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1.
Trials ; 22(1): 430, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225764

RESUMO

BACKGROUND: Sensorimotor impairments of upper limb (UL) are common after stroke, leading to difficulty to use the UL in daily life. Even though many have sensory impairments in the UL, specific sensory training is often lacking in stroke rehabilitation. Thus, the aim of this paper is to provide a detailed description of the novel intervention "SENSory re-learning of the UPPer limb after stroke (SENSUPP)" that we have developed to improve functioning in the UL in persons with mild to moderate impairments after stroke. METHODS: The SENSUPP protocol was designed using information from literature reviews, clinical experience and through consultation of experts in the field. The protocol integrates learning principles based on current neurobiological knowledge and includes repetitive intensive practice, difficulty graded exercises, attentive exploration of a stimulus with focus on the sensory component, and task-specific training in meaningful activities that includes feedback. For reporting the SENSUPP protocol, the Template for Intervention Description and Replication (TIDieR) checklist was used. RESULTS: The essential features of the SENSUPP intervention comprise four components: applying learning principles based on current neurobiological knowledge, sensory re-learning (exercises for touch discrimination, proprioception and tactile object recognition), task-specific training in meaningful activities, and home-training. The training is performed twice a week, in 2.5-h sessions for 5 weeks. CONCLUSION: Since there is close interaction between the sensory and motor systems, the SENSUPP intervention may be a promising method to improve UL functioning after stroke. The TIDieR checklist has been very useful for reporting the procedure and development of the training. TRIAL REGISTRATION: ClinicalTrials.gov NCT03336749 . Registered on 8 November 2017.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Lista de Checagem , Terapia por Exercício , Humanos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Extremidade Superior
2.
Ther Umsch ; 78(6): 249-258, 2021 Aug.
Artigo em Francês | MEDLINE | ID: mdl-34291656

RESUMO

Stroke patient education: scientific evidence, practical application Abstract. Stroke is a sudden and brutal event that changes every aspect of daily life. The patient and his family will need to develop skills in self-management of this chronic disease over the long term, managing risk factors, lifestyle changes and consequences of stroke. In recent years, randomized clinical trials have demonstrated the effectiveness of patient education and of several lifestyle-changing interventions adopted after a stroke. We summarize this scientific knowledge and describe the practical aspects of implementing a patient education program in a stroke unit, an essential approach in the treatment and follow-up of stroke patients.


Assuntos
Autogestão , Acidente Vascular Cerebral , Doença Crônica , Humanos , Estilo de Vida , Educação de Pacientes como Assunto , Acidente Vascular Cerebral/terapia
3.
Ther Umsch ; 78(6): 328-338, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291661

RESUMO

Stroke Unit- / Stroke Center Care Abstract. About 16'000 people in Switzerland suffer from stroke, each year. In Switzerland, 23 Stroke units and Stroke centers are available to provide individual care for the vast majority of stroke patients. Comprehensive, interdisciplinary therapeutic strategies are standardized and include prevention and therapy of acute complications, expedited diagnostic workup, and early rehabilitation. Stroke units not only reduce mortality and permanent disability in stroke patients, but-alongside advanced recanalization therapies-represent the cornerstone of modern stroke care. The following article gives a detailed overview of core tasks and the current standards of treatment in stroke unit care.


Assuntos
Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Suíça
4.
Ther Umsch ; 78(6): 277-289, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291662

RESUMO

Atherosclerosis of the intracranial arteries and of the extracranial carotid artery. Abstract. Intracranial atherosclerotic stenoses are the most common cause of ischemic stroke worldwide. Nowadays, three therapeutic approaches are available for consideration for patients with intracranial atherosclerotic stenoses: A conservative therapy (best medical treatment, management of vascular risk factors and healthy lifestyle), endovascular and surgical therapy. Conservative approach has been recommended for patients with asymptomatic intracranial atherosclerotic stenoses, as well as for those with symptomatic stenoses. Endovascular therapy should be considered as a treatment option for carefully selected patients with recurrent ischemic strokes attributed to the stenotic artery while receiving best medical therapy. Surgical revascularisation is rarely favored in patients with intracranial stenoses. In patients with extracranial atherosclerotic stenoses, carotid endarterectomy (CEA) has been associated with a lower risk of death and recurrent stroke when compared to carotid angioplasty and stenting (CAS). Especially in elderly patients over 70 years of age CEA is preferred over CAS due to the twofold increased 30-day risk of recurrent stroke or death in patients treated with CAS. Results from contemporary studies using modern techniques and devices are expected. It remains unclear whether patients with asymptomatic extracranial atherosclerotic stenoses receiving best medical treatment would benefit of invasive procedures such as CEA or CAS.


Assuntos
Aterosclerose , Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Aterosclerose/terapia , Artérias Carótidas , Estenose das Carótidas/terapia , Humanos , Fatores de Risco , Stents , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
5.
Ther Umsch ; 78(6): 299-304, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291664

RESUMO

Post stroke depression Abstract. Post stroke depression is a common psychiatric disorder after a cerebrovascular insult. It effects the outcome of the rehabilitation after the stroke and leads to an increased mortality. The symptomatic description of the depressive symptoms is done according to the ICD-10 criteria. The following article aims to provide an overview of the etiologic theories, diagnostic approaches, and therapeutic strategies regarding PSD.


Assuntos
Transtorno Depressivo , Acidente Vascular Cerebral , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Transtorno Depressivo/terapia , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
6.
Zhongguo Zhen Jiu ; 41(7): 711-5, 2021 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-34259399

RESUMO

OBJECTIVE: To compare the clinical effect between yin-yang penetrating acupuncture with elongated needle and routine acupuncture for spastic limb dysfunction after stroke. METHODS: A total of 60 patients were randomized into an observation group and a control group, 30 cases in each group. Both groups received basic treatment, yin-yang penetrating acupuncture with elongated needle was applied from Yanglingquan (GB 34) to Xuanzhong (GB 39), Quchi (LI 11) to Wenliu (LI 7), Huantiao (GB 30) to Fengshi (GB 31), Jianyu (LI 15) to Quchi (LI 11), etc. on the affected side in the observation group; routine acupuncture was applied at Neiguan (PC 6), Shuigou (GV 26), Sanyinjiao (SP 6), Jiquan (HT 1), Chize (LU 5), Weizhong (BL 40), Jianyu (LI 15), etc. on the affected side in the control group. Once a day, 5 times a week, 2 weeks as a course, 2 courses were required in the two groups. Before and after treatment,the modified Ashworth scale (MAS) grade, Fugl-Meyer assessment scale (FMA) score, activity of daily living scale (ADL) (Barthel index) score were observed, and the clinical effect was evaluated in the two groups. RESULTS: Compared before treatment, the MAS grade after treatment was improved in the two groups (P<0.05), that in the observation group was superior to the control group (P<0.05). Compared before treatment, the FMA and ADL scores after treatment were increased in the two groups (P<0.05), the changes in the observation group were larger than the control group (P<0.05). The total effective rate in the observation group was 80.0% (24/30), which was superior to 70.0% (21/30) in the control group (P<0.05). CONCLUSION: Yin-yang penetrating acupuncture with elongated needle could improve muscle tension, spasm grade and motor function in patients with spastic limb dysfunction after stroke, enhance the activity of daily living, its clinical effect is superior to routine acupuncture.


Assuntos
Terapia por Acupuntura , Acidente Vascular Cerebral , Pontos de Acupuntura , Humanos , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Yin-Yang
7.
Zhongguo Zhen Jiu ; 41(7): 717-20, 2021 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-34259400

RESUMO

OBJECTIVE: To observe the effect of tapping at acupoints along meridian combined with thunder-fire moxibustion on upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke. METHODS: A total of 140 patients with upper-limb hemiplegia after stroke were randomly divided into a combination group (35 cases, 2 cases dropped off), an acupoint-tapping group (35 cases), a moxibustion group (35 cases, 2 cases dropped off) and a routine group (35 cases). The patients in the routine group were only treated with routine treatment and nursing. On the basis of the treatment in the routine group, the patients in the acupoint-tapping group were treated with tapping along the large intestine meridian of hand yangming, with Hegu (LI 4), Shousanli (LI 10), Quchi (LI 11), Shouwuli (LI 13) and Jianyu (LI 15) as the key acupoints, once a day, 10 min each time; the patients in the moxibustion group were treated with thunder-fire moxibustion at the affected-side Shousanli (LI 10), Quchi (LI 11) and their surrounding area, once a day, 15 min each time. The patients in the combination group were treated with tapping at acupoints along meridian, followed by thunder-fire moxibustion. The treatment was 6 days a week for 4 weeks in the 4 groups. The body mass index of joint activity (shoulder abduction, elbow extension, wrist flexion) and Barthel index (BI) score were observed before and after treatment in the four groups. RESULTS: Compared before treatment, body mass indexs of shoulder abduction, elbow extension, wrist flexion as well as BI scores in the four groups were significantly increased after treatment (P<0.05). After treatment, the body mass indexs of joint activity in the combination group were higher than those in the other three groups (P<0.05). The BI scores in the acupoint-tapping group, the moxibustion group and the combination group were higher than those in the routine group (P<0.05). The BI score in the combination group was higher than the acupoint-tapping group and the moxibustion group (P<0.05). CONCLUSION: Tapping at acupoints along meridian combined with thunder-fire moxibustion could effectively improve the upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke, and its effect is superior to simple tapping at acupoints along meridian or thunder-fire moxibustion.


Assuntos
Terapia por Acupuntura , Meridianos , Moxibustão , Acidente Vascular Cerebral , Atividades Cotidianas , Pontos de Acupuntura , Hemiplegia/etiologia , Hemiplegia/terapia , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Punho
8.
Trials ; 22(1): 439, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243808

RESUMO

BACKGROUND: Many therapeutic interventions are performed by physiotherapists to improve upper extremity function and/or activities of daily living (ADL) in stroke patients. Mirror therapy (MT) is a simple technique that can be self-administered by the patients with intact cognition following patient education by a skilled physiotherapist. However, the effectiveness of self-administered MT in post-stroke patients in upper extremity function remains unclear. Therefore, the objective of this study is to examine the effectiveness of MT in improving upper extremity function and recovery in acute stroke patients. METHODS: This study is a single-center, prospective, randomized, open-label, controlled trial with blinded outcome evaluation (PROBE design), in which a total of 36 eligible acute stroke patients will be randomly assigned to control (n=18) and experimental group (n=18). Participants in the control group will receive regular rehabilitation interventions whereas participants in the experimental group will receive MT education in addition to their regular interventions for 4 weeks. STUDY OUTCOME: The primary outcome measure will be upper extremity function that will be measured using the Fugl-Meyer Assessment scale and the Wolf Motor Function Test. The secondary outcome measure will be behaviors related to ADL as estimated using the Modified Barthel Index. Outcome measures will be assessed at baseline and at 4 weeks post-rehabilitation intervention/MT. RESULTS: A two-way repeated analysis of variance (ANOVA) with time and group effects will be used to analyze between-group differences. The level of significance will be set at P < 0.05. CONCLUSION: The results of the study will provide critical information to include self-administered MT as an adjuvant to regular interventions and may facilitate recovery of the upper extremity function of stroke patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04542772 . Registered on 9 September 2020. Protocol version: Final 1.0.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Extremidade Superior
10.
Trials ; 22(1): 463, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281611

RESUMO

BACKGROUND: Protocols involving intensive practice have shown positive outcomes. Constraint induced movement therapy (CIT) appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about lower extremity constraint-induced movement therapy (LE-CIT) and its effects on gait and balance. OBJECTIVE: To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke. METHODS: The study adopts a randomized, controlled, single-blinded study design. Forty-two patients, who suffered a stroke, who were in the chronic phase of recovery (>6 months), with gait disability (no community gait), and who were able to walk at least 10 m with or without the advice or support of 1 person, will be randomly allocated to 2 groups: the LE-CIT group or the control group (intensive conventional therapy). People will be excluded if they have speech deficits that render them unable to understand and/or answer properly to evaluation scales and exercises selected for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome will be assessed at baseline (T0), immediately after the intervention (T1), and after 6 months (T2). The outcome measures chosen for this trial are as follows: 6-min walk test (6minWT), 10-m walk test (10mWT), timed up and go (TUG), 3-D gait analysis (3DGA), Mini Balance Evaluation Systems Test (Mini-BESTest), and as a secondary measure, Lower Extremity Motor Activity Log will be evaluated (LE-MAL). The participants in both groups will receive 15 consecutive days of daily exercise. The participants in the LE-CIT group will be submitted to this protocol 2.5 h/day for 15 consecutive days. It will include (1) intensive supervised training, (2) use of shaping as strategy for motor training, and (3) application of a transfer package (plus 30 min). The control group will receive conventional physiotherapy for 2.5 h/day over 15 consecutive days (the same period as the CIT intervention). Repeated measures analyses will be made to compare differences and define clinically relevant changes between groups. RESULTS: Data collection is currently on-going and results are expected in 2021. DISCUSSION: LE-CIT seems to be a good protocol for inclusion into stroke survivors' rehabilitation as it has all the components needed for positive results, as well as intensity and transference of gains to daily life activities. TRIAL REGISTRATION: www.ensaiosclinicos.gov.br RBR-467cv6 . Registered on 10 October 2017. "Effects of Lower Extremities - Constraint Induced Therapy on gait and balance function in chronic hemipretic post-stroke patients".


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Terapia por Exercício , Marcha , Humanos , Extremidade Inferior , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
11.
Trials ; 22(1): 457, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271979

RESUMO

BACKGROUND: Stroke results in neurologic impairments and aerobic deconditioning that contribute to limited walking capacity which is a major barrier post-stroke. Current exercise recommendations and stroke rehabilitation guidelines recommend moderate-intensity aerobic training post-stroke. Locomotor high-intensity interval training is a promising new strategy that has shown significantly greater improvements in aerobic fitness and motor performance than moderate-intensity aerobic training in other populations. However, the relative benefits and risks of high-intensity interval training and moderate-intensity aerobic training remain poorly understood following stroke. In this study, we hypothesize that locomotor high-intensity interval training will result in greater improvements in walking capacity than moderate-intensity aerobic training. METHODS: Using a single-blind, 3-site randomized controlled trial, 50 chronic (> 6 months) stroke survivors are randomly assigned to complete 36 locomotor training sessions of either high-intensity interval training or moderate-intensity aerobic training. Main eligibility criteria are age 40-80 years, single stroke for which the participant received treatment (experienced 6 months to 5 years prior to consent), walking speed ≤ 1.0 m/s, able to walk at least 3 min on the treadmill at ≥ 0.13 m/s (0.3 mph), stable cardiovascular condition (American Heart Association class B), and the ability to walk 10 m overground without continuous physical assistance. The primary outcome (walking capacity) and secondary outcomes (self-selected and fast gait speed, aerobic fitness, and fatigue) are assessed prior to initiating training and after 4 weeks, 8 weeks, and 12 weeks of training. DISCUSSION: This study will provide fundamental new knowledge to inform the selection of intensity and duration dosing parameters for gait recovery and optimization of aerobic training interventions in chronic stroke. Data needed to justify and design a subsequent definitive trial will also be obtained. Thus, the results of this study will inform future stroke rehabilitation guidelines on how to optimally improve walking capacity following stroke. TRIAL REGISTRATION: ClinicalTrials.gov NCT03760016 . Registered on November 30, 2018.


Assuntos
Treinamento Intervalado de Alta Intensidade , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Caminhada
12.
Trials ; 22(1): 481, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294134

RESUMO

BACKGROUND: Opposing needling has an obvious curative effect in the treatment of post-stroke hemiplegia; however, the mechanism of the opposing needling in the treatment of post-stroke hemiplegia is still not clear. The purpose of this study is to investigate the effect of opposing needling on the excitability of primary motor cortex (M1) of healthy participants and patients with post-stroke hemiplegia, which may provide insight into the mechanisms of opposing needling in treating post-stroke hemiplegia. METHODS: This will be a single-blind, randomised, sham-controlled trial in which 80 healthy participants and 40 patients with post-stroke hemiplegia will be recruited. Healthy participants will be randomised 1:1:1:1 to the 2-Hz, 50-Hz, 100-Hz, and sham electroacupuncture groups. Patients with post-stroke hemiplegia will be randomised 1:1 to the opposing needling or conventional treatment groups. The M1 will be located in all groups by using neuroimaging-based navigation. The stimulator coil of transcranial magnetic stimulation (TMS) will be moved over the left and right M1 in order to identify the TMS hotspot, followed by a recording of resting motor thresholds (RMTs) and motor-evoked potentials (MEPs) of the thenar muscles induced by TMS before and after the intervention. The primary outcome measure will be the percent change in the RMTs of the thenar muscles at baseline and after the intervention. The secondary outcome measures will be the amplitude (µV) and latency (ms) of the MEPs of the thenar muscles at baseline and after the intervention. DISCUSSION: The aim of this trial is to explore the effect of opposing needling on the excitability of M1 of healthy participants and patients with post-stroke hemiplegia. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900028138 . Registered on 13 December 2019.


Assuntos
Córtex Motor , Acidente Vascular Cerebral , Voluntários Saudáveis , Hemiplegia/diagnóstico , Hemiplegia/etiologia , Hemiplegia/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Estimulação Magnética Transcraniana
13.
Am J Speech Lang Pathol ; 30(4): 1805-1818, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34233121

RESUMO

Purpose The COVID-19 pandemic has led to stay-at-home orders and social distancing guidelines that have the potential to greatly impact individuals' behavior and social engagement. Adults recovering from stroke or other brain trauma, who often have communication difficulties and other long-term challenges, are a population already at risk of isolation and lower quality of life. We investigated the impact of public health guidelines and related behavioral changes on self-perceptions of communication abilities and psychosocial factors in this population. Method The Stroke Comeback Center, a community-based center for stroke and other brain trauma survivors with communication impairments, disseminated an online survey to current members to investigate changes in communication, social engagement, and quality of life. Results Participants (N = 50) reported a number of changes in their day-to-day activities that reflect the current social distancing guidelines, such as reduced outings into the community and fewer in-person conversations with those living outside one's home. Overall, feelings of connectedness to others and overall quality of life were reported to be decreased when compared to before the COVID-19 pandemic, whereas receptive language abilities and technology skills were reported to have improved. Perhaps most interestingly, certain behavioral changes (including healthy movement activities and participation in virtual programs) had specific relationships with perceived communication abilities and social engagement. Conclusions Changes in daily life resulting from the COVID-19 pandemic have had a tangible impact on self-perceived psychosocial elements (e.g., quality of life) and communication abilities among stroke and other brain trauma survivors. Clinicians and researchers may consider these perceived changes when engaging with this population as the effects of the pandemic continue and in the period of community re-entry that may follow. Supplemental Material https://doi.org/10.23641/asha.14830881.


Assuntos
Lesões Encefálicas Traumáticas , COVID-19 , Acidente Vascular Cerebral , Adulto , Comunicação , Humanos , Pandemias , Saúde Pública , Qualidade de Vida , SARS-CoV-2 , Acidente Vascular Cerebral/terapia , Sobreviventes
14.
J Biomed Nanotechnol ; 17(6): 1170-1183, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34167630

RESUMO

Exosomes, a component of extracellular vesicles, are shown to carry important small RNAs, mRNAs, protein, and bioactive lipid from parent cells and are found in most biological fluids. Investigators have demonstrated the importance of mesenchymal stem cells derived exosomes in repairing stroke lesions. However, exosomes from endothelial progenitor cells have not been tested in any stroke model, nor has there been an evaluation of whether these exosomes target/home to areas of pathology. Targeted delivery of intravenous administered exosomes has been a great challenge, and a targeted delivery system is lacking to deliver naïve (unmodified) exosomes from endothelial progenitor cells to the site of interest. Pulsed focused ultrasound is being used for therapeutic and experimental purposes. There has not been any report showing the use of low-intensity pulsed focused ultrasound to deliver exosomes to the site of interest in stroke models. In this proof of principle study, we have shown different parameters of pulsed focused ultrasound to deliver exosomes in the intact and stroke brain with or without intravenous administration of nanobubbles. The study results showed that administration of nanobubbles is detrimental to the brain structures (micro bleeding and white matter destruction) at peak negative pressure of >0.25 megapascal, despite enhanced delivery of intravenous administered exosomes. However, without nanobubbles, pulsed focused ultrasound enhances the delivery of exosomes in the stroke area without altering the brain structures.


Assuntos
Exossomos , Células-Tronco Mesenquimais , Acidente Vascular Cerebral , Encéfalo/diagnóstico por imagem , Humanos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Ondas Ultrassônicas
15.
BMC Health Serv Res ; 21(1): 619, 2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187462

RESUMO

BACKGROUND: The economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke. METHODS: In this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs. RESULTS: We identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65-84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus $52,829 ± 59,955 for men, and median cost was $36,703 [$16,496-$72,227] for women versus $32,903 [$15,485-$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care. CONCLUSIONS: Patterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings.


Assuntos
Caracteres Sexuais , Acidente Vascular Cerebral , Idoso , Estudos de Coortes , Atenção à Saúde , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Ontário/epidemiologia , Acidente Vascular Cerebral/terapia
16.
Int J Health Geogr ; 20(1): 31, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187473

RESUMO

PURPOSE: Rapid accessibility of (intensive) medical care can make the difference between life and death. Initial care in case of strokes is highly dependent on the location of the patient and the traffic situation for supply vehicles. In this methodologically oriented paper we want to determine the inequivalence of the risks in this respect. METHODS: Using GIS we calculate the driving time between Stroke Units in the district of Münster, Germany for the population distribution at day- & nighttime. Eight different speed scenarios are considered. In order to gain the highest possible spatial resolution, we disaggregate reported population counts from administrative units with respect to a variety of factors onto building level. RESULTS: The overall accessibility of urban areas is better than in less urban districts using the base scenario. In that scenario 6.5% of the population at daytime and 6.8% at nighttime cannot be reached within a 30-min limit for the first care. Assuming a worse traffic situation, which is realistic at daytime, 18.1% of the population fail the proposed limit. CONCLUSIONS: In general, we reveal inequivalence of the risks in case of a stroke depending on locations and times of the day. The ability to drive at high average speeds is a crucial factor in emergency care. Further important factors are the different population distribution at day and night and the locations of health care facilities. With the increasing centralization of hospital locations, rural residents in particular will face a worse accessibility situation.


Assuntos
Acesso aos Serviços de Saúde , Acidente Vascular Cerebral , Demografia , Alemanha , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Transportes
17.
Rev Peru Med Exp Salud Publica ; 38(1): 41-48, 2021.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-34190922

RESUMO

OBJECTIVE: To evaluate the effect of educational videos to improve the practical skills and knowledge of stroke patients' informal caregivers. MATERIALS AND METHODS: Pretest/posttest study. The participants were 10 caregivers aged 18 to 65 years and of both sexes of patients in the subacute phase of stroke. We developed eight educational videos related to positioning, mobilizations and transfers, which were implemented in the caregivers' and/or patients' homes along three days (on the first day, three videos; second day, three videos; and third day, two videos). Each video was viewed on a tablet for 30 minutes. We evaluated skills and knowledge before and after each video, and finally, the caregivers' satisfaction. We used three instruments, a checklist to assess practical skills, a questionnaire to assess knowledge, and another for satisfaction. RESULTS: The practical skills score increased from 21,6 to 56,1 points (p <0,001) and knowledge from 11,6 to 21,6 points (p <0,001). 7/10 of the caregivers were very satisfied with the videos, 7/10 considered the words easy, 7/10 considered easy to put the indications into practice, 9/10 would definitely recommend the videos, and everyone considered them useful. CONCLUSION: Educational videos improve the practical skills and knowledge of stroke informal caregivers. Developed educational videos could be successful in training caregivers on the management of these patients.


Assuntos
Cuidadores , Acidente Vascular Cerebral , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Acidente Vascular Cerebral/terapia , Inquéritos e Questionários
19.
JMIR Mhealth Uhealth ; 9(6): e24116, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114961

RESUMO

BACKGROUND: Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. METHODS: The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95% CI and 95% prediction interval (PI) were calculated. RESULTS: In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD -5.49; 95% CI -7.87 to -3.10; P<.001; 95% PI -10.46 to -0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD -9.09; 95% CI -12.71 to -5.46; P<.001) or only telephone (MD -4.34; 95% CI -6.55 to -2.13; P<.001; 95% PI -7.24 to -1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ≤1 week (MD -6.51; 95% CI -9.36 to -3.66; P<.001; 95% PI -12.91 to -0.10) or a baseline systolic blood pressure ≥140 mm Hg (MD -6.15; 95% CI -9.44 to -2.86; P<.001; 95% PI -13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. CONCLUSIONS: In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Telemedicina , Pressão Sanguínea , Humanos , Hipertensão/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/terapia
20.
J Stroke Cerebrovasc Dis ; 30(8): 105931, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34157669

RESUMO

OBJECTIVES: The Quality in Acute Stroke Care (QASC) protocol is a multidisciplinary approach to implement evidence-based treatment after acute stroke that reduces death and disability. This study sought to evaluate the cost-effectiveness of implementing the QASC protocol across Australia, from a healthcare and a societal perspective. MATERIALS AND METHODS: A decision-analytic model was constructed to reflect one-year outcomes post-stroke, aligned with the stroke severity categories of the modified Rankin scale (mRS). Decision analysis compared outcomes following implementation of the QASC protocol versus no implementation. Population data were extracted from Australian databases and data inputs regarding stroke incidence, costs, and utilities were drawn from published sources. The analysis assumed a progressive uptake and efficacy of the QASC protocol over five years. Health benefits and costs were discounted by 5% annually. The cost of each year lived by an Australian, from a societal perspective, was based on the Australian Government's 'value of statistical life year' (AUD 213,000). RESULTS: Over five years, the model predicted 263,722 strokes among the Australian population. The implementation of the QASC protocol was predicted to prevent 1,154 deaths and yield a gain of 876 years of life (0.003 per stroke), and 3,180 quality-adjusted life years (QALYs) (0.012 per stroke). There was an estimated net saving of AUD 65.2 million in healthcare costs (AUD 247 per stroke) and AUD 251.7 million in societal costs (AUD 955 per stroke). CONCLUSIONS: Implementation of the QASC protocol in Australia represents both a dominant (cost-saving) strategy, from a healthcare and a societal perspective.


Assuntos
Protocolos Clínicos , Custos de Cuidados de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Melhoria de Qualidade/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Acidente Vascular Cerebral/terapia , Austrália/epidemiologia , Redução de Custos , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Avaliação da Deficiência , Estado Funcional , Humanos , Incidência , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
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