Long-term rehabilitation after stroke: where do we go from here?

2010 ◽  
Vol 20 (3) ◽  
pp. 239-245 ◽  
Author(s):  
NA Aziz
Keyword(s):  
Sample Size ◽  
Hospital Setting ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Stroke Management ◽  
Stroke Patients ◽  
Community Based ◽  
Rehabilitation Intervention ◽  
Current Guidelines

SummaryCurrent guidelines in stroke management are divided on the issue of providing further rehabilitation to stroke patients who have had stroke six months ago and longer. Whilst consensus considers that long-term rehabilitation is neither practical nor beneficial, rehabilitation remains vital in the complex management of longer-term stroke care, as it provides continuity from the formal rehabilitation intervention in the hospital setting. Longer-term rehabilitation is principally a community-based intervention, as it aims to assist the survivors to become more independent through social and leisure-based interventions. Available evidence is limited, with available studies heterogeneous and small in sample size. This review aims to look into the existing evidence, and discusses the feasibility and challenges in providing longer-term rehabilitation to stroke survivors.

Abstract WP408: Tacls: Taking Action for Optimal Community and Long Term Stroke Care

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Theresa L Green ◽  
Patrice Lindsay
Keyword(s):  
Health Care ◽  
Acute Stroke ◽  
Health Care Providers ◽  
Stroke Care ◽  
Residential Aged Care ◽  
Stroke Survivors ◽  
Care Providers ◽  
Community Based ◽  
Taking Action

Introduction: In Canada, approximately 12% of acute stroke patients are admitted to long-term care (LTC; or residential aged care) facilities following an acute stroke event. An additional 20-30% of patients are discharged home from hospital with referral for community-based homecare. Training programs for health care providers in these settings is variable and at times inconsistent with best practices. Internationally, focus is now shifting from a predominant inpatient acute care focus, to one encompassing ongoing care and support in the community for people living with stroke. In 2015, an educational resource called Taking Action for Optimal Community & Long Term Stroke Care (TACLS) was launched across Canada to ensure the appropriate knowledge and skills of front line care providers for stroke survivors in community and LTC facilities; the focus of this resource is on rehabilitation and recovery. Methods: The purpose of this interactive session is to introduce the TACLS resource and to engage health professionals in an examination of current international community based rehabilitation and recovery programs. The discussion/workshop will allow participants to examine, compare and contrast components of the TACLS program with programs being developed or offered elsewhere. Results: As health care providers helping stroke survivors live well and longer means investing in the use of best practice tools and resources that fit the local context and organizational practices. Bringing together international opinions and observations around post-stroke community care will allow cross-collaboration and inter-professional networking opportunities that ultimately will benefit patients living with stroke in community based settings. Discussion: As care shifts from hospital to community based settings, the importance of tools available to support stroke survivors in this area of the care continuum is essential. In Canada, utilizing the HSF education resource (TACLS) provides information to support community based health care providers working with people who have had a stroke in helping them achieve optimal outcomes, regain their best level of functioning, and live meaningful lives.

Estimating the Prevalence of Sleep-Disordered Breathing in Community-Based, Long-Term Stroke Survivors Using a Validated Predictive Model

2008 ◽  
Vol 26 (4) ◽  
pp. 441-446 ◽  
Author(s):  
Dora C. Pearce ◽  
Dominique A Cadilhac ◽  
Robert J. Pierce ◽  
Amanda G. Thrift ◽  
Stephen David ◽  
...  
Keyword(s):  
Predictive Model ◽  
Sleep Disordered Breathing ◽  
Stroke Survivors ◽  
Community Based ◽  
Disordered Breathing

Abstract P839: ‘Stroke Home Care’- A Mobile Application: Home Based Innovative Nursing Care Intervention Developed by Stroke Nurse: A Need of the Time in Covid-19 Pandemic Like Situation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ashok Kumar ◽  
Dheeraj Khurana ◽  
Smita Pattanaik ◽  
Mukesh Kumar ◽  
Manish Modi ◽  
...  
Keyword(s):  
Home Care ◽  
Nursing Care ◽  
Mobile Application ◽  
Frozen Shoulder ◽  
Tube Feeding ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
Home Based

Introduction: Stroke nurse is functioning as a vital member of the stroke team. She/he provides care to the stroke patients in acute as well as post-acute periods. She/he coordinates among other team members to facilitate the stroke care continuum. Post-stroke care is always a challenge for health care professional as well as caregivers. During current pandemic conditions, it is essential to provide quality care at their home. Purpose: To develop a mobile application to provide home based care for prevention and management of post stroke complications among survivors. Methods: Survey was carried out among 170 bedridden stroke survivors and their caregivers to assess problems faced like aspiration pneumonia, bedsore, urinary tract infection, deep vein thrombosis, frozen shoulder, contractures, and caregiver burden. On the basis of findings ‘Stroke home care’ a bilingual (in Hindi and English) mobile application was developed which contains step by step nursing-care-procedural videos to prevent bedsore, bedsore dressing, positioning change, Ryle’s tube feeding, Foley’s catheter care, active and passive range of motion exercises, hand washing with soap-water as well with sanitizer, psychological support to patients. Results: Through this intervention, caregivers of bedridden stroke patients get trained for care procedures so that they can provide best possible nursing care to their patients at home and can prevent post stroke complications and ultimately enhances quality of life of survivors and reduce caregivers’ burden. Conclusion: ‘Stroke Home Care’ is a novel intervention developed by a stroke nurse which has been developed and tested not just for its feasibility and acceptability but also proven for its clinical applicability through PROBE designed study. This web based intervention can provide rehabilitation services to bedridden stroke survivors at their home in this pandemic.

Abstract T MP69: Do Neighborhood Characteristics Elevate Post-Stroke Mortality?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Theresa Osypuk ◽  
J. Robin Moon ◽  
Amy Ehntholt ◽  
M Maria Glymour
Keyword(s):  
General Population ◽  
Social Integration ◽  
Stroke Care ◽  
Racial Composition ◽  
Stroke Survivors ◽  
Stroke Mortality ◽  
Neighborhood Characteristics ◽  
Stroke Patients ◽  
Post Stroke ◽  
White Neighborhoods

Background: Neighborhood context predicts long-term mortality of both stroke patients and stroke-free general community populations. If the association of neighborhood characteristics and mortality is stronger among stroke survivors than in the general population, it would implicate stroke-care-specific mechanisms. We hypothesized that neighborhood risk factors predict post-stroke mortality, and that these associations are stronger than in stroke free populations. Methods: Health and Retirement Study participants age 50+ free of stroke at baseline (n=15,974) were followed up to 12 years for incident stroke (1,809 events) and mortality (5,578 Deaths). We compared mortality hazard ratios associated with both objective neighborhood measures (census tract poverty, racial composition, residential stability, and foreign born) and self-reported neighborhood social integration (social ties and informal socializing), among stroke-free and post-stroke individuals, using covariate adjusted Cox models. Results: Stroke predicted elevated mortality (HR= 1.98; 95% CI: 1.85, 2.13), as did residence in census tracts in the highest quartile of % non-white (HR= 1.12; 1.22, 1.04). Percent non-white was more strongly related to mortality among stroke patients (HR= 1.32; 1.52, 1.14) than among stroke-free individuals (HR= 1.08; 1.00, 1.18; p for interaction=.013). Low neighborhood social integration also significantly predicted mortality, but the relative effects were similar for stroke survivors and stroke-free individuals. Conclusions: In this large cohort, neighborhood racial composition and social integration predicted survival. Neighborhood racial composition had larger effects on post-stroke survival than on survival in the general population. Post-stroke care available to residents of non-white neighborhoods may be less effective than care available to residents of predominantly white neighborhoods.

Abstract TP307: Promising Practices to Improve the Quality of Pre-Hospital Stroke Care Transitions

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Stephanie M Teixeira-Poit ◽  
Jacqueline Amoozegar ◽  
Joanna Elmi ◽  
Megan Chambard ◽  
Kyle Emery ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Transitions ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Stroke Care ◽  
Hospital Staff ◽  
Promising Practices ◽  
Stroke Patients ◽  
Suspected Stroke

Introduction: Between 2012-2015 the Centers for Disease Control and Prevention’s (CDC) Paul Coverdell National Acute Stroke Program (PCNASP) funded 11 state health departments to improve the quality of stroke care across the continuum, beginning with the initial signs and symptoms of stroke through the transition from hospital to post-hospital setting. Hypothesis: We assessed the hypothesis that PCNASP quality improvement activities enhanced the quality of pre-hospital stroke care transitions. Methods: We conducted 72 semi-structured telephone interviews with stakeholders of the 11 PCNASP grantees, including program administrators, epidemiologists, quality improvement consultants, partners, emergency medical services (EMS) and hospital staff. Using grounded theory (Glaser and Strauss), we developed and applied a coding scheme to the interview transcripts to identify emerging themes related to pre-hospital quality improvement activities. Results: Many PCNASP grantees provided training and support for EMS and hospital staff that improved calling of a stroke code team and recognition of stroke, improved EMS pre-notifications about suspected stroke patients, advanced hospital holding of CT scanners in anticipation of suspected stroke patients, and reduced door-to-CT and door-to-needle time. PCNASP grantees had different approaches to balancing timeliness and quality of care. Some grantees developed statewide destination protocols that required EMS to bypass proximate hospitals for certified stroke care hospitals. Other grantees had challenges implementing statewide destination protocols because EMS agencies were decentralized with local authority to determine where to transport patients. In other cases, grantees promoted a “drip and ship” model where EMS transported patients to proximate hospitals for IV-tPA and then to a primary stroke center and focused on increasing the reach of stroke telemedicine. Conclusion: PCNASP grantees developed promising practices to improve the quality of pre-hospital stroke care transitions that accounted for their unique state context. These approaches may become the basis for best practices for improving pre-hospital transitions of stroke care across the nation.

scholarly journals What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

2013 ◽  
Vol 04 (04) ◽  
pp. 413-420 ◽  
Author(s):  
Aznida Firzah Abdul Aziz ◽  
Nor Azlin Mohd Nordin ◽  
Syed Mohamed Aljunid ◽  
Aznida Firzah Abdul Aziz ◽  
Noor Azah Abd Aziz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Stroke Care ◽  
Post Treatment ◽  
Initial Contact ◽  
Care Providers ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Care Clinic

ABSTRACT Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care‑driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long‑term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1‑year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI). Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t‑tests or Wilcoxon‑signed rank test. Significance level was set at 0.05. Results: Ninety‑one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2−100) to 90.5 (range: 27−100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0−22) to 3.0 (range: 0−19) though the change was not significant (Z= −0.744, P = 0.457). Conclusions: Primary care‑driven long‑term stroke care services yield favorable outcomes for blood pressure control and functional level.

Longitudinal Impact of Community-Based Rehabilitation Programs on Functional Recovery After Stroke: A Scoping Review

2021 ◽  
pp. 108482232110355
Author(s):  
Ingyu Yoo
Keyword(s):  
Scoping Review ◽  
Relevant Literature ◽  
Walking Ability ◽  
Longitudinal Impact ◽  
Long Term Effects ◽  
Stroke Patients ◽  
Community Based ◽  
Therapeutic Benefits ◽  
Significant Difference

The purpose of this scoping review is to guide the effects of long-term application of CBRP in stroke patients and to help make recommendations for developing treatment protocols for therapeutic application. The study examined relevant literature published between 2009 and 2020 using searches of 4 scientific databases. CBRP may have long-term effects on the functional effectiveness of stroke patients. In particular, long-term effects on walking ability and level of daily living activities have been identified. However, disease-related health conditions and quality of life were less effective in the long run. The effect decreased over time, but the long-term effect was maintained. Long-term intervention after discharge has proven to make a significant difference in the outcome of the goal. Given the potential therapeutic benefits of this process, the results of this review highlight the lack of further research to establish the effectiveness of this form of community-based long-term rehabilitation therapy for stroke patients.

scholarly journals An Investigation of the Outcomes of Stroke Patients in the Community: is it Possible to Recovery Well after Golden Rehabilitation Period

2020 ◽  
Vol 5 (7) ◽  
Keyword(s):  
Retrospective Study ◽  
Cause Of Death ◽  
Lower Limbs ◽  
Upper Limbs ◽  
Stroke Patients ◽  
Community Based ◽  
Rehabilitation Care ◽  
Community Clinic ◽  
Rehabilitation Period

Stroke is the fourth leading cause of death in Taiwan and is the main cause of disability globally [1]. Chiou stated that the disability of patients with stroke is about 60% after one month, and about 50-55% for 3~6 months after stroke [2]. Yang, et al, address most of the stroke people whose aged 65 and over are cared for at home, but the frequency of rehabilitation care for these elderly is the lowest. Community-based care is another way to look after stroke patients in long-term condition. Currently, little is known about community clinic care of stroke patients when the patients returned home from the hospital. The purpose of this study is to analyze the patient data of a community clinic to understand the outcome of the care of stroke patients. A retrospective study which reviewed the stroke patients’ charts in a community clinic was adopted. Data were collected from 2011 to 2016. 389 patients’ data were showed in this study. The result showed that the improvement of stroke patients in the upper limbs and lower limbs is the most significant, and its progress can reach nearly 75~80%. Moreover, the slurred speech of this group can be improved by about 20%. Although the symptoms of drooling and choking were also improved, the progress is about 10~15%. This result indicates that the community clinic care may be another way to facilitate the progress of stroke patients after transition from the hospital to the home.

scholarly journals Measuring Quality of Life in Stroke Survivors

2020 ◽  
Vol 25 (3) ◽  
pp. 11-16
Author(s):  
M. Tsalta-Mladenov ◽  
D. Georgieva ◽  
S. Andonova
Keyword(s):  
Quality Of Life ◽  
Treatment Options ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
High Dependency ◽  
Evaluation Time ◽  
Number Of Patients

Introduction: The number of patients living with the consequences of stroke is increasing worldwide due to the improving stroke care and the modern differentiated treatment options for ischemic stroke – thrombolysis and thrombectomy. Hence, a significant interest has arisen in quality of life (QOL) measurement in post-stroke patients. Objectives. Measuring QOL in stroke survivors can be achieved by using various generic and stroke specific questionnaires. All tools should assess different domains of health such as physical acting, communication, daily activities and others. This article describes the most commonly used scales for measuring post-stroke QOL. Methods. We searched the PubMed electronic databases with the keywords — Quality of life, Stroke, Measuring for the period from January 2000 to May 2020. Results. Various generic and specific scales for quality of life measuring are available. The advantages of the specific scales include high accuracy and detailed information for the assessed domains. The limitations are due to numerous items, long evaluation time and high dependency on patient’s compliance. The generic scales give the ability to compare the QOL in patients with different diseases. The disadvantage is lack of detailed information for the health status in certain disease or condition. Conclusion. Measuring the different aspects of QOL in post-stroke patients is powerful tool in order to focus the further efforts to the most affected domains. A combination between generic and stroke-specific measure might be considered in order to overcome the limitations. The choice of measuring scales must be balanced in the terms of lengthy and repetitive surveys.

Abstract W MP106: Clinical Effectiveness of Anticoagulation with Warfarin among Ischemic Stroke Patients with Atrial Fibrillation: Findings from the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Jingjing Wu ◽  
Emily C O’Brien ◽  
Gregg C Fonarow ◽  
DaiWai M Olson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Warfarin Therapy ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Warfarin Treatment

Background: Oral anticoagulation is recommended for ischemic stroke patients with atrial fibrillation, based on clinical trials done in selected populations. However, little is known about whether the clinical benefit of warfarin is preserved outside the clinical trial setting, especially in older patients with ischemic stroke. Methods: PROSPER, a PCORI-funded research program designed by stroke survivors and stakeholders, used American Heart Association Get With The Guidelines (GWTG)-Stroke data linked to Medicare claims to evaluate the association between warfarin treatment at discharge and long-term outcomes among ischemic stroke survivors with atrial fibrillation (AF) and no contraindication to or prior anticoagulation therapy. The primary outcome prioritized by patients was home-time (defined as days spent alive and not in inpatient post-acute care facility) within 2-year follow-up after discharge. Results: Of 12,552 ischemic stroke patients with AF admitted from 2009-2011, 11,039 (88%) received warfarin treatment at discharge. Compared with those not receiving any anticoagulation, warfarin-treated patients were slightly younger (mean 80 vs. 83, p<0.001), less likely to have a history of prior stroke or coronary artery disease, but had similar stroke severity as measured by NIHSS (median 5 [IQR 2-12] vs. 6 [2-13], p=0.09). After adjustment for all observed baseline characteristics using propensity score inverse probability weighting method, patients discharged on warfarin therapy had 45 more days of home-time during 2-year follow-up than those not receiving any oral anticoagulant (513 vs. 468 days, p<0.001). Warfarin use was also associated with a lower risk of all-cause mortality, cardiovascular readmission or death, and ischemic stroke (Table). Conclusions: Among ischemic stroke patients with atrial fibrillation, warfarin therapy was associated with improved long-term outcomes.

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