The Morfeo Study: A 1-year follow-up of complications of vegetative state in a dedicated facility

Fabbri, Giampietro; Fantini, Maria Pia; Buggi, Federico; Carretta, Elisa; Lorenzini, Luca; Piperno, Roberto; Matera, Nunzio; Leo, Maria Rosaria; Coulter, David L.

doi:10.3109/02699051003652831

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…After screening for titles and abstracts, 219 full‐length articles were selected, of which 30 met the inclusion criteria. Three [13–15] out of these 30 studies were excluded from the quantitative analyses because the outcome of the anoxic patients could not be retrieved. Twenty‐three out of the 27 included studies reported all outcomes of interest.…”

Section: Resultsmentioning

confidence: 99%

“…The selected studies included an overall sample of 2844 patients with disorders of consciousness (eight in coma, 0.3%; 1774 in VS/UWS, 62.4%; 926 in MCS, 32.6%; 136 having emerged from MCS [eMCS], 4.7%) caused by different aetiologies (traumatic brain injury 992, 34.9%; non‐traumatic brain injury 1852, 65.1%), with a mean age of 48 years (not available in two studies); 1825 (64.2%) patients were male (not available in one study). Most studies [3, 5, 13–19, 21, 23, 24, 26, 31, 32, 35, 36, 39, 40] investigated the prognostic role of demographic, clinical and anamnestic factors. Some studies also included neurophysiological [5, 16, 19, 20, 22, 23, 25, 28, 30, 32, 33, 38] or neuroimaging [15, 26, 29, 37–39] investigations.…”

Section: Resultsmentioning

confidence: 99%

“…The details of the included studies are reported in Table S1. Most studies [3,5,14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] enrolled patients in Europe (23/30, 77%), whereas five studies [15,[36][37][38][39] (16%) included patients from China, and two studies [13,40] (7%) included patients from the Americas.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Magliacano

Bellis

Panico

et al. 2023

Euro J of Neurology

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Background and purposeThe prognosis of prolonged (28 days to 3 months post‐onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long‐term outcome of post‐anoxic pDoC and identify the possible predictive value of demographic and clinical information.MethodThis is a systematic review and meta‐analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross‐sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non‐survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered.ResultsTwenty‐seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness.ConclusionsPatients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision‐making on patient management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Magliacano

Bellis

Panico

et al. 2023

Euro J of Neurology

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“…prevention of pressure sores, contractures, pneumonia). In the past decade, some practitioners and researchers have shifted from the term “treatment” towards “quality management” (von Wild et al , 2007), and literature addressing these issues from PT's perspectives tend to agree (Farmer and James, 2001; Reddy et al , 2006; Fabbri et al , 2010). Still, the question of rehabilitation, improvement of technology, and creating means to better understand consciousness, are still debated intensively (Lotze et al , 2011; Monti et al , 2010; Owen et al , 2006; Owen and Coleman, 2008).…”

Section: Introductionmentioning

confidence: 99%

Physiotherapists' attitudes towards old and young patients in persistent vegetative state (PVS)

Inbar

Doron

Ohry

2012

Quality in Ageing and Older Adults

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PurposeThe purpose of this paper is to uncover attitudes of physical therapists (PTs) who treat vegetative state (VS) patients, and to raise awareness to ethical and professional dilemmas: Are PTs influenced by ageist perceptions? Do they consider physiotherapy to be effective or futile?Design/methodology/approachEthical questions and complex dilemmas are by and large subconscious and rarely explicitly voiced, but can be identified by revealing implicit therapists' personal and professional approach to patients. A quantitative six‐point Likert scale questionnaire was developed, which presented two VS cases – young and old, followed by practical‐ethical questions concerning key issues including: treatment choices, quality of life, prolongation of life, futile treatment (n=101, 68 percent return rate).FindingsThe results reveal a complex reality: on the one hand PTs expressed a positive perception of their profession, and consider all treatment components important for VS patients and their families regardless of age; on the other hand, significant preference for treating the younger VS patient was found.Practical implicationsThere is a need for raising awareness of physiotherapists to the social phenomenon of ageism and its implications on daily professional and ethical conduct.Originality/valueWhile other studies revealed ageism in various health care settings, this study was original both in its methodology (examining implicit ageism via contrasting vignettes), and its unique context (VS patients) which in theory could be viewed as “ageless” in light of the patients' permanent condition.

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Risk factors for mortality in 600 patients in vegetative and minimally conscious states

et al. 2014

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A significant proportion of patients who survive traumatic or nontraumatic severe acquired brain injuries experiences disorders of consciousness. The vegetative state and the minimally conscious state may have different prognoses, and while some patients regain awareness, others have negative outcomes and die. The aim of this work is to identify age-related, medical and behavioural risk factors for mortality in those patients. Participants were enrolled from June 2009 to March 2012 in 107 Italian health care institutions. Univariate and multivariate Cox proportional hazard models were adopted to screen and test candidate risk factors. The study enrolled 600 subjects in vegetative and minimally conscious states for an overall mortality rate of 180.1 per 1,000 person-years. The following traits were associated with a significantly lower chance of survival: age at the acute event higher than 51 years, disease duration less than 1 year, post-anoxic aetiology, absence of visual fixation, and the presence of endocrine, nutritional, and metabolic diseases, and immunity disorders. Clinical history, behavioural assessment, and age-related factors provide important prognostic information on negative outcomes that helps clinicians and researchers to predict patients who are at higher risk of mortality. This knowledge has important clinical, managerial, and ethical implications.

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The Morfeo Study: A 1-year follow-up of complications of vegetative state in a dedicated facility

Abstract: The data that proved significant suggest a minimum set of quality-of-care indicators in VS patients: pressure sores follow-up, nutritional status, ROM and incidence of infections.

Cited by 6 publications

References 11 publications

Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Physiotherapists' attitudes towards old and young patients in persistent vegetative state (PVS)

Risk factors for mortality in 600 patients in vegetative and minimally conscious states

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