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1.
Medicine (Baltimore) ; 100(12): e25077, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761665

RESUMO

BACKGROUND: Music-supported therapy has been widely used clinically to relieve post-stroke rehabilitation. However, the efficacy of Music-supported therapy in the treatment of Mood in post-stroke rehabilitation Patients is uncertain. The purpose of this study is to determine the effectiveness and safety of Music-supported therapy in the treatment of Mood in post-stroke rehabilitation Patients. METHODS: Search PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, China Biomedical Literature Database, and search related randomized controlled trials. Two reviewers will independently select studies, collect data, and evaluate methodological quality through the Cochrane Deviation Risk Tool. Revman V.5.3 will be used for meta-analysis. RESULTS: This study will evaluate the current status of Music-supported therapy treatment for mood in post-stroke rehabilitation Patients, aiming to illustrate the effectiveness and safety of Music-supported therapy treatment. CONCLUSION: This study will provide a basis for judging whether Music-supported therapy is effective in treating mood in post-stroke rehabilitation Patients. INPLASY REGISTRATION NUMBER: INPLASY202120011.


Assuntos
Ansiedade/reabilitação , Depressão/reabilitação , Musicoterapia/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Afeto , Ansiedade/etiologia , Depressão/etiologia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(9): e24656, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655929

RESUMO

INTRODUCTION: To facilitate the command to the learner, therapist can use verbal cues for guidance: internal focus (own body) and external focus (consequence of movement in the environment). OBJECTIVE: To examine the effects of different attentional focus on upper limb motor performance in post-stroke. METHODS: Randomized controlled trial with 2 groups. Study realized at Integrated Clinic of the Faculty of Health Science at Trairi (Santa Cruz, Rio Grande do Norte, Brazil). Twelve participants allocated into 2 groups. Two motor tasks were used: task 1, reach-point; task 2, reach-grasp-fit, with the paretic extremity, using verbal commands directed by a trained therapist. In the first phase, Group 1 received commands with internal focus, while Group 2 was instructed with commands with external focus. After 1 week, the command type was changed between groups. The variables collected was movement time, velocity and number of peaks velocity. RESULTS: Both attentional focus promoted significant differences in movement time and velocity, however, only Internal Focus provided significant results in both tasks of the same variables. DISCUSSION: The benefits of 1 attentional focus on the other are not fully confirmed. However, not receiving any kind of attention guidance compromises motor performance. The results support the hypothesis that the benefits of the External Focus are accentuated when preceded by the Internal Focus. CLINICAL TRIAL REGISTRATION: Research Ethics Committee of the Faculty of Helth Science at Trairi (Facisa - UFRN)- Number CAAE 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials - RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/).


Assuntos
Atenção , Desempenho Psicomotor/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Extremidade Superior/fisiopatologia , Idoso , Brasil , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Projetos Piloto , Acidente Vascular Cerebral/fisiopatologia
3.
Medicine (Baltimore) ; 100(10): e24968, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725863

RESUMO

BACKGROUND: Poststroke depression is a common secondary mental disorder after stroke, which increases the recurrence rate and mortality rate after stroke and hinders the recovery of function. As a combination therapy, simple acupuncture combined with fluoxetine has achieved good clinical effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of acupuncture combined with fluoxetine in the treatment of poststroke depression by meta-analysis. METHODS: Search Chinese and English databases: China national knowledge infrastructure, VP information Chinese Journal Service Platform, Wanfang, the China Biomedical Database, PubMed, Embase, the Cochrane Library, and web of science. A randomized controlled trial of simple acupuncture combined with fluoxetine in the treatment of poststroke depression will be selected. The retrieval time is of the establishment of the database in January 2021. Selected literature is extracted and deleted by 2 researchers, and the quality of the included literature is evaluated. The included literature is analyzed by Meta with RevMan5.3 software. RESULTS: In this study, the efficacy and safety of acupuncture combined with fluoxetine in the treatment of post-stroke depression are evaluated by Hamilton Depression scale (HAMD) and its reduction rate, Treatment Emergency Symptom Scale, Self-rating Depression Scale, and Activities of Daily living scale. CONCLUSION: This study will provide reliable evidence-based evidence for the clinical application of acupuncture combined with fluoxetine in the treatment of post-stroke depression. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/5J896.


Assuntos
Terapia por Acupuntura , Depressão/terapia , Fluoxetina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/complicações , Atividades Cotidianas , Terapia Combinada/métodos , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Humanos , Metanálise como Assunto , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/métodos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(10): e25026, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725884

RESUMO

ABSTRACT: Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors' performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one's own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors' recovery outcomes.


Assuntos
Autogestão/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia , Idoso , Ajustamento Emocional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autoeficácia , Autogestão/psicologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/mortalidade , Reabilitação do Acidente Vascular Cerebral/psicologia
5.
Occup Ther Int ; 2021: 6675680, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33727902

RESUMO

Objective: Instrumental activities of daily livings are important for independent living and active participation in the community. The present study is aimed at determining factors predicting instrumental activities of daily living performance in patients with stroke. Methods: In this cross-sectional study, a convenient sample of 90 patients with stroke entered from five occupational therapy centers, which were selected based on the cluster randomization method. Lawton IADL scale, Barthel Index, Trail Making Test (A and B), Digit span subtest of Wechsler memory scale, Motorcity index, and Beck Depression Inventory-II were used to investigate the study's aim. Statistical analyses were performed using independent sample t-test, one-way ANOVA, Pearson correlation, and multiple linear regression analysis. Results: Age (r = -0.384, p < 0.001), memory (r = 0.565, p < 0.001), basic activities of daily living (r = 0.818, p < 0.001), depression (r = -0.758, p < 0.001), Trial Making Test (B-A) (r = -0.614, p < 0.001), and motoricity index (r = 0.670, p < 0.001) were significantly associated with instrumental activities of daily living performance. Conclusions: Basic activities of daily living were the strongest predictor of IADL's performance. Age, TMT (B-A), and depression were orderly the next strongest predictors. Stroke patients with more dependency in basic activities of daily living, older age, cognitive impairment, and depression are more opted to be dependent in instrumental activities of daily living and as a result, less participation in home and community affairs.


Assuntos
Atividades Cotidianas , Disfunção Cognitiva/complicações , Função Executiva/fisiologia , Qualidade de Vida/psicologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/epidemiologia , Avaliação da Deficiência , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional , Acidente Vascular Cerebral/complicações
6.
Medicine (Baltimore) ; 100(12): e25041, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761663

RESUMO

BACKGROUND: Post-stroke depression (PSD) is one of the most common stroke complications with high morbidity. Researchers have done much clinical research on Traditional Chinese Medicine (TCM) treatment, but very little research on diagnosis. Based on the thought of combination of disease and syndrome, this study will establish a unified and objective quantitative diagnosis model of TCM syndromes of PSD, so as to improve the clinical diagnosis and treatment of PSD. OBJECTIVE: First: To establish a unified and objective quantitative diagnosis model of TCM syndromes in PSD under different disease courses, and identify the corresponding main, secondary, and concurrent symptoms, which are based on the weighting factor of each TCM symptom. Second: To find out the relationship between different stages of PSD and TCM syndromes. Clarify the main syndrome types of PSD under different stages of disease. Reveal the evolution and progression mechanism of TCM syndromes of PSD. METHODS AND ANALYSIS: This is a retrospective study of PSD TCM diagnosis. Three hundred patients who were hospitalized in the First Teaching Hospital of Tianjin University of TCM with complete cases from January 2014 to January 2019 are planned to be recruited. The study will mainly collect the diagnostic information from the cases, find the related indicators of TCM and Western medicine in PSD, and clarify the relationship between different disease stages and TCM syndromes. Finally, the PSD TCM syndrome quantitative diagnosis model will be established based on the operation principle of Back Propagation (BP) artificial neural network. CONCLUSION: To collect sufficient medical records and establish models to speed up the process of TCM diagnosis.


Assuntos
Depressão/diagnóstico , Medicina Tradicional Chinesa , Acidente Vascular Cerebral/psicologia , Adolescente , Adulto , Idoso , Depressão/terapia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Adulto Jovem
7.
Medicine (Baltimore) ; 100(8): e24945, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663134

RESUMO

BACKGROUND: Post-stroke depression (PSD) is one of the most common neuropsychiatric complications after stroke and is associated with increased risk of death and poor functional outcomes. Strong evidence shows that exercise has benefits for depression. However, it is not clear whether exercise has benefits specifically for PSD. This study aims to explore the effects of exercise on PSD and to establish safe and effective exercise prescriptions. METHODS AND ANALYSIS: The PubMed, Cochrane Library and EMBASE, databases will be searched using prespecified search strategies. Randomized controlled trials and non-randomized prospective controlled cohort studies regarding exercise for PSD will be included. The primary outcomes are depression scale and stroke outcome. The secondary outcomes are the occurrence of adverse events, cognitive function, quality of life indices, and the expression of nerve cell factors. The methodological quality of each study will be evaluated by the physiotherapy evidence database scale. The heterogeneity will be evaluated using the I2 test. If I2 > 50%, random effects models will be used in the analysis; otherwise, fixed effects models will be used to pool the data. RESULTS: This study will assess the efficacy and safety of exercise for PSD. CONCLUSIONS: Our findings will be helpful for clinicians to re-examine the clinical decision-making in the treatment of PSD, by assessing the efficacy of a promising treatment modality for patients with PSD. ETHICS AND DISSEMINATION: Ethical approval is not required because this study is a secondary analysis. The results of this study will be disseminated through journals and academic exchanges. SYSTEMATIC REVIEW REGISTRATION NUMBER: INPLASY202110100.


Assuntos
Depressão/etiologia , Depressão/terapia , Terapia por Exercício , Exercício Físico , Acidente Vascular Cerebral/complicações , Humanos , Metanálise como Assunto , Acidente Vascular Cerebral/psicologia , Revisões Sistemáticas como Assunto
8.
Stroke ; 52(4): 1407-1414, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33588588

RESUMO

BACKGROUND AND PURPOSE: The coronavirus disease 2019 (COVID-19) outbreak has led to disruptions in health care service delivery worldwide, inevitably affecting stroke survivors requiring ongoing rehabilitation and chronic illness management. To date, no published research has been found on stroke caregiving during the COVID-19 pandemic. This study aimed to explore Hong Kong stroke caregivers' caregiving experiences in the midst of this difficult time. METHODS: Individual semistructured interviews were conducted with 25 Chinese adult primary stroke caregivers from May to June 2020 via telephone. Interviews were transcribed verbatim and analyzed using an interpretive description approach and constant comparison strategy. RESULTS: Five themes of the stroke caregiving experience during the COVID-19 pandemic emerged: care service adversities, additional caregiving workload and strain, threatened relationship between caregiver and stroke survivors, threats to caregivers' physical and psychological well-being, and needs for continuing caregiving roles. Our findings suggested that caregivers have worsened physical and psychological well-being because of increases in care burden with simultaneously reduced formal and informal support. The relationship between caregiver and stroke survivor was subsequently affected, placing some survivors at heightened risk of abuse. CONCLUSIONS: Our study provides valuable findings about stroke caregiving experiences and needs during the pandemic. Delivery of psychological support, telemedicine, and household hygiene resources would be useful to mitigate caregivers' psychological distress during the COVID-19 pandemic.


Assuntos
/psicologia , Cuidadores/psicologia , Pandemias , Pesquisa Qualitativa , Reabilitação do Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Cuidadores/tendências , China/epidemiologia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/tendências , Sobreviventes/psicologia
9.
BMC Neurol ; 21(1): 76, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33596841

RESUMO

BACKGROUND: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.


Assuntos
Assistência Ambulatorial/normas , Psicoterapia/normas , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consenso , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Neuropsicologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Projetos Piloto , Indicadores de Qualidade em Assistência à Saúde , Reprodutibilidade dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia
10.
Medicine (Baltimore) ; 100(7): e24859, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607860

RESUMO

BACKGROUND: The purpose of this paper is to evaluate the effectiveness and safety of electroacupuncture in the treatment of spasticity after stroke. METHODS: We will electronically search PubMed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan-Fang Database from the date of creation to November 2020. In addition, we will manually retrieve other resources including the reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to electroacupuncture in the treatment of spasticity after stroke will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The modified Ashworth scale was the primary outcomes. Simplified Fugl-Meyer assessment scale (FMA), Stroke specific quality of life scale (SS-QOL) and adverse events will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis. If it is not appropriate for a meta- analysis, then a descriptive analysis will be conducted. Data synthesis will use the risk ratio and the standardized or weighted average difference of continuous data to represent the results. RESULTS: This study will provide a high-quality synthesis to assess the effectiveness and safety of electroacupuncture in the treatment of spasticity after stroke. CONCLUSION: This systematic review will provide evidence to judge whether electroacupuncture is an effective and safety intervention for patients with spasticity after stroke. ETHICS AND DISSEMINATION: The protocol of the systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION: CRD42021220300.


Assuntos
Eletroacupuntura/métodos , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , China/epidemiologia , Gerenciamento de Dados , Eletroacupuntura/efeitos adversos , Feminino , Humanos , Masculino , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Acidente Vascular Cerebral/psicologia , Resultado do Tratamento
11.
Neurology ; 96(13): e1701-e1710, 2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33568545

RESUMO

OBJECTIVE: To determine how young stroke survivors want their unmet needs to be addressed, we undertook an international online survey of people living with stroke. METHODS: Participants self-selected to complete an online survey that included a questionnaire on demographics and stroke-related characteristics, the Young Stroke Needs Screening Tool, and a questionnaire on how they wanted their needs to be met. RESULTS: One hundred seventy-one responses were received (68% female respondents, mean age 45 years, interquartile range 36-51 years). Preferences for methods of meeting needs varied depending on the domain of need and participants' demographic and stroke-related characteristics. Face-to-face contact with a health care professional was a popular means of meeting needs, but methods outside of a traditional health care setting such as a succinct list of tips or peer support were widely acceptable and sometimes preferred. CONCLUSION: This work provides the impetus for developing alternative methods of meeting young stroke survivors' needs, many of which are not resource intensive or do not require an appointment with a health care professional.


Assuntos
Determinação de Necessidades de Cuidados de Saúde , Preferência do Paciente , Angústia Psicológica , Acidente Vascular Cerebral/fisiopatologia , Sobreviventes , Adulto , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Grupo Associado , Relações Profissional-Paciente , Retorno ao Trabalho , Apoio Social , Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Telemedicina
12.
Medicine (Baltimore) ; 100(4): e23908, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530189

RESUMO

BACKGROUND: Poststroke depression (PSD) is a severe problem; it will significantly increase the mortality of patients after stroke, and affect the quality of life of patients after discharge. For stroke patients without noticeable adverse reactions, massage can effectively improve the patient's mood, thereby treating poststroke depression. But so far, there is still no systematic research to provide reliable evidence that massage can effectively treat poststroke depression. Therefore, the purpose of this study is to comprehensively summarize and evaluate the effectiveness and safety of massage therapy for poststroke depression. METHODS: We conduct a detailed search regardless of publication grade and language status. The search databases include the Web of Science, the Cochrane Library search, EMBASE, PubMed, CNKI, Chinese biomedical literature database, Chongqing VIP, and Wanfang. All randomized controlled trials and cohort studies on massage therapy for poststroke depression are published, as of November 15, 2020. The team consists of 2 experienced researchers who will select the retrieved documents and extract data. Later they used RevMan V.5.3 software for data analysis and data synthesis. RESULTS: The effectiveness and safety of massage therapy intended for poststroke depression will be subject to a systematic evaluation under this program. CONCLUSION: It will be substantiated in this review whether massage therapy is a reliable intervention for poststroke depression by examining the evidence collected. INPLASY REGISTRATION NUMBER: INPLASY2020110085.


Assuntos
Depressão/terapia , Massagem , Metanálise como Assunto , Acidente Vascular Cerebral/psicologia , Revisões Sistemáticas como Assunto , Protocolos Clínicos , Humanos , Massagem/efeitos adversos , Projetos de Pesquisa
13.
J Stroke Cerebrovasc Dis ; 30(4): 105641, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33549861

RESUMO

OBJECTIVES: The purpose of this study was to clarify the interaction among cognitive and physical functions associated with toilet independence in stroke patients. MATERIALS AND METHODS: We retrospectively examined 125 stroke patients. We performed decision tree analysis to detect the interaction associated with toilet independent using assessment of motor function on the affected side, muscle strength on unaffected side, trunk function, neglect, motivation, and cognitive function. The interactions detected via decision tree confirmed the existence and influence using logistic regression. RESULTS: The verticality test of the Stroke Impairment Assessment Set (3 or ≤2 points) was selected at the first level, and the Revised Hasegawa's dementia scale (≥19 or ≤18 points) and age (≥70 or ≤69 y) were selected at the second level of decision tree. Interaction terms created by these factors were significantly associated with toilet independence after adjusting for the independent influence of each factor using logistic regression. CONCLUSIONS: Our results show an interaction of trunk and cognitive functions or trunk function and age associated with toilet independence. The probability of toilet independence dramatically changes if two factors of each interaction were satisfied in stroke patients.


Assuntos
Atividades Cotidianas , Cognição , Defecação , Atividade Motora , Autocuidado , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Micção , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Árvores de Decisões , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Força Muscular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Tronco/fisiopatologia , Resultado do Tratamento
14.
J Stroke Cerebrovasc Dis ; 30(4): 105656, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33571877

RESUMO

OBJECTIVES: Post-stroke complications affect stroke survivors across the world, although data on them are limited. We conducted a questionnaire survey to examine the real-world state and issues regarding post-stroke complications in Japan, which represents a super-aged society. MATERIALS AND METHODS: In 2018, a nationwide multi-center questionnaire survey was conducted in the top 500 Japanese hospitals regarding the number of stroke patients treated. Three questionnaires regarding post-stroke complications were mailed to the doctors responsible for stroke management. RESULTS: Responses were obtained from 251 hospitals (50.2%). The chief doctors responsible for stroke management answered the questionnaires. The number of stroke patients in the departments of neurology and neurosurgery was 338.3 ± 195.3 and 295.8 ± 121.8. Hospitals were classified using the categories secondary (n =142) and tertiary hospitals (n = 106); most hospitals were acute hospitals. Dementia was the most common complication (30.9%), followed by dysphagia (29.3%), and apathy (16.3%). Dementia was thought to be more common by neurologists than neurosurgeons, while apathy and bladder-rectal disorder were thought to be more common by neurosurgeons than neurologists (p = 0.001). The most difficult complication to treat was dysphagia (40.4%), followed by dementia (33.9%), epilepsy (4.1%), and fall (4.1%). Dementia was considered to lack clinical evidence regarding treatment (32.8%), followed by dysphagia (25.3%), and epilepsy (14.1%). Epilepsy was considered to lack clinical evidence among hospitals with a larger number of stroke cases (p = 0.044). CONCLUSION: This study revealed the current state and issues regarding post-stroke complications in Japan. Clinicians should be aware of the importance of post-stroke complications, although data on them remain unsatisfactory.


Assuntos
Afasia/epidemiologia , Demência/epidemiologia , Epilepsia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidentes por Quedas , Apatia , Afasia/fisiopatologia , Afasia/terapia , Demência/psicologia , Demência/terapia , Epilepsia/fisiopatologia , Epilepsia/terapia , Pesquisas sobre Serviços de Saúde , Humanos , Japão/epidemiologia , Saúde Mental , Neurologistas , Neurocirurgiões , Doenças Retais/epidemiologia , Especialização , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Doenças da Bexiga Urinária/epidemiologia
15.
Medicine (Baltimore) ; 100(1): e24173, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429802

RESUMO

BACKGROUND: Whether the addition of Chinese herbal medicine (CHM) in routine western medicines for post-stroke depression yields additional therapeutic effects still remains to be controversial. This study aimed to assess the efficacy and safety of combination of CHM with routine western medicines versus routine western medicines alone in patients with post-stroke depression (PSD). METHODS: Electronic databases such as PubMed, EmBase, Cochrane library, and China National Knowledge Infrastructure were systematically searched from inception till October 2019. Studies designed as randomized controlled trials (RCTs) and that investigated the therapeutic effects of CHM plus routine western medicines (CHM group) versus routine western medicines alone (control group) in PSD patients were eligible. The relative risk (RR) and weighted mean difference (WMD) with 95% confidence interval (CI) were used to assess the categories and continuous data using random-effects model. Software STATA was applied to perform statistical analysis (Version 10.0; StataCorp, TX,). RESULTS: A total of 18 RCTs involving a total of 1,367 PSD patients were selected for final analysis. The effective rate in CHM group was significantly higher than that in control group (RR: 1.18; 95%CI: 1.12-1.24; P < .001). Moreover, patients in CHM group showed association with lower Hamilton Depression Rating Scale (WMD: -3.17; 95%CI: -4.12 to -2.22; P < .001) and Scandinavian Stroke Scale (WMD: -3.84; 95%CI: -5.73 to -1.96; P < .001) than those in control group. Furthermore, patients in CHM were associated with high level of Barthel Index than those in control group (WMD: 11.06; 95%CI: 4.01 to 18.10; P = .002). Finally, patients in CHM group had lower risk of gastrointestinal (RR: 0.49; 95%CI: 0.31-0.77; P = .002) and neurological (RR: 0.50; 95%CI: 0.33-0.75; P = .001) adverse events than those in control group. CONCLUSIONS: The study findings revealed that addition of CHM to routine therapies could improve the therapeutic effects and reduce gastrointestinal or neurological adverse events.


Assuntos
Depressão/tratamento farmacológico , Depressão/etiologia , Medicina Tradicional Chinesa/normas , Acidente Vascular Cerebral/complicações , Depressão/psicologia , Humanos , Medicina Tradicional Chinesa/métodos , Medicina Tradicional Chinesa/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Acidente Vascular Cerebral/psicologia
16.
J Psychosom Res ; 142: 110353, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33421630

RESUMO

BACKGROUND: Stroke can negatively impact the health-related quality of life (HRQoL). Anxiety or depression after stroke have been associated with poorer HRQoL, higher mortality and greater dependence in activities of daily living. We aimed to analyze HRQoL, anxiety and depressive symptoms in patients with and without atrial fibrillation (AF) up to 12 months post-stroke. METHODS: Find-AFRANDOMISED was a prospective, randomized multicenter study, which included 398 patients ≥60 years with acute cerebral ischemia. HRQoL data were collected using the 3-level EuroQol-5D (EQ-5D-3L) and Stroke Impact Scale (SIS-16). Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). The severity of stroke was measured using the modified Rankin Scale (mRS). RESULTS: In this study (mean age 72.7 ± 7.5 years, 40.2% females), there was a significant improvement in HRQoL using EQ-5D-3L after 3 months (ß = 0.37, p < .01), 6 months (ß = 0.43, p < .01) and 12 months (ß = 0.44, p < .01) post-stroke compared to baseline. HADS anxiety scores after 3 months (ß = -0.22, p < .01) and 12 months (ß = -0.28, p < .01) were significantly reduced. Older patients reported reduced HRQoL and more depressive symptoms. Females indicated lower HRQoL and more anxiety. mRS score at baseline was an independent predictor for HRQoL. There was a significant but small effect of AF on EQ-5D-3L and on HADS anxiety. CONCLUSIONS: Patients showed significant improvement in HRQoL and reduced anxiety after 3 and 12 months after stroke. We could demonstrate that the severity of stroke as well as sex and age impact long-term post-stroke HRQoL. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01855035.


Assuntos
Atividades Cotidianas/psicologia , Ansiedade/psicologia , Fibrilação Atrial/psicologia , Depressão/psicologia , Qualidade de Vida/psicologia , Acidente Vascular Cerebral/psicologia , Fatores Etários , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores Sexuais , Fatores de Tempo
17.
J Stroke Cerebrovasc Dis ; 30(4): 105600, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33454587

RESUMO

BACKGROUND: Stroke survivors often have impaired quality of live (QOL). There is very little information about the determining factors of QOL of stroke survivors in developing countries managed in public health structures with limited access to state of the art treatments. OBJECTIVE: To identify the main determinants of QOL in Tunisian stroke survivors. METHODS: QOL was assessed at 3, 6 and 12 months after the stroke using the Tunisian version of the SF-36 questionnaire. Patients were evaluated using the National Institue of Health Stroke Scale, the motor index of Demeurisse, the Functional Independence Measure instrument, the Reintegration to Normal Living Index, the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale. RESULTS: 65 stroke survivors were included (60% males; mean age 62.2±10.3 years). Eighty-sex percent of the patients had an ischemic infarction. Most of the stroke patients had minor or moderate stroke. All the QOL dimensions were altered at 3 months post stroke. Between the 3 and 6-months follow-ups, there were significant changes in the SF-36 scores and individual domains but QOL remained altered. Between 6 and 12 months, there were no significant changes in the majority of the SF-36 domains. Advanced age, neurologic impairment, depression and disability measured 1 month after stroke, the stroke side (left hemisphere), the life style, and higher education, were associated with worse QOL. CONCLUSIONS: Stroke severity, advanced age, post-stroke depression and disability seem to represent consistent determinants of QOL in Tunisian stroke patients.


Assuntos
Avaliação da Deficiência , Testes de Estado Mental e Demência , Qualidade de Vida , Acidente Vascular Cerebral/diagnóstico , Inquéritos e Questionários , Sobreviventes/psicologia , Fatores Etários , Idoso , Depressão/diagnóstico , Depressão/psicologia , Feminino , Seguimentos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Tunísia
18.
N Z Med J ; 134(1528): 46-56, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33444306

RESUMO

AIM: To investigate the knowledge and practice of health professionals when advising persons on driving restrictions after a transient ischaemic attack (TIA) or stroke in a tertiary hospital in New Zealand. METHODS: Health professionals working in the area of stroke care across the acute and rehabilitation services in a large tertiary hospital were invited to complete an electronic survey around knowledge of driving restrictions based on the New Zealand Transport Agency (NZTA) guidelines. Knowledge was assessed for both private and commercial vehicle use. The other information gathered included participant profession, level of seniority and experience working in stroke care, previous education around medical-related driving restrictions and how and what driving recommendations were discussed with patients. Knowledge of driving restrictions was established by the number and percentage of correct responses for each condition (single TIA, multiple TIA and stroke with full recovery) relating to the recommended restrictions in both private and commercial vehicle use. RESULTS: Forty-nine participants' surveys were analysed with representation from across all the health professions (24.5% [12/49] doctors, 38.8% [19/49] nurses and 36.7% [18/49] allied health). Only 38.8% reported having had received training around post-stroke driving restrictions. Knowledge around driving restrictions was highest for a single episode TIA for private vehicle use (73.5% [36/49]). For all other categories, fewer than 50% of participants answered correctly, with knowledge of commercial vehicle restrictions being the least accurate. CONCLUSIONS: Many health professionals have discussions with people about driving restrictions following a TIA or stroke. However, there appears to be limited knowledge of all the restrictions for each condition as they relate to either private or commercial vehicle use. Insufficient training and education for clinicians might explain this gap.


Assuntos
Atenção/fisiologia , Condução de Veículo , Conhecimentos, Atitudes e Prática em Saúde , Médicos/normas , Acidente Vascular Cerebral/psicologia , Feminino , Humanos , Masculino , Nova Zelândia , Inquéritos e Questionários
19.
Curr Probl Cardiol ; 46(4): 100737, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33412349

RESUMO

BACKGROUND: The COVID-19 pandemic's mental health consequences remain unknown. AIM: To assess the mental health status of ambulatory cardiometabolic patients during COVID-19 pandemic lockdown in Spanish speaking Latin American countries. METHODS: Cardiometabolic patients without COVID-19 evidence in 13 Latin American countries answered a survey between June 15th and July 15th, 2020. The Diagnosis Manual of Mental Disorders fifth edition was used to identify the presence of major depressive symptoms. RESULTS: The sample included 4216 patients, 1590 (37.71%; IC95% 36.24-39.19) were considered suffering major depression. Female gender, consuming ≥5 medications day, physical activity <100 minutes weekly, low fruits and vegetables intake, poor treatment adherence, reduced food consumption were independently associated to the presence of major depressive symptoms. CONCLUSIONS: The CorCOVID Latam Psy study showed that one-third of the Latin American Spanish speaking population is suffering from major depressive symptoms during the COVID-19 outbreak.


Assuntos
Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Diabetes Mellitus/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/psicologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/psicologia , Dieta/estatística & dados numéricos , Dislipidemias/epidemiologia , Dislipidemias/psicologia , Ingestão de Alimentos , Exercício Físico/psicologia , Feminino , Frutas , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , América Latina/epidemiologia , Masculino , Saúde Mental , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Verduras
20.
J Stroke Cerebrovasc Dis ; 30(4): 105612, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33493876

RESUMO

BACKGROUND: Following stroke, individuals commonly experience persisting loss of function. Whilst long-term care should involve continued support for ongoing stroke sequelae, this is often not routinely practiced globally. The Post Stroke Checklist was designed to standardise the process of detecting persisting treatable problems following stroke. AIMS: This cross-sectional study aimed to identify the long-term problems reported in Australian and Chinese participants at six months post stroke using the Post Stroke Checklist. It also aimed to provide global insight into poststroke sequelae by comparing the study results to previously published studies which administered the Post Stroke Checklist in other countries. METHODS: Participants were recruited from two hospitals in Australia and one hospital in China. The Post Stroke Checklist consists of 11 problem areas commonly experienced after stroke. This study follows a sequence of studies which have applied the checklist to monitor long-term outcomes after stroke in Germany, Italy, Singapore, Sweden and the United Kingdom. RESULTS: Comparisons between Australia (n = 112) and China (n = 97) demonstrated statistically significant differences on the Post Stroke Checklist items. Across all seven countries, collectively the most common persisting difficulties post-stroke related to: cognition, life after stroke, mood, mobility and activities of daily living. An analysis of means procedure compared individual countries for each checklist item against the overall group mean (all countries combined). CONCLUSIONS: Globally, individuals report persisting functional difficulties following stroke. There appear to be differences in the proportions affected across the various countries, and healthcare systems may benefit from geographically tailoring post-stroke care.


Assuntos
Atividades Cotidianas , Lista de Checagem , Acidente Vascular Cerebral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Austrália , China , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Valor Preditivo dos Testes , Estudos Prospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral , Fatores de Tempo , Resultado do Tratamento
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