Ischemic Stroke Survivors Research Articles

Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery.

This cross-sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7years post-stroke in order to analyze the relation between late cognitive ability and employment. Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score ≤2 on the National Institutes of Health Stroke Scale at long-term follow-up 7years post-stroke were included. At this follow-up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self-reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function. Seven years post-stroke 112/142 (79%) had part-time or full-time work and 30/142 (21%) had full-time disability pension or sick leave. Compared to those with full-time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self-ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self-rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61-4.21), processing speed (OR 3.50, 95% CI 1.67-7.33) and self-rated communication skills (OR 3.46, 95% CI 1.75-6.85) as most important correlates (area under the curve 0.83-0.87) of having current employment. This study indicates that cognitive dysfunction is an important contributor to long-term work disability amongst young stroke survivors with good physical recovery.

Physiotherapy Outcomes on Sexual Dysfunction among Ischemic and Hemorrhagic Stroke Survivors

Background and Purpose: Stroke is a major cause of disability and premature death in various developing countries, including India. Although various physical and psychological dysfunctions are associated with stroke, sexual dysfunction that is not often addressed either by the patient or by the health care provider can greatly influence the quality of living among stroke survivors. Aim: The study is aimed at comparing the physiotherapy outcomes of sexual rehabilitation on sexual dysfunction among ischemic and hemorrhagic post-stroke survivors. Materials and Methods: A total of 109 stroke patients, Ischemic (n=76) and Hemorrhagic (n=29) were selected for this research. A written consent was taken after inclusion criteria is satisfied. Both groups were given structured physiotherapy daily for a one-hour session along with psychological support by verbal communication. The sexual functioning is calculated by CSFQ-14 before intervention and after six months of follow-up. Results: After sexual rehabilitation, both groups showed statistically significant improvement in sexual functioning (CSFQ-14 scores), pIS LESS THAN 0.001. But there was no significant difference between ischemic and hemorrhagic post-stroke survivors in sexual functioning statistically. Conclusion: Both ischemic and hemorrhagic post-stroke survivors showed similar results on sexual functioning after physiotherapy. Hence, both ischemic and hemorrhagic post-stroke survivors can be included in a sexual rehabilitation program.

Racial differences in persistence to secondary prevention medication regimens after ischemic stroke

ABSTRACT Background: Prior stroke is one of the biggest risk factors for future stroke events. Effective secondary prevention medication regimens can dramatically reduce recurrent stroke risk. Guidelines recommend the use of antithrombotic, antihypertensive and lipid-lowering medications after stroke. Medication adherence is known to be better in the presence of a caregiver but long-term adherence after stroke is unknown and disparities may persist. Methods: We examined the effects of race and sex on baseline prescription and maintenance of secondary prevention regimens in the presence of a caregiver using the Caring for Adults Recovering from the Effects of Stroke (CARES) study, an ancillary study of the national REasons for Geographic and Racial Differences in Stroke (REGARDS). Results: Incident ischemic stroke survivors (N = 172; 36% Black) with family caregivers had medications recorded at hospital discharge and on average 9.8 months later during a home visit. At discharge, antithrombotic prescription (95.9%), lipid-lowering medications (78.8%) and antihypertensives (89.9%) were common and there were no race or sex differences in discharge prescription rates. One year later, medication persistence had fallen to 86.6% for antithrombotics (p = 0.002) and 69.8% for lipid lowering (p = 0.008) but increased to 93.0% for antihypertensives (p = 0.30). Blacks were more likely to have discontinued antithrombotics than Whites (18.3% v 7.7%, p = 0.04). No significant differences in persistence were seen with age, sex, income, depression, or cognitive impairment. Conclusions: Medication persistence was high in this sample, likely due to the presence of a caregiver. In our cohort, despite similar prescription rates at the time of hospital discharge, Black stroke survivors were more than twice as likely to stop antithrombotics than Whites. The effect of changes in patterns of medication usage on health outcomes in Black stroke survivors warrants continued investigation.

Association between physical exercise and stroke recurrence among first-ever ischemic stroke survivors

The relationship between exercise and stroke recurrence is controversial. This study was designed to test whether an association exists between exercise and ischemic stroke recurrence in first-ever ischemic stroke survivors. Data were collected from January 2010 to June 2016. Baseline information was obtained during face-to-face interviews, and follow-up phone interviews were conducted every 3 months. Exercise type, frequency, intensity, and duration were recorded. Discrete-time survival analysis was used to determine the relationship between exercise and stroke recurrence. 760 first-ever ischemic stroke survivors who were able to exercise were enrolled. After adjusting for covariates, patients who exercised 3.5–7 h per week and more than 7 h per week had a lower relapse risk than patients who did not exercise (3.5–7: OR 0.415; > 7: OR 0.356). Moreover, if the fluctuation of exercise duration was over 4 h, the patients had a higher risk of stroke recurrence than those with variability of less than 2 h (OR 2.153, P = 0.013). Stroke survivors who engage in long-term regular mild exercise (more than 5 sessions per week and lasting on average 40 min per session) have a lower recurrence rate. Irregular exercise increases the risk of stroke recurrence.

Risk of Fractures in Stroke Patients Treated With a Selective Serotonin Reuptake Inhibitor: A Systematic Review and Meta-Analysis.

Stroke survivors have an increased risk of depression and bone fractures. Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of fractures in observational studies. Several randomized controlled trials (RCTs) reporting the effect of SSRIs on the risk of fractures in stroke survivors have been published recently but have not been subject to a meta-analysis. We aimed to determine the risk of fractures associated with the use of SSRIs, and the risk of falls, seizures, and recurrent strokes as possible mediators of fractures, in stroke survivors. We conducted a systematic review and meta-analysis of RCTs of SSRIs in stroke survivors according to a protocol registered in PROSPERO (CRD42020192632). Web of Science, EMBASE, PsycINFO, and Ovid Medline/PubMed bibliographic databases, clinical trial registers, and grey literature sources were searched. RCTs of SSRIs versus placebo or no intervention that report the risk of fractures in adult survivors of hemorrhagic or ischemic stroke were included. Two reviewers independently screened search results and extracted data. Meta-analyses were conducted for each outcome using the Mantel-Haenszel random-effects models. The searches yielded 683 records, of which 4 RCTs of 6 months duration with a total of 6549 participants were included in the meta-analysis: 3 studies of fluoxetine and 1 study of citalopram. Treatment with an SSRI for 6 months increased the risk of fractures with a risk ratio of 2.36 (95% CI, 1.64–3.39) compared with placebo. The risk of falls, seizures, and recurrent stroke was not statistically significantly increased. Only studies of fluoxetine and citalopram were available for inclusion in the review, and hence the generalizability of the findings to other SSRIs is uncertain. Based on available RCTs of fluoxetine and citalopram, SSRIs used for 6 months doubled the risk of fractures in stroke survivors. https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020192632.

A Potential New Treatment to Assist Stroke Recovery

In survivors of ischemic stroke, about 60% are reported to have some level of upper-extremity (UE) weakness 6 months poststroke. Conventional physical

Health-related quality of life after first-ever acute ischemic stroke: associations with cardiovascular health metrics.

To investigate the associations between cardiovascular health (CVH) metrics and health-related quality of life (HRQL) among patients with ischemic stroke in China, and further explore the role of physical and cognitive function in their associations. This hospital-based study included 1714 patients with first-ever acute ischemic stroke (age ≥ 40years; 36.7% women) who were admitted to two university hospitals in Shandong, China. We collected information on seven CVH metrics (smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting blood glucose) through interviews, clinical examinations, and laboratory tests. EQ-5D-3L was used to assess HRQL. Cognitive and physical functioning was assessed by the Montreal Cognitive Assessment test and Barthel index, respectively. Data were analyzed using the general linear regression models. The average score (SD) was 0.746 (0.23) for HRQL index and 72.7 (15.8) for self-rated health. Optimal levels of four individual CVH metric components (diet, physical activity, blood pressure, and blood glucose) and a higher composite CVH score were significantly associated with a greater HRQL index and better self-rated health (p < 0.05 for all). Physical dependence and cognitive impairment were associated with a lower HRQL index and poorer self-rated health status (p < 0.001). Furthermore, the relationships between CVH metrics and HRQL index varied by functional status, such that their associations were statistically significant only among people who had physical dependence or cognitive impairment. Achieving a better cardiovascular health profile is associated with better quality of life among ischemic stroke survivors, primarily in those with physical or cognitive impairment.

Hospital readmission rates among acute ischemic stroke survivors with severe mental illness (83)

Hospital readmission rates among acute ischemic stroke survivors with severe mental illness (83)

Risk of a coronary event in patients after ischemic stroke or transient ischemic attack.

Coronary artery disease (CAD) together with stroke are the leading causes of death worldwide, and together, they pre-sent a health and economic burden. Ischemic stroke survivors and patients who suffered transient ischemic attack (TIA) have a higher prevalence of coronary atherosclerosis, and they have a relatively high risk of myocardial infarcti-on and nonstroke vascular death. Pubmed was searched for studies focused on investigating coronary atherosclerosis in ischemic stroke survivors or patients who suffered TIA and their cardiovascular risk assessment. There were corona-ry plaques in 48%-70% of stroke survivors without a known history of CAD, and significant stenosis of at least one coronary artery can be found in 31% of these patients. CAD is a major cause of morbidity and mortality in stroke survivors. Detection and treatment of silent CAD may improve the long-term outcome and survival of these patients.

Abstract P718: The Relationship Between Abdominal Obesity and Quality of Life and Recurrence After First-Ever Ischaemic Stroke: A Hospital-Based Prospective Study

Background and Objective: Both quality of life (Qol) and stroke recurrence are prognostic indicators for stroke survivor in different aspects. Studies have analyzed Qol and survival outcomes at the same time were sparse. And the comprehensive impact of abdominal obesity on Qol and recurrence remains unclear. The purpose of this study was to explore the comprehensive effect of abdominal obesity on the Qol and recurrence among ischaemic stroke survivors in China. Methods: Baseline information was collected with face-to-face interviews, Qol and obesity status for each patient were obtained through every 3 months via telephone follow-up, from 2010 to 2018. Qol was evaluated with the 12-item Short-Form Health Survey (SF-12), consists of physical component summary scores (PCS) and mental component summary scores (MCS). WC (waist circumference) were 2 categories (normal WC and abdominal obesity), according to Chinese-specific criteria. After establishing the linear mixed effect model and spline-PH model by R software, joint model model was used to explore the comprehensive effect of abdominal obesity on the Qol and recurrence. Results: According to the inclusion and exclusion criteria, 894 subjects were included in the study. At baseline, subjects were aged 17 to 89 years, and 487(54.47%) were abdominal obesity. During the study period, 195 (21.81%) patients recurred. Controlling for comorbidity and socio-demographic characteristics, abdominal obesity have similar effect on Qol and recurrence (overall effect: 0.162; HR: 1.176; 95%CI: 0.877~1.579). Similar results were obtained, when analysis of both PCS and recurrence (overall effect: 0.141; HR: 1.151, 95%CI: 0.857~1.547). As for the comprehensive effect on MCS and recurrence, abdominal obesity got higher risk than normal WC (overall effect: 1.280; HR: 3.597, 95%CI: 1.555~8.317). Conclusion: abdominal obesity increased comprehensive risk of MCS and recurrence, and abdominal obesity may have greater impact on the MCS of stroke survivors than PCS.

Abstract P252: Discharge Antithrombotic Therapy for Ischemic Stroke Patients With Prior Aspirin Failure

Introduction: Aspirin is one of the most commonly used medications for cardiovascular disease and stroke prevention. Many older patients who present with a first or recurrent stroke are already on aspirin monotherapy, yet little evidence is available to guide antithrombotic strategies for these patients. Method: Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we described discharge antithrombotic treatment pattern among Medicare beneficiaries without atrial fibrillation who were discharged alive for acute ischemic stroke from 1734 hospitals in the United States between October 2012 and December 2017. Results: Of 261,634 ischemic stroke survivors, 100,016 (38.2%) were on prior aspirin monotherapy (median age 78 years; 53% women; 79.4% initial stroke and 20.6% recurrent stroke). The most common discharge antithrombotics (Figure) were 81 mg aspirin monotherapy (20.9%), 325 mg aspirin monotherapy (18.2%), clopidogrel monotherapy (17.8%), and dual antiplatelet therapy (DAPT) of 81 mg aspirin and clopidogrel (17.1%). Combined, aspirin monotherapy, clopidogrel monotherapy, and DAPT accounted for 86.8% of discharge antithrombotics. The rest of 13.2% were discharged on either aspirin/dipyridamole, warfarin or non-vitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotics at all. Among patients with documented stroke etiology (TOAST criteria), 81 mg aspirin monotherapy (21.2-24.0%) was the most commonly prescribed antithrombotic for secondary stroke prevention. The only exception was those with large-artery atherosclerosis, in which, 25.3% received DAPT of 81 mg aspirin and clopidogrel at discharge. Conclusion: Substantial variations exist in discharge antithrombotic therapy for secondary stroke prevention in ischemic stroke with prior aspirin failure. Future research is needed to identify best management strategies to care for this complex but common clinical scenario.

Abstract P660: Statin Therapy is Associated With Lower Mortality One Year After Ischemic Stroke: A National Data Linkage Study

Introduction: Statins significantly reduce the risk of fatal and non-fatal cardiovascular events in patients with atherosclerotic cardiovascular disease and other high-risk conditions. Current guidelines strongly recommend the use of statins in all eligible patients after an ischaemic stroke, but some patient groups (e.g. elderly, female) still miss out, suggesting more evidence of benefit is still needed. Aim: To investigate the effect of statins on one-year mortality outcomes in ischaemic stroke survivors. Methods: This retrospective study linked routinely collected health data from the Scottish Stroke Care Audit (SSCA), the Prescribing Information System (PIS) and the Scottish Morbidity Record (SMR) 01 and mortality data from the National Records of Scotland (NRS). The study population included patients from January 2010 to December 2015 who survived an ischaemic stroke. Statin therapy was defined as at least one statin prescription within six months of the stroke event (yes/no) and data modelled to analyse the effect on mortality outcomes up to one year. Data were analysed using Cox proportional hazards in SPSS version 25. Results: The study population included 24 499 patients discharged from hospital to their usual place of residence within thirty days after an incident ischaemic stroke and who survived to six months. Statins were prescribed to 21 356 (87.2%) within the first six months in the community setting. Patients on a statin were more likely to be younger [median age 71.2 (IQR 61.1 to 79.5) versus 73.2 (IQR 55.5 to 83.2) years] and male (53.7% versus 46.3%) but had similar Charlson Comorbidity Index scores compared with patients not prescribed a statin. Post stroke statin therapy significantly reduced the risk of death [HR 0.49 (95% confidence interval 0.41 to 0.59)] when adjusted for age, sex, prior statin therapy and baseline stroke severity. Separate analysis also revealed similar benefits regardless of age and sex. Conclusion: Post-stroke statin therapy was associated with a reduced risk of death within one year even accounting for age, sex or comorbidities. This reinforces the benefit of current guideline implementation.

Burden of Depression Among Survivors of Ischemic Stroke of Southern Punjab

Background; Depression is one of the most frequent neuropsychiatric disturbances after ischemic stroke. The frequency of depression in stroke patients has varied widely in different populations. Post stroke depression is an important factor limiting recovery and rehabilitation in acute stroke patients. This study was done to ascertain frequency of depression among patients with ischemic stroke in our local population. Objective; To assess the frequency of depression in patients with ischemic stroke in Pakistan. Material and Methods; Consecutive 150 patients fulfilling inclusion criteria was enrolled and this descriptive study was conducted at department of Psychiatry and Neurology OPD, Nishtar Hospital, Multan using non – probability convenient sampling technique. All patients were assessed by single psychiatrist on PHQ-9 scale, for Depression. Results; Of these 150 study cases, 94 (62.7 %) were male patients while 56 (37.3 %) were female patients. Mean age of our study cases was 54.69 ± 7.18 years (with minimum age of our study cases was 44 years while maximum age was 71 years). Of these 150 study cases, 71 (47.3 %) belonged to rural areas and 79 (52.7 %) belonged to urban areas. Monthly family income up to Rs. 50000 was noted in 89 (59.3%) while more than Rs. 50000 was noted in 61 (40.7%). Of these 150 study cases, 83 (55.3%) were illiterate and 67 (44.7%) were literate. Of these 150 study cases, site of lesion in basal ganglia was 61 (40.7%), subcortical in 56 (37.3%) and cortical in 33 (22.0%) and Depression was noted in 77 (51.3%). Conclusion; Very high frequency of depression was observed in our study among patients having ischemic stroke. Depression was significantly associated with gender, occupation, educational level, prolonged duration of illness and site of lesion. Clinicians treating stroke patients should anticipate depressive symptoms and diagnose them to treat them in early stages. Keywords; Ischemic stroke, depression, frequency. DOI: 10.7176/JMPB/69-01 Publication date: March 31 st 2021

Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors

Background and purposeDepression is common after stroke and is often treated with antidepressant medications (AD). ADs have also been hypothesised to improve stroke recovery, although recent randomised trials were neutral....

Ассоциация полиморфных вариантов гена каталитической субъединицы глутаматцистеинлигазы с клиническими характеристиками ишемического инсульта

An imbalance between the production of reactive oxygen species and their neutralization lies at the core of oxidative stress implicated in ischemic stroke (IS) and the subsequent brain tissue damage. The aim of this study was to investigate the effects of common polymorphic variants of the glutamate cysteine ligase catalytic subunit gene on the extent of brain damage and clinical manifestations in patients with ischemic stroke. A total of 589 ischemic stroke survivors were genotyped for 6 single nucleotide polymorphisms (SNPs) of the GCLC gene, including rs12524494, rs17883901, rs606548, rs636933, rs648595 and rs761142, using a MassARRAY-4 analyzer. The study found that genotypes rs636933-G/A-A/A (р = 0.009) and rs761142-A/C-C/C (р = 0.015) were associated with an enlargement of the cerebral lesion size. Genotypes rs12524494-G/G (р = 0.05) and rs606548-T/T (р = 0.003) were associated with a risk of 2 or more IS episodes. Genotype rs17883901-G/A was associated with early onset of IS (р = 0.004). The study revealed multiple associations of GCLC SNPs with the clinical manifestations of ischemic stroke. Thus, GCLC polymorphisms are important DNA markers affecting the size of the cerebral lesion in patients with ischemic stroke and are associated with age at onset, the number of past strokes and the clinical manifestations of the disease.

RELATIONSHIP BETWEEN LEVEL OF EDUCATION AND POST-STROKE COGNITIVE STATUS IN HOSPITAL-BASED ISCHEMIC STROKE SURVIVORS

Background: Post-ischemic stroke cognitive decline is significantly affecting the quality of life of its survivors. Its prevalence was about 7.5-72% which was mostly determined by the existing of vascular risk factors and cognitive reserve of the subjects. Level of education is one of determinants of cognitive reserve, a factor that affect the susceptibility of subjects to cognitive decline after experiencing ischemic stroke-related neuronal damage. Since level of education is protective for cognitive function, the intervention on it can reduce the occurrence of cognitive decline. Objective: To investigate the relationship between level of education and cognitive status among hospital-based ischemic stroke survivors. Methods: This cross-sectional study involved post-ischemic stroke outpatients in two hospitals. The data collected in this study were demographic data, including level of education, and clinical data as well. The level of education was categorized into ≥12 years and &lt;12 years groups. Cognitive status was assessed using Montreal Cognitive Assessment in Indonesia version (MoCA-Ina) and subjects with score of 26-30 were normal. The relationship between level of education as well as clinical data and cognitive status were analyzed using chi-square test. Results: There were 166 subjects eligible for this study (n=166). The mean age of subjects was 58 years and 68.67% of them were male. Cognitive decline were found 80.12% of subjects (n=133). The level of education was significantly associated with cognitive status of the subjects and hypertension as well. Conclusion: The level of education had significant relationship with cognitive decline in the hospital-based population of ischemic stroke survivors.

A Pilot One Group Feasibility, Acceptability, and Initial Efficacy Trial of LISTEN for Loneliness in Lonely Stroke Survivors.

IntroductionLoneliness is a prevalent problem for adult stroke survivors, and a known contributor to hypertension, secondary stroke, functional decline, poorer quality of life, and mortality in older adults. LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a theoretically based behavioral health intervention designed to target loneliness, in a sample of lonely survivors of ischemic stroke. Objectives: To assess the feasibility and acceptability of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes) in lonely stroke survivors and to evaluate the initial efficacy of LISTEN for loneliness, depressive symptoms, neurological quality of life, and blood pressure in a sample of lonely survivors of ischemic stroke. Methods: The study design was framed using the psychoneuroimmunology paradigm and employed a prospective non-randomized one group design. Six adult stroke survivors were recruited from a Neurology outpatient clinic. Once consented and enrolled, participants attended 5 sequential weekly group sessions of LISTEN. Evaluations, field notes, and video recordings of each session were used to assess feasibility and acceptability of LISTEN. Quantitative data was collected at enrollment and at 1, 6, and 12 weeks post last LISTEN session to assess initial efficacy on loneliness (revised UCLA loneliness scale), depressive symptoms (PHQ-9), neurological quality of life (NeuroQoL), and blood pressure. SPSS was used for descriptive and comparative data analysis to examine within subject changes. Results: LISTEN was feasible to deliver in the selected clinical setting and participants rated LISTEN as highly useful, organized, and clear with an overall rating as excellent for loneliness. Participants reported significant decline in loneliness and improved scores on three subscales of the NeuroQoL; executive function, positive affect and well-being, and satisfaction with social roles. Recruiting stroke survivors for the trial was time intensive for the study team. Conclusions: Larger randomized trials of LISTEN in stroke survivors are needed to build evidence for the longer term effectiveness of LISTEN on loneliness, depressive symptoms, and quality of life. Future study designs will include planning to diminish barriers to recruitment.

Prevalence, predictors, and prognoses of prestroke neuropsychiatric symptoms at 3 months poststroke.

Prior neuropsychiatric disturbances are risk factors for stroke. There is a knowledge gap on the predictors of prestroke psychopathology, as well as their association with stroke outcomes in survivors living in low- and middle-income countries (LMICs). We estimated prevalence, predictors, and association of prestroke neuropsychiatric symptoms with poststroke depression (PSD), disability, and mortality. Prospective observation. Nigeria. Adult ischemic and hemorrhagic stroke survivors. Prestroke psychopathology were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Outcomes were assessed using validated tools, including the Centre for Epidemiologic Studies - Depression Scale (CES-D 10) and modified Rankin scale (mRS). Independent associations were investigated using regression models with Bonferroni corrections, and presented as standardized mean differences (SMD) and odds ratios (OR) within 95% confidence intervals (CI). Among 150 participants, prestroke neuropsychiatric symptoms were found in 78 (52%). In multivariate logistic regression analyses, prestroke sleep disturbance was associated with systemic hypertension (OR = 5.39, 95% CI = 1.70-17.08). Prestroke neuropsychiatric symptoms independently predicted worse motor disability scores (SMD = 0.92, 95% CI = 0.21-1.62) and greater odds of poststroke mortality (OR = 2.7, 95% CI = 1.1-7.0) at 3 months. However, prestroke depression was not significantly associated with PSD. Prestroke sleep disturbances was associated with systemic hypertension, a key index of high cardiovascular risk profile and stroke. The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with sleep symptoms who have multiple, additional, risks of stroke.

The Effect of “SELF-HELP Packages” on Post Stroke Depression among Ischemic Stroke Survivors

Background: There are several factors that contribute to Post Stroke Depression (PSD). Since a single intervention is proven ineffective to deal with PSD, an intervention which includes biological, psychological, social, and spiritual aspects (“SELF-HELP Packages”), therefore, needs to be established.Purpose: The purpose of the study was to investigate the effect of “SELF HELP Packages” intervention on PSD among ischemic stroke survivors after three months from onset and its effect after confounding variables were controlled.Methods: This study was a pre and post quasi-experiment with a control group involving 34 ischemic stroke survivors each group. The inclusion criteria were survivors after three months from ischemic stroke, no aphasia, having a good hearing, and having Mini Mental Status Examination (MMSE) score of ≥ 22. GRID-HAMD 17, Multidimensional Scale of Perceived Social Support (MSPSS), and Barthel-Index were used to measure PSD, social support, and functional status respectively. “SELF-HELP Packages” intervention was delivered in three sessions, namely information delivery, discussion and activity. Statistical analyses were conducted using McNemar test, Chi-square and logistic regression.Results: The result showed that “SELF-HELP Packages” considerably decreased PSD in the intervention group (p=0.004). There were also significant differences in PSD after the intervention between two groups (p=0.008). Logistic regression showed that ‘SELF-HELP Package” had no effect on PSD when other confounding variables were controlled (p=0.075, OR=0.288, 95% CI 0.073 – 1.135).Conclusion: SELF-HELP Packages” should be applied in providing the nursing intervention among stroke ischemic survivors in clinical setting. A longer period of time for the intervention is also recommended for the next study in order to obtain a more robust result.

Atrial Cardiopathy Features Differ for Black and White Ischemic Stroke Survivors

Atrial Cardiopathy Features Differ for Black and White Ischemic Stroke Survivors