The relationship between Rating of Everyday Arm-use in the Community and Home (REACH) scale affected arm-use assessment, activity and participation after stroke.

BACKGROUND AND OBJECTIVES: While arm function has been traditionally used as a primary goal for upper extremity rehabilitation post-stroke, we propose a simple measure of arm use, which may translate into better activities and participation. The aim was to determine the relationship between arm use and measures of activity and participation. METHODS: This was a cross-sectional study with evaluative components involving community-dwelling individuals with chronic stroke. The Rating of Everyday Arm-Use in the Community and Home (REACH) Scale was used to assess affected arm use, Barthel Index and activity domain of the Stroke Impact Scale (SIS) for activities, and participation domain of the SIS for participation. The participants were also asked if they resumed driving after the stroke. RESULTS: Forty-nine individuals (mean age = 70.3 ± 11.5 years, male sex = 51%) living with the effects of a stroke for at least 3 months participated in this study. There was a positive relationship between affected arm use and activities (Barthel Index score - rs  = 0.464; SIS activities - rs  = 0.686), participation (rs  = 0.479), and driving (rs  = 0.581). The Barthel Index scores were higher for individuals with dominant arm hemiparesis (p = 0.003) or left hemisphere lesions (p = 0.005). There was also greater arm use in left hemisphere lesions (p = 0.018). CONCLUSIONS: Affected arm use in individuals with chronic stroke is related to activities and participation. Given the importance of arm use in activities and participation after stroke, rehabilitation therapists may consider utilizing the REACH Scale, a simple and quick outcome measure, as a means to assess arm use and implement effective interventions for improving arm use.

The prevalence of cardiometabolic multimorbidity and its association with physical activity, diet, and stress in Canada: evidence from a population-based cross-sectional study.

BACKGROUND: Cardiometabolic multimorbidity (CM) is defined as having a diagnosis of at least two of stroke, heart disease, or diabetes, and is an emerging health concern, but the prevalence of CM at a population level in Canada is unknown. The objectives of this study were to quantify the: 1) prevalence of CM in Canada; and 2) association between CM and lifestyle behaviours (e.g., physical activity, consumption of fruits and vegetables, and stress). METHODS: Using data from the 2016 Canadian Community Health Survey, we estimated the overall and group prevalence of CM in individuals aged ≥50 years (n = 13,226,748). Multiple logistic regression was used to quantify the association between CM and lifestyle behaviours compared to a group without cardiometabolic conditions. RESULTS: The overall prevalence of CM was 3.5% (467,749 individuals). Twenty-two percent (398,755) of people with diabetes reported having another cardiometabolic condition and thus CM, while the same was true for 32.2% (415,686) of people with heart disease and 48.4% (174,754) of stroke survivors. 71.2% of the sample reported eating fewer than five servings of fruits and vegetables per day. The odds of individuals with CM reporting zero minutes of physical activity was 2.35 [95% CI = 1.87 to 2.95] and having high stress was 1.89 [95% CI = 1.49 to 2.41] times the odds of the no cardiometabolic condition reference group. The odds of individuals with all three cardiometabolic conditions reporting zero minutes of physical activity was 4.31 [95% CI = 2.21 to 8.38] and having high stress was 3.93 [95% CI = 2.03 to 7.61]. CONCLUSION: The number of Canadians with CM or at risk of CM is high and these individuals have lifestyle behaviours that are associated with adverse health outcomes. Lifestyle behaviours tend to diminish with increasing onset of cardiometabolic conditions. Lifestyle modification interventions focusing on physical activity and stress management for the prevention and management CM are warranted.

Healthcare utilization after stroke in Canada- a population based study.

BACKGROUND: More people are surviving stroke but are living with functional limitations that pose increasing demands on their families and the healthcare system. The aim of this study was to determine the extent to which stroke survivors use healthcare services on a population level compared to people without a stroke. METHODS: This was a cross-sectional population-based survey that collected information related to health status, healthcare utilization and health determinants using the 2014 Canadian Community Health Survey. Healthcare utilization was assessed by a computer-assisted personal interview asking about visits to healthcare professionals in the last 12 months. Negative binomial regression was used to estimate the incidence rate ratios (IRR) and 95% confidence intervals (CI) for the number of health professional visits between stroke survivors and people without a stroke. The regression models were adjusted for demographics, as well as for mobility, mood/anxiety disorder and cardiometabolic comorbid conditions. RESULTS: The study sample included 35,759 respondents (948 stroke, 34,811 non-stroke) and equate to 12,396,641 (286,783 stroke; 12,109,858 non-stroke) when sampling weights were applied. Stroke survivors visited their family doctor the most, and stroke was significantly associated with more visits to most healthcare professionals [e.g., family doctor IRR 1.6 (CI 1.4-1.8); nurse IRR 3.0 (CI 1.8-4.8); physiotherapist IRR 1.8 (CI 1.1-1.9); psychologist IRR 4.0 (CI 1.1-5.7)] except the dental practitioner, which was less [IRR 0.7 (CI 0.6-0.9)]. Mood/anxiety condition, but not cardiometabolic comorbid condition increased the probability of visiting a family doctor or social worker/ counsellor among people with stroke. CONCLUSION: Stroke survivors visited healthcare professionals more often than people without stroke, and were approximately twice as likely to visit with those who manage problems that may arise after a stroke (e.g., family doctor, nurse, psychologist, physiotherapist). The effects of a stroke include mobility impairment and mood/ anxiety disorders. Therefore, adequate access to stroke-related healthcare services should be provided for stroke survivors, as this may improve functional outcome and reduce future healthcare costs.

Standardized outcome measures for cerebral palsy among physiotherapists in southwestern Nigeria: awareness, use, barriers, and facilitators.

The use of outcome measures for assessing progress in the management and treatment of cerebral palsy (CP) is widely recommended. This study was, therefore, carried out to determine awareness and use of standardized outcome measures among physiotherapists managing CP in Nigeria. Barriers to and facilitators for the use of outcome measures were also investigated. This was a descriptive study involving 138 physiotherapists from selected hospitals in southwestern Nigeria. A self-administered questionnaire was used to obtain relevant information on socio-demographics, awareness, use, barriers to, and facilitators for the use of seven standardized outcome measures. The Gross Motor Function Measure was the most recognized (78.9%) and commonly used (58%) outcome measure, while the Paediatric Outcomes Data Collection Instrument (23.2%) and the Paediatric Evaluation of Disability Inventory (10.9%) were the least recognized and least used, respectively. The greatest perceived facilitators were familiarity (87.7%), positive attitude (87.7%), and that outcome measures allow for a balanced clinical assessment (89.1%). The greatest perceived barriers identified were the need for extra accommodation to apply outcome measures (63%) and time consumption on the part of patients (44.2%). Many physiotherapists in this study identified the standardized outcome measures, but fewer used them irrespective of educational status and years of work experience. Generally, there was a positive attitude toward the use of outcome measures. The use of outcome measures should be promoted among physiotherapists in Nigeria, through training programs and translation into the native languages, to effectively assess, manage, and monitor the progress of patients with CP, putting into consideration barriers and facilitators.

Support service utilization and out-of-pocket payments for health services in a population-based sample of adults with neurological conditions.

BACKGROUND: Social support can help to deal with the consequences of neurological conditions and promote functional independence and quality of life. Our aim was to evaluate the impact of neurological conditions on the use of support and health-care services in a population-based sample of community-dwelling adults with neurological conditions. METHODS: Data were from the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents. Formal and informal support received and out-of-pocket payments were assessed by personal interviews. Logistic regression was used to explore the association between support service utilization and six common neurological conditions (Stroke, Parkinson's disease, Alzheimer's disease/dementias, traumatic brain injury, spinal cord injury and multiple sclerosis) with stroke as the reference category. RESULTS: The sample contained 2,410 respondents and equate to an estimated 459,770 when sample weights were used. A larger proportion of people within each of the neurological conditions received informal support than formal support (at least twice as much). Samples with the non-stroke conditions were more likely to receive formal assistance for personal (odds ratios 2.7 to 5.6; P < 0.05) and medical (odds ratios 2.4 to 4.4; P < 0.05) care compared to the stroke group. Also, the non-stroke conditions were more likely to receive informal assistance (odds ratios 2.7 to 17.9; P < 0.05) and less likely to make out-of-pocket payments for rehabilitation therapy (odds ratios 0.2 to 0.3; P < 0.05) than the stroke group. The Alzheimer's disease/dementia group had the highest proportion who received formal and informal support services. CONCLUSIONS: Our findings suggest that Canadians with neurological conditions receive more informal assistance than formal assistance. Furthermore, it appears that stroke survivors receive less support services, while those with Alzheimer's disease/dementia receive the most compared to other adult neurological conditions. Such data can help inform the development of support services in the community.

Rehabilitation Interventions for Improving Social Participation After Stroke: A Systematic Review and Meta-analysis.

BACKGROUND: Despite the fact that social participation is considered a pivotal outcome of a successful recovery after stroke, there has been little attention on the impact of activities and services on this important domain. OBJECTIVE: To present a systematic review and meta-analysis from randomized controlled trials (RCTs) on the effects of rehabilitation interventions on social participation after stroke. METHODS: A total of 8 electronic databases were searched for relevant RCTs that evaluated the effects of an intervention on the outcome of social participation after stroke. Reference lists of selected articles were hand searched to identify further relevant studies. The methodological quality of the studies was assessed using the Physiotherapy Evidence Database Scale. Standardized mean differences (SMDs) and confidence intervals (CIs) were estimated using fixed- and random-effect models. RESULTS: In all, 24 RCTs involving 2042 stroke survivors were identified and reviewed, and 21 were included in the meta-analysis. There was a small beneficial effect of interventions that utilized exercise on social participation (10 studies; SMD = 0.43; 95% CI = 0.09, 0.78;P= .01) immediately after the program ended. Exercise in combination with other interventions (13 studies; SMD = 0.34; 95% CI = 0.10, 0.58;P= .006) also resulted in beneficial effects. No significant effect was observed for interventions that involved support services over 9 studies (SMD = 0.09 [95% CI = -0.04, 0.21];I(2)= 0%;P= .16). CONCLUSIONS: The included studies provide evidence that rehabilitation interventions may be effective in improving social participation after stroke, especially if exercise is one of the components.

Awareness of stroke risk factors and warning signs in Nigerian adolescents compared with adults.

BACKGROUND: Stroke, a significant health problem affecting adults, is increasing among younger age groups, particularly because of changing lifestyles. The aim of the study was to compare the awareness of stroke risk factors and warning signs among students and teachers in selected secondary schools in Osun State, Nigeria. METHODS: This was a cross-sectional survey involving 703 (589 students and 114 teachers) respondents in selected secondary schools in Osun, Nigeria. Information on the awareness of stroke risk factors and warning signs was collected with the aid of a structured questionnaire. RESULTS: Hypertension (69.4%) was the most commonly identified stroke risk factor, with more teachers (79.8%) identifying correctly than the students (67.4%). Weakness (51.9%) was the most commonly identified warning sign of stroke with more students (53.8%) identifying correctly than the teachers (42.1%). There were significant differences in the awareness of some risk factors (age, obesity, family history, alcohol use, diet, transient ischemic attack, and hyperlipidemia) and warning signs (dizziness, weakness, and vision problems) between students and teachers. Predictors for adequate awareness of risk factors were being a teacher, not being obese and being hypertensive, whereas predictors for adequate awareness of warning signs were stroke in the family and being hypertensive. CONCLUSIONS: There was inadequate awareness of risk factors and warning signs among the respondents with students having better awareness of warning signs and teachers having better awareness of risk factors. Stroke campaigns should emphasize stroke risk factors particularly among adolescents and warning signs in adults. The use of media, particularly television, is recommended.

Functional limitations due to fatigue among independently ambulant stroke survivors in Osun, South-Western Nigeria.

BACKGROUND AND PURPOSE: Functional limitations in stroke survivors are sometimes associated with fatigue. This study assessed the functional limitations due to fatigue in community-dwelling stroke survivors undergoing physiotherapy. The differences in functional limitations due to fatigue were determined between sexes, stroke types, sides of affectation, age categories and levels of disability. Relationships between functional limitation due to fatigue and these variables were also determined. METHODS: This was a cross-sectional study involving 63 stroke survivors (35 male survivors and 28 female survivors) with ages ranging from 45 to 79 years (mean = 53.68 ± 10.95 years). Functional limitation due to fatigue was assessed with the modified fatigue impact scale (MFIS). Modified Rankin scale was used to categorize the disability of the participants. Data were analysed using descriptive (mean, standard deviation, percentage and frequency) and inferential (Mann-Whitney U-test and Spearman correlation analysis) statistics. Significance was set at 0.05 α level. RESULTS/FINDINGS: The mean MFIS score was 31.74 ± 12.39. Many participants (58.7%) had moderate functional limitations due to fatigue. The result of Mann-Whitney U-test showed significant difference in functional limitation due to fatigue between participants with slight disability and those with moderate disability (p = 0.000), with participants with moderate disability having higher MFIS scores (more functional limitations). There was also a significant correlation between functional limitation due to fatigue and level of disability (ρ = 0.625, p = 0.000). DISCUSSION: Functional limitation due to fatigue occurs frequently in stroke survivors and is related to level of disability. Functional limitations due to fatigue should be assessed frequently in all stroke survivors with varying degrees of disability and the outcome should be considered during rehabilitation and retraining of physical function.

Awareness of risk factors and warning signs of stroke in a Nigeria university.

BACKGROUND: Rapid access to medical services which is an important predictor of treatment and rehabilitation outcome requires that there is an understanding of stroke risk factors and early warning signs. This study assessed awareness of stroke risk factors and warning signs among students and staff of Obafemi Awolowo University, Nigeria. METHODS: This was a cross sectional survey involving 994 (500 students and 494 staff) respondents. Information on the awareness of stroke risk factors and warning signs was collected with the aid of a structured questionnaire. Descriptive and inferential statistics were used for data analysis. RESULTS: Weakness (66.2%) was the most commonly identified warning sign of stroke with more staff (69.8%) identifying correctly than students (62.6%). Hypertension (83.4%) was the most commonly identified stroke risk factor, with more staff (91.7%) identifying correctly than students (83.2%). There were significant differences (p < 0.05) in the awareness of some risk factors (age, hypertension, stress and obesity), and warning signs (dizziness, numbness, weakness, headache and vision problems) between students and staff. Predictors for adequate awareness of both stroke risk factors and warning signs were younger age, smoking history and higher educational level. CONCLUSIONS: Majority of the respondents recognized individual important stroke risk factors and warning signs, but few recognized multiple stroke risk factors and warning signs. Awareness programs on stroke should be organized, even in communities with educated people to increase public awareness on the prevention of stroke and on the reduction of morbidity in the survivors.