Abstract TMP83: Long-term Clinical and Health Economic Consequences of Worsened Post-stroke Status in Patients With Pre-morbid Disability

The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults. A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events. A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD) = 0.53; 95% confidence interval (95% CI): (0.07–0.99); Modified Tardieu Scale (MTS): SMD = 0.56; 95% CI: (0.01–1.12); Visual Analogue Scale (VAS): SMD = 0.35; 95% CI: (−0.21–0.91); PROM: SMD = 0.69; 95% CI: (0.20–1.19). ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.

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Postural Control Disturbances Induced by Virtual Reality in Stroke Patients

Applied Sciences ◽

10.3390/app11041510 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1510

Author(s):

Charles Morizio ◽

Maxime Billot ◽

Jean-Christophe Daviet ◽

Stéphane Baudry ◽

Christophe Barbanchon ◽

...

Keyword(s):

Virtual Reality ◽

Postural Control ◽

Virtual Environments ◽

Center Of Pressure ◽

Dynamic Condition ◽

Static Condition ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke

People who survive a stroke are often left with long-term neurologic deficits that induce, among other impairments, balance disorders. While virtual reality (VR) is growing in popularity for postural control rehabilitation in post-stroke patients, studies on the effect of challenging virtual environments, simulating common daily situations on postural control in post-stroke patients, are scarce. This study is a first step to document the postural response of stroke patients to different challenging virtual environments. Five subacute stroke patients and fifteen age-matched healthy adults were included. All participants underwent posturographic tests in control conditions (open and closed eyes) and virtual environment without (one static condition) and with avatars (four dynamic conditions) using a head-mounted device for VR. In dynamic environments, we modulated the density of the virtual crowd (dense and light crowd) and the avoidance space with the avatars (near or far). Center of pressure velocity was collected by trial throughout randomized 30-s periods. Results showed that more challenging conditions (dynamic condition) induced greater postural disturbances in stroke patients than in healthy counterparts. Our study suggests that virtual reality environments should be adjusted in light of obtaining more or less challenging conditions.

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Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

BMC Neurology ◽

10.1186/s12883-021-02241-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chia-Yu Hsu ◽

Chun-Yu Cheng ◽

Jiann-Der Lee ◽

Meng Lee ◽

Bruce Ovbiagele

Keyword(s):

Valproic Acid ◽

Ischemic Stroke ◽

Cox Regression ◽

Population Based ◽

Primary Diagnosis ◽

Research Database ◽

Post Stroke ◽

Risk Of Death ◽

Index Stroke

Abstract Objective We aim to compare the effect of long-term anti-seizure medication (ASM) monotherapy on the risk of death and new ischemic stroke in patients with post-stroke epilepsy (PSE). Patients and methods We identified all hospitalized patients (≥ 20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohort were defined as the stroke patients (1) who had no epilepsy and no ASMs use before the index stroke, and (2) who had epilepsy and ASMs use after 14 days from the stroke onset. The patients with PSE receiving ASM monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new ASM groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of death and new ischemic stroke within 5 years across all groups, using the new ASM group as the reference. Results Of 6962 patients with PSE using ASM monotherapy, 3917 (56 %) were on phenytoin, 1623 (23 %) on valproic acid, 457 (7 %) on carbamazepine, and 965 (14 %) on new ASMs. After adjusting for confounders, compared with new ASM users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95 % CI: 1.06–2.55). On the other hand, all ASM groups showed a similar risk of new ischemic stroke in 5 years. Conclusions Among patients with PSE on first-line monotherapy, compared to new ASMs, use of phenytoin was associated with a higher risk of death in 5 years.

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Identifying unmet needs in long-term stroke care using in-depth assessment and the Post-Stroke Checklist – The Managing Aftercare for Stroke (MAS-I) study

European Stroke Journal ◽

10.1177/2396987318771174 ◽

2018 ◽

Vol 3 (3) ◽

pp. 237-245 ◽

Cited By ~ 16

Author(s):

Benjamin Hotter ◽

Inken Padberg ◽

Andrea Liebenau ◽

Petra Knispel ◽

Sabine Heel ◽

...

Keyword(s):

Quality Of Life ◽

Caregiver Burden ◽

Unmet Needs ◽

Community Dwelling ◽

Social Needs ◽

Interquartile Range ◽

Stroke Patients ◽

Post Stroke

Introduction Detailed data on the long-term consequences and treatment of stroke are scarce. We aimed to assess the needs and disease burden of community-dwelling stroke patients and their carers and to compare their treatment to evidence-based guidelines by a stroke neurologist. Methods We invited long-term stroke patients from two previous acute clinical studies ( n = 516) in Berlin, Germany to participate in an observational, cross-sectional study. Participants underwent a comprehensive interview and examination using the Post-Stroke Checklist and validated standard measures of: self-reported needs, quality of life, overall outcome, spasticity, pain, aphasia, cognition, depression, secondary prevention, social needs and caregiver burden. Results Fifty-seven participants (median initial National Institutes of Health Stroke Scale score 10 interquartile range 4–12.75) consented to assessment (median 41 months (interquartile range 36–50) after stroke. Modified Rankin Scale was 2 (median; interquartile range 1–3), EuroQoL index value was 0.81 (median; interquartile range 0.70–1.00). The frequencies for disabilities in the major domains were: spasticity 35%; cognition 61%; depression 20%; medication non-compliance 14%. Spasticity ( p = 0.008) and social needs ( p < 0.001) had the strongest impact on quality of life. The corresponding items in the Post-Stroke Checklist were predictive for low mood ( p < 0.001), impaired cognition ( p = 0.015), social needs ( p = 0.005) and caregiver burden ( p = 0.031). In the comprehensive interview, we identified the following needs: medical review (30%), optimization of pharmacotherapy (18%), outpatient therapy (47%) and social work input (33%). Conclusion These results suggest significant unmet needs and gaps in health and social care in long-term stroke patients. Further research to develop a comprehensive model for managing stroke aftercare is warranted. Clinical Trial Registration: clinicaltrials.gov NCT02320994.

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Health economic measures in schizophrenia research

The British Journal of Psychiatry ◽

10.1192/bjp.191.50.s42 ◽

2007 ◽

Vol 191 (S50) ◽

pp. s42-s45 ◽

Cited By ~ 10

Author(s):

Paul McCrone

Keyword(s):

Health Economic ◽

Economic Evaluation ◽

Cost Utility ◽

Outcome Data ◽

Cost Utility Analysis ◽

Economic Evaluations ◽

Utility Analysis ◽

Short Term ◽

Effectiveness Analysis

BackgroundIt is essential in economic evaluations of schizophrenia interventions that all relevant costs are identified and measured appropriately Also of importance is the way in which cost data are combined with information on outcomesAimsTo examine the use of health economicsin evaluations of interventions for schizophreniaMethodsAreview of the key methods used to estimate costs and to link costs and outcomes was conductedResultsCosts fall on a number of different agencies and can be short term or long term. Cost-effectiveness analysis and cost-utility analysis are the most appropriate methods for combing cost and outcome dataConclusionsSchizophrenia poses a number of challenges for economic evaluation

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Economic Consequences of Implementing the Engagement Partner: Signature Requirement in the UK

International Business Research ◽

10.5539/ibr.v10n9p141 ◽

2017 ◽

Vol 10 (9) ◽

pp. 141 ◽

Cited By ~ 1

Author(s):

Min Liu

Keyword(s):

Information Asymmetry ◽

Control Sample ◽

Economic Consequences ◽

Forecast Errors ◽

Omitted Variables ◽

Ceteris Paribus ◽

Forecast Dispersion ◽

Short And Long Term ◽

The Uk

This paper examines whether and the extent to which requiring the audit engagement partner (EP) signature influences on information asymmetry, analysts’ forecast errors, and forecast dispersion. I predict and find that, ceteris paribus, there is a significant decline in information asymmetry, analysts’ forecast errors and forecast dispersion from the pre- to post-EP signature period in the UK over both of short-term (i.e., 2008-2010) and long-term (i.e., 2004-2014). These findings hold when using a control sample approach, indicating that my results are not likely due to the effect of concurrent events and correlated omitted variables. These findings suggest that implementing the EP signature requirement benefits analysts forecasts over a short- and long-term.

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The Long Term Health and Economic Consequences of 1959-1961 Famine in China

SSRN Electronic Journal ◽

10.2139/ssrn.841764 ◽

2002 ◽

Cited By ~ 2

Author(s):

Yuyu Chen ◽

Li-An Zhou

Keyword(s):

Economic Consequences

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Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽

10.1136/bmjopen-2017-016566 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016566

Author(s):

Eline C C van Lieshout ◽

Johanna M A Visser-Meily ◽

Sebastiaan F W Neggers ◽

H Bart van der Worp ◽

Rick M Dijkhuizen

Keyword(s):

Motor Cortex ◽

Upper Limb ◽

Brain Stimulation ◽

Primary Outcome ◽

Primary Motor Cortex ◽

Repetitive Transcranial Magnetic Stimulation ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

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Economic components of the morbidity and rehabilitation of the musculoskeletal system as factors of the organization of the system of physical therapy at the ambulatory stage

Health, sport, rehabilitation ◽

10.34142/hsr.2020.06.01.07 ◽

2020 ◽

Vol 6 (1) ◽

pp. 57

Author(s):

S. М. Fedorenko ◽

M. S. Balazh ◽

V. V. Vitomskyi ◽

О.B. Lazarіeva ◽

M. V. Vitomskа

Keyword(s):

Physical Therapy ◽

Musculoskeletal System ◽

Economic Feasibility ◽

Economic Consequences ◽

Medical Reform ◽

High Incidence ◽

Permanent Loss ◽

Need For Rehabilitation

The aim: to consider the economic consequences of morbidity and rehabilitation of the musculoskeletal system (MSS) among the able-bodied population to confirm the economic feasibility of using physical therapy and the development of its system in the country in order to reduce losses from MSS pathologies in Ukraine.Material and methods: the data of 63 literature sources on the prevalence of MSS diseases among the working population, their economic consequences (payments for treatment, employers' losses), the role of rehabilitation, physical therapy in reducing financial costs, and the needs of the population in rehabilitation and physical therapy were analyzed.Results. Occupational diseases of the MSS are characterized by long-term disability and a high incidence of disability. The effectiveness of rehabilitation, including economic, with injuries and diseases of the MSS was given great attention in the works of domestic and foreign authors. A significant amount of research has confirmed that the funds spent on the implementation of rehabilitation are reimbursed many times by reducing the periods of temporary and permanent loss of working capacity.Conclusion. The economic feasibility of directing the funds for rehabilitation and physical therapy in pathologies of the MSS is reflected in the short duration of disability, the period of adaptation of patients to work, and the need for rehabilitation. Therefore, channeling funds into building a rehabilitation and physical therapy system in Ukraine is appropriate in the framework of medical reform and will have long-term positive economic consequences.

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