Abstract WP140: Functional Independence Scores of Acute Stroke Patients is Associated With Discharge Directly to Home

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Hiroyuki Kawano ◽  
Takashi Johno ◽  
Masataka Torii ◽  
Hiroshi Kamiyama ◽  
Tatsuo Amano ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Independence ◽  
Stroke Patients

Abstract WP471: Significant Factors for Early Independent Toilet Activities in Acute Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yuki Sawada ◽  
Takahisa Mori ◽  
Yuna Hosaka
Keyword(s):  
Cognitive Function ◽  
Acute Stroke ◽  
Mmse Score ◽  
Multiple Logistic Regression Analysis ◽  
Early Discharge ◽  
Functional Independence ◽  
Lower Limbs ◽  
Stroke Patients ◽  
Trunk Control ◽  
Significant Factors

Introduction: Acute stroke patients have problems with toilet activities. Independent toilet activity in hospitalized patients is important for dischargee to home. Hypothesis: Lower limbs function, trunk control and cognitive function are important factors of early independent toilet activities and discharge to home within 7 days. Methods: We included acute ischemic stroke patients who 1) were admitted from June 2017 to May 2018 and 2) received early rehabilitation treatment. Patients with disturbed level of consciousness were excluded. Functional independence measure (FIM) scale of 6 or 7 was defined as independence and FIM scale of 5 or less as dependence. We evaluated Brunnstrom Recovery Stage (BRS) of arms, fingers and lower limbs, trunk control test (TCT), Mini-Mental State Examination (MMSE) and investigated significant factors of early independent toilet activities and discharge to home within 7 days. Results: One-hundred twenty-four patients met our inclusive criteria. Their average age was 75.8 years, male gender of 63.7%, median BRS of arms, fingers and lower limbs was 5, 5 and 5, median TCT score and MMSE score were 94 and 24.7, respectively. Fifty-three patients were independent in toilet activity and 73 patients were dependent. All patients with independent toilet activity discharged to home within 7 days. In independent and dependent toilet activity patients, an average age was 73.6 and 77.4 (p<0.05), median BRS of arms was 5 and 5 (p<0.01), median BRS of fingers was 6and 5 (p<0.01), median BRS of lower limbs was 5 and 5 (p<0.01), median TCT score was 100 and 61 (p<0.01), and median MMSE score was 27.8 and 22.5 (p<0.01), respectively. Multiple logistic regression analysis showed that MMSE score (p<0.01), TCT score (p<0.01), and BRS of lower limbs (p<0.05) were independent factors for independent toilet activity and discharge to home. Receiver operating characteristic (ROC) curve for early discharge to home demonstrated that cut-off values of MMSE score, TCT score and MRS of lower limbs were 27 or more, 87 or more and 5 or more, respectively. Conclusion: BRS as lower limbs function, TCT as trunk control and MMSE as cognitive function were important factors of early independent toilet activities and early discharge to home.

scholarly journals Adherence to Post-Acute Rehabilitation Guidelines Improves Functional Recovery in Stroke

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 333-333
Author(s):  
Pamela W Duncan ◽  
Ronnie D Horner ◽  
Dean M Reker ◽  
VA Medical Ctr ◽  
Kansas City ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Acute Stroke ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Functional Independence ◽  
Case Mix ◽  
Stroke Patients ◽  
Sf 36 ◽  
Acute Rehabilitation

97 Purpose & Methods: To assess if compliance with post-stroke rehabilitation guidelines improves functional recovery. The design of the study was an inception cohort of stroke patients followed prospectively for 6 months. The setting was eleven Department of Veteran Affairs Medical Centers providing care to stroke patients. The subjects included 288 selected patients with stroke admitted between January 1998 - March 1999. Data were abstracted from medical records and telephone interviews. Primary outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and post-acute rehabilitation composite compliance scores (range 0–100) were derived from an algorithm. All outcomes were adjusted for case mix. Results: Average compliance scores in acute and post acute care settings were 68.2% (+ 14) and 69.5% (+ 14.4), respectively. After case-mix adjustment, level of compliance with post-acute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function scores and mortality were not affected by compliance with post-acute rehabilitation guidelines. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. Conclusion: Process of care in post-acute stroke rehabilitation affects 6-month functional recovery. Our findings support the use of guidelines as means of assessing quality of care and improving outcomes. These quality indicators are needed to ensure that quality of care is not comprised with new organizational and funding changes involving post-acute stroke care.

Abstract TMP12: Does Prehospital Magnesium Sulfate Differentially Improve Outcome in Hyperacute Stroke Patients With Higher Pretreatment Blood Pressure?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Phoebe H Johnson-Black ◽  
Sidney Starkman ◽  
Nerses Sanossian ◽  
David Liebeskind ◽  
Samuel Stratton ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cerebrovascular Disease ◽  
Acute Stroke ◽  
Magnesium Sulfate ◽  
Controlled Trial ◽  
Functional Independence ◽  
Forest Plot ◽  
Stroke Patients ◽  
Improve Outcome ◽  
Acute Cerebral Ischemia

Introduction: Magnesium sulfate (Mg) has blood pressure (BP) lowering, cerebral blood flow enhancing, and neuroprotective effects in preclinical and clinical studies. In the IMAGES phase 3 trial, Mg up to 12h after onset showed no benefit in acute stroke, but was associated with improved outcome in patients with higher blood pressure at entry. Hypothesis: We tested the hypothesis that ultra-early Mg improves functional outcome in acute stroke patients with higher baseline BP. Methods: FAST-MAG is a multicenter, double-blind, randomized, placebo-controlled trial of paramedic-initiated Mg, administered to patients with suspected stroke within 2h of symptom onset. The primary analysis showed neutral effect of Mg. This secondary analysis examines rates of functional independence (mRS 0-2) at 3m for Mg and placebo for different field BP groups. Results: Among 1622 patients with acute cerebrovascular disease, age was 69.6 (±13.4), 42% female, entry deficit severity in the field was LAMS 3.8 (±1.2), and first post-enrollment NIHSS in the ED was 11.5 (±9.9). Systolic blood pressure prior to enrollment was higher among patients with intracerebral hemorrhage (ICH) than acute cerebral ischemia (ACI), 175 (±25) vs 155 (±27), p < .001. The Figure shows the Forest plot for Mg vs placebo and functional independence among blood pressure groups. Heterogeneity of treatment effect was noted in the all-cerebrovascular patients population (p < .01), with fewer independent outcomes with Mg than placebo among patients with higher entry BPs. Analysis of Functional Independence (mRS 0-2) at 90 Days in Prespecified Subgroups Conclusion: This analysis did not confirm the prior finding of magnesium sulfate benefit among acute stroke patients with elevated blood pressure (and actually provided a signal in the opposing direction). Mg was not demonstrated to improve outcome when started in the first 2h of onset among patients with acute cerebrovascular disease and higher blood pressures.

Abstract WP148: Functional Independence Score of Acute Stroke Patients Can Predict Favorable Clinical Outcome at 3 Months After Stroke Onset

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Takashi Johno ◽  
Hiroyuki Kawano ◽  
Masataka Torii ◽  
Hiroshi Kamiyama ◽  
Tatsuo Amano ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Functional Independence ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Favorable Clinical Outcome

Abstract TP261: Beyond the Golden Hour: Treating Acute Stroke in the Platinum 30 Minutes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Anantbir S Randhawa ◽  
Sidney Starkman ◽  
Nerses Sanossian ◽  
David S Liebeskind ◽  
Gilda Avila ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Study Drug ◽  
Functional Independence ◽  
Multicenter Trial ◽  
Stroke Patients ◽  
Golden Hour ◽  
Treatment Start ◽  
Acute Cerebral Ischemia ◽  
Trial Testing

Background: As hemorrhagic and ischemic strokes progress, acute stroke therapy is time dependent. To emphasize treatment speed for time-sensitive conditions, emergency medicine has developed not only the concept of the “golden hour,” but also the “platinum thirty”. Acute stroke patients treated within the first half-hour of onset have not been previously characterized. Methods: We analyzed all patients with acute stroke symptoms enrolled in the multicenter NIH-funded FAST-MAG trial, testing paramedic prehospital start of neuroprotective agent within 2h of onset. The frequency, demographic, clinical, and outcome features of patients with treatment start within the platinum 30m were compared with later treated patients. Results: Among the 1700 enrolled patients, 180 (10.6%) received study agent within 30 minutes of last known well (LKW). In these platinum-30 patients, final diagnoses were: acute cerebral ischemia in 70.0% (ischemic stroke 59.4%, TIA 10.6%); intracranial hemorrhage in 26.7%; and mimic in 2.8%, similar to the overall study population. Mean age was 68.3 (±13.2) years, 46.1% were women, initial deficit in the field on the Los Angeles Motor Scale was mean 4.1 (±1.2) and early-post-arrival NIHSS deficit was 11.3 (±10.5). Time from LKW to 911 call was median 4m (IQR 2-6); from LKW to paramedic evaluation 10m (IQR 7-12); from LKW to study drug start 27m (IQR 25-29); and from LKW to ED arrival 36m (IQR 31-41). Outcomes at 3 months included freedom from disability (mRS 0-1) in 35.0%, functional independence (mRS 0-2) in 53.3%, and mortality in 17.2%. Demographic, medical history, presenting deficit severity, and 3m outcomes among the platinum-30 patients were largely similar to the 1415 patients treated between 31-120m after onset. Conclusions: Paramedic prehospital initiation of neuroprotection study agent permits treatment start within the platinum first 30 minutes in a substantial proportion of acute ischemic and hemorrhagic stroke patients, accounting for more than 1 in 10 patients enrolled in a multicenter trial. Hyperacute, <30m patients activated the 911 system sooner after onset but were otherwise similar to later patients and are a treatable target in prehospital stroke trials.

Abstract T P122: Functional Independence Measure Scores Predict Self-care Levels Required for Post-acute Stroke Patients Classified by the Long-Term Care Insurance System in Japan: A Multicenter Retrospective Cohort Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Naoki Saji ◽  
Kazumi Kimura ◽  
Goro Ohsaka ◽  
Yasuto Higashi ◽  
Yoichi Teramoto ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Long Term Care ◽  
Self Care ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Early Prediction ◽  
Stroke Patients ◽  
Term Care ◽  
Long Term Care Insurance

Background and purpose: Early prediction of clinical outcomes in stroke patients is socioeconomically important. The aim of this study was to clarify whether Functional Independence Measure (FIM) scores on admission can predict their discharge destinations and future self-care levels required for post-acute stroke patients classified by the Long-Term Care Insurance (LTCI) system, the national insurance plan for care in Japan. Methods: We enrolled post-acute stroke patients admitted to 12 convalescent rehabilitation wards (CRW) from 9 acute stroke centers. A CRW was defined as a specialized ward for intensive rehabilitation to prevent a bedridden state and to promote home rehabilitation by improving ability to perform activities of daily living. We evaluated self-care abilities using FIM scores and modified Rankin Scale (mRS) scores as traditional assessment scales and compared with certified self-care levels within the LTCI system (seven levels; slight impairment to bedridden). We divided patients into those who were discharged home from a CRW and all others. Results: Among 1261 patients (47% female, mean age 75 years), 984 (78%) were discharged home. FIM scores at discharge were significantly correlated with both mRS scores at discharge and certified self-care levels within the LTCI system (P < .001). The cut-off values for home discharge were a FIM score on admission of 50 points and an age of 75 years. On multivariate analysis, FIM scores ≥50 on admission [odds ratio (OR), 95% confidence interval (95% CI); 5.80, 4.30-7.91] and age <75 years (2.16, 1.60-2.95) were independently associated with home discharge. Conclusions: FIM scores in post-acute stroke patients can predict self-care levels within the LTCI system. Early prediction of self-care levels may promote careful preparation of healthcare planning and improve the efficiency of stroke management.

Abstract WP161: Early Short Physical Performance Battery (SPPB) Score Can Predict Functional Independence and Death for Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ken-ichi Kumagae ◽  
Kohta Yamauchi ◽  
Risa Hagiwara ◽  
Yasuhiro Koyanagi ◽  
Shuji Arakawa ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Acute Stroke ◽  
Roc Curve ◽  
Assessment Tool ◽  
Functional Independence ◽  
Curve Analysis ◽  
Lower Extremity Function ◽  
Stroke Patients ◽  
Roc Curve Analysis ◽  
Extremity Function

Background and Purpose: Lower extremity function is a strong predictor for functional outcome and death in a variety of pathological status. National Institute of Health Stroke Scale (NIHSS) is a world-wide standard scoring system for stroke patients; however, it is not sufficient to evaluate lower extremity function. Short Physical Performance Battery (SPPB) is a simple assessment tool for lower extremity function, consists of standing balance, walking speed, and repetitive standing (range: 0-12, 12: high function). SPPB can predict adverse events, such as disability and mortality in elderly population, but its disease specific utility for stroke patients is still unknown. The purpose of this study was to determine whether SPPB score predicts functional independence and death for acute stroke. Methods: Between April 2013 and November 2014, 410 consecutive stroke patients admitted within 7 days after the onset. Patients with premorbid modified Rankin Scale (mRS) of 0-2, and evaluated SPPB at 7 th days after the admission were enrolled in this study. Clinical data were analyzed using univariate and multivariate model to assess functional independence (defined as mRS of 0-2) at 3 months and 1 year mortality adjusting covariates to investigate the association between SPPB and functional independence or death. Receiver operating characteristics (ROC) curve analysis was performed for detecting optimal cut-off value. Results: A total of 243 patients (mean age 73.8 years, male 58.4%) were included in this study. Of them, 132 (54.3%) patients were independent at 3 months follow up, and 14 (5.8%) patients have died. Median SPPB score at 7 th days after the admission was 6 (IQR: 1-11). After adjusting age, sex, BMI, NIHSS score on admission, SPPB score at 7 th days after the admission was significantly associated with 3-month functional independence (odds ratio, 1.48; 95%CI, 1.29-1.69; p<0.001) and 1-year death (hazard ratio, 0.36; 95% CI, 0.17-0.74; p=0.005). ROC curve analysis revealed the cut-off point of SPPB for functional independence was 6 (AUC:0.88, 95%CI, 0.83-0.93, p<0.001, sensitivity: 0.83, specificity:0.84). Conclusions: Early SPPB score is a useful assessment tool in predicting functional independence and death for acute stroke patients.

EFFECT OF STROKE SEVERITY INDEX WITH FUNCTIONAL INDEPENDENCE ON CAREGIVERS BURDEN IN ACUTE STROKE PATIENTS.

2021 ◽  
pp. 13-16
Author(s):  
Dhruvina Jaykumar Suru ◽  
Shivani Milind Pandirkar ◽  
Shailaja Sandeep Jaywant
Keyword(s):  
Acute Stroke ◽  
Caregiver Burden ◽  
Negative Correlation ◽  
Barthel Index ◽  
Tertiary Care ◽  
Functional Independence ◽  
Stroke Severity ◽  
Care Hospital ◽  
Stroke Patients ◽  
The Impact

Greater number of stroke survivors suffer from disability and extended years of care is required to be undertaken by family members which adds burden to caregivers daily life. Thus burden on caregivers needs attention to study the impact of stroke .Till now, scarce literature is found to study the correlation of severity of stroke and burden on caregivers. This study was done to nd the correlation of severity of stroke with functional independence and also intends to nd the correlation of Functional dependency with the caregivers burden& severity of stroke with caregivers burden in acute stroke patients Patients admitted in the tertiary care hospital of metropolitan city in Maharashtra with the Acute stroke within 48 hours of onset were included in study , on 3rd day after stroke/admission to hospital. National Institutes Of Health Stroke Scale ( NIHSS), Barthel Index (BI), Burden Scale For Family Caregivers (BSFC), were used to gather information from 100 stroke patients admitted in hospital wards. Study showed strong negative correlation of -0.705 between NIHSS and BI, Barthel index correlation with caregiver burden score shows moderate negative correlation of – 0.482, NIH scale score correlation with caregiver burden score shows moderate positive correlation of 0.59. Thus stroke severity affects negatively on functional independence. caregivers have reported moderate burden due to dependance of patient. stroke severity has positive impact on caregivers burden. Further research in various stages of Stroke recovery on caregivers burden and functional independence level is recommended

Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke: the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS)

2021 ◽  
pp. neurintsurg-2021-018045
Author(s):  
Ilaria Casetta ◽  
Enrico Fainardi ◽  
Giovanni Pracucci ◽  
Valentina Saia ◽  
Stefano Vallone ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Case Fatality ◽  
Functional Independence ◽  
Primary Outcome Measure ◽  
Stroke Patients ◽  
Infarct Core ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracranial Hemorrhage ◽  
Contrast Ct

BackgroundClinical trials and observational studies have demonstrated the benefit of thrombectomy up to 16 or 24 hours after the patient was last known to be well. This study aimed to evaluate the outcome of stroke patients treated beyond 24 hours from onset.MethodsWe analyzed the outcome of 34 stroke patients (mean age 70.7±12.3 years; median National Institutes of Health Stroke Scale (NIHSS) score 13) treated with endovascular thrombectomy beyond 24 hours from onset who were recruited in the Italian Registry of Endovascular Thrombectomy in Acute Stroke. Selection criteria for patients were: pre-stroke modified Rankin scale (mRS) score of ≤2, non-contrast CT Alberta Stroke Program Early CT score of ≥6, good collaterals on single phase CT angiography (CTA) or multiphase CTA, and CT perfusion mismatch with an infarct core size ≤50% of the total hypoperfusion extent or involving less than one-third of the extent of the middle cerebral artery territory evaluated by visual inspection. The primary outcome measure was functional independence assessed by the mRS at 90 days after onset. Safety outcomes were 90 day mortality and the occurrence of symptomatic intracranial hemorrhage (sICH).ResultsSuccessful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was present in 76.5% of patients. Three month functional independence (mRS score 0–2) was observed in 41.1% of patients. The case fatality rate was 26.5%. and the incidence of sICH was 8.8%.ConclusionsThese findings suggest that, in a real world setting, very late endovascular therapy is feasible in appropriately selected patients.

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