Abstract NS13: Road to Recovery after Stroke: Understanding Predictors of Discharge Destination, Functional Independence, and Quality of Life after Hospital Discharge

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Pamela Roberts ◽  
Harriet Aronow ◽  
Sonia Guerra ◽  
Tingjian Yan
Keyword(s):  
Quality Of Life ◽  
Comparative Effectiveness ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Functional Scores ◽  
Brain Involvement

Introduction: Stroke is the leading cause of long-term disability and affects 795,000 people in the U.S. each year. This study was conducted to enhance knowledge of outcomes during recovery and the options for participating in rehabilitation and preventive care during patients’ transitions to the community. Comprehensive Stroke Certification charges hospitals with the task of expanding knowledge of functional and quality of life outcomes for all stroke patients through the continuum examining effects of stroke severity, functional impairment, and patient characteristics on discharge destinations, functional independence, and quality of life after discharge. Methods: Retrospective analysis of an acute stroke quality improvement database which includes measures collected by MedTel Outcomes LLC on all stroke patients one month after discharge. Included, is the Functional Independence Measure and standardized quality of life and participation measures. In the database are standardized measures from the medical record such stroke type, Modified Rankin score, and acute functional independence measure score for 719 patients with a 30-day follow-up phone assessment for functional and quality of life measures from January 1, 2011 to December 31, 2012. Preliminary Findings: Over 75% of patients had hemiparesis, & over 90% survived 30-days post discharge and were living in the community. At follow-up, mostwere independent in self-care, and half were independent in mobility excluding stairs. Those with right brain involvement had a complicated, slower recovery. Those with left brain involvement,had lower functional scores and a higher percentage of them were not living in the community, rather, living in institutions. Conclusions: All patients experiencing a stroke should have evidence-based information on their options & what to expect during their recovery during their transitions into the community. The data base is useful as a source of outcome data for comparative effectiveness and to build a regional collaborative outcomes database for Comparative Effectiveness Research and quality benchmarking. Findings can be used to understand the functional trajectory of recovery based on severity of stroke and other factors.

scholarly journals Quality of Life of Stroke Patients at 1 Year after Discharge from Inpatient Rehabilitation: A Multicenter Study

2021 ◽  
Vol 73 (4) ◽  
pp. 216-223
Author(s):  
Vilai Kuptniratsaikul
Keyword(s):  
Quality Of Life ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Linear Regression Analysis ◽  
Leisure Activity ◽  
Inpatient Rehabilitation ◽  
Stroke Patients ◽  
Functional Scores

Objective: To investigate quality of life (QoL) and its related factors 1-year after discharge from post-stroke inpatient rehabilitation. Methods: This longitudinal study was performed among 9 rehabilitation centres. Quality of life of stroke patients was evaluated using the WHOQOL-BREF. Its scores ranged from 26-130, with a higher score representing better quality of life. The QoL scores at 1-year follow-up were compared with the scores at discharge. Factors related to quality of life at 1-year after discharge were analysed using univariate and multiple linear regression. Results: One hundred and ninety-seven patients were recruited, with a mean age of 62.3 years. The mean quality of life score at 1-year after discharge was significantly lower than the score at discharge. In multiple linear regression analysis, only 5 factors were associated with quality of life, including having a leisure activity, modified Barthel (Activity of Daily Living, ADL) Index (mBI) at follow-up period, need caregiver, anxiety score, and depression score with the regression coefficient (b) of 6.29 (95%CI: 2.23, 10.35), 0.63 (95%CI: 0.07, 1.20), -7.72 (95%CI: -12.04, -3.40), -0.78 (95%CI: -1.40, -0.17), and -1.14 (95% CI: -1.72, -0.57) respectively. Conclusion: At one year after discharge from inpatient rehabilitation, patients with stroke had poorer quality of life. Factors related to poor quality of life included no leisure activity, and need for caregiver, low functional scores at follow-up, anxiety and depression. Strategies to prevent these factors could enhance QoL of stroke patients.

Dance, functioning and quality of life in children with Down syndrome and autism spectrum disorder dance, functioning and quality of life in Down syndrome and autism spectrum disorder

2021 ◽  
pp. 135910452110617
Author(s):  
Evanilza T. Adorno ◽  
Daiany C de J. Dos Santos ◽  
Beatriz M. DeJesus ◽  
Adrielle A. Passos ◽  
Lavínia Teixeira-Machado
Keyword(s):  
Quality Of Life ◽  
Autism Spectrum Disorder ◽  
Down Syndrome ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Children With Down Syndrome

This study investigated dance practice in psychosocial and functional aspects, and quality of life in children with Down syndrome and autism spectrum disorder. Children with DS and ASD, between 3 and 12 years old, attended a dance program during 16 sessions/lessons, lasting 60 min, twice a week, in suitable place. Functional Independence Measure (FIM), Childhood Autism Rating Scale SF-36 quality of life survey, and Knowledge, Attitude and Practice Inquiry (KAP Inquiry) were applied before and after dance classes. Eleven participants concluded the study. Functional independence changes were observed in relation to self-care, sphincter control, locomotion, and communication domains. Children’ “quality of life” reported by parents showed changes in functional capacity, vitality, mental health, physical and social aspects, and general state of health domains. These findings suggest that regular dance practice can underlie psychosocial adjustments in children with DS and ASD.

Long-term Neurological Outcome and Quality of Life after World Federation of Neurosurgical Societies Grades IV and V Aneurysmal Subarachnoid Hemorrhage in an Interdisciplinary Treatment Concept

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 967-974 ◽  
Author(s):  
Christoph Schwartz ◽  
Thomas Pfefferkorn ◽  
Caroline Ebrahimi ◽  
Caroline Ottomeyer ◽  
Gunther Fesl ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Short Form ◽  
Functional Independence ◽  
World Federation ◽  
Long Term Survivors ◽  
Short Form Health

Abstract BACKGROUND: Detailed data on long-term functional outcome of patients with World Federation of Neurosurgical Societies (WFNS) grades IV and V aneurysmal subarachnoid hemorrhages (aSAH) are still scarce. OBJECTIVE: Assessment of long-term outcome of WFNS IV and V aSAH patients. METHODS: Functional outcome and quality of life were assessed by the modified Rankin scale (mRS) and the 36-item short-form health survey in consecutively treated aSAH WFNS IV and V patients between 2005 and 2010. Scores from the 36-item short-form health survey were compared to a healthy German population. Prognostic factors were analyzed by uni- and multivariate models. RESULTS: One hundred and seven eligible patients (median age: 53.0 years) were identified. After interdisciplinary consensus on optimal treatment, aneurysms were obliterated either by clipping (n = 35) or by coiling (n = 72). Ten patients were lost to long-term follow-up; the median clinical follow-up period was 3.2 years for the remaining 97 cases. Twenty-five of 97 died during the acute hospital phase and another 10 patients over the follow-up period leaving 62 long-term survivors. At the end of clinical follow-up, 40/97 patients, including 40/62 of long-term survivors, reached functional independence (mRS ≤ 2). Twelve of 97 patients were moderately (mRS = 3), 10/97 patients were severely disabled (mRS ≥ 4). Younger age (≤ 53 years; P = .001) and radiological absence of cerebral infarction (P = .03) were the strongest predictors for favorable outcome. Quality of life was perceived to be only moderately reduced compared to the healthy control group. CONCLUSION: Poor-grade aSAH is not necessarily associated with poor long-term functional outcome; after aneurysm repair ∼60% of patients survived and among long-term survivors ∼ 60% regained functional independence.

scholarly journals The effect on subjective quality of life of occupational therapy based on adjusting the challenge–skill balance: a randomized controlled trial

2019 ◽  
Vol 33 (11) ◽  
pp. 1732-1746
Author(s):  
Ippei Yoshida ◽  
Kazuki Hirao ◽  
Ryuji Kobayashi
Keyword(s):  
Quality Of Life ◽  
Occupational Therapy ◽  
Controlled Trial ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Subjective Quality ◽  
Subjective Quality Of Life ◽  
Rehabilitation Process ◽  
And Control

Objective: To verify the effect of adjusting the challenge–skill balance with respect to rehabilitation process. Design: A single-blind, two-arm, parallel-group, randomized controlled trial. Setting: Recovery rehabilitation unit of Harue Hospital, Japan. Subjects: The trial included 72 clients (mean (SD): age, 74.64 (9.51) years; Functional Independence Measure score, 98.26 (15.27)) with cerebral or spinal disease or musculoskeletal disease. Interventions: Clients were randomly divided into two groups: the experimental group, who received occupational therapy with adjustment of the challenge–skill balance, and the control group who received conventional occupational therapy. Time from admission to discharge was considered the implementation period; the final evaluation was conducted at three months after discharge. Main measures: The primary outcome was subjective quality of life (Ikigai-9). Secondary outcomes were the health-related quality of life (EuroQol–5 Dimensions, Five Levels (EQ-5D-5L)), the Flow State Scale for Occupational Tasks, and the Functional Independence Measure. A cost-effectiveness analysis was conducted using total cost and quality-adjusted life-year based on the EQ-5D-5L. Results: Significant differences were observed between the experimental and control groups with respect to the Ikigai-9 score ( P = 0.008) and EQ-5D-5L ( P = 0.038), and the effect sizes were 0.76 (95% confidence interval [CI]: 0.27–1.24) and 0.62 (95% CI: 0.14–1.10), respectively. No significant between-group differences in other outcomes were observed, for example, the Functional Independence Measure score improved in both experimental and control groups (119.80 (5.50) and 118.84 (6.97), respectively. The incremental cost-effectiveness ratio was US$5518.38. Conclusions: Adjusting the challenge–skill balance may be a useful approach to improve the participant’s subjective quality of life in the rehabilitation process.

Determinants of quality of life (QoL) in elderly stroke patients: A short-term follow-up study

2011 ◽  
Vol 53 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Rezzan Gunaydin ◽  
Altinay Goksel Karatepe ◽  
Taciser Kaya ◽  
Ozgur Ulutas
Keyword(s):  
Quality Of Life ◽  
Stroke Patients ◽  
Short Term ◽  
Follow Up Study

scholarly journals Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial

2016 ◽  
Vol 31 (2) ◽  
pp. 197-206 ◽  
Author(s):  
Silvina Santana ◽  
José Rente ◽  
Conceição Neves ◽  
Patrícia Redondo ◽  
Nina Szczygiel ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Controlled Trial ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Primary Outcome Measure ◽  
Control Group ◽  
Stroke Patients ◽  
Control Groups ◽  
Open Label

Objective: To evaluate an early home-supported discharge service for stroke patients. Design: We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care. Setting: The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013. Subjects: We included stroke patients aged 25–85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent. Interventions: Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services. Main measures: The primary outcome measure was the Functional Independence Measure at six months after stroke. Results: We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78). Conclusions: It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.

scholarly journals Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors

2008 ◽  
Vol 23 (5) ◽  
pp. 441-448 ◽  
Author(s):  
Keh-chung Lin ◽  
Ya-fen Chang ◽  
Ching-yi Wu ◽  
Yi-an Chen
Keyword(s):  
Quality Of Life ◽  
Motor Performance ◽  
Functional Independence Measure ◽  
Proximal Part ◽  
Functional Independence ◽  
Control Group ◽  
Intensive Training ◽  
Hemiparetic Stroke ◽  
Bilateral Arm Training

Background and Objective. This study investigated the relative effects of distributed constraint-induced therapy (CIT) and bilateral arm training (BAT) on motor performance, daily function, functional use of the affected arm, and quality of life in patients with hemiparetic stroke. Methods. A total of 60 patients were randomized to distributed CIT, BAT, or a control intervention of less specific but active therapy. Each group received intensive training for 2 hours/day, 5 days/week, for 3 weeks. Pretreatment and posttreatment measures included the Fugl—Meyer Assessment (FMA), Functional Independence Measure (FIM), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The proximal and distal scores of FMA were used to examine separate upper limb (UL) elements of movement. Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group. The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups. Enhanced performance was found for the distributed CIT group in the MAL, the subtest of locomotion in the FIM, and certain domains of the SIS (eg, ADL/IADL). Conclusion. BAT may uniquely improve proximal UL motor impairment. In contrast, distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis.

scholarly journals Η επίδραση ενός προγράμματος αποκατάστασης στη μυϊκή λειτουργικότητα του βαρέως πάσχοντος μετά την έξοδο από τη Μονάδα Εντατικής Θεραπείας

2017 ◽  
Author(s):  
Ειρήνη Πατσάκη
Keyword(s):  
Quality Of Life ◽  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Nottingham Health Profile ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Health Profile

Εισαγωγή: Οι ασθενείς που εξέρχονται από τη Μονάδα Εντατικής Θεραπείας (ΜΕΘ) παρουσιάζουν σημαντικά ελλείμματα που επηρεάζουν τη λειτουργικότητα και την ποιότητα ζωής τους. Σκοπός: Σκοπός αυτής της τυχαιοποιημένης τυφλής μελέτης ήταν η αξιολόγηση της επίδρασης του Ηλεκτρονευρομυϊκού Ερεθισμού (ΗΝΜΕ) και ενός προγράμματος άσκησης στη μυϊκή ισχύ των βαρέως πασχόντων κατά την έξοδο από το Νοσοκομείο. Μεθοδολογία: 128 ασθενείς (83♂/45♀) που εξήλθαν από τη ΜΕΘ οι οποίοι είχαν παραμείνει υπό μηχανικό αερισμό για > 72 ώρες και μπορούσαν να εκτελέσουν απλές εντολές, τυχαιοποιήθηκαν κατά επίπεδα (ηλικία & MRC) στην ομάδα ΗΝΜΕ ή στην ομάδα ελέγχου. Στην ομάδα ΗΝΜΕ έγινε καθημερινή εφαρμογή ΗΝΜΕ και προγράμματος ασκήσεων ενώ στην ομάδα ελέγχου έγινε εφαρμογή εικονικού ΗΝΜΕ και δέχτηκαν τη συνήθη θεραπευτική παρέμβαση. Η κλίμακα μυϊκής ισχύος Medical Research Council (MRC) και η δυναμομέτρηση χειρός χρησιμοποιήθηκαν για την αξιολόγηση της μυϊκής ισχύος. Η λειτουργικότητα αξιολογήθηκε με την κλίμακα Functional Independence Measure (FIM) και η ποιότητα ζωής με τα ερωτηματολόγια Euro-Qol 5D (Euro- Quality of Life) και Nottingham Health Profile. Αποτελέσματα: Η MRC μυϊκής ισχύος κατά την έξοδο από τη ΜΕΘ και το νοσοκομείο δεν διέφερε μεταξύ των δυο ομάδων. Η ΔMRC% έτεινε να είναι υψηλότερη στην ομάδα ΗΝΜΕ κατά την 1η και 2η εβδομάδα παραμονής στο Νοσοκομείο. Στους ασθενείς με MRC<48/60 κατά την έξοδο από τη ΜΕΘ, η ΔMRC% ήταν σημαντικά υψηλότερη στην ομάδα ΗΝΜΕ σε σχέση με την ομάδα ελέγχου κατά την 1η και 2η εβδομάδα παραμονής στο Νοσοκομείο (33%±31% vs 18%±15%, p=0.07, 59%±54% vs 30%±20%, p=0.05, αντίστοιχα). Η δυναμομέτρηση χειρός και η κλίμακα λειτουργικότητα δεν έδειξαν διαφοροποίηση μεταξύ των δύο ομάδων. Επίσης δεν υπήρξε διαφορά και στην ποιότητα ζωής. Συμπέρασμα: Η εφαρμογή του ΗΝΜΕ συμπληρωματικά με ένα πρόγραμμα αποκατάστασης μπορεί να συμβάλλει στη βελτίωση της μυϊκής ισχύς κυρίως ασθενών με σοβαρή μυϊκή αδυναμία .Ο ΗΝΜΕ φαίνεται να είναι ιδιαίτερα αποτελεσματικός στη βραχεία περίοδο εξόδου από τη ΜΕΘ επιτυγχάνοντας τη φυσική διαδικασία ίασης.

scholarly journals Influence of Physical Therapy and Cholinergic Medication on the Life Quality Parameters in Post-Stroke with the arm Motor Dysfunction

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Iriah Festus Uwa-Agbonikhena
Keyword(s):  
Quality Of Life ◽  
Physical Therapy ◽  
Functional Independence ◽  
Motor Dysfunction ◽  
Stroke Patients ◽  
Post Stroke ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Motor dysfunction makes the greatest contribution to the patient’s functional independence and has a significant impact on the quality of life (QOL) of post-stroke patients. The objective of the research was to evaluate the impact of different physical therapy approaches and choline alphoscerate on the functional independence and quality of life in patients in 1 year after ischemic stroke. Materials and methods. There were 104 patients examined in 1-year period after first anterior circulation ischemic stroke. Neurological status, functional independence and QOL were assessed according to the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Functional Independence Measurement (FIM) and Stroke Specific Quality of Life Scale (SS-QOL). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for hand motility improvement for 2 months; patients in Group 3 received choline alphoscerate 400 mg twice a day for 2 months in addition to the abovementioned physical therapy. Results. 2 months of physical therapy in Group 1 resulted in increase of “Transfer” and subtotal motor scores. A significant increase in the “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in the patients in Group 2 and Group 3; the motor subtotal and total scores in Group 3 were 11.4% and 11.6 % higher than the same indices in Group 1, respectively. The most significant improvement of QOL parameters was observed in patients in Group 3, whose total score increased by 36.8% from the baseline (p<0.05), and exceeded the same index of Group 1 by 17.1% (p<0.05). Conclusions. Adding of hand exercise into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore functional independence. Stimulation of cholinergic neurotransmission with the choline alphoscerate may also increase the efficacy of physical therapy and contribute to patients’ general mobility, upper extremity function and QOL.

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