scholarly journals Post-stroke fatigue: A factor associated with inability to return to work in patients <60 years—A 1-year follow-up

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255538
Author(s):  
Nicole Anna Rutkowski ◽  
Elham Sabri ◽  
Christine Yang
Keyword(s):  
Return To Work ◽  
Young Patients ◽  
Outpatient Rehabilitation ◽  
Stroke Severity ◽  
Loss To Follow Up ◽  
Post Stroke ◽  
Persistent Fatigue ◽  
Fatigue Severity ◽  
Driving Fatigue

This study investigated the association between post-stroke fatigue and inability to return to work/drive in young patients aged <60 years with first stroke who were employed prior to infarct while controlling for stroke severity, age, extent of disability, cognitive function, and depression. The Fatigue Severity Scale (FSS) was used to evaluate post-stroke fatigue in this 1-year prospective cohort study. Follow-ups were completed at 3, 6, and 12 months post rehabilitation discharge. A total of 112 patients were recruited, 7 were excluded, due to loss to follow-up (n = 6) and being palliative (n = 1), resulting in 105 participants (71% male, average age 49 ±10.63 years). Stroke patients receiving both inpatient and outpatient rehabilitation were consecutively recruited. Persistent fatigue remained associated with inability to return to work when controlling for other factors at 3 months (adjusted OR = 18, 95% CI: 2.9, 110.3, p = 0.002), 6 months (adjusted OR = 29.81, 95% CI: 1.7, 532.8, p = 0.021), and 12 months (adjusted OR = 31.6, 95% CI: 1.8, 545.0, p = 0.018). No association was found between persistent fatigue and return to driving. Fatigue at admission was associated with inability to return to work at 3 months but not return to drive. Persistent fatigue was found to be associated with inability to resume work but not driving. It may be beneficial to routinely screen post-stroke fatigue in rehabilitation and educate stroke survivors and employers on the impacts of post-stroke fatigue on return to work.

scholarly journals Inter-hemispheric inhibition in stroke survivors is related to fatigue and cortical excitability

2019 ◽  
Author(s):  
Sasha Ondobaka ◽  
Nick Ward ◽  
Annapoorna Kuppuswamy
Keyword(s):  
Cortical Excitability ◽  
Effective Connectivity ◽  
Self Report ◽  
Stroke Survivors ◽  
Corticomotor Excitability ◽  
Post Stroke ◽  
Motor Cortex Excitability ◽  
Persistent Fatigue ◽  
Fatigue Severity ◽  
Exercise Induced

ABSTRACTObjectivePersistent post-stroke fatigue is a major debilitating condition that has been linked to low corticomotor excitability and aberrant attention, both phenomena that are associated with the inter-hemispheric inhibition balance in the brain. In this study, we examined the relationship between inter-hemispheric inhibitory effective connectivity, motor cortex excitability and chronic persistence of post-stroke fatigue.MethodsWe tested eighteen non-depressed stroke survivors with minimal motoric and cognitive impairments using spectral dynamic causal modelling (spDCM) of ‘resting state’ magnetic resonance imaging (rs-fMRI) and transcranial magnetic stimulation (TMS) measures of cortical excitability. We also assessed the levels of non-exercise induced, persistent fatigue using Fatigue Severity Scale (FSS) - a self-report questionnaire which has been widely applied and validated across different conditions. To understand neural effective connectivity mechanisms involved in fatigue and corticomotor excitability we examined the balance in inhibitory connectivity between homologue regions in M1, anterior insula, caudate and thalamus of the resting brain.ResultsInter-hemispheric inhibition balance between left and right M1 accounted for 67% of variability in the reported fatigue (R=.82, p<0.001). Inter-hemispheric inhibition balance in M1 also accounted for 54% of variability in the corticomotor excitability characterised by individual resting motor thresholds (R=.74, p<0.001), a measure that has been associated with subjective fatigue reports. Other examined inter-hemispheric connections did not show significant relationships with either fatigue or cortical excitability measures.ConclusionOur findings suggest that the balance in inter-hemispheric effective connectivity between primary motor regions is involved in regulation of corticomotor excitability and could explain subjective post-stroke fatigue.

scholarly journals Low T3 Level and Prognosis of Acute Ischemic Stroke: A Comparative Analysis

2018 ◽  
Vol 18 (2) ◽  
pp. 145-148
Author(s):  
Hosne Ara Rahman ◽  
Mahbub Ur Rahman ◽  
Jasmine Ara Haque ◽  
Samira Sharmin ◽  
Anup Kumar Saha
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Impairment ◽  
Functional Improvement ◽  
Stroke Severity ◽  
Cross Sectional ◽  
Post Stroke ◽  
Low T3 ◽  
Level Group

Objectives: Neuroendocrine profile is significantly altered in acute ischemic stroke. Increasing evidences suggested that low T3 levels immediately following acute ischemic stroke is associated with greater stroke severity, higher mortality rates and poorer functional outcome. The objective of this study was to see the possible association of serum T3 level with severity of acute ischemic stroke as well as post stroke recovery.Material & Methods: It was a prospective cross sectional study. From October 2014 to June 2015 patients with acute ischemic stroke, presented within 48 hours of onset of symptoms having radiologically confirmed cerebral infarct were enrolled in this study. Blood for thyroid hormone estimation was collected within 48 hours of onset of symptom. Neurological impairment and improvement were assessed using National Institute of Health Stroke Scale (NIHSS) score together with modified Rankin Scale (mRS) on admission day and at 4 weeks post stroke follow-up visit.Result: A total 83 patients met all inclusion criteria were studied. Mean age was 63.4 ± 15.6 years (range 47-79 years). Among eighty three patients 49 (59%) had normal T3 level and rest 34 (41%) had low T3 level. Mean T3 level was 0.4 ± 0.3 ng/ml and 1.8 ±0.5 ng/ml in lowT3 and normal T3 level group respectively. Based on NIHSS scores on admission, a much higher portion of patients (73.5%) belonged to lowT3 level group fell into moderate-to-severe category while majority of patients (53.0%) fell into mild category for normal T3 level group. In post stroke follow up, about 63.2 % patients with normal T3 level showed favorable neurological functional improvement compared to 38.2% having low T3 level (Chi square=4.9, P<0.05).Conclusion: In patients with acute ischemic stroke lower T3 level elevated the risk of poor functional outcome.Bangladesh J. Nuclear Med. 18(2): 145-148, July 2015

Abstract WMP53: Sex Differences n Long-term Mortality and Disability After Stroke: The International Stroke Outcomes Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hoang T Phan ◽  
Mathew J Reeves ◽  
Leigh Blizzard ◽  
Amanda Thrift ◽  
Dominique Cadilhac ◽  
...  
Keyword(s):  
Sex Differences ◽  
Population Based ◽  
Stroke Severity ◽  
Related Factors ◽  
Post Stroke ◽  
Modifiable Factors ◽  
Mortality Rate Ratio ◽  
The Impact

Introduction: It is uncertain why women suffer worse long-term outcomes after stroke than men. We examined sex differences in mortality and disability 1 and 5 years after stroke and identified factors contributing to these differences. Methods: Individual patient data pooling study of incident strokes (ischemic and hemorrhagic) from 1987-2013 obtained from 12 population-based cohorts from Australasia, Europe, South America and the Caribbean. Data on socio-demographics, stroke-related factors and pre-stroke health were obtained for each patient and harmonized between studies. Poisson modelling estimated the mortality rate ratio (MRR) for women compared to men at 1 year (12 studies) and 5 years (7 studies) post-stroke. Log binomial regression estimated the relative risk (RR) of poor outcome (modified Rankin scale>2 or Barthel Index <20) for women compared to men at 1 year (9 studies) and 5 years (6 studies) after stroke. Multivariable models were adjusted for potential confounders including age, pre-stroke dependency, stroke severity and comorbidities. Results: A total of 16557 first-ever-stroke patients with follow-up data to 1 year and 12,839 with follow-up to 5 years were included. The pooled crude mortality was greater in women than men at 1-year (MRR 1.37 95% CI 1.27-1.48) and 5 years (MRR 1.25 95% CI 1.13-1.39). However, these sex differences were reversed after adjustment for confounders at both 1 year (MRR 0.94 95% CI 0.82-1.06) and 5-years post stroke (MRR 0.74 95% CI 0.66-0.84). Similarly, the pooled crude RR for disability after stroke was greater in women than men at 1-year (RR 1.28 95% CI 1.17-1.39 and 5-year (RR 1.32 95% CI 1.18-1.47), but these sex differences disappeared after adjustment at both 1 year (RR 1.08 95%CI 0.98-1.18) and 5-years post stroke (RR 1.08 95% CI 0.97-1.20). The key contributors to worse outcomes in women were greater age, pre-stroke dependency, severe strokes and atrial fibrillation (AF, mortality only) compared with men. Conclusion: Worse outcomes in women were mostly due to age and potentially modifiable factors of stroke severity and AF providing potential targets to reduce the impact of stroke in women.

scholarly journals Post-stroke dementia: frequency, predictors, and health impact

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Bastawy Al Fawal ◽  
Ahmed Ibrahim ◽  
Mohamed Abd Elhamed
Keyword(s):  
Risk Factors ◽  
Recurrent Stroke ◽  
Demographic Data ◽  
Health Impact ◽  
Stroke Severity ◽  
Post Stroke ◽  
Abnormal Gait ◽  
Psychotic Features ◽  
Demographic Data Collection

Abstract Background Cognitive impairment is an important aspect for stroke survivors. Little data are available about the frequency and risk factors of post-stroke dementia in Egypt. Objectives The aim of this study is to evaluate the frequency and predictors of post-stroke dementia and its impact on outcome. Methods A total of 380 patients with acute stroke were included. Patients were subjected to demographic data collection, neurological examination, and assessment of vascular risk factors. Furthermore, assessment of stroke severity by Barthel Index was done. After 6 months, patients were assessed for outcome and development of post-stroke dementia. Results Post-stroke dementia was detected in 20.8% of patient. It was recorded more in old ages, illiterates, unmarried, unemployed, and those with recurrent stroke and with cerebral infarction (significantly with cardio-embolic). Conclusion Post-stroke dementia is high in Egypt, especially in those with illiteracy, atrial fibrillation, brain atrophy, severe strokes, and those presented with hemiplegia, sphincter affection, abnormal gait, and psychotic features. Assessment for post-stroke dementia should be done during follow up of stroke patients.

scholarly journals Efeitos da Terapia da Fala em Pacientes Internados com Disfagia Pós-Acidente Cerebrovascular: Revisão Sistemática de Estudos Observacionais

2017 ◽  
Vol 30 (12) ◽  
pp. 870 ◽  
Author(s):  
Joice Santos Andrade ◽  
Wagner Walter Oliveira de Jesus Souza ◽  
Luiz Renato Paranhos ◽  
Danielle Ramos Domenis ◽  
Carla Patrícia Hernandez Alves Ribeiro César
Keyword(s):  
Early Intervention ◽  
Recovery Time ◽  
Speech Therapy ◽  
Oropharyngeal Dysphagia ◽  
Control Group ◽  
Loss To Follow Up ◽  
Post Stroke ◽  
Swallowing Rehabilitation ◽  
Hospital Bed

Introduction: Since dysphagia may be one of the brain post-stroke consequences, the objective of this study was to analyze the average recovery time of patients with cerebrovascular accident and dysphagia subjected to speech therapy in a hospital bed.Material and Methods: Systematic review performed following the ‘Preferred Reporting Items is Systematic Reviews and MetaAnalyses’ instructions. The search was performed in different electronic databases, without restriction of time and language. The studies were evaluated regarding their methodological quality.Results: Of 5671 titles, five studies were included. 176 patients with stroke and dysphagia were obtained (aged between 22 and 91 years old – average: 68.95), with no preference regarding gender. Improvement occurred in 84.26% of the subjects and the recovery time was between one and ninety days (average: 22 days). Randomization, blinding, loss to follow-up and withdrawal were not performed with control group in any study.Discussion: The success of rehabilitation of oropharyngeal dysphagia as a post-stroke sequela will depend on the extent, location of the neurological lesion and early intervention in the hospital bed. Despite the recognition of health professionals about the importance of swallowing rehabilitation for these patients, there is a lack of studies that support an evidence-based practice, although the results point to improvements in this regard.Conclusion: Speech therapy in hospital bed in post-stroke hospitalized patients with dysphagia seems to bring satisfactory results in the short-term, revealing the importance of diagnosis and early intervention in these cases.

Abstract 172: Medical and Demographic Predictors of Long-term Cognitive Outcomes of Pediatric Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alice A Holland ◽  
Kimberly D Goodspeed ◽  
Patricia Plumb ◽  
Peter L Stavinoha ◽  
Michael Dowling
Keyword(s):  
Neurological Impairment ◽  
Cognitive Outcomes ◽  
Stroke Severity ◽  
Pediatric Stroke ◽  
Post Stroke ◽  
Age Related ◽  
Long Term Follow Up ◽  
The Relationship

Introduction: Studies examining cognitive outcomes for pediatric stroke are sparse, and few account for stroke severity. The Pediatric Stroke Outcome Measure (PSOM) provides an objective, comprehensive rating of neurological impairment. This study investigated the relationship between initial PSOM score and long-term cognitive outcomes. It was hypothesized that greater severity of stroke (worse initial PSOM score) would predict lower IQ at long-term follow-up. Other factors considered were age at stroke and months post stroke. Age-related studies in broad cognitive outcomes for pediatric stroke are sparse and somewhat inconsistent in findings. It was hypothesized that severity of stroke would be more relevant than age of stroke for long-term cognitive outcomes. Methods: PSOM scores at initial visit and IQ scores at long-term follow-up (M=3.77 years) were obtained for 84 survivors of pediatric stroke ages 4:0-25:6 (M=11:5 years; 37 females). A one-sample t-test was conducted to compare mean IQ to the normative sample. To examine the hypotheses, all variables of interest (PSOM, age at stroke, and months s/p) were entered into a stepwise regression equation. Results: Mean IQ for the sample was 84.77 (SD=17.26), significantly below average relative to healthy norms ( t =-8.088, p =.000). PSOM scores ranged 0-5.5 (median/mode=1.0). The regression was significant ( F =8.798; p =.000), with both PSOM score ( b =-.350; t [80]=-3.483; p =.001) and months post stroke ( b =-.355; t [80]=-3.005; p =.004) significantly contributing to the model, but not age at stroke. Conclusions: PSOM was more relevant than age at stroke in predicting long-term cognitive outcomes, and greater stroke severity was associated with lower IQ at follow-up. Finding suggest that initial PSOM score and greater time since stroke may be more relevant to long-term cognitive outcomes than age at stroke. The present study lends validity to using the PSOM both as a marker of functional severity of stroke and a potential indicator of relative risk for poorer long-term cognitive outcomes. Better predictors of cognitive outcomes for pediatric stroke are greatly needed in order to facilitate earlier intervention/rehabilitation and improve the efficacy of such efforts.

Abstract WP195: Patients Beginning Community Based Outpatient Stroke Rehabilitation Program More Than 6 Months Post Stroke Achieve Equally Excellent Outcomes as Sub-Acute Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Joan Breen ◽  
Jeanne Andrusin ◽  
Tom Ferlito
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Rehabilitation Program ◽  
Chronic Stroke ◽  
Outpatient Rehabilitation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Community Based ◽  
Post Stroke ◽  
Rehabilitation Programs

Background: Despite the availability of community based outpatient rehabilitation programs in the U.S., few use standardized measure sets and assessments, and outcomes studies are sparse. There is especially a knowledge gap regarding outcomes of participating chronic stroke patients (rehabilitation begins more than 6 months post stroke). Methods: Prospective observational study of stroke patients treated between 12/2011-1/2015 in an interdisciplinary outpatient rehabilitation program that addresses health literacy, risk factors, physical, psychosocial, cognitive, communicative and vocational issues. Patients were classified as chronic if admitted to the program >6 months and sub-acute if admitted <6 months post stroke. Results: Among 96 consecutive patients, 71 were sub-acute (72% ischemic, 28% hemorrhages) and 25 chronic (68% ischemic, 32% hemorrhages) who were admitted to the program an average 18.5 months post stroke (range 6-121 months). Chronic vs subacute stroke patients were 64% vs 59% male, with no difference in age (mean 66, range 27-90 years vs 65, range 18-90 years), but with greater stroke severity (chronic mean NIHSS score 8.32, range 2-15 vs subacute NIHSS of 5.2, range 0-16). On admission, chronic vs subacute patients were 44% vs 34% aphasic and 96% vs 86% needed assistance with activities of daily living (chronic with modified Rankin Scale [mRS] of 3=28% and 4=68% vs subacute mRS of 3=65% and 4=21%). The percent change in outcomes from baseline to program discharge for subacute and chronic stroke patients is presented in the Table. Conclusions: Although age, sex and stroke types were similar in both groups, chronic patients were more severely impaired than subacute patients but achieved greater improvement in activities of daily living, recovery, walking speed, balance, and risk factor knowledge. These findings demonstrate that outpatient rehabilitation programs can aid in stroke recovery independent of time since stroke onset.

Abstract TP156: NIH Stroke Scale at Discharge as a Predictor for Return to Work Status After Mild Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Susan B Taboada ◽  
Caroline Wisialowski ◽  
Jennifer Blum ◽  
Sarah Clark ◽  
Ilene Staff ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Return To Work ◽  
Significant Proportion ◽  
Work Status ◽  
Stroke Severity ◽  
Unskilled Labor ◽  
Convenience Sample ◽  
Post Stroke ◽  
Mild Stroke

Background: A significant proportion of patients are unable to return to work (RTW) post stroke. While post-stroke depression and fatigue have been linked to patients’ RTW status, the role of discharge NIHSS has not been studied. Objective: To evaluate role of stroke severity, depression, fatigue, and cognitive impairment on patients’ ability to RTW. Methods: A retrospective study was conducted using a survey completed by a convenience sample of patients during follow-up in stroke clinic. The survey included PHQ-9, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). Demographic, work status, and clinical data (discharge NIHSS, mRS, medical history) were also collected. NIHSS was evaluated both continuously and dichotomized ( < 1, > 1). Patients who did and did not RTW were compared using chi square tests of proportions and Wilcox Ranked Sum tests; independence of factors was explored using logistic regression predicting RTW. Results: Out of 135 patients surveyed, 41% (N=56) reported employment at the time of their stroke. Of those, a significant percentage of patients were unable to RTW post stroke (57.1%); 39.3% (N=22) were unable to RTW due to physical limitations. Further analysis revealed patients who did not RTW were more likely to suffer from fatigue (p=0.026), have higher rates of cognitive impairment (p=0.027) and a higher NIHSS at discharge (p<0.001). Very low NIHSS was a very strong RTW predictor as patients with an NIHSS ≤ 1 at discharge were 15 times more likely to RTW than patients with a higher NIHSS (p=.001). Patients who worked in professional, managerial, or artistic occupations pre-stroke were more likely to return to work than those in public service, skilled or unskilled labor occupations (p=0.023). In multivariate analyses, fatigue, cognitive impairment and depression were no longer significant when NIHSS at discharge was a covariate. Type of occupation was independent of NIHSS. Conclusions: For patients with mild stroke, NIHSS at discharge indicating minimal to no disability is a strong independent predictor for RTW status. For patients with greater deficit, depression, fatigue and cognitive impairment could play a greater role; additional studies of patients with greater variety of stroke severity would be needed.

Abstract T P115: Racial/Ethnic Differences in Post-Stroke Rehabilitation Utilization and Functional Outcomes in the South Carolina Stroke Belt

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Charles Ellis ◽  
Andrea D Boan ◽  
Tanya N Turan ◽  
Shelly Ozark ◽  
David Bachman ◽  
...  
Keyword(s):  
South Carolina ◽  
Ethnic Differences ◽  
Functional Outcomes ◽  
Daily Living ◽  
Stroke Rehabilitation ◽  
Stroke Severity ◽  
Post Stroke ◽  
One Year ◽  
Racial Ethnic

Background: Significant racial and ethnic disparities in stroke incidence, severity, morbidity and mortality have been consistently reported, but there are limited reports on racial/ethnic differences in post-stroke rehabilitation utilization and long term functional outcomes. Objective: To examine racial and ethnic differences in post-stroke rehabilitation utilization and functional outcomes. Methods: We examined one year follow-up data collected as part of the STEP-South Carolina Project that was designed to measure clinical, treatment, and functional outcomes in post-stroke patients. We used univariate and multivariate regression analyses adjusted for stroke severity to examine racial-ethnic differences in rehabilitation utilization (occupational therapy, physical therapy, speech therapy) and functional outcomes using a 20 question measure of activities of daily living (ADL) & instrumental activities of daily living (IADL) performance, life participation and driving. Results: Data from 162 stroke survivors (106 White, 56 Black) were collected at one year follow-up. As shown in the table, no significant differences were found between Blacks and Whites for rehabilitation utilization. In multivariate comparisons controlling for NIHSS, Blacks were less likely to report independence in overall functional performance outcomes as well as specific measures of toileting, walking, transportation, laundry and shopping. In addition, fewer Blacks reported driving at one year post-discharge. Conclusions: Fewer Blacks exhibited ADL and IADL independence at one year post-stroke after controlling for stroke severity, despite the fact that there were no racial-ethnic differences in rehabilitation utilization. Future studies are needed to further understand the reason for this disparity in recovery

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