Shorter Interval between Onset and Admission to Convalescent Rehabilitation Wards Is Associated with Improved Outcomes in Ischemic Stroke Patients

Yoshimura, Yoshihiro; Wakabayashi, Hidetaka; Momosaki, Ryo; Nagano, Fumihiko; Shimazu, Sayuri; Shiraishi, Ai

doi:10.1620/tjem.252.15

Cited by 24 publications

(11 citation statements)

References 30 publications

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“…Multivariate logistic regression analysis revealed that age, duration from stroke onset to admission, living situation, and FIM motor score at admission were also associated with home discharge in subacute stroke patients. Previous studies have reported the association between discharge and age [8], duration from stroke onset to admission [14], social factors [7-9, 11, 15, 17], and FIM score [6, 8, 10, 16]; these ndings are consistent with our ndings. Therefore, it is essential to prepare for home discharge by assessing cognitive function and considering age, social factors, and ADL ability at admission in subacute stroke patients.…”

Section: Discussionsupporting

confidence: 93%

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Cognitive Function is a Predictor of Home Discharge in Subacute Stroke Patients: A Retrospective Cohort Study

Ito

Kawakami

Ishii

et al. 2022

Preprint

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Background: To investigate the cognitive function and its relation to home discharge of patients following subacute stroke.Methods: This retrospective cohort study included 1,229 convalescent patients experiencing first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariate logistic regression analysis to identify factors related to home discharge. Results: Of the 1,229 participants (mean age: 68.7±13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91–0.96; P<0.001), duration from stroke onset to admission (OR, 0.98; 95% CI, 0.96–0.99; P=0.003), living situation (OR, 4.40; 95% CI, 2.69–7.20; P<0.001), MMSE score at admission (OR, 1.05; 95% CI, 1.00–1.09; P=0.035), FIM motor score at admission (OR, 1.04; 95% CI, 1.01–1.06; P=0.001), and FIM cognitive score at admission (OR, 1.08; 95% CI, 1.04–1.13; P<0.001) were significantly associated with home discharge. Conclusions: MMSE at admission may be a useful indicator for predicting home discharge.

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Section: Discussionsupporting

confidence: 93%

“…Previous studies have reported factors related to home discharge in patients with subacute stroke [6][7][8][9][10][11][12][13][14][15][16][17][18]. In particular, many studies have consistently suggested that functional disability is related to home discharge.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Function is a Predictor of Home Discharge in Subacute Stroke Patients: A Retrospective Cohort Study

Ito

Kawakami

Ishii

et al. 2022

Preprint

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“…As a result, covariates selected to adjust bias included age, sex (male), LOS, CCI, FIM-motor, and FIM-cognitive on admission, FILS on admission, energy intake on admission, and total rehabilitation therapy (units/day), all of which were previously reported to be clinically relevant predictors of rehabilitation outcomes. [32][33][34][35][36] To reduce bias, adjustment for common confounders was performed via a series of multivariate analyses outcomes. Multicollinearity was assessed via variance in ation factor (VIF), with values ranging from 1 to 10 indicating the absence of multicollinearity.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

Matsumoto¹,

Yoshimura²,

Nagano³

et al. 2021

Preprint

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BackgroundEvidence is scarce regarding the polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine.AimTo investigate the prevalence and impact on outcomes of polypharmacy and PIMs in stroke rehabilitation.MethodsA retrospective cohort study was conducted with 849 older inpatients after stroke.Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included Functional Independence Measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay and the rate of home discharge. To consider the impact of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes.ResultsAfter enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = -0.072, P = 0.017), FIM-cognitive score (β = -0.077, P = 0.011), energy intake (β = -0.147, P = 0.004), and home discharge (OR: 0.499; 95% CI: 0.280, 0.802; P = 0.015). PIMs were negatively associated with energy intake (β = -0.066, P = 0.042) and home discharge (OR: 0.452; 95% CI: 0.215, 0.756; P = 0.005).ConclusionsPolypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy and PIMs are negatively associated with outcomes.

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“…The baseline patient demographic characteristics were recorded upon admission, including age, sex, body mass index, stroke type, stroke history, days from stroke onset to admission [ 17 ]; nutritional status, assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) [ 18 ]; swallowing status, assessed using the Food Intake Level Scale (FILS) and presence of dysphagia requiring supplemental feeding defined by the FILS scores <7 [ 19 ]; comorbidities, assessed using the Charlson Comorbidity Index (CCI) [ 20 ]; and premorbid ADL, assessed using the modified Rankin Scale (mRS) [ 21 ]. Information was collected on the presence of paralysis and localization and stage of paralysis according to the Brunnstrom recovery stages (BRS) [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Stored Energy Increases Body Weight and Skeletal Muscle Mass in Older, Underweight Patients after Stroke

Yoshimura¹,

Wakabayashi

Momosaki

et al. 2021

Nutrients

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We conducted a retrospective observational study in 170 older, underweight patients after stroke to elucidate whether stored energy was associated with gains in body weight (BW) and skeletal muscle mass (SMM). Energy intake was recorded on admission. The energy requirement was estimated as actual BW (kg) × 30 (kcal/day), and the stored energy was defined as the energy intake minus the energy requirement. Body composition was measured by bioelectrical impedance analysis. The study participants gained an average of 1.0 ± 2.6 kg of BW over a mean hospital stay of 100 ± 42 days with a mean stored energy of 96.2 ± 91.4 kcal per day. They also gained an average of 0.2 ± 1.6 kg of SMM and 0.5 ± 2.3 kg of fat mass (FM). This means about 9600 kcal were needed to gain 1 kg of BW. In addition, a 1 kg increase in body weight resulted in a 23.7% increase in SMM and a 45.8% increase in FM. Multivariate regression analyses showed that the stored energy was significantly associated with gains in BW and SMM. Aggressive nutrition therapy is important for improving nutritional status and function in patients with malnutrition and sarcopenia.

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Shorter Interval between Onset and Admission to Convalescent Rehabilitation Wards Is Associated with Improved Outcomes in Ischemic Stroke Patients

Cited by 24 publications

References 30 publications

Cognitive Function is a Predictor of Home Discharge in Subacute Stroke Patients: A Retrospective Cohort Study

Cognitive Function is a Predictor of Home Discharge in Subacute Stroke Patients: A Retrospective Cohort Study

Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

Stored Energy Increases Body Weight and Skeletal Muscle Mass in Older, Underweight Patients after Stroke

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