Stroke Severity and The Risk of Depression among Post-Stroke Patients: A Meta-Analysis

Introduction Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). Methods The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Results Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. Conclusions In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

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THE EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE THERAPY TO REDUCE SPASTICITY OF LOWER LIMB FOR POST–STROKE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

10.26226/morressier.5ab8f564d462b8029238d2d0 ◽

2018 ◽

Author(s):

Rosa Cabanas Valdés

Keyword(s):

Systematic Review ◽

Shock Wave ◽

Lower Limb ◽

Meta Analysis ◽

Extracorporeal Shock Wave Therapy ◽

Shock Wave Therapy ◽

Stroke Patients ◽

Post Stroke ◽

Extracorporeal Shock Wave

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The Impact of Immersive and Non-Immersive Virtual Reality Trends in Sensorimotor Recovery of Post-Stroke Patients-A Meta-Analysis

Journal of Intellectual Disability - Diagnosis and Treatment ◽

10.6000/2292-2598.2021.09.05.14 ◽

2021 ◽

Vol 9 (5) ◽

pp. 555-564

Author(s):

Jaza Rizvi ◽

◽

Abid Khan ◽

Sumaira Imran Farooqui ◽

Bashir Ahmed Soomro ◽

...

Keyword(s):

Virtual Reality ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Stroke Patients ◽

Post Stroke ◽

Randomized Controlled ◽

Sensorimotor Recovery ◽

The Impact

Virtual Reality (VR) is an approach in stroke rehabilitation with ever-improving technological advancement for targeted motor rehabilitation by providing a user interface in a simulated environment with proprioceptive and visual feedback. This meta-analysis intended to evaluate the impact of immersive and non-immersive VR-based interventions compared to conventional rehabilitation in sensorimotor recovery following stroke. Randomized Controlled Trials based on the impact of VR, either immersive or non-immersive type in comparison to conventional rehabilitation on post-stroke patients (>18 years) sensorimotor recovery were searched on six databases including Google Scholar, PEDro, MEDLINE, Cochrane Library, EMBASE, and Web of Science from August to November 2020. A total of 17 randomized controlled trials on VR based intervention showed significant improvement in sensorimotor recovery following a stroke in overall FMA outcomes in comparison to the control group with pool effects in terms of SMD in a random effect model showed an impact of 0.498 at 95% CI (p<0.001) depicts a moderate effect size. An immersive and non-immersive emerging VR trend appears to be a promising therapeutic tool in sensorimotor recovery following stroke.

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Rehabilitation Effort to Improve Upper Extremity Function in Post-Stroke Patients: A Meta-Analysis

Journal of Physical Therapy Science ◽

10.1589/jpts.13.5 ◽

2001 ◽

Vol 13 (1) ◽

pp. 5-9 ◽

Cited By ~ 20

Author(s):

Koichi Hiraoka

Keyword(s):

Upper Extremity ◽

Meta Analysis ◽

Stroke Patients ◽

Post Stroke ◽

Extremity Function ◽

Upper Extremity Function

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Vitamin D and Rehabilitation after Stroke: Status of Art

Applied Sciences ◽

10.3390/app10061973 ◽

2020 ◽

Vol 10 (6) ◽

pp. 1973 ◽

Cited By ~ 1

Author(s):

Mariacristina Siotto ◽

Massimo Santoro ◽

Irene Aprile

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Stroke Recovery ◽

Stroke Severity ◽

Nucleotide Polymorphisms ◽

Stroke Patients ◽

Vitamin D Metabolism ◽

Rehabilitation Treatment ◽

Post Stroke ◽

Vitamin D Levels

Stroke is the first cause of disability in the population and post-stroke patients admitted to rehabilitation units often present a malnutrition status which can influence nutritional indices and then vitamin levels. Vitamin D deficiency seems implicated beyond stroke severity and stroke risk, and also affects post-stroke recovery. Some studies on vitamin D levels and outcome in stroke patients are available but very few data on vitamin D levels and outcome after rehabilitation treatment are reported. This literature review shows the possible relationship between vitamin D deficiency and recovery in post-stroke patients undergoing rehabilitation treatment. Moreover, because several studies have reported that single nucleotide polymorphisms and promoter methylation in genes are involved in vitamin D metabolism and might affect circulating vitamin D levels, these aspects are evaluated in the current paper. From the studies evaluated in this review, it emerges that vitamin D deficiency could not only have an important role in the recovery of patients undergoing rehabilitation after a stroke, but that genetic and epigenetic factors related to vitamin D levels could have a crucial role on the rehabilitation outcome of patients after stroke. Therefore, further studies are necessary on stroke patients undergoing rehabilitation treatment, including: (a) the measurement of the 25(OH) vitamin D serum concentrations at admission and post rehabilitation treatment; (b) the identification of the presence/absence of CYP2R1, CYP27B1, CYP24A1 and VDR polymorphisms, and (c) analysis of the methylation levels of these genes pre- and post-rehabilitation treatment.

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WMH and long-term outcomes in ischemic stroke

Neurology ◽

10.1212/wnl.0000000000007142 ◽

2019 ◽

Vol 92 (12) ◽

pp. e1298-e1308 ◽

Cited By ~ 24

Author(s):

Marios K. Georgakis ◽

Marco Duering ◽

Joanna M. Wardlaw ◽

Martin Dichgans

Keyword(s):

Ischemic Stroke ◽

Functional Impairment ◽

Recurrent Stroke ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Stroke Recurrence ◽

Stroke Severity ◽

Stroke Patients ◽

Increased Risk

ObjectiveTo investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality.MethodsFollowing the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle–Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models.ResultsWe included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72–2.73), cognitive impairment (RR 2.29, 95% CI 1.48–3.54), functional impairment (RR 2.21, 95% CI 1.83–2.67), any recurrent stroke (RR 1.65, 95% CI 1.36–2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26–2.88), all-cause mortality (RR 1.72, 95% CI 1.47–2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44–2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias.ConclusionsPresence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.

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