Functional Status Of Stroke Patients Research Articles

Direct Exposure to Outdoor Air Pollution Worsens the Functional Status of Stroke Patients Treated with Mechanical Thrombectomy

Background The effect of air pollutants on the functional status of stroke patients in short-term follow-up is unknown. The aim of this study was to evaluate the effect of air pollution occurring in the stroke period and during hospitalization on the functional status of patients undergoing mechanical thrombectomy (MT). Methods Our study included stroke patients for which the individual-level exposure to ambient levels of O3, CO, SO2, NO2, PM2.5, and PM10 during the acute stroke period was assessed. The correlations between the air pollutants’ concentration and the patients’ functional state were analyzed. A total of 499 stroke patients (mean age: 70) were qualified. Results The CO concentration at day of stroke onset was found to be significant regarding the functional state of patients on the 10th day (OR 0.014 95% CI 0–0.908, p = 0.048). The parameters which increased the risk of death in the first 10 days were as follows: NIHSS (OR 1.27; 95% CI 1.15–1.42; p < 0.001), intracranial bleeding (OR 4.08; 95% CI 1.75–9.76; p = 0.001), and SO2 concentration on day 2 (OR 1.21; 95% CI 1.02–1.47; p = 0.03). The parameters which increased the mortality rate within 90 days include age (OR 1.07; 95% CI 1.02–1.13; p = 0.005) and NIHSS (OR 1.37; 95% CI 1.19–1.63; p < 0.001). Conclusions Exposure to air pollution with CO and SO2 during the acute stroke phase has adverse effects on the patients’ functional status. A combination of parameters, such as neurological state, hemorrhagic transformation, and SO2 exposure, is unfavorable in terms of the risk of death during a hospitalization due to stroke. The risk of a worsened functional status of patients in the first month of stroke rises along with the increase in particulate matter concentrations within the first days of stroke.

High Nutritional Risk Is Associated with Poor Functional Status and Prognostic Biomarkers in Stroke Patients at Admission to a Rehabilitation Unit.

Considering that malnutrition (undernutrition) is common in stroke patients and may negatively impact body function, the aim of this study was to determine the relationship between nutritional risk and functional status in stroke patients at admission to a rehabilitation unit. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score. Functional status was assessed using the Barthel Index, the modified Rankin Scale, the Trunk Control Test and the Sitting Balance Scale, and cognitive function was assessed using the Short Portable Mental Status Questionnaire. C-reactive protein, fibrinogen and D-dimer were also evaluated as established prognostic biomarkers. Stroke patients (n = 245; age 69.7 ± 12.8 years; 47%, women; 82% ischemic stroke) at admission to a rehabilitation unit were included in this study. A high prevalence of nutritional risk was detected with each tool and was found to be greater using the GNRI and in patients aged ≥75 years. Multiple logistic regression analysis showed that age and dysphagia were independent predictors of high nutritional risk. High risk groups performed worse on all functional tests compared to the low-risk groups (p < 0.05). Nutritional risk with each tool was associated with functional and cognitive statuses (with the highest correlation being with the Trunk Control Test). Significant associations were also found with C-reactive protein, fibrinogen and D-dimer. In conclusion, a high nutritional risk, as evaluated with the GNRI, the PNI and the CONUT score, was detected in stroke patients at admission to a rehabilitation unit. High nutritional risk was associated with functional status and with predictors of clinical outcomes (and specifically in older patients).

The Effect of Early Mobilization on Functional Status of Stroke Patients: A Literature Review

Stroke impact to the altering functional status. Early mobilization is one of stroke care components that can minimize impact due to altering functional status such as weakness and paralysis in stroke patients. The review of early mobilization was proved increasing the functional status among critical illness patients. Limited review regarding the effect of early mobilization on changes in the level of functional status of stroke patients The aim the study was to determine the effect of early mobilization at the level of functional status of stroke patients. This research used the literature review with the MeSH search tool. The keywords and syntax included "stroke", "early mobilization", and "functional status". Articles found with keywords early mobilization; functional status; stroke retrieve 12,114 articles, namely 2069 articles from Proquest, 4774 articles from Pubmed, 35 articles from Scopus, and 5236 articles from ScienceDirect which were filtered based on the specified criteria and obtained 10 articles for review published in the period 2011-2021, with patient research samples strokes. The effect of early mobilization mostly showedan increasing degree of functional status level among stroke patients. It is recommended to provide early mobilization among stroke patient. Future research should conduct a meta-analysis in analysing effect of early mobilisation among stroke patients.

The Effect of Early Mobilization on Functional Status of Stroke Patients: A Literature Review

Stroke impact to the altering functional status. Early mobilization is one of stroke care components that can minimize impact due to altering functional status such as weakness and paralysis in stroke patients. The review of early mobilization was proved increasing the functional status among critical illness patients. Limited review regarding the effect of early mobilization on changes in the level of functional status of stroke patients The aim the study was to determine the effect of early mobilization at the level of functional status of stroke patients. This research used the literature review with the MeSH search tool. The keywords and syntax included "stroke", "early mobilization", and "functional status". Articles found with keywords early mobilization; functional status; stroke retrieve 12,114 articles, namely 2069 articles from Proquest, 4774 articles from Pubmed, 35 articles from Scopus, and 5236 articles from ScienceDirect which were filtered based on the specified criteria and obtained 10 articles for review published in the period 2011-2021, with patient research samples strokes. The effect of early mobilization mostly showedan increasing degree of functional status level among stroke patients. It is recommended to provide early mobilization among stroke patient. Future research should conduct a meta-analysis in analysing effect of early mobilisation among stroke patients.

Do Knee Joint Orthoses Affect the Functional Status of Stroke Patients? A Literature Review

Stroke is the leading cause of adult disability in developed countries. As a result of damage to the central nervous system, the patient's independence in performing everyday activities is reduced, which often leads to dependence on the environment. The symptoms of syndromes affect many functions, including: speech, the upper limb, gait, balance and coordination disorders. These disorders lead to a decrease in the patient's quality of life. Many patients require knee braces to learn to walk. In this review article, the most commonly used scales used to assess the functional status of patients after stroke are discussed, with particular attention being paid to gait assessment. We described simple (basic ADL) and instrumental (extended) scales of activities of daily living (instrumental, extended ADL), methods of clinical gait and balance assessment, International Classification of Functioning, Disability and Health, ICF), as well as recommendations of the European Stroke Organisation (ESO, Neurorehabilitation Committee). These guidelines regard methods of evaluating the results of post-stroke rehabilitation for clinical use - Outcome Measures for Clinical Use, in which, among others, the Berg scale and the timed Up &amp; Go test are recommended for the lower limb, the Barthel scale and the Functional Independence Measure for ADL, and the Stroke Impact Scale for the participation column in all 3 ICF domains. In the article, the current state of knowledge is presented regarding the impact of knee braces on the functional status of people after stroke. Mechanical knee and ankle orthoses are called KAFO (Knee Ankle Foot Orthosis). Their main tasks include immobilisation of the knee joint and aid in learning to walk.

Evaluation of Motion Segment Size as a New Sensor-based Functional Outcome Measure in Stroke Rehabilitation.

ObjectiveTo evaluate a novel parameter, motion segment size (MSS), in stroke patients with upper limb impairment and validate its clinical applicability by correlating results with a standard clinical task-based functional evaluation tool.MethodsIn this cross-sectional study, patients with hemiplegia and healthy controls equipped with multiple inertial measurement unit (IMU) sensors performed Action Research Arm Test (ARAT) and activities of daily living (ADL) tasks. Acceleration of the wrist and Euler angles of each upper limb segment were measured. The average and maximum MSS, accumulated motion, total performance time, and average motion speed (AMS) were extracted for analysis.ResultsData from nine patients and 10 controls showed that the average MSS of forearm supination/pronation and elbow flexion/extension during full ARAT tasks showed a significant difference between patients and controls and a significant correlation with ARAT scores.ConclusionsWe suggest that MSS may provide clinically relevant information regarding upper limb functional status in stroke patients.

A Comparative Analysis of Functional Status and Mobility in Stroke Patients with and without Aphasia.

All researchers agree that aphasia is a serious consequence of a stroke, but they also report contradictory data regarding the functional outcome. The aim of this study was, therefore, to assess the functional outcomes of stroke patients with and without aphasia, who were undertaking a regular rehabilitation programme. Materials and Methods: The study group consisted of 116 post-stroke patients, including 54 patients without aphasia (G1) and 62 patients with aphasia (G2). The following tests were used before (T1) and after (T2) rehabilitation measurement points: Barthel Index (BI), Sitting Assessment Scale (SAS), Berg Balance Scale (BBS), Trunk Control Test (TCT), Test Up & Go (TUG) and the Timed Walk Test (TWT). Results: The group of post-stroke patients with aphasia had a significantly longer time since a stroke on admission, a significantly longer length of stay in the ward and significantly worse SAS and TCT scores at T2, compared to patients without aphasia. Both groups achieved significant improvement in all studied parameters (SAS, TCT, BI, BBS, TUG and TWT). Aphasia was a predictor of functional status in the stroke patients group, but only at the time of admission to the ward. Conclusions: Patients with and without aphasia have an equal likelihood of improving their functional status and returning to independence. Aphasia should not be an absolute factor that excludes stroke patients from research studies on their functional status.

Objective assessment of the functional status of stroke patients: Can comprehensive rehabilitation treatment improve their functional efficiency?

Abstract Study aim: To check if the short rehabilitation treatment (3 weeks) complemented by complex rehabilitation on advanced equipment improves the functional status of chronic stroke patients; and which clinical and objective parameters can be used to assess the efficacy of such treatment. Material and methods: 28 patients 3 to 6 months after the stroke. They participated in 3 weeks rehabilitation program in Rehabilitation Hospital. This program was supplemented by rehabilitation on: Zebris treadmill, ALFA and GAMMA platform, Biodex Balance System SD, the Balance Tutor treadmill. Their functional status was assessed by: Scandinavian Stroke Scale (SSS), Timed-Up-And-Go test (TUG), balance tests on Zebris, instrumented gait analysis on BTS system. Results: The positive changes of the patients’ functional status were found in time of TUG test, in case of balance test for 95% of the ellipsoid area, lengths of major and minor axes of the ellipsoid, average sway speed, sway path length, total ground reaction force for left and right leg, and Gillette Gait Index in case of the gait analysis. Conclusions: The improvement of the functional status of chronic stroke patients after relatively short rehabilitation treatment was achieved, due to the addition to the standard rehabilitation treatment the program on the advanced technologically equipment.

Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents

Patients who have suffered a chronic cerebrovascular accident or a stroke need long-term physiotherapy treatments. However, they have had to be stopped due to the COVID-19 pandemic. To be able to offer these patients an online functional assessment, a proposal was put forward to design an adaptation of the Spanish version of the Fugl Meyer assessment scale and to test its viability. The adapted online scale, based on the Fugl Meyer assessment scale. The motor function, balance and pain domains were kept, and items requiring assistance for the patient were removed. This scale was administered to 13 patients with a chronic cerebrovascular accident from the Salamanca Acquired Brain Injury Association (Asociacion de Dano Cerebral Adquirido) via different web platforms. The procedure followed was the same as for the original scale and lasted from 30 to 45 minutes. All the patients completed the Fugl Meyer assessment scale, online version. The greatest difficulty was encountered in the assessment of the lower limbs. Patients and physiotherapists highlighted how easy it was to complete the items in the scale. On comparing the versions, statistically significant positive correlations were found with the original version (p < 0.001) and the correlation coefficients indicated a strong association. The difference between the equivalent sections of the scale in each instrument was no greater than 5%, except for balance. The Fugl Meyer assessment scale, online version, is a feasible, useful and easy to apply scale that allows assessment of the functional status of stroke patients and can help meet the current needs during the COVID-19 pandemic.

Multidisciplinary Care after Acute Care for Stroke: A Prospective Comparison between a Multidisciplinary Post-Acute Care Group and a Standard Group Matched by Propensity Score.

In this large-scale prospective cohort study, a propensity score matching method was applied in a natural experimental design to investigate how post-acute care (PAC) after stroke affects functional status and to identify predictors of functional status. The main objective of this study was to examine longitudinal changes in various measures of functional status in stroke patients and predictors of scores for these measures before and after PAC. A group of patients who had received PAC for stroke at one of two medical centers (PAC group, n = 273) was compared with a group who had received standard care for stroke at one of four hospitals (three regional hospital and one district hospital; non-PAC group, n = 273) in Taiwan from March, 2014, to October, 2018. The patients completed the functional status measures before rehabilitation, the 12th week and the 1st year after rehabilitation. Generalized estimating equations were used to estimate differences-in-differences models for examining the effects of PAC. The average age was 68.0 (SD = 8.1) years, and males accounted for 57.9%. During the follow-up period, significant risk factors for poor functional outcomes were advanced age, hemorrhagic stroke, and poor function scores before rehabilitation (p < 0.05). Between-group comparisons at subsequent time points revealed significantly higher functional status scores in the PAC group versus the non-PAC group (p < 0.001). Notably, for all functional status measures, between-group differences in total scores significantly increased over time from baseline to 1 year post-rehabilitation (p < 0.001). The contribution of this study is its further elucidation of the clinical implications and health policy implications of rehabilitative care after stroke. Specifically, it improves understanding of the effects of PAC in stroke patients at different follow-up times. Therefore, a policy implication of this study is that standard care for stroke should include intensive rehabilitative PAC to maximize recovery of overall function.

Is an Oral Health Status a Predictor of Functional Improvement in Ischemic Stroke Patients Undergoing Comprehensive Rehabilitation Treatment?

The study’s aim was a clinical observation concerning the influence of oral health on functional status in stroke patients undergoing neurorehabilitation. This pilot cross-sectional clinical study was performed in 60 subacute phase stroke patients during 12 weeks of treatment. The program was patient-specific and consisted of neurodevelopmental treatment by a comprehensive rehabilitation team. The functional assessment was performed using the Barthel index (BI), Berg balance scale (BBS), functional independence measure (FIM), and Addenbrooke’s cognitive examination III (ACE III) scales. Oral health was assessed according to World Health Organization (WHO) criteria, and it was presented using DMFT, DMFS, gingival index (GI), and plaque index (PlI). Significant improvement in many functional scales was noticed. However, important differences in most dental parameters without relevant changes in GI and PlI after the study were not observed. Reverse interdependence (p < 0.05) was shown between physical functioning (BI, FIM, or BBS) with GI and PlI results, and most dental parameters correlated with ACE III. Using multivariate regression analysis, we showed that ACE III and BI are predictive variables for DMFT, just as FIM is for DS (p < 0.05). The present research revealed that poor oral health status in patients after stroke might be associated with inpatient rehabilitation results.

Functional Status Is Associated With Prefrontal Cortex Activation in Gait in Subacute Stroke Patients: A Functional Near-Infrared Spectroscopy Study.

Increasing cerebral oxygenation, more precisely the overactivation of the prefrontal cortex (PFC), reflects cortical control of gait in stroke disease. Studies about the relationship between brain activation and the functional status in stroke patients remain scarce. The aim of this study was to compare brain activation, gait parameters, and cognitive performances in single and dual tasks according to the functional status in subacute stroke patients. Twenty-one subacute stroke patients were divided in two groups according to Barthel Index (“low Barthel” and “high Barthel”) and randomly performed ordered walking, cognitive task (n-back task), and dual tasks (walking + n-back task). We assessed gait performances (speed, variability) using an electronic walkway system and cerebral oxygenation (ΔO2Hb) by functional near-infrared spectroscopy. Patients with better functional status (high Barthel) showed a lower PFC activation (ΔO2Hb) and better gait parameters in single and dual tasks compared to low-Barthel patients, who exhibited decreased gait performances despite a higher PFC activation, especially in the unaffected side (P < 0.001). PFC overactivation in less functional subacute stroke patients may be due to the loss of stepping automaticity. Our results underline the interest of proposing rehabilitation programs focused on walking, especially for patients with low functional capacity.

Post-stroke Aphasia as a Prognostic Factor for Cognitive and Functional Changes in Patients With Stroke: Ischemic Versus Hemorrhagic.

ObjectiveTo investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients.MethodsSixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments.ResultsThe initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients.ConclusionAphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.

Role of Gender on Quality of Life and Functional Status in Stroke Patients with Urinary Incontinance

Role of Gender on Quality of Life and Functional Status in Stroke Patients with Urinary Incontinance

The impact of post-acute care rehabilitation on functional status in stroke patients from different hospital accreditation level

In order to construct a medical transfer system for the stroke, Taiwan Ministry of Health and Welfare implemented a national program of Post-acute Care for Cerebrovascular Diseases (PAC-CVD) in March 2014. Under the intensive in-patient rehabilitation programs and per diem payment, the healthcare utilization was expected to be improved. The purpose of this study was to investigate the impact of intensive post-acute stroke rehabilitation on functional status in different hospital accreditation level. The stroke patients who were admitted to post-acute ward in two hospitals during 2014/03/01 to 2017/8/31 were indicated to the study. The patients was separated to group 1 (a rural regional hospital) and group 2 (a metropolitan district hospital). The modified Rankin Scale (mRS) score, Barthal Index (BI), Instrumental Activities of Daily Living Scale (IADL) and Berg Balance Scale (BBS) were used to evaluate functional status. In total, 740 stroke patients (311 patients in group 1, and 429 patients in group 2) were included. The length of days (LOS) between stroke onset and post-acute care (PAC) ward admission were 11.60 days in group 1, and 21.41 days in group 2. The length of days in PAC ward were 27.02 days in group 1, and 36.85 days in group 2. The percentage of patients referred from other acute hospitals were 23.47% in group 1, and 89.51% in group 2. The severity (MRS grading on PAC admission day) was 3.53 in group 1, and 3.88 in group 2. The functional improvement after rehabilitation training was noted in both groups. Under the intensive post-acute in-patient rehabilitation programs, the stroke patients got functional improvement. No matter the accreditation level of the hospital, the same payment may make more chance for the district hospitals to develop. The healthcare utilization may work efficiently under the medical transfer system.

Abstract P351: Evaluation of Analytic Approaches to Ceiling Effect in Patient-Reported Functional Status After Stroke

Setting: Researchers use several tools to measure functional status in stroke patients. Analyses often use simple linear models, which assume a common treatment effect regardless of stroke severity. However, patients with mild stroke or TIA may perform at the maximum of an instrument, or the ceiling. The presence of a so-called ceiling effect conflicts with the normality assumption of linear models and can diminish the ability to detect efficacy, unless addressed in study design and analyses. Objectives: Our objectives were to (1) review the literature describing the instruments used to measure functional status and the analytic methods used in the presence of ceiling effect; and to (2) valuate methods which may be used to account for treatment effect heterogeneity induced by ceiling effect in comparative effectiveness trials of post-stroke functional status outcomes. Methods: The literature review was conducted by two reviewers using PubMed. To compare type I error control and power in the presence of a ceiling effect, we used simulation studies and compared linear, logistic, and cumulative logistic models. Data were simulated to mirror the empirical distribution of instrumental activities of daily living (IADL) scores found in the published data from the Secondary Prevention of Small Subcortical Strokes (SPS3) clinical trial, a study of lacunar stroke patients, in which there was a pronounced ceiling effect. To accommodate treatment effect heterogeneity induced by ceiling effect, we explored stratification by stroke severity. Results: Our literature review yielded 262 stroke clinical trials that included patient reported outcomes. Only 41% of trials cited ceiling effect in the functional status instrument used; most did not account for it in their analyses. Our simulation studies demonstrate that while linear modeling may result in well controlled type 1 error rates in the presence of pronounced ceiling effect, study power may be unacceptably low. Dichotomizing the outcome and directly modeling the probability of maximum scores with logistic models may be preferred. In contrast, when outcome scores in the untreated group cover the range of the instrument, use of a linear model may be advantageous over logistic models that categorize the outcome. Conclusions: It is important to consider the distribution of functional outcome scores in target stroke population when developing the analysis strategy for a study, perhaps by conducting a pilot study. Specifically, it is important to evaluate if the instrument being used can identify change in outcomes in low-severity groups. Lastly, powering the study to identify lesser treatment effect in low-severity patients may be useful as a secondary trial aim rather than attempting to establish benefit in all patients as a primary outcome.

Relationship between obstructive sleep apnea syndrome and cognitive impairment and functional status after stroke

Objective:To analyze the correlation between obstructive sleep apnea syndrome (OSAHS) and cognitive impairment and functional status after stroke. Method:From February 2014 to September 2016, a total of 189 patients were included in the study, 33 patients with mild OSAHS were excluded, and finally 86 patients in the study group and 70 patients in the control group were included in the final analysis. The main indicators included the cognitive and functional status. Cognitive status was assessed by nine dimensions: vigilance, attention, memory, working memory, executive, language, insight, mental activity, psychomotor, and intelligence. Functional status was assessed using neurological status and functional independence. Secondary measures included sleepiness, fatigue, anxiety and depression, and sleep quality. Result:The age of the study group was higher than the control group, the BMI was higher than the control group, the average hospitalization time was longer than the control group, and all of the difference were statistically significant (all P<0.05). The total cognitive status of the two groups was significantly different, and the total cognitive status study group was significantly worse than in the control group (t=9.276, P=0.012). In the nine dimensions of cognitive ability, the study group's attention, execution, insight, mental adjustment and intelligence were lower than the control group, and the difference was statistically significant (P<0.05). The functional status of the study group was worse than that of the control group (t=38.094, P=0.000). There were no significant differences between the two groups in terms of sleepiness, fatigue, sleep quality, anxiety and depression (P>0.05). Conclusion:The cognitive impairment and functional status of stroke patients with OSAHS are significantly worse. OSAHS is a risk factor for poor prognosis in stroke patients.

Interprofessional collaboration to improve professional practice and healthcare outcomes.

Poor interprofessional collaboration (IPC) can adversely affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes. To assess the impact of practice-based interventions designed to improve interprofessional collaboration (IPC) amongst health and social care professionals, compared to usual care or to an alternative intervention, on at least one of the following primary outcomes: patient health outcomes, clinical process or efficiency outcomes or secondary outcomes (collaborative behaviour). We searched CENTRAL (2015, issue 11), MEDLINE, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform to November 2015. We handsearched relevant interprofessional journals to November 2015, and reviewed the reference lists of the included studies. We included randomised trials of practice-based IPC interventions involving health and social care professionals compared to usual care or to an alternative intervention. Two review authors independently assessed the eligibility of each potentially relevant study. We extracted data from the included studies and assessed the risk of bias of each study. We were unable to perform a meta-analysis of study outcomes, given the small number of included studies and their heterogeneity in clinical settings, interventions and outcomes. Consequently, we summarised the study data and presented the results in a narrative format to report study methods, outcomes, impact and certainty of the evidence. We included nine studies in total (6540 participants); six cluster-randomised trials and three individual randomised trials (1 study randomised clinicians, 1 randomised patients, and 1 randomised clinicians and patients). All studies were conducted in high-income countries (Australia, Belgium, Sweden, UK and USA) across primary, secondary, tertiary and community care settings and had a follow-up of up to 12 months. Eight studies compared an IPC intervention with usual care and evaluated the effects of different practice-based IPC interventions: externally facilitated interprofessional activities (e.g. team action planning; 4 studies), interprofessional rounds (2 studies), interprofessional meetings (1 study), and interprofessional checklists (1 study). One study compared one type of interprofessional meeting with another type of interprofessional meeting. We assessed four studies to be at high risk of attrition bias and an equal number of studies to be at high risk of detection bias.For studies comparing an IPC intervention with usual care, functional status in stroke patients may be slightly improved by externally facilitated interprofessional activities (1 study, 464 participants, low-certainty evidence). We are uncertain whether patient-assessed quality of care (1 study, 1185 participants), continuity of care (1 study, 464 participants) or collaborative working (4 studies, 1936 participants) are improved by externally facilitated interprofessional activities, as we graded the evidence as very low-certainty for these outcomes. Healthcare professionals' adherence to recommended practices may be slightly improved with externally facilitated interprofessional activities or interprofessional meetings (3 studies, 2576 participants, low certainty evidence). The use of healthcare resources may be slightly improved by externally facilitated interprofessional activities, interprofessional checklists and rounds (4 studies, 1679 participants, low-certainty evidence). None of the included studies reported on patient mortality, morbidity or complication rates.Compared to multidisciplinary audio conferencing, multidisciplinary video conferencing may reduce the average length of treatment and may reduce the number of multidisciplinary conferences needed per patient and the patient length of stay. There was little or no difference between these interventions in the number of communications between health professionals (1 study, 100 participants; low-certainty evidence). Given that the certainty of evidence from the included studies was judged to be low to very low, there is not sufficient evidence to draw clear conclusions on the effects of IPC interventions. Neverthess, due to the difficulties health professionals encounter when collaborating in clinical practice, it is encouraging that research on the number of interventions to improve IPC has increased since this review was last updated. While this field is developing, further rigorous, mixed-method studies are required. Future studies should focus on longer acclimatisation periods before evaluating newly implemented IPC interventions, and use longer follow-up to generate a more informed understanding of the effects of IPC on clinical practice.

Psychological health of caregivers and association with functional status of stroke patients

Objective: Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients.Methods: This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey.Results: The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores.Conclusion: Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.

Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan.

To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital. Retrospective cohort study. One acute and one rehabilitation hospital in Japan. Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years). Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital. Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5). The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.