Predictors of Spasticity 3-6 Months Post Stroke: A 5-Year Retrospective Cohort Study.

OBJECTIVE: To identify predictors of post stroke spasticity (PSS; modified Ashworth Scale scores, mAS ≥1) at 3-6 months post stroke. DESIGN: A 5-year (2015-2020) retrospective cohort of patients who attended inpatient stroke rehabilitation in Southwestern Ontario, Canada were included. Sociodemographic, clinical, stroke-related, rehabilitation-related, and outcome measure data were extracted from paper charts and electronic databases. RESULTS: Of the 922 individuals attending inpatient stroke rehabilitation, 606 (55.8% males; mean age = 70.9 ± 14.2 years) returned for an outpatient visit. Most patients had a first ever (n = 518; 85.5%), ischemic (n = 470; 77.6%) stroke with hemiplegia (n = 449, 74.1%). A total of 20.3% (N = 122) of patients had developed PSS by 4 months post stroke. A binary logistic regression significantly predicted PSS (χ2(6) = 111.696, p < .0001) with good model fit (χ2(8) = 12.181, p = .143). There were six significant PSS predictors: hemorrhagic stroke (p = .049), younger age (p < .001), family history of stroke (p = .015), Functional Independence Measure admission score (p < .001), use of SSRIs p = .044), and hemiplegia (p < .001). CONCLUSIONS: Patients should be monitored closely for PSS after discharge from stroke rehabilitation and throughout the care continuum.

Exploring Perspectives on Stroke Standard Set Data Collection: A Qualitative Descriptive Study.

ABSTRACT: BACKGROUND: The International Consortium on Health Outcome Measurement developed a standard set for stroke (SSS) that includes patient-reported outcome measures to help capture patients' perspectives on their poststroke recovery. The objective of this study was to explore the experiences and perspectives of individuals who collected SSS data from patients who were admitted to hospital for a stroke. METHODS: A qualitative descriptive approach was taken. Semistructured, audio-recorded interviews were conducted with individuals employed at 2 acute neurological inpatient units in Southwestern Ontario, Canada. Interviews were transcribed verbatim and written text responses were analyzed directly. Transcripts were coded line by line and then organized into 5 overarching themes: adoption, acceptance, appropriateness, feasibility, and sustainability. RESULTS: Six interviews were conducted with participants from varying roles (eg, nurses, manager, web developer, social worker, medical clerk). Participants reported that patients were receptive to completing the SSS. Follow-up phone calls provided a significant opportunity to monitor patients' recovery postdischarge. Many patients requested medical guidance and help navigating health and social resources for unmet stroke-related needs. Barriers to consistent SSS assessment included high employee turnover and lack of time, space, or capacity for follow-up. To sustain data collection, a dedicated, financially supported neurological nursing role was suggested. CONCLUSION: Participants were supportive of SSS data collection that could provide monitoring, oversight, and follow-up of stroke patients after discharge from acute care. However, the utility of the dataset is heavily dependent on having the data collection process properly resourced.

Mortality and discharge disposition among older adults with moderate to severe traumatic brain injury.

PURPOSE: This study examined the research on older adults with a moderate to severe traumatic brain injury (TBI), with a focus on mortality and discharge disposition. METHOD: Systematic searches were conducted in MEDLINE, CINAHL, EMBASE and PsycINFO for studies up to April 2022 in accordance with PRISMA guidelines. RESULTS: 64 studies, published from 1992 to 2022, met the inclusion criteria. Mortality was higher for older adults ≥60 years old than for their younger counterparts; with a dramatic increase for those ≥80 yr, with rates as high as 93 %. Similar findings were reported regarding mortality in intensive care, surgical mortality, and mortality post-hospital discharge; with an 80 % rate at 1-year post-discharge. Up to 68.4 % of older adults were discharged home; when compared to younger adults, those ≥65 years were less likely to be discharged home (50-51 %), compared to those <64 years (77 %). Older adults were also more likely to be discharged to long-term care (up to 31.6 %), skilled nursing facilities (up to 46.1 %), inpatient rehabilitation (up to 26.9 %), and palliative or hospice care (up to 58 %). CONCLUSION: Given their vulnerability, optimizing outcomes for older adults with moderate-severe TBI across the healthcare continuum is critical.