scholarly journals Comparison of Physical Disability in Mild, Moderate and Severe Stroke Survivors

2021 ◽  
Vol 17 (1) ◽  
pp. 31-37
Author(s):  
Mandeep Kang ◽  
Navkaran Singh Shergill
Keyword(s):  
Physical Disability ◽  
Stroke Survivors ◽  
Severe Stroke

Domiciliary Care Service: Factors Influencing Improvement in Activities of Daily Living Among Stroke Survivors

2019 ◽  
Vol 32 (1) ◽  
pp. 45-52
Author(s):  
Nur Raihan Ismail ◽  
Anees Abdul Hamid ◽  
Noor Aman Hamid
Keyword(s):  
Ischemic Stroke ◽  
Odds Ratio ◽  
Daily Living ◽  
Care Service ◽  
Stroke Survivors ◽  
Severe Stroke ◽  
Domiciliary Care ◽  
Factors Influencing ◽  
Home Based ◽  
Stroke Type

Stroke is a debilitating disease, adding to morbidity and mortality. Home-based rehabilitation has an influence on functional recovery among stroke survivors. This study aimed to determine factors influencing the improvement in activities of daily living (ADL) among stroke survivors after domiciliary care service. A state-wide record-review study using Domiciliary Care Record from health clinics with comprehensive domiciliary care was conducted. A logistic regression (LR) model was performed to assess factors influencing ADL improvement. Improved ADL was defined as obtaining at least 30% improvement on the Modified Barthel Index at the end of the program. From the records review, 72.2% of the participants had improved ADL following domiciliary care service. The mean age of the sample was 68.21 years ( SD = 11.99). The majority were ischemic stroke survivors (81.2%). In the single LR model, the influencing factors of ADL improvement were younger age (odds ratio [OR] = 2.76; p = .004), married (OR = 2.04; p = .018), ischemic stroke type (OR = 6.35; p < .001), less severe stroke (OR = 4.18; p < .001), no previous stroke (OR = 4.24; p < .001), and 9 to 12 home visits (OR = 2.79; p < .006). The multiple LR model showed ischemic stroke type (adjusted odds ratio [Adj. OR] = 5.30; p < .001), less severe stroke (Modified Rankin Scale score = 4; Adj. OR = 3.70; p < .001), and no previous stroke (Adj. OR = 3.51; p = .001) as significant factors when adjusted for other variables. Recognition of these factors associated with the improvement in stroke recovery is beneficial to intensify an optimal stroke care and home-based rehabilitation services.

scholarly journals What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nahal Mavaddat ◽  
Euan Sadler ◽  
Lisa Lim ◽  
Kate Williams ◽  
Elizabeth Warburton ◽  
...  
Keyword(s):  
Physical Disability ◽  
Physical Symptoms ◽  
Lifestyle Changes ◽  
Control Group ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Self Rated Health ◽  
Reported Health ◽  
The Difference ◽  
The Uk

Abstract Background Levels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors. Methods Face to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’. Results Individuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals. Conclusions The disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation.

Predictors of Caregiver Burden of Moderate and Severe Stroke Survivors: A Cross-Sectional Study from South India

2021 ◽  
pp. 251660852098054
Author(s):  
Usha M. Khanapur ◽  
Jacob John ◽  
Arun Mathai Mani ◽  
Sanjith Aaron
Keyword(s):  
Caregiver Burden ◽  
Cross Sectional Study ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Severe Stroke ◽  
Decompressive Hemicraniectomy ◽  
The Mean

Introduction: Caregivers have an important role in stroke recovery, especially after the acute phase of treatment. Caregiving for stroke survivors is associated with caregiver burden. Knowledge of factors influencing this caregiver burden is important for both the patient and the caregiver. Aim: To study the prevalence and predictors of major caregiver burden in survivors of moderate to severe stroke treated both conservatively and with surgical decompression. Methods: A community-based cross-sectional study where caregivers of stroke survivors with moderate to severe disability at discharge (modified Rankin Scale >3) were assessed between 3 months and 3 years of discharge. Results: Caregivers of 115 stroke survivors (82 conservatively treated and 33 who underwent decompressive hemicraniectomy) were studied. The majority (80%) were females. The mean period of caregiving was 18.8 ± 10.3 months (range 3-44 months). Major caregiver burden was seen in 36% (confidence interval [CI] = 27.3-44.7%). The significant predictors of major caregiver burden were daily caregiving for ≥4 hours (adjusted odds ratio [AOR] 5.3; CI = 1.84-15.3), patient activities of daily living dependency (AOR 3.66; CI = 1.03-13.03), and caregiver being the spouse (AOR 4.52; CI = 1.25-16.3). A total of 17% of the caregivers stopped working. Only (18%) had health insurance and 59% had borrowed money for treatment. A total of 88% of caregivers were happy regarding their decision to opt for surgery despite their current burden. Conclusion: Caregivers had stress in various domains. Shortening the caregiving hours especially in the initial months may help reduce the burden since the caregiver burden is also influenced by the patient’s dependency which improves over time.

scholarly journals Social Participation after Stroke: One-Year Follow-Up of Stroke Survivors in Nigeria

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Grace O. Vincent-Onabajo
Keyword(s):  
Social Participation ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Severe Stroke ◽  
Domain Specific ◽  
Physical Independence ◽  
One Year ◽  
London Handicap Scale

Background. Stroke may negatively affect social participation in survivors. Aims. This study assessed the pattern of social participation in a sample of Nigerian stroke survivors across the first 12 months after stroke. Methods. Stroke survivors were consecutively recruited while on admission at a tertiary health institution. The London handicap scale was used to assess social participation at 1, 3, 6, 9, and 12 months at the homes of the stroke survivors. Overall and domain-specific patterns of social participation were examined independently and also in relation to initial stroke severity. Results. Overall social participation significantly improved over 12 months (), while significant improvements were observed only in the mobility, physical independence, and work and leisure domains at P equals 0.04, 0.04, and 0.05, respectively. In spite of the improvement in the work and leisure domain, the domain recorded the lowest level of participation. Social participation also differed by initial stroke severity with severe stroke survivors having the lowest level of participation across 12 months after stroke. Conclusions. The poor outcome in the work and leisure domain of social participation and in individuals with initial severe stroke has implications for planning and provision of appropriate long-term stroke rehabilitation.

scholarly journals Most important factors for deciding rehabilitation provision for severe stroke survivors post hospital discharge: A study protocol for Best-Worst Scaling experiment (Preprint)

2020 ◽  
Author(s):  
Sushmita Mohapatra ◽  
Kei Long Cheung ◽  
Mickael Hiligsmann ◽  
Nana Anokye
Keyword(s):  
Decision Making ◽  
Hospital Discharge ◽  
Relative Weight ◽  
Hierarchical Bayes ◽  
Bayes Estimation ◽  
Stroke Survivors ◽  
Incentive Payment ◽  
Severe Stroke ◽  
Best Worst Scaling ◽  
Multidisciplinary Staff

UNSTRUCTURED Introduction: Objective decision-making is crucial to ensure adequate rehabilitation after stroke with optimal use of healthcare resources. Establishing the factors associated with making decisions concerning rehabilitation is important to guide clinical staff for making person-centred decisions for rehabilitation after severe stroke. In order to further validate the factors that impact decision-making, this study aims to identify the most important factors and their relative weight for decision making for rehabilitation concerning severe stroke survivors, post hospital discharge Methods and analysis: In this study, we will conduct a best-worst scaling (BWS) experiment, specifically a BWS object case. Fractional, efficient designs will be applied regards the survey design. Key multidisciplinary staff regularly involved in making decisions for rehabilitation in a stroke unit will be recruited to participate in an online BWS survey. Hierarchical Bayes estimation will be used as the main analysis method, with the best-worst count analysis as a secondary analysis. Ethics and dissemination Ethical approval for the study will be obtained from the College Research Ethics Committee (CREC) at Brunel University London. All participants will be provided with a participant information sheet with online consent before undertaking the survey, and there will be no incentive payment of any form to participants. Participants will remain anonymous throughout. No funding has been received for this study. Findings of the study will be presented in local, national and international platforms and published in peer reviewed journals. Published results will also be shared though various clinical forums for multidisciplinary staff, such as CAPHR and NIHR-CLHARC.

Clinical outcomes for moderate and severe stroke survivors receiving early supported discharge: A quasi-experimental cohort study

2020 ◽  
Vol 83 (11) ◽  
pp. 680-689
Author(s):  
Kathleen Leach ◽  
Sharon Neale ◽  
Sarah Steinfort ◽  
Danielle Hitch
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Standard Treatment ◽  
Functional Independence ◽  
Control Group ◽  
Stroke Survivors ◽  
Severe Stroke ◽  
Early Supported Discharge ◽  
Significant Difference ◽  
Quasi Experimental

Introduction The aim of this study was to compare outcomes for functional independence, activities of daily living participation and balance achieved by moderate and severe stroke survivors receiving an early supported discharge model of care with those receiving standard treatment. Method A quasi-experimental cohort method was utilised, with a control group of convenience. Forty-one patients ( n = 28 early supported discharge group, n = 13 control group) who were medically stable post stroke, safe for discharge home, able to be treated in the home environment and requiring intensive rehabilitation from at least two disciplines participated. Results There was no significant difference in outcomes between early supported discharge and control groups for functional independence, activities of daily living participation or balance from baseline to 4 weeks, or 4 weeks to 8 weeks. However, patients receiving early supported discharge made further improvements across the study period, while those receiving standard care made limited improvement between 4 weeks and 8 weeks. All minimal clinically important differences on outcome measures were identified between baseline and 4 weeks. Conclusions Moderate and severe stroke survivors can achieve comparable outcomes when receiving early supported discharge or standard treatment. Early supported discharge models of care may also enhance ongoing improvement during the early phases of stroke recovery.

scholarly journals Spatial Neglect in Stroke: Identification, Disease Process and Association with Outcome During Inpatient Rehabilitation

2019 ◽  
Vol 9 (12) ◽  
pp. 374 ◽  
Author(s):  
Ulrike Hammerbeck ◽  
Matthew Gittins ◽  
Andy Vail ◽  
Lizz Paley ◽  
Sarah F Tyson ◽  
...  
Keyword(s):  
Service Provision ◽  
Disease Process ◽  
Inpatient Rehabilitation ◽  
Spatial Neglect ◽  
Future Research ◽  
Stroke Survivors ◽  
Inpatient Stay ◽  
Comparable Amount ◽  
Severe Stroke ◽  
Mild Stroke

We established spatial neglect prevalence, disease profile and amount of therapy that inpatient stroke survivors received, and outcomes at discharge using Sentinel Stroke National Audit Programme (SSNAP) data. We used data from 88,664 National Health Service (NHS) admissions in England, Wales and Northern Ireland (July 2013–July 2015), for stroke survivors still in hospital after 3 days with a completed baseline neglect National Institute for Health Stroke Scale (NIHSS) score. Thirty percent had neglect (NIHSS item 11 ≥ 1) and they were slightly older (78 years) than those without neglect (75 years). Neglect was observed more commonly in women (33 vs. 27%) and in individuals with a premorbid dependency (37 vs. 28%). Survivors of mild stroke were far less likely to present with neglect than those with severe stroke (4% vs. 84%). Those with neglect had a greatly increased length of stay (27 vs. 10 days). They received a comparable amount of average daily occupational and physiotherapy during their longer inpatient stay but on discharge a greater percentage of individuals with neglect were dependent on the modified Rankin scale (76 vs. 57%). Spatial neglect is common and associated with worse clinical outcomes. These results add to our understanding of neglect to inform clinical guidelines, service provision and priorities for future research.

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