Predictors of functional outcome in first-ever ischemic stroke: A special interest to ischemic subtypes, comorbidity and age

Turhan, Nur; Atalay, Ayçe; Müderrisoğlu, Haldun

doi:10.3233/nre-2009-0485

Cited by 32 publications

(24 citation statements)

References 19 publications

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“…Although there is little data published on predictors of dysphagia recovery in stroke patients, baseline NIHSS score [32], stroke lesion volume [33], and age [34] have been found to be important factors influencing functional recovery in stroke patients and were included in the analysis; since swallowing functions in our patients were expected to recover over time, time-to-stimulation was also included in our analysis. Our model shows that baseline NIHSS, DOSS scores and anodal tDCS were associated with improvement.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Brain Stimulation May Improve Stroke-Related Dysphagia

Kumar

Wagner

Frayne

et al. 2011

Stroke

158

152

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Background and purpose Treatment options for stroke related dysphagia are currently limited. In this study we investigated whether non-invasive brain stimulation in combination with swallowing maneuvers facilitates swallowing recovery in dysphagic stroke patients during early stroke convalescence. Methods Fourteen patients with subacute unilateral hemispheric infarction were randomized to anodal transcranial direct current stimulation (tDCS) versus sham stimulation to the sensorimotor cortical representation of swallowing in the unaffected hemisphere over 5 consecutive days with concurrent standardized swallowing maneuvers. Severity of dysphagia was measured using a validated swallowing scale, Dysphagia Outcome and Severity Scale (DOSS), before the first and after the last session of tDCS or sham. The effect of tDCS was analyzed in a multivariate linear regression model using changes in DOSS as the outcome variable, after adjusting for the effects of other potential confounding variables such as the NIH Stroke Scale (NIHSS) and DOSS scores at baseline, acute ischemic lesion volumes, patient’s age and time from stroke onset to stimulation. Results Patients who received anodal tDCS gained 2.60 points improvement in DOSS scores compared to patients in the sham stimulation group who showed an improvement of 1.25 points (P=0.019) after controlling for the effects of other aforementioned variables. 6 out 7 (86%) patients in tDCS stimulation group gained at least 2 points improvement compared with 3 out 7 (43%) patients in sham group (P=0.107). Conclusion Since brainstem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brainstem swallowing may be beneficial for dysphagia recovery.

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Section: Discussionmentioning

confidence: 99%

Noninvasive Brain Stimulation May Improve Stroke-Related Dysphagia

Kumar

Wagner

Frayne

et al. 2011

Stroke

158

152

View full text Add to dashboard Cite

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“…29 Age was entered as a continuous variable. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, and other.…”

Section: Methodsmentioning

confidence: 99%

Geographic and Facility Variation in Inpatient Stroke Rehabilitation: Multilevel Analysis of Functional Status

Reistetter

Kuo

Karmarkar

et al. 2015

Archives of Physical Medicine and Rehabilitation

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Objective Examine geographic and facility variation in cognitive and motor functional outcomes following post-acute inpatient rehabilitation in patients with stroke. Design Retrospective cohort design using Centers for Medicare and Medicaid Services (CMS) claims files. Records from 1,209 rehabilitation facilities in 298 hospital referral regions (HRRs) were examined. 145,460 inpatient records from 2006 through 2009 were analyzed using linear mixed models. Multilevel models were used to calculate the variation in outcomes attributable to facilities and geographic regions. Setting Inpatient rehabilitation units and facilities in the United States. Intervention Not applicable. Main Outcome Measure Cognitive and motor functional status at discharge measured by items in the CMS Inpatient Rehabilitation Facility-Patient Assessment Instrument. Results Variation profiles indicated that 19.1% of rehabilitation facilities were significantly below the mean functional status rating (81.58, sd=22.30) with 221 facilities (18.3%) above the mean. Total discharge functional status ratings varied by 3.57 points across regions. Across facilities functional status values varied by 29.2 points with a 9.1 point difference between the top and bottom deciles. Variation in discharge motor function attributable to hospital referral region was reduced 82% after controlling for cluster effects at the facility level. Conclusions Our findings suggest that variation in motor and cognitive function at discharge following post-acute rehabilitation in patients with stroke is accounted for more by facility than geographic location.

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“…Demographic variables known to influence rehabilitation outcomes 46;47 were used as covariates. These factors included age, gender, race/ethnicity, marital status, and insurance status.…”

Section: Methodsmentioning

confidence: 99%

Regional Variation in Stroke Rehabilitation Outcomes

Reistetter

Karmarkar

Graham

et al. 2014

Archives of Physical Medicine and Rehabilitation

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Objective To examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation. Design Retrospective cohort design. Setting Inpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation (UDSMR) from the United States. Participants 143,036 patients with stroke discharged from inpatient rehabilitation during 2006 and 2007. Interventions Not applicable. Main Outcome Measures Community discharge, length of stay, discharge functional status ratings (motor, cognitive), across ten geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS). Results Approximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the southwest (CMS 9) to 59.4% in the northeast (CMS 2). Adjusted length of stay varied by 2.1 days with CMS 1 having the longest length of stay at 18.3 days and CMS 5 and 9 being the shortest at 16.2 days. Conclusion Rehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and length of stay remained after adjusting for demographic and clinical characteristics.

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Predictors of functional outcome in first-ever ischemic stroke: A special interest to ischemic subtypes, comorbidity and age

Cited by 32 publications

References 19 publications

Noninvasive Brain Stimulation May Improve Stroke-Related Dysphagia

Noninvasive Brain Stimulation May Improve Stroke-Related Dysphagia

Geographic and Facility Variation in Inpatient Stroke Rehabilitation: Multilevel Analysis of Functional Status

Regional Variation in Stroke Rehabilitation Outcomes

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