Measuring Stroke Survivors’ Functional Status Independence: Five Perspectives

Shih, Minmei; Rogers, Joan C.; Skidmore, Elizabeth R.; Irrgang, James J.; Holm, Margo B.

doi:10.5014/ajot.63.5.600

Cited by 16 publications

(13 citation statements)

References 25 publications

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“…Since patients' clinical characteristics could have different impacts on rtPA treatment irrespective of whether stroke patients receive rtPA in the SSU or NSU, this study investigated the effect of demographic and clinical risk factors on rtPA-treated stroke patients and improved functional outcomes in the NSU and the SSU. Functional outcomes after stroke treatment is generally assessed using different variables including mRS or the Barthel Index (BI) (Shih et al, 2009;Kasner, 2006;Lees et al, 2012). The current study used quantified functional ambulation based on the performance or activities of daily living, such as mobility to determine improved functional outcomes in rtPA-treated stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

M.D.¹,

Blum²,

Brechtel³

et al. 2017

J Exp Stroke Transl Med

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Background-The disparities in stroke care between specialized stroke units and non-stroke units have been reported. While most of the existing studies investigated how intrinsic characteristics of specific treatment units have impact on the outcomes, the influence of patients' characteristics on functional outcomes of recombinant tissue plasminogen activator-treated patients in specialized stroke units and non-stroke units is not fully understood. Method-The demographic and clinical risk factors that significantly impact functional improvement outcomes in recombinant tissue plasminogen activator-treated acute ischemic stroke in the non-stroke unit and the specialized stroke unit were determined. Univariate analysis was used to determine improved functional differences, while adjusted multivariable models were used to determine the association between demographic and clinical variables on the functional outcome. Results-In stroke patients that received recombinant tissue plasminogen activator in the specialized stroke unit and the non-stroke unit, a history of previous transient ischemic attack (ORadj, 0.347, 95% CI (0.160, 0.752); p=0.007) and patients taking antiplatelet medications (ORadj, 1.954, 95% CI (1.116, 3.421, p=0.019) were significantly associated with improved functional outcome. Patients with a history of carotid artery stenosis (ORadj, 5.265, 95% CI (1.067, 2.977), p=0.041) and a history of transient ischemic attack (ORadj, 0.295, 95% CI (0.100, 0.872), p=0.027) were significantly associated with improved functional outcome following treatment with recombinant tissue plasminogen activator in the specialized stroke unit. In the adjusted model analysis for the non-stroke unit, the major predictors of functional outcome were: the NIH stroke scale (ORadj=1.381, 95% CI (1.086, 1.757), p=0.009), the risk of mortality (ORadj =0.691, 95% CI (0.518, 0.922) p=0.012), female gender (ORadj=0.306, 95% CI (0.120, 0.778), p=0.013), and race/ethnicity (ORadj=0.285, 95% CI (0.084, 0.970), p=0.045). Conclusion-After the adjusted analysis, the specialized stroke unit and non-stroke unit reveal significantly improved functional outcomes for patients treated with recombinant tissue plasminogen activator in few clinical variables. Values for functional outcomes were not significantly associated with most of the variables for treated patients in both the specialized stroke unit and non-stroke unit even after adjustment in the recombinant tissue plasminogen activator-treated stroke population.

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Section: Discussionmentioning

confidence: 99%

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

M.D.¹,

Blum²,

Brechtel³

et al. 2017

J Exp Stroke Transl Med

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“…For the present study, dependence in activities of daily living (ADL) was defined using the Barthel Index (BI) ≤60, Glasgow Outcome Scale (GOS) ≤3, and modified Rankin Scale (mRS) from 3 to 6. [ 16 , 17 ] Second outcomes included evacuation rate of hematoma, complications, operation time, and hospital stay.…”

Section: Methodsmentioning

confidence: 99%

Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage

et al. 2017

Medicine

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Background:In recent years, neuroendoscopy has been used as a method for treating intracerebral hemorrhages (ICHs). However, the efficacy and safety of neuroendoscopic surgery is still controversial compared with that of craniotomy. Our aim was to compare the outcomes of neuroendoscopic surgery and craniotomy in patients with supratentorial hypertensive ICH using a meta-analysis.Methods:We searched on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of eligible studies was evaluated and the related data were extracted by 2 reviewers independently. This study assessed clinical outcomes, evacuation rates, complications, operation time, and hospital stay for patients who underwent neuroendoscopic surgery (NE group) or craniotomy (craniotomy group).Results:Meta-analysis included 1327 subjects from verified studies of acceptable quality. There was no significant heterogeneity between the included studies based on clinical outcomes. Compared with craniotomy, neuroendoscopic surgery significantly improved clinical outcomes in both randomized controlled studies (RCTs) group (relative risk: 0.62; 95% confidence interval [CI], 0.47–0.81, P < .001) and non-RCTs group (relative risk: 0.84; 95% CI: 0.75–0.95, P = .005); decreased the rate of death (relative risk: 0.53; 95% CI, 0.37–0.76, P < .001) in non-RCTs group but not in RCTs group (relative risk: 0.58; 95% CI, 0.26–1.29, P = .18); increased evacuation rates in non-RCTs group (standard mean differences: 0.75; 95% CI, 0.24–1.26, P = .004) and had a tendency of higher evacuation rates in RCTs group (standard mean differences: 1.34; 95% CI, 0.01–2.68, P = .05); reduced the total risk of complications in non-RCTs group (relative risk: 0.45; 95% CI, 0.25–0.83, P = .01) and RCTs group (relative risk: 0.37; 95% CI, 0.28–0.49, P < .001); reduced the operation time in non-RCTs group (standard mean differences: 3.26; 95% CI: 1.20–5.33, P < .001) and RCTs group (standard mean differences: 4.37; 95% CI: 3.32–5.41, P < .001).Conclusions:Our results suggested that the NE group showed better clinical outcomes than the craniotomy group for patients with supratentorial hypertensive ICH. Moreover, the patients who underwent neuroendoscopy had a higher evacuation rate, lower risk of complications, and shorter operation time compared with those that underwent a craniotomy.

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“…The cutoff points of dependence in the activities of daily living scales were a Barthel Index (score of ≤60, modified Rankin Scale score of >2, and a Glasgow Outcome Scale score of ≤3. 25,26 However, in the Auer 1989 study, dependence was considered to be Grade 5 according to its own scale. 17 If there was more than one scale to evaluate the patients' functional outcome within one article, we first selected the Barthel Index as the assessment scale, then the modified Rankin Scale and Glasgow Outcome Scale.…”

Section: Data Extractionmentioning

confidence: 99%

Minimally Invasive Surgery for Spontaneous Supratentorial Intracerebral Hemorrhage

Zhou

Chen²,

Li³

et al. 2012

Stroke

201

120

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Background and Purpose— There has been a nonstandard surgical procedure and extensive international controversy in minimally invasive surgery (MIS) for the management of spontaneous supratentorial intracerebral hemorrhage. This meta-analysis assessed the effectiveness of MIS as compared with other treatment options, including conservative medical treatment and conventional craniotomy, in patients with supratentorial intracerebral hemorrhage. Methods— PubMed, Embase, Cochrane Controlled Trials Register (CCTR), Web of Science, European Association for Grey Literature Exploitation (EAGLE), National Technical Information Service (NTIS), Current Controlled Trials, Clinical Trials, International Clinical Trials Registry, Internet Stroke Center, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI) (last searched December 2011) were searched. Randomized controlled trials on MIS in patients with computed tomography-confirmed supratentorial intracerebral hemorrhage were included. We excluded low-quality randomized controlled trials. The death or dependence at the end of follow-up was defined as the primary outcome, and the death at the end of follow-up was defined as the secondary outcome. Results— The 313 randomized controlled trials met the included criteria. We only analyzed 12 high-quality randomized controlled trials involving 1955 patients. The quality of the included trials was consistently high. OR of the primary outcome and secondary outcome of MIS both showed significant reductions (OR, 0.54, P <0.00001; OR, 0.53, P <0.00001). Conclusions— Patients with supratentorial intracerebral hemorrhage may benefit more from MIS than other treatment options. The most likely candidates to benefit from MIS are both sexes, age of 30 to 80 years with superficial hematoma, Glasgow Coma Scale score of ≥9, hematoma volume between 25 and 40mL, and within 72 hours after onset of symptoms. Our study could help select appropriate patients for MIS and guide clinicians to optimize treatment strategies in supratentorial intracerebral hemorrhage.

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Measuring Stroke Survivors’ Functional Status Independence: Five Perspectives

Cited by 16 publications

References 25 publications

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage

Minimally Invasive Surgery for Spontaneous Supratentorial Intracerebral Hemorrhage

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