Outcomes In Terms Of Disability Research Articles

Spectrum of Anti-NMDA Receptor Antibody Encephalitis: Clinical Profile, Management and Outcomes.

Background:Anti-N-methyl D-aspartate receptor (anti NMDAR) antibody encephalitis is an immune-mediated entity characterised by a constellation of neuro-psychiatric symptoms.Objective:To describe clinical profile and treatment outcomes of patients with anti NMDAR antibody encephalitis.Settings and Design:Subjects were selected by screening for all patients satisfying Graus et al.'s criteria for probable anti NMDAR antibody encephalitis, admitted in neurology department of a tertiary care centre in Eastern India.Materials and Methods:A prospective, longitudinal study was conducted by identifying 25 patients with anti NMDAR antibodies in CSF and or serum, between September 2018 to February 2020.Statistical Analysis:Chi square test was used to compare variables.Results:Out of 98 patients screened, 25 subjects (14 females: 11 male) were positive for anti NMDAR autoantibodies, with a mean age of 17 years. 13 subjects belonged to paediatric age group. Most common presenting feature was memory/learning deficit (88%) followed by behavioural abnormalities (84%) and seizures (68%). 11 patients (44%) patients needed escalation to second line therapy, rituximab. Seven (28%) and twelve (48%) patients underwent complete (mRS 0-1) and partial recovery (mRS 2-3) respectively, while 4 (16%) became disabled (mRS 4-5). Mortality was 8%. Paediatric population had a better outcome in terms of disability (p = 0.043).Conclusion:Anti NMDAR-Ab encephalitis is the most common cause of antibody positive autoimmune encephalitis worldwide. There are important clinical markers and investigational profiles which carry prognostic significance.

The Association Between Early Postoperative Leg Pain Intensity and Disability at 1-Year and 2-Year Follow-Up After First-Time Lumbar Discectomy

Study Design:Longitudinal cohort study.Objectives:To investigate whether a cutoff point in leg pain intensity measured preoperatively or at early follow-up could identify patients at risk of poor outcomes in terms of disability at 1-year and 2-year follow-up after first-time lumbar discectomy, and to identify the characteristics associated with early postoperative leg pain intensity.Methods:From 2010 to 2013, 556 patients underwent lumbar discectomy. Leg pain intensity was measured preoperatively and at early postoperative follow-up and dichotomized according to an established cutoff point on a 0 to 100 visual analogue scale (mild <30, moderate/severe ≥30). The outcome measurement was Oswestry Disability Index (ODI). Generalized estimating equations modelling established the association between leg pain intensity and ODI. Characteristics associated with early postoperative leg pain intensity were identified using common hypothesis tests.Results:Moderate/severe leg pain intensity at early follow-up showed a statistically significant association with higher ODI at 1-year and 2-year follow-up compared to mild leg pain intensity (median [interquartile range]: 24 [26] and 26 [26] versus 12 [18] and 10 [20], respectively). Patients reporting moderate/severe leg pain intensity were more often smokers, were more prone to receive social benefits, and were more prone to have chronic back pain. The preoperative measurement of leg pain intensity showed inferior associations.Conclusion:The proposed cutoff point in leg pain intensity at early follow-up can identify patients at risk of disability at both 1-year and 2-year follow-up after first-time discectomy. Future research should be undertaken to investigate whether patients with moderate/severe leg pain intensity at early postoperative follow-up could benefit from additional or more intensive postoperative interventions.

Therapeutic Advantages of Frequent Physical Therapy Sessions for Patients With Lumbar Spinal Stenosis.

A retrospective study of a randomized clinical trial and a prospective study of patients with lumbar spinal stenosis (LSS). The aim of this study was to identify the effects of the number of physical therapy (PT) sessions on clinical outcomes of patients with LSS. Supervised PT for patients with LSS has been reported to lead to better short-term outcomes in terms of disability and leg pain than unsupervised exercise. However, no studies have investigated the relationship between the number of PT sessions and the therapeutic effects in patients with LSS. All patients received exercise therapy for 6 weeks. Included were 43 patients receiving supervised PT twice a week (P2 group), 38 patients receiving supervised PT once a week (P1 group), and 43 patients receiving a home exercise program alone (HE group). Clinical outcomes were measured using the Zurich Claudication Questionnaire (ZCQ), a numerical rating scale (NRS) of back pain and leg pain, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at baseline and at 6 weeks. At 6 weeks, the P2 group showed significant improvements in ZCQ physical function, back and leg pain on the NRS compared with the P1 group (P < 0.05). Compared with the HE group, the P2 group showed significant improvements in ZCQ symptom severity and physical function, back and leg pain on the NRS, and JOABPEQ gait disturbance (P < 0.05). There were no significant differences in mean changes after 6 weeks between the P1 and HE groups. Six weeks of supervised PT twice a week resulted in significant short-term improvements in symptom severity, physical function, back and leg pain, and gait disturbance compared with once a week and/or home exercise alone. Patients with LSS should be treated with intensive and supervised exercise programs to obtain maximum benefit of exercise therapy. 3.

Treatment responses, disability outcomes and prognosis of a cohort of Sri Lankan patients with clinically definite multiple sclerosis: Preliminary data from a dedicated MS clinic

Introduction Multiple sclerosis (MS) is a demyelinating disorder of the CNS which is an emerging neurological problem in Sri Lanka. We looked at treatment responses and disability outcomes of a cohort of 100 Sri Lankan patients with confirmed MS in terms of their EDSS, annualized relapse rates (ARR) and time to first relapse (TTFR) Objective To determine the disability outcomes and overall prognosis of Sri Lankan MS patients in terms of their demographic, clinical, radiological and treatment status. Methods 100 confirmed MS patients (McDonald 2010 & MAGNIMS 2016) attending the MS clinic at the National Hospital of Sri Lanka were randomly assessed using direct interviews and patient registries. AQP4-IgG and MOG-IgG serology was negative in all. Results Majority were females (63%). Average age at onset was 29Y. Predominantly RRMS (75%). Mean EDSS 2.8 (Mean duration of follow-up 7.9y) with 81% having EDSS Conclusion MS patients in Sri Lanka had reasonably good outcomes in terms of disability and progression perhaps due to early diagnosis and treatment.

The influence of hand grip strength on surgical outcomes after surgery for degenerative lumbar spinal stenosis: a preliminary result.

Although a number of prognostic factors have been demonstrated to be associated with surgical outcome of degenerative lumbar spinal stenosis (DLSS), no study has investigated the relation between hand grip strength (HGS) and treatment outcome of DLSS. The purpose of the present study was to examine the influence of HGS on surgical outcomes after surgery for patients with DLSS. This is an observational study. Patients who underwent spine surgery for DLSS were included in the study. Oswestry Disability Index (ODI), EuroQOL (EQ-5D), and visual analog scale (VAS) scores for back or leg pain were assessed. A total of 172 consecutive patients who underwent spine surgery for DLSS were included in the present study. Patients were assigned to either high HGS group (≥26 kg for men and ≥18 kg for women, n=124) or low HGS group (<26 kg for men and <18 kg for women, n=48) based on their preoperative HGS performance. Oswestry Disability Index, EQ-5D, and VAS scores for back and leg pain were assessed and compared between two groups preoperatively, 3 and 6 months after surgery. The primary outcome measure was baseline-adjusted ODI scores 6 months after surgery. The secondary outcome measures, including the overall ODI score, EQ-5D score, VAS score for back and leg pain, were assessed at each time point during the 6-month follow-up period. As primary outcome, baseline-adjusted ODI scores were significantly lower in the high HGS group than in the low HGS group 6 months after surgery. In the secondary outcome measurements, the ODI, EQ-5D, and VAS scores for back and leg pain improved significantly with time after surgery in both groups. The effects of HGS group on the overall changes in the ODI and EQ-5D scores during the 6-month period were significantly different between the two groups; however, they were not significantly different on VAS score for back and leg pain. The pattern of change in the ODI during the follow-up period was significantly different between the two groups. Patients with preoperative high HGS display better surgical outcome in terms of disability and health status 6 months after spine surgery. Preoperative HGS can act as a predictor of surgical outcome in patients with DLSS.

Mortality and health-related quality of life in patients surgically treated for spondylodiscitis.

To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). Sixty-five patients were diagnosed with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre- and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD = 22) and mean EQ-5D time trade-off score was 0.639 (SD = 0.262); this was significantly lower than that in the normal population ( p < 0.001). Patients with neurological impairment prior to index surgery had lower EQ-5D scores ( p = 0.005) and higher ODI ( p = 0.02) at final follow-up compared with patients without neurological impairment. Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.

Posterior lumbar interbody fusion and posterolateral fusion: Analogous procedures in decreasing the index of disability in patients with spondylolisthesis.

Objective:The purpose of this study was to evaluate the disability in patients with spondylolisthesis who assigned either to posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) and to compare it between two groups.Methods:In a prospective observational study, 102 surgical candidates with low-grade degenerative and isthmic spondylolisthesis enrolled from 2012 to 2014, and randomly assigned into two groups: PLF and PLIF. Evaluation of disability has been done by a questionnaire using Oswestry Disability Index (ODI). The questionnaire was completed by all patients before the surgery, the day after surgery, after 6 months and after 1-year.Results:There were no statistically significant differences in terms of age and sex distribution and pre-operation ODI between groups (P > 0.05). Comparison of the mean ODI scores of two groups over the whole study period showed no significant statistical difference (P = 0.074). ODIs also showed no significant differences between two groups the day after surgery, 6th months and 1-year after surgery (P = 0.385, P = 0.093, P = 0.122 and P = 433) respectively. Analyzing the course of ODI over the study period, showed a significant descending pattern for either of groups (P < 0.0001).Conclusion:Both surgical fusion techniques (PLF and PLIF) were efficient to lessen the disability of patients with spondylolisthesis, and none of the fusion techniques were related to a better outcome in terms of disability.

Stroke in pregnancy: A rare case of protein C and protein S deficiency

Stroke in pregnancy is a rare occurrence, its reported incidence being 11–26 deliveries per 100,000. Ischemic strokes are slightly more common than hemorrhages. Subarachnoid hemorrhage, embolism and cerebral venous thrombosis can also occur, albeit with a lesser incidence. Peak incidence of stroke is in the peripartum and postpartum period. Mortality rate of pregnancy associated stroke is 10.13%. Therefore, rapid recognition and management of these patients are imperative to ensure successful outcome. We report a rare case of stroke during pregnancy which has the protein C and protein S deficiency as its precipitating cause.We report a case of a 24-year-old female, with previous cesarean section in her third trimester, suddenly developed weakness of left side of the body and deviation of face to the right. There was no history of head trauma, fever, unconsciousness or seizure. She did not have any skin rash, arthritis or signs of deep vein thrombosis. There was no history of prior fetal loss. Protein C and protein S levels were low. We report a rare case of stroke during pregnancy which has the protein C and protein S deficiency as its precipitating cause. Stroke is a recognized complication of pregnancy, is uncommon but feared. Stroke in young adults aged 15–35 years is more common in women with poorer outcome in terms of disability and dependence. Most pregnancy related stroke occurs in peripartum and puerperium.

Why do ischemic stroke and transient ischemic attack patients get readmitted?

ObjectiveReadmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences. MethodsConsecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined. ResultsTwo hundred sixty-five patients (50.9% male; 79.6%African American; mean age 60.9years) were included. There were 205(77.4%) strokes and 60(22.6%) TIAs. Thirteen (5%) patients died during their first admission. Of the remaining 252 patients, 25 (9.9%) were readmitted within 30days. The reason for readmission was neurological in 8/25 patients (32%; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68%). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5% vs. 14.7%; p=0.001) An NIH stroke scale ≥10 predicted readmission (50.0% vs. 25.4% for NIHSS <10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2% vs. 23.8%; p value=0.01). InterpretationDisabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30days and determine best practices that prevent readmission.

Diagnosing and managing headache in children

Once the correct diagnosis of migraine in a child is established, a treatment plan can be developed. This often entails a combination of acute therapies, preventive therapies, and biobehavioral interventions. Goals of treatment should be clearly established for the patients and parents, and realistic time courses discussed. Overall outcome in terms of disability and quality of life also may need to be addressed and included within the evaluation and management scheme.

Lifestyle in adults aged 35 years who were born with open spina bifida: prospective cohort study

Background and MethodsFrom 1963 to 1971, 117 babies with open spina bifida were treated non-selectively from birth. In 2002 we reviewed all the survivors by postal questionnaire and telephone call. The aims were to find out how many were living independently in the community or were in open employment or drove a car. In addition to these achievements we recorded health, medication and admissions to hospital and asked how much daily help they needed.ResultsAscertainment was 100%. There had been 63 deaths, mainly of the most severely affected. The mean age of the 54 survivors was 35 years. The outcome in terms of disability ranged from apparent normality to total dependency. It reflected both the neurological deficit, which had been recorded in infancy in terms of sensory level, and events in the CSF shunt history. Overall about 2 in 5 of the survivors lived independently in the community, 2 in 5 drove a car, 1 in 5 was in competitive employment and 1 in 5 could walk 50 metres.ConclusionAlthough those who survived to age 35 years tended to be less disabled, 2 in 5 continued to need daily care.

A comparison of five stroke scales with measures of disability, handicap, and quality of life.

Recently much debate has arisen on the appropriateness of assessing stroke outcomes with stroke impairment scales. Our purpose was to study the relationship between long-term impairments and functional outcomes in terms of disability, handicap, and quality of life. We studied 87 patients who had a stroke 6 months earlier. Impairments were scored on five stroke scales: the Orgogozo Scale, the National Institutes of Health scale, the Canadian Neurological Scale, the Mathew scale, and the Scandinavian Stroke Scale. Disability was assessed with the Barthel Index, handicap with the Rankin scale, and quality of life with the Sickness Impact Profile. The linear relationship between stroke scales and functional scales was assessed with correlation coefficients. We used regression analyses to explain functional health. The stroke scales were highly related to one another (range, r = -.85 to .92). The correlation between stroke scales and functional scales was < .70 and decreased from Barthel (mean r2 = 47.5%) to Rankin (mean r2 = 36.5%) to Sickness Impact Profile (mean r2 = 33%). Stroke scales were rather poorly correlated with patients' psychosocial conditions (mean r2 = 11.5%). Functional health status was mainly related to leg power and orientation. The standardized stroke scale weights of the explanatory items were lower than their standardized regression weights. Stroke scales only partly explain functional health. The impact of impairments on functional outcomes seems to be underestimated by the stroke scale weights. The correlation patterns give empirical support to the hierarchical structure of the International Classification of Impairments, Disabilities and Handicaps.