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Kimura Y, Suzuki Y, Abe M. Association between the initial physical activity and functional recovery after 1 month of inpatient rehabilitation for subacute stroke: stratified analysis by nutritional status. Int J Rehabil Res 2024; 47:103-109. [PMID: 38618657 DOI: 10.1097/mrr.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n = 133); <92, low GNRI group ( n = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P = 0.049] and high GNRI group ( B = 0.11, 95% CI = 0.01; 0.21, P = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.
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Affiliation(s)
- Yosuke Kimura
- Department of Science and Engineering, Health Science and Technology Course, Kanto Gakuin University, Yokohama
- HEalth Promotional Physical Therapy for Stroke Survivors: HEPPS, Strategic Issues Resolution Commission, Japanese Society of Neurological Physical Therapy
| | - Yoshiki Suzuki
- Department of Rehabilitation, Tokyo Shinjuku Medical Center, Japan Community Health Care Organization
| | - Marie Abe
- Department of Rehabilitation, Minamino Hospital, Eiseikai Association, Tokyo, Japan
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Nylén MC, Abzhandadze T, Persson HC, Sunnerhagen KS. Prediction of long-term functional outcome following different rehabilitation pathways after stroke unit discharge. J Rehabil Med 2024; 56:jrm19458. [PMID: 38770699 PMCID: PMC11135335 DOI: 10.2340/jrm.v56.19458] [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: 09/19/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To investigate whether referral for different types of rehabilitation on discharge from Swedish stroke units can predict functional outcomes at 1 and 5 years after a stroke. DESIGN A longitudinal and registry-based study. SUBJECTS/PATIENTS A total of 5,118 participants with index stroke in 2011 were followed-up at 1 and 5 years after the stroke. METHODS Ordinal logistic regression models were developed to predict the category of functional outcome: independent, dependent, or dead. The primary predictors were planned rehabilitation in a home setting, inpatient rehabilitation, and outpatient rehabilitation, with no planned rehabilitation as the reference category. RESULTS Planned outpatient rehabilitation predicted independence (compared with death) at 1 year. Planned rehabilitation in the home setting predicted independence (compared with death) at 1 and 5 years. Compared with other planned pathways, participants planned for inpatient rehabilitation had more severe conditions, and planned inpatient rehabilitation did not predict independence. CONCLUSION Planning for outpatient or home-based rehabilitation appeared to lead more effectively to participants achieving independence over the course of 1-5 years. This may have been due to the less severe nature of these participants' conditions, compared with those requiring inpatient rehabilitation.
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Affiliation(s)
- Malin C Nylén
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna C Persson
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden; Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kaseke F, Gwanzura L, Musarurwa C, Gori E, Nyengerai T, Kaseke T, Stewart A. Factors influencing survival outcomes in patients with stroke in Zimbabwe: A 12-month longitudinal study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.02.24305220. [PMID: 38633793 PMCID: PMC11023643 DOI: 10.1101/2024.04.02.24305220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background In this longitudinal study, we aimed to determine factors influencing survival outcomes among patients with stroke over a 12-month period. The investigation sought to uncover influential determinants to enhance the precision of prognostic assessments and inform targeted interventions for individuals affected by strokes. Methods Employing a longitudinal study design, participants were observed for 12 months from baseline, censoring survivors at the endpoint. The dataset originated from a comprehensive study involving stroke patients treated at three referral hospitals in Zimbabwe: Parirenyatwa, Sally Mugabe, and Chitungwiza Central Hospital. The primary outcome variable, the duration of survival until death, was measured in days from the initiation of stroke treatment. Gompertz parametric regression analysis was utilized for data modeling following Accelerated Failure Time (AFT) model diagnostics. Results In our study, 188 stroke patients were enrolled at baseline. However, 51 patients were excluded from the analysis due to either missing information or loss to follow-up. Among the remaining 137 patients who were tracked over a 12-month period, 42% were censored, and 58% were deceased. Individuals utilizing 'Free Service (older than 65/pensioners/retirees)' hospital bill payment methods showed a decreased risk of death (HR: 0.4, 95% CI: 0.20, 0.80), suggesting a protective effect compared to cash paying patients. Those with a secondary school level education displayed a significantly lower risk of death (HR: 0.2, 95% CI: 0.04, 0.69) compared to those without formal education. Age was a significant factor, with individuals aged 45-65 and those over 65 years showing higher adjusted hazard ratios (HR: 4.9, 95% CI: 1.80, 13.25; HR: 5.5, 95% CI: 1.92, 15.95, respectively) relative to those below 45 years of age. Housing status revealed a protective effect for those residing with parents/relatives (adjusted HR: 0.4, 95% CI: 0.20, 0.66), while individuals with a 'Very severe' functional outcome showed an increased hazard (adjusted HR: 4.9, 95% CI: 1.12, 21.33). Conclusion The study findings demonstrate that hospital bill payment methods, housing status, educational attainment, functional outcome, and age significantly affect survival outcomes among stroke patients. This highlights the need to consider socio-demographic and clinical variables in the development of prognostic assessments and targeted interventions for individuals recovering from stroke.
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Affiliation(s)
- Farayi Kaseke
- Department of Physiotherapy, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Lovemore Gwanzura
- Department of Laboratory diagnostic and investigative sciences Department of Medical Laboratory Sciences, Faculty of Medicine, University of Zimbabwe, Zimbabwe
| | - Cuthbert Musarurwa
- Department of Biomedical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Elizabeth Gori
- Department of Medical Biochemistry, Molecular Biology and Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | | | - Timothy Kaseke
- Zimbabwe AIDS Prevention Project (ZAPP), Harare, Zimbabwe
| | - Aimee Stewart
- Department of Physiotherapy. University of The Witwatersrand, Johannesburg, South Africa
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Ishida S, Harashima H, Miyano S, Kawama K. Effect of rehabilitation motivation on improving activities of daily living in subacute stroke patients. J Stroke Cerebrovasc Dis 2023; 32:107385. [PMID: 37839300 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES To determine the effect of rehabilitation motivation on activities of daily living improvement in subacute stroke patients starting intensive rehabilitation. MATERIALS AND METHODS This was a single-center cohort study involving patients with a subacute stroke who were admitted to or discharged from a Recovery Rehabilitation Unit between February 2021 and August 2022. Improvement in Activity of Daily Living was evaluated using the Functional Independence Measure. We calculated the corrected motor Functional Independence Measure effectiveness using its motor-related items at admission and discharge. The Behavioral Regulation in Exercise Questionnaire 2 was used to evaluate admission rehabilitation motivation, and the Relative Autonomy index was calculated. Hierarchical multiple regression analysis was used to examine the relationship between the corrected motor Functional Independence Measure effectiveness and the Relative Autonomy Index. RESULTS Eighty-six of the 231 patients (37.2 %) were included in the analysis. Hierarchical multiple regression analysis adjusted for demographic and clinical variables demonstrated that age, comorbidities, and Relative Autonomy Index were significantly associated with corrected motor Functional Independence Measure effectiveness (R2 = 0.423, p ≺ .001). CONCLUSION Motivation at intensive rehabilitation initiation in patients with a subacute stroke influences Activities of Daily Living improvement. These results may help develop rehabilitation programs aimed at improving Activities of Daily Living in patients with subacute strokes.
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Affiliation(s)
- Shinnosuke Ishida
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Egota, Nakano-, ku, Tokyo 165-8906, Japan; Department of Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyouku, Tokyo 112-0012, Japan.
| | - Hiroaki Harashima
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Egota, Nakano-, ku, Tokyo 165-8906, Japan
| | - Satoshi Miyano
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Egota, Nakano-, ku, Tokyo 165-8906, Japan
| | - Kennosuke Kawama
- Department of Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyouku, Tokyo 112-0012, Japan
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Kimura Y, Otobe Y, Suzuki M, Tanaka S, Kusumi H, Yamamoto S, Saegusa H, Yoshimura T, Yamada M. A U-shaped relationship between body mass index and functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation. Clin Neurol Neurosurg 2023; 232:107881. [PMID: 37423090 DOI: 10.1016/j.clineuro.2023.107881] [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: 05/02/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE A relationship between body mass index and functional recovery in older survivors of stroke is unclear. Therefore, this study aimed to investigate the association of body mass index with post-stroke functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation. METHODS This was a multicenter retrospective observational study of 757 older survivors of stroke, from six convalescent rehabilitation hospitals in Japan. The participants were classified into seven categories according to body mass index at admission. The measurements included outcomes of the absolute gain in the motor subscale of the Functional Independence Measure. Poor functional recovery was defined as gain < 17 points. Multivariate logistic regression analysis was performed to examine the impact of these body mass index categories on poor functional recovery. RESULTS The mean motor gains were highest in the 23.5-25.4 kg/m2 group (28.1 points), and lowest in the < 17.5 kg/m2 group (220.0 points). The results of the multivariate regression analyses (reference; 23.5-25.4 kg/m2 group) showed that the < 17.5 kg/m2 group (odds ratios 4.30; 95 % confidence intervals 2.09-8.87), the 17.5-19.4 kg/m2 group (1.99; 1.03-3.87), the 19.5-21.4 kg/m2 group (1.93; 1.05-3.54), and the ≥ 27.5 kg/m2 group (3.34; 1.33-8.42) were significantly associated with poor functional recovery, but not in the other groups. CONCLUSIONS Older survivors of stroke with high-normal weight had the most favorable functional recovery among the seven groups. Meanwhile, both low and extremely high body mass indexes were associated with poor functional recovery.
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Affiliation(s)
- Yosuke Kimura
- College of Science and Engineering, Health Science and Technology Course, Kanto Gakuin University, 1-50-1 Mutsuura East, Kanazawa-ku, Yokohama 236-8501, Japan.
| | - Yuhei Otobe
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-city, Osaka 583-8555, Japan
| | - Mizue Suzuki
- Faculty of Allied Health Sciences, Yamato University, 2-5-1, Katayama-cho, Suita-shi, Osaka 564-0082, Japan
| | - Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo 144-8535, Japan
| | - Haruhiko Kusumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Seiya Yamamoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Hiroki Saegusa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Tomohiro Yoshimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
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Dusenbury W, Malkoff MD, Schellinger PD, Köhrmann M, Arthur AS, Elijovich L, Alexandrov AV, Tsivgoulis G, Alexandrov AW. International beliefs and head positioning practices in patients with spontaneous hyperacute intracerebral hemorrhage. Ther Adv Neurol Disord 2023; 16:17562864231161162. [PMID: 36993938 PMCID: PMC10041589 DOI: 10.1177/17562864231161162] [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: 06/29/2022] [Accepted: 02/15/2023] [Indexed: 03/31/2023] Open
Abstract
Background Prior to the conduct of the Head Position in Stroke Trial (HeadPoST), an international survey (n = 128) revealed equipoise for selection of head position in acute ischemic stroke. Objectives We aimed to determine whether equipoise exists for head position in spontaneous hyperacute intracerebral hemorrhage (ICH) patients following HeadPoST. Design This is an international, web-distributed survey focused on head positioning in hyperacute ICH patients. Methods A survey was constructed to examine clinicians' beliefs and practices associated with head positioning of hyperacute ICH patients. Survey items were developed with content experts, piloted, and then refined before distributing through stroke listservs, social media, and purposive snowball sampling. Data were analyzed using descriptive statistics and χ2 test. Results We received 181 responses representing 13 countries on four continents: 38% advanced practice providers, 32% bedside nurses, and 30% physicians; overall, participants had median 7 [interquartile range (IQR) = 3-12] years stroke experience with a median of 100 (IQR = 37.5-200) ICH admissions managed annually. Participants disagreed that HeadPoST provided 'definitive evidence' for head position in ICH and agreed that their 'written admission orders include 30-degree head positioning', with 54% citing hospital policies for this head position in hyperacute ICH. Participants were unsure whether head positioning alone could influence ICH longitudinal outcomes. Use of serial proximal clinical and technology measures during the head positioning intervention were identified by 82% as the most appropriate endpoints for future ICH head positioning trials. Conclusion Interdisciplinary providers remain unconvinced by HeadPoST results that head position does not matter in hyperacute ICH. Future trials examining the proximal effects of head positioning on clinical stability in hyperacute ICH are warranted.
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Affiliation(s)
| | - Marc D. Malkoff
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Adam S. Arthur
- University of Tennessee Health Science Center, Memphis, TN, USA
- Semmes-Murphey Neurosurgery, Memphis, TN, USA
| | - Lucas Elijovich
- University of Tennessee Health Science Center, Memphis, TN, USA
- Semmes-Murphey Neurosurgery, Memphis, TN, USA
| | - Andrei V. Alexandrov
- University of Tennessee Health Science Center, Memphis, TN, USA
- Banner University Hospital, University of Arizona College of Medicine, Phoenix, AZ
| | - Georgios Tsivgoulis
- National and Kapodistrian University of Athens, Athens, Greece
- University of Tennessee Health Science Center, Memphis, TN, USA
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Yan H, Chen H, Liu Y, Zhang Q, Guo Y, Fu Y, Ren H, Wang H, Wang C, Ge Y. Assessment of cognitive impairment after acute cerebral infarction with T1 relaxation time measured by MP2RAGE sequence and cerebral hemodynamic by transcranial Doppler. Front Neurol 2022; 13:1056423. [PMID: 36561306 PMCID: PMC9763460 DOI: 10.3389/fneur.2022.1056423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to investigate early brain microstructural changes discovered using magnetization-prepared two rapid acquisition gradient echo (MP2RAGE) sequence and cerebral hemodynamic using TCD for cognitive impairment after acute cerebral infarction. Methods We enrolled 43 patients with acute cerebral infarction and 21 healthy people in the study, who were subjected to cognitive assessments, the MP2RAGE sequence, and a cerebral hemodynamic examination. A total of 26 brain regions of interest were investigated. Furthermore, we used cerebral hemodynamics to explain brain microstructural changes, which helped us better understand the pathophysiology of cognitive impairment after acute cerebral infarction and guide treatment. Results T1 relaxation times in the left frontal lobe, right frontal lobe, right temporal lobe, left precuneus, left thalamus, right hippocampus, right head of caudate nucleus, and splenium of corpus callosum were substantially different across the three groups, which were significantly correlated with neuropsychological test scores. CI group patients had significantly lower cerebral blood flow velocity than those in the N-CI and Normal groups. The receiver operating curve analysis revealed that most T1 relaxation times had high sensitivity and specificity, especially on the right temporal lobe and right frontal lobe. There was a potential correlation between T1 relaxation times and MMSE scores through TCD parameters. Conclusion The MP2RAGE sequence can detect alterations in whole brain microstructure in patients with cognitive impairment after acute cerebral infarction. Brain microstructural changes could influence cognitive function through cerebral hemodynamics. T1 relaxation times on the right temporal lobe and the right frontal lobe are expected to be a prospective biomarker of cognitive impairment after acute cerebral infarction.
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Affiliation(s)
- Hongting Yan
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Honghai Chen
- The Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yanzhi Liu
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qiannan Zhang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunchu Guo
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yu Fu
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hongling Ren
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hairong Wang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Chun Wang
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China,*Correspondence: Chun Wang
| | - Yusong Ge
- The Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China,Yusong Ge
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Kimura Y, Otobe Y, Suzuki M, Masuda H, Kojima I, Tanaka S, Kusumi H, Yamamoto S, Saegusa H, Yoshimura T, Yamada M. The effects of rehabilitation therapy duration on functional recovery of patients with subacute stroke stratified by individual's age: a retrospective multicenter study. Eur J Phys Rehabil Med 2022; 58:675-682. [PMID: 36052892 PMCID: PMC10019476 DOI: 10.23736/s1973-9087.22.07581-5] [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: 11/08/2022]
Abstract
BACKGROUND The duration of rehabilitation therapy is one of the key elements for promoting post-stroke functional recovery. However, whether an individual's age affects the effectiveness of the duration of rehabilitation therapy on post-stroke functional recovery remains unclear. AIM This study aimed to investigate whether age has an influence on the relationship between the duration of rehabilitation therapy and post-stroke functional recovery. DESIGN This is a retrospective observational study. SETTING Six convalescent inpatient rehabilitation hospitals in Japan. POPULATION The population of the study was represented by a total of 1186 participants with subacute stroke. METHODS Participants were stratified into four groups according to their age (≤59, 60-69, 70-79, and ≥80 years). The data of minutes involved in performing rehabilitation therapy for participants during hospitalization per day (extracted from the medical records of each hospital). The outcome measurement was the absolute change in the functional independence measure (FIM) score during hospitalization. RESULTS The mean FIM gains in the ≤59 years, 60-69 years, 70-79 years, and the ≥80 years groups were 38.7 (18.8), 32.8 (18.0), 29.7 (16.6), and 25.4 (17.2), respectively. The results of the multivariate regression analyses showed that there was a significant association between the duration of daily rehabilitation therapy and the FIM gain in the 70-79 years and the ≥80 years groups (-70-79 years group: B=1.289, β=0.290, 95% confidence intervals (CIs): 0.718-1.859, P<0.001; the ≥80 years group: B=2.375, β=0.371, 95% CIs: 1.644-3.107, P<0.001), but not in the other groups. CONCLUSIONS For patients with subacute stroke in rehabilitation hospitals, a higher duration of daily rehabilitation therapy was associated with better functional recovery in the 70-79 years group and ≥80 years groups. Understanding the responsiveness of patients with stroke to rehabilitation therapy by age group helps to better allocate medical resources and develop more effective approaches. CLINICAL REHABILITATION IMPACT An increased duration of daily rehabilitation therapy may be helpful in older adults with stroke selected for intensive rehabilitation for improvement of basic daily functioning.
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Affiliation(s)
- Yosuke Kimura
- College of Science and Engineering, Health and Sports Technology Course, Kanto Gakuin University, Yokohama, Japan -
| | - Yuhei Otobe
- School of Medicine, Department of Rehabilitation Science, Physical Therapy Course, Osaka Metropolitan University, Osaka, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shu Tanaka
- School of Health Sciences, Department of Rehabilitation, Tokyo University of Technology, Tokyo, Japan
| | - Haruhiko Kusumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Seiya Yamamoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroki Saegusa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Tomohiro Yoshimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
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Togashi Y, Fujita T, Ohashi T, Jinbo R, Kasahara R. Effect of life-space mobility on subjective well-being in aged home-based rehabilitation users with different levels of independence in activities of daily living. J Phys Ther Sci 2022; 34:18-21. [PMID: 35035073 PMCID: PMC8752280 DOI: 10.1589/jpts.34.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The relationship between quality of life and life-space mobility in
community-dwelling older adults has recently been reported. The present study aimed to
elucidate this relationship in home-based rehabilitation users with limited life-space
mobility and loss of independence in activities of daily living. [Participants and
Methods] The study population comprised 33 home-based rehabilitation users. The
participants were expected to have a wide range of the level of independence in activities
of daily living; therefore, they were categorized into three groups according to the
Barthel Index score: independent (95–100 points), moderately disabled (90–65 points), and
severely disabled (60–0 points) groups. We examined the relationships among the
Philadelphia Geriatric Center Morale Scale, Life-Space Assessment, and Barthel Index
scores and age. [Results] We detected a strong positive correlation between the
Philadelphia Geriatric Center Morale Scale and Life-Space Assessment scores in the
independent group; however, no significant correlations were observed in the moderately
and severely disabled groups. [Conclusion] Our findings suggest a relationship between
subjective well-being and life-space mobility in home-based rehabilitation users who are
mostly independent in activities of daily living. However, owing to the small sample size
and characteristics of the scales used in this study, further studies are warranted to
verify these results.
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Affiliation(s)
- Yui Togashi
- Hobara Regional Comprehensive Support Center, Japan
| | - Takaaki Fujita
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University: 10-6 Sakaemachi, Fukushima City, Fukushima 960-8516, Japan
| | - Takuro Ohashi
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
| | - Ryohei Jinbo
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
| | - Ryuichi Kasahara
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
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Stroke among highly active antiretroviral therapy-naive people living with the human immunodeficiency virus in China: a retrospective study of the characteristics, risk factors, and prognosis. BMC Infect Dis 2022; 22:4. [PMID: 34983408 PMCID: PMC8725276 DOI: 10.1186/s12879-021-06989-6] [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: 06/17/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to clarify the characteristics, risk factors, and prognosis of stroke among HAART-naive people living with HIV (PLWH) in China. METHODS We selected HAART-naive PLWH admitted to Beijing Ditan Hospital, Capital Medical University, from 1 January 2009 to 31 December 2019. Demographic and clinical data were obtained by searching an anonymous electronic case system. Descriptive analysis and logistic regression and Cox proportional hazard models were used to determine the characteristics and predictors of stroke among all HAART-naive PLWH and evaluate the risk factors of mortality in HAART-naive PLWH with stroke. RESULTS Stroke was diagnosed in 105 cases (3.7%) of 2867 HAART-naive PLWH. Multivariate logistic regression indicated that age of 30-55 years (OR 1.903, 95% CI 1.005-3.603, p = 0.048), age of ≥ 55 years (OR 4.104, 95% CI 1.928-8.737, p < 0.001), and CD4 count of < 200 cells/µL (OR 2.005, 95% CI 1.008-3.985, p = 0.047) were associated with increased odds of stroke. Diabetes (OR 3.268, 95% CI 1.744-6.125, p < 0.001), hypertension (OR 2.301, 95% CI 1.425-3.717, p = 0.001), syphilis (OR 2.003, 95% CI 1.300-3.089, p = 0.002), and complicated AIDS-defining CNS diseases (OR 7.719, 95% CI 4.348-13.703, p < 0.001) were risk factors for stroke. Of the 105 stroke patients, 12 (11.4%) died during hospitalisation, and the risk factors for mortality among patients with stroke were age of > 65 years (AHR: 8.783, 95% CI 1.522-50.668, p = 0.015), complicated severe pneumonia (AHR: 3.940, 95% CI 1.106-14.029, p = 0.034), and AIDS-defining CNS diseases (AHR: 19.766, 95% CI 3.586-108.961, p = 0.001). CONCLUSIONS For HAART-naive people living with HIV (PLWH), stroke occurred in various age groups, and early screening for stroke, timely intervention for risk factors among patients in various age groups, and controlling the CD4 count are extremely important in reducing the burden of stroke.
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Lamm AG, Goldstein R, Slocum CS, Silver JK, Grabowski DC, Schneider JC, Zafonte RD. For-Profit and Not-For-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes. Arch Phys Med Rehabil 2021; 103:851-857. [PMID: 34856156 DOI: 10.1016/j.apmr.2021.11.003] [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: 03/16/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To describe differences in traumatic brain injury patient characteristics and outcomes by inpatient rehabilitation facility profit status. DESIGN Retrospective database review utilizing the Uniform Data System for Medical Rehabilitation® (UDSMR). SETTING Inpatient rehabilitation facilities. PARTICIPANTS Individual discharges (n = 53,630) from 877 distinct rehabilitation facilities for calendar years 2016 through 2018. INTERVENTION NA MAIN OUTCOME MEASURES: Patient demographic data (age, race, primary payer source), admission and discharge Functional Independence Measure® (FIM®), FIM® gain, length of stay efficiency, acute hospital readmission from for-profit and not-for-profit IRFs within 30 days, and community discharges by facility profit status. RESULTS Patients at for-profit facilities were significantly older (69.69 vs. 64.12 years), with lower admission FIM® scores (52 vs. 57), shorter lengths of stay (13 vs. 15 days), and higher discharge FIM® scores (88 vs. 86); for-profit facilities had higher rates of community discharges (76.8% vs. 74.6%), but also had higher rates of readmission (10.3% vs. 9.9%). CONCLUSIONS The finding that for-profit facilities admit older patients who are reportedly less functional on admission and more functional on discharge, with higher rates of community discharge but higher readmission rates than not-for-profit facilities is an unexpected and potentially anomalous finding. In general, older, less functional patients who stay for shorter periods of time would not necessarily be expected to make greater functional gains. These differences should be further studied, to determine if differences in patient selection, coding/billing, or other unreported factors underlie these differences.
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Affiliation(s)
- Adam G Lamm
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI
| | - Richard Goldstein
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Chloe S Slocum
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Ross D Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA.
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12
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Sha L, Xu T, Ge X, Shi L, Zhang J, Guo H. Predictors of death within 6 months of stroke onset: A model with Barthel index, platelet/lymphocyte ratio and serum albumin. Nurs Open 2021; 8:1380-1392. [PMID: 33378600 PMCID: PMC8046075 DOI: 10.1002/nop2.754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS To develop and internally validate a nomogram to predict the risk of death within 6 months of onset of stroke in Chinese. Identifying risk factors with potentially direct effects on the nomogram will improve the quality of risk assessment and help nurses implement preventive measures based on patient-specific risk factors. DESIGN A retrospective study. METHODS We performed a least absolute shrinkage and selection operator (LASSO) regression modelling and multivariate logistic regression analysis to establish a prediction model of death risk in stroke patients within 6 months of onset. LASSO and time-dependent Cox regression models were further used to analyse the 6-month survival of stroke patients. Data were collected from 21 October 2013-6 May 2019. RESULTS The independent predictors of the nomogram were Barthel index (odds ratio (OR) = 0.980, 95% confidence interval (CI) = 0.961-0.998, p = .03), platelet/lymphocyte ratio (OR = 1.005, 95% CI = 1.000-1.010, p = .04) and serum albumin (OR = 0.854, 95% CI = 0.774-0.931, p < .01). This model showed good discrimination and consistency, and its discrimination evaluation C-statistic was 0.879 in the training set and 0.891 in the internal validation set. The DCA indicated that the nomogram had a higher overall net benefit over most of the threshold probability range. The time-dependent Cox regression model established the impact of the time effect of the age variable on survival time. CONCLUSIONS Our results identified three predictors of death within 6 months of stroke in Chinese. These predictors can be used as risk assessment indicators to help caregivers performing clinical nursing work, and in clinical practice, it is suggested that nurses should evaluate the self-care ability of stroke patients in detail. The constructed nomogram can help identify patients at high risk of death within 6 months, so that intervention can be performed as early as possible.
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Affiliation(s)
- Ling Sha
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Tiantian Xu
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Xijuan Ge
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Lei Shi
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Jing Zhang
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Huimin Guo
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
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13
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Pego Pérez ER, Fernández I, Pumar JM. Functional outcomes of patients with stroke treated with thrombectomy by aspiration. Brain Inj 2021; 35:476-483. [PMID: 33635736 DOI: 10.1080/02699052.2021.1887519] [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: 10/22/2022]
Abstract
Purpose: To determine the time of procedure, the value of modified Thrombolysis in Cerebral Infarction and National Institute Health of Stroke Scale as predictors of the functional results of patients with stroke treated with mechanical thrombectomy by aspiration.Methods: Observational, analytical, and retrospective case series analysis of consecutive patients with internal carotid and cerebral media branch occlusions. Clinical outcome was measured with the modified Rankin Scale at 90 days after stroke. To analyze the differences between groups, the Chi2 test was used for the qualitative variables.Results: The sample size was 58 patients treated with thrombectomy by aspiration. We observed that the thrombectomy time determines the recanalization results; meanwhile, modified Thrombolysis in Cerebral Infarction is a predictor of modified Rankin Scale at discharge but not after 3 months. National Institute Health of Stroke Scale was determinant for modified Rankin Scale result.Conclusions: Mechanical thrombectomy by aspiration proves to be an effective treatment of acute stroke, improving the patient's vital and functional prognosis. The thrombectomy time is a predictor of the result in relation to the degree of recanalization determined by the modified Thrombolysis in Cerebral Ischemia. Also, the degree of recanalization predicts functional outcome at discharge but not at 3 months.
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Affiliation(s)
- E Rubén Pego Pérez
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isaac Fernández
- Department of Psychiatry, Radiology, Public Health, Medicine and Nursing-External, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Manuel Pumar
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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14
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O'Dell MW, Jaywant A, Frantz M, Patel R, Kwong E, Wen K, Taub M, Campo M, Toglia J. Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation. Arch Phys Med Rehabil 2021; 102:645-655. [PMID: 33440132 DOI: 10.1016/j.apmr.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. DESIGN Retrospective, longitudinal cohort study. SETTING Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. INTERVENTION None. MAIN OUTCOME MEASURES Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as "improved," "unchanged," or "declined" between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS). RESULTS For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. CONCLUSIONS Despite group gains from DC to 6M and an apparent "plateau" after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.
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Affiliation(s)
- Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
| | - Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Megan Frantz
- Kaiser Foundation Rehabilitation Center, Vallejo, California
| | - Ruchi Patel
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Erica Kwong
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Karen Wen
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Michael Taub
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Marc Campo
- Department of Allied Health and Natural Sciences, Mercy College, Dobbs Ferry, New York
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Allied Health and Natural Sciences, Mercy College, Dobbs Ferry, New York
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15
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Sex Differences in 28-Day Mortality of Ischemic Stroke in Iran and Its Associated Factors: A Prospective Cohort Study. J Stroke Cerebrovasc Dis 2020; 29:104896. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/27/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022] Open
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16
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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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17
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Survival After Ischemic and Hemorrhagic Stroke: A 4-Year Follow-Up at a Mexican Hospital. J Stroke Cerebrovasc Dis 2019; 28:2109-2114. [PMID: 31133484 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Overall, 75.2% of deaths from stroke occur in low- and middle-income countries. Mexico is a middle-income country with little information about the prognosis of early and late postischemic and hemorrhagic stroke. OBJECTIVE To evaluate the factors associated with post-stroke survival in the Mexican population. METHODS Observational study of consecutive stroke cases involving a first-ever hemorrhagic or ischemic stroke, with patients who received care at the National Institute of Neurology and Neurosurgery, in Mexico City, between 2009 and 2012. Patients were followed for up to 4 years after the index event. Exploratory analysis of survival was carried out with Kaplan-Meier and log-rank tests. Factors associated with survival time were determined using Cox models. RESULTS A total of 300 out of 544 (55.15%) patients had a hemorrhagic stroke, 135 of 544 (24.82%) patients died during the entire follow-up period, and 56 of 544 (10.29%) died in the first 30 days post-stroke (early mortality). Early mortality after stroke was associated with age ≥ 65 years (Adjusted Hazard Ratio - AHR = 2.07, P = .02) and ≥ 2 in-hospital medical complications (AHR = 46.13, P < .01). Late mortality was associated with age ≥ 65 years (AHR = 3.43, P < .01), ≥2 in-hospital medical complications (AHR = 2.55, P < .01), high comorbidity (AHR = 5.43, P < .01), and recurrence (AHR = 1.90, P = .01). CONCLUSIONS Patients with hemorrhagic and ischemic stroke who presented in-hospital medical complications, high comorbidity, and were over 65 years old had higher rates of early and late mortality.
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18
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Öztürk GT, Erden E, Yalçın S, Bölük H, Karabay İ, Sümer G, Durmuş E, Ersöz M, Kara M. Independent predictors of mortality in subacute and chronic stroke patients: A single center study in Turkey. J Back Musculoskelet Rehabil 2017; 30:987-990. [PMID: 28505952 DOI: 10.3233/bmr-160534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the long-term survival and related predictors have been identified in stroke patients, there is little evidence about the mortality rates and its associated factors in stroke patients treated in rehabilitation units. OBJECTIVE To evaluate 5-year mortality rates of patients with stroke and its relationship with the clinical characteristics after inpatient subacute-chronic rehabilitation. METHODS The files of 1016 stroke patients (482 male, 534 female) who received inpatient rehabilitation program were examined retrospectively. Patients' characteristics and functional ambulation category were recorded at the end of the rehabilitation program. The survival probability was estimated using the Kaplan-Meier method and the univariate effects of predictors were determined using the log-rank test. The possible factors determined with univariate analyses were checked in the Cox regression analysis. RESULTS A total of 273 patients (32%) died within 5 years after stroke. Age (p< 0.001, RR: 1.06, 95% CI: 1.05-1.08), presence of coronary artery disease (p= 0.003, RR: 1.53, 95% CI: 1.16-2.03) and poor walking ability (p< 0.001, RR: 2.06, 95% CI: 1.49-2.86) were independent prognostic factors for increased mortality. CONCLUSIONS About one-third of the rehabilitation patients died within 5 years after stroke. As independent ambulation was a strong predictor for long-term survival, it should be provided via rehabilitation techniques. Future studies are proposed to determine the effects of rehabilitation methods on mortality rates.
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Affiliation(s)
- Gökhan Tuna Öztürk
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ender Erden
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Süha Yalçın
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Hüma Bölük
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - İlkay Karabay
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Gözde Sümer
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ebru Durmuş
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Murat Ersöz
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Murat Kara
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
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19
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Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study. Arch Phys Med Rehabil 2017; 98:2399-2407. [PMID: 28433415 DOI: 10.1016/j.apmr.2017.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. DESIGN Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. SETTING Retrospective cohort study. PARTICIPANTS Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. INTERVENTIONS None. MAIN OUTCOME MEASURE Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. RESULTS Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR, 1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity (Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted HR, 4.23). CONCLUSIONS First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation.
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Desmaele S, Putman K, De Wit L, Dejaeger E, Gantenbein AR, Schupp W, Steurbaut S, Dupont AG, De Paepe K. A comparative study of medication use after stroke in four countries. Clin Neurol Neurosurg 2016; 148:96-104. [DOI: 10.1016/j.clineuro.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/31/2016] [Accepted: 07/02/2016] [Indexed: 01/04/2023]
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Functional Gain After Inpatient Stroke Rehabilitation. Stroke 2015; 46:2976-80. [DOI: 10.1161/strokeaha.115.010440] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/11/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Prediction of functional outcome after stroke rehabilitation (SR) is a growing field of interest. The association between SR and survival still remains elusive. We sought to investigate the factors associated with functional outcome after SR and whether the magnitude of functional improvement achieved with rehabilitation is associated with long-term mortality risk.
Methods—
The study population consisted of 722 patients admitted for SR within 90 days of stroke onset, with an admission functional independence measure (FIM) score of <80 points. We used univariable and multivariable linear regression analyses to assess the association between baseline variables and FIM gain and univariable and multivariable Cox analyses to assess the association of FIM gain with long-term mortality.
Results—
Age (
P
<0.001), marital status (
P
=0.003), time from stroke onset to rehabilitation admission (
P
<0.001), National Institutes of Health Stroke Scale score at rehabilitation admission (
P
<0.001), and aphasia (
P
=0.021) were independently associated with FIM gain. The
R
2
of the model was 0.275. During a median follow-up of 6.17 years, 36.9% of the patients died. At multivariable Cox analysis, age (
P
<0.0001), coronary heart disease (
P
=0.018), atrial fibrillation (
P
=0.042), total cholesterol (
P
=0.015), and total FIM gain (
P
<0.0001) were independently associated with mortality. The adjusted hazard ratio for death significantly decreased across tertiles of increasing FIM gain.
Conclusions—
Several factors are independently associated with functional gain after SR. Our findings strongly suggest that the magnitude of functional improvement is a powerful predictor of long-term mortality in patients admitted for SR.
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Morone G, Paolucci S, Iosa M. In What Daily Activities Do Patients Achieve Independence after Stroke? J Stroke Cerebrovasc Dis 2015; 24:1931-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 03/17/2015] [Accepted: 05/06/2015] [Indexed: 11/25/2022] Open
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Espinoza AV, Van Hooff RJ, De Smedt A, Moens M, Yperzeele L, Nieboer K, Hubloue I, De Keyser J, Dupont A, De Wit L, Putman K, Brouns R. PreSSUB II: The prehospital stroke study at the Universitair Ziekenhuis Brussel II. J Transl Int Med 2015; 3:57-63. [PMID: 27847888 PMCID: PMC4936443 DOI: 10.1515/jtim-2015-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Stroke is a time-critical medical emergency requiring specialized treatment. Prehospital delay contributes significantly to delayed or missed treatment opportunities. In-ambulance telemedicine can bring stroke expertise to the prehospital arena and facilitate this complex diagnostic and therapeutic process. AIMS This study evaluates the efficacy, safety, feasibility, reliability and cost-effectiveness of in-ambulance telemedicine for patients with suspicion of acute stroke. We hypothesize that this approach will reduce the delay to in-hospital treatment by streamlining the diagnostic process and that prehospital stroke care will be improved by expert stroke support via telemedicine during the ambulance transportation. DESIGN PreSSUB II is an interventional, prospective, randomized, open-blinded, end-point, single-center trial comparing standard emergency care by the Paramedic Intervention Team of the Universitair Ziekenhuis Brussel (control) with standard emergency care complemented with in-ambulance teleconsultation service by stroke experts (PreSSUB). STUDY OUTCOMES The primary efficacy endpoint is the call-to-brain imaging time. Secondary endpoints for the efficacy analysis include the prevalence of medical events diagnosed and corrected during in-ambulance teleconsultation, the proportion of patients with ischemic stroke receiving recanalization therapy, the assessment of disability, functional status, quality of life and overall well-being. Mortality at 90 days after stroke is the primary safety endpoint. Secondary safety analysis will involve the registration of any adverse event. Other analyses include assessment of feasibility and reliability and a health economic evaluation.
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Affiliation(s)
- Alexis Valenzuela Espinoza
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Interuniversity Center for Health Economics Research (I-CHER), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium
| | - Robbert-Jan Van Hooff
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel, Belgium
| | - Ann De Smedt
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel, Belgium
| | - Maarten Moens
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Belgium
| | - Laetitia Yperzeele
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel, Belgium; Department of Neurology, Universitair Ziekenhuis Antwerpen, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Koenraad Nieboer
- Department of Radiology, Universitair Ziekenhuis Brussel, Belgium
| | - Ives Hubloue
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium and Research Group on Emergency and Disaster Medicine (ReGEDiM), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Jacques De Keyser
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel, Belgium; Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Alain Dupont
- Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Liesbet De Wit
- Public Health, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Koen Putman
- Interuniversity Center for Health Economics Research (I-CHER), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Public Health, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Raf Brouns
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel, Belgium
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Hou WH, Ni CH, Li CY, Tsai PS, Lin LF, Shen HN. Stroke Rehabilitation and Risk of Mortality: A Population-Based Cohort Study Stratified by Age and Gender. J Stroke Cerebrovasc Dis 2015; 24:1414-22. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 02/17/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022] Open
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Meyer S, Verheyden G, Brinkmann N, Dejaeger E, De Weerdt W, Feys H, Gantenbein AR, Jenni W, Laenen A, Lincoln N, Putman K, Schuback B, Schupp W, Thijs V, De Wit L. Functional and motor outcome 5 years after stroke is equivalent to outcome at 2 months: follow-up of the collaborative evaluation of rehabilitation in stroke across Europe. Stroke 2015; 46:1613-9. [PMID: 25953370 DOI: 10.1161/strokeaha.115.009421] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Recovery of patients within the first 6 months after stroke is well documented, but there has been little research on long-term recovery. The aim of this study was to analyze functional and motor recovery between admission to rehabilitation centres and 5 years after stroke. METHODS This follow-up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe study, included patients from 4 European rehabilitation centres. Patients were assessed on admission, at 2 and 6 months, and 5 years after stroke, using the Barthel Index, Rivermead Motor Assessment Gross Function, Leg and Trunk function, and Arm function. Linear mixed models were used, corrected for baseline characteristics. To account for the drop-out during follow-up, the analysis is likelihood-based (assumption of missingness at random). RESULTS A total of 532 patients were included in this study, of which 238 were followed up at 5 years post stroke. Mean age at stroke onset was 69 (±10 SD) years, 53% were men, 84% had ischemic strokes, and 53% had left-sided motor impairment. Linear mixed model analysis revealed a significant deterioration for all 4 outcomes between 6 months and 5 years (P<0.0001). Scores at 2 months were not statistically significant different from scores at 5 years after stroke. Higher age (P<0.0001) and increasing stroke severity on admission (P<0.0001) negatively affected long-term functional and motor recovery. CONCLUSIONS Five-year follow-up revealed deterioration in functional and motor outcome, with a return to the level measured at 2 months. Increasing age and increasing stroke severity negatively affected recovery up to 5 years after stroke.
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Affiliation(s)
- Sarah Meyer
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.).
| | - Geert Verheyden
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Nadine Brinkmann
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Eddy Dejaeger
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Willy De Weerdt
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Hilde Feys
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Andreas R Gantenbein
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Walter Jenni
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Annouschka Laenen
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Nadina Lincoln
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Koen Putman
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Birgit Schuback
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Wilfried Schupp
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Vincent Thijs
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
| | - Liesbet De Wit
- From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.)
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Boudreau DM, Guzauskas GF, Chen E, Lalla D, Tayama D, Fagan SC, Veenstra DL. Cost-Effectiveness of Recombinant Tissue-Type Plasminogen Activator Within 3 Hours of Acute Ischemic Stroke. Stroke 2014; 45:3032-9. [DOI: 10.1161/strokeaha.114.005852] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Despite the availability of results from multiple newer clinical trials and changing healthcare costs, the cost-effectiveness of recombinant tissue-type plasminogen activator (r-tPA) for treatment of acute ischemic stroke within 0 to 3 hours of symptom onset was last evaluated in 1998 for the United States Using current evidence, we evaluate the long-term cost-effectiveness of r-tPA administered 0 to 3 hours after acute ischemic stroke onset versus no r-tPA.
Methods—
A disease-based decision model to project lifetime outcomes of patients after acute ischemic stroke by r-tPA treatment status from the US payer perspective was developed. Model inputs were derived from a recent meta-analysis of r-tPA trials, cohort studies, and health state preference studies. Cost data, inflated to 2013 dollars, were based on drug wholesale acquisition cost and the literature. To compare r-tPA to no r-tPA, we calculated incremental total direct costs, incremental quality-adjusted life years, and incremental cost-effectiveness ratios. We performed 1-way and probabilistic sensitivity analyses to evaluate uncertainty in the results.
Results—
r-tPA resulted in a gain of 0.39 quality-adjusted life years (95% confidence range, 0.16–0.66) on average per patient and a lifetime cost-saving of $25 000 (95% confidence range, −$42 500 to −$11 000) compared with no r-tPA. In probabilistic sensitivity analyses, r-tPA was dominant compared with no r-tPA in ≈100% of simulations. The model was sensitive to inputs for r-tPA efficacy, healthcare costs for disabled patients, mortality rates for disabled and nondisabled patients, and quality of life estimates.
Conclusions—
Our analysis supports earlier economic evaluations that r-tPA is a cost-effective method to treat stroke. Appropriate use of r-tPA should be prioritized nationally.
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Affiliation(s)
- Denise M. Boudreau
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Gregory F. Guzauskas
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Er Chen
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Deepa Lalla
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Darren Tayama
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Susan C. Fagan
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - David L. Veenstra
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
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Tanovic E, Selimovic S, Tanovic H. Assessment of the effects of rehabilitation after cerebrovascular accident in patients with diabetes mellitus and hypertension as risk factors. Med Arch 2014; 68:124-7. [PMID: 24937938 PMCID: PMC4272494 DOI: 10.5455/medarh.2014.68.124-127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: The aim of this study is to evaluate the results of rehabilitation, to determine the prevalence of major risk factors in cerebrovascular accident and their consequences, as well as to propose measures and procedures that will affect the better rehabilitation. Methods: The survey analyzed: age, sex, duration of rehabilitation, activities in daily life through the Barthel index at admission and at discharge, presence of risk factors HTA and DM. The study included a total of 116 patients, the majority of patients are older than 61 years. We had 49% of male patients and 51% of female patients and they spent 31-40 days at the rehabilitation. Results: The most common risk factor is HTA (83%) and diabetes (33%). Most of the patients at admission had a BI from 0 to 4 (32.7%), and at discharge BI in the range 17-20 (36.2%). Statistical analysis shows that there is a statistically significant correlation between the BI at admission, BI at discharge and risk factors of HTA and diabetes mellitus. Conclusions: the rehabilitation results in most patients is good results of rehabilitation. The most important risk factors in patients are HTA, DM and directly affect on results of rehabilitation. For the better results we should have energetic fight against risk factors for HTA and DM through primary and secondary prevention and patient education about early detection and treatment of these risk factors.
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Affiliation(s)
- Edina Tanovic
- Clinic of Physiatry and Rehabilitation, Clinical center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
- Corresponding author: Edina Tanovic, ass.prof. Clinic of Physiatry and Rehabilitation, KCUS, Sarajevo, Bosnia and Herzegovina. Phone: +387 33 278 465; :
| | | | - Haris Tanovic
- Clinic of Abdominal Surgery, Clinical canter of Sarajevo University, Sarajevo, Bosnia and Herzegovina
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Gjerde G, Naess H. Risk factor burden predicts long-term mortality after cerebral infarction. Acta Neurol Scand 2014; 129:173-7. [PMID: 23803011 DOI: 10.1111/ane.12159] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Previous studies have shown significant association between the number of traditional risk factors and long-term mortality of cerebral infarction in young stroke patients. The aim was to investigate risk factors separately and in sum in relation to long-term mortality after cerebral infarction, irrespective of age. MATERIALS AND METHODS Long-term mortality in relation to number of traditional risk factors (angina pectoris, myocardial infarction, intermittent claudication, hypertension, diabetes mellitus, and smoking at the time of the index stroke) and etiology was studied in patients with acute cerebral infarction admitted to the Stroke Unit, Department of Neurology, Haukeland University Hospital, between February 2006 and February 2011. Only patients alive 30 days after stroke onset were included. Cox regression analyses were performed. RESULTS After a mean follow-up time of 2.4 years, 14% with no risk factors had died, while the corresponding frequencies in patients with 1-3 or more risk factors were 13%, 19%, and 26%, respectively (P < 0.001). The number of risk factors was associated with mortality on Cox regression analysis (HR = 1.3, P < 0.001). CONCLUSION Increasing number of traditional risk factors is associated with long-term mortality in patients with cerebral infarction, irrespective of age. Careful long-term follow-up is important, especially among patients with several risk factors.
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Affiliation(s)
- G. Gjerde
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
- Institute of Clinical Medicine; University of Bergen; Bergen Norway
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Association Between the Volume of Inpatient Rehabilitation Therapy and the Risk of All-Cause and Cardiovascular Mortality in Patients With Ischemic Stroke. Arch Phys Med Rehabil 2014; 95:269-75. [DOI: 10.1016/j.apmr.2013.08.239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/17/2013] [Indexed: 11/21/2022]
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30
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Chen HF, Li CY, Lee SP, Kwok YT, Chu YT. Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital. TOHOKU J EXP MED 2014; 232:47-54. [DOI: 10.1620/tjem.232.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital
- School of Medicine, Fujen Catholic University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University
- Department of Public Health, China Medical University
| | - Siu-Pak Lee
- Department of Neurology, Far Eastern Memorial Hospital
| | - Yam-Ting Kwok
- Department of Neurology, Far Eastern Memorial Hospital
| | - Yiu-Tong Chu
- Department of Neurology, Far Eastern Memorial Hospital
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De Wit L, Putman K, Devos H, Brinkmann N, Dejaeger E, De Weerdt W, Jenni W, Lincoln N, Schuback B, Schupp W. Long-term prediction of functional outcome after stroke using single items of the Barthel Index at discharge from rehabilitation centre. Disabil Rehabil 2013; 36:353-8. [PMID: 23692390 DOI: 10.3109/09638288.2013.793411] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prognostic value of single items of the Barthel Index (BI) at discharge from rehabilitation, in predicting independence in personal activities of daily living (ADL) (BI score ≥ 95/100) at five years after stroke. METHOD People with stroke were recruited consecutively from four European rehabilitation centres. BI was assessed on discharge and at five years after stroke. Stepwise multivariate logistic regression analysis was used to determine independent predictors of BI score ≥ 95/100 at five years after stroke. Thereupon, percentage chance of reaching BI ≥ 95/100 at five years after stroke was calculated. RESULTS Data were available for 153 patients. Independence in dressing (odds ratio (OR)=5.22, 95% confidence interval (CI)=1.85-14.76, p=0.002) and bathing (OR=8.10, 95% CI=3.40-19.32, p<0.0001) were independent predictors. Independence in both items resulted in 74.1% (57.6-85.8) chance of reaching BI ≥ 95/100 at five years after stroke. Dependence in both items resulted in 6.3% (5.1-7.9) chance. Independence in bathing, but dependence in dressing resulted in 35.4% (30.7-40.4) chance whereas the opposite resulted in 26.1% (20.7-32.3) chance. CONCLUSION Simple assessment of dressing and bathing on discharge from rehabilitation enables therapeutic staff to predict prognosis for long-term independence in personal ADL. This method can be used for early identification of persons with stroke who need intensive follow-up. Implications for Rehabilitation (In)dependence for dressing and bathing at discharge from a rehabilitation centre are significant factors in the prediction of (in)dependence in personal ADL at five years after stroke. This predictive tool can be used for targeting inpatient stroke rehabilitation and early identification of those patients who need intensive follow-up.
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Affiliation(s)
- Liesbet De Wit
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven , Leuven , Belgium
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