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Youkee D, Deen GF, Sackley C, Lisk DR, Marshall I, Soley-Bori M. Quality of life and quality-adjusted life years after stroke in Sierra Leone. Int J Stroke 2024:17474930241249589. [PMID: 38651761 DOI: 10.1177/17474930241249589] [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: 04/25/2024]
Abstract
BACKGROUND Stroke is a leading cause of mortality and negatively affects health-related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at 1 year post-stroke and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population. METHODS A prospective stroke register was established at the two-principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at 7, 90 days, and 1 year post-stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the UK and Zimbabwe (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at 1 year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables, respectively, were used. RESULTS EQ-5D-3L data were available for 373/460 (81.1%), 360/367 (98.1%), and 299/308 (97.1%) participants at 7, 90 days, and 1 year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI: -0.16 to 0.59) at 7 days post-stroke to 0.76 (0.47 to 1.0) at 90 days and remained stable at 1 year 0.76 (0.49 to 1.0). Mean QALYs at 1 year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid hemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, while being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0. CONCLUSION We generated QALYs after stroke for the first time in an African country. QALYs were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods. DATA AVAILABILITY The Stroke in Sierra Leone anonymized dataset is available on request to researchers, see data access section.
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Affiliation(s)
- Daniel Youkee
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | | | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Iain Marshall
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Marina Soley-Bori
- School of Life Course & Population Sciences, King's College London, London, UK
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Kitcharanant N, Atthakomol P, Khorana J, Phinyo P, Unnanuntana A. Predictive Model of Recovery to Prefracture Activities-of-Daily-Living Status One Year after Fragility Hip Fracture. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:615. [PMID: 38674261 PMCID: PMC11051767 DOI: 10.3390/medicina60040615] [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: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Achieving prefracture functional status is a critical objective following a hip fracture, yet fewer than half of patients reach this milestone. The adoption of tools for assessing functional outcomes is increasingly recognized as essential for evaluating recovery following treatment for fragility hip fractures. We developed multivariable clinical prediction criteria to estimate the likelihood of patients regaining their prefracture activities-of-daily-living (ADL) status one year after sustaining a fragility hip fracture. Materials and Methods: A retrospective cohort of patients treated for fragility hip fractures at a university-affiliated tertiary care center between February 2017 and April 2019 served as the basis for developing and internally validating the clinical prediction criteria. We applied a multivariable fractional polynomial method to integrate several continuous predictors into a binary logistic regression model. Results: The study included 421 patients, 324 (77%) of whom reported regaining their prefracture activities-of-daily-living level one year after experiencing fragility hip fractures. Significant predictors, such as the prefracture Barthel index, EQ-VAS score, and treatment modality, were incorporated into the predictive model. The model demonstrated excellent discriminative power (AuROC of 0.86 [95% CI 0.82-0.91]) and satisfactory calibration. Conclusions: The predictive model has significant discriminative ability with good calibration and provides clinicians with a means to forecast the recovery trajectories of individual patients one year after a fragility hip fracture, which could be useful because prompt clinical decision-making is aided by this information. Patients and caregivers can also be counseled and encouraged to follow up with the medical activities and interventions deemed essential by doctors who used the prediction tool. Access to the model is provided through a web application. External validation is warranted in order to prove its applicability and generalizability.
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Affiliation(s)
- Nitchanant Kitcharanant
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand;
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Youkee D, Pessima S, Sackley C, Soley-Bori M, Deen GF, Marshall IJ. The feasibility, repeatability, validity and responsiveness of the EQ-5D-3L in Krio for patients with stroke in Sierra Leone. Health Qual Life Outcomes 2024; 22:29. [PMID: 38549069 PMCID: PMC10976786 DOI: 10.1186/s12955-024-02246-x] [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: 01/25/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES To assess the feasibility, repeatability, validity and responsiveness of the EQ-5D-3L in Krio for patients with stroke in Sierra Leone, the first psychometric assessment of the EQ-5D-3L to be conducted in patients with stroke in Sub Saharan Africa. METHODS A prospective stroke register at two tertiary government hospitals recruited all patients with the WHO definition of stroke and followed patients up at seven days, 90 days and one year post stroke. The newly translated EQ-5D-3L, Barthel Index (BI), modified Rankin Scale (mRS) and National Institute of Health Stroke Scale (NIHSS), a measure of stroke severity, were collected by trained researchers, face to face during admission and via phone at follow up. Feasibility was assessed by completion rate and proportion of floor/ceiling effects. Internal consistency was assessed by inter item correlations (IIC) and Cronbach's alpha. Repeatability of the EQ-5D-3L was examined using test-retest, EQ-5D-3L utility scores at 90 days were compared to EQ-5D-3L utility scores at one year in the same individuals, whose Barthel Index had remained within the minimally clinical important difference. Known group validity was assessed by stroke severity. Convergent validity was assessed against the BI, using Spearman's rho. Responsiveness was assessed in patients whose BI improved or deteriorated from seven to 90 days. Sensitivity analyses were conducted using the UK and Zimbabwe value sets, to evaluate the effect of value set, in a subgroup of patients with no formal education to evaluate the influence of patient educational attainment, and using the mRS instead of the BI to evaluate the influence of utilising an alternative functional scale. RESULTS The EQ-5D-3L was completed in 373/460 (81.1%), 360/367 (98.1%) and 299/308 (97.1%) eligible patients at seven days, 90 days and one year post stroke. Missing item data was low overall, but was highest in the anxiety/depression dimension 1.3% (5/373). Alpha was 0.81, 0.88 and 0.86 at seven days, 90 days and one year post stroke and IIC were within pre-specified ranges. Repeatability of the EQ-5D-3L was moderate to poor, weighted Kappa 0.23-0.49. EQ-5D-3L utility was significantly associated with stroke severity at all timepoints. Convergent validity with BI was strong overall and for shared subscales. EQ-5D-3L was moderately responsive to both improvement Cohen's D 0.55 (95% CI:0.15-0.94) and deterioration 0.92 (95% CI:0.29-1.55). Completion rates were similar in patients with no formal education 148/185 (80.0%) vs those with any formal education 225/275 (81.8%), and known group validity for stroke severity in patients with no formal education was strong. Using the Zimbabwe value set instead of the UK value set, and using the mRS instead of the BI did not change the direction or significance of results. CONCLUSIONS The EQ-5D-3L for stroke in Sierra Leone was feasible, and responsive including in patients with no formal education. However, repeatability was moderate to poor, which may be due to the study design, but should add a degree of caution in the analysis of repeated measures of EQ-5D-3L over time in this population. Known group validity and convergent validity with BI and mRS were strong. Further research should assess the EQ-5D in the general population, examine test-retest reliability over a shorter time period and assess the acceptability and validity of the anxiety/depression dimension against other validated mental health instruments. Development of an EQ-5D value set for West Africa should be a research priority.
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Affiliation(s)
- Daniel Youkee
- King's School of Life Course and Population Sciences, King's College London, London, UK.
| | - Sahr Pessima
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Sackley
- School of Medicine and Rehabilitation, University of Nottingham, Nottingham, UK
| | - Marina Soley-Bori
- King's School of Life Course and Population Sciences, King's College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Iain J Marshall
- King's School of Life Course and Population Sciences, King's College London, London, UK
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Aked J, Delavaran H, Wennerström F, Lindgren AG. Recovery, Functional Status, and Health-Related Quality of Life Status up to 4 Years after First-Ever Stroke Onset: A Population-Based Study. Neuroepidemiology 2024:1-11. [PMID: 38531332 DOI: 10.1159/000538222] [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: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Stroke is a leading cause of acquired disability in adults worldwide, and the burden of stroke is projected to increase. Current long-term stroke outcome data including functional status, activity, and participation limitations as well as information on health-related quality of life (HRQoL) are vital for future rehabilitation and resource planning of stroke survivors. METHODS First-ever stroke survivors from a population-based cohort with ischemic stroke or intracerebral hemorrhage were followed up 3-4 years after stroke onset via clinic appointments, home visits, or telephone. Ischemic stroke was stratified by clinical syndrome (Oxfordshire Community Stroke Project classification) and pathogenetic mechanism (TOAST classification). We assessed the participants' functional status and independence with the modified Rankin Scale (mRS) and Barthel Index (BI) and their HRQoL across several domains (Short Form Questionnaire-36, EuroQoL-5D, and Stroke Impact Scale (SIS)). We used logistic and linear regression analyses to analyze potential baseline predictors of 3-4-year outcome. RESULTS Four hundred individuals were included; 151 died before clinical follow-up and 47 (12%) were lost to detailed follow-up. Two hundred and two individuals (median age: 72, IQR: 65-79; 40% female) were followed up after a median of 3.2 years (IQR: 3.1-3.5). Nineteen individuals (9%) had a recurrent stroke during the 3-4-year follow-up period. Among the 202 follow-up attendees, 147 (73%) had favorable functional outcome (mRS ≤2) and 134 (69%) of the 195 respondents reported good-excellent HRQoL according to SF-36. Age (HR: 1.03; 95% CI: 1.00-1.05), initial stroke severity (HR: 1.16; 95% CI: 1.10-1.22; p < 0.001), living with in-home care or in care facility at baseline (HR: 8.77; 95% CI: 2.98-25.64), and recurrent stroke (HR: 3.58; 95% CI: 1.47-8.77) were predictors of poor functional outcome (mRS>2). Poor functional outcome/death was less common among IS due to Other Causes and Small Artery Occlusion than other pathogenetic mechanisms (20% and 33% vs. 56-68%; p < 0.01). SIS respondents with poor functional outcomes (n = 32) reported worst outcome in the hand domain of SIS (median: 28/100; IQR: 0-73). CONCLUSIONS Most 3-4-year stroke survivors have favorable functional outcomes and are independent in ADL in a population-based cohort. Despite its relative rarity, recurrent stroke was a predictor of poor functional outcome, emphasizing the need of adequate secondary prevention.
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Affiliation(s)
- Joseph Aked
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Medicine, Blekinge Hospital, Karlskrona, Sweden
| | - Hossein Delavaran
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | | | - Arne G Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Disorders, Geriatrics, Skåne University Hospital, Lund, Sweden
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Kitcharanant N, Atthakomol P, Khorana J, Phinyo P, Unnanuntana A. Prognostic Factors for Functional Recovery at 1-Year Following Fragility Hip Fractures. Clin Orthop Surg 2024; 16:7-15. [PMID: 38304218 PMCID: PMC10825251 DOI: 10.4055/cios23177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/30/2023] [Accepted: 09/08/2023] [Indexed: 02/03/2024] Open
Abstract
Background The main objective of treating fragility hip fractures is to maximize the patients' ability to return to their basic activities of daily living (ADL) levels. This study explored prognostic factors associated with the ability to recover pre-fracture ADL levels at 1 year after fragility hip fractures. Methods We retrospectively recruited patients admitted with fragility hip fractures between July 2016 and September 2018. Details of the following were extracted from electronic medical records: age, sex, body mass index; pre-fracture Charlson Comorbidity Index (CCI), Barthel index, and EuroQol-Visual Analog Scale (EQ-VAS) scores; pre-fracture ambulatory status; and fracture type and treatment. The primary endpoint was the ability to return to the pre-fracture ADL status at 1 year. Multivariable logistic regression analysis assessed the prognostic ability of predictors. Results Of 405 patients, 284 (70.1%) managed to return to their pre-fracture ADL status. Multivariable logistic regression analysis demonstrated that the predictor with the most apparent effect size was pre-fracture EQ-VAS scores ≥ 65 (multivariable odds ratio [mOR], 12.90; p = 0.03). Other influential predictors were CCI scores < 5 (mOR, 1.96; p = 0.01) and surgical treatment for the hip fracture. Conclusions Three prognostic factors can predict a hip fracture patient's ability to return to the pre-fracture ambulatory status at 1 year. They are the patient's CCI score, operative treatment for the hip fracture, and the pre-fracture EQ-VAS score. This information could be used to develop a clinical prediction model based on the prognostic factors.
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Affiliation(s)
- Nitchanant Kitcharanant
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Masuccio FG, Grange E, Di Giovanni R, Marengo D, Prosperini L, Solaro C. Evaluation of mild-to-moderate COVID-19 through dual-task paradigm: a longitudinal case-controlled study. Neurol Sci 2023; 44:4167-4177. [PMID: 37880453 DOI: 10.1007/s10072-023-07137-5] [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: 05/15/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Coronavirus disease (COVID-19) was associated with cognitive alterations affecting everyday life activities. These need input integration of both motor and cognitive systems. The study aim is to evaluate cognitive-motor interference phenomenon in previously independent patients with mild-to-moderate COVID-19 (PwMCOVID-19) compared with healthy controls (HC), through dual-task (DT) paradigm. METHODS PwMCOVID-19 were included if being independent at home, had no previous referred cognitive impairment, mechanical ventilation or oxygen need. They were assessed at admission and after 6 months with a motor-cognitive DT test (counting backward by twos while walking 2 min). HC were enrolled as control group. Differences between single-task (ST) and DT performance, DT effect (DTE) and task prioritization amongst groups and during time points were analyzed. RESULTS One-hundred PwMCOVID-19 [mean age=67.32(12.08) years; 53 M/47 F] and 39 HC [mean age=63.11(9.90) years; 20 M/19 F] were recruited. Upon T0, PwMCOVID-19 showed lower cognitive and motor DT performances than ST and HC. Mutual interference pattern was predominant in PwMCOVID-19. At T1, 41 PwMCOVID-19 were examined [mean age=64.85(10.75); 22 M/19 F]. They had a worse DT performance compared to ST, although DT improved at T1. A stronger cognitive ST-DT difference was present at T0, compared to ST-DT difference at T1, while motor ST-DT difference was unchanged over time in PwCOVID-19. CONCLUSION In PwMCOVID-19, there is an impairment of DT counting while walking at baseline and after 6 months from hospitalization, with a more pronounced DT mutual interference pattern at T0. After 6 months, the motor and cognitive ST and DT performances ameliorated, not reaching the HC level.
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Affiliation(s)
- Fabio Giuseppe Masuccio
- Department of Neurorehabilitation, C.R.R.F. "Mons. Luigi Novarese", Loc. Trompone, SNC, 13040, Moncrivello, Italy.
| | - Erica Grange
- Department of Neurorehabilitation, C.R.R.F. "Mons. Luigi Novarese", Loc. Trompone, SNC, 13040, Moncrivello, Italy
| | - Rachele Di Giovanni
- Department of Neurorehabilitation, C.R.R.F. "Mons. Luigi Novarese", Loc. Trompone, SNC, 13040, Moncrivello, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudio Solaro
- Department of Neurorehabilitation, C.R.R.F. "Mons. Luigi Novarese", Loc. Trompone, SNC, 13040, Moncrivello, Italy
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Quinn EB, LeLaurin JH, Eliazar-Macke ND, Orozco T, Montague M, Freytes IM, Uphold CR. Effect of a telephone and web-based problem-solving intervention for stroke caregivers on stroke patient activities of daily living: A randomized controlled trial. Clin Rehabil 2023; 37:1062-1073. [PMID: 36847253 DOI: 10.1177/02692155231157301] [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] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To test for effects of a problem-solving intervention for stroke caregivers on stroke survivor activities of daily living. DESIGN Two-arm parallel randomized clinical trial with repeated measures at 11 weeks and 19 weeks. SETTING Medical centers for US military Veterans. SUBJECTS Caregivers of stroke survivors. INTERVENTION A registered nurse guided caregivers in using problem-solving strategies emphasizing creative thinking, optimism, planning, and expert information to address challenges associated with caregiving. Caregivers in the intervention completed one telephone orientation session followed by eight online, asynchronous messaging center sessions. The messaging center sessions involved (a) education on the Resources and Education for Stroke Caregivers' Understanding and Empowerment website (https://www.stroke.cindrr.research.va.gov/en/), (b) supportive communication between the nurse and caregiver, (c) nurse and caregiver interactions to improve problem-solving, and (d) maintain adherence to discharge planning instructions. MAIN OUTCOME The Barthel Index was used to measure activities of daily living. RESULTS 174 participants (standard care n = 88, intervention n = 86) were enrolled at baseline. There were no significant differences between groups at baseline. Change scores in activities of daily living between baseline and 11 weeks were significantly higher in the intervention group than the standard care group (group difference = 6.43, 95% confidence interval: 1.28, 11.58). Group differences in change scores between baseline and 19 weeks were not statistically significant (group difference = 3.89, 95% confidence interval: -3.58, 11.36). CONCLUSIONS This web-based caregiver intervention improved stroke survivor activities of daily living by 11 weeks, but intervention effects were undetectable after 19 weeks.
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Affiliation(s)
- Edward B Quinn
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Anthropology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Jennifer H LeLaurin
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Tatiana Orozco
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Magda Montague
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - I Magaly Freytes
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Constance R Uphold
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Aging & Geriatrics, College of Medicine, University of Florida, Gainesville, FL, USA
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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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Zheng Z, Song R, Zhao Y, Lv H, Wang Y, Yu C. An investigation of the level of stigma and the factors influencing it in the rehabilitation of young and middle-aged stroke patients-a cross-sectional study. BMC Neurol 2023; 23:139. [PMID: 37005567 PMCID: PMC10067210 DOI: 10.1186/s12883-023-03189-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND There are few reported studies on stigma in young and middle-aged stroke patients during the rehabilitation period, however, the rehabilitation period plays a key role in the patients' disease regression. Exploring the level of stigma and the influencing factors in young and middle-aged stroke patients during the rehabilitation period is crucial for determining how to reduce the level of stigma and improve the patients' motivation for rehabilitation treatment. Therefore, this study investigated the level of stigma in young and middle-aged stroke patients and analyzed the factors influencing stigma in order to provide a reference or basis for healthcare professionals to develop effective and targeted stigma intervention programs. METHODS Using a convenience sampling method, 285 young and middle-aged stroke patients admitted to the rehabilitation medicine department of a tertiary care hospital in Shenzhen, China, from November 2021 to September 2022 were selected and surveyed using a general information questionnaire, the Stroke Stigma Scale(SSS), the Barthel Index(BI), and the Positive and Negative Emotions Scale(PANAS), and multiple linear regression and smoothed curve fitting were used to analyze the factors influencing the stigma of young and middle-aged stroke patients during the rehabilitation period. RESULTS SSS score of 45.08 ± 11.06, univariate analysis of age, occupation, education level, pre-stroke monthly income, insurance type, comorbid chronic disease status, primary caregiver, BI, positive and negative emotion as factors influencing stigma. Multiple linear regression showed that age, pre-stroke monthly income, BI, positive and negative emotions were independent influences on stigma in young and middle-aged stroke patients, explaining 58.0% of the total variance in stigma. A smoothed curve fit revealed a curvilinear relationship between the above influences and stigma. CONCLUSION Young and middle-aged stroke patients have a moderate level of stigma. Medical staff should focus on young patients aged 18-44 years, those with high monthly income before the stroke, those with poor self-care ability, and those with low positive and high negative emotion scores, and conduct early assessments and adopt targeted intervention programs according to the influencing factors to reduce the stigma of young and middle-aged stroke patients, improve their motivation for rehabilitation, and help them return to their families and society as soon as possible. TRIAL REGISTRATION Registration number of China Clinical Trials Registration Center: 20,220,328,004-FS01.
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Affiliation(s)
- Zixiu Zheng
- Inner Mongolia Baogang Hospital, Baotou, China
- Henan University of Science and Technology, Luoyang, China
| | - Runluo Song
- Henan University of Science and Technology, Luoyang, China
| | - Yunxiao Zhao
- Department of Nursing, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hongxia Lv
- Inner Mongolia Baogang Hospital, Baotou, China
| | | | - Cong Yu
- Department of Nursing, Shenzhen Second People's Hospital, Shenzhen, China.
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10
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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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11
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Gamberini G, Masuccio FG, Cerrato M, Strazzacappa M, Ferraro D, Solaro C. Previously independent patients with mild-symptomatic COVID-19 are at high risk of developing cognitive impairment but not depression or anxiety. J Affect Disord 2023; 324:645-651. [PMID: 36610599 PMCID: PMC9812466 DOI: 10.1016/j.jad.2022.12.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/20/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of the study was to explore the cognitive functions of a large sample of hospitalised subjects with mild symptomatic Coronavirus Disease (COVID-19) who were previously independent at home and without neurological diseases. METHODS Patients admitted in a COVID-19 Unit for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection between November 2020 and March 2021 were recruited. Inclusion criteria were: being independent at home before the infection, radiologically confirmed COVID-19 pneumonia, positive reverse transcriptase-polymerase chain reaction nasopharyngeal swab and no oxygen supplementation at the time of evaluation. EXCLUSION CRITERIA cognitive impairment or neurological diseases previous to the infection, delirium episodes, and history of any mechanical ventilation use. They were evaluated with Montreal Cognitive Assessment (MoCA), Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). RESULTS Out of 522 subjects admitted in the COVID-19 Unit, 90 were enrolled [mean age = 68.32(11.99); 46M/44F]. An impaired MoCA (cut-off < 23) was found in 60 subjects (66.66 %). Pathological scores were obtained by 36.7 % of the subjects with <65 years and 78.3 % of those older than 65 years. A high prevalence of executive function and memory impairment was detected. CONCLUSIONS The results underline a high rate of cognitive impairment in previously independent mild COVID-19 patients. This might represent a potential threat for the everyday independence of these patients due to the consequences on everyday life activities and work following discharge from hospital. These subjects should, therefore, be monitored in order to allow a better understanding of the progression and consequences of the so-called "Long COVID".
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Affiliation(s)
- Giulia Gamberini
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Moncrivello, Italy
| | | | - Marta Cerrato
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Moncrivello, Italy
| | - Mara Strazzacappa
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Moncrivello, Italy
| | - Diana Ferraro
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Italy
| | - Claudio Solaro
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Moncrivello, Italy.
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12
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Hu W, Li P, Zeng N, Tan S. DIA-based technology explores hub pathways and biomarkers of neurological recovery in ischemic stroke after rehabilitation. Front Neurol 2023; 14:1079977. [PMID: 36959823 PMCID: PMC10027712 DOI: 10.3389/fneur.2023.1079977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/06/2023] [Indexed: 03/09/2023] Open
Abstract
Objective Ischemic stroke (IS) is a common disease that causes severe and long-term neurological disability in people worldwide. Although rehabilitation is indispensable to promote neurological recovery in ischemic stroke, it is limited to providing a timely and efficient reference for developing and adjusting treatment strategies because neurological assessment after stroke treatment is mostly performed using scales and imaging. Therefore, there is an urgent need to find biomarkers that can help us evaluate and optimize the treatment plan. Methods We used data-independent acquisition (DIA) technology to screen differentially expressed proteins (DEPs) before and after ischemic stroke rehabilitation treatment, and then performed Gene Ontology (GO) and pathway enrichment analysis of DEPs using bioinformatics tools such as KEGG pathway and Reactome. In addition, the protein-protein interaction (PPI) network and modularity analysis of DEPs were integrated to identify the hub proteins (genes) and hub signaling pathways for neurological recovery in ischemic stroke. PRM-targeted proteomics was also used to validate some of the screened proteins of interest. Results Analyzing the serum protein expression profiles before and after rehabilitation, we identified 22 DEPs that were upregulated and downregulated each. Through GO and pathway enrichment analysis and subsequent PPI network analysis constructed using STRING data and subsequent Cytoscape MCODE analysis, we identified that complement-related pathways, lipoprotein-related functions and effects, thrombosis and hemostasis, coronavirus disease (COVID-19), and inflammatory and immune pathways are the major pathways involved in the improvement of neurological function after stroke rehabilitation. Conclusion Complement-related pathways, lipoprotein-related functions and effects, thrombosis and hemostasis, coronavirus disease (COVID-19), and inflammation and immunity pathways are not only key pathways in the pathogenesis of ischemic stroke but also the main pathways of action of rehabilitation therapy. In addition, IGHA1, LRG1, IGHV3-64D, and CP are upregulated in patients with ischemic stroke and downregulated after rehabilitation, which may be used as biomarkers to monitor neurological impairment and recovery after stroke.
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Affiliation(s)
- Wei Hu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, China
| | - Ping Li
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, China
| | - Nianju Zeng
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, China
- *Correspondence: Nianju Zeng
| | - Sheng Tan
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Sheng Tan
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13
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Luo B, Luo Z, Zhang X, Xu M, Shi C. Status of cognitive frailty in elderly patients with chronic kidney disease and construction of a risk prediction model: a cross-sectional study. BMJ Open 2022; 12:e060633. [PMID: 36572488 PMCID: PMC9806025 DOI: 10.1136/bmjopen-2021-060633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 09/02/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the risk factors of cognitive frailty in elderly patients with chronic kidney disease (CKD), and to establish an artificial neural network (ANN) model. DESIGN A cross-sectional design. SETTING Two tertiary hospitals in southern China. PARTICIPANTS 425 elderly patients aged ≥60 years with CKD. METHODS Data were collected via questionnaire investigation, anthropometric measurements, laboratory tests and electronic medical records. The 425 samples were randomly divided into a training set, test set and validation set at a ratio of 5:3:2. Variables were screened by univariate and multivariate logistic regression analyses, then an ANN model was constructed. The accuracy, specificity, sensitivity, receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were used to evaluate the predictive power of the model. RESULTS Barthel Index (BI) score, albumin, education level, 15-item Geriatric Depression Scale score and Social Support Rating Scale score were the factors influencing the occurrence of cognitive frailty (p<0.05). Among them, BI score was the most important factor determining cognitive frailty, with an importance index of 0.30. The accuracy, specificity and sensitivity of the ANN model were 86.36%, 88.61% and 80.65%, respectively, and the AUC of the constructed ANN model was 0.913. CONCLUSION The ANN model constructed in this study has good predictive ability, and can provide a reference tool for clinical nursing staff in the early prediction of cognitive frailty in a high-risk population.
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Affiliation(s)
- Baolin Luo
- School of Nursing, Shantou University Medical College, Shantou, Guangdong, China
- Nursing Department, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Zebing Luo
- School of Nursing, Shantou University Medical College, Shantou, Guangdong, China
- Cancer Department, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaoyun Zhang
- School of Nursing, Shantou University Medical College, Shantou, Guangdong, China
- Nephrology Department, Shantou Central Hospital, Shantou, Guangdong, China
| | - Meiwan Xu
- Nephrology Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Chujun Shi
- School of Nursing, Shantou University Medical College, Shantou, Guangdong, China
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14
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Krupp S, Jennifer K, Balck F, Lammich J, Willkomm M. [One-Year Course of Geriatric Rehabilitation Candidates with and Without Outpatient Geriatric Rehabilitation Care (AGRV)]. DIE REHABILITATION 2022; 61:383-394. [PMID: 35292955 DOI: 10.1055/a-1725-6568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The multicentre, prospective, controlled cohort study examines whether geriatric patients with or without participation in outpatient geriatric rehabilitation (AGRV) in Schleswig-Holstein differ with regard to the characteristics of independence, mobility, pain intensity, quality of life, need for support, changing their place of residence or utilization of hospital treatment or other forms of non-pharmaceutical therapy in the course of one year. METHODS Between May 2013 and April 2016 patients for whom geriatricians had recommended AGRV at five locations were interviewed four times within a year by telephone. The data were analyzed regarding the development within the groups as well as under the aspect of the different types of medical care (AGRV performed/not performed). RESULTS At the beginning and in the second half of the study period, the two groups (122 persons without AGRV, 283 with at least 15 days of AGRV) did not differ significantly in any of the outcome parameters, and the null hypothesis (no difference between the groups in the Barthel Index after one year) was accepted. Patients with AGRV achieved faster progress in terms of their mobility and quality in life. CONCLUSION AGRV enables many rehabilitation patients to improve their mobility more quickly. If the speed of achieving the therapeutic goal is of minor importance, outpatient physiotherapy and ergotherapy is sufficient for many patients. The Barthel Index is of limited use for follow-up of AGRV candidates.
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Affiliation(s)
- Sonja Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck-Geriatriezentrum, Lübeck
| | - Kasper Jennifer
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck-Geriatriezentrum, Lübeck
| | - Friedrich Balck
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck-Geriatriezentrum, Lübeck.,Abteilung Psychosoziale Medizin und Entwicklungsneurowissenschaften, Med. Fakultät Carl Gustav Carus, Technische Universität Dresden
| | - Justus Lammich
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck-Geriatriezentrum, Lübeck
| | - Martin Willkomm
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck-Geriatriezentrum, Lübeck
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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:ijerph192113965. [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
- Correspondence: ; Tel.: +34-91-394-15-17
| | - 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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'Quality of life at 90 days after stroke and its correlation to activities of daily living': A prospective cohort study. J Stroke Cerebrovasc Dis 2022; 31:106806. [PMID: 36191565 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The main goal of stroke rehabilitation is to improve the health-related quality of life (HRQoL). In developed countries, several studies evaluating the HRQoL among stroke survivors have been conducted. In India, HRQoL related to stroke as an important health care issue has not received sufficient attention. The study was conducted to encourage the professionals to use stroke-specific HRQoL scales in clinical practice as one of the measures of stroke outcome. OBJECTIVES To study the correlation between activities of daily living (ADLs) and HRQoL at 90 days following an acute stroke. METHODS In this prospective study, functional independence of patients admitted with stroke were measured using Barthel Index (BI). At 90 days post-stroke patients were assessed using two questionnaires. RESULTS Significant improvement in BI total and domains scores at 90 days (p < .001) were seen. At follow-up, Stroke Specific Quality of Life Scale-12 (SS-QoL-12) score for 59 patients was 48 (high QoL). Individuals scored lowest for psychosocial subscale of HRQoL compared to physical subscale. All items and the total score of the BI showed a significant positive partial correlation (p< .001) with the HRQoL total score. The self-care domain of BI showed the highest correlation with QoL total score at 0.88. CONCLUSIONS Patient dependent in ADL constantly scored less in all QoL domains. The psychosocial QoL was found to be most affected even in the presence of complete functional independence paving way for further studies on factors that impact psychosocial QoL of stroke survivors.
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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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Ciro CA, James SA, McGuire H, Lepak V, Dresser S, Costner-Lark A, Robinson W, Fritz T. Natural, longitudinal recovery of adults with COVID-19 using standardized rehabilitation measures. Front Aging Neurosci 2022; 14:958744. [PMID: 36092810 PMCID: PMC9452908 DOI: 10.3389/fnagi.2022.958744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background While studies recommend rehabilitation following post-hospitalization recovery from COVID-19, few implement standardized tools to assess continued needs. The aim of this study was to identify post-hospitalization recommendations using an interdisciplinary needs assessment with standardized rehabilitation measures. A secondary aim was to use these tools to measure recovery over a 30-day period. Materials and methods Using a 30-day longitudinal design, we completed weekly rapid needs assessments in this convenience sample of 20 people diagnosed with COVID-19 discharged from the hospital to home. We computed summary statistics and used the Wilcoxon Signed Rank Test to assess change over the 4-week course of the study with alpha level = 0.05. Results Our sample (65% male, 47% over 50 years of age, 35% White, 37% with a confirmed diagnosis of diabetes, and 47% obese) included no patients who had required mechanical ventilation. Initial assessments demonstrated the majority of our participants were at an increased risk of falls, had disability in activities of daily living (ADL) and instrumental activities of daily living (IADL), mild cognitive impairment, and dyspnea. At the 30-day follow-up, most were independent in mobility and basic ADLs, with continued disability in IADLs and cognitive function. Discussion In this sample of patients who were not mechanically-ventilated, early and individualized rehabilitation was necessary. The results of this study suggest patients would benefit from a multi-disciplinary team needs assessment after medical stabilization to minimize fall risk and disability, and to prevent secondary complications resulting from post-hospital deconditioning due to COVID-19.
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Affiliation(s)
- Carrie A. Ciro
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Carrie A. Ciro,
| | - Shirley A. James
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Hillary McGuire
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Vince Lepak
- Department of Rehabilitation Sciences, The University of Oklahoma Health Sciences Center at the OU-Tulsa Schusterman Campus, Tulsa, OK, United States
| | - Susan Dresser
- College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Amy Costner-Lark
- College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Wanda Robinson
- College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Terrie Fritz
- Anne and Henry Zarrow School of Social Work, Dodge Family College of Arts and Sciences, The University of Oklahoma, Norman, OK, United States
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Li K, Zhang Q, Lu X, Yao S. Effects of Butylphthalide Sodium Chloride Injection Combined with Edaravone Dexborneol on Neurological Function and Serum Inflammatory Factor Levels in Sufferers Having Acute Ischemic Stroke. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1509407. [PMID: 35463675 PMCID: PMC9020939 DOI: 10.1155/2022/1509407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
For investigating an influence on butylphthalide sodium chloride injection combined with edaravone dexborneol on neurological function and serum inflammatory factor levels in sufferers having acute ischemic stroke, 120 sufferers having acute ischemic stroke from September 2020 to September 2021 are chosen for the study subjects. In line with the diverse therapies, they took part in a control group and the study group, with 60 examples in each group. The control group is treated with edaravone dexborneol, and the study group is treated with butylphthalide sodium chloride injection, based on the control group. The posttreatment curative efficacy on the two groups is recorded, and treatment of both the two groups is compared. Before and after neurological function indexes (NIHSS and mRS), inflammatory factor indexes (IL-6, CRP, and TNF-α), life quality index (Barthel index), hemorheological indexes (plasma-specific viscosity), and neurological levels of NSE are logged and contrasted between the two groups of adverse reactions during therapy. Postcure, the overall response rate and Barthel index of the study group obviously overtop those of the control group (p < 0.05). IL-6, CRP, TNF-α, NSE, plasma specific viscosity, and NIHSS and mRS scores obviously hypodown those of the control group (p < 0.05), and untoward effects on the two groups during curing are lower, and the discrepancy is not obvious(p > 0.05). Butylphthalide sodium chloride injection combined with edaravone dexborneol can enhance curative efficacy on sufferers having acute ischemic stroke, improve neurological function, blood rheology, and quality of life, and decrease the secretion of cytokine, having a better effect and high medication safety.
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Affiliation(s)
- Keliang Li
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Qiting Zhang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Xuesheng Lu
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Shengqi Yao
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
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Convergent and Discriminant Validity of the Barthel Index and the EQ-5D-3L When Used on Older People in a Rehabilitation Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910314. [PMID: 34639614 PMCID: PMC8508393 DOI: 10.3390/ijerph181910314] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/01/2021] [Accepted: 09/26/2021] [Indexed: 12/12/2022]
Abstract
This study compares the empirical performance of a commonly used functional-status measure, the Barthel Index (BI), to that of a widely used generic preference-based instrument, the EuroQoL-5-Dimensions 3 Level (EQ-5D-3L), in older people. Data from older people receiving rehabilitation services were used to test the validity of the BI and EQ-5D-3L. Convergent validity was investigated using Spearman’s correlation, exploratory factor analysis (EFA), scatter plots, Krippendorff’s alpha and modified Bland-Altman plots. Discriminant validity was examined using Kruskal Wallis tests, ceiling effects and EFA. A total of 1690 participants were included in the analysis. The BI total and EQ-5D-3L utility scores showed moderate correlation (r = 0.51; Krippendorff’s alpha = 0.52). Kendall’s Tau-B correlations between BI items and EQ-5D-3L dimensions measuring the same construct were weak to moderate (0.05 ≤ absolute r ≤ 0.54). In the EFA, some BI items cross-loaded onto the same factors as EQ-5D-3L dimensions, suggesting that the instruments were interrelated. The BI, however, focuses more on physical functioning, while the EQ-5D-3L measures broader wellbeing concepts. Both instruments showed good discriminant validity and would therefore be equally valuable for measuring subgroup differences. Researchers should consider using the BI in rehabilitation to capture more physical functioning-specific constructs not measured by the EQ-5D-3L.
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Hernández-Méndez B, Martín-Silva I, Tapias-Vilanova M, Moreno-Gallo Y, Sanjuan-Menendez E, Lorenzo-Tamayo E, Ramos-González M, Montufo-Rosal M, Zuriguel-Pérez E. Very early mobilization in the stroke unit: Functionality, quality of life and disability at 90 days and 1 year post-stroke. NeuroRehabilitation 2021; 49:403-414. [PMID: 34308915 DOI: 10.3233/nre-210118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The evidence of early mobilization after stroke is conflicting, and the recovery period is an important concern. OBJECTIVE To analyse the functionality, quality of life and disability at 90 days and 1 year post-stroke of patients who received a Very Early Mobilization Protocol (VEMP). METHODS Prospective cohort study in a tertiary stroke unit. Consecutive patients aged≥18 years and without prior significant disability, who presented motor deficit after acute stroke, were included. A symmetry test was performed to compare the changes in the main variables: Barthel Index (BI), Functional Ambulation Category (FAC), modified Rankin Scale (mRS) and EuroQol five-dimensions three-level (EQ-5D-3L) between 90 days and 1 year post-stroke. RESULTS A total of 123 patients were recruited. The BI reflected an improvement at 1 year in transfer to chair/bed in 25.8%(p < 0.01) of patients and in toilet use in 25.8%(p = 0.02). The FAC showed an improvement at 1 year in 44.4%(p < 0.01) of patients and the mRS in 19.1%(p = 0.01). The usual activities dimension of the EQ-5D-3L showed a clinically relevant improvement after 1 year in 15.9%(p = 0.23) of patients. CONCLUSIONS A significant percentage of patients show improvements in some functional areas and in disability between 90 days and 1 year post-stroke.
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Affiliation(s)
- Beatriz Hernández-Méndez
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Nursing Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Isabel Martín-Silva
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Martíi Tapias-Vilanova
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Yolanda Moreno-Gallo
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Estela Sanjuan-Menendez
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain.,Stroke Research, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Eva Lorenzo-Tamayo
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Montserrat Ramos-González
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Marina Montufo-Rosal
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
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Long-Term Patient-Centred Follow-up in a Prospective Cohort of Patients with COVID-19. Infect Dis Ther 2021; 10:1579-1590. [PMID: 34152573 PMCID: PMC8215633 DOI: 10.1007/s40121-021-00461-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction To better define COVID-19 long-term impact we prospectively analysed patient-centred outcomes, including general health and symptom duration. Methods Barthel index (BI), St. George’s Respiratory Questionnaire adapted to patients with COVID-19 (aSGRQ) and WHO Clinical Progression Scale (CPS) were measured at enrolment and at 6 weeks from the onset of symptoms. Persistence of most frequently reported symptoms was assessed at 6 weeks and, among symptomatic patients, at 12 weeks from the onset of symptoms. Predictors of impaired general health over time were identified using an ordinal multilevel multivariate model. Results A total of 448 patients (55% men, median age 56 years) were enrolled. WHO-CPS showed mild, moderate and severe disease in 48%, 42% and 10% of patients at admission and mild disease in all patients at follow-up, respectively. BI and aSGRQ were normal in 96% and 93% patients before COVID-19 but only in 47% and 16% at COVID-19 diagnosis and in 87% and 65% at 6-week follow-up. Male gender was identified by all three assessments as a predictor of impaired general health (BI, OR 2.14, p < 0.0001; aSGRQ, OR 0.53, p = 0.003; WHO-CPS, OR 1.56, p = 0.01). Other predictors included age, ICU admission and comorbidities (e.g. cardiovascular disease and cancer) for BI, hospital admission for aSGRQ, age and presence of comorbidities for WHO-CPS. At 6- and 12-week follow-up, 39% and 20% of patients, respectively, were still reporting symptoms. Fatigue and breathlessness were the most frequently reported symptoms. Conclusions Long-term follow-up facilitates the monitoring of health impairment and symptom persistence and can contribute to plan tailored interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00461-3.
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Chen L, Wang W, Zhang S, Liu H, Yuan X, Yang X, Gu P. Value of Barthel, PLAN and NIHSS scores for predicting the death of patients with acute ischemic stroke during their 5-year follow-up. J Clin Neurosci 2021; 90:94-98. [PMID: 34275588 DOI: 10.1016/j.jocn.2021.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to investigate the value of Barthel, PLAN, and NIHSS scores for predicting death in the 5-year follow-up after patients with AIS are discharged and find a simple and convenient predictive scale. METHODS Data were prospectively collected from 678 patients with AIS. Patients' death after 5 years of follow-up was considered the final event. The predictors of death were examined through single-factor and multivariate analysis. The receiver operating characteristic curve (ROC) of the patients' Barthel, PLAN, and NIHSS scores was drawn, and the area under the curve (AUC) was calculated. Differences in the predictive power of the three scales were compared using MedCalc. The goodness of fit between predictive and actual models was evaluated with the Hosmer-Lemeshow method. RESULTS Multivariate analysis suggested that the BI score was an independent predictor of death from AIS in the 5-year follow-up. The Barthel, PLAN, and NIHSS scale scores predicted the 5-year mortality AUC values of AIS were 0.687 [95% CI, (0.649-0.722)], 0.621 [95% CI, (0.583-0.659)], 0.637 [95% CI, (0.599-0.674)], the Hosmer-Lemeshow test revealed P > 0.05, indicating that the three models had a good fit. In pairwise comparison, the AUC value of the BI score was significantly greater than that of the NIHSS scores (Pc = 0.0189). BI and PLAN scores were very close to statistical significance (Pc = 0.0513). However, PLAN and NIHSS scores had no significant differences (Pc = 1.7493). CONCLUSION Simple BI scores had a high predictive value for the death of Chinese patients with AIS within 5 years.
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Affiliation(s)
- Lili Chen
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Wenting Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Sai Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Huimiao Liu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Xiaoyang Yuan
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, China
| | - Ping Gu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China.
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Ning H, Zhao Y, Liao L, Chen H, Tao Z, Chen X, Feng H. Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study. Pain Manag Nurs 2021; 23:338-344. [PMID: 33994304 DOI: 10.1016/j.pmn.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS The objective of this study was to determine the prevalence of frailty and pain among older adults with physical functional limitations in China. We also assessed the impact of pain and psychosocial determinants on frailty among this vulnerable population. DESIGN This study was a cross-sectional study. SETTING AND PARTICIPANTS Totally, 2,323 Chinese elders with physical functional limitation were enrolled. METHODS Physical functioning was assessed by the Barthel Index, participants who reported "often troubled with pain" were further asked about the intensity of their pain using a 1-10 numeric rating scale, and frailty was assessed by the Assessment of frailty FRAIL scale. The impact of pain and psychosocial factors on frailty was assessed by multivariable binary logistic regression. RESULTS The prevalence of frailty and pain were 30.9% and 46.1%, respectively. Compared with subjects who reported no pain, those who reported mild (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.31), moderate (OR = 2.10, 95% CI = 1.53-2.82), or severe pain (OR = 2.31, 95% CI = 1.56-3.40) tended to be more vulnerable to frailty. Furthermore, compared with participants with positive psychosocial determinants, those with negative psychosocial determinants seemed more likely to be frail. CONCLUSIONS These findings suggest that the incidence of pain, negative psychosocial status, and frailty were prevalent, and the presence of pain and negative psychosocial factors increased the risk of frailty among older adults with physical functional limitation.
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Affiliation(s)
- Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lulu Liao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Huijing Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zirong Tao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University.
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang Hospital, Hongzhou, Zhejiang, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China; Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, Hunan, China.
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Ning H, Du Y, Ellis D, Deng HW, Hu H, Zhao Y, Chen H, Liao L, Li M, Peng L, Feng H. Malnutrition and its associated factors among elderly Chinese with physical functional dependency. Public Health Nutr 2021; 24:1404-1414. [PMID: 32389160 PMCID: PMC7864553 DOI: 10.1017/s1368980019005299] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the prevalence and to identify the associated factors of malnutrition among elderly Chinese with physical functional dependency. DESIGN Face-to-face interviews using standardised questionnaires were conducted to collect demographic information, health-related issues and psychosocial status. Physical function was measured by the Barthel Index (BI), and nutrition status was assessed by the Mini Nutritional Assessment-Short Form. Multivariate binary logistic regression was used to assess associated factors of malnutrition. SETTING China. PARTICIPANTS A total of 2323 participants (aged ≥ 60 years) with physical functional dependency in five provinces in China were enrolled using a multistage cluster sampling scheme. RESULTS The prevalence of malnutrition was 17·9 % (95 % CI 16·3, 19·4). Multivariable binary logistic regression revealed the independent risk factors of poor nutrition status were being female, older age, lower educational status, poor hearing, poor physical functional status, lack of hobbies, low religious participation, poor social support, lack of social participation and changes in social participation. The study found that the most significant independent risk factor for malnutrition was complete physical functional dependence (OR 4·46, 95 % CI 2·92, 6·82). CONCLUSIONS The findings of the study confirm that malnutrition and the risk of malnutrition are prevalent in Chinese older adults with physical functional dependency. In addition to demographic and physical health-related factors, psychosocial factors, which are often overlooked, are independently associated with nutrition status in Chinese older adults with physical functional dependency. A holistic approach should be adopted to screen for malnutrition and develop health promotion interventions in this vulnerable population.
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Affiliation(s)
- Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan410013, China
| | - Yan Du
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA70112, USA
| | - Donna Ellis
- RN School of Nursing, Loyola University New Orleans, New Orleans, LA70118, USA
| | - Hong-Wen Deng
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA70112, USA
- School of Basic Medical Sciences, Central South University, Changsha, Hunan410013, China
| | - Hengyu Hu
- Xiangya School of Nursing, Central South University, Changsha, Hunan410013, China
| | - Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, Hunan410013, China
| | - Huijing Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan410013, China
| | - Lulu Liao
- Xiangya School of Nursing, Central South University, Changsha, Hunan410013, China
| | - Mengqi Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan410013, China
| | - Linlin Peng
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan410013, China
- Xiangya School of Nursing, Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, Hunan410013, China
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Umehara T, Tanaka R, Nagao S, Tomiyama D, Kawabata Y, Nagano Y, Takeuchi Y, Kakehashi M. Efficient predictors for the decline of activities of daily living in patients with hip fracture one year after surgery: A multicenter prospective cohort study. J Back Musculoskelet Rehabil 2020; 33:553-560. [PMID: 32444533 DOI: 10.3233/bmr-181126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have examined when activities of daily living (ADL) recovery more than six months after surgery can be predicted, and how much accuracy the predictors have. OBJECTIVE The purpose of this study was to determine the predictors of ADL decline and evaluate their accuracies one year post-operation for hip-fracture patients. METHODS We studied patients who underwent hip fracture surgery and were able to walk independently pre-operatively. The predictors of ADL declined one year post-operation, as analyzed using data of the basic medical attributes of the patients, including pain, 30-s chair-stand test, dementia [using the Revised Hasegawa Dementia Scale (HDS-R)], and walking/mobility style [using Barthel Index (BI)]. Using a receiver operating curve (ROC) curve, the cut-off value for each significant predictor was determined in the logistic regression analysis. To calculate the cut-off values and diagnostic performances of each of the extraction factors. RESULTS The data of 36 patients were collected over a period of one year. The prior probability of ADL decline at one year post-operation was 44.4%. The results of logistic regression analyses showed that the score of HDS-R at admission and the walking/mobility BI score at three weeks post-operation were significant predictors of the one year post-operative decline in ADL. The results of the ROC analyses showed that the cut-off value of the HDS-R score at admission was < 23 points. The posterior probability increased to 62.0%. In contrast, the cut-off value of the walking/mobility BI score was 0 points. The posterior probability increased to 91.0%. CONCLUSION The ADL decline of the patients who underwent hip fracture surgery at one year after surgery can be predicted at three weeks post-operation.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
| | - Susumu Nagao
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Daisuke Tomiyama
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Yuki Kawabata
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Yoshihiro Nagano
- Department of Rehabilitation, Saiseikai Hiroshima Hospital, Hiroshima, Japan
| | - Yumi Takeuchi
- Department of Rehabilitation, Saiseikai Hiroshima Hospital, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Romano A, Caprì T, Semino M, Bizzego I, Di Rosa G, Fabio RA. Gross Motor, Physical Activity and Musculoskeletal Disorder Evaluation Tools for Rett Syndrome: A Systematic Review. Dev Neurorehabil 2020; 23:485-501. [PMID: 31668104 DOI: 10.1080/17518423.2019.1680761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In recent years, much attention has been paid to motor impairment of persons with Rett Syndrome (RTT), with increasing literature aimed to describe gross motor functioning and musculoskeletal disorders of the RTT population. The aim of this systematic review is to describe clinical evaluation tools used in the last decade to assess motor functioning and musculoskeletal abnormalities of patients with RTT. Thirty-four studies were reviewed and 20 tools were presented. Results showed that only two tools were used to measure functional change after rehabilitative or therapeutic interventions. This review underlies the lack of adequate evaluation tools to assess musculoskeletal abnormalities and deformities in RTT population. The absence of these assessments could be due to a statistical difficulty as it is challenging to build an evaluation tool that can score the entities of the abnormalities related to the amount of disability they cause.
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Affiliation(s)
- Alberto Romano
- Movement Analysis and Robotics Laboratory (MARLab) , Rome, Italy
| | - Tindara Caprì
- Department of Clinical and Experimental Medicine, University of Messina , Via Bivona, Messina, Italy
| | - Martina Semino
- Centro AIRETT Ricerca e Innovazione (CARI), Research and Innovation Airett Center , Verona, Italy
| | - Ilaria Bizzego
- Centro AIRETT Ricerca e Innovazione (CARI), Research and Innovation Airett Center , Verona, Italy
| | - Gabriella Di Rosa
- Division of Child Neurology and Psychiatry, G. Martino Hospital, University of Messina , Messina, Italy
| | - Rosa Angela Fabio
- Department of Clinical and Experimental Medicine, University of Messina , Via Bivona, Messina, Italy
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28
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Li L, Huang J, Wu J, Jiang C, Chen S, Xie G, Ren J, Tao J, Chan CCH, Chen L, Wong AWK. A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17219. [PMID: 32401221 PMCID: PMC7254286 DOI: 10.2196/17219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/08/2020] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. OBJECTIVE This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone-based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. METHODS A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. RESULTS Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95% and 82% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95% and 80% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (X21=1.6, P=.21 for 2-week follow-up; X21=1.9, P=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (X23=6.7, P=.04 for 2-week follow-up; X23=8.0, P=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (X23=13.9; P=.03). CONCLUSIONS The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. TRIAL REGISTRATION chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831&htm=4.
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Affiliation(s)
- Li Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou, China
| | - Jingsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Cai Jiang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shanjia Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Guanli Xie
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jinxin Ren
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, HongKong, Hong Kong
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, China
| | - Alex W K Wong
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States.,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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29
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Ma C, Zhou W. Predictors of rehospitalization for community-dwelling older adults with chronic heart failure: A structural equation model. J Adv Nurs 2020; 76:1334-1344. [PMID: 32056280 DOI: 10.1111/jan.14327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
AIMS To examine the effects of health literacy, activities of daily living, frailty and self-care on rehospitalization for older adults with chronic heart failure using a structural equation model. DESIGN This was a cross-sectional study. METHODS Two hundred and seventy-one older patients with chronic heart failure were recruited using a convenience sampling method from three community healthcare centres in Guangzhou, Southern China. The data were collected using a questionnaire survey between April 2018 and October 2018 by three research assistants. FINDINGS The proposed model revealed a good fit to the data (χ2 /d.f. = 2.39, root mean square error of approximation = 0.06, goodness of fit index = 0.93, comparative fit index = 0.91, normed fit index = 0.91). Health literacy (β = 0.21), activities of daily living (β = 0.43), frailty (β = 0.29) and self-care (β = 0.40) directly affected the rehospitalization of older patients with chronic heart failure. Health literacy (β = 0.19), activities of daily living (β = 0.36) and frailty (β = 0.33) indirectly affected rehospitalization through self-care. Frailty (β = 0.16) indirectly affected rehospitalization by activities of daily living. Activities of daily living had the highest direct and total effects on rehospitalization; the effect values were 0.43 and 0.57, respectively. CONCLUSION Community-dwelling older adults with chronic heart failure who had limited health literacy, frailty, declined activities of daily living and lower self-care were eligible for rehospitalization. Self-care and activities of daily living were considered mediators between rehospitalization and its predictors. A future longitudinal study is required to validate the results. IMPACT Tailored and targeted measures aiming to enhance self-care and activities of daily living have been developed for older patients with chronic heart failure because they are not only predictors but also mediators. Assessment of health literacy level of this population is the first step before developing health education. Frailty of patients with chronic heart failure should be reduced to a minimum level.
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Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Wei Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China
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Value of the Barthel scale in prognostic prediction for patients with cerebral infarction. BMC Cardiovasc Disord 2020; 20:14. [PMID: 31931720 PMCID: PMC6956477 DOI: 10.1186/s12872-019-01306-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to evaluate the ADL(activity of daily living) of patients with acute cerebral infarction through BI scoring, in order to observe its predictive value in the prognosis of these patients. Methods According to the inclusion and exclusion criteria, patients with acute anterior circulation cerebral infarction were included in the present study. Then, the BI scoring was analyzed through five grades, in order to further investigate the dose-response relationship between BI scoring and mortality risk in patients with cerebral infarction. The receiver operating characteristic (ROC) curves for BI-scored patients were drawn, and the predictive authenticity of the Barthel scale in prognostic prediction for patients with cerebral infarction was estimated. Results The difference in BI scores between the survival group and death group were statistically significant (t = 10.029, P < 0.05), in which the score was lower in the death group than in the survival group. According to the linear trend ×2-test, the decrease in BI score indicates an increase in mortality risk in patients with cerebral infarction. The area under the curve (AUC) of the ROC curve was 0.794 with a P–value of < 0.05. Conclusion BI scoring is a highly valuable scoring system for the prognostic prediction of patients with acute cerebral infarction.
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Oliveira VPD, Mello RGBD, Costa AF, Corte RRD, Flores FDR, Xavier NB, Nunes NM, Moriguchi EH. Prevalence of atrial fibrillation, oral anticoagulation prescription and associated factors in Brazilian older adults. GERIATRICS, GERONTOLOGY AND AGING 2020. [DOI: 10.5327/z2447-212320202000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Atrial fibrillation increases five times the risk of stroke. Anticoagulation reduces the incidence of cerebrovascular events. However, many patients do not receive thromboprophylaxis. OBJECTIVES: To estimate the prevalence of atrial fibrillation in the elderly at a Brazilian university hospital and the proportion of anticoagulation prescription. Secondary objectives were to identify the therapeutic options, the main reasons for non-prescription and the factors associated with ineffectiveness or lack of treatment. METHOD: cross-sectional study with a consecutive sample of 1,630 outpatients selected at Hospital de Clínicas de Porto Alegre between April and June of 2017. Atrial fibrillation was identified in 220 (13.50%) individuals. Medical records from 145 patients were accessed, followed by a telephone interview. The association between variables and outcomes was checked using the Mann-Whitney’s U Test and the binary logistic regression. RESULTS: The prevalence of atrial fibrillation was 13.50%. Anticoagulation therapy was prescribed in 77.93% of cases. In 76.11% of patients, warfarin was the chosen drug. There was a tendency towards no prescription in patients with previous bleeding (RR = 2.32; 95%CI 0.95 – 5.64; p = 0.06) and falls (RR = 2.02; 95%CI 0.82 – 5.03; p = 0.08). We found an association between reduced functional capacity (Barthel’s Activities of Daily Living Score < 80) and higher rate of anticoagulation in therapeutic aim (RR = 0.22; 95%CI 0.06 – 0.87; p = 0.04). CONCLUSION: The prevalence of atrial fibrillation in this population was 13.50% and in 77.93% of cases anticoagulant were prescribed. Functional impairment was associated with a higher rate of anticoagulation in therapeutic aim.
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Lorenzano S, Vestri A, Lancia U, Bovi P, Cappellari M, Stanzione P, Samà D, Bruscoli M, Cavazzuti M, Zini A, Rasura M, Beccia M, Comi G, Sessa M, Gandolfo C, Balestrino M, Agnelli G, Caso V, Gerbino Promis P, Pozzessere C, Anticoli S, Perini F, Marcon M, Vinattieri A, Caruso A, Magoni M, Furlan M, Orlandi G, Di Lazzaro V, Valente M, Nencini P, Cordisco M, Verna R, Toni D. Thrombolysis in elderly stroke patients in Italy (TESPI) trial and updated meta-analysis of randomized controlled trials. Int J Stroke 2019; 16:43-54. [PMID: 31657284 DOI: 10.1177/1747493019884525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since its approval, the use of alteplase had been limited to patients aged ≤80 years. AIMS TESPI trial had been designed to evaluate whether alteplase treatment within 3 h in patients with acute ischemic stroke aged >80 years resulted in favorable benefit/risk ratio compared with standard care. The meta-analysis of randomized controlled trials was updated to put findings in the context of all available evidence. METHODS TESPI was a multicenter, open-label with blinded outcome evaluation, randomized, controlled trial. Main clinical endpoints were 90-day favorable functional outcome (mRS score 0-2) and mortality and symptomatic intracerebral hemorrhage. The trial was prematurely terminated for ethical reasons after publication of IST-3 trial which provided evidence of treatment benefit in elderly. RESULTS Of the planned 600 patients, 191 (88 assigned to alteplase) were enrolled. Overall, 24/83 (28.9%) alteplase patients had a favorable outcome compared to 22/95 (23.2%) controls (non-significant absolute difference of 5.7% for alteplase; OR 1.35, 95% CI 0.69-2.64, P = 0.381). Rates of death were non-significantly lower in the alteplase patients (18.1% vs. 26.5%); rates of symptomatic intracerebral hemorrhage were similar between the two groups (5.9% vs. 5.1%). The updated meta-analysis showed consistent results with prior estimates and add weights. CONCLUSIONS The effects of alteplase observed in this interrupted trial did not reach statistical significance, probably for the small numbers, but are consistent with and add weight to the sum total of the randomized evidence demonstrating that alteplase is beneficial in patients with acute ischemic stroke aged over 80 years, particularly if given within 3 h.
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Affiliation(s)
- Svetlana Lorenzano
- Emergency Department Stroke Unit, Department of Human Neurosciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Ugo Lancia
- Department of Biology, University of Rome, Tor Vergata, Rome, Italy
| | | | | | - Paolo Stanzione
- Policlinico Tor Vergata Hospital, University of Tor Vergata, Rome, Italy
| | - Domenico Samà
- Policlinico Tor Vergata Hospital, University of Tor Vergata, Rome, Italy
| | - Maddalena Bruscoli
- Department of Emergency Medicine, S. Maria Annunziata Hospital, Florence, Italy
| | - Milena Cavazzuti
- Stroke Unit, Ospedale Civile S.Agostino-Estense, University Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Zini
- Stroke Unit, Ospedale Civile S.Agostino-Estense, University Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizia Rasura
- S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mario Beccia
- S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Maria Sessa
- Scientific Institute S. Raffaele, Milan, Italy
| | | | | | | | - Valeria Caso
- S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | | | | | | | | | | | | | | | - Giovanni Orlandi
- Azienda Ospedaliera Universitaria Policlinico S. Chiara, Pisa, Italy
| | | | - Mariarosaria Valente
- Neurology Unit, Department of Medicine, University of Udine Medical School, Udine
| | | | - Moira Cordisco
- Center for Clinical Research, Sapienza University, Rome, Italy
| | - Roberto Verna
- Research Center for Sport Medicine and Management, Sapienza University, Rome, Italy; CRISC - Center for Clinical Research, Sapienza University, Rome, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
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Giannotti C, Sambuceti S, Signori A, Ballestrero A, Murialdo R, Romairone E, Scabini S, Caffa I, Odetti P, Nencioni A, Monacelli F. Frailty assessment in elective gastrointestinal oncogeriatric surgery: Predictors of one-year mortality and functional status. J Geriatr Oncol 2019; 10:716-723. [DOI: 10.1016/j.jgo.2019.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 12/11/2022]
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Acute Phase Predictors of 6-Month Functional Outcome in Italian Stroke Patients Eligible for In-Hospital Rehabilitation. Am J Phys Med Rehabil 2019; 97:467-475. [PMID: 29369053 PMCID: PMC6282660 DOI: 10.1097/phm.0000000000000897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose The aim of the study was to assess early poststroke prognostic factors in patients admitted for postacute phase rehabilitation. Methods A 1-yr multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for postacute rehabilitation. Clinical data were collected in the stroke or acute care units (acute phase), then in rehabilitation units (postacute phase), and, subsequently, after a 6-mo poststroke period (follow-up). Clinical outcome measures were represented using the Barthel Index and the modified Rankin Scale. Univariate and multivariate analyses were performed to identify the most important prognostic index. Results Modified Rankin Scale score, minor neurologic impairment, and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to Barthel Index (power of prediction = 37%). Similarly, age, premorbid modified Rankin Scale score, and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the modified Rankin Scale (power of prediction = 48%). Barthel Index at admission and certain co-morbidities were also significant prognostic factors correlated with a better outcome. Conclusions According to the Barthel Index and modified Rankin Scale, early mobilization is an early predictor of favorable outcome. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Incorporate prognostic factors of good clinical outcomes after stroke in developing treatment plans for patients admitted to rehabilitation; (2) Identify acute phase indicators associated with favorable 6-mo outcome after stroke; and (3) Recognize the cut-off for early mobilization linked to better outcome in stroke survivors admitted to rehabilitation. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Gherardini S, Biricolti C, Benvenuti E, Almaviva MG, Lombardi M, Pezzano P, Bertini C, Baccini M, Di Bari M. Prognostic Implications of Predischarge Assessment of Gait Speed After Hip Fracture Surgery. J Geriatr Phys Ther 2019; 42:148-152. [DOI: 10.1519/jpt.0000000000000144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Ning H, Harrison TC, Zhao Y, Hu H, Chen H, Liao L, Yu R, Wu S, Feng H. Correlates of Depressive Symptoms Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study in China. Res Gerontol Nurs 2019; 12:133-146. [DOI: 10.3928/19404921-20190306-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
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Pucciarelli G, Ausili D, Rebora P, Arisido MW, Simeone S, Alvaro R, Vellone E. Formal and informal care after stroke: A longitudinal analysis of survivors’ post rehabilitation hospital discharge. J Adv Nurs 2019; 75:2495-2505. [DOI: 10.1111/jan.13998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/03/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
| | - Davide Ausili
- Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Paola Rebora
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Maeregu W. Arisido
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Silvio Simeone
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
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Ehler J, Petzold A, Wittstock M, Kolbaske S, Gloger M, Henschel J, Heslegrave A, Zetterberg H, Lunn MP, Rommer PS, Grossmann A, Sharshar T, Richter G, Nöldge-Schomburg G, Sauer M. The prognostic value of neurofilament levels in patients with sepsis-associated encephalopathy - A prospective, pilot observational study. PLoS One 2019; 14:e0211184. [PMID: 30677080 PMCID: PMC6345472 DOI: 10.1371/journal.pone.0211184] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/08/2019] [Indexed: 12/20/2022] Open
Abstract
Sepsis-associated encephalopathy (SAE) contributes to mortality and neurocognitive impairment of sepsis patients. Neurofilament (Nf) light (NfL) and heavy (NfH) chain levels as biomarkers for neuroaxonal injury were not evaluated in cerebrospinal fluid (CSF) and plasma of patients with sepsis-associated encephalopathy (SAE) before. We conducted a prospective, pilot observational study including 20 patients with septic shock and five patients without sepsis serving as controls. The assessment of SAE comprised a neuropsychiatric examination, electroencephalography (EEG), magnetic resonance imaging (MRI) and delirium screening methods including the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). CSF Nf measurements in sepsis patients and longitudinal plasma Nf measurements in all participants were performed on days 1, 3 and 7 after study inclusion. Plasma NfL levels increased in sepsis patients over time (p = 0.0063) and remained stable in patients without sepsis. Plasma NfL values were significantly higher in patients with SAE (p = 0.011), significantly correlated with the severity of SAE represented by ICDSC values (R = 0.534, p = 0.022) and correlated with a poorer functional outcome after 100 days (R = -0.535, p = 0.0003). High levels of CSF Nf were measured in SAE patients. CSF NfL levels were higher in non-survivors (p = 0.012) compared with survivors and correlated with days until death (R = -0.932, p<0.0001) and functional outcome after 100 days (R = -0.749, p<0.0001). The present study showed for the first time that Nf levels provide complementary prognostic information in SAE patients indicating a higher chance of death and poorer functional/cognitive outcome in survivors.
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Affiliation(s)
- Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
- Department of Neuroimmunology, Institute of Neurology, University College London, London, United Kingdom
- * E-mail:
| | - Axel Petzold
- Department of Neuroimmunology, Institute of Neurology, University College London, London, United Kingdom
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Matthias Wittstock
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Stephan Kolbaske
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Martin Gloger
- Department of Internal Medicine, Intensive Care Unit, University Medical Center Rostock, Rostock, Germany
| | - Jörg Henschel
- Department of Internal Medicine, Intensive Care Unit, University Medical Center Rostock, Rostock, Germany
| | - Amanda Heslegrave
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
| | - Henrik Zetterberg
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Michael P. Lunn
- Department of Neuroimmunology, Institute of Neurology, University College London, London, United Kingdom
| | - Paulus S. Rommer
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Annette Grossmann
- Institute for Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Tarek Sharshar
- Department of Neuro-anesthesiology and Intensive Care Medicine, Saint-Anne Teaching Hospital, Paris-Decartes University, Paris, France
- Laboratory of Human Histopathology and Animal Models, Institut Pasteur, Paris, France
| | - Georg Richter
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Gabriele Nöldge-Schomburg
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Martin Sauer
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
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Musa KI, Keegan TJ. The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PLoS One 2018; 13:e0208594. [PMID: 30571691 PMCID: PMC6301695 DOI: 10.1371/journal.pone.0208594] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 11/20/2018] [Indexed: 02/05/2023] Open
Abstract
Background Acute stroke results in functional disability measurable using the well-known Barthel Index. The objectives of the study are to describe the change in the Barthel Index score and to model the prognostic factors for Barthel Index change from discharge up to 3 months post-discharge using the random intercept model among patients with acute first ever stroke in Kelantan, Malaysia. Methods A total 98 in-hospital first ever acute stroke patients were recruited, and their Barthel Index scores were measured at the time of discharge, at 1 month and 3 months post-discharge. The Barthel Index was scored through telephone interviews. We employed the random intercept model from linear mixed effect regression to model the change of Barthel Index scores during the three months intervals. The prognostic factors included in the model were acute stroke subtypes, age, sex and time of measurement (at discharge, at 1 month and at 3 month post-discharge). Results The crude mean Barthel Index scores showed an increased trend. The crude mean Barthel Index at the time of discharge, at 1-month post-discharge and 3 months post-discharge were 35.1 (SD = 39.4), 64.4 (SD = 39.5) and 68.8 (SD = 38.9) respectively. Over the same period, the adjusted mean Barthel Index scores estimated from the linear mixed effect model increased from 39.6 to 66.9 to 73.2. The adjusted mean Barthel Index scores decreased as the age increased, and haemorrhagic stroke patients had lower adjusted mean Barthel Index scores compared to the ischaemic stroke patients. Conclusion Overall, the crude and adjusted mean Barthel Index scores increase from the time of discharge up to 3-month post-discharge among acute stroke patients. Time after discharge, age and stroke subtypes are the significant prognostic factors for Barthel Index score changes over the period of 3 months.
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Affiliation(s)
- Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kbg Kerian, Kelantan, Malaysia
- * E-mail:
| | - Thomas J. Keegan
- The Centre for Health Informatics, Computing, and Statistics (CHICAS), Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture. Arch Orthop Trauma Surg 2018; 138:1671-1677. [PMID: 30094561 DOI: 10.1007/s00402-018-3020-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION To investigate the validity of Barthel Index (BI) compared with de Morton Mobility Index (DEMMI), EuroQol-visual analog scale (EQ-VAS), 2-min walk test (2MWT), and timed get-up-and-go test (TUG), and to evaluate the responsiveness of all outcome measures for assessing functional recovery in older patients who underwent hemiarthroplasty after femoral neck fracture. MATERIAL AND METHOD Eighty-one femoral neck fracture patients who were enrolled in a study evaluating functional recovery after bisphosphonate therapy during 2013 to 2015, and who had data available at both baseline and 12 months after surgery were included in this study. RESULTS All scores improved significantly from baseline to the 1-year follow-up. BI had moderate to strong correlation with DEMMI, 2MWT, and TUG (r-value: 0.490-0.843), and mild to moderate correlation with EQ-VAS (r-value: 0.278-0.323). All outcome measurements had high effect estimates. The minimal clinically important difference (MCID) of BI at 12 months was 9.8 points. CONCLUSION Since BI was shown to have good validity (moderate to strong correlation with DEMMI and performance-based tests, and mild to moderate correlation with EQ-VAS), BI can be used to accurately assess functional recovery in patients who undergo hemiarthroplasty after femoral neck fracture.
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dos Santos MA, da Conceição AP, Ferretti-Rebustini REDL, Ciol MA, Heithkemper MM, da Cruz DDALM. Non-pharmacological interventions for sleep and quality of life: a randomized pilot study. Rev Lat Am Enfermagem 2018; 26:e3079. [PMID: 30462790 PMCID: PMC6248705 DOI: 10.1590/1518-8345.2598.3079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/01/2018] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure. METHOD pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group. RESULTS all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week. CONCLUSION the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm.
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Affiliation(s)
| | | | | | - Marcia Aparecida Ciol
- University of Washington, Department of Rehabilitation Medicine,
Seattle, WA, United States of America
| | - Margareth McLean Heithkemper
- University of Washington, Department of Behavioral Nursing and
Health Informatics, Seattle, WA, United States of America
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Diagnostic value of NT-proCNP compared to NSE and S100B in cerebrospinal fluid and plasma of patients with sepsis-associated encephalopathy. Neurosci Lett 2018; 692:167-173. [PMID: 30423400 DOI: 10.1016/j.neulet.2018.11.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 01/22/2023]
Abstract
Sepsis-associated encephalopathy (SAE) has significant impact on the neurocognitive outcome of sepsis survivors. This study was conducted to analyze the amino-terminal propeptide of the C-type natriuretic peptide (NT-proCNP) as a biomarker for SAE in comparison to neuron-specific enolase (NSE) and S100B protein. Cerebrospinal fluid (CSF) and plasma samples from twelve septic patients with SAE and nine non-septic controls without encephalopathy were analyzed. The assessment of SAE comprised a neuropsychiatric examination, delirium screening using the confusion assessment method in the ICU (CAM-ICU) and magnetic resonance imaging (MRI) in all participants. NSE, S100B and NT-proCNP were measured in plasma at study days 1, 3 and 7 in sepsis patients, once in controls and once in the CSF of both groups. The long-term outcome was assessed using the validated Barthel index (BI). Plasma NT-proCNP levels were significantly higher in the sepsis cohort compared to controls with peak concentrations at study day 1 (10.1 ± 6.6 pmol/l vs. 3.3 ± 0.9 pmol/l; p < 0.01) and a decrease over time. Plasma NT-proCNP levels at day 7 correlated with NT-proCNP in CSF (r = 0.700, p < 0.05). A comparable decrease of significantly higher plasma S100B values in sepsis patients compared to controls was observed. Plasma NSE levels were not significantly different between both groups. CSF NT-proCNP levels just tended to be higher in sepsis patients compared to controls and tended to be higher in patients with septic brain lesions seen on MRI. In the sepsis cohort CSF NT-proCNP levels correlated with CSF Interleukin-6 (IL-6) levels (r = 0.616, p < 0.05) and systemic inflammation represented by high plasma procalcitonin (PCT) levels at day 3 (r = 0.727, p < 0.05). The high peak concentration of plasma NT-proCNP in the early phase of sepsis might help to predict the emergence of SAE during the further course of disease. NT-proCNP in plasma might, in contrast to CSF, indicate neurological impairment in patients with SAE.
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Uemura Y, Shibata R, Takemoto K, Koyasu M, Ishikawa S, Murohara T, Watarai M. Prognostic Impact of the Preservation of Activities of Daily Living on Post-Discharge Outcomes in Patients With Acute Heart Failure. Circ J 2018; 82:2793-2799. [DOI: 10.1253/circj.cj-18-0279] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yusuke Uemura
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine
| | - Kenji Takemoto
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
| | - Masayoshi Koyasu
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
| | - Shinji Ishikawa
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Masato Watarai
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
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Castiglia SF, Galeoto G, Lauta A, Palumbo A, Tirinelli F, Viselli F, Santilli V, Sacchetti ML. The culturally adapted Italian version of the Barthel Index (IcaBI): assessment of structural validity, inter-rater reliability and responsiveness to clinically relevant improvements in patients admitted to inpatient rehabilitation centers. FUNCTIONAL NEUROLOGY 2018; 22:221-228. [PMID: 29306359 PMCID: PMC5762108 DOI: 10.11138/fneur/2017.32.4.221] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Barthel Index (BI) is widely used to determine eligibility criteria for inpatient rehabilitation and to monitor patients' recovery, irrespective of the illnesses that affect them. The culturally adapted Italian version of the Barthel Index (IcaBI) was recently validated. This paper reports the structural validity and inter-rater reliability of the IcaBI and its responsiveness to the results of inpatient rehabilitation. The IcaBI was administered to a cohort of 264 patients hospitalized in two rehabilitation centers in Rome, Italy. Factor analysis using principal component analysis revealed a monofactorial structure for neurological patients and, after removal of item 1 "feeding", also for orthopedic patients. Substantial to optimal inter-rater reliability was found (0.74 > intraclass correlation coefficient < 0.96). The IcaBI was found to be accurate (area under the curve= 0.72) with a minimal clinically important change score of 35 points. This work confirms that IcaBI is a useful tool for measuring disability in health and social care settings along the continuum of care. Further studies are needed to assess its criterion validity, interpretability and responsiveness in other specific disease conditions.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy
- Department of Neuromotor and Orthopedic Rehabilitation, Institute of Neurosciences, Neurological Centre of Latium (NCL), Rome, Italy
| | - Giovanni Galeoto
- Department of Anatomical, Histological, Forensic Medicine and Musculoskeletal System Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Antonella Lauta
- Department of Neuromotor and Orthopedic Rehabilitation, Institute of Neurosciences, Neurological Centre of Latium (NCL), Rome, Italy
| | - Andrea Palumbo
- Department of Anatomical, Histological, Forensic Medicine and Musculoskeletal System Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Franca Tirinelli
- UO Lepanto, San Giovanni Battista Hospital ACI SMOM, Rome, Italy
| | - Fabio Viselli
- UO Lepanto, San Giovanni Battista Hospital ACI SMOM, Rome, Italy
| | - Valter Santilli
- Department of Anatomical, Histological, Forensic Medicine and Musculoskeletal System Sciences, “Sapienza” University of Rome, Rome, Italy
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Ma C. The prevalence of depressive symptoms and associated factors in countryside-dwelling older Chinese patients with hypertension. J Clin Nurs 2018. [DOI: 10.1111/jocn.14349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chunhua Ma
- School of Nursing; Guangzhou Medical University; Guangzhou China
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Reliability and validity of telephonic Barthel Index: an experience from multi-centric randomized control study. Acta Neurol Belg 2018; 118:53-59. [PMID: 29368116 DOI: 10.1007/s13760-017-0843-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
Telephonic Barthel Index (BI) assessment is less time-consuming and more feasible than a face-to-face interview. The aim of this study was to test the validity as well as reliability of the BI administered by telephone in comparison with face-to-face assessment in a multi-centric study. The study was conducted during the course of a randomized controlled trial in which 120 patients with subacute strokes from five teaching hospitals from different parts of India were recruited. Central telephonic follow-up and face-to-face assessment of BI and modified Rankin Scale (mRS) at 3 and 6 months were done by trained and certified blinded researchers. Kappa or weighted kappa (wK) was estimated. Sensitivity and specificity at various cutoff levels of telephonic BI were calculated. Concurrent validity of the telephonic BI was assessed by correlating it with the mRS and National Institutes of Health Stroke Scales (NIHSS) at 3 and 6 months. We observed high sensitivity and specificity at various cutoff levels of BI. Moderate to substantial agreement was observed between the two methods at 6 months wK 0.72 (95% CI 0.70-0.77). Item-wise and center-wise kappa also reflected substantial agreement. The study shows that telephonic assessment of activities of daily living with the BI in moderate to severely disabled stroke patients is valid and reliable compared to face-to-face assessment. Our study shows that telephonic assessment requires smaller sample size compared to face-to-face assessment of BI.
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Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis. J Cardiovasc Nurs 2018; 32:180-189. [PMID: 26938506 DOI: 10.1097/jcn.0000000000000325] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. OBJECTIVES The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. METHODS This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster. RESULTS Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. CONCLUSION The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.
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Heinsberg LW, Turi E, Ren D, Crago E, Alexander S, Stanfill AG, Conley YP. Evaluation of APOE Genotype and Ability to Perform Activities of Daily Living Following Aneurysmal Subarachnoid Hemorrhage. Biol Res Nurs 2017; 20:177-182. [PMID: 29258400 DOI: 10.1177/1099800417746504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Survivors of aneurysmal subarachnoid hemorrhage (aSAH) often experience unfavorable functional outcomes that result in a reduced ability to independently perform activities of daily living. The apolipoprotein E gene ( APOE) encodes for a protein known to facilitate lipid transport and aid in neuronal repair within the central nervous system and to moderate the inflammatory response, making functional variations in this gene likely candidate biomarkers to predict outcomes following aSAH. In the present work, we examined the relationship between APOE genotype and the ability to perform activities of daily living as measured by the Barthel Index (BI) score at 3 months ( n = 298) and 12 months ( n = 288) following aSAH. APOE genotypes were determined using polymerase chain reaction followed by restriction digestion and gel electrophoresis and treated as binary variables depending on the presence or absence of alleles E4 and E2. Multiple logistic regression was used to determine whether APOE genotype accounted for variability in BI score after controlling for age, sex, and severity of clinical condition as measured by the Hunt and Hess classification. No significant association was found between the presence of allele E4 and BI score at 3 ( p = .20) or 12 months ( p = .29) or between the presence of allele E2 and BI score at 3 ( p = .23) or 12 months ( p = .86) after controlling for covariates. The results of this study do not support a relationship between APOE genotype and the ability to perform activities of daily living after aSAH.
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Affiliation(s)
| | - Eleanor Turi
- 2 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Dianxu Ren
- 1 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Crago
- 1 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sheila Alexander
- 1 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ansley Grimes Stanfill
- 3 College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, USA.,4 College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yvette Perry Conley
- 1 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.,5 Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
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Measurement of function in older adults transitioning from hospital to home: an integrative review. Geriatr Nurs 2017; 39:336-343. [PMID: 29249631 DOI: 10.1016/j.gerinurse.2017.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Abstract
Older adults often experience decline in functional status during the transition from hospital to home. In order to determine the effectiveness of interventions to prevent functional decline, researchers must have instruments that are reliable and valid for use with older adults. The purpose of this integrative review is to: (1) summarize the research uses and methods of administering functional status instruments when investigating older adults transitioning from hospital to home, (2) examine the development and existing psychometric testing of the instruments, and (3) discuss gaps and implications for future research. The authors conducted an integrative review of forty research studies that assessed functional status in older adults transitioning from hospital to home. This review reveals important gaps in the functional status instruments' psychometric testing, including limited testing to support their validity and reliability when administered by self-report and limited evidence supporting their ability to detect change over time.
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Guerreiro AC, Tonelli AC, Orzechowski R, Dalla Corte RR, Moriguchi EH, de Mello RB. Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders. Front Med (Lausanne) 2017; 4:122. [PMID: 28824911 PMCID: PMC5535297 DOI: 10.3389/fmed.2017.00122] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/13/2017] [Indexed: 01/24/2023] Open
Abstract
Objective To evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3 months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound. Methods Cohort study of patients aged 65 years or more admitted to a medium complexity unit in a teaching hospital in southern Brazil. Comprehensive geriatric assessment and ultrasound evaluation of the dominant thigh of each participant were performed. After 3 months of hospital discharge, telephone contact was made to evaluate the outcomes of rehospitalization or death and functional decline—assessed by the 100 points Barthel scale and defined as a decrease of five or more points. Results 100 participants were included. There was no statistically significant difference between intraobserver measurements in the GEE method analysis (p > 0.05), and the mean bias obtained in Bland–Altman plots was close to zero in all four analyses performed, suggesting good intra and interobserver agreement. There was a significant correlation between the echographic measurements (quadriceps thickness and contractile index) and gait speed, timed up and go, and handgrip tests. There was a significant association between contractile index (quadriceps thickness over total anterior thigh thickness multiplied by 100) lower than 60% and functional decline (relative risk 1.35; CI 95% 1.10–1.65; p = 0.003) as well as between the thickness of the quadriceps and rehospitalization or death, in both individuals with preserved walking capacity and in bedridden elders (relative risk 1.34; CI 95% 1.02–1.75; p = 0.04). Conclusion The ultrasonographic method to evaluate thigh thickness was easily applicable and reproducible. The thickness of the quadriceps could predict rehospitalization or death, even in those patients without walking capacity—unable to perform gait speed and timed up and go tests. Additionally, the contractile index was associated with functional decline after 3 months of hospital discharge. This is a promising result, which highlights the bedside ultrasound of the quadriceps as a potential tool for the prognosis evaluation of bedridden hospitalized elderly patients.
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Affiliation(s)
- Ana Clara Guerreiro
- Geriatric Medicine Residency Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana Claudia Tonelli
- Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Health School, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Roman Orzechowski
- Geriatric Medicine Residency Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Roberta Rigo Dalla Corte
- Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emilio Hideyuki Moriguchi
- Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato Bandeira de Mello
- Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Studies Program in Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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