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OBJECTIVE: To investigate whether patients experienced improved functional outcomes as a result of their admission to rehabilitation and to identify whether the service provided effective, patient-centered and goal-directed rehabilitation. DESIGN: Retrospective chart review of admission and discharge data from patients accessing the service between 2011 and 2019. SETTING: Community-based interdisciplinary rehabilitation service. PARTICIPANTS: Consecutive patients (N=612) admitted to the service. INTERVENTIONS: Routine care delivered with a median duration of 181 days and an interquartile range of 120-261 days. MAIN OUTCOME MEASURES: The Canadian Occupational Performance Measure (COPM) administered on admission and discharge and an improvement ≥2 in the COPM subscales of performance and satisfaction. RESULTS: Of 612 participants, 96% had the COPM administered at admission (baseline) and 68% again at discharge. Performance and satisfaction were measured in 584 patients at admission, 406 at discharge, and 404 at both time points. For performance, 243 patients (60%) experienced an improvement (≥2), with an average of 2.2 points. For satisfaction, 268 patients (66%) experienced an improvement (≥2), with an average of 2.8 points. Factors influencing outcomes, differed. For each 10 year increase in patient age, the average improvement in satisfaction was 0.26 points lower (95% confidence interval, 0.07-0.45) after adjusting for sex, duration, completion, and health condition. CONCLUSIONS: Irrespective of patient-related factors and regardless of age, sex, health condition, or discharge plan, the majority of patients reported a positive functional outcome in COPM Performance and satisfaction as a result of time spent in the community-based rehabilitation service. This service provided equitable care and patient-centered, goal-focused, and outcome-based therapy that enabled patients to improve their functional capacity.
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INTRODUCTION: Stroke affects all ages. Despite increased incidence in those <65 years, little is known about age-based differences in inpatient rehabilitation management and outcomes. OBJECTIVES: To investigate management and outcomes, comparing younger (<65 years) and older (≥65 years) patients with stroke, who received inpatient rehabilitation. METHODS: Multicentre, cross-sectional study using data from Australian hospitals who participated in the Stroke Foundation national stroke rehabilitation audit (2016-2018). Chi-square tests compared characteristics and care by age. Multivariable regression models were used to compare outcomes by age (e.g. length of stay). Models were adjusted for sex, stroke type and severity factors. RESULTS: 7,165 audited cases from 127 hospitals; 23% <65 years (66% male; 72% ischaemic stroke). When compared to older patients, younger patients were more likely male (66% vs 52%); identify as Aboriginal or Torres Strait Islander (6% vs 1%); be less disabled on admission; receive psychology (46% vs 34%) input, and community reintegration support, including return to work (OR 1.47, 95% CI 1.03, 2.11), sexuality (OR 1.60, 95% CI 1.39, 1.84) and self-management (OR 1.39, 95% CI 1.23, 1.57) advice. Following adjustment, younger patients had longer lengths of stay (coeff 3.54, 95% CI 2.27, 4.81); were more likely to be independent on discharge (aOR 1.96, 95% CI 1.68, 2.28); be discharged to previous residences (aOR 1.64, 95% CI 1.41, 1.91) and receive community rehabilitation (aOR: 2.27, 95% CI 1.91, 2.70). CONCLUSIONS: Age-related differences exist in characteristics, management and outcomes for inpatients with stroke accessing rehabilitation in Australia.
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Disparidades em Assistência à Saúde/tendências , Hospitais de Reabilitação/tendências , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Reabilitação do Acidente Vascular Cerebral/tendências , Acidente Vascular Cerebral/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Austrália/epidemiologia , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Pacientes Internados , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Fatores Raciais , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Stroke can affect a person's ability to drive a motor vehicle. In Australia, there is a 4-week restriction in driving after stroke and a 2-week restriction after transient ischemic attack. Concerns exist as to whether people discharged home from the acute setting receive education about these driving restrictions. OBJECTIVES: This study sought to investigate health professionals' knowledge about, and responsibilities for patients return-to-driving (RTD) education after stroke and TIA. METHODS: A cross-sectional online survey was designed and included questions about health professional demographic characteristics and knowledge and opinions of RTD guidelines. An open-ended question at the end of the survey enabled respondents to provide additional, free text information. Descriptive analyses were used to describe respondents' demography and characteristics. Chi-square analysis was used to compare responses across the different professional groups. Significance was tested using a p-value of 0.05. Data obtained from the free text question were analyzed through an inductive thematic approach. RESULTS: A total of 455 health professionals responded to the survey, with 45% being occupational therapists. Only 22% of health professionals correctly selected the 4-week restriction period after stroke and 27% selected the 2-week restriction period for those with TIA. Occupational therapists were identified by 85% of respondents as the profession responsible for providing RTD education, followed by doctors (72%). Health professionals lack clarity in RTD guidelines and often defer the responsibility of managing RTD to others. CONCLUSIONS: Education of health professionals in RTD guidelines is recommended to improve the processes of care after stroke.
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Condução de Veículo/normas , Conhecimentos, Atitudes e Prática em Saúde , Terapeutas Ocupacionais/psicologia , Terapia Ocupacional/métodos , Médicos/psicologia , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Alta do Paciente/estatística & dados numéricos , Percepção , Reabilitação do Acidente Vascular Cerebral/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Despite being one of the few evidence-based treatments for acute ischemic stroke, intravenous thrombolysis has low implementation rates-mainly due to a narrow therapeutic window and the health system changes required to deliver it within the recommended time. This systematic review and meta-analyses explores the differential effectiveness of intervention strategies aimed at improving the rates of intravenous thrombolysis based on the number and type of behaviour change wheel functions employed. METHOD: The following databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL and SCOPUS. Multiple authors independently completed study selection and extraction of data. The review included studies that investigated the effects of intervention strategies aimed at improving the rates of intravenous thrombolysis and/or onset-to-needle, onset-to-door and door-to-needle time for thrombolysis in patients with acute ischemic stroke. Interventions were coded according to the behaviour change wheel nomenclature. Study quality was assessed using the QualSyst scoring system for quantitative research methodologies. Random effects meta-analyses were used to examine effectiveness of interventions based on the behaviour change wheel model in improving rates of thrombolysis, while meta-regression was used to examine the association between the number of behaviour change wheel intervention strategies and intervention effectiveness. RESULTS: Results from 77 studies were included. Five behaviour change wheel interventions, 'Education', 'Persuasion', 'Training', 'Environmental restructuring' and 'Enablement', were found to be employed among the included studies. Effects were similar across all intervention approaches regardless of type or number of behaviour change wheel-based strategies employed. High heterogeneity (I2 > 75%) was observed for all the pooled analyses. Publication bias was also identified. CONCLUSION: There was no evidence for preferring one type of behaviour change intervention strategy, nor for including multiple strategies in improving thrombolysis rates. However, the study results should be interpreted with caution, as they display high heterogeneity and publication bias.
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Isquemia Encefálica , Acidente Vascular Cerebral , Terapia Comportamental , Humanos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia TrombolíticaRESUMO
BACKGROUND: Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the "Thrombolysis ImPlementation in Stroke (TIPS)" study, which aimed to improve rates of intravenous thrombolysis in Australia. METHODS: A posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0-2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5-6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups. RESULTS: There was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73-3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73-2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56-2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61-3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21-1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36-2.52). CONCLUSION: The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage. TRIAL REGISTRATION: Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796 .
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Fibrinolíticos/administração & dosagem , AVC Isquêmico/tratamento farmacológico , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Terapia Trombolítica/tendências , Idoso , Idoso de 80 Anos ou mais , Austrália , Avaliação da Deficiência , Feminino , Fibrinolíticos/efeitos adversos , Estado Funcional , Humanos , Infusões Intravenosas , Hemorragias Intracranianas/induzido quimicamente , AVC Isquêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The current study aimed to evaluate the effects of a multi-component in-hospital intervention on the door-to-needle time for intravenous thrombolysis in acute ischaemic stroke. DESIGN: This study was a post hoc analysis of door-to-needle time data from a cluster-randomised controlled trial testing an intervention to boost intravenous thrombolysis implementation. SETTING: The study was conducted among 20 hospitals from three Australian states. PARTICIPANT: Eligible hospitals had a Stroke Care Unit or staffing equivalent to a stroke physician and a nurse, and were in the early stages of implementing thrombolysis. INTERVENTION: The intervention was multifaceted and developed using the behaviour change wheel and informed by breakthrough collaborative methodology using components of the health behaviour change wheel. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome for this analysis was door-to-needle time for thrombolysis and secondary outcome was the proportion of patients received thrombolysis within 60 min of hospital arrival. RESULTS: The intervention versus control difference in the door-to-needle times was non-significant overall nor significant by hospital classification. To provide additional context for the findings, we also evaluated the results within intervention and control hospitals. During the active-intervention period, the intervention hospitals showed a significant decrease in the door-to-needle time of 9.25 min (95% CI: -16.93 to 1.57), but during the post-intervention period, the result was not significant. During the active intervention period, control hospitals also showed a significant decrease in the door-to-needle time of 5.26 min (95% CI: -8.37 to -2.14) and during the post-intervention period, this trend continued with a decrease of 12.13 min (95% CI: -17.44 to 6.81). CONCLUSION: Across these primary stroke care centres in Australia, a secular trend towards shorter door-to-needle times across both intervention and control hospitals was evident, however the TIPS (Thrombolysis ImPlementation in Stroke) intervention showed no overall effect on door-to-needle times in the randomised comparison. TRIAL REGISTRATION NUMBER: Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN 12613000939796.
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Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Tempo para o Tratamento , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Austrália , Serviços Médicos de Emergência , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Terapia Trombolítica/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The Thrombolysis ImPlementation in Stroke (TIPS) trial tested the effect of a multicomponent, multidisciplinary, collaborative intervention designed to increase the rates of intravenous thrombolysis via a cluster randomized controlled trial at 20 Australian hospitals (ten intervention, ten control). This sub-study investigated changes in self-reported perceptions and practices of physicians and nurses working in acute stroke care at the participating hospitals. METHODS: A survey with 74 statements was administered during the pre- and post-intervention periods to staff at 19 of the 20 hospitals. An exploratory factor analysis identified the structure of the survey items and linear mixed modeling was applied to the final survey domain scores to explore the differences between groups over time. RESULT: The response rate was 45% for both the pre- (503 out of 1127 eligible staff from 19 hospitals) and post-intervention (414 out of 919 eligible staff from 18 hospitals) period. Four survey domains were identified: (1) hospital performance indicators, feedback, and training; (2) personal perceptions about thrombolysis evidence and implementation; (3) personal stroke skills and hospital stroke care policies; and (4) emergency and ambulance procedures. There was a significant pre- to post-intervention mean increase (0.21 95% CI 0.09; 0.34; p < 0.01) in scores relating to hospital performance indicators, feedback, and training; for the intervention hospitals compared to control hospitals. There was a corresponding increase in mean scores regarding perceptions about the thrombolysis evidence and implementation (0.21, 95% CI 0.06; 0.36; p < 0.05). Sub-group analysis indicated that the improvements were restricted to nurses' responses. CONCLUSION: TIPS resulted in changes in some aspects of nurses' perceptions relating to the evidence for intravenous thrombolysis and its implementation and hospital performance indicators, feedback, and training. However, there is a need to explore further strategies for influencing the views of physicians given limited statistical power in the physician sample. TRIAL REGISTRATION: ACTRN12613000939796, UTN: U1111-1145-6762.
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Atitude do Pessoal de Saúde , Isquemia Encefálica/tratamento farmacológico , Capacitação em Serviço/organização & administração , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Adulto , Austrália , Feminino , Fidelidade a Diretrizes , Humanos , Capacitação em Serviço/normas , Masculino , Corpo Clínico Hospitalar , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar , Percepção , Guias de Prática Clínica como Assunto/normas , Terapia Trombolítica/normas , Adulto JovemAssuntos
Terapia Ocupacional , Acidente Vascular Cerebral , Idoso , Humanos , Retorno ao Trabalho , SobreviventesRESUMO
OUTLINE OF PROBLEM: Allied health professionals working in rural settings have broad caseloads requiring advanced skills as general specialists. This can include children with specialised needs. DESIGN: Educational secondments were coordinated for allied health professionals to achieve self-nominated learning objectives. Learning objectives were assessed using pre and post evaluations to determine the effect of the educational secondment on knowledge and confidence specific to the nominated learning outcomes. SETTING: Educational secondments were undertaken by allied health professionals from New South Wales Health facilities in regional or rural locations outside of the Sydney metropolitan area. The educational secondments occurred in tertiary-level hospitals or specialist health facilities. KEY MEASURES FOR IMPROVEMENT: Using self-reported questionnaires, allied health secondees' outcomes were assessed prior to the secondment, immediately following and again at 6 months post-secondment, and their managers at 6 months post-secondment. The program aimed to improve the allied health professional's knowledge and confidence around self-selected learning objectives related to the specialised care of children with complex health needs in rural settings. STRATEGIES FOR CHANGE: Allied health professionals reported increased knowledge and confidence immediately following the secondment which was sustained at 6 months. On the basis of this outcome, the secondment program will continue. EFFECTS OF CHANGE: The secondment program resulted in changes to the ongoing clinical practice of participating clinicians as well as other health professionals within the departments where they worked. LESSONS LEARNT: Educational secondments can improve the knowledge and skills of allied health professionals working in rural and remote locations with a view to improving access to equitable health care for children living in rural settings.
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Pessoal Técnico de Saúde/educação , Pessoal Técnico de Saúde/normas , Competência Clínica/normas , Educação Continuada em Enfermagem/organização & administração , Enfermagem Pediátrica/educação , Enfermagem Pediátrica/normas , Serviços de Saúde Rural/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Inquéritos e Questionários , Centros de Atenção Terciária/normasRESUMO
Gaps exist in the knowledge of return-to-driving guidelines, and education is needed for Australian health professionals working in the field of stroke. In this paper, authors evaluate the implementation of an e-learning module. A pre- and post-module knowledge test and survey were used to assess the e-module's success in achieving its learning objectives. Initially, 204 learners completed the module, with 68% of learners scoring 100% in the post-module knowledge test. Only 12 learners completed the survey. The authors recommend that health professionals other than occupational therapists access this e-module, and a review on e-module structure is required to improve results of knowledge tests.
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Condução de Veículo/normas , Instrução por Computador , Pessoal de Saúde/educação , Reabilitação do Acidente Vascular Cerebral , Austrália , Condução de Veículo/legislação & jurisprudência , Humanos , Internet , Licenciamento , Terapia Ocupacional , Guias de Prática Clínica como Assunto , Inquéritos e QuestionáriosRESUMO
BACKGROUND/AIM: In Australia, all stroke survivors should not drive for four weeks and transient ischaemic attack (TIA) survivors should not drive for two weeks. This study investigates the provision of return-to-driving education in the acute hospital setting and the use of this education by a cohort of Australian patients who have experienced a mild stroke or TIA and who are discharged directly home from their acute hospital admission. METHODS: A medical record audit was conducted of stroke patients discharged home from a regional hospital in Australia. All audited patients were sent a post-discharge anonymous survey of their post-stroke driving behaviours. RESULTS: A total of 78 medical records were audited (32 women, 46 men; 15 TIA, 63 strokes). Mean age was 67.4 years (SD = 13.7, range 20-89 years). Only 27 (34.6%) patients had documented evidence that return-to-driving was discussed with them by a health professional, with only 10 (12.8%) having a restriction period documented. A total of 31 surveys were analysed (10 females, 21 males) and 20 participants had returned to driving. From 31 survivors of mild stroke/TIA, 21 recalled receiving advice on return-to-driving and seven resumed driving during the non-driving period of one month. CONCLUSIONS: Inconsistencies exist in the documentation of return-to-driving management after acute stroke or TIA and it is unknown whether patients who lack documentation in their medical records were provided with education or not.
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Condução de Veículo/estatística & dados numéricos , Ataque Isquêmico Transitório/reabilitação , Terapia Ocupacional/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Ataque Isquêmico Transitório/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Prontuários Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
Stroke is one of the leading causes of death and disability and it is more likely to occur in those who are older. Because people are living longer, the definition of "old" continues to evolve. Age alone should not influence the healthcare that a patient receives, however, evidence indicates that this does occur, especially in older patients. On the basis of the available evidence, it is time to reconsider whether or not stroke care should differ in older survivors of stroke and if so, why. This is a narrative review of stroke-related health care in those with a recent ischemic stroke. It seeks to answer the following question: Should patients aged ≥80 years who have experienced a recent ischemic stroke receive standard care or something different, and if they should receive something different, what should they receive and why? The review focusses on long-term survival, hyper-acute care, secondary prevention, and rehabilitation. The authors propose a number of recommendations in relation to stroke care in older survivors of a recent ischemic stroke.
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Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p > 0.0014) and indirect (p = 0.001) occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p = 0.001). Patients admitted to the metropolitan hospital received more face-to-face (p > 0.000) and indirect (p > 0.000) physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p > 0.000). Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient's first therapy session.
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BACKGROUND AND PURPOSE: As populations age, an increasing number of older women are living with stroke. This study looks at long-term outcomes for women with stroke, comparing mortality rates for women with poor physical function (PF) and those with higher levels of function. The purpose is to understand not only how long women might live after a stroke, but also how long they live with physical disability. METHODS: The study uses 15 years of data on women from the Australian Longitudinal Study on Women's Health 1921 to 1926 cohort. The risk of stroke and the risk of stroke and poor PF were estimated using Cox proportional hazard model. Among women who reported a stroke during the study period, mortality risk was compared according to their physical functioning level after that stroke. RESULTS: Almost half of the women who had a stroke and poor PF survived past 10 years. The 10-year mortality rate was 37% for women with stroke and adequate PF and 51% for women with stroke and poor PF at the time of the stroke (hazard rate ratio, 1.52; 95% CI, 1.18-1.95; P=0.0015 adjusting for demographic and health covariates). CONCLUSIONS: This study provides evidence of the long-term outcomes of stroke among older women, with women living for many years with poor PF. This outcome has important implications for the women's quality of life during their later years and in understanding the burden of disability associated with stroke.
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Atividades Cotidianas , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Efeitos Psicossociais da Doença , Avaliação da Deficiência , Feminino , Humanos , Estudos Longitudinais , Qualidade de Vida , Risco , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Taxa de Sobrevida , Saúde da MulherRESUMO
We examined older women's qualitative experiences of stroke with the World Health Organization's 18-item Brief International Classification of Functioning, Disability and Health Core Set for Stroke. Women were participants of the Australian Longitudinal Study on Women's Health, born between 1921 and 1926, who had experienced a stroke in the previous 3 years. An inductive thematic analysis was conducted of women's qualitative experiences of stroke, which were then examined with the 18-item Brief Core Set for Stroke for congruency. Our analysis showed that for older Australian women, their concerns of poststroke living were not adequately classified, potentially impeding a full recovery.
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Atividades Cotidianas , Nível de Saúde , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Adaptação Psicológica , Idoso , Austrália , Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Estudos Longitudinais , Reprodutibilidade dos Testes , Perfil de Impacto da Doença , Apoio Social , Acidente Vascular Cerebral/fisiopatologia , Organização Mundial da SaúdeRESUMO
BACKGROUND: Upper-limb (UL) dysfunction is experienced by up to 75% of patients poststroke. The greatest potential for functional improvement is in the first month. Following reperfusion, evidence indicates that neuroplasticity is the mechanism that supports this recovery. OBJECTIVE: This preliminary study hypothesized increased activation of putative motor areas in those receiving intensive, task-specific UL training in the first month poststroke compared with those receiving standard care. METHODS: This was a single-blinded, longitudinal, randomized controlled trial in adult patients with an acute, first-ever ischemic stroke; 23 participants were randomized to standard care (n = 12) or an additional 30 hours of task-specific UL training in the first month poststroke beginning week 1. Patients were assessed at 1 week, 1 month, and 3 months poststroke. The primary outcome was change in brain activation as measured by functional magnetic resonance imaging. RESULTS: When compared with the standard-care group, the intensive-training group had increased brain activation in the anterior cingulate and ipsilesional supplementary motor areas and a greater reduction in the extent of activation (P = .02) in the contralesional cerebellum. Intensive training was associated with a smaller deviation from mean recovery at 1 month (Pr>F0 = 0.017) and 3 months (Pr>F = 0.006), indicating more consistent and predictable improvement in motor outcomes. CONCLUSION: Early, more-intensive, UL training was associated with greater changes in activation in putative motor (supplementary motor area and cerebellum) and attention (anterior cingulate) regions, providing support for the role of these regions and functions in early recovery poststroke.
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Isquemia Encefálica/reabilitação , Encéfalo/fisiopatologia , Terapia por Exercício/métodos , Transtornos dos Movimentos/reabilitação , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Mapeamento Encefálico , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Plasticidade Neuronal/fisiologia , Estudos Prospectivos , Recuperação de Função Fisiológica/fisiologia , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Although many people survive an initial stroke, little is known about long-term impacts of stroke on survival. METHODS: Data from the Australian Longitudinal Study on Women's Health were used to compare 12-year survival rates in older women with prevalent stroke, incident stroke, and no stroke. Cox regression models were fitted to assess the effect of lifestyle and demographic characteristics on the relationship between stroke and all-cause mortality. The "no stroke" group was used as the reference category in all statistical models. RESULTS: At baseline, 4% of the women reported a previous stroke (prevalent stroke). At survey 2 in 1999, a further 3% reported having a stroke between 1996 and 1999 (incident stroke). Stroke was significantly associated with reduced long-term survival. Age-adjusted hazards ratios (HRs) were: 1.64 (1.43-1.89) for the "prevalent stroke" group and 2.29 (1.97-2.66) for the "incident stroke" group. Adjusting for comorbidities reduced the HRs, but the risk of death was still significantly higher in the 2 stroke groups. Adjusting for demographic and lifestyle factors did not make any further difference to the relationship between stroke and survival. However, obesity and past smoking were also risk factors for mortality. CONCLUSIONS: This study highlights the long-term impacts of stroke on life expectancy and the importance of comorbidities and other lifestyle factors in affecting poststroke survival.
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Estilo de Vida , Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso , Austrália/epidemiologia , Comorbidade , Feminino , Humanos , Incidência , Estudos Longitudinais , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumar , Acidente Vascular Cerebral/mortalidade , Taxa de SobrevidaRESUMO
Stroke is the leading cause of adult disability, and as a consequence, most therapists will provide health care to patients with stroke during their professional careers. An increasing number of studies are investigating the association between upper limb recovery and changes in brain activation patterns following stroke. In this review, we explore the translational implications of this research for health professionals working in stroke recovery. We argue that in light of the most recent evidence, therapists should consider how best to take full advantage of the brain's natural ability to reorganize, when prescribing and applying interventions to those with a stroke-affected upper limb. The authors propose that stroke is a brain-based problem that needs a brain-based solution. This review addresses two topics, anticipating recovery and maximizing recovery. It proposes five practice-ready recommendations that are based on the evidence reviewed. The over-riding aim of this review and discussion is to challenge therapists to reconsider the health care they prescribe and apply to people with a stroke-affected upper limb.
Assuntos
Terapia Ocupacional/organização & administração , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior/fisiopatologia , Medicina Baseada em Evidências , HumanosRESUMO
Background. Evidence indicates that Stroke Units decrease mortality and morbidity. An Acute Stroke Unit (ASU) provides specialised, hyperacute care and thrombolysis. John Hunter Hospital, Australia, admits 500 stroke patients each year and has a 4-bed ASU. Aims. This study investigated hospital admissions over a 5-year period of all strokes patients and of all patients admitted to the 4-bed ASU and the involvement of allied health professionals. Methods. The study retrospectively audited 5-year data from all stroke patients admitted to John Hunter Hospital (n = 2525) and from nonstroke patients admitted to the ASU (n = 826). The study's primary outcomes were admission rates, length of stay (days), and allied health involvement. Results. Over 5 years, 47% of stroke patients were admitted to the ASU. More male stroke patients were admitted to the ASU (chi(2) = 5.81; P = 0.016). There was a trend over time towards parity between the number of stroke and nonstroke patients admitted to the ASU. When compared to those admitted elsewhere, ASU stroke patients had a longer length of stay (z = -8.233; P = 0.0000) and were more likely to receive allied healthcare. Conclusion. This is the first study to report 5 years of ASU admissions. Acute Stroke Units may benefit from a review of the healthcare provided to all stroke patients. The trends over time with respect to the utilisation of the John Hunter Hospitall's ASU have resulted in a review of the hospitall's Stroke Unit and allied healthcare.
RESUMO
OBJECTIVE: Neurological dysfunction commonly occurs in the upper limb contralateral to the hemisphere of the brain in which stroke occurs; however, the impact of stroke on function of the ipsilesional upper limb is not well understood. This study aims to systematically review the literature relating to the function of the ipsilesional upper limb following stroke and answer the following research question: Is the ipsilesional upper limb affected by stroke? DATA SOURCE: A systematic review was carried out in Medline, Embase, and PubMed. REVIEW METHODS: All studies investigating the ipsilesional upper limb following stroke were included and analysed for important characteristics. Outcomes were extracted and summarised. Results. This review captured 27 articles that met the inclusion criteria. All studies provided evidence that the ipsilesional upper limb can be affected following stroke. CONCLUSION: These findings demonstrate that clinicians should consider ipsilesional upper limb deficits in rehabilitation and address this reduced functional capacity. Furthermore, the ipsilesional upper limb should not be used as a "control" measure of recovery for the contralateral upper limb.