Racial and ethnic disparities in stroke outcomes: a scoping review of post-stroke disability assessment tools

Background and Purpose: Several studies suggest that racial/ethnic minority groups experience worse disability across the course of stroke recovery. However, there is little consistency in the measurement of stroke outcomes, which may contribute to some inconclusive evidence of racial/ethnic disparities in post-stroke disability. The objective of the current review is to examine how stroke outcomes are measured to identify racial/ethnic disparities in disability and functioning among stroke survivors in the US. Methods: A review of the literature was conducted to identify outcome measures used in racial/ethnic disparities in post-stroke disability literature, use the International Classification of Functioning, Disability, and Health (ICF) model as a frame of reference for mapping the contents of the identified measures, and evaluate the time points of measured outcomes and racial/ethnic representation. Articles published between January 2001 and July 2017 were identified with our search criteria through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion criteria. Results: One hundred and ninety-four articles met inclusion criteria for full-text review and 41 articles were included in the final review. Although we found evidence of outcome measure content aligning with all ICF domains, little research has examined contextual factors in post-stroke disability disparities research. Additionally, we discovered the outcome measures are conducted across stroke recovery trajectories including pre-stroke, acute stroke, early recovery (≤90 days), and long-term (>90 days) but little consistency in outcome measure use was discovered. African American and Hispanic populations were assessed most frequently and minimal studies examined disparities among other minority populations comprising the US (i.e., Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native). Conclusions: A variety of outcome measures have been used to assess disparities in disability across the course of stroke recovery. Yet, the lack of consistency in what outcomes are measured and when specific outcomes are assessed may contribute to mixed findings in the racial/ethnic disparities literature. Additional concerns include the lack of evidence on validity of outcome measures among racial/ethnic minority populations, the lack of representation among all racial/ethnic populations comprising the US, and minimal emphasis placed on the disparities in personal and environmental factors that contribute to disability. This review sheds light on the need for additional disparities in post-stroke disability research focusing on contextual factors and greater representation among less studied populations in the US.

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Developing an ICF core set for post-stroke disability assessment and verification in Taiwan: a preliminary study

Disability and Rehabilitation ◽

10.3109/09638288.2011.638033 ◽

2011 ◽

Vol 34 (15) ◽

pp. 1254-1261 ◽

Cited By ~ 13

Author(s):

Kwang-Hwa Chang ◽

Hung-Chou Chen ◽

Yennung Lin ◽

Shih-Ching Chen ◽

Hung-Yi Chiou ◽

...

Keyword(s):

Disability Assessment ◽

Icf Core Set ◽

Post Stroke ◽

Core Set ◽

Stroke Disability ◽

Preliminary Study

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Racial and Ethnic Disparities in Palliative Care: A Systematic Scoping Review

Families in Society The Journal of Contemporary Social Services ◽

10.1177/1044389418809083 ◽

2018 ◽

Vol 99 (4) ◽

pp. 301-316 ◽

Cited By ~ 5

Author(s):

Daniel S. Gardner ◽

Meredith Doherty ◽

Gleneara Bates ◽

Aliza Koplow ◽

Sarah Johnson

Keyword(s):

Palliative Care ◽

End Of Life ◽

Scoping Review ◽

End Of Life Care ◽

Ethnic Disparities ◽

Racial And Ethnic Disparities ◽

Life Care ◽

Search Terms ◽

Communities Of Color ◽

Social Environmental

Despite the advances and spread of palliative care programs, communities of color remain significantly underserved. Although these disparities are widely known, there is a marked lack of empirical evidence. The authors conducted a systematic scoping review that synthesized the literature since 2000 about racial and ethnic disparities in palliative and end-of-life care. We searched PubMed, Medline, SocIndex, CINAHL, Social Work Abstracts, and PsycINFO, using search terms including palliative care or end-of-life care, disparities or barriers or utilization, and race or ethnicity or African American or Hispanic. Findings lend support to extant literature that social-environmental barriers and disparities distinctly affect access to care for these populations. The review expands upon understanding of how social determinants drive disparities in palliative and end-of-life care and suggests implications for practice, policy, and research in promoting health equity in serious illness.

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Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.650024 ◽

2021 ◽

Vol 12 ◽

Author(s):

Dhanya Menoth Mohan ◽

Ahsan Habib Khandoker ◽

Sabahat Asim Wasti ◽

Sarah Ismail Ibrahim Ismail Alali ◽

Herbert F. Jelinek ◽

...

Keyword(s):

Gait Analysis ◽

Scoping Review ◽

Predictive Analytics ◽

Low Cost ◽

Research Question ◽

Assessment Tools ◽

Support Vector ◽

Clinical Settings ◽

Post Stroke ◽

Accuracy And Repeatability

Background: Gait dysfunction or impairment is considered one of the most common and devastating physiological consequences of stroke, and achieving optimal gait is a key goal for stroke victims with gait disability along with their clinical teams. Many researchers have explored post stroke gait, including assessment tools and techniques, key gait parameters and significance on functional recovery, as well as data mining, modeling and analyses methods.Research Question: This study aimed to review and summarize research efforts applicable to quantification and analyses of post-stroke gait with focus on recent technology-driven gait characterization and analysis approaches, including the integration of smart low cost wearables and Artificial Intelligence (AI), as well as feasibility and potential value in clinical settings.Methods: A comprehensive literature search was conducted within Google Scholar, PubMed, and ScienceDirect using a set of keywords, including lower extremity, walking, post-stroke, and kinematics. Original articles that met the selection criteria were included.Results and Significance: This scoping review aimed to shed light on tools and technologies employed in post stroke gait assessment toward bridging the existing gap between the research and clinical communities. Conventional qualitative gait analysis, typically used in clinics is mainly based on observational gait and is hence subjective and largely impacted by the observer's experience. Quantitative gait analysis, however, provides measured parameters, with good accuracy and repeatability for the diagnosis and comparative assessment throughout rehabilitation. Rapidly emerging smart wearable technology and AI, including Machine Learning, Support Vector Machine, and Neural Network approaches, are increasingly commanding greater attention in gait research. Although their use in clinical settings are not yet well leveraged, these tools promise a paradigm shift in stroke gait quantification, as they provide means for acquiring, storing and analyzing multifactorial complex gait data, while capturing its non-linear dynamic variability and offering the invaluable benefits of predictive analytics.

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Spatial Neglect Subtypes, Definitions and Assessment Tools: A Scoping Review

Frontiers in Neurology ◽

10.3389/fneur.2021.742365 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lindy J. Williams ◽

Jocelyn Kernot ◽

Susan L. Hillier ◽

Tobias Loetscher

Keyword(s):

Psychometric Properties ◽

Scoping Review ◽

Spatial Neglect ◽

Assessment Tools ◽

Screening Tools ◽

Post Stroke ◽

Screening And Diagnosis

Objective: The objective of this scoping review was to capture the reported definitions for the subtypes of neglect post stroke and map the range of assessment tools employed for each neglect subtype.Methods: EMBASE, Emcare, Medline, and psychINFO were searched from database inception. Searching included all allied terms and mesh headings for stroke, spatial neglect, measurement, screening tools, psychometric properties. Two reviewers independently screened studies for inclusion. Primary studies with documented protocols of a spatial neglect tool for adults post stroke, with some aspect of validity or reliability were included. Two reviewers independently reviewed the documented protocols of each tool to determine the underlying subtypes and disagreements were resolved through discussion.Results: There were 371 articles included with 292 tools used for the screening or diagnosis of neglect. The majority of studies (67%) included a tool that did not specify the neglect subtype being assessed, therefore an analysis of the underlying subtypes for each tool is presented.Conclusions: There is no consistency with the terms used to refer to the syndrome of spatial neglect with over 200 different terms used within the included studies to refer to the syndrome as a whole or one of its subtypes. It is essential to unify the terminology and definition for each neglect subtype. There are hundreds of neglect tools available, however many are not able to differentiate presenting subtypes. It is important for clinicians and researchers to critically evaluate the neglect tools being used for the screening and diagnosis of neglect.

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