Stroke Patients In Korea Research Articles

Epidemiology and Functional Outcome of Acute Stroke Patients in Korea using Nationwide data.

Korea's healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. 86,568 acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016 to 2021, focusing on acute subarachnoid hemorrhage, acute intracerebral hemorrhage, and acute ischemic stroke. Of these 86,568 patients, 8.3% was subarachnoid hemorrhage, 16.3% intracerebral hemorrhage, and 74.9% ischemic stroke. Trends showed decreasing subarachnoid hemorrhage and increasing intracerebral hemorrhage cases over the years. 68.3% stroke patients had the clear onset time. 49.6 % stroke patients arrived within 4.5 hours of symptom onset, with more treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of subarachnoid hemorrhage patients, 34.6% of intracerebral hemorrhage patients, and 63.8% of ischemic stroke patients. The results showed that ischemic stroke was the most common subtype, followed by intracerebral hemorrhage and subarachnoid hemorrhage. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and subarachnoid hemorrhage compared to intracerebral hemorrhage.

Dynamic changes and lifetime effect of functional disability profiles for stroke patients: real-world evidence from South Korea.

This work aimed to investigate the long-term dynamic changes of functional disabilities and estimate lifetime outcomes of different functional disabilities after a stroke, using real-world data from a nationally representative South Korean cohort. Patients aged 18 and above with ischemic and hemorrhagic strokes were identified from the Korea Health Panel (KHP) data (2008-2018). Functional disabilities were repeatedly measured for patients aged 55 and over for the prevalence of disabilities associated with activities of daily living (ADL), and kernel smoothing means were estimated for each item. The lifetime survival function of stroke patients in Korea was adopted from another study utilizing the National Health Insurance Service of Korea's national sample cohort. By multiplying the disability-free proportion with the survival function throughout life, disability-free life expectancy (DFLE) for each ADL item was estimated. The loss-of-DFLE was calculated by subtracting the DFLE from age-, sex-, and calendar year-matched referents simulated from Korean life tables. The KHP dataset included 466 stroke patients. The overall functional disability needs increased over time after stroke diagnosis. DFLE was lowest for bathing (10.1 years for ischemic stroke and 12.8 years for hemorrhagic stroke), followed by those for dressing and washing. Loss-of-DFLE was highest for bathing for ischemic and hemorrhagic strokes (7.2 and 10.7 years, respectively), indicating that this task required the most assistance for stroke patients compared with the other tasks. DFLEs were slightly lower than the quality-adjusted life expectancy of stroke patients. Our findings provide valuable insights for resource allocation and policy decisions in long-term stroke care, potentially enhancing the quality of life for stroke survivors and caregivers.

Fabry disease screening in young patients with acute ischemic stroke in Korea

Background: Fabry disease is an X-linked lysosomal storage disorder that results from a mutation in the α-galactosidase A (GLA) gene. It shows multiple organ involvement, including cerebrovascular disease. Since Fabry disease has a prevalence of approximately 4% in young patients with cryptogenic stroke, screening for this condition is recommended for young stroke patients. This study aimed to investigate the prevalence of Fabry disease in young acute ischemic stroke patients in Korea, the distribution of GLA gene mutations, and the subtypes of ischemic stroke. Methods: This study included 211 young patients with acute ischemic stroke or transient ischemic attack. To screen for Fabry disease, α-galactosidase A (α-Gal A) enzyme activity was measured and DNA sequencing analysis of the GLA gene was performed. Results: None of the patients exhibited low α-Gal A enzyme activity or had a pathogenic GLA mutation, but 18 nonpathogenic GLA gene variants were detected, including c.-10C>T in 16 patients, c.-33C>T in one patient, and c.196G>C in one patient. The mean α-Gal A enzyme activity in 14 male patients with the c.-10C>T variant was 5.17±1.19, which was significantly lower than that of male patients with the normal genotype (7.47±3.48, P<0.05). The distribution of stroke subtypes in patients with GLA gene polymorphisms was not significantly different from that in patients with a normal genotype.Conclusions: This study demonstrates that Fabry disease is rare in young patients with ischemic stroke or transient ischemic attack in Korea, and we suggest that routine screening for Fabry disease may not be necessary for ischemic stroke patients.

Clinical Practice Guideline for Stroke Rehabilitation in Korea-Part 1: Rehabilitation for Motor Function (2022).

This clinical practice guideline (CPG) is the fourth edition of the Korean guideline for stroke rehabilitation, which was last updated in 2016. The development approach has been changed from a consensus-based approach to an evidence-based approach using the Grading of Recommendations Assessment Development and Evaluation (GRADE) method. This change ensures that the guidelines are based on the latest and strongest evidence available. The aim is to provide the most accurate and effective guidance to stroke rehabilitation teams, and to improve the outcomes for stroke patients in Korea. Fifty-five specialists in stroke rehabilitation and one CPG development methodology expert participated in this development. The scope of the previous clinical guidelines was very extensive, making it difficult to revise at once. Therefore, it was decided that the scope of this revised CPG would be limited to Part 1: Rehabilitation for Motor Function. The key questions were selected by considering the preferences of the target population and referring to foreign guidelines for stroke rehabilitation, and the recommendations were completed through systematic literature review and the GRADE method. The draft recommendations, which were agreed upon through an official consensus process, were refined after evaluation by a public hearing and external expert evaluation.

국내 다기관 전향적 코호트 연구를 통한 우리나라 뇌졸중 환자의 발병 5년 생존율과 재발률

Seyoung Shin, Won Hyuk Chang, Deog Young Kim, Jongmin Lee, Min Kyun Sohn, Min-Keun Song, Yong-Il Shin, Yang-Soo Lee, Min Cheol Joo, So Young Lee, Jeonghoon Ahn, Gyung-Jae Oh, Young Hoon Lee, Junhee Han, Yun-Hee Kim. Public Health Weekly Report 2022;15:2719-33. https://doi.org/10.56786/PHWR.2022.15.43.2719

A Retrospective Study on the Status of Risk Factor Management in Patients with Ischemic Stroke Based on a Large Linked Dataset of Stroke Patients in Korea.

A Retrospective Study on the Status of Risk Factor Management in Patients with Ischemic Stroke Based on a Large Linked Dataset of Stroke Patients in Korea.

Korean Model for Post-acute Comprehensive rehabilitation (KOMPACT): The Study Protocol for a Pragmatic Multicenter Randomized Controlled Study on Early Supported Discharge

Introduction: Early supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients' discharge to home. Previous studies have demonstrated that ESD provides equivalent patient and caregiver outcomes with superior cost-effectiveness compared to conventional rehabilitation (CR). This study intends to examine the feasibility of ESD in Korea.Methods and Analysis: This study is designed as a multicenter assessor-blinded, randomized controlled trial. Ninety post-acute stroke patients with mild to moderate disability (modified Rankin Scale 1–3) will be recruited from three university hospitals (30 patients per hospital) in Korea and allocated to either the ESD group or the CR group in a 1:1 ratio. Patients in the ESD group will receive individualized discharge planning and goal setting, a 4-week home-based rehabilitation program, and liaison service to community-based resources by a multidisciplinary team. Patients in the CR group will receive rehabilitation practices according to their current hospital policy.Outcomes: The primary outcome is the Korean version of the modified Barthel Index, and the primary endpoint was post-onset 3 months. Clinical outcomes, patient/caregiver reported outcomes, and socioeconomic outcomes will be measured at baseline, 1 month after discharge, 2 months after discharge, and 3 months after onset.Discussion: The efficacy and cost-effectiveness of ESD can vary according to the healthcare system and sociocultural aspects. To establish ESD as an alternative transitional care model for post-acute stroke patients in Korea, its feasibility needs to be examined in prior. This study will add evidence on the applicability of ESD in Korea.Ethical Considerations: The study protocol was reviewed and approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB number B-2012/654-308). The study protocol was registered at ClinicalTrials.gov (Identifier NCT04720820). Disseminations will include submission to peer-reviewed journals and presentations at conferences.

Healthcare quality assessments: no guarantees of same outcomes for different socio-economic stroke patients.

Healthcare quality assessment is being conducted in many countries. Although improving health equity is one of the major objectives of medical quality assessment, it is not clear whether different socio-economic statuses show the same health outcomes even in the same medical quality hospitals. No study has directly compared the health outcomes of different socio-economic statuses in the same hospitals nationwide. To determine whether the mortality rate of acute stroke patients differs according to socioeconomic status. This study was a retrospective, observational study of patients who were subject to acute stroke quality assessment in 2013. A total of 10 399 stroke cases were included in the study. When evaluating the mortality rate, the researchers analysed 10 228 cases, after excluding 171 cases that were measured twice for the same person. The levels of socio-economic status were divided according to the use of medical benefits, either National Health Insurance (NHI) for general population or Medical Aid (MA) for the vulnerable. The primary outcomes measured according to socio-economic status were in-hospital mortality rate and 1-year follow-up mortality rate of stroke patients. The secondary outcome was the composite performance score. MA recipients had a higher in-hospital mortality rate (12.5 vs. 8.3%, P < 0.001) and 1-year follow-up mortality rate (14.9 vs. 10.8%, P < 0.001) than NHI subscribers. MA recipients had slightly lower scores than NHI subscribers (83.2 vs. 84.4, P = 0.02). In hospitals of the same grade, MA recipients had lower performance scores than NHI subscribers, although the difference was not statistically significant. There is a difference in mortality and healthcare performance according to socio-economic status in stroke patients in Korea. Efforts to improve equity are needed, including the development and monitoring of equality indicators and developing policies for healthcare equity.

Development of a categorical naming test in Korean: Standardization and clinical application for patients with stroke

PurposeThe purpose of this study was to develop and standardize a new categorical naming test, titled the Categorical Naming Test (CNT), for stroke patients, and to investigate its validity and clinical usefulness for patients with stroke.Materials and methodsThe CNT was developed based on semantic category, imageability, and psycholinguistic factors such as word frequency and word length. The test materials included two main semantic categories (living objects and artificial objects) comprising 60 items. We standardized the CNT on 221 healthy adults and administered the CNT to 112 stroke patients.ResultsInternal consistency and concurrent validity of the test were high. The mean total CNT scores varied significantly according to participants’ age, sex, and education. Among healthy controls, the scores for naming living objects were significantly higher than those for artificial objects. The analysis of stroke patients showed that the total CNT score revealed a statistically significant difference based on the patients’ lesion laterality and presence of aphasia, after controlling for age, sex, and education. However, the categorical scores achieved by comparing the naming scores for living and artificial objects showed no significant differences according to lesion laterality, stroke type, and presence of aphasia.ConclusionThe CNT is a newly developed version of an overt naming task with high internal consistency validity for stroke patients in Korea. The newly developed CNT can prove useful in evaluating naming ability in stroke patients.

Development of a Short Version of ICF Core Set for Stroke Adapted for Rehabilitation in Korea: a Preliminary Study.

This study aimed to develop a short version of the International Classification of Functioning, Disability, and Health (ICF) core set and verify functioning levels of patients for stroke rehabilitation in Korea. Using the Delphi technique, a 3-round consensus process was conducted. Thirty multidisciplinary rehabilitation experts from different hospitals completed the consensus study. The questionnaire for this study adopted the comprehensive ICF core set for stroke developed by the Geyh group. A 7-point Likert-type scale was used by participants to weigh the impact of each category on activities of daily living or rehabilitation after a stroke. The consensus of ratings was assessed with Spearman's rho and inter-quartile range indices. A core set to assess functioning levels of patients with stroke was developed from those categories. A short version of ICF core set to assess and verify functioning levels of patients with stroke was developed for 12 categories, including 3 categories (consciousness, muscle power, and attention) from body functions, 1 (structure of brain) from body structures, 5 (eating, walking, moving around, changing basic body position, and carrying out daily routine) from activities and participation, and 3 (individual attitudes of immediate family members, immediate family, and personal care providers/personal assistants) from environmental factors. This preliminary study developed a Delphi consensus process, gathering statistical evidence and expert commands based on the short version of ICF core set for rehabilitation of stroke patients in Korea.

Systematic Review and Meta-Analysis of Effectiveness of Transcranial Direct-Current Stimulation (tDCS ) on Cognitive Function for Stroke Patients

Abstract Date Presented 03/27/20 In this study, we will systematically analyze tDCS-based cognitive rehabilitation studies applied to stroke patients in Korea and foreign countries abroad and calculate their effect sizes through meta-analysis. Through this study, tDCS was found to be effective for attention and memory. We have found that the application methods of tDCS differ, suggesting that we need to pay attention to research of formalized tDCS protocols and to foster experts. Primary Author and Speaker: Min Ah Yang Contributing Authors: Kyung-A Won, Hye-Yeon Park, Ji-Hyuk Park

Psychometric Properties of the Korean Dispositional Hope Scale Using the Rasch Analysis in Stroke Patients.

Background It is reported that hopeful thinking plays a positive role in encouraging patients to achieve functional goals during the rehabilitation process. Hope is a key concept in evaluating stroke outcomes in research and rehabilitation practice. Aims The purpose of this study was to investigate the psychometric properties of the Korean Dispositional Hope Scale (K-DHS) using the Rasch analysis in patients with hemiplegic stroke. Methods The K-DHS was completed by 166 community-dwelling hemiplegic stroke patients in Korea. Data were analyzed according to item fit, item difficulty, and the appropriateness of the rating scale using the Rasch analysis. Results Item fit analysis showed that 8 items of the K-DHS are appropriate because the infit MSNQ was between 0.7 and 1.3. Item difficulty results revealed that there is a difference in distribution between personal attributes and item difficulty. It shows that the item fit statistics of the 4-point Likert scale of K-DHS are all good. The person separation index demonstrated that the K-DHS could differentiate two or three hope status strata in stroke patients. The item separation index indicated that the items were useful with high reliability. Conclusion The K-DHS comprises appropriate items for measuring the hope of stroke patients living in the community, and the rating scale of the K-DHS is also appropriate. This study is the first to conduct an analysis of the rating scale and its appropriateness, as well as the difficulty of items based on item response theory, and offers new insights for enhancing hope and improving well-being following stroke.

Validation of the Korean Version of the Standardized Swallowing Assessment and the National Institute of Health Stroke Scale Among Acute Stroke Patients

Proper management and prevention of dysphagia are urgently needed in acute care of stroke patients in Korea. However, no highly sensitive and accessible nurse-led screening tools have been validated within the Korean settings. The purpose of this study was to validate a screening tool led by nurses to identify dysphagia and aspiration risks among acute stroke patients. Registered nurses (RNs) screened 131 residents from a university hospital in South Korea using the Korean version of the Standardized Swallowing Assessment (KSSA). Results were validated against those from the Gugging Swallowing Screen (GUSS). Compared to results from the GUSS, with 9- and 14-point cutoffs, the K-SSA had a sensitivity of 0.80 and specificity of 0.90 [95% CI 0.806, 0.992] for screening dysphagia and 1.00 sensitivity and 0.94 specificity [95% CI 0.862, 1.000] for screening aspiration risks. The K-SSA demonstrated excellent sensitivity and specificity for screening individuals at risk of dysphagia and aspiration when led by RNs for acute stroke patients.

The Impact of Nurse Staffing on In-Hospital Mortality of Stroke Patients in Korea.

Stroke is one of the leading causes of death in Korea, and a well-qualified, adequate nursing force achieves better patient outcomes. This study examined the association between nurse staffing and in-hospital mortality among stroke patients in a nationally representative sample. This cross-sectional retrospective study was conducted using 2009 National Health Insurance claims data of stroke patients admitted to variously sized Korean hospitals. The data included patient (individual and clinical) and hospital characteristics. Mortality was measured using crude in-hospital mortality rates; nurse staffing was expressed as number of registered nurses per 100 beds. Logistic regression was used to study the association between nurse staffing and patient mortality during hospitalization, after adjusting for related factors. The data of 11 819 stroke inpatients from 615 hospitals were analyzed. Mean patient age was 66.9 ± 13.1 years, 47.5% were women, 77.4% were ischemic patients, and 20.3% underwent surgery. The crude in-hospital mortality rate was 5.5%. Nurse staffing was found to be negatively related to mortality (odds ratio, 0.988; 95% confidence interval, 0.977-0.999), after controlling for major confounders, such as comorbidities, physician-to-bed ratio, and medical costs. Policies to educate sufficient numbers of nurses and retain them in the field are warranted, especially because medical-cost containment has become a dominant concern in most countries. Further studies are needed to understand the mechanisms and other protective roles of nurse staffing to ensure long-term health outcomes after hospital discharge.

The sensitivity and specificity of the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale for hemiplegic stroke patients.

[Purpose] This study attempted to investigate the sensitivity and specificity of the Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC) for community residents with hemiplegic stroke. [Subjects and Methods] The FES and the ABC data were collected for a sample of 99 community-dwelling hemiplegic stroke patients in Korea. The Receiver Operating Characteristic (ROC) curve was used to determine the cut-off values, and the area under the curve (AUC) was used to assess the overall accuracy of each balance test. Multivariate logistic regression analysis was employed to identify the predictors of falling. [Results] The cut-off value was 63.75 in the ABC and 66.50 in the FES. The sensitivity and specificity of the ABC was 41.3% and 92.0%, respectively. The sensitivity and specificity of the FES was 69.8% and 63.9%, respectively. The AUC was 0.691 for the ABC and 0.678 for the FES. The ABC explained 28.0% of the variance in the experience of falls. [Conclusion] The ABC has the ability to determine non-fallers, and it was a good explanatory factor of experience of falls.

Self-Care Performance of Middle-Aged Stroke Patients in Korea.

The incidence rate of middle-aged ischemic stroke patients has been increasing. Because of their high risk of recurrence, it is important for them to adhere to their self-care performance. The purpose of this study was to investigate predictors of self-care performance among middle-aged ischemic stroke patients. A descriptive correlational and cross-sectional survey design was used. About 140 participants who had been diagnosed with ischemic stroke within a year and visited neurological outpatients were investigated. Participants answered self-report questionnaires, the Secondary Stroke Prevention Knowledge Scale, the Health-Related Hardiness Scale, and the Subjective Self-Care Performance Scale. Hardiness, secondary-stroke-prevention knowledge, age, and stroke-diagnosis duration had statistically significant influences on self-care performance; hardiness had the largest effect. This study highlighted hardiness as the major predictor of self-care performance. To improve middle-aged ischemic stroke patients' self-care performance, nurses need an integrated approach that considers a patient's age, diagnosis duration, secondary-stroke-prevention knowledge, and, especially, hardiness.

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

ObjectiveThe objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. MethodsThis paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. ResultsUsers of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p = 0.003), bilateral paralysis (p = 0.040), and loss of balance (p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p = 0.006). ConclusionsThe use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

Role of Intensive Inpatient Rehabilitation for Prevention of Disability after Stroke: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study

• This study provided current status of intensive rehabilitation treatment during subacute stage and functional outcome at chronic stage in the first-ever stroke patients in Korea. • This information will be valuable for establishing comprehensive and systematic care system for stroke patients. Brain Neurorehabil. 2016 Sep;9(2):e4 https://doi.org/10.12786/bn.2016.9.e4 pISSN 1976-8753·eISSN 2383-9910

Assessment of Geographic Variations regarding the Transportation of Stroke Patients in Korea

Introduction Stroke recently became the second cause of death in Korea. Nevertheless, many studies have reported that the delay of emergency medical service (EMS) transportation in specific areas is a major obstacle to reduce the mortality and morbidity of stroke. The objective of this study was to assess geographic variation regarding this factor at the national level in Korea throughout a funnel plot. Setting Emergency departments. Methods Data were obtained from the “2010 Emergency Medicine Annual Report” published by the National Emergency Medical Centre of Korea. This report describes the general characteristics of eligible Emergency Departments (EDs) across Korea. Therefore, we were able to calculate retrospectively the percentage of stroke patients who reached an ED within 3 hours after the development of symptoms against the volume of total visiting patients according to area. Subsequently, we generated a correlation matrix between ratio of stroke patients who visited EDs within the therapeutic period and ratio of usage of EMS ambulances. Results We found that four areas out of 16 administrative divisions in Korea were located beyond the lower control limit and one area was between the lower warning and lower control limits, according to a funnel plot showing the percentage of patients within the therapeutic period of stroke against the total volume of patients according to area. The ratio of stroke patients who visited EDs within the therapeutic period was significantly correlated with the ratio of use of EMS ambulances to a moderately positive degree (r=0.51; p&lt;0.05). Conclusions Encouraging the public in Korea to use an EMS ambulance in case of stroke may shorten the pre-hospital delay.

Abstract NS18: Prevalence and Predictors of Depression among Elderly Stroke Patients in Korea

Background: Depression after stroke not only affects rehabilitation and recovery, but increases caregiver burden. With rapidly increasing aged population, stroke burden substantially increases in Korea, which makes depression after stroke an important concept to assess. Purpose: The purposes of this study were to (1) assess the prevalence of depression and (2) identify predictors of depression among elderly stroke patients in Korea. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. We assessed depression using the Hospital Anxiety and Depression Scale (HADS) and collected demographic data and stroke severity (e.g., hemiparesis, dysphagia, cognitive impairment). Descriptive statistics, chi-square test, and logistic regression analyses were used for data analysis. Results: Of the total participants, 60.5% were men, 76.8% were aged ≥ 61 years, 70% were married, 80.3% lived with family, and 71.7% were depressed (HADS depression scale ≥ 8). Individuals who were women (χ 2 =10.32), lived alone (χ 2 =3.38), had symptoms of dysphagia (χ 2 =6.14), dysphasia (χ 2 =8.14), hemiparesis (χ 2 =5.61), cognitive impairment (χ 2 =4.86), or anxiety (χ 2 =54.53) were more likely to be depressed than those who were men, lived with family, had no symptoms of dysphagia, dysphasia, hemiparesis, cognitive impairment ( p &lt; .05), or anxiety. The likelihood of being depressed was higher in individuals who had anxiety (OR=18.93, 95% CI=[6.88, 52.08]) or lived alone (OR=0.28, 95% CI=[0.06, 0.77]) than individuals who did not have anxiety or lived with family. Conclusions: In conclusion, the study findings suggest that clinicians who handle elderly stroke patients should pay attention to the individuals who have anxiety or live alone as the risk of depression after stroke seems to be higher in these groups. Further research focus should be given to (1) identifying underlying factors of anxiety, (2) developing preventive interventions for depression after stroke, including strategies to decrease anxiety and ensure social support, and (3) exploring the association of depression with other health outcomes, such as quality of life and mortality.