Admission in Neurorehabilitation and Association with Functional Outcomes after Stroke in France: A Nation-Wide Study, 2010-2014

Gabet, Amélie; Peretti, Christine de; Woimant, F.; Giroud, M.; Béjot, Yannick; Schnitzler, A.; Olié, Valérie

doi:10.1016/j.jstrokecerebrovasdis.2018.08.005

Cited by 6 publications

(8 citation statements)

References 22 publications

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“…The greater efficiency of rehabilitation in the conditions of a specialized inpatient department [12] was proved and it was demonstrated that to a large extent the effectiveness of rehabilitation measures depended on the functional state of patients at the beginning of the disease [13,14]. This was demonstrated in our study too, namely from the level of neurological deficit according to NIHSS (P ˂ 0.01).…”

Section: Discussionsupporting

confidence: 62%

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Мєдвєдкова

Dronova

2021

Patologìâ

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The aim of our study was the investigation of the dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke (HHS) in the recovering period of the disease by comprehensive neurological, medical and social research. Materials and methods. 90 patients in the age from 38 to 70 years were studied, 58 men – 64.4 % and 32 women – 35.6 %. The condition of the patients was evaluated by NIHSS, mRS, BI and MSA on the 30th, 180th, 360th day of HHS. Depending on their self-care recovering level the patients were divided in two groups for analysis: the first one was formed with the patients whose self-care level completely was restored on the 360th day (ВІ = 100), and the second one was formed with the patients with BI 95 and less on the 360th day. Results. Structure of indicators according to NIHSS, mRS, ВІ and MSA on the 30th day of disease in these groups was analyzed during rehabilitation, as well as distribution of the patients based on their gender and process lateralization. Analyzing the data of the dynamics of the recovery period of HHS depending on the lateralization of the process and the sex of patients, we can notice that there was no significant difference during the recovery period of HHS depending of the lateralization of the process, for example, in patients with the damaged dominant hemisphere median score of BI was 70 points on the 30th day, patients with the lesion of subdominant hemisphere – 65, and on the 360th days in both groups it was 95 points. There was also no significant difference in the dynamics of neurological deficit and recovery of functional activity depending on the gender of patients. On the 30th day of the disease in the group of patients who fully restored their daily activity on the 360th day of HHS a significantly higher score for BI was determined than in the group with incomplete recovery (80 (70; 85) points against 55 (45; 65) points (P ˂ 0.05)). Although a significantly greater regression of functional disorders was found in the second group of patients (P ˂ 0.05). An analysis of the impact of spasticity on the recovery of self-care level showed a significant negative impact of increased muscle tone on the recovery of self-care (P ˂ 0.05) and reduction of the probability of complete recovery of independence in everyday life with increasing degree of spasticity (P ˂ 0.05). At the same time, no significant factors (sex, age, side of the lesion, etc.) were identified that would affect the development of spasticity in patients with HHS, except for the level of neurological deficit according to NIHSS. When we analyzed the distribution of patients in these two groups by sex, it was revealed that the groups didn't have any significant difference. There was also no significant difference in the study's groups depending of the lateralization of the stroke. Conclusions. It was found that on the 30th day of the disease in 35.6 % of patients the total score on NIHSS ranged from 2 to 6 points, 55.6 % of patients had mRS of 3 points and 48.9 % of patients had severe dependent of outside help in daily life by BI. Significant positive dynamics of recovery on NIHSS, mRS, BI scales on the 180th and 360th day of the disease (P ˂ 0.05) was revealed. The dependence of the indicators of the level of self-care on the 360th day of HHS, on the severity of stroke on the 30th day of the disease (P ˂ 0.01) and on the presence of manifestations of increased muscle tone was established. It was found that patients who had manifestations of spasticity on the 360th day of the disease had a significantly higher score for NIHSS at the onset of the disease, on the 30th day of the disease and on the 360th day of the disease than patients without manifestations of increased muscle tone (P ˂ 0.05). However, no interconnection was found between the indicators of the level of self-care on the 360th day of HHS and the lateralization of the process as well as the sex of patients.

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Section: Discussionsupporting

confidence: 62%

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Мєдвєдкова

Dronova

2021

Patologìâ

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“…In-hospital mortality risks were reduced by 80% in the thrombolysis-only group with a median follow-up time of 9 days, and 89% in the EVT group with 11 days. General post-stroke rehabilitation has been shown to be associated with lower mortality risk with volume-dependent effect in patients with ischemic stroke, but these were retrospective studies including patients with and without intravenous thrombolysis ( 6 , 20 , 21 ). Numerous reports demonstrated that r-tPA and EVT improved the functional outcome but did not lower the mortality of the reperfusion group ( 4 , 16 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Association between rehabilitation after reperfusion treatment and in-hospital mortality: Results from a national registry study

Fang

Zhang

et al. 2022

Front. Neurol.

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BackgroundThere is no effective regimen to reduce the mortality of patients treated with intravenous thrombolysis or endovascular therapy (EVT). Therefore, we aimed to examine whether sequential therapy by rehabilitation could effectively reduce the in-hospital mortality of patients treated with reperfusion therapy.MethodsThis prospective registry study included patients with ischemic stroke who were treated by intravenous thrombolysis or endovascular therapy at Stroke Center Work Plan in China between 1 October 2018 and 31 July 2020. The patients were divided into 2 groups: those with (IRT+) or without (IRT–) inpatient rehabilitation therapy (IRT). The primary outcome was all-cause in-hospital mortality. We used Cox proportional hazards models and conducted a propensity score matching analysis to calculate hazard ratios (HRs) for mortality in the thrombolysis-only and EVT groups.ResultsOf the 189,519 patients in the thrombolysis-only group, 35.7% were women, and the median (interquartile range, IQR) age, onset-to-needle time, and follow-up time were 66 (57–74) years, 165 (119–220) min, and 9 (5–12) days, respectively. Among the 45,211 patients in the EVT group, 35.9% were women, and the median (interquartile range, IQR) age, onset-to-puncture time, and follow-up time were 66 (56–74) years, 297 (205–420) min, and 11 (6–16) days, respectively. In the thrombolysis-only group with a median (IQR) initial National Institutes of Health Stroke Scale (NIHSS) score of 6 (3–11), 105,244 patients (55.5%) treated with IRT had significantly lower all-cause in-hospital mortality [0.6 vs. 2.3%; adjusted HR 0.18 (95% confidence interval (CI) 0.16–0.2)] than those without IRT. In the EVT group with a median (IQR) initial NIHSS score of 15 (10–20), 31,098 patients (68.8%) treated with IRT also had significantly lower all-cause in-hospital mortality [2 vs. 12.1%; adjusted HR, 0.13 (95% CI 0.12–0.15)]. IRT remained significantly associated with reduced in-hospital mortality in sensitivity, subgroup, and propensity score matching analyses among both the thrombolysis-only and EVT groups.ConclusionAmong the patients with ischemic stroke treated with intravenous thrombolysis or endovascular therapy, sequential therapy by rehabilitation was associated with lower all-cause in-hospital mortality. These findings suggest the necessity of promoting inpatient rehabilitation therapy after reperfusion in patients with ischemic stroke.

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“…Moreover, factors other than socio-environmental variables may influence discharge destination. In included studies, socio-environmental factors were combined with age, gender, functional status measured with the Functional Independence Measure (FIM), sitting balance, postural stability, or the presence of multiple comorbidities [26,29,38,47,48,53,60]. Functional status assessed with the FIM was also evaluated in a previous systematic review [2] that showed the positive impact of increased FIM scores on discharge home in patients with stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies [45,58] found a relation between higher numbers of family members and discharge home, whereas two other ones [13,59] found no significant difference regarding the number of family members. Finally, one study [60] compared rehabilitation outcome in a neurological unit with a geriatric and general unit and found that patients receiving neurological rehabilitation had a greater likelihood of returning home (OR 1.38, 95%CI 1.29-1.47) (Table 4).…”

Section: Further Factorsmentioning

confidence: 99%

Socio-environmental predictive factors for discharge destination after inpatient rehabilitation in patients with stroke: a systematic review and meta-analysis

Chevalley

Truijen

Saeys

et al. 2021

Disability and Rehabilitation

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Purpose: To identify which of the socio-environmental factors of patients with stroke are predictive for discharge to their home after inpatient rehabilitation. Because discharge planning is a key component of rehabilitation, it is important to recognize the predictive factors for a discharge home. Other systematic reviews demonstrated the value of functional outcome measures. This review adds to the current literature by assessing the predictive value of socio-environmental factors, which shape the context in which a person lives. Methods: We performed a systematic search in seven databases. Two independent reviewers selected studies and assessed them for methodological quality. We extracted data to estimate pooled odds ratio for household situation, social support, ethnicity and socioeconomic status. Results: Forty studies were included. Significant estimates were found for living with others (OR 2.60; 95%CI 1.84-3.68), having support at home (OR 11.48; 95%CI 6.52-20.21), being married (OR 2.05; 95%CI 1.80-2.33) and living at home before stroke (OR 31.01;. Conclusion:Living at home and benefiting from social support, including living with others, are important factors to consider during discharge planning after stroke. Further research should consider the impact of socioeconomic status. ä IMPLICATIONS FOR REHABILITATIONEvaluating the social and environmental factors of patients with stroke plays an important role in discharge planning. Next to functional status, caregiver availability (support at home) is among the strongest predictive factors for discharge home. To assess caregiver availability, the presence of a willing and able caregiver should be surveyed at admission. Further predictive factors for discharge home are cohabitation and marital status.

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Admission in Neurorehabilitation and Association with Functional Outcomes after Stroke in France: A Nation-Wide Study, 2010-2014

Cited by 6 publications

References 22 publications

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Association between rehabilitation after reperfusion treatment and in-hospital mortality: Results from a national registry study

Socio-environmental predictive factors for discharge destination after inpatient rehabilitation in patients with stroke: a systematic review and meta-analysis

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