wen
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Mei-Ying Wang
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Li-Na Wang
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Li-Ming Lu
- Evidence-based Medicine and Data Science Centre, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kun-Bin Li
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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Jitpratoom P, Boonyasiri A. Clinical and laboratory features in patients with positive syphilis serology presenting with acute ischemic stroke or transient ischemic attack: a prospective cohort study. BMC Infect Dis 2022; 22:717. [PMID: 36042411 PMCID: PMC9429294 DOI: 10.1186/s12879-022-07700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neurosyphilis (NS) can lead to acute ischemic stroke (AIS) or transient ischemic attack (TIA). We compared the clinical characteristics and laboratory features among AIS and TIA patients who were syphilis-seronegative (control group) or had latent syphilis (LS) or NS to evaluate their stroke outcome. Methods This prospective cohort study was conducted on patients who had recently suffered AIS or TIA. After serological syphilis screening, clinical and laboratory data were collected, and brain imaging and spinal tap (serologically syphilis-positive patients only) were performed. Stroke outcome was re-evaluated approximately three months later. Results The 344 enrolled patients were divided into three groups: control group (83.7%), LS (13.1%), and NS (3.2%). A multivariate analysis revealed: 1) age of ≥ 70 years, generalized brain atrophy via imaging, and alopecia (adjusted odds ratio [AOR] = 2.635, 2.415, and 13.264, respectively) were significantly associated with LS vs controls; 2) age of ≥ 70 years (AOR = 14.633) was significantly associated with NS vs controls; and 3) the proportion of patients with dysarthria was significantly lower (AOR = 0.154) in the NS group than in the LS group. Regarding the NS patient cerebrospinal fluid (CSF) profile, only 2/11 cases had positive CSF-Venereal Disease Research Laboratory (VDRL) test results; the other nine cases were diagnosed from elevated white blood cell counts or protein levels combined with positive CSF fluorescent treponemal antibody absorption (FTA-ABS) test results. Regarding disability, the initial modified Rankin scale (mRS) score was lower in the control group than in the NS group (p = 0.022). At 3 months post-stroke, the mRS score had significantly decreased in the control (p < 0.001) and LS (p = 0.001) groups. Regarding activities of daily living, the 3-month Barthel Index (BI) score was significantly higher in control patients than in LS (p = 0.030) or NS (p = 0.002) patients. Additionally, the 3-month BI score was significantly increased in the control (p < 0.001) and LS (p = 0.001) groups. Conclusions Because syphilis was detected in many AIS and TIA patients, especially those aged ≥ 70 years, routine serological syphilis screening may be warranted in this population. Patients with syphilitic infection had worse stroke outcomes compared with NS patients.
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Affiliation(s)
| | - Adhiratha Boonyasiri
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Lakshmikantha N, Lakshman K. Long-Term Outcomes of Laparoscopic Repair of Ventral Hernia with Intraperitoneal Polypropylene Mesh. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hosoda T, Hamada S. Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study. BMC Geriatr 2021; 21:638. [PMID: 34772350 PMCID: PMC8586826 DOI: 10.1186/s12877-021-02597-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02597-w.
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Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, 210-0013, Japan.
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Physical Therapy Practice for Critically Ill Patients With COVID-19 in the Intensive Care Unit. Cardiopulm Phys Ther J 2021. [DOI: 10.1097/cpt.0000000000000188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Andrew MK, MacDonald S, Godin J, McElhaney JE, LeBlanc J, Hatchette TF, Bowie W, Katz K, McGeer A, Semret M, McNeil SA. Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness. J Am Geriatr Soc 2021; 69:696-703. [PMID: 33294986 PMCID: PMC7984066 DOI: 10.1111/jgs.16950] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVES Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under-studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI). DESIGN Protective observational cohort study. SETTING Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season. PARTICIPANTS A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI. MEASUREMENTS Influenza was laboratory-confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100-point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living. RESULTS Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty-six (37.4%) had laboratory-confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI. CONCLUSION Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.
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Affiliation(s)
- Melissa K. Andrew
- Geriatric Medicine Research, Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
| | - Sarah MacDonald
- Department of Family MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Judith Godin
- Geriatric Medicine Research, Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Jason LeBlanc
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
- Department of PathologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Todd F. Hatchette
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
- Department of Medicine (Infectious Diseases)Dalhousie UniversityHalifaxNova ScotiaCanada
| | - William Bowie
- Department of Medicine (Infectious Diseases)University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kevin Katz
- North York General HospitalTorontoOntarioCanada
| | | | - Makeda Semret
- McGill University Health Centre Research InstituteMontrealQuebecCanada
| | - Shelly A. McNeil
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
- Department of Medicine (Infectious Diseases)Dalhousie UniversityHalifaxNova ScotiaCanada
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Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults. Palliat Support Care 2020; 19:515-523. [PMID: 33234188 DOI: 10.1017/s1478951520001200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults. METHOD Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann-Whitney U test. RESULTS There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05). SIGNIFICANCE OF RESULTS This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.
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Ghanbari Ghoshchi S, De Angelis S, Morone G, Panigazzi M, Persechino B, Tramontano M, Capodaglio E, Zoccolotti P, Paolucci S, Iosa M. Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145233. [PMID: 32698430 PMCID: PMC7399919 DOI: 10.3390/ijerph17145233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022]
Abstract
Cerebrovascular diseases, including stroke, are historically considered diseases of old adults so only in a few studies has “return to work” (RTW) been considered as an index of rehabilitative outcome. At the moment, data on RTW in patients with stroke are highly variable: four different reviews reported the following ranges: 11–85%, 19–73%, 22–53%, and 40–45%. The absence of re-integration to work after a stroke is shown to be associated with an increase of cardiac disorders and depression, with a higher level of mortality, with social isolation and with insufficient adaptive skills. The aim of this study was to verify the effectiveness of technological treatment, performed with optic (SonicHand) and wearable (Riablo™) systems providing auditory and visual biofeedback, on RTW in patients with stroke. RTW was found to be associated with a higher independence in the activities of daily living (assessed by the Modified Barthel Index). No significant differences were found between technological versus conventional rehabilitation in terms of RTW, despite the former showing a higher odds ratio than the latter (OR = 9 vs. 6). Assistive devices were mainly used in patients who had not returned to work. Finally, quality of life was found higher in those patients who returned to work with the same conditions (work duties and time) as before stroke.
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Affiliation(s)
- Sheyda Ghanbari Ghoshchi
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Sara De Angelis
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Giovanni Morone
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27040 Montescano, Italy;
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27100 Pavia, Italy;
| | - Benedetta Persechino
- Italian Workers’ Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, 00078 Rome, Italy;
| | - Marco Tramontano
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, 00135 Rome, Italy
| | - Edda Capodaglio
- Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27100 Pavia, Italy;
| | - Pierluigi Zoccolotti
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Paolucci
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
| | - Marco Iosa
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; (S.G.G.); (S.D.A.); (G.M.); (M.T.); (P.Z.); (S.P.)
- Correspondence:
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