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Zeng H, Cai A, Zhao W, Wu J, Ding Y, Zeng X. Factors and predictive model for malnutrition in poststroke disabled patients: A multicenter cross-sectional study. Nutrition 2024; 123:112423. [PMID: 38583267 DOI: 10.1016/j.nut.2024.112423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/10/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Although malnutrition has been shown to influence the clinical outcome of poststroke disabled patients, the associated factors and the prediction model have yet to be uncovered. OBJECTIVES This study aims to assess the current prevalence and factors associated with malnutrition in poststroke disabled patients and establish a prediction model. METHODS A multicenter cross-sectional survey among Chinese poststroke disabled patients (≥18 y old) was conducted in 2021. Information on patients' basic data, medical history, Barthel Index, dysphagia, and nutritional status was collected. A multivariable logistic regression model was used to identify the factors that influence malnutrition. Nomogram was developed and internal validation was conducted using 5-fold cross-validation. External validation was performed using the data from a preliminary survey. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA) were used to analyze the predictive value of the nomogram. RESULTS Four hundred fifty-seven cases were enrolled, with the prevalence of malnutrition as 71.77%. Age (aOR = 1.039, 95% CI: 1.006-1.078), pulmonary infection (aOR = 4.301, 95% CI: 2.268-14.464), dysphagia (aOR = 24.605, 95% CI: 4.966-191.058), total intake volume (aOR = 0.997, 95% CI: 0.995-0.999), Barthel Index (aOR = 0.965, 95% CI: 0.951-0.980), and nasogastric tube (aOR = 16.529, 95% CI: 7.418-52.518) as nutrition support mode (compared to oral intake) were identified as the associated factors of malnutrition in stroke-disabled patients (P < 0.05). ROC analysis showed that the area under the curve (AUC) for nomogram was 0.854 (95% CI: 0.816-0.892). Fivefold cross-validation showed the mean AUC as 0.829 (95% CI: 0.784-0.873). There were no significant differences between predicted and actual probabilities. The DCA revealed that the model exhibited a net benefit when the risk threshold was between 0 and 0.4. CONCLUSIONS Age, pulmonary infection, dysphagia, nutrition support mode, total intake volume, and Barthel Index were factors associated with malnutrition in stroke-related disabled patients. The nomogram based on the result exhibited good accuracy, consistency and values.
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Affiliation(s)
- Hongji Zeng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ang Cai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weijia Zhao
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Junfa Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - Yu Ding
- Department of Neurology, The Second Medical Center, PLA General Hospital, Beijing, China
| | - Xi Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China.
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Yuan L, Shen J, Ye S, Zhou N. Assessing care dependence status and associated influencing factors among middle-aged hemiplegic stroke patients during the post-acute rehabilitation phase: A correlational study. J Clin Nurs 2024; 33:2249-2258. [PMID: 38509780 DOI: 10.1111/jocn.17124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
AIMS To comprehensively examine the prevailing condition of care dependence among middle-aged individuals who have experienced hemiplegia subsequent to a stroke and were currently undergoing post-acute rehabilitation. Additionally, the study sought to analyse the determinants that impacted this phenomenon. DESIGN A single-centre, cross-sectional study design. METHODS During the period from January 2020 to October 2022, a cohort of 196 hemiplegic stroke patients, aged between 40 and 65, and within 6 months of their stroke onset, was selected from the cerebrovascular outpatient clinic at a tertiary hospital in Hangzhou. The demographic and disease-related data, care dependence level, mental state, nutrition and depression status were collected. Furthermore, all collected data were analysed by descriptive and correlative statistical methods. RESULTS The care dependence level was 51.04 ± 9.42, with an incidence of care dependence of 78.1%. Multivariate regression analysis showed that age, history of falls, physical dysfunction, chronic comorbidities, depression, nutritional status and cognitive dysfunction were influencing factors for care dependence in the participants after a stroke. CONCLUSION The incidence of care dependence among hemiplegic patients aged from 40 to 65 years old in the early stage after a stroke was high. Nursing staff should focus on these patients with a history of falling, physical dysfunction, comorbidity, depression status, nutritional status and cognitive dysfunction in clinical practice. RELEVANCE TO CLINICAL PRACTICE The incidence of care dependence in middle-aged hemiplegic patients following a stroke is significantly increased. Some risk factors should be assessed, monitored, and controlled by nursing staff as early as possible in order to reduce the dependence levels in post-acute rehabilitation period and improve the quality of life of hemiplegia patients. REPORTING METHOD Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies (see Table S1). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Lianfeng Yuan
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jun Shen
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shan Ye
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Na Zhou
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Usman JS, Salisu R, Abdullahi A, Salihu AT, Muhammad AH, Sulaiman SK, Yakasai AM. Assistive Technology utilization among stroke survivors in Kano, Northwest Nigeria: A cross-sectional study. Assist Technol 2024; 36:209-216. [PMID: 37699108 DOI: 10.1080/10400435.2023.2244560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/14/2023] Open
Abstract
Mobility impairments and participation restrictions are common occurrences post-stroke, which may necessitate the need to utilize Assistive Technology (AT). This study investigated the prevalence, pattern, and satisfaction with AT utilization in stroke survivors (SS). The study was conducted in two hospitals in Kano, Nigeria. The QUBEC user evaluation of satisfaction with AT (QUEST) questionnaire and the Rivermead Mobility Index were used to assess satisfaction with AT utilization and mobility, respectively. Pearson correlation and independent t-test were used to determine the relationship and gender difference among the outcomes, respectively. A total of 280 SS participated; however, only 115 (41.07%) were AT users. The commonly used AT was wheelchair 84 (73%), while the least used was walking frame 3 (2.6%). About two-thirds of the participants were quite or very satisfied with their ATs. The duration of AT utilization is positively related to stroke duration (r = 0.940) but negatively related to mobility level (r = -0.246). There is no significant gender difference in duration and satisfaction with AT utilization. AT like wheelchairs seems uncommonly utilized among SS in Kano, Nigeria, likely due to patients' lack of knowledge of use, economic factors, and culture among others.
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Affiliation(s)
- Jibrin Sammani Usman
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Rabbilu Salisu
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Auwal Abdullahi
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ashiru Hamza Muhammad
- Department of Public Health, Godiya Disability Inclusion and Development Initiative, Dutse, Jigawa, Nigeria
| | - Surajo Kamilu Sulaiman
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
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Barbosa PM, Szrek H, Ferreira LN, Cruz VT, Firmino-Machado J. Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals. Ann Phys Rehabil Med 2024; 67:101824. [PMID: 38518399 DOI: 10.1016/j.rehab.2024.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. OBJECTIVE To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. METHODS A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. RESULTS From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. CONCLUSION Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
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Affiliation(s)
- Pedro Maciel Barbosa
- Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; Centro de Investigação em Reabilitação, Escola Superior de Saúde, Instituto Politécnico do Porto, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - Helena Szrek
- Centre for Economics and Finance, University of Porto, R. Dr. Roberto Frias, 4200-464 Porto, Portugal
| | - Lara Noronha Ferreira
- ESGHT, Universidade do Algarve, Estr. da Penha 139, 8005-246 Faro, Portugal; Centre for Health Studies and Research of the University of Coimbra, Avenida Dias da Silva 165, 3004-512 Coimbra, Portugal; Research Centre for Tourism, Sustainability and Well-Being (CinTurs), Portugal.
| | - Vitor Tedim Cruz
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Centro Académico Clínico Egas Moniz, 810-193 Aveiro, Portugal; Centro Hospitalar Vila Nova de Gaia/Espinho, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
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Lee JW, Sohn MK, Lee J, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Kim YH, Song MK, Chang WH. Predictors of Burden for First-Ever Stroke Survivor's Long-Term Caregivers: A Study of KOSCO. Medicina (Kaunas) 2024; 60:559. [PMID: 38674206 PMCID: PMC11052313 DOI: 10.3390/medicina60040559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Long-term changes in caregiver burden should be clarified considering that extended post-stroke disability can increase caregiver stress. We assessed long-term changes in caregiver burden severity and its predictors. This study was a retrospective analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Patients with an acute first-ever stroke were enrolled from August 2012 to May 2015. Data were collected at 6 months and 6 years after stroke onset. The caregiver burden was measured with a subjective caregiver burden questionnaire based on the Korean version of the Caregiver Burden Inventory. The caregivers' characteristics and patients' clinical and functional status were also examined at each follow-up. A high caregiver burden, which suggests a risk of burnout, was reported by 37.9% and 51.7% of caregivers at 6 months and 6 years post-stroke, respectively. Both the caregiver burden total score and proportion of caregivers at risk of burnout did not decrease between 6 months and 6 years. The patients' disability (OR = 11.60; 95% CI 1.58-85.08; p = 0.016), caregivers' self-rated stress (OR = 0.03; 95% CI 0.00-0.47; p = 0.013), and caregivers' quality of life (OR = 0.76; 95% CI 0.59-0.99; p = 0.042) were burden predictors at 6 months. At 6 years, only the patients' disability (OR = 5.88; 95% CI 2.19-15.82; p < 0.001) and caregivers' psychosocial stress (OR = 1.26; 95% CI 1.10-1.44; p = 0.001) showed significance. Nearly half of the caregivers were at risk of burnout, which lasted for 6 years after stroke onset. The patients' disability and caregivers' stress were burden predictors in both subacute and chronic phases of stroke. The findings suggest that consistent interventions, such as emotional support or counseling on stress relief strategies for caregivers of stroke survivors, may reduce caregiver burden. Further research is needed to establish specific strategies appropriate for Korean caregivers to alleviate their burden in caring for stroke patients.
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Grants
- 3300-3334-300-260-00, 2013-E33017-00, 2013E-33017-01, 2013E-33017-02, 2016-E33003-00, 2016-E33003-01, 2016-E33003-02, 2019-E3202-00, 2019-E3202-01, 2019-E3202-02, and 2022-11-006 Korea Disease Control and Prevention Agency
- NRF-2022R1A2C1091592 National Research Foundation of Korea
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Affiliation(s)
- Jin-Won Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City 63243, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon 24252, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
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Rodriquez J, Bullock D, Cotsonis G, Clark PC, Blanton S. Neighborhood socioeconomic disadvantage measures in rehabilitation clinical trials: Lessons learned in recruitment. Appl Nurs Res 2023; 73:151718. [PMID: 37722786 DOI: 10.1016/j.apnr.2023.151718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/19/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity. METHODS Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device. RESULTS Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5-5, range 1-9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related. CONCLUSIONS The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.
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Affiliation(s)
- Josue Rodriquez
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - DeAndrea Bullock
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, United States of America.
| | - Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
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Fu L, Wang F, Ma Z, Zhang J, Xiong W, Wang L. Effect of Acupuncture and Rehabilitation Therapy on the Recovery of Neurological Function and Prognosis of Stroke Patients. Comput Math Methods Med 2022; 2022:4581248. [PMID: 35242206 PMCID: PMC8888046 DOI: 10.1155/2022/4581248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/30/2021] [Accepted: 01/08/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Stroke is a common cerebrovascular disease among the middle-aged and elderly, which can lead to a series of neurological disorders. Acupuncture is an important part of traditional Chinese medicine, with great value in improving the neurological deficits of stroke patients. In addition, rehabilitation therapy is also of great significance for alleviating the neurological deficits of patients and improving their activities of daily living. OBJECTIVE To explore the effect of acupuncture and moxibustion combined with rehabilitation therapy on the recovery of neurological function and prognosis of stroke patients. METHODS The case data of 100 stroke patients treated in the Wuhan Hospital of Traditional Chinese Medicine from January 2019 to July 2021 were analyzed retrospectively. According to the treatment plan patients received, they were divided into the following two groups: an observation group (n = 52) treated with acupuncture combined with rehabilitation therapy and a control group (n = 48) treated with rehabilitation therapy alone. The two groups were compared in terms of the following items: therapeutic efficacy, plasma levels of cortisol (Cor) and neuropeptide Y (NPY), nerve function, motor function, balance ability, self-care ability, swallowing function, negative emotions, and quality of life. RESULTS The therapeutic effect of the observation group was significantly higher than that of the control group (P < 0.05). The levels of Cor and NPY, as well as the neurological function, motor function, balance ability, self-care ability, swallowing function, and negative emotions, were not significantly different between the two groups before treatment (P > 0.05). While after intervention, all the above indexes improved in both groups, with better improvements in the observation group compared with the control group (P < 0.05). And the various dimensions concerning the quality of life of patients were also significantly better in the observation group when compared with the control group. CONCLUSION Acupuncture of traditional Chinese medicine combined with rehabilitation therapy has outstanding effects in stroke treatment and can effectively improve the neurological function, prognosis, and quality of life of patients, which is worthy of clinical promotion.
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Affiliation(s)
- Lanping Fu
- Department of Acupuncture and Moxibustion, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430000 Hubei Province, China
| | - Fei Wang
- Stroke Department of Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430000 Hubei Province, China
| | - Zhiyi Ma
- Department of Rheumatology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430000 Hubei Province, China
| | - Jin Zhang
- Department of Orthopedics, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430000 Hubei Province, China
| | - Wuzhong Xiong
- Department of Internal Medicine, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430000 Hubei Province, China
| | - Le Wang
- Department of Acupuncture and Moxibustion, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430000 Hubei Province, China
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Yeh HJ, Chen TA, Cheng HC, Chou YJ, Huang N. Long-Term Rehabilitation Utilization Pattern Among Stroke Patients Under the National Health Insurance Program. Am J Phys Med Rehabil 2022; 101:129-134. [PMID: 33782272 DOI: 10.1097/phm.0000000000001747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to understand the frequency of patients receiving rehabilitation services at various periods after stroke and the possible medical barriers to receiving rehabilitation. DESIGN A retrospective cohort study was conducted using a nationally representative sample in Taiwan. A total of 14,600 stroke patients between 2005 and 2011 were included. Utilization of physical therapy or occupational therapy at different periods after stroke onset was the outcome variable. Individual and geographic characteristics were investigated to determine their effect on patients' probability of receiving rehabilitation. RESULTS More severe stroke or more comorbid diseases increased the odds of receiving physical therapy and occupational therapy; older age was associated with decreased odds. Notably, sex and stroke type influenced the odds of rehabilitation only in the early period. Copayment exemption lowered the odds of rehabilitation in the first 6 mos but increased the odds in later periods. Rural and suburban patients had significantly lower odds of receiving physical therapy and occupational therapy, as did patients living in areas with fewer rehabilitation therapists. CONCLUSIONS Besides personal factors, geographic factors such as urban-rural gaps and number of therapists were significantly associated with the utilization of post-stroke rehabilitation care. Furthermore, the influence of certain factors, such as sex, stroke type, and copayment exemption type, changed over time.
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Affiliation(s)
- Huan-Jui Yeh
- From the Department of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan (H-JY, T-AC); Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-JY, Y-JC); Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan (H-CC); Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); Department of Life Sciences and Institute of Genome Sciences, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan (NH)
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Song Y, Zhang W, Li Q, Ma W. Medical Data Acquisition and Internet of Things Technology-Based Cerebral Stroke Disease Prevention and Rehabilitation Nursing Mobile Medical Management System. Comput Math Methods Med 2022; 2022:4646454. [PMID: 35126624 PMCID: PMC8816578 DOI: 10.1155/2022/4646454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/19/2021] [Accepted: 12/31/2021] [Indexed: 11/18/2022]
Abstract
This research was aimed at exploring the application value of a mobile medical management system based on Internet of Things technology and medical data collection in stroke disease prevention and rehabilitation nursing. In this study, on the basis of radio frequency identification (RFID) technology, the signals collected by the sensor were filtered by the optimized median filtering algorithm, and a rehabilitation nursing evaluation model was established based on the backpropagation (BP) neural network. The performance of the medical management system was verified in 32 rehabilitation patients with hemiplegia after stroke and 6 healthy medical staff in the rehabilitation medical center of the hospital. The results showed that the mean square error (MSE) and peak signal-to-noise ratio (PSNR) of the median filtering algorithm after optimization were significantly higher than those before optimization (P < 0.05). When the number of neurons was 23, the prediction accuracy of the test set reached a maximum of 89.83%. Using traingda as the training function, the model had the lowest training time and root mean squared error (RMSE) value of 2.5 s and 0.29, respectively, which were significantly lower than the traingd and traingdm functions (P < 0.01). The error percentage and RMSE of the model reached a minimum of 7.56% and 0.25, respectively, when the transfer functions of both the hidden and input layers were tansig. The prediction accuracy in stages III~VI was 90.63%. It indicated that the mobile medical management system established based on Internet of Things technology and medical data collection has certain application value for the prevention and rehabilitation nursing of stroke patients, which provides a new idea for the diagnosis, treatment, and rehabilitation of stroke patients.
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Affiliation(s)
- Yunna Song
- Mathematics Teaching and Research Section, Qiqihar Medical University, Qiqihar, 161000, China
| | - Wenjing Zhang
- Teaching and Research Section of Computer Science, Qiqihar Medical University, Qiqihar 161000, China
| | - Qingjiang Li
- Teaching and Research Section of Computer Science, Qiqihar Medical University, Qiqihar 161000, China
| | - Wenhui Ma
- Computer Experimental Teaching Center, Qiqihar Medical University, Qiqihar 161000, China
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Du J, Wang S, Cheng Y, Xu J, Li X, Gan Y, Zhang L, Zhang S, Cui X. Effects of Neuromuscular Electrical Stimulation Combined with Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function Rehabilitation in Stroke Patients with Hemiplegia. Comput Math Methods Med 2022; 2022:9455428. [PMID: 35027944 PMCID: PMC8752218 DOI: 10.1155/2022/9455428] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of neuromuscular electrical stimulation (NMES) combined with repetitive transcranial magnetic stimulation (rTMS) on upper limb motor dysfunction in stroke patients with hemiplegia. METHODS A total of 240 stroke patients with hemiplegia who met the inclusion criteria were selected and randomly divided into 4 groups (60 cases in each group): control group, NMES group, rTMS group, and NMES + rTMS group. Before treatment and 4 weeks after treatment, we evaluated and compared the results including Fugl-Meyer assessment of upper extremity (FMA-UE) motor function, modified Barthel index (MBI), modified Ashworth scale (MAS), and motor nerve electrophysiological results among the 4 groups. RESULTS Before treatment, there was no significant difference in the scores of FMA-UE, MBI, MAS, and motor nerve electrophysiological indexes among the four groups, with comparability. Compared with those before treatment, the scores of the four groups were significantly increased and improved after treatment. And the score of the NMES + rTMS group was notably higher than those in the other three groups. CONCLUSION NMES combined with rTMS can conspicuously improve the upper extremity motor function and activities of daily life of stroke patients with hemiplegia, which is worthy of clinical application and promotion.
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Affiliation(s)
- Junqiu Du
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Shouyong Wang
- Department of Neurology, Huai'an NO.3 People's Hospital, Huai'an, Jiangsu 223002, China
| | - Yun Cheng
- Department of Rehabilitation Medicine, Huai'an NO.3 People's Hospital, Huai'an, Jiangsu 223002, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Xuejing Li
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Yimin Gan
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Liying Zhang
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
| | - Song Zhang
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
| | - Xiaorui Cui
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
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MacDonald SL, Hall RE, Bell CM, Cronin S, Jaglal SB. Association of material deprivation with discharge location and length of stay after inpatient stroke rehabilitation in Ontario: a retrospective, population-based cohort study. CMAJ Open 2022; 10:E50-E55. [PMID: 35078823 PMCID: PMC8920538 DOI: 10.9778/cmajo.20200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low socioeconomic status is associated with increased risk of stroke and worse poststroke functional status. The aim of this study was to determine whether socioeconomic status, as measured by material deprivation, is associated with direct discharge to long-term care or length of stay after inpatient stroke rehabilitation. METHODS We performed a retrospective, population-based cohort study of people admitted to inpatient rehabilitation in Ontario, Canada, after stroke. Community-dwelling adults (aged 19-100 yr) discharged from acute care with a most responsible diagnosis of stroke between Sept. 1, 2012, and Aug. 31, 2017, and subsequently admitted to an inpatient rehabilitation bed were included. We used a multivariable logistic regression model to examine the association between material deprivation quintile (from the Ontario Marginalization Index) and discharge to long-term care, and a multivariable negative binomial regression model to examine the association between material deprivation quintile and rehabilitation length of stay. RESULTS A total of 18 736 people were included. There was no association between material deprivation and direct discharge to long-term care (most v. least deprived: odds ratio [OR] 1.07, 95% confidence interval [CI] 0.89-1.28); however, people living in the most deprived areas had a mean length of stay 1.7 days longer than that of people in the least deprived areas (p = 0.004). This difference was not significant after adjustment for other baseline differences (relative change in mean 1.02, 95% CI 0.99-1.04). INTERPRETATION People admitted to inpatient stroke rehabilitation in Ontario had similar discharge destinations and lengths of stay regardless of their socioeconomic status. In future studies, investigators should consider further examining the associations of material deprivation with upstream factors as well as potential mitigation strategies.
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Affiliation(s)
- Shannon L MacDonald
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont.
| | - Ruth E Hall
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Chaim M Bell
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Shawna Cronin
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Susan B Jaglal
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
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12
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Cuccurullo SJ, Fleming TK, Kostis JB, Greiss C, Eckert A, Ray AR, Scarpati R, Zinonos S, Gizzi M, Cosgrove NM, Cabrera J, Oh-Park M, Kostis WJ. Impact of Modified Cardiac Rehabilitation Within a Stroke Recovery Program on All-Cause Hospital Readmissions. Am J Phys Med Rehabil 2022; 101:40-47. [PMID: 33657031 DOI: 10.1097/phm.0000000000001738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A Stroke Recovery Program (SRP) including cardiac rehabilitation demonstrated lower all-cause mortality rates, improved cardiovascular function, and overall functional ability among stroke survivors. Neither an effect of SRP on acute care hospital readmission rates nor cost savings have been reported. DESIGN This prospective matched cohort study included 193 acute stroke survivors admitted to an inpatient rehabilitation facility between 2015 and 2017. The 105 SRP participants and 88 nonparticipants were matched exactly for stroke type, sex, and race and approximately for age, baseline functional scores, and medical complexity scores. Primary outcome measured acute care hospital readmission rate up to 1 yr post-stroke. Secondary outcomes measured costs. RESULTS A 22% absolute reduction (P = 0.006) in hospital readmissions was observed between the SRP participant (n = 47, or 45%) and nonparticipant (n = 59, or 67%) groups. This resulted in significant cost savings. The conventional care cost to the Center for Medicare and Medicaid Services for stroke patients for both readmissions and outpatient therapy is estimated at $9.67 billion annually. The yearly cost for these services with utilization of the SRP is $8.55 billion. CONCLUSION Acute care hospital readmissions were reduced in stroke survivors who participated in SRP. Future study is warranted to examine whether widespread application of a similar program may improve quality of life and decrease cost.
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Affiliation(s)
- Sara J Cuccurullo
- From the JFK Johnson Rehabilitation Institute, Edison, New Jersey (SJC, TKF, CG, AE, ARR, RS); Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (JBK, SZ, NMC, JC, WJK); Hackensack University Medical Center, Hackensack, New Jersey (MG); and Burke Rehabilitation Hospital, White Plains, New York (MO-P)
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Abstract
BACKGROUND The COMprehensive Post-Acute Stroke Services study was a cluster-randomized pragmatic trial designed to evaluate a comprehensive care transitions model versus usual care. The data collected during this trial were complex and analysis methodology was required that could simultaneously account for the cluster-randomized design, missing patient-level covariates, outcome nonresponse, and substantial nonadherence to the intervention. OBJECTIVE The objective of this study was to discuss an array of complementary statistical methods to evaluate treatment effectiveness that appropriately addressed the challenges presented by the complex data arising from this pragmatic trial. METHODS We utilized multiple imputation combined with inverse probability weighting to account for missing covariate and outcome data in the estimation of intention-to-treat effects (ITT). The ITT estimand reflects the effectiveness of assignment to the COMprehensive Post-Acute Stroke Services intervention compared with usual care (ie, it does not take into account intervention adherence). Per-protocol analyses provide complementary information about the effect of treatment, and therefore are relevant for patients to inform their decision-making. We describe estimation of the complier average causal effect using an instrumental variables approach through 2-stage least squares estimation. For all preplanned analyses, we also discuss additional sensitivity analyses. DISCUSSION Pragmatic trials are well suited to inform clinical practice. Care should be taken to proactively identify the appropriate balance between control and pragmatism in trial design. Valid estimation of ITT and per-protocol effects in the presence of complex data requires application of appropriate statistical methods and concerted efforts to ensure high-quality data are collected.
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Affiliation(s)
- Matthew A. Psioda
- Department of Biostatistics, Collaborative Studies Coordinating Center
| | - Sara B. Jones
- Department of Epidemiology, Gillings School of Global Public Health
| | - James G. Xenakis
- Department of Genetics, University of North Carolina, Chapel Hill
| | - Ralph B. D’Agostino
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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14
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Matsushita T, Nishioka S, Taguchi S, Yamanouchi A, Okazaki Y, Oishi K, Nakashima R, Fujii T, Tokunaga Y, Onizuka S. Effect of Improvement in Sarcopenia on Functional and Discharge Outcomes in Stroke Rehabilitation Patients. Nutrients 2021; 13:nu13072192. [PMID: 34202303 PMCID: PMC8308200 DOI: 10.3390/nu13072192] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 01/07/2023] Open
Abstract
This cross-sectional study investigated the proportion of patients’ recovery from sarcopenia status and the relationship between improvement in sarcopenia (IS) and function and discharge outcome in hospitalized patients with stroke. This study included patients with stroke, aged 65 years or more, with a diagnosis of sarcopenia, who were admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were divided according to the presence or absence of sarcopenia at discharge: IS group and non-improvement in sarcopenia (NIS) group. Among the 227 participants (mean age: 80.5 years; 125 females), 30% (69/227) of the patients were in the IS group, while 70% (158/227) were in the NIS group. The IS group showed a higher Functional Independence Measure (FIM) than the NIS group (median 112 vs. 101, p = 0.003). The results demonstrated that IS was independently associated with higher FIM (partial regression coefficient, 5.378; 95% confidence interval (CI), 0.709–10.047). The IS group had higher odds of home discharge than the NIS group (odds ratio, 2.560; 95% CI, 0.912–7.170). In conclusion, recovery from sarcopenia may be associated with better function in patients with stroke.
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15
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Kim CH, Chu H, Kang GH, Kim KH, Lee YU, Lim HS, Sung KK, Lee S. Comparison of gait recovery patterns according to the paralyzed side in stroke patients: An observational study based on a retrospective chart review (STROBE compliant). Medicine (Baltimore) 2021; 100:e25212. [PMID: 33879656 PMCID: PMC8078470 DOI: 10.1097/md.0000000000025212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
Gait rehabilitations have been abundantly performed for post-stroke patients, because gait is the most important factor for the return of post-stroke patients to daily life. However, conventional uniform gait rehabilitations tend to be tedious and reduce motivation. The aim of this study was to contribute to the development of personalized rehabilitation of gait by identifying differences in gait recovery pattern according to the paralyzed side of post-stroke patients.The gait analysis was performed on stroke patients who are right-handed and can walk independently. We retrospectively analyzed the results of pelvic movements and displacement of center of pressure (COP) during gait using corresponding equipments. To show the difference of gait recovery pattern according to the paralyzed side, we divided subjects into two groups, right (n = 19) and left (n = 20) hemiparesis group. The measured variables were as follows: tilt, obliquity, and rotation symmetries of pelvis; area, velocity, and lateral symmetry of COP.First, in the left hemiparesis group, obliquity (P < .01) and rotation (P < .01) symmetries of the movement of the pelvis were significantly improved in the follow-up compared to the initial gait analysis. In the right hemiparesis group, tilt (P < .001), obliquity (P < .001), and rotation (P < .05) symmetries were significantly improved in the follow-up compared to the initial gait analysis. Second, COP area and COP velocity values in the follow-up were significantly smaller than those in the initial gait analysis in the left (P < .001, P < .05) and right (P < .001, P < .01) hemiparesis groups. The positive value of lateral symmetry increased, although not a significant difference statistically, as walking ability improved in both groups. In the correlation analysis among variables obtained using Treadmill, there were significant positive linear relationships between the lateral symmetry and the COP area (P < .05), and between the COP velocity and the lateral symmetry (P < .001) of the follow-up gait analysis in the right hemiparesis group.It was confirmed that the gait recovery pattern differs according to the paralyzed side of post-stroke patients and the role of the intact side, such as moving the COP to the intact side, is important for the improvement of gait function in both groups.This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984) and was approved by the Institutional Review Board (IRB) of the WKUGH (WKIRB [2018-25], November 28, 2018).
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Affiliation(s)
| | - Hongmin Chu
- Department of Internal Medicine and Neuroscience
| | - Geon-Hui Kang
- Hanbang Cardio-Renal Syndrome Research Center, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Kwang-Ho Kim
- Department of Internal Medicine and Neuroscience
| | | | | | | | - Sangkwan Lee
- Department of Internal Medicine and Neuroscience
- Hanbang Cardio-Renal Syndrome Research Center, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea
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16
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Bayliss WS, Bushnell CD, Halladay JR, Duncan PW, Freburger JK, Kucharska-Newton AM, Trogdon JG. The Cost of Implementing and Sustaining the COMprehensive Post-Acute Stroke Services Model. Med Care 2021; 59:163-168. [PMID: 33273292 PMCID: PMC8594619 DOI: 10.1097/mlr.0000000000001462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged home, was tested against status quo postacute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. This study examined the hospital-level costs associated with implementing and sustaining COMPASS. METHODS Using an activity-based costing survey, we estimated hospital-level resource costs spent on COMPASS-related activities during approximately 1 year. We identified hospitals that were actively engaged in COMPASS during the year before the survey and collected resource cost estimates from 22 hospitals. We used median wage data from the Bureau of Labor Statistics and COMPASS enrollment data to estimate the hospital-level costs per COMPASS enrollee. RESULTS Between November 2017 and March 2019, 1582 patients received the COMPASS intervention across the 22 hospitals included in this analysis. Average annual hospital-level COMPASS costs were $2861 per patient (25th percentile: $735; 75th percentile: $3,475). Having 10% higher stroke patient volume was associated with 5.1% lower COMPASS costs per patient (P=0.016). About half (N=10) of hospitals reported postacute clinic visits as their highest-cost activity, while a third (N=7) reported case ascertainment (ie, identifying eligible patients) as their highest-cost activity. CONCLUSIONS We found that the costs of implementing COMPASS varied across hospitals. On average, hospitals with higher stroke volume and higher enrollment reported lower costs per patient. Based on average costs of COMPASS and readmissions for stroke patients, COMPASS could lower net costs if the model is able to prevent about 6 readmissions per year.
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Affiliation(s)
- William S Bayliss
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem
| | - Jacqueline R Halladay
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Pamela W Duncan
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, Pittsburgh, PA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
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Xi X, Li H, Wang L, Yin X, Zeng J, Song Y, Zhai Y, Zeng X, Zhao X. How demographic and clinical characteristics contribute to the recovery of post-stroke dysphagia? Medicine (Baltimore) 2021; 100:e24477. [PMID: 33530262 PMCID: PMC7850691 DOI: 10.1097/md.0000000000024477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022] Open
Abstract
According to the analysis to find out how demographic and clinical characteristics influent the dysphagia outcome after stroke, furthermore, giving some insights to clinical treatment.One hundred eighty post-stroke dysphagia (PSD) patients were enrolled in this retrospective study at the stroke rehabilitation department. The outcome measurements are beside water swallow test at discharge and length of stay at hospital. Twenty-five demographic and clinical variables were collected for this study. Logistic regression and multilinear regression were utilized to estimate models to identify the risk and protect predictors of PSD outcome.Mouth-opening degree, drooling severity scale (DSS) level, mini-mental state exam (MMSE) level, Barthel index and Berg balance scale were significant different between recovered and unrecovered group. Type of stroke, MMSE degree, DSS and hemoglobin level shown significant predictive value for PSD outcome in logistic regression. In addition, obstructive sleep apnea (OSA) and DSS degree were important risk factors for PSD outcome. Gender, body mass index, drinking, hypertension, recurrent stroke, water swallow test level on admission, Berg balance scale, DSS and days between onset to admission shown significant predictive value for length of stay of PSD patients.PSD outcome was influenced by type of stroke, MMSE degree, DSS and hemoglobin level significantly and obstructive sleep apnea act as an important risk role for PSD recovery.
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Abstract
Objectives To investigate the current status of participation and explore the characteristics of individuals with different levels of participation among stroke survivors in mainland China. Design Cross-sectional survey. Setting Participants were recruited by convenience sampling from the neurology department of the tertiary hospitals and communities. Subjects Stroke survivors (N = 517; mean (±SD) age, 69.97±11.51 y; 36.8% female). Intervention Not applicable. Main outcome measures Participation was measured using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Rating of disability was assessed using the Modified Rankin Scale (mRS). The Perceived Social Support Scale (PSSS), the Medical Coping Modes Questionnaire (MCMQ), and the Herth Hope Scale (HHS) were also employed to measure social support, coping strategy, and hope of stroke survivors. The latent profiles analysis (LPA) was conducted using the Mplus version 8.3. Results The mean score of participation was 41.21±21.204. Participants were divided into three groups according to the participation using the LPA. The mean score on the sum of IPA for the high, medium, and low participation groups was 18.93±8.529, 42.50±8.302, and 69.44±9.516, respectively. Conclusions Stroke survivors have a low level of participation. Stroke survivors with low income, high mRS stage, bad health condition, and being dissatisfied for life tended to have low participation. Healthcare professionals should pay special attention to them and make targeted interventions based on their characteristics.
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Affiliation(s)
- Yuxia Li
- School of Nursing, Second Military Medical University, Shanghai, China
| | - Xuemei Li
- School of Nursing, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- School of Nursing, Second Military Medical University, Shanghai, China
- * E-mail:
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19
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Prat-Luri A, Moreno-Navarro P, García JA, Barbado D, Vera-Garcia FJ, Elvira JL. Do Initial Trunk Impairment, Age, Intervention Onset, and Training Volume Modulate the Effectiveness of Additional Trunk Exercise Programs after Stroke? A Systematic Review with Meta-Analyses. Int J Environ Res Public Health 2020; 17:E8714. [PMID: 33255211 PMCID: PMC7727690 DOI: 10.3390/ijerph17238714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022]
Abstract
The aim of this systematic review is to analyze how, after additional trunk-focused training programs (ATEP), motor recovery after a stroke is modulated by potential effect modifiers. Twenty randomized controlled studies that carried out ATEP were included. Results showed moderate-to-high effects in favor of ATEP for trunk function, balance ability, gait performance, and functional mobility. Studies with a higher initial trunk impairment obtained a higher effect on trunk function and balance; studies with older participants had a higher effect on trunk function, limit of stability, and functional mobility, but not on balance ability. Older and more affected patients were, as well, those who started the intervention earlier, which was also linked with higher effects on trunk function, balance, and gait performance. Longer ATEP found a high effect on trunk function and balance ability. The potential effect modifiers seem to be important in the modulation of the effectiveness of ATEP and should be considered in the design of rehabilitation programs. Thus, since potential effect modifiers seem to modulate ATEP effectiveness, future studies should consider them in their experimental designs to better understand their impact on stroke rehabilitation.
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Affiliation(s)
- Amaya Prat-Luri
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Pedro Moreno-Navarro
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Jose A. García
- Infectious Diseases Unit, Hospital General Universitario de Elche, Miguel Hernández University of Elche, 03203 Elche, Spain;
| | - David Barbado
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Francisco J. Vera-Garcia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Jose L.L. Elvira
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
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Sullivan R, Harding K, Skinner I, Hemsley B. Falls in hospital patients with acquired communication disability secondary to stroke: A systematic review and meta-analysis. Int J Lang Commun Disord 2020; 55:837-851. [PMID: 32970385 DOI: 10.1111/1460-6984.12570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Falls are a common safety incident in people with stroke. Studies report that between 14% and 65% of people with stroke fall at least once during their hospital admission. Risk factors for falls in people with stroke have been reported to include neglect, balance and dependence for activities of daily living. Communication disability has been identified as a risk factor for patient safety incidents in hospital that has not been closely examined as a potential risk factor for falls in people with stroke. AIM To determine the association between communication disability secondary to stroke and falls in people with stroke in hospital. METHODS & PROCEDURES Systematic searches of five electronic databases were conducted in June 2019 using the key concepts of 'falls' and 'stroke' (PROSPERO CRD 42019137199). Included studies provided comparative data of falls in patients with stroke with and without communication disability. The methodological quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Both a narrative synthesis and a meta-analysis were completed. MAIN CONTRIBUTION A total of 15 studies met the criteria for inclusion and 11 were included in a meta-analysis. Three studies found people with communication disability had an increased rate of falls in hospital. However, a meta-analysis showed no significant association between a non-specific classification of communication disability and an increased risk of falls. There was some indication from individual studies that higher risk of falls may be associated with severe communication disability, but there were insufficient data reported on the severity of the communication disability to draw robust conclusions. CONCLUSION & IMPLICATIONS The results of this systematic review suggest that a generic classification of communication disability following stroke is not a risk factor for falls. However, further research that is inclusive of this population and considers severity of communication disability more specifically is required. What this paper adds What is already known on the subject The association between communication disability following stroke and falls in hospital is unclear. The literature reports mixed results regarding the impact of a communication disability following stroke on falls risk or rates of falls during hospital admission. What this paper adds to existing knowledge This review is the first to bring together this diverse literature to examine the association between communication disability following stroke and falls in hospital. The results suggest that a generic classification of communication disability following stroke is not a risk factor for falls. What are the potential or actual clinical implications of this work? There is a possibility that moderate to severe communication disability may be related to falls in patients in hospital. Further research is indicated to be more inclusive of people with communication disability, including those with severe communication disability.
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Affiliation(s)
- Rebecca Sullivan
- Speech Pathology Department, Eastern Health, Box Hill, Melbourne, Australia
| | - Katherine Harding
- Allied Health Clinical Research Office, Eastern Health & La Trobe University
| | - Ian Skinner
- School of Community Health, Charles Sturt University
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de Havenon A, Yaghi S, Mistry EA, Delic A, Hohmann S, Shippey E, Stulberg E, Tirschwell D, Frontera JA, Petersen NH, Anadani M. Endovascular thrombectomy in acute ischemic stroke patients with COVID-19: prevalence, demographics, and outcomes. J Neurointerv Surg 2020; 12:1045-1048. [PMID: 32989032 PMCID: PMC7523171 DOI: 10.1136/neurintsurg-2020-016777] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND We aimed to compare the outcome of acute ischemic stroke (AIS) patients who received endovascular thrombectomy (EVT) with confirmed COVID-19 to those without. METHODS We performed a retrospective analysis using the Vizient Clinical Data Base and included hospital discharges from April 1 to July 31 2020 with ICD-10 codes for AIS and EVT. The primary outcome was in-hospital death and the secondary outcome was favorable discharge, defined as discharge home or to acute rehabilitation. We compared patients with laboratory-confirmed COVID-19 to those without. As a sensitivity analysis, we compared COVID-19 AIS patients who did not undergo EVT to those who did, to balance potential adverse events inherent to COVID-19 infection. RESULTS We identified 3165 AIS patients who received EVT during April to July 2020, in which COVID-19 was confirmed in 104 (3.3%). Comorbid COVID-19 infection was associated with younger age, male sex, diabetes, black race, Hispanic ethnicity, intubation, acute coronary syndrome, acute renal failure, and longer hospital and intensive care unit length of stay. The rate of in-hospital death was 12.4% without COVID-19 vs 29.8% with COVID-19 (P<0.001). In mixed-effects logistic regression that accounted for patient clustering by hospital, comorbid COVID-19 increased the odds of in-hospital death over four-fold (OR 4.48, 95% CI 3.02 to 6.165). Comorbid COVID-19 was also associated with lower odds of a favorable discharge (OR 0.43, 95% CI 0.30 to 0.61). In the sensitivity analysis, comparing AIS patients with COVID-19 who did not undergo EVT (n=2139) to the AIS EVT patients with COVID-19, there was no difference in the rate of in-hospital death (30.6% vs 29.8%, P=0.868), and AIS EVT patients had a higher rate of favorable discharge (32.4% vs 47.1%, P=0.002). CONCLUSION In AIS patients treated with EVT, comorbid COVID-19 infection was associated with in-hospital death and a lower odds of favorable discharge compared with patients without COVID-19, but not compared with AIS patients with COVID-19 who did not undergo EVT. AIS EVT patients with COVID-19 were younger, more likely to be male, have systemic complications, and almost twice as likely to be black and over three times as likely to be Hispanic.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Shadi Yaghi
- Neurology, NYU School of Medicine, Brooklyn, New York, USA
| | - Eva A Mistry
- Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alen Delic
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | | | | | - Eric Stulberg
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | | | | | | | - Mohammad Anadani
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Trimble J, Patterson J. Cough reflex testing in acute stroke: A survey of current UK service provision and speech and language therapist perceptions. Int J Lang Commun Disord 2020; 55:899-916. [PMID: 32893941 DOI: 10.1111/1460-6984.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Silent aspiration (SA)-airway entry of food, drink or other material without a cough response-is common post-stroke. Clinical swallowing examination misses up to 40% of dysphagic patients with SA. This may put these patients at risk of aspiration pneumonia, prolonged length of hospital stay and increased healthcare costs. After stroke, the laryngeal cough reflex is frequently impaired with significant relationships between pneumonia rates and reduced cough strength and sensitivity. There has been a significant amount of recent interest in cough reflex testing (CRT) as a potential means to improve clinical identification of patients at risk of SA. However, there is a lack of consensus regarding the methodology and protocols for use of CRT with widely varying outcomes reported in the literature. AIMS To provide an overview of current practice in the UK with regards to clinical use of CRT by speech and language therapists (SLTs) in acute stroke settings and to explore the perceptions regarding its potential application in clinical dysphagia management and the barriers and facilitators associated with adopting CRT in clinical practice. METHODS & PROCEDURES A cross-sectional web-based survey was developed, piloted and delivered. The survey targeted all UK-based SLTs working in acute stroke settings. OUTCOMES & RESULTS A total of 129 SLTs with varying levels of experience of CRT from all regions of the UK responded. Only four SLT services in the UK were reported to be currently using CRT clinically with acute stroke patients. A total of 29% of respondents who were not using CRT were considering introducing CRT into their service's dysphagia protocol. Variation was reported in the procedures and protocols. Overall, users reported improved confidence in the clinical detection of SA and felt that the introduction of CRT had improved their patient-related outcomes. Issues included difficulties procuring citric acid, implications for SLT time (including service set-up and delivery of CRT) and restricted access to instrumental assessments. CONCLUSIONS & IMPLICATIONS This survey gives valuable insight into the current practice and perceptions of SLTs in the UK working in acute stroke settings in relation to CRT. It highlights discrepancies between reported approaches and recommendations from existing guidelines and validation studies. The variation in responses indicates a need to develop a consensus statement and further research to guide practice. What this study adds What is already known on the subject CRT is gaining popularity as a screening tool for the clinical identification of SA with acute stroke patients. However, there is a lack of consensus in the literature regarding the methodology and protocols with widely varying outcomes. Further work needs to be done to standardize its use, especially if it is to be incorporated into dysphagia protocols for use in the acute stroke setting. What this paper adds to existing knowledge This survey of SLTs working in acute stroke settings highlights variability in practice in CRT service delivery in the UK, reflecting findings from the existing CRT literature. What are the potential or actual clinical implications of this work? The findings of this study support the need for further research relating to clinical screening tests for SA and standardization of methodology and protocols for CRT use if its use is to be continued clinically.
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Affiliation(s)
- Julie Trimble
- Adult Speech and Language Therapy Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Joanne Patterson
- School of Health Sciences, Institute of Clinical Sciences/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
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Ren XR, Wei YY, Su XN, Hua Y, Shao P, Xiao T, Wang J, Ni CP, Guo HX. Correlation between self-perceived burden and self-management behavior in elderly stroke survivors: A longitudinal observational study. Medicine (Baltimore) 2020; 99:e22862. [PMID: 33126330 PMCID: PMC7598859 DOI: 10.1097/md.0000000000022862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to assess the levels of self-perceived burden (SPB) and self-management behavior in elderly stroke survivors during the first 3 months after acute stroke, and to explore the correlation between them.A total of 203 consecutive hospitalized elderly patients diagnosed with stroke were recruited. Self-perceived Burden Scale and Stroke Self-management Scale in 1 month (T1) and 3 months (T2) post-stroke were assessed and compared.The score of SPB in elderly stroke survivors was 28.96 ± 5.50 and 27.25 ± 6.17 at T1 and T2, respectively. Stroke self-management scale scored 165.93 ± 9.82 at T1 and 167.29 ± 10.60 at T2. In the first 3 months post-stroke, the physical burden was dominant (T1 14.73 ± 3.07, T2 14.40 ± 3.13), and the behavior of stroke symptoms and signs monitoring (T1 27.58 ± 6.56, T2 28.64 ± 6.43) and rehabilitation exercise management (T1 21.40 ± 3.28, T2 20.74 ± 3.15) was the worst. SPB was negatively correlated with self-management behavior (T1 r = -.202, T2 r = -.511).Elderly stroke survivors experienced a medium level of SPB and self-management behavior in the first 3 months post-stroke. There is a positive relationship between reduced SPB and improved self-management behavior. Addressing the characteristics and correlations as well as development of targeted interventions for SPB decreasing is beneficial to improving self-management behavior for elderly survivors.
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Affiliation(s)
- Xiao-Ran Ren
- School of Nursing, the Fourth Military Medical University, Xi’an
| | - Yuan-Yuan Wei
- School of Nursing, the Fourth Military Medical University, Xi’an
- Leshan Retired Cadre Sanatorium, Sichuan Military Region, Leshan
| | - Xiang-Ni Su
- School of Nursing, the Fourth Military Medical University, Xi’an
| | - Yan Hua
- School of Nursing, the Fourth Military Medical University, Xi’an
| | - Pei Shao
- School of Nursing, the Fourth Military Medical University, Xi’an
| | - Ting Xiao
- School of Nursing, the Fourth Military Medical University, Xi’an
| | - Jing Wang
- School of Nursing, the Fourth Military Medical University, Xi’an
| | - Chun-Ping Ni
- School of Nursing, the Fourth Military Medical University, Xi’an
| | - Hong-Xia Guo
- School of Nursing, Sichuan University, Chengdu, China
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Irisawa H, Mizushima T. Correlation of Body Composition and Nutritional Status with Functional Recovery in Stroke Rehabilitation Patients. Nutrients 2020; 12:nu12071923. [PMID: 32610491 PMCID: PMC7400130 DOI: 10.3390/nu12071923] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 01/10/2023] Open
Abstract
Previous studies have suggested that the nutritional status after stroke is independently associated with long-term outcomes and that sarcopenia delays poststroke rehabilitation and worsens the prognosis. However, many stroke patients have a deteriorated nutritional status and a decreased muscle mass in the acute phase. This prospective study included 179 patients who were admitted to the stroke rehabilitation unit. We performed bioelectrical impedance analysis and determined the Geriatric Nutritional Risk Index (GNRI) to assess muscle mass and the nutritional status on admission. Furthermore, we analyzed the activities of daily living using the Functional Independence Measure (FIM) at the time of admission and four weeks later. Furthermore, we evaluated the change in motor FIM items and examined the relationship with the data. Multiple regression analysis revealed that a high muscle rate (skeletal muscle mass/body weight) (odds ratio OR = 2.43), high phase angle (OR = 3.32), and high GNRI (OR = 2.57) were significantly associated with motor FIM items at four weeks in male and female patients. Muscle mass maintenance through nutritional management and early rehabilitation in the acute period of stroke is essential for functional recovery in stroke patients.
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Affiliation(s)
- Hiroshi Irisawa
- Department of Rehabilitation Medicine, Dokkyo Medical University, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi 3210293, Japan;
- Department of Rehabilitation Medicine, Setagaya Memorial Hospital, 2-30-10, Noge, Setagaya, Tokyo 1580092, Japan
- Correspondence: ; Tel.: +81-282872170
| | - Takashi Mizushima
- Department of Rehabilitation Medicine, Dokkyo Medical University, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi 3210293, Japan;
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Ehsanian R, Anderson S, Schneider B, Kennedy D, Mansourian V. Prevalence of Low Plasma Vitamin B1 in the Stroke Population Admitted to Acute Inpatient Rehabilitation. Nutrients 2020; 12:nu12041034. [PMID: 32290066 PMCID: PMC7230706 DOI: 10.3390/nu12041034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the prevalence of vitamin B1 (VitB1) deficiency in the stroke population admitted to acute inpatient rehabilitation. DESIGN Retrospective cohort study. SETTING Acute inpatient rehabilitation facility at an academic medical center. PARTICIPANTS 119 consecutive stroke patients admitted to stroke service from 1 January 2018 to 31 December 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Plasma VitB1 level. RESULTS There were 17 patients (14%; 95% CI 9-22%) with low VitB1 with a range of 2-3 nmol/L, an additional 58 (49%; CI 40-58%) patients had normal low VitB1 with a range of 4-9 nmol/L, twenty-five patients (21%; CI 15-29%) had normal high VitB1 with a range of 10-15 nmol/L, and nineteen patients (16%; CI 10-24%) had high VitB1 with a range of 16-43 nmol/L. CONCLUSIONS In this cohort of patients admitted to the stroke service at an acute rehabilitation facility, there is evidence of thiamine deficiency. Moreover, the data suggest that there is inadequate acute intake of VitB1. Given the role of thiamine deficiency in neurologic function, further study of the role of thiamine optimization in the acute stroke rehabilitation population is warranted.
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Affiliation(s)
- Reza Ehsanian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Department of Neurosurgery, Stanford University, Palo Alto, CA 34304, USA
- Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Sean Anderson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Byron Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - David Kennedy
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Vartgez Mansourian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Correspondence: ; Tel.: +615-936-7708
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Ontario Health (Quality). Continual Long-Term Physiotherapy After Stroke: A Health Technology Assessment. Ont Health Technol Assess Ser 2020; 20:1-70. [PMID: 32194882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Stroke is a serious health issue in which an interruption in blood flow to any part of the brain damages brain cells. About 83% of people survive with substantial morbidity after their first stroke. We conducted a health technology assessment of continual long-term physiotherapy for people with a diagnosis of stroke, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding continual long-term physiotherapy for people with a diagnosis of stroke, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence. We also performed a systematic literature search of the economic evidence. We did not conduct a primary economic evaluation because there was insufficient clinical evidence. We also analyzed the budget impact of publicly funding continual long-term physiotherapy after stroke in Ontario. To contextualize the potential value of continual long-term physiotherapy after stroke, we spoke with people who had been diagnosed with stroke, as well as their caregivers. RESULTS We did not find any published studies that met the specific clinical inclusion criteria. We did not identify any studies that compared the cost-effectiveness of continual long-term versus short-term physiotherapy after stroke. The budget impact of publicly funding continual long-term physiotherapy after stroke in Ontario over the next 5 years ranges from $445,000 in year 1 at an uptake rate of 8% to $888,000 in year 5 at an uptake rate of 16%. The people who had been diagnosed with stroke with whom we spoke reported that they had benefitted from continual long-term physiotherapy. CONCLUSIONS We did not identify studies that addressed the specific research question. Based on the clinical evidence review, we are unable to determine the benefits of continual long-term compared with short-term physiotherapy after stroke. The cost-effectiveness of continual long-term physiotherapy after stroke in Ontario is unknown. We estimate that publicly funding continual long-term physiotherapy after stroke in Ontario would result in additional costs of between $445,000 and $888,000 annually over the next 5 years. Patients and caregivers who we spoke with felt that patients who have experienced a stroke should be able to continue with physiotherapy.
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Hong I, Goodwin JS, Reistetter TA, Kuo YF, Mallinson T, Karmarkar A, Lin YL, Ottenbacher KJ. Comparison of Functional Status Improvements Among Patients With Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities. JAMA Netw Open 2019; 2:e1916646. [PMID: 31800069 PMCID: PMC6902754 DOI: 10.1001/jamanetworkopen.2019.16646] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Health care reform legislation and Medicare plans for unified payment for postacute care highlight the need for research examining service delivery and outcomes. OBJECTIVE To compare functional outcomes in patients with stroke after postacute care in inpatient rehabilitation facilities (IRF) vs skilled nursing facilities (SNF). DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients with stroke who were discharged from acute care hospitals to IRF or SNF from January 1, 2013, to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. Data analyses were conducted from January 17, 2017, through April 25, 2019. EXPOSURES Inpatient rehabilitation received in IRFs vs SNFs. MAIN OUTCOMES AND MEASURES Changes in mobility and self-care measures during an IRF or SNF stay were compared using multivariate analyses, inverse probability weighting with propensity score, and instrumental variable analyses. Mortality between 30 and 365 days after discharge was included as a control outcome as an indicator for unmeasured confounders. RESULTS Among 99 185 patients who experienced a stroke between January 1, 2013, and November 30, 2014, 66 082 patients (66.6%) were admitted to IRFs and 33 103 patients (33.4%) were admitted to SNFs. A higher proportion of women were admitted to SNFs (21 466 [64.8%] women) than IRFs (36 462 [55.2%] women) (P < .001). Compared with patients admitted to IRFs, patients admitted to SNFs were older (mean [SD] age, 79.4 [7.6] years vs 83.3 [7.8] years; P < .001) and had longer hospital length of stay (mean [SD], 4.6 [3.0] days vs 5.9 [4.2] days; P < .001) than those admitted to IRFs. In unadjusted analyses, patients with stroke admitted to IRF compared with those admitted to SNF had higher mean scores for mobility on admission (44.2 [95% CI, 44.1-44.3] points vs 40.8 [95% CI, 40.7-40.9] points) and at discharge (55.8 [95% CI, 55.7-55.9] points vs 44.4 [95% CI, 44.3-44.5] points), and for self-care on admission (45.0 [95% CI, 44.9-45.1] points vs 41.8 [95% CI, 41.7-41.9] points) and at discharge (58.6 [95% CI, 58.5-58.7] points vs 45.1 [95% CI, 45.0-45.2] points). Additionally, patients in IRF compared with those in SNF had larger improvements for mobility score (11.6 [95% CI, 11.5-11.7] points vs 3.5 [95% CI, 3.4-3.6] points) and for self-care score (13.6 [95% CI, 13.5-13.7] points vs 3.2 [95% CI, 3.1-3.3] points). Multivariable, propensity score, and instrumental variable analyses showed a similar magnitude of better improvements in patients admitted to IRF vs those admitted to SNF. The differences between SNF and IRF in odds of 30- to 365-day mortality (unadjusted odds ratio, 0.48 [95% CI, 0.46-0.49]) were reduced but not eliminated in multivariable analysis (adjusted odds ratio, 0.72 [95% CI, 0.69-0.74]) and propensity score analysis (adjusted odds ratio, 0.75 [95% CI, 0.72-0.77]). These differences were no longer statistically significant in the instrumental variable analyses. CONCLUSIONS AND RELEVANCE In this cohort study of a large national sample, inpatient rehabilitation in IRFs for patients with stroke was associated with substantially improved physical mobility and self-care function compared with rehabilitation in SNFs. This finding raises questions about the value of any policy that would reimburse IRFs or SNFs at the same standard rate for stroke.
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Affiliation(s)
- Ickpyo Hong
- University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston
| | - James S. Goodwin
- University of Texas Medical Branch, School of Medicine, Sealy Center on Aging, Department of Internal Medicine, Galveston
| | - Timothy A. Reistetter
- University of Texas Health Science Center at San Antonio, School of Health Professions, Department of Occupational Therapy, San Antonio
| | - Yong-Fang Kuo
- University of Texas Medical Branch, School of Medicine, Sealy Center on Aging, Department of Preventive Medicine and Population Health, Galveston
| | - Trudy Mallinson
- George Washington University, School of Medicine and Health Sciences, Clinical Research and Leadership, Washington, DC
| | - Amol Karmarkar
- University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston; now with Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond
| | - Yu-Li Lin
- University of Texas Medical Branch, School of Medicine, Department of Preventive Medicine and Population Health, Galveston
| | - Kenneth J. Ottenbacher
- University of Texas Medical Branch, School of Health Professions, Sealy Center on Aging, Division of Rehabilitation Sciences, Galveston
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Al-Senani F, Salawati M, AlJohani M, Cuche M, Seguel Ravest V, Eggington S. Workforce requirements for comprehensive ischaemic stroke care in a developing country: the case of Saudi Arabia. Hum Resour Health 2019; 17:90. [PMID: 31791343 PMCID: PMC6889528 DOI: 10.1186/s12960-019-0408-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ischaemic stroke care requires a co-ordinated multi-disciplinary approach to optimise patient outcomes. Current care provision in Saudi Arabia is below international recommendations, and with increasing patient numbers, variable access to new therapies, and sub-optimal co-ordination of staff, the Kingdom's Ministry of Health has prioritised strategies to develop stroke care. Our objective was to use local epidemiological data to predict stroke incidence and to combine this with international staffing recommendations to estimate future staff requirements and their costs over a 10-year period. METHODS We researched existing stroke services and staff availability within Saudi Arabia to establish current provision, undertook epidemiological modelling to predict stroke incidence, and used international staffing recommendations for acute and rehabilitation services to develop a care pathway to provide state-of-the-art stroke services. This information was used to determine the additional staff requirements, and their costs, across the Kingdom. RESULTS Our research concluded that current staff numbers and services are inadequate to cope with the projected increase in the number of stroke cases. In order to provide acute and rehabilitation services which use the latest technologies, re-organisation of existing staff and services would be required, together with significant investment in new staff across several disciplines. An estimated additional 43.8 full-time equivalent stroke neurologists would be required, plus 53.5 full-time equivalent interventional neuroradiologists in addition to expansion of occupational therapy and psychology services. The total cost of additional staff over 10 years was estimated to be 862 390 778 Saudi Riyals ($229 970 874). CONCLUSIONS Providing high-quality care for ischaemic stroke patients would involve significant investment in new staff in Saudi Arabia. Further research is required on the applicability of international staffing ratios to countries where there is a significant workforce gap. Nevertheless, this analysis provides a framework to inform stroke care planning and can be adapted to other regions or countries.
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Affiliation(s)
- Fahmi Al-Senani
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Salawati
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed AlJohani
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Matthieu Cuche
- Neurovascular Health Economics and Reimbursement, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | | | - Simon Eggington
- Corporate Health Economics and Reimbursement, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
- Medtronic International Trading Sàrl, Route du Molliau 31, 1131, Tolochenaz, Switzerland
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Keptner KM, Smyth K, Koroukian S, Schluchter M, Furlan A. Utilization of Rehabilitation Services in Stroke: A Study Utilizing the Health and Retirement Study With Linked Medicare Claims Data. Arch Phys Med Rehabil 2019; 100:2244-2250. [PMID: 31421093 PMCID: PMC7739196 DOI: 10.1016/j.apmr.2019.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 06/14/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe Medicare fee-for-service beneficiaries who used poststroke rehabilitation services and identified the strongest predictors of utilization after the initial stroke care episode. DESIGN Pooled, cross-sectional design using data from 1998 to 2010 from the Health and Retirement Study (HRS) with linked Medicare claims data. SETTING NA. PARTICIPANTS Stroke survivors who were Medicare fee-for-service beneficiaries and participated in the HRS were included (N=515). MAIN OUTCOME MEASURE Utilization of rehabilitation services up to 10 years poststroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors, and social support. RESULTS Rehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and <16% in years 2, 4, 6, 8, and 10, respectively. Age was the primary factor predicting use of rehabilitation in the first 10 years poststroke (odds ratio: 1.14; P=.001). Recurrent stroke (odds ratio: 1.64; P=.051) was also significantly associated with utilization, whereas unspecified incident stroke at incident trended toward significance (odds ratio: 2.17; P=.077). None of the other factors was a significant predictor of participation in rehabilitation services in this period. CONCLUSION A small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years poststroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.
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Affiliation(s)
- Karen M Keptner
- School of Medicine, Case Western Reserve University, Cleveland, OH.
| | - Kathleen Smyth
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Siran Koroukian
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Mark Schluchter
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Anthony Furlan
- School of Medicine, Case Western Reserve University, Cleveland, OH
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Mohd Nordin NA, Yusoff NAH, Ajit Singh DK. Facilitating Exercise Engagement among Community Dwelling Stroke Survivors: Is a once Per Week Group Session Sufficient? Int J Environ Res Public Health 2019; 16:E4746. [PMID: 31783575 PMCID: PMC6926925 DOI: 10.3390/ijerph16234746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022]
Abstract
Although exercise is proven as an effective strategy to combat post-stroke complications and the risk of stroke recurrence, many stroke survivors fail to engage in this activity following rehabilitation. In this study, we assessed the feasibility and usefulness of a low-frequency group exercise to determine its suitability as an approach to facilitate exercise engagement among stroke survivors. Forty-one stroke survivors, mean (SD) age 59.34 (10.02) years, mean time post-stroke 17.13 (17.58) months, completed a 90 minute, once per week, group exercise supervised by therapists for 12 weeks. The exercise outcomes were measured using standardized clinical tests. We observed improvement in the group's physical performance; balance score by 3 units (Z = -3.88, p < 0.001), speed of repetitive sit to stand by 3.4 s (Z = -4.69, p < 0.001), and walking speed by 8.22 m/min (Z = -3.25, p < 0.001). Scores of seven out of 14 Berg's balance scale items increased significantly, indicating better balance ability among the survivors. In conclusion, a 12-week, once per week group exercise session seems feasible and sufficient to improve the physical performance of community dwelling stroke survivors. This exercise arrangement may be offered to stroke survivors to facilitate exercise practice following rehabilitation.
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Affiliation(s)
- Nor Azlin Mohd Nordin
- Physiotherapy Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda, Abdul Aziz, Kuala Lumpur 50300, Malaysia; (N.A.H.Y.); (D.K.A.S.)
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Olmedo Vega V, Aguilar Idáñez MJ, Arenillas Lara JF. [Analysis of factors associated with the comprehensive recovery of stroke patients at acute hospital discharge]. Rev Esp Salud Publica 2019; 93:e201910103. [PMID: 31659148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/08/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE Stroke is a public health problem of the first magnitude, being the first cause of disability in Spain. Although the fundamental role of psychophysical rehabilitation is known in patients suffering from this pathology, little is known about the integral and functional recovery of this type of patient. The Public Health Systems pay for or manage part of the treatment, but never its entirety. The aim of our study was to identify the factors that hinder access to the different treatments and care that allow the functional recovery of stroke patients. METHODS Bivariate correlational descriptive analysis was performed on a sample of 102 stroke patients, over 30 years of age, admitted to the University Clinical Hospital of Valladolid, who required comprehensive rehabilitation upon discharge from hospital. Additionally, a multivariable analysis (logistic regression) was carried out to adjust results and eliminate confusing variables. RESULTS The study showed that the factors initially associated with access to total rehabilitation were age (p<0.001), place of residence (p<0.001), marital status (p=0.007) and the existence of family support (p=0.01). Sex (p=0.18) and income (p=0.62) were not statistically significant. Age and place of residence (rural or urban) were the explanatory factors for access to comprehensive rehabilitation (values adjusted for all other variables p<0.001 were obtained). CONCLUSIONS The results show the existence of very unequal access variables to comprehensive rehabilitation, with the consequences of loss of quality of life and impossibility of functional recovery that this implies, both for stroke patients of advanced age and for patients residing in rural areas.
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Affiliation(s)
- Verónica Olmedo Vega
- Unidad Trabajo Social Sanitario. Área Neurología. Hospital Clínico Universitario de Valladolid. Valladolid. España
| | - Mª José Aguilar Idáñez
- Catedrática de Trabajo Social y Servicios Sociales. Universidad de Castilla y La Mancha. Albacete. España
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Gaspari AP, Cruz EDDA, Batista J, Alpendre FT, Zétola V, Lange MC. Predictors of prolonged hospital stay in a Comprehensive Stroke Unit. Rev Lat Am Enfermagem 2019; 27:e3197. [PMID: 31618390 PMCID: PMC6792336 DOI: 10.1590/1518-8345.3118.3197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/23/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital. METHOD this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation). RESULTS 353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days). CONCLUSION this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units.
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Affiliation(s)
- Ana Paula Gaspari
- Universidade Federal do Paraná, Complexo Hospitalar de Clínicas,
Curitiba, PR, Brasil
| | | | - Josemar Batista
- Governo do Estado do Paraná, Secretaria do Estado da Educação,
Curitiba, PR, Brasil
| | | | - Viviane Zétola
- Universidade Federal do Paraná, Complexo Hospitalar de Clínicas,
Curitiba, PR, Brasil
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Jang MU, Kang J, Kim BJ, Hong JH, Yeo MJ, Han MK, Lee BC, Yu KH, Oh MS, Choi KC, Lee SH, Hong KS, Cho YJ, Park JM, Cha JK, Kim DH, Park TH, Lee KB, Lee SJ, Lee J, Kim JT, Kim DE, Choi JC, Lee J, Lee JS, Gorelick PB, Bae HJ. In-Hospital and Post-Discharge Recovery after Acute Ischemic Stroke: a Nationwide Multicenter Stroke Registry-base Study. J Korean Med Sci 2019; 34:e240. [PMID: 31538419 PMCID: PMC6753366 DOI: 10.3346/jkms.2019.34.e240] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Using data from a large national stroke registry, we aimed to investigate the incidence and determinants of in-hospital and post-discharge recovery after acute ischemic stroke and the independence of their occurrence. METHODS In-hospital recovery was defined as an improvement of 4 points or > 40% in the National Institutes of Health Stroke Scale (NIHSS) score from admission to discharge. Post-discharge recovery was defined as any improvement in the modified Rankin Scale (mRS) score from discharge to 3 months after stroke onset. Two analytic methods (multivariate and multivariable logistic regression) were applied to compare the effects of 18 known determinants of 3-month outcome and to verify whether in-hospital and post-discharge recovery occur independently. RESULTS During 54 months, 11,088 patients with acute ischemic stroke meeting the eligibility criteria were identified. In-hospital and post-discharge recovery occurred in 36% and 33% of patients, respectively. Multivariate logistic regression with an equality test for odds ratios showed that 7 determinants (age, onset-to-admission time, NIHSS score at admission, blood glucose at admission, systolic blood pressure, smoking, recanalization therapy) had a differential effect on in-hospital and post-discharge recovery in the way of the opposite direction or of the same direction with different degree (all P values < 0.05). Both in-hospital and post-discharge recovery occurred in 12% of the study population and neither of them in 43%. The incidence of post-discharge recovery in those with in-hospital recovery was similar to that in those without (33.8% vs. 32.7%, respectively), but multivariable analysis showed that these 2 types of recovery occurred independently. CONCLUSION Our findings suggest that, in patients with acute ischemic stroke, in-hospital and post-discharge recovery may occur independently and largely in response to different factors.
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Affiliation(s)
- Min Uk Jang
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Min Ju Yeo
- Department of Neurology, Hankook General Hospital, Jeju, Korea
| | - Moon Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung Chan Choi
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang Hwa Lee
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Keun Sik Hong
- Department of Neurology, Inje University, Ilsan Paik Hospital, Ilsan, Korea
| | - Yong Jin Cho
- Department of Neurology, Inje University, Ilsan Paik Hospital, Ilsan, Korea
| | - Jong Moo Park
- Department of Neurology, Eulji University, Eulji General Hospital, Seoul, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Joon Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Dong Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Asan Medical Center, Clinical Research Center, Seoul, Korea
| | - Philip B Gorelick
- Department of Translational Science and Molecular Medicine and Mercy Health Hauenstein Neurosciences, Michigan State University College of Human Medicine, Michigan, United States
| | - Hee Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Barker-Collo S, Krishnamurthi R, Theadom A, Jones K, Starkey N, Feigin V. Incidence of stroke and traumatic brain injury in New Zealand: contrasting the BIONIC and ARCOS-IV studies. N Z Med J 2019; 132:40-54. [PMID: 31563926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIMS Traumatic Brain Injury (TBI) and stroke are the main causes of acquired brain injury. The differences in demographic profiles of stroke and TBI suggest that high-quality epidemiological studies of the two be compared. This study examined incidence of stroke and TBI by age and ethnicity in New Zealand. METHODS Incidence rates are presented by age and ethnicity from two New Zealand population-based epidemiological studies (Brain Injury Outcomes New Zealand In the Community (BIONIC); and Auckland Regional Outcomes of Stroke Studies (ARCOS-IV)). RESULTS Males and females had similar stroke risk, while males had 2x relative risk of mild TBI and 3x the relative risk of moderate/severe TBI compared to females. More TBI cases (35.6%) were identified through non-medical sources compared to stroke (3%). Incidence of TBI was greater than 5 times that of stroke. New Zealand European/Pākehā had the highest TBI incidence when less than 5 years of age, while Māori had the highest incidence after five years of age. For stroke, Pacific people and Māori had higher incidences until 75-84 years, after which Europeans had higher incidence. CONCLUSIONS Differences in TBI and stroke incidence suggest targeting prevention very differently for the two groups. Incidence profiles suggest TBI is much more common; and a need to target males and those of Māori ethnicity for TBI prevention.
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Affiliation(s)
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland
| | - Alice Theadom
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland
| | - Kelly Jones
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland
| | | | - Valery Feigin
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland, on behalf of the BIONIC and ARCOS-IV study groups
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Thompson S, Ranta A, Porter K, Bondi N. How much rehabilitation are our patients with stroke receiving? N Z Med J 2019; 132:49-55. [PMID: 31352474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Stroke rehabilitation often needs to continue following discharge from hospital. The New Zealand Stroke Network recommends community team review within seven calendar days of discharge and a minimum of three hours of therapy per specialty per week. International stroke guidelines make similar recommendations. The Wellington Community Older Adults, Rehabilitation and Allied Health team aimed to determine current local community stroke rehabilitation practice and compare this to guideline recommendations. METHOD A prospective cohort of 50 patients with a new diagnosis of stroke, referred to a community rehabilitation team in Wellington, were included in this service audit. The amount of rehabilitation patients received in the first four weeks and first three months following hospital discharge was measured, as well as time to first appointment. In addition, a service satisfaction questionnaire was sent to the patients. RESULTS The median (interquartile range, IQR) number of days from hospital discharge until first appointment with the community team was 10 (6.3-14.8) calendar days. In the first four weeks after hospital discharge, patients received from all health professionals an average (SD) of 1.1(0.4) rehabilitation sessions and 34.2 (43.6) minutes of rehabilitation per week. The average (SD) in the first three months or to point of discharge, whichever occurred first was 1.1 (1.1) sessions and 42.2 (49.3) minutes of rehabilitation per week. CONCLUSION There were delays in providing an initial community rehabilitation appointment and insufficient therapy intensity when comparing audit results to New Zealand Guideline expectations. As a result of this audit, recommendations for service improvements have been made.
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Affiliation(s)
- Stephanie Thompson
- Study Coordinator, Clinical Trials Unit, Capital and Coast District Health Board, Wellington
| | - Annemarei Ranta
- Associate Professor and Head of Department, Department of Medicine, University of Otago, Wellington; Consultant Neurologist, Department of Neurology, Wellington Hospital, Wellington
| | - Karen Porter
- Physiotherapist, Wellington Community Team, Older Adults, Rehabilitation and Allied Health Service, Capital and Coast District Health Board, Wellington
| | - Naomi Bondi
- Speech and Language Therapist, Wellington Community Team, Older Adults, Rehabilitation and Allied Health Service, Capital and Coast District Health Board, Wellington
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van der Veen DJ, Döpp CME, Siemonsma PC, Nijhuis-van der Sanden MWG, de Swart BJM, Steultjens EM. Factors influencing the implementation of Home-Based Stroke Rehabilitation: Professionals' perspective. PLoS One 2019; 14:e0220226. [PMID: 31344103 PMCID: PMC6657875 DOI: 10.1371/journal.pone.0220226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background Stroke has a major impact on survivors and their social environment. Care delivery is advocated to become more client-centered and home-based because of their positive impact on client outcomes. The objective of this study was to explore professionals’ perspectives on the provision of Home-Based Stroke Rehabilitation (HBSR) in the Netherlands and on the barriers and facilitators influencing the implementation of HBSR in daily practice. Methods Semi-structured focus groups were conducted to explore the perspectives of health and social care professionals involved in stroke rehabilitation. Directed content analysis was performed to analyze the transcripts of recorded conversations. Results Fourteen professionals participated in focus groups (n = 12) or, if unable to attend, an interview (n = 2). Participants varied in professional backgrounds and roles in treating Dutch clients post stroke. Barriers and facilitators influencing the implementation of HBSR in daily practice were identified in relation to: the innovation, the user, the organization and the socio-political context. Participants reported that HBSR can be efficient and effective to most clients because it facilitates client- and caregiver-centered rehabilitation within the clients’ own environment. However, barriers in implementing HBSR were perceived in a lack of (structured) inter-professional collaboration and the transparency of expertise of primary care professionals. Also, the current financial structures for HBSR in the Netherlands are viewed as inappropriate. Discussion In line with previous studies, we found that HBSR is recognized by professionals as a promising alternative to institution-based rehabilitation for clients with sufficient capabilities (e.g. their own health and informal support). Conclusion Multiple factors influencing the implementation of HBSR were identified. Our study suggests that, in order to implement HBSR in daily practice, region specific implementation strategies need to be developed. We recommend developing strategies concerning: organized and coordinated inter-professional collaboration, transparency of the expertise of primary care professionals, and the financial structures of HBSR.
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Affiliation(s)
- Dinja J. van der Veen
- Institute of Health Studies, University of Applied Sciences HAN, Nijmegen, the Netherlands
- * E-mail:
| | | | - Petra C. Siemonsma
- Healthy Living, TNO Leiden, Leiden, the Netherlands
- University of Applied Sciences THIM, Nieuwegein, the Netherlands
- Faculty of Health, University of Applied Sciences Leiden, Leiden, the Netherlands
| | | | - Bert J. M. de Swart
- Institute of Health Studies, University of Applied Sciences HAN, Nijmegen, the Netherlands
- Department of Neurorehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esther M. Steultjens
- Institute of Health Studies, University of Applied Sciences HAN, Nijmegen, the Netherlands
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Han J, Lee HI, Shin YI, Son JH, Kim SY, Kim DY, Sohn MK, Lee J, Lee SG, Oh GJ, Lee YS, Joo MC, Han EY, Chang WH, Kim YH. Factors influencing return to work after stroke: the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. BMJ Open 2019; 9:e028673. [PMID: 31300502 PMCID: PMC6629413 DOI: 10.1136/bmjopen-2018-028673] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the rate of return to work and identify key factors associated with return to work between 3 months and 2 years after stroke. DESIGN Prospective cohort study. SETTING The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) in Korea. PARTICIPANTS A total of 193 persons with first-ever stroke who reported working status at 3 months after stroke. OUTCOME MEASURES Data on baseline characteristics were collected from medical records. Functional assessments were performed using the National Institutes of Health Stroke Scale, the modified Rankin Scale, the Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the Korean version of the Frenchay Aphasia Screening Test, the American Speech-Language-Hearing Association National Outcomes Measurement System, the Korean-Modified Barthel Index, the Geriatric Depression Scale-Short Form and the EuroQol-5 dimensions. An enumeration survey included the Reintegration to Normal Living Index, the Psychosocial Well-being Index-Short Form (, the Family Support Index and the Caregivers Burden Index. RESULTS Overall, 145 (75.1%) patients who had a stroke in the "Continuously-Employed" group and 48 (24.9%) in the "Employed-Unemployed" group returned to work between 3 months and 2 years after stroke. Multivariate logistic analysis demonstrated that in patients who had a stroke, characteristics such as age, PWI-SF Score, and caregiver characteristics, including age, sex (female) and living arrangements, were significantly associated with return to work between 3 months and 2 years after stroke. CONCLUSION Age and PWI-SF Score of patients who had a stroke, as well as the age, sex and living arrangements of caregivers, are key factors influencing the return to work after stroke. TRIAL REGISTRATION NUMBER NCT03402451.
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Affiliation(s)
- Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, The Republic of Korea
| | - Hae In Lee
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Ju Hyun Son
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, The Republic of Korea
| | - Min Kyun Sohn
- School of Medicine, Department of Rehabilitation Medicine, Chungnam National University, Daejeon, The Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, The Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, The Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, The Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, School of Medicine, Jeju National University, Jeju, The Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
- Department of Health Sciences and Technology,Department of Medical Device Management & Research, Department of DigitalHealth, SAIHST, Sungkyunkwan University, Seoul, The Republic of Korea
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Abstract
The aim of this study was to examine predictors of discharge of hospitalized stroke patients to either an acute inpatient rehabilitation facility (IRF) or subacute skilled nursing facility (SNF).A retrospective cohort study was done in a large multicampus urban academic medical center of individuals hospitalized for stroke between January 1, 2015 and December 31, 2015 and who were discharged to either an IRF (n = 84) or SNF (n = 59). A set of characteristics and scales were collected on each patient and assessed using univariate and multivariate regression analyses.Although univariate analyses revealed multiple measures were associated with discharge destination, the most predictive multivariate logistic regression model for discharge to SNF incorporated age (odds ratio [OR] = 1.09, 95% confidence interval [CI], 1.05-1.13), premorbid physical disability (OR 7.52, 95% CI 1.66-34.14), and inability to ambulate before discharge (OR 5.84, 95% CI 2.01-16.92) with an overall c-statistic of 0.85.Increasing age, premorbid physical disability, and inability to ambulate increase the overall likelihood of discharge to a SNF. These findings need to be replicated in larger samples to determine whether they are generalizable.
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Affiliation(s)
- Neal Rakesh
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Department of Rehabilitation Medicine, Weill Cornell Medical College
- NewYork-Presbyterian Hospital, New York, NY
| | - Daniel Boiarsky
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
| | - Ammar Athar
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
| | - Shaliesha Hinds
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Department of Rehabilitation Medicine, Weill Cornell Medical College
- NewYork-Presbyterian Hospital, New York, NY
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GÜÇLÜ GÜNDÜZ A, YAZICI G, ÖZKUL Ç, KÜÇÜK H, BATUR ÇAĞLAYAN HZ, NAZLIEL B. The effects of early neurodevelopmental Bobath approach and mobilization on quadriceps muscle thickness in stroke patients. Turk J Med Sci 2019; 49:318-326. [PMID: 30761855 PMCID: PMC7350825 DOI: 10.3906/sag-1808-83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background/aim Following stroke, damage to the central nervous system and adaptive changes in muscle tissue are factors responsible for the loss of muscle strength. Even though it is suggested that early physiotherapy and mobilization prevent structural adaptive changes in muscle tissue, studies regarding this issue are insufficient. The aim of this study is to investigate the effects of early physiotherapy and mobilization on quadriceps muscle thickness (QMT) in stroke patients. Materials and methods Twelve stroke patients who were admitted to the neurology intensive care unit and 13 healthy controls were included in the study. QMT was examined at admission and discharge for each subject. Additionally, functional extremity movements, balance, and functional ambulation status were evaluated with the Stroke Rehabilitation Assessment of Movement Scale (STREAM). All of the patients were mobilized as early as possible by a physiotherapist and included in a treatment program consisting of the neurodevelopmental Bobath approach. Results The patients’ QMT values at admission and discharge were found to be similar to those of the healthy control group (P > 0.05). When the patients’ QMT at the time of admission and discharge were compared, it was seen that the affected side and the nonaffected side were similar (P > 0.05). Additionally, when the admission and discharge results were compared, improvements in functional extremity movements, balance, and functional ambulation levels were observed (P < 0.05). Conclusion It can be seen that QMT can be preserved and functional improvements can be provided through intense physiotherapy and mobilization initiated in the early period following stroke.
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Affiliation(s)
- Arzu GÜÇLÜ GÜNDÜZ
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Gökhan YAZICI
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, AnkaraTurkey
| | - Çağla ÖZKUL
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, AnkaraTurkey
| | - Hamit KÜÇÜK
- Division of Internal Medicine, Department of Rheumatology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | | | - Bijen NAZLIEL
- Department of Neurology, Faculty of Medicine, Gazi University, AnkaraTurkey
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Haq U, Malik AN. Does lumbar mobilization help stroke patients to improve functional outcomes? J PAK MED ASSOC 2019; 69:253-255. [PMID: 30804595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Stroke survivors often face functional deficits and gait impairments. The current study aimed to observe effects of lumbar mobilization on gait of stroke patients. Quasiinterventional study was conducted on 30 stroke survivors. Sample included either gender with onset of stroke (>03-months), patients with other pathologies were excluded. Gait was assessed using gait dynamic index, timed up and go test; 5-times sit to stand and 10-meter walk test. Three sessions of lumbar mobilization were given to all patients and the data were analyzed on Spss-20. Participants had a mean age of 50±10.66 years. Among stroke survivors 20 (66 . 7%) ha haemorrhagic stroke while 10(33.3%) stroke survivors had ischaemic stroke. After 03 days of intervention significant improvement was recorded in timed up and go test score (p<0.001) 5-times sit to stand (p<0.001) and 10-meter walk test (p<0.001). Dynamic balance and walking also improved as reported by gait dynamic index (p<0.001). The Current study suggested lumbarmobilization to be effective in improving gait in stroke survivors.
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Affiliation(s)
- Umama Haq
- Bahria International Hospital, Rawalpindi
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Yeoh YS, Koh GCH, Tan CS, Tu TM, Singh R, Chang HM, De Silva DA, Ng YS, Ang YH, Yap P, Chew E, Merchant RA, Yeo TT, Chou N, Venketasubramanian N, Lee KE, Young SH, Hoenig H, Matchar DB, Luo N. Health-related quality of life loss associated with first-time stroke. PLoS One 2019; 14:e0211493. [PMID: 30689666 PMCID: PMC6349359 DOI: 10.1371/journal.pone.0211493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/15/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to quantify health-related quality of life (HRQoL) loss associated with first episode of stroke by comparing patient-reported HRQoL before and after stroke onset. The impact of stroke in local population was also evaluated by comparing the pre- and post-stroke HRQoL with that of the general population. METHODS The HRQoL of stroke survivors was assessed with the EQ-5D-3L index score at recruitment, for recalled pre-stroke HRQoL, and at 3 and 12 month post-stroke. Change in HRQoL from pre-stroke to 3 and 12 month was self-reported by 285 and 238 patients, respectively. Mean EQ index score at each time point (baseline: 464 patients; 3 month post-stroke: 306 patients; 12 month post-stroke: 258 patients) was compared with published population norms for EQ-5D-3L. RESULTS There was a significant decrease in HRQoL at 3 (0.25) and 12 month (0.09) post-stroke when compared to the retrospectively recalled patients' mean pre-stroke HRQoL level (0.87). The reduction at 3 month was associated with the reduction in all EQ-5D-3L health dimensions; reductions remaining at 12 month were limited to dimensions of mobility, self-care, usual activities, and anxiety/depression. Stroke patients had a lower mean EQ index than the general population by 0.07 points pre-stroke (0.87 vs. 0.94), 0.33 points at 3 month (0.61 vs. 0.94) and 0.18 points at 12 month (0.76 vs. 0.94) post-stroke. CONCLUSIONS Stroke has a substantial impact on HRQoL in Singapore, especially in the first three months post-stroke. Compared to the general population, stroke survivors have lower HRQoL even before stroke onset. This pre-stroke deficit in HRQoL should be taken into account when quantifying health burden of stroke or setting goals for stroke rehabilitation.
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Affiliation(s)
- Yen Shing Yeoh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Hui Meng Chang
- Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, Singapore, Singapore
| | - Deidre A. De Silva
- Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Reshma A. Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Ning Chou
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | | | - Kim En Lee
- Farrer Park Medical Centre, Farrer Park Hospital, Singapore, Singapore
| | - Sherry H. Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine & Rehabilitation Service, Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - David Bruce Matchar
- Health Services & Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
- Center for Clinical Health Policy Research, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Cheiloudaki E, Alexopoulos EC. Adherence to Treatment in Stroke Patients. Int J Environ Res Public Health 2019; 16:ijerph16020196. [PMID: 30641978 PMCID: PMC6351941 DOI: 10.3390/ijerph16020196] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/30/2018] [Accepted: 01/10/2019] [Indexed: 11/16/2022]
Abstract
Background: Compliance with medication in patients who have suffered stroke is usually not-optimal. This study aims to measure the level of compliance with the treatment and to identify socio-demographic, clinical, and subjective factors related to the long-term compliance of stroke patients with their treatment. Methods: 140 patients (66.4% males) suffered an ischemic stroke at least six months old, participated in the survey. Compliance was measured using the Medication Adherence Report Scale and the quality of life by the Stroke Specific Quality of Life questionnaire. Furthermore, the Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire on perceptions about the disease were assessed. The doctor–patient relationship was assessed by the Common-Sense Model of Self-Regulation questionnaire and the family support was assessed by the FSS scale. Univariate and multivariate analysis was employed to identify the significant factors affecting compliance in these stroke patients. Results: In 68.6% of patients the compliance was classified as optimal, in 25.7% as partial and as poor in 5.7%; the last two categories were treated as sub-optimal compliance in multivariate analysis. The high compliance was related to patient’s mental state (OR:3.94 95% CI: 1.84–4.46), the perception medication necessity (OR:1.26 95% CI: 1.01–1.56), and the doctor–patient communication (OR:1.76 95% CI: 1.15–2.70). Men showed a lower compliance than women, as well as increased concerns about taking medication (OR: 0.83, 95% CI: 0.69–0.99). Paradoxically, the work /productivity related quality of life was inversely associated with compliance (OR (95% CI): 0.44 (0.23 to 0.82)). Conclusions: The perception of medication necessity and the doctor–patient communication are manageable factors associated with compliance in treating patients who have suffered stroke. In addition, rehabilitation and return to work programs should consider these factors when providing support to those persons.
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Affiliation(s)
| | - Evangelos C Alexopoulos
- School of Social Sciences, Hellenic Open University, 26335 Patra, Greece.
- Occupational Health Department, Metropolitan General Hospital, 15562 Athens, Greece.
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Hempler I, Maun A, Kampling H, Thielhorn U, Farin E. [Poststroke care in Germany : Results of an online survey of inpatient and outpatient experts in southern Germany]. Nervenarzt 2019; 90:824-831. [PMID: 30617567 DOI: 10.1007/s00115-018-0655-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To avoid long-term care after stroke and to promote occupational reintegration as well as to continue improving rehabilitation results, a good inpatient and outpatient care is necessary. More importantly a gapless transition into aftercare is required. The aim of this study was to gather expert opinions and experiences on the current care process during rehabilitation discharge and aftercare as well as to identify barriers and to discuss possible solutions. METHODS Clinicians from inpatient neurological rehabilitation, general practitioners and physiotherapists working in outpatient rehabilitation from Baden-Württemberg (BW) and Bavaria (BY) took part in an online survey on poststroke care (n = 77). The following topics were addressed: discharge process into follow-up care, follow-up care after rehabilitation; as well as cooperation and communication in the discharge process and during follow-up care. The online survey was conducted between 1 June 2017 and 3 August 2017 and was descriptively analyzed. RESULTS The perceptions of inpatient and outpatient experts with respect to significance and barriers of the factors involved in the discharge process and in the aftercare were mainly discrepant. In particular, the interdisciplinary cooperation and communication were criticized. Differences were mentioned depending on the occupational group, when asked about the leading cause that makes it difficult for the patient to return to their home environment. DISCUSSION Practitioner networks and standardized communication pathways can help to strengthen intradisciplinary and interdisciplinary cooperation and communication and thus achieve an improvement in the discharge process as well as in the aftercare system.
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Affiliation(s)
- Isabelle Hempler
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106, Freiburg, Deutschland.
| | - Andy Maun
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106, Freiburg, Deutschland
- Lehrbereich Allgemeinmedizin, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Hanna Kampling
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106, Freiburg, Deutschland
| | | | - Erik Farin
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106, Freiburg, Deutschland
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Swanson JO, Moger TA. Comparisons of readmissions and mortality based on post-discharge ambulatory follow-up services received by stroke patients discharged home: a register-based study. BMC Health Serv Res 2019; 19:4. [PMID: 30611279 PMCID: PMC6321669 DOI: 10.1186/s12913-018-3809-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 12/11/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have focused on post-discharge ambulatory care for stroke patients and subsequent differences in readmission and mortality rates. Identifying groups at higher risk according to services received is important when planning post-discharge follow-up in ambulatory care. According to a recent Whitepaper by the Norwegian Government, patients receiving ambulatory care should have follow-up with a general practitioner (GP) within 14 days of hospital discharge. METHODS All home discharged stroke cases occurring in Oslo from 2009 to 2014 were included. 90- and 365-day all-cause readmissions and mortality were compared separately for patients categorized based on services received (no services, home nursing, ambulatory rehabilitation and home nursing with ambulatory rehabilitation) and early GP follow-up within 14 days following discharge. Variables used to adjust for differences in health status and demographics at admission included inpatient days and comorbidities the year prior to admission, calendar year, sex, age, income, education and functional score. Cox regression reporting hazard ratios (HR) was used. RESULTS There were no significant differences in readmission rates for early GP follow-up. Patients receiving home nursing and/or rehabilitation had higher unadjusted 90- and 365-day readmission rates than those without services (HR from 1.87 to 2.63 depending on analysis, p < 0.001), but the 90-day differences disappeared after risk adjustment, except for patients receiving only rehabilitation. There were no significant differences in mortality rates according to GP follow-up after risk adjustment. Patients receiving rehabilitation had higher mortality than those without services, even after adjustment (HR from 2.20 to 2.69, p < 0.001), whereas the mortality of patients receiving only home nursing did not differ from those without services. CONCLUSIONS Our results indicate that the observed differences in unadjusted readmission and mortality rates according to GP follow-up and home nursing were largely due to differences in health status at admission, likely unrelated to the stroke. On the other hand, mortality for patients receiving ambulatory rehabilitation was twice as high compared to those without, even after adjustment and irrespective of also receiving home nursing. Hence, assessing the needs of these patients during discharge planning and providing careful follow-up after discharge seems important.
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Affiliation(s)
- Jayson O. Swanson
- Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, PO Box 1089, Blindern, NO-0317 Oslo, Norway
| | - Tron Anders Moger
- Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, PO Box 1089, Blindern, NO-0317 Oslo, Norway
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Zhang T, Liu L, Xie R, Peng Y, Wang H, Chen Z, Wu S, Ni C, Zheng J, Li X, Liu H, Xu G, Fan J, Zhu Y, Zhang F, Du Y, Wang X, Wang Y, Xiao W, Liu M, Mou X, Zhao J, Song L, Li B. Value of using the international classification of functioning, disability, and health for stroke rehabilitation assessment: A multicenter clinical study. Medicine (Baltimore) 2018; 97:e12802. [PMID: 30334972 PMCID: PMC6211934 DOI: 10.1097/md.0000000000012802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to evaluate the efficiency of the International Classification of Functioning, Disability, and Health (ICF) in stroke rehabilitation assessment in China and to identify correlations between the ICF and several commonly used clinical assessment instruments for stroke.In total, 52 hospitals and 5 premier rehabilitation and neurology research centers participated in this cross-sectional multicenter clinical study. A total of 2822 stroke patients admitted to a neurology or rehabilitation department of a participating medical center between July 2012 and June 2014 were included. The ICF checklist contains 4 parts with 128 two-level items: body functions, body structures, activities and participation, and environmental factors. We analyzed the results of ICF assessments and determined whether correlations existed between the various items of the ICF and several commonly used clinical assessment instruments.In all but 3 instances, the scores for the ICF-b-body function, ICF-s-body structure-degree of impairment, ICF-s-body structure-impairment location, ICF-d-activity performance, ICF-d-ability performance, ICF-e-facilitator, and ICF-e-barrier correlated significantly (P < .05) with the scores for the commonly used clinical assessment instruments.The ICF checklist is a new rehabilitation assessment instrument that is compatible with commonly used clinical assessment scales for stroke and can be used in combination with these scales.
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Affiliation(s)
- Tong Zhang
- China Rehabilitation Research Center, Beijing Boai Hospital, Integrative Department, Capital Medical University Rehabilitation Academy
| | - Lixu Liu
- China Rehabilitation Research Center, Beijing Boai Hospital, Integrative Department, Capital Medical University Rehabilitation Academy
| | - Rong Xie
- Department of Rehabilitation, People's Hospital of Xinjiang Uygur Autonomous Region
| | - Ying Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Huifang Wang
- Department of Rehabilitation, Shanghai East Hospital of Tongji University
| | - Zhuoming Chen
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University
| | - Shizheng Wu
- Department of Neurology, Qinghai People's Hospital
| | - Chaomin Ni
- Department of Rehabilitation, Anhui Provincial Hospital
| | - Jiejiao Zheng
- Department of Rehabilitation, Huadong Hospital, Fudan University
| | - Xueping Li
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University
| | - Heyu Liu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University
| | - Guangxu Xu
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University
| | - Jianzhong Fan
- Department of Rehabilitation, Nanfang Hospital, Southern Medical University
| | - Yuhong Zhu
- Department of Neurology, The Second Affiliated Hospital of Kunming Medical College
| | - Fang Zhang
- Department of Rehabilitation, The Second Hospital of Lanzhou University
| | - Yanhui Du
- Department of Neurology, The Affiliated Hospital of Ningxia Medical University
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital
| | - Weimin Xiao
- Department of Neurology, Dongguan People's Hospital
| | - Ming Liu
- Department of Neurology, West China Hospital of Sichuan University
| | - Xiang Mou
- Department of Rehabilitation, The First Affiliated Hospital of Fourth Military Medical University, Beijing, China
| | - Jun Zhao
- China Rehabilitation Research Center, Beijing Boai Hospital, Integrative Department, Capital Medical University Rehabilitation Academy
| | - Luping Song
- China Rehabilitation Research Center, Beijing Boai Hospital, Integrative Department, Capital Medical University Rehabilitation Academy
| | - Bingjie Li
- China Rehabilitation Research Center, Beijing Boai Hospital, Integrative Department, Capital Medical University Rehabilitation Academy
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Langhammer B, Sunnerhagen KS, Sällström S, Becker F, Stanghelle JK. Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study. Brain Behav 2018; 8:e01055. [PMID: 30022609 PMCID: PMC6085896 DOI: 10.1002/brb3.1055] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work-related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow-up services and participation in social networks and recreational activities. METHODS The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow-up services, the maintenance of recreational activities, and networks, were performed 6 and 12 months post discharge from rehabilitation. RESULTS The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6 months and from 10% to 80% at 12 months. Access to postrehabilitation follow-up services varied in the different countries from 24% to 100% at 6 months and from 21% to 100% at 12 months. Physical therapy was the most common follow-up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat-11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment. CONCLUSIONS In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients.
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Affiliation(s)
- Birgitta Langhammer
- Faculty of Health SciencesSunnaas Rehabilitation HospitalOslo Metropolitan UniversityOsloNorway
- Sunnaas Rehabilitation HospitalNesoddtangenNorway
| | | | | | - Frank Becker
- Sunnaas Rehabilitation HospitalNesoddtangenNorway
- Faculty of MedicineUniversity of OsloNesoddtangenNorway
| | - Johan K. Stanghelle
- Sunnaas Rehabilitation HospitalNesoddtangenNorway
- Faculty of MedicineUniversity of OsloNesoddtangenNorway
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Clarke DJ, Burton LJ, Tyson SF, Rodgers H, Drummond A, Palmer R, Hoffman A, Prescott M, Tyrrell P, Brkic L, Grenfell K, Forster A. Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units. Clin Rehabil 2018; 32:1119-1132. [PMID: 29582712 PMCID: PMC6068965 DOI: 10.1177/0269215518765329] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/24/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify why the National Clinical Guideline recommendation of 45 minutes of each appropriate therapy daily is not met in many English stroke units. DESIGN Mixed-methods case-study evaluation, including modified process mapping, non-participant observations of service organisation and therapy delivery, documentary analysis and semi-structured interviews. SETTING Eight stroke units in four English regions. SUBJECTS Seventy-seven patients with stroke, 53 carers and 197 stroke unit staff were observed; 49 patients, 50 carers and 131 staff participants were interviewed. RESULTS Over 1000 hours of non-participant observations and 433 patient-specific therapy observations were undertaken. The most significant factor influencing amount and frequency of therapy provided was the time therapists routinely spent, individually and collectively, in information exchange. Patient factors, including fatigue and tolerance influenced therapists' decisions about frequency and intensity, typically resulting in adaptation of therapy rather than no provision. Limited use of individual patient therapy timetables was evident. Therapist staffing levels were associated with differences in therapy provision but were not the main determinant of intensity and frequency. Few therapists demonstrated understanding of the evidence underpinning recommendations for increased therapy frequency and intensity. Units delivering more therapy had undertaken patient-focused reorganisation of therapists' working practices, enabling them to provide therapy consistent with guideline recommendations. CONCLUSION Time spent in information exchange impacted on therapy provision in stroke units. Reorganisation of therapists' work improved alignment with guidelines.
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Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Sarah F Tyson
- School of Health Sciences, Manchester
Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Helen Rodgers
- Stroke Research Group, Institute of
Neuroscience, Newcastle University, Newcastle, UK
| | - Avril Drummond
- Faculty of Medicine and Health Sciences,
University of Nottingham, Nottingham, UK
| | - Rebecca Palmer
- Health Services Research, School of
Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alex Hoffman
- Sentinel Stroke National Audit
Programme, Royal College of Physicians, London, UK
| | - Matthew Prescott
- Physiotherapy Department, Bradford
Teaching Hospitals NHS Trust, Bradford, UK
| | - Pippa Tyrrell
- Salford Royal NHS Foundation Trust and
Manchester Academic Health Science Centre, The University of Manchester, Manchester,
UK
| | - Lianne Brkic
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
- Stroke Research Group, Institute of
Neuroscience, Newcastle University, Newcastle, UK
| | - Katie Grenfell
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
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Waddell KJ, Lang CE. Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic. Arch Phys Med Rehabil 2018; 99:1913-1916. [PMID: 29408483 DOI: 10.1016/j.apmr.2017.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/22/2017] [Accepted: 12/18/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare self-reported with sensor-measured upper limb (UL) performance in daily life for individuals with chronic (≥6mo) UL paresis poststroke. DESIGN Secondary analysis of participants enrolled in a phase II randomized, parallel, dose-response UL movement trial. This analysis compared the accuracy and consistency between self-reported UL performance and sensor-measured UL performance at baseline and immediately post an 8-week intensive UL task-specific intervention. SETTING Outpatient rehabilitation. PARTICIPANTS Community-dwelling individuals with chronic (≥6mo) UL paresis poststroke (N=64). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Motor Activity Log amount of use scale and the sensor-derived use ratio from wrist-worn accelerometers. RESULTS There was a high degree of variability between self-reported UL performance and the sensor-derived use ratio. Using sensor-based values as a reference, 3 distinct categories were identified: accurate reporters (reporting difference ±0.1), overreporters (difference >0.1), and underreporters (difference <-0.1). Five of 64 participants accurately self-reported UL performance at baseline and postintervention. Over half of participants (52%) switched categories from pre-to postintervention (eg, moved from underreporting preintervention to overreporting postintervention). For the consistent reporters, no participant characteristics were found to influence whether someone over- or underreported performance compared with sensor-based assessment. CONCLUSIONS Participants did not consistently or accurately self-report UL performance when compared with the sensor-derived use ratio. Although self-report and sensor-based assessments are moderately associated and appear similar conceptually, these results suggest self-reported UL performance is often not consistent with sensor-measured performance and the measures cannot be used interchangeably.
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Affiliation(s)
| | - Catherine E Lang
- Program in Physical Therapy, Department of Neurology, Program in Occupational Therapy, Washington University, St Louis, MO.
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49
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Condon M, Guidon M. A survey of exercise professionals' barriers and facilitators to working with stroke survivors. Health Soc Care Community 2018; 26:250-258. [PMID: 29143386 DOI: 10.1111/hsc.12517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
Stroke survivors (SSs) are largely inactive despite the benefits of exercise. Exercise professionals (EPs), skilled in exercise prescription and motivation, may have a role in promoting exercise among SSs. However, the number of EPs working with SSs is estimated to be low. This study aimed to investigate EPs' opinions on working with SSs by rating their agreement of barriers and facilitators to working with SSs. The study also investigated EPs skills, interest and experience working with SSs and the relationship between EPs' barriers and facilitators with their training on stroke. A descriptive cross-sectional study was conducted using a researcher-designed online survey between October and December 2015. Purposive sampling was used to survey EPs on the Register of Exercise Professionals in Ireland (n = 277). The response rate was 31% (87/277). Only 22% (19/86) of EPs had experience working with SSs. The primary barriers rated by EPs included insufficient training on psychological problems post-stroke (84%; 61/73), unsuitable equipment for SSs (69%; 50/73) and the level of supervision SSs require (56%; 41/73). The primary facilitators rated included access to suitable equipment (97%; 69/71), practical (100%; 71/71) and theoretical training (93%; 66/71) on stroke. Respondents with no training on stroke were significantly more likely to agree that insufficient training on psychological problems post-stroke and lack of experience were barriers. Seventy-six per cent of EPs (58/76) were interested in one-to-one exercise sessions with SSs but only 53% (40/76) were interested in group sessions. Eighty-two per cent of EPs (62/76) rated their motivational skills as good or very good but 42% (32/76) indicated having only acceptable skills dealing with psychological problems. Results indicate that EPs are interested in working with SSs despite limited experience and practical barriers. Training opportunities on stroke need to be developed; taking into account EPs' barriers, facilitators and skills along with access to suitable equipment.
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Affiliation(s)
- Marie Condon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Guidon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Ekechukwu N, Olaleye O, Hamzat T. Clinical and Psychosocial Predictors of Community Reintegration of Stroke Survivors Three Months Post In-Hospital Discharge. Ethiop J Health Sci 2017; 27:27-34. [PMID: 28458488 PMCID: PMC5390226 DOI: 10.4314/ejhs.v27i1.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There appears to be a dearth of published literature on the biopsychosocial predictors of community reintegration (CR) among stroke survivors. This study aims to investigate the clinical and psychosocial predictors of CR among stroke survivors three months post in-hospital discharge. METHODS Fifty-two stroke survivors took part in this prospective exploratory study. The participants' clinical attributes of motor function (MF), balance (Bal) and psychosocial characteristics of Fall Self-Efficacy (FSE), Balance Self-Efficacy (BSE), Self-Esteem (SEst) and Social Support (SS) were assessed pre-discharge and at three months post-discharge. CR was also assessed at three months post-discharge. Data were analyzed using paired t-test, Pearson's Moment correlation and multiple regressions. Level of significance was set at p = 0.05. RESULTS The mean age of the participants was 61.21±11.25 years with mean hospital length of stay of 5.31±3.71weeks. There were significant differences in the mean MF, Bal, FSE, BSE, SEst and SS scores of the participants pre- and post-discharge (p < 0.05). Also, there was a significant correlation between CR and each of MF, Bal, FSE, BSE, SEst and SS. Pre-discharge Age (β = -0.226, p = 0.001) and FSE (β = 1.387, p = 0.040) significantly predicted CR. Post-discharge age (β = -0.164, p = 0.005) and Bal (β = 0.142, p = 0.048). FSE (β = 1.243, p = 0.034) also significantly predicted CR. CONCLUSION Age, Bal and FSE are important predictors of CR among stroke survivors. Therefore, rehabilitation programmes should focus on improving Bal and FSE in order to enhance community reintegration among stroke survivors.
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Affiliation(s)
- Nelson Ekechukwu
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Olubukola Olaleye
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Talhatu Hamzat
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
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