Proportion Of Stroke Survivors Research Articles

Stroke, depression, and self-harm in later life.

To examine recently published results of randomized placebo-controlled trials investigating the clinical effects of selective serotonin reuptake inhibitors on the prevalence of clinically significant symptoms of depression and suicidal ideation after an acute stroke. The prevalence of poststroke depression varies markedly according to the approach used to define depression, with recently published data suggesting that about one in every three stroke survivors will experience clinically significant symptoms of depression over a period of 12 months. The proportion of stroke survivors with clinically significant symptoms of depression decreases progressively with time, but in 30% of them symptoms persist or recur over 12 months. Routine daily treatment with 20 mg of fluoxetine for 6 months does not affect the prevalence of depression in this population, nor is it effective at treating or preventing poststroke depressive symptoms. Treatment discontinuation, gastrointestinal adverse effects, seizures and bone fractures are more frequent among stroke survivors treated with antidepressants than placebo. Moreover, current data show that thoughts about death or suicide are more frequent among adults who had a stroke than the general population, although recurring suicidal thoughts are uncommon. Routine daily treatment with 20 mg of fluoxetine for 6 months does not change the proportion of people who disclose suicidal thoughts over a period of 12 months after an acute stroke. Current evidence raises concerns about the efficacy and safety of antidepressants for the management and prevention of poststroke clinically significant symptoms of depression. It is unclear if these findings can be generalized to people with severe strokes or to stroke survivors with moderate to severe major depressive episodes.

LONG-TERM OUTCOMES AMONG NIGERIAN STROKE SURVIVORS - DATA FROM THE CogFAST-NIGERIA STUDY

<h3>Background</h3> Africa faces a rising burden of stroke with rising incidence and prevalence but little is known about the profile and trajectory of long-term stroke outcomes This study aimed to explore the profile, trajectory and determinants of long-term outcomes up to four years among a cohort of stroke survivors recruited into the CogFAST-Nigeria study. <h3>Methods</h3> The data analysed were collected in a longitudinal study of stroke survivors who were prospectively recruited from the Federal Medical Centre, Abeokuta and University College Hospital, Ibadan Nigeria. Subjects with subarachnoid haemorrhage, neurologic illness, or any systemic disease that could impair cognition were excluded from the study. Cognitive function was assessed using the vascular neuropsychological battery, depression through the Geriatric Depression Scale-short form, and functional dependency through the Barthel Index tool. Baseline enrolment was done three months after stroke (2010 -2011) and the stroke survivors were thereafter followed up for a period of four years (2014-2015). <h3>Results</h3> Of the 253 stroke survivors recruited into the study, the overall mean age was 60.2 (±9.8) <i>years</i>, 62.6% males, and overall mean number of years of formal education was 10.21 (±5.3). The proportion of stroke survivors with cognitive impairment was 53.2% at six months, 56.9%, 58.7%, 60.9 %, and 66.7 % at one, two, three, and four years, respectively, while depression was 39.3 % at three months, 35.2 %, 35.5 %, 26.7 %, and 36.1 % at one, two, three, and four years respectively. At six months after a stroke, the case fatality rate was 7.5 % (95 % C.I = 4.82-11.4), and 24.8 % (95 % C.I = 19.93-30.6), 39.4 % (95 % CI=3.65-45.7), and 45.3 % (95 % CI=39.42-51.6) at 1, 3 and 4 years respectively. Factors associated with mortality at 10% significance level include professional occupation (OR= 0.49; 90% CI=0.27-0.92; p-value=0.063) and those living with spouse/spouse and children (OR=0.57; 90%CI=0.35-0.93 p-value=0.058) while previous stroke was associated with functional dependency (OR=2.17; 95% C.I = 1.19-3.95, p-value 0.011). Older age (>70 yrs) (OR=23.47; 95%C.I=2.71-203.44, p-value=0.004), higher education (OR=0.17 95%C.I=0.04-0.69, p-value=0.013), professional occupation (OR=13.25; 95%C.I=1.04-168.55; p-value=0.046), previous stroke (OR=7.03 95%C.I=1.30-37.96, p-value=0.023), and caregiver burden (OR=3.51; 05% C.I=1.53-8.05, p-value=0.003) were predictors of cognitive impairment among the stroke survivors. <h3>Conclusion</h3> The study findings re-emphasize the importance of educational attainment, secondary stroke prevention and rich social network as a way of improving stroke outcomes.

Causes and Trends of Disabilities in Community-Dwelling Stroke Survivors: A Population-Based Study.

Many stroke survivors live with disabilities in the community. This study aimed to investigate the causes and trends of disabilities among community-dwelling stroke survivors. A total of 1547 community-dwelling stroke survivors ≥ 19 years were identified using the Korea National Health and Nutrition Examination Survey (KNHANES) database from 2007 to 2018. We analyzed the causes and trends of disabilities in strokes survivors using complex-samples procedures. During 2007-2018, 38.0% of stroke survivors were found to have disabilities. Stroke itself was the most common cause of disabilities (21.3%). Musculoskeletal (back or neck problems, 7.0%; arthritis, 5.7%; and leg pain excluding arthritis, 2.3%), sensory (visual problems, 3.6%; and auditory problems, 1.4%), and medical problems (diabetes 2.6%; hypertension, 2.3%; heart disease, 1.5%) accounted for the rest of the other causes of disabilities. Upon analyzing the trends, we found that both the proportion of stroke survivors with disabilities and that of stroke survivors with stroke-related disabilities decreased from KNHANES IV (2007-2009) to V (2010-2012). After 2010-2012, the proportion of both groups stayed constant. The burden of disabilities in non-hospitalized stroke survivors has decreased but still remains high. Attention is warranted because many other problems than a stroke can cause disabilities in community-dwelling stroke survivors.

Abstract P207: Association Between Rehabilitation and Functional Outcomes of Stroke Survivors: A Population-Based Study

Background: The increasing rate of stroke and its consequent disabilities has contributed to a growing proportion of stroke survivors requiring rehabilitation. Further research is needed to understand the provision of rehabilitation in the community settings and relationship between variance in stroke care and patient outcomes. Hypothesis: To investigate the association between rehabilitation and functional outcomes of stroke survivors. Method: Data for this analysis was derived from the Canadian Community Health Survey (CCHS) (merged cycles 2013-2016: 237,121 participants). Participants reporting complications from stroke were selected to assess the effect of physiotherapy (PT) and other allied health (AH) utilization. Primary endpoints included need for assistance in activity of daily living (ADL) and injury due to fall in the past 12 months (Inj-Fall). All statistical analyses were performed using R (V.4.0.2) and survey design. Results: Overall, 3,773 (1.1%) patients with stroke (47% females, 71.1% older than 60 years) were studied. Total of 0.2% and 1.6% of stroke survivors in 2013-14 had consulted PT and AH compared to 9.1% and 21% in 2015-16, respectively. Consequently, the rate of need for ADL and Inj-Fall were significantly greater in 2013-14. In general, age was a significant predictor of low accessibility to PT (OR=0.66(0.51-0.85)) or AH (OR=0.79(0.66-0.93)) whereas no significant association between sex and access to PT or AH (P=0.1). As expected, higher income was associated with greater PT utilization (OR=2.11(1.1-4.2)). Finally, PT or AH consultations were significantly associated with less need for assistance in ADL and lower Inj-Fall (Table1). Conclusion: Results of this study reinforce the beneficial effect of rehabilitation on ADL and injury in stroke survivors. Future longitudinal work is necessary to understand directionality of the relationship, and the impact of healthcare access, within varied healthcare systems and models of health .

Patient-reported, health-related, quality of life after stroke thrombectomy in clinical practice.

To determine patient-reported health-related quality of life (HRQOL) after stroke thrombectomy in clinical practice and to identify predictors of better HRQOL by analyzing data of 504 consecutive patients treated in a large university stroke center. All patients with stroke treated by thrombectomy (June 2015-October 2018) were prospectively enrolled in this observational study. At 90 days, functional outcome was assessed by the modified Rankin Scale (mRS) and patient-reported HRQOL was assessed by the EuroQol Group 5-Dimension (EQ-5D) self-report questionnaire, consisting of 5 health domains. The EQ-5D utility index (EQ-5D-I) score (-0.594 to 1.00, with higher values indicating better HRQOL) was calculated. Linear regression analysis was applied to identify predictors of better HRQOL (higher EQ-5D-I score). Of 504 patients (median age 76 years, 51.8% female), the mean EQ-5D-I score was 0.39 (SD 0.44). The proportion of stroke survivors who reported complaints in the different domains decreased from 66% in Usual Activities to 57% in Mobility, 50.4% in Self-Care, 41.7% in Pain/Discomfort, and 40.8% Anxiety/Depression. Lower age, lower prestroke mRS score, lower baseline NIH Stroke Scale score, higher Alberta Stroke Program Early CT Score, concomitant thrombolysis therapy, and a successful recanalization were independent predictors of better HRQOL. Patient-reported HRQOL provides a more comprehensive assessment of stroke outcome than the mRS score. Health domains involving motor function most frequently showed complaints in HRQOL after stroke thrombectomy, while a large proportion of patients did not report any complaints across the different health domains. Predictors of better HRQOL closely match the predictors of better functional outcome measured by the mRS in other thrombectomy studies.

Long-term unmet needs after stroke: systematic review of evidence from survey studies

ObjectivesTo synthesise evidence on longer term unmet needs perceived by stroke survivors, and psychometric properties of the tools used to evaluate unmet care needs after stroke.DesignSystematic review.SettingCommunity or patients’ home.ParticipantsStroke...

Proton pump inhibitor use and the risk of osteoporosis and fracture in stroke patients: a population-based cohort study

A considerable proportion of stroke survivors are prescribed with proton pump inhibitors (PPIs). Our study investigated the association between PPI use and the risk of osteoporosis and fracture among stroke survivors. A population-based propensity-matched retrospective cohort study was conducted using the National Health Insurance Research Database in Taiwan. Patients diagnosed with a new stroke between 2000 and 2012 were identified. After propensity score matching, 10,596 patients were enrolled, and 5298 patients were each assigned to the PPI user and non-user groups. Hazard ratios (HRs) were calculated for the risk of osteoporosis, hip fracture, and vertebral fractures according to PPI use or non-use. Sensitivity analyses were conducted to evaluate the dose effects of PPI. PPI use after stroke was associated with an increased risk of osteoporosis, hip fracture, or vertebral fracture, with an adjusted HR (aHR) of 1.28 (P<0.001). The aHRs were also significant for each outcome: osteoporosis, 1.26 (P<0.001); hip fracture, 1.18 (P=0.048); vertebral fracture, 1.33 (P<0.001). A pattern of dose effect was identified. For any event (osteoporosis/hip fracture/vertebral fracture), the aHR for PPI use of 1-90, 91-365, and >365 cDDDs was 1.22 (P<0.001), 1.27 (P<0.001), and 1.66 (P<0.001), respectively. For each outcome, the highest dose was associated with the highest risk, with aHR of 1.79 (P<0.001), 1.41 (P=0.039), and 1.82 (P<0.001) for osteoporosis, hip fracture, and vertebral fracture, respectively. Age- and sex-stratified analyses revealed similar patterns. PPI use is associated with an increased risk of osteoporosis, hip fracture, and vertebral fracture in stroke patients.

Editorial: Principles Underlying Post-Stroke Recovery of Upper Extremity Sensorimotor Function – A Neuroimaging Perspective

Editorial: Principles Underlying Post-Stroke Recovery of Upper Extremity Sensorimotor Function – A Neuroimaging Perspective

Abstract W P281: Improving Prediction of Readmission After Ischemic Stroke: A Nationwide Retrospective Cohort Analysis

Background: Previous models for predicting readmission after ischemic stroke rely solely on administrative claims. The Minimum Data Set (MDS) is a nationwide clinical database required for all U.S. nursing home residents. We hypothesized MDS variables would improve prediction of 30-day acute hospital readmission after ischemic stroke. Methods: Medicare inpatient claims for the year 2008 were used to identify ischemic stroke cases over age 65 as defined by ICD-9 principal diagnosis codes 433.x, 434.x, and 436.x. Unique individuals were linked to full MDS records. Logistic regression was used to construct risk-adjusted models of unplanned readmission 30 days post acute care hospitalization. Covariates were derived from Medicare Part A claims and clinically relevant MDS variables. Model performance was assessed through construction of receiver operator characteristic (ROC) curves. Results: Among 252,569 ischemic stroke admissions, there were 87,094 (36%) individuals admitted to nursing homes. The analytical sample was composed of 39,178 (14%) patients directly admitted to nursing homes. At 30-days post acute hospital discharge there were 11,648 (21%) readmissions and 6,394 (12%) deaths. Independent predictors of readmission included feeding tube (OR 1.20, CI 1.06-1.35), congestive heart failure (OR 1.18, CI 1.08-1.29), chronic obstructive pulmonary disease (OR 1.26, CI 1.15-1.39), renal disease (OR 1.26, CI 1.12-1.43), and pressure ulcers (OR 1.34, CI 1.20-1.51). Clostridium difficile infection was most strongly associated with readmission (OR 1.44, CI 1.05-1.97). Hemiparesis (34%) and aphasia (16%) were not significant predictors of 30-day readmission. Area under the ROC curve for predicting readmission at 30 days was 0.65. Conclusions: Nursing home admission is required for a significant proportion of stroke survivors over age 65. The addition of multiple individual clinical variables derived from the MDS resulted in a modest improvement in area under the ROC curve (.65) compared to previous models utilizing only Medicare Part A data (.60). The prediction model presented here provides novel targets for readmission reduction programs among stroke patients cared for in nursing homes.

Trajectory of Motor Performance Over Twelve Months in Nigerian Stroke Survivors

Objective: Submissions on recovery of post-stroke motor performance vary, especially in relation to increasing time after stroke. This study examined the trajectory of motor performance over the first 12 months after stroke.Methods: Consecutive first-incidence stroke survivors (N= 83) were recruited within 1 month of onset from a tertiary health institution in Nigeria. Simplified Fugl Meyer scale (S-FM) was used to assess motor performance at monthly intervals. Changes in overall motor performance, and differences between the affected upper and lower extremities, were examined using Friedman's ANOVA and pairedt-tests, respectively.Results: Significant improvement in motor performance was observed across 12 months (p&lt; .001), with the proportion of stroke survivors with severe impairment at onset (53.3%) decreasing to 20% by 12 months. Lower extremity motor performance scores were significantly higher than for the upper extremity from 1 to 12 months (p&lt;.01 at 3, 4, 5, 6 and 12 months; andp&lt; .05 at the remaining months).Conclusions: The potential for long-term improvement in motor performance after stroke was observed, suggesting that this can be harnessed by long-term rehabilitation efforts. The comparatively poorer outcome in the upper extremity indicates the need for extra rehabilitation strategies to enhance upper-extremity motor recovery in the first year of stroke.

Abstract WP199: Higher Stroke Prevalence Rates among Ribeirinhos Compared to Townsmen in the Brazilian Amazon.

There is a lack of epidemiological studies addressing cerebrovascular diseases in remote places as the Amazon river basin. We aimed to calculate the stroke prevalence rates among "ribeirinhos", rural inhabitants who living in riverbanks fishing and extracting fruit and nuts, in the rainforest comparing to townsmen in the same municipality. Methods: From May to October 2011, 6216 residents aged over 35 years in the of Coari, a municipality that is coverage by the Family Health Program with of 76 000 inhabitants, 35% of them are "ribeirinhos”. We trained all community health workers to carry out a door-to-door application of the “Stroke Symptom Questionnaire” for people over 35 years-old. This tool was applied first for the family for stroke screening and further for the index stroke case, including questions about six key functional impairment. It was previously translated to Portuguese and validated by a neurologist. Results: From a total of of 4897 respondents of urban area and 1028 "ribeirinhos", we calculated crude prevalence of stroke of 6.3% (95% CI; 5.0-7.7) among the "ribeirinhos" and of 3.7% (95% CI; 3.3-4.1) among townsmen. This difference was maintained after sex-age-adjustment. The female:male prevalence ratio was 1.37 (95% CI; 1.02-1.85) in urban area and the rural area of 0.93 (95% CI; 0.57-1.52). Among stroke suffers, the "ribeirinhos" were those with less access to medical care (32.1% vs. 52.5%, p=0.01) and a lower proportion of stroke survivors requiring help with least 1 activity of daily living (16.9% vs. 39.3%, p=0.001) in comparison to townsmen. Conclusion: To our knowledge it was the first study that provided a population-based stroke survey in the Amazon rainforest revealing a higher stroke prevalence among "ribeirinhos" compared to townsmen of the same municipality.

Making music after stroke: using musical activities to enhance arm function

A common long-term consequence of stroke is impaired arm function, which affects independence and quality of life in a considerable proportion of stroke survivors. There is a growing need for self-management strategies that enable stroke survivors to continue their recovery after rehabilitation has ceased. Interventions with high-intensity, repetitive task training and feedback are most likely to improve function. Achieving the required amount of self-practice is challenging, however. Innovative approaches are required to translate therapies into rewarding activities that can be undertaken independently. This paper describes the key principles and development of a novel intervention that integrates individuals' preferred music with game technology in upper limb rehabilitation. The "tap tempo" paradigm, which uses rhythmic auditory cueing, provides repetitive upper limb task training, which can be tailored to individual goals and progress (e.g., in terms of movement range and complexity), while providing sensitive quantitative feedback to promote skill acquisition and enhance self-management.

Prevalence of stroke and related burden among older people living in Latin America, India and China

ObjectivesDespite the growing importance of stroke in developing countries, little is known of stroke burden in survivors. The authors investigated the prevalence of self-reported stroke, stroke-related disability, dependence and care-giver...

Assessing Cognitive Function After Stroke Using the FIMTM Instrument*

This study investigated the cognitive impact of stroke on an urban population. A total of 2,862 participants who had suffered a stroke during the past 10 years and had been admitted to a rehabilitation facility were included in the study. The average FIM score 64.44 on admission, 85.39 at discharge, and 98.16 at 6-month follow-up. The average FIM Cognitive subscale score at admission was 22.32, 25.56 at discharge, and 29.94 at follow-up. It was found that 24% of patients showed no improvement in cognitive scores between admission and discharge. After discharge, 36.2% showed no improvement in cognitive function at 6 months as determined by the FIM instrument. Overall, 17.4% of people showed no cognitive improvement between admission and follow-up. Differences in cognitive function levels were identified for age, gender, and marital status, although not for ethnicity. The implication of these findings is that a large proportion of stroke survivors show little, if any, improvement in their cognitive function after stroke despite vigorous rehabilitation. This demonstrates a continued need for nurses to identify strategies and interventions for improving cognition, minimizing the effect of cognitive deficits on the person and family, and establishing ways to maximize the quality of life for all concerned.

Medico-social consequences and direct costs of stroke in a Swedish community

Two hundred and eighty-one patients who had sustained a stroke for the first time were investigated in the municipality of Söderhamn, Sweden, and its rural surroundings. Of these patients 226 (80%) had lived in their own homes before the insult, while the majority of the remainder had lived in old people's homes. One hundred and eighty-nine patients survived for at least 3 months. The proportion of stroke survivors who were living at home was 53% after 3 months, 65% after 1 year and 68% after 2 and 3 years. The average number of days in hospital was 65 for men and 81 for women after 1 year and 111 and 181 respectively after 3 years. Only 11% were gainfully employed before the attack. This proportion varied between 1 and 10% in the 3-year post-stroke period. About 85% were retired, while the rest were receiving sickness benefit or a disability pension (4-16%). The direct costs of stroke per stroke patient in the municipality of Söderhamn, was estimated at 129 000 Swedish kr. (25 800 US dollars); index 1980. The major part of this sum consisted of charges for hospital care (43-46%), followed by charges for nursing care in old people's homes (16-24%) and home-helps (8-16%), during the 3-year follow-up. Disability pension or sickness benefit accounted for only 5-11%, auxiliary equipment for 1-6%, medication for 1-3% and out-patient care at the medical department for 1%.(ABSTRACT TRUNCATED AT 250 WORDS)