Integrated multidisciplinary assessment of cerebral stroke outcome after treatment in a comprehensive stroke unit

Objective – to explore the possibility of integral assessment of the stroke outcome and to develop a method of integral assessment of the stroke outcome after in-patient treatment on the level of impairment and and the level of activities of daily living, which were assessed using rating scales and indices.Materials and methods. The study was conducted at the Stroke Center (SC), Oberig’ multidisciplinary hospital division, which operates according to the principles of Comprehensive Stroke Unit. Patients with a cerebral stroke who were admitted to the SC in 2010–2018 were enrolled. The data of the participants were prospectively entered into a special database and included discharge assessments using 8 valid rating scales and indices. Cluster analysis methods (in particular Kohonen neural networks) were used to design the integral assessment. Statistical analysis of the values of the rating scales and indices in the selected clusters was performed using the Kruskal–Wallis criterion, post hoc comparisons were made using the Dunn multiple comparison criterion.Results. 852 patients (42.5 % women and 57.5 % men, median age – 66.7 year) were enrolled. 81 % of patients were diagnosed with ischemic stroke, and 19 % had hemorrhagic stroke. According to the chosen method, it is necessary and sufficient to split the data into 4 clusters. All participants in the study according to their assessments at discharge using the set of selected measures could be assigned to one of 4 isolated clusters: K1 (n = 366), K2 (n = 93), K3 (n = 104) or K4 (n = 289). National Institutes of Health Stroke Scale, modified Rankin scale, Barthel Index, Berg Balance Scale та Functional Ambulation Classification were the most significant determinants of the patient cluster. For the 5 measures there have been significant differences (p < 0.001) in the four clusters. The condition of the patients in K4 cluster was the best (p < 0.05), whereas the patients in the K1 cluster were worse (p < 0.05), and the condition of the patients in the clusters K2 and K3 was much worse (p < 0.05) compared with the cluster K4.Conclusions. Based on the integrated assessments of neurological impairments and activities of daily living all of stroke patients could be assigned to one of four identified clusters. Detecting predictors of poor outcome after in-patient management may help to find ways to improve their prognosis.

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Functional recovery and instrumental activities of daily living: follow-up 1-year after treatment in a stroke unit

Brain Injury ◽

10.1080/02699050110103337 ◽

2002 ◽

Vol 16 (3) ◽

pp. 207-216 ◽

Cited By ~ 34

Author(s):

Francisco Javier Carod-Artal ◽

José Luis González-Gutiérrez ◽

José Antonio Egido Herrero ◽

Thomas Horan ◽

Eduardo Varela De Seijas

Keyword(s):

Activities Of Daily Living ◽

Functional Recovery ◽

Daily Living ◽

Stroke Unit ◽

Instrumental Activities

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Concurrent and Construct Validity of Scores on the Timed Movement Battery

Physical Therapy ◽

10.1093/ptj/81.2.789 ◽

2001 ◽

Vol 81 (2) ◽

pp. 789-798 ◽

Cited By ~ 34

Author(s):

Gwenda L Creel ◽

Kathye E Light ◽

Mary T Thigpen

Keyword(s):

Construct Validity ◽

Activities Of Daily Living ◽

Barthel Index ◽

Daily Living ◽

Assessment Tool ◽

Berg Balance Scale ◽

Community Dwelling ◽

Movement Speed ◽

Elderly Individuals ◽

Balance Scale

Abstract Background and Purpose. The Timed Movement Battery (TMB) is a new assessment tool designed to measure mobility in elderly individuals. “Mobility” was defined as a person's ability to maneuver his or her body independently in order to accomplish everyday tasks. The purpose of this study was to assess the concurrent and construct validity of scores obtained with the TMB as a measure of mobility in a group of elderly individuals who reported moderate or no difficulty in performing either basic or instrumental activities of daily living (BADL or IADL). Subjects. Thirty community-dwelling elderly people, with a mean age of 77.5 years (SD=7.0, range=65–92), participated in this study. Methods. Subjects responded to 2 questionnaires regarding their activities of daily living (ADL) (ie, Barthel Index and an 18-item ADL/IADL scale) and completed 3 assessments of mobility (ie, Berg Balance Scale, Timed “Up & Go” Test, and the TMB). Subjects were asked to perform the items on the TMB at a “self-selected” speed (their normal speed) and at a “maximum-movement” speed (as quickly as they could safely perform the items). Subjects' scores on the TMB were cross-correlated with data for 4 criterion tests (ie, Berg Balance Scale, Timed “Up & Go” Test, Barthel Index, and the 18-item ADL/IADL scale) using Spearman rank correlations and Pearson product moment correlations. Results. Composite scores of the TMB performed at self-selected speeds correlated highly with data for the criterion tests and differentiated between those subjects reporting difficulty with ADL and those reporting no difficulty. Conclusion and Discussion. These results support the validity of scores obtained with the TMB as a measure of mobility in this sample of elderly individuals with moderate or no reported difficulty with ADL.

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Stroke outcome prediction using reciprocal number of initial activities of daily living status

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2004.10.001 ◽

2005 ◽

Vol 14 (1) ◽

pp. 8-11 ◽

Cited By ~ 24

Author(s):

Shigeru Sonoda ◽

Eiichi Saitoh ◽

Shota Nagai ◽

Yuko Okuyama ◽

Toru Suzuki ◽

...

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Outcome Prediction ◽

Stroke Outcome

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Stroke Unit Versus General Medical Wards, II: Neurological Deficits and Activities of Daily Living

Stroke ◽

10.1161/01.str.29.3.586 ◽

1998 ◽

Vol 29 (3) ◽

pp. 586-590 ◽

Cited By ~ 72

Author(s):

Ole Morten Rønning ◽

Bjørn Guldvog

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Stroke Unit ◽

Neurological Deficits ◽

Medical Wards

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Protocol for PD SENSORS: Parkinson’s Disease Symptom Evaluation in a Naturalistic Setting producing Outcome measuRes using SPHERE technology. An observational feasibility study of multi-modal multi-sensor technology to measure symptoms and activities of daily living in Parkinson’s disease

BMJ Open ◽

10.1136/bmjopen-2020-041303 ◽

2020 ◽

Vol 10 (11) ◽

pp. e041303

Author(s):

Catherine Morgan ◽

Ian Craddock ◽

Emma L Tonkin ◽

Kirsi M Kinnunen ◽

Roisin McNaney ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Activities Of Daily Living ◽

Outcome Measures ◽

Daily Living ◽

Rating Scales ◽

Activity Level ◽

Small Scale ◽

Clinical Rating ◽

Sensor Platform

IntroductionThe impact of disease-modifying agents on disease progression in Parkinson’s disease is largely assessed in clinical trials using clinical rating scales. These scales have drawbacks in terms of their ability to capture the fluctuating nature of symptoms while living in a naturalistic environment. The SPHERE (Sensor Platform for HEalthcare in a Residential Environment) project has designed a multi-sensor platform with multimodal devices designed to allow continuous, relatively inexpensive, unobtrusive sensing of motor, non-motor and activities of daily living metrics in a home or a home-like environment. The aim of this study is to evaluate how the SPHERE technology can measure aspects of Parkinson’s disease.Methods and analysisThis is a small-scale feasibility and acceptability study during which 12 pairs of participants (comprising a person with Parkinson’s and a healthy control participant) will stay and live freely for 5 days in a home-like environment embedded with SPHERE technology including environmental, appliance monitoring, wrist-worn accelerometry and camera sensors. These data will be collected alongside clinical rating scales, participant diary entries and expert clinician annotations of colour video images. Machine learning will be used to look for a signal to discriminate between Parkinson’s disease and control, and between Parkinson’s disease symptoms ‘on’ and ‘off’ medications. Additional outcome measures including bradykinesia, activity level, sleep parameters and some activities of daily living will be explored. Acceptability of the technology will be evaluated qualitatively using semi-structured interviews.Ethics and disseminationEthical approval has been given to commence this study; the results will be disseminated as widely as appropriate.

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Impact of Strengthening and Proprioceptive Exercises on Balance and Activities of Daily Living (ADLS) In Knee Osteoarthritis Patients from West Delhi, Indianpopulation

International Journal of Pharmaceutical and Bio-Medical Science ◽

10.47191/ijpbms/v1-i8-04 ◽

2021 ◽

Vol 01 (08) ◽

Author(s):

Sudhakar Viswas ◽

Keyword(s):

Knee Osteoarthritis ◽

Activities Of Daily Living ◽

Daily Living ◽

Study Groups ◽

Berg Balance Scale ◽

Joint Disease ◽

Endurance Range ◽

Ethical Approval ◽

Spss Software ◽

The Impact

Background: Knee osteoarthritis (OA)is a chronic joint disease, primarily occurring in aged population. Rehabilitation of knee osteoarthritis aims to reduce pain and disability by strengthening, raising endurance, range of motion, proprioception and improving aerobic fitness. Aim and Objectives: This study aimed to analyse and compare the impact of strengthening and proprioceptive exercises on balance and activities of daily living in knee OAin population of west Delhi, India. Material & Methods- Thirty OA patients were enrolled from Khetarpal hospital, Delhi, after taking ethical approval and informed consent. A study was explained to subjects and data was obtained as per proforma. Age of patients ranged from 50-80 years. Diagnosis was established based on radiological examination shown in the knee joint X-ray. Statistical analysis was performed by using SPSS software (Version 26). Results- Patients treated with the strengthening and proprioceptive exercises showed t-value on Berg balance scale(BBS)as -16.12 and 13.15 respectively, and the parameter of Knee Injury and Osteoarthritis Outcome Score (KOOS) showed -13.21 and 13.481 respectively, were statistically significant. Conclusion-The study groups showed, both the exercises helped reduce pain and improved the balance of daily-based activities. Furthermore, both the groups showed a significant improvement in BBS and KOOS scales.

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Predictors of dependency in post-discharge activities of daily living among stroke in-patients managed in a comprehensive stroke unit

INTERNATIONAL NEUROLOGICAL JOURNAL ◽

10.22141/2224-0713.5.107.2019.176707 ◽

2019 ◽

Vol 0 (5.107) ◽

pp. 52-61

Author(s):

Yu.V. Flomin ◽

V.H. Huryanov ◽

O.L. Kushnerenko ◽

I.R. Gavryliv ◽

M.V. Gulyayeva ◽

...

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Stroke Unit ◽

Post Discharge

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Dependency in Activities of Daily Living During the First Year After Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.736684 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hannah E. Wurzinger ◽

Tamar Abzhandadze ◽

Lena Rafsten ◽

Katharina S. Sunnerhagen

Keyword(s):

Logistic Regression ◽

Activities Of Daily Living ◽

Daily Living ◽

Stroke Unit ◽

Binary Logistic Regression ◽

Early Discharge ◽

University Hospital ◽

Regression Analyses ◽

Patient Centered ◽

Post Stroke

Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation.Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke.Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed.Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke.Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.

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