Lower Barthel Index Scores Research Articles

Spatial Relationship between Acute Lacunar Infarction and White Matter Hyperintensities

Background: White matter hyperintensities (WMH) predict incident strokes and new lacunes; moreover, WMH may also affect infarct locations. Our aim in this study was to examine the spatial relationship between WMH and acute lacunar infarction. Methods: Five hundred and ninety patients with acute lacunar infarction in supratentorial region were included. Four situations between infarction and WMH were assessed by axial and coronal MRI: no contact (Grade 0), contact without overlap (Grade Ia), partial overlap (Grade Ib), and complete overlap (Grade II) with preexisting WMH. Furthermore, we defined infarctions in Grades Ia and Ib as edge-localized infarctions and investigated their predictors and short-term outcome. Results: 47.9% (283) of the infarctions were edge-localized infarctions (Grade Ia = 27.6% and Grade Ib = 20.3%), 51.5% (304) were Grade 0, only 0.5% (3) were Grade II. Patients with edge-localized infarction had larger infarct size, more severe WMH, higher National Institutes of Health Stroke Scale (NIHSS) and lower Barthel index (BI) score at admission than those with non-edge-localized infarction. They also had lower BI score at discharge. Infarction in subcortical white matter, diffusion-weighted imaging infarct size, periventricular WMH and deep WMH were predictors for edge-localized infarction. Conclusions: Half of lacunar infarctions were located at the edge of WMH. Both periventricular WMH and deep WMH were predictors for edge-localized infarction.

Abstract 10754: Nutritional Status in Elderly Heart Failure is a Determinant of Functional Status and Readmission After Cardiac Rehabilitation: A Retrospective Cohort Study

Introduction: The prevalence of malnutrition in elderly heart failure (HF) is high in cardiac rehabilitation (CR) settings. Malnutrition in elderly patients with chronic diseases admitted to hospitals is often associated with poor functional recovery in daily activities. However, there is few evidence of the impact of poor nutritional status on the effects of CR in HF patients. Hypothesis: We examined the hypothesis that nutritional status in elderly HF patients is a determinant of functional status and readmission after CR. Methods: One hundred ten HF patients at age of 65 years or older were included. All patients underwent CR during their hospitalization. Nutritional status and functional status were assessed by Mini Nutritional Assessment Short Form (MNA-SF) at the start of CR and Barthel Index score at discharge, respectively. The association between nutritional status and CR outcomes including functional status and the 1-year readmission rate were examined. Results: The medians of CR duration and sessions were 21 days and 11 sessions, respectively. Fifty-eight patients (53%) were malnourished (MNA-SF score ≦ 7). Patients with malnutrition had a lower Barthel Index score at discharge than those without malnutrition (median 85 vs. 90, p<0.01). Barthel Index score at discharge was lower in patients with chronic disease-related malnutrition, starvation-related malnutrition and acute disease or injury-related malnutrition. In multiple regression analysis, age, MNA-SF score, chronic disease-related malnutrition and starvation-related malnutrition were independent predictors of Barthel Index score at discharge (adjusted R 2 =0.20, p<0.01). The median follow up period was 150 days. Readmission due to worsening HF occurred in 55 patients (50%). The 1-year readmission rate by the Kaplan-Meier method was significantly higher in patients with malnutrition than those without malnutrition (p<0.05). Using Cox multivariate analysis adjusted for age and sex, BNP level, MNA-SF score and total lymphocyte count were independent predictors of the readmission (hazard ratio 2.58, 0.82, 0.99, respectively; p<0.05). Conclusions: Nutritional status in elderly HF patients is an important determinant of both functional status and readmission after CR.

Use of Stroke-Related Income Supplements and Predictors of Use in a Working-Aged Finnish Ischemic Stroke Cohort

Compared with the direct costs, the indirect costs of stroke may be larger contributors to the socioeconomic burden of stroke, and the need to better understand the indirect costs of stroke is well established. We investigated the indirect costs of stroke according to a novel outcome, the use of stroke-related income supplements, in a Finnish cohort of working-aged patients. Consecutive patients (n = 230) who experienced a first-ever ischemic stroke were recruited. Demographic, clinical, and cognitive function data (which were measured using clinical neuropsychological assessments) were collected at baseline and at 6-month and 2-year follow-ups. Data on the use of income supplements within the first 3 years of the stroke were retrieved from national insurance registry files and used to construct survival models. Stroke patients used a mean of 11 months of stroke-related income supplements; this use was associated with atrial fibrillation, cognitive impairment, prestroke income supplement use, higher National Institutes of Health Stroke Scale scores, lower Barthel Index scores, and increased lesion sizes. In multivariate survival models, atrial fibrillation and cognitive impairment were the factors most strongly associated with the use of stroke-related income supplements. Using stroke-related income supplement data to quantify poststroke productivity losses allowed a working-aged cohort to be investigated without inclusion restrictions based on occupational status or other factors; the use of these data as an outcome emphasized the well-known detrimental effects of atrial fibrillation and cognitive impairment on stroke outcome. The results support stroke-related income supplement use as a complementary outcome for understanding stroke-related productivity losses.

ACUTE ISCHEMIC STROKE

Among all deaths, 40-50% are due to vascular events and out of these 10% aredue to stroke. More than 66% of the global stroke occurrence is in developing countries, wherethe average age of patients with stroke is 15 years less than in developed countries. Objectives:To determine the correlation between higher total cholesterol level and high Barthel Indexscore(estimate of functional daily independent activity level) in patients with acute ischemicstroke. Design: Cross sectional study. Period: May 2013 to Apr 2014. Setting: Medical Units ofDHQ and Allied Hospital, Faisalabad. Methodology: Sample size of 200 patients was collectedand patients were included through Consecutive (non-probability) sampling technique. Allpatients underwent CT scan Brain from the radiology department of the hospital to determinethe respective changes (hypo dense area) of the ischemic stroke. Fasting serum cholesterolwas measured in all patients after an overnight fast of 12 hours. Then patients were assessed byusing Barthel Index score (BI). The data was analyzed by using SPSS version 16.0. SpearmanRank correlation coefficient was calculated to BI score in patients with ischemic stroke. Results:The mean age of the patients was noted as 61.76±11.55 years. In this study 55.50% weremales and 44.50% patients were females. The mean total cholesterol value of patients wasnoted as 251.58±71.15 mg/dl. Out of 200 patients, 111(55.5%) patients had high cholesterol(>200mg/dl) whereas 89(44.5%) patient had low cholesterol of(<200mg/dl).In statical analysisthe results showed that the mean value of total Barthel index score was 57.50±19.52. The studyresults described that 51.50% patients had high Barthel index score (>53) whereas 48.50%patients had low Barthel index score (<53). Spearman correlation coefficient was calculatedbetween high TC and high BI score as r= 0.641. This value was statistically significant i.e.p-value=0.000*. Conclusions: With the help of this study, we found a significant positiverelationship between high TC and high BI score in patients presented with ischemic stroke.Now we can better prognosticate the functional outcome of ischemic stroke in our patients.

The effectiveness of inpatients rehabilitation for spinal cord patients in Siriraj hospital.

Retrospective study. To study the effectiveness of inpatient rehabilitation in spinal cord injury (SCI) patients. Rehabilitation Medicine Department, Faculty of Medicine Siriraj Hospital. SCI patients admitted from 2006 to 2010. Medical records of SCI patients including baseline characteristic, functional score using Barthel index (BI), length of stay (LOS) and complications were reviewed. The effectiveness and efficiency were calculated by difference of BI admission and BI discharge (ΔBI) and ΔBI/LOS, respectively. The factors associated with the effectiveness were then determined by multivariate linear regression analysis. There were 201 admissions with complete data. There were 164 (81.6%) admissions that had objective for intensive rehabilitation. The average LOS was 39.8 days (s.d.=23.6). BI score was significantly increased after inpatient rehabilitation with the effectiveness of 13.0 (s.d.=15.2) and BI efficiency of 0.37 score per day (s.d.=0.47). SCI patients admitted for intensive rehabilitation goal had significantly better BI effectiveness and efficiency compared with other objective group. Only the objective of admission for intensive rehabilitation, the shorter duration of onset before admission, lower BI score on admission and absence of comorbidity were found to associate with the change of BI score. Inpatient rehabilitation is considered as important part for improving SCI patients' functional abilities. The shorter duration between SCI and rehabilitation, a lower BI score on admission, the absence of comorbidity and the ability to undertake an intensive rehabilitation program were positively associated with the effectiveness of rehabilitation. These factors should be taken care during inpatient rehabilitation program.

Validity of EQ-5D-5L in stroke.

PurposeTo assess EQ-5D-5L (5L) validity in patients with acute stroke, in comparison with EQ-5D-3L (3L).MethodsCross-sectional study of 408 patients during index hospitalization. We compared 5L and 3L in terms of feasibility, frequency of unique health states, ceiling effect and discriminatory power (informativity). We assessed construct validity in terms of known-groups validity and convergent validity of 5L dimensions with other stroke outcome measures.ResultsThe overall proportion of patients with acute stroke reporting ‘no problems’ with 3L—6.1 % was further reduced to 5.6 % with 5L (relative reduction of 8.2 %). The highest improvement in relative discriminatory power, when moving from 3L to 5L, was noticed in pain/discomfort and anxiety/depression dimensions (Shannon Evenness Index 0.91 for both 5L dimensions; relative increase 34.4 and 29.1 %, respectively). Known-groups validity tests confirmed prior hypotheses: Health state utilities were lower in following subpopulations—females, patients with high modified Rankin Scale (mRS) score, low Barthel Index (BI) or VAS score, patients with subarachnoid hemorrhage or intracerebral hemorrhage, and when proxy respondent was used. Convergence of EQ-5D-5L dimensions with mRS, BI and EQ VAS was improved or at least the same as for 3L dimensions.ConclusionsResults support the validity of the EQ-5D-5L descriptive system as a generic health outcome measure in patients with acute stroke, demonstrating some psychometric advantages in comparison with EQ-5D-3L.

Post-stroke Spasticity: Predictors of Early Development and Considerations for Therapeutic Intervention

ObjectiveThe complexities of post-stroke spasticity (PSS), and the resultant difficulties in treating the disability, present a significant challenge to patients, stroke rehabilitation teams, and caregivers. Reducing the severity of spasticity and its long-term complications may be facilitated by early intervention, making identification of stroke patients at high risk for developing spasticity essential. Factors that predict which patients are at risk for the development of PSS are identified. TypeSystematic search and review Literature SurveyA PubMed search of the following terms was conducted: predictors OR risk factors AND stroke AND spasticity. Studies discussing predictors of early PSS development and factors predictive of motor/functional outcomes and recovery were selected and reviewed in detail. SynthesisSeveral predictors of PSS have been proposed, based on studies conducted in patients within 6 months after stroke, including development of increased muscle tone, greater severity of paresis, hemihypesthesia, and low Barthel Index score. Predictors identified in later stages post-stroke (within 12 months) have also proved useful for clinicians, as has the consideration of predictors of motor and functional outcomes and recovery; yet there is a need for additional studies in this area. An understanding of these and other potential predictive factors—such as motor impairment, neurologic and sensory deficit, lesion volume and location, and associated diseases—has not progressed to the same extent and warrants further investigation. ConclusionThe studies discussed in this review support the notion that early identification of factors predictive of PSS should significantly affect the course of intervention, help target individuals who would benefit most from specific types and intensities of therapy, and possibly provide better motor and functional outcomes.

Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study

To investigate the association between nutritional status and rehabilitation outcome in elderly inpatients with hospital-associated deconditioning. A prospective cohort study. One hundred sixty-nine consecutive elderly inpatients diagnosed with hospital-associated deconditioning. Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center. Body mass index, haemoglobin, albumin, total lymphocyte count, C-reactive protein, cause of malnutrition, and feeding route were also investigated. Primary outcome was Barthel Index score at discharge. A total of 148 patients (87.6%) were malnourished, and 21 were at risk for malnutrition. There were no patients with normal nutritional status. Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition. Chronic disease-related malnutrition, oral intake, and parenteral nutrition were associated with the Barthel Index score at discharge. There were significant correlations between the Barthel Index score at discharge and nutritional score, albumin, and total lymphocyte count. In multiple regression analysis, Mini Nutritional Assessment Short Form, albumin, and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge. Most elderly inpatients with hospital-associated deconditioning are malnourished. Nutritional status, albumin, and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning.

Variables predictoras de mortalidad en pacientes ancianos hospitalizados por insuficiencia cardiaca con fracción de eyección preservada

Background and objectivesThe prevalence of heart failure (HF) increases with age. Even though the mortality of patients≥80years of age with HF and preserved left ventricle ejection fraction (LVEF) is very high, the predictor variables are not well-known. The main goal of this study was to evaluate the mortality predictor factors in this subgroup of the elderly population. Patients and methodsAn observational and prospective study of patients hospitalized due to HF with preserved LVEF has been conducted. The demographic, clinical, functional and analytic factors were evaluated when the patients were admitted with special attention to the co-morbidities. The primary endpoint was the total mortality in the subgroup of patients≥80years of age after a year of follow-up. The predictor variables were studied by means of a multivariate Cox regression model. ResultsFrom a total of 218 patients with an average age of 75.6 (±8.7) years of age, 75 patients (34.4%) were≥80years. The mortality rate of patients≥80 years of age totaled 42.7%, in relation to 26.6% for the lower age group (log-rank<.001). After a multivariate analysis using the Cox regression model in patients≥80, the serum urea levels above the average (hazard ratio [HR] 3.93; 95% confidence interval [95% CI] 1.58-9.75; P=.003), the age (HR 1.17; 95% CI 1.07-1.28; P<.001), the hyponatremia (HR 3.19; 95% CI 1.51-6.74; P=.002) and a lower score on the Barthel index (BI) (HR 1.016; 95% CI 1.002-1.031; P=.034) were independent mortality predictors after an one-year follow-up. ConclusionsSerum urea levels, age, hyponatremia and a low BI score could be proposed as independent mortality predictors in patients≥80 of age hospitalized for HF with preserved LVEF.

Association between Functional Status of Chinese Nursing Home Older Adults and Long Term Mortality

To investigate the strength of association between impaired functional status and long-term (3-year) mortality in Chinese nursing home older adults. A 3-year prospective multicenter cohort study. Nine nursing homes in Hong Kong. A total of 672 nursing home older adults (224 men; 448 women), mean age 85.0 ± 7.4. Functional statuses of participants were assessed by Barthel Index (BI) and participants were stratified into different groups according to their BI score: BI score 100, BI score 75-95, BI score 45-70, BI score 15-40, and BI score 0-10. Other covariates included age, sex, comorbidities, score of abbreviated mental test, serum albumin, serum creatinine, serum hemoglobin, and hospitalization in the preceding year. The outcome measures were the 1-year, 2-year, and 3-year all-cause mortality. Older adults with lower BI score had significantly higher all-cause mortality and this trend persisted in 1-year, 2-year, and 3-year mortality (P < .001). After multivariate analysis, there was a dose-response relationship in hazard ratio (HR) between BI score and 3-year all-cause mortality (compared with BI score 100; BI score 75-95: HR 1.38 [CI: 1.00-2.56; P < .05]; BI score 45-70: HR 1.80 [CI: 1.04-3.11; P < .001]; BI score 15-40: HR 2.12 [1.21-3.70; P < .001]; BI score 0-10: HR 3.13 [1.82-5.41; P<.001]; and trend test P < .05). Similar relationships were found in 1-year and 2-year mortality. Impaired functional status is associated with higher short-term and long-term mortality with a dose-response relationship in Chinese nursing home older adults.

Case fatality of patients with stroke over a 12-month period post stroke

Stroke is among the top 4 causes of death in South Africa and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge from hospital. A total of 200 patients with first-time ischaemic stroke were recruited from Chris Hani Baragwanath Academic Hospital and followed up for 12 months. The Barthel Index (BI) and Rivermead Mobility Index (RMI) were used to establish patient functional ability and, by inference, stroke severity. Follow-up assessments were performed at 3, 6 and 12 months post discharge. Data analysis was largely descriptive in nature. Thirty-eight per cent of patients died within the 12 month follow-up period; 25.5% within 3 months of discharge. The average length of hospital stay was 6 days. Low BI scores at discharge were observed in the majority of patients who died. The 12-month cumulative mortality was high (highest at the 3-month follow-up). The short hospital stay and poor functional ability of the patients post stroke possibly left them vulnerable to bed-rest complications, such as chest infections and pressure sores.

The incidence of venous thromboembolism following stroke and its risk factors in eastern China

Few studies have documented the prevalence of venous thromboembolism (VTE) in the Chinese population. We aimed to investigate the incidence of VTE following stroke and to determine the potential risk factors for the onset of VTE in patients of eastern China. A prospective multi-center study was conducted. A total of 1,380 patients with acute stroke received venous duplex ultrasound (VDU) examination on both lower limbs. The National Institutes of Health Stroke Scale (NIHSS), Barthel index (BI), Wells, and modified Rankin scale scores were determined. Among 1,380 cases of acute stroke, 4.49 % (62 cases) had deep venous thrombosis (DVT) and 0.80 % (11 cases) had pulmonary thromboembolism (PTE). In the cases of DVT, 48.4 % had no clinical symptoms. The independent risk factors for the incidence of DVT, following the acute stage of stroke, were an age ≥ 70 years, bed-ridden, a Wells score ≥ 2, an NIHSS score of lower limbs ≥ 3, a low BI score, and an elevated concentration of D: -dimer. Rehabilitative and anti-coagulant therapy prevented the incidence of DVT following stroke. Moreover, an age ≥ 70 years, bed-ridden and having DVT were the independent risk factors for the incidence of PTE among stroke patients during the acute stage. Finally, 1.51 % of the patients had DVT whereas no PTE occurred during the period of the follow-up study. VDU examination is recommended for patients with acute stroke, which may help to diagnose and treat asymptomatic DVT early as well as prevent the subsequent incidence of PTE.

Men Recover Ability to Function Less Than Women Do

The aim of this study was to investigate the association between sex and functional outcome after acute inpatient rehabilitation in hip-fracture patients. We investigated 1094 of 1186 people admitted consecutively to our rehabilitation hospital because of a hip fracture. Functional outcome was assessed using Barthel Index scores. Barthel Index efficiency (improvement per day of stay length) and Barthel Index effectiveness (proportion of potential improvement achieved) were calculated. The median Barthel Index score at discharge from inpatient rehabilitation was 85 in the 970 women and 75 in the 124 men (interquartile range, 65-95 in women and 60-95 in men, P = 0.001). Both Barthel Index efficiency and effectiveness were significantly lower in men (P = 0.030 and P = 0.007, respectively). After adjustment for six confounders, we confirmed that men had lower Barthel Index scores (P = 0.030), Barthel Index efficiency (P = 0.024), and Barthel Index effectiveness (P = 0.040). The risk of achieving a low Barthel Index score (i.e., <85) at the end of acute inpatient rehabilitation was higher for men than for women (adjusted odds ratio, 2.055; 95% CI, 1.212-3.483; P = 0.007). In our large sample of hip-fracture patients, men had a significantly worse functional outcome than did women after acute inpatient rehabilitation.

Prevalence and Correlates of Geriatric Frailty in a Northern Taiwan Community

Frailty is the core of geriatric syndromes in the elderly. However, there is no solid prevalence data in Taiwan even with the rapid growth of the elderly population. The aim of this study was to explore the prevalence of frailty defined by different instruments and to identify the factors associated with frailty in a northern Taiwan community. The 65-79-year old community-dwelling residents randomly selected from Toufen were first screened with a telephone version of the Chinese Canadian Study of Health and Aging Clinical Frailty Scale (CCSHA-CFS; level 1-7). Those who scored 3-6 with this instrument were evaluated at a local hospital with the Fried Frailty Index (FFI) and the Edmonton Frail Scale (EFS). Other baseline characteristics including health and functional performance were also evaluated. Among the 2900 population representative samples, 845 (29.1%) completed the CCSHA-CFS telephone interview with the prevalence of frailty approximately 11.0% [95% confidence interval (CI) 8.9-13.1]. Among the 275 who completed assessments with FFI and EFS, prevalence of frailty was 11.3% (95% CI = 7.6-15.0) by FFI and 14.9% (95% CI = 10.7-19.1) by EFS. About 57.5% of respondents had memory impairment, 29.8% experienced pain, 25.1% experienced falls, 16.7% had depression, 14.5% had urinary incontinence, and 5.8% had polypharmacy. Being older, having more complaints with falls, pain, dysphagia, polypharmacy, depression, comorbidity, longer time for the Timed Up and Go test, less education, lower Mini-Mental State Examination score, and lower Barthel Index were associated with frailer status. In multinomial logistic regression analysis, increasing age, less education status, lower Barthel Index score and depression were positively associated with physical frailty. In this study, the prevalence of frailty was from 11.0% to 14.9% by different criteria and methodology. Various correlates were independently associated with frailty status. It is suggested that intervention for frailty requires an interdisciplinary approach.

Neoplastic myelopathies and traumatic spinal cord lesions: an Italian comparison of functional and neurological outcomes

Although neoplastic spinal cord injuries (NSCIs) constitute ∼25% of all non-traumatic spinal cord lesions, patients with such pathologies are seldom, if ever, admitted to specialized centers; further, their rehabilitation typically is short because of the perception that rehabilitation prolongs hospital stays unnecessarily and is reserved only for patients with very good prognoses. This study is a retrospective analysis. The objective of this study is to evaluate the neurological and functional outcomes of patients with NSCIs compared with those of patients with traumatic spinal cord injury (TSCI). We evaluated 208 patients with TSCIs and 63 with NSCIs; using a matching cohorts procedure, 43 comparable couples were selected from each group. The measures used to assess these patients were the American Spinal Injury Association standards, the Barthel Index (BI), the Rivermead Mobility Index and the Walking Index for Spinal Cord Injury. In the general population, NSCI patients are older and have longer lesion-to-admission times and more incomplete lesions than TSCI patients. Therefore, the functional status at admission and outcomes differed between the groups. In the matching cohorts, TSCI patients had lower BI scores at admission than NSCI subjects. At discharge, the two groups had comparable functional outcomes. Neurological status was similar at admission and at discharge. Although they had slightly disparate functional levels at admission, NSCI and TSCI patients had the same outcomes at discharge. Our data suggest that in a selected cohort of NSCI patients, rehabilitation is as successful as that in TSCI subjects and allows most patients to be discharged instead of being institutionalized.

Gender-Specific Predictors of Functional Outcome after Stroke Rehabilitation: Potential Role of the Autonomic Nervous System

The aim of this study was to assess the impact of cardiac autonomic derangement on gender-associated functional outcome of patients with subacute ischemic stroke undergoing a hospital-based rehabilitation program. The study population included 126 consecutive first-ever stroke survivors (mean age 59.7 ± 11.6 years). Time-domain measures of heart rate variability (HRV) by 24-hour Holter monitoring (HM) were considered in all cases. By the end of the rehabilitation program an unfavorable functional outcome with dependency (Barthel Index score of <75) was found in 27 men (40.3%) and in 31 women (52.5%; p = 0.168). Multivariate analysis demonstrated that high age, low Barthel Index score and low Rankin Scale score on admission were independent predictors of an unfavorable functional outcome in both men and women. The standard deviation of normal-to-normal RR intervals on HM was an independent predictor of rehabilitation outcome only in men (OR 15.29, 95% CI 2.47–46.58, p = 0.001). The presence of insular damage on neuroimaging studies was independently associated with an unfavorable functional outcome only in female (OR 18.89, 95% CI 2.34–71.4, p = 0.006). HRV does not predict functional outcome after rehabilitation in women. Instead, insular damage appears to have a role in determining the final results of rehabilitation in women but not in men.

Vitamin D insufficiency and frailty syndrome in older adults living in a Northern Taiwan community

This study explored the association between vitamin D insufficiency and frailty syndrome defined by the Fried Frailty Index (FFI) and the Edmonton Frail Scale (EFS) in a northern Taiwan community. Data of 215 subjects participating in an integrated interventional trial involving community-dwelling older adults with a high frailty risk were analyzed. Subjects were first screened by telephone interview and then evaluated at a local hospital with questionnaires, physical performance tests, and serum 25(OH)D measurements. Of the 215 participants, 31% had 25(OH)D insufficiency (< 20 ng/ml). Frail subjects based on the FFI were older, had lower Mini-Mental Status Exam (MMSE) scores, Barthel Index (BI) scores, and 25(OH)D levels. Using the EFS, frailer cases were more likely to be female, have less education, higher comorbid conditions, lower MMSE scores, lower Barthel Index scores, and lower 25(OH)D levels. The associations between insufficient 25(OH)D status and both frailty scales were significant. After adjustment of variables, the odds ratio of 25(OH)D insufficiency was 10.74 (95% CI 2.60–44.31) for frail versus robust individuals. The prevalence of vitamin D insufficiency was high in this population. There was a strong association between vitamin D insufficiency and the FFI. Vitamin D measurements and supplements are suggested for high-risk older people.

Predictors of 3-year mortality in subjects over 95 years of age. The NonaSantfeliu study.

To examine the survival rates of subjects aged 95 or over after a follow-up period of 3 years, and to determine predictive factors for mortality risk. A prospective cohort study. A community-based study. Forty-eight subjects aged 95 or over. Sociodemographic data, Barthel Index, Lawton-Brody Index, Spanish version of the Mini-Mental State Examination, short version of the Mini Nutritional Assessment, comorbidity (Charlson Index), and prevalent chronic diseases were evaluated. Patients who died were compared with the rest. Thirty-six deaths (75%) were recorded during follow-up. The Cox multivariate analysis showed that lower Barthel Index scores and a history of heart failure were independently associated with long-term mortality. In subjects aged 95 or over, poor functional status and history of heart failure were the two independent risk factors for 3-year mortality.

The Use of a Biplot in Studying Outcomes After Stroke

Background and purpose. This study aimed to unravel the multidimensional profile of stroke outcomes by investigating the global correlation structure of motor, functional, and emotional problems of patients, as well as their caregivers’ strain, at 6 months after stroke. Potential differential associations based on patients’ level of functioning on admission to the rehabilitation center were analyzed. Methods. Data were collected within the CERISE-study (Collaborative Evaluation of Rehabilitation in Stroke across Europe). Six months after stroke, the Rivermead Motor Assessment (RMA), Extended Activities of Daily Living (EADL), Hospital Anxiety and Depression Scale—Anxiety (HADS-A) and Hospital Anxiety and Depression Scale—Depression (HADS-D), EuroQol—Health State (EQ-HS), EuroQol—Visual Analogue Scale (EQ-VAS), and Caregiver Strain Index (CSI) were administered. Patients were classified into 3 categories according to their Barthel Index (BI) score on admission to the rehabilitation center. Principal component analysis was carried out, and a biplot was constructed. Results. Data were available on 510 patients. One cluster was formed by RMA and EADL, and a second one by HADS-A, HADS-D, and EQ-VAS. EQ-HS was situated between these two. CSI formed a third dimension. Patients with low BI scores on admission to the rehabilitation center had higher HADS-A and HADS-D scores 6 months after stroke. High BI scores were associated with large variations in HADS-A and HADS-D scores. Conclusions. This novel biplot strategy for rehabilitation studies revealed 2 clusters: one of motor/functional problems and one of emotional problems. Patients with mild functional deficit measured on admission to the rehabilitation center can suffer from mild to severe anxiety and depression at 6 months poststroke. Screening for emotional disorders in all patients is recommended.

Quantification of the Probability of Reaching Mobility Independence at Discharge from a Rehabilitation Hospital in Nonwalking Early Ischemic Stroke Patients: A Multivariate Study

Background: This study was designed to quantify the probability of recovery of mobility in admission nonwalking stroke survivors. Methods: We evaluated 437 of 500 consecutive patients admitted for sequelae of first ischemic stroke within the first month. We performed several logistic regressions using mobility status at discharge (independence in stair climbing; walking outside and inside, without aid or supervision; walking with cane or other aid, or need for wheelchair) as dependent variable, and several independent variables, including stratification of patients according to their Barthel Index (BI) score into 6 classes (≤10; 11–20; 21–30; 31–40; 41–50; 51–60). Results: At discharge, 4.58% of patients were independent in stair climbing, 8.70% were able to walk outside, 14.41% to walk inside, and 27.46% to walk with cane or other aid, while 44.85% remained in wheelchair. Very low BI scores at admission were associated with a high risk of need for wheelchair, whereas patients with BI score 51–60 showed a high probability to reach independence in stair climbing (OR = 5.60). Age, severity of neurological impairment, global aphasia, unilateral spatial neglect, male gender and vocational status also played a prognostic role. Conclusions: The probability of potential mobility recovery can be quantified at admission with better accuracy for independence in stair climbing and walking outside without any aid (percentages correctly predicted 95.4 and 91.8%, respectively). Stratification of BI score may be useful to better quantify the risk for each patient.