The Prevalence of Joint Contractures, Pressure Sores, Painful Shoulder, Other Pain, Falls, and Depression in the Year After a Severely Disabling Stroke

Abstract

Background and Purpose-Complications after stroke have been shown to impede rehabilitation, lead to poor functional outcome, and increase cost of care. This inception cohort study sought to investigate the prevalence of immobilityrelated complications during the first year after severely disabling stroke in relation to functional independence and place of residence. Methods-Over a 7-month period, 600 stroke survivors were identified in the hospital through the Nottingham Stroke Register.Those who had a Barthel Index score Յ10 3 months poststroke and did not have a primary diagnosis of dementia were eligible to participate in the study. Assessments of complications were carried out at 3, 6, and 12 months poststroke. Results-Complications were recorded for 122 stroke survivors (mean age, 76 years; 57% male). Sixty-three (52%) had significant language impairment and of the remaining 59 who were able to complete an assessment of cognitive function, 10 (8%) were cognitively impaired. The numbers of reported complications over 12 months, in rank order, were falls, 89 (73%); contracture, 73 (60%); pain, 67 (55%); shoulder pain, 64 (52%); depression, 61 (50%); and pressure sores, 26 (22%). A negative correlation was found between Barthel Index score and the number of complications experienced (low scores on the Barthel Index correlate with a high number of complications). The highest relative percentages of complications were experienced by patients who were living in a nursing home at the time of their last completed assessment. Conclusions-Immobility-related complications are very common in the first year after a severely disabling stroke.Patients who are more functionally dependent in self-care are likely to experience a greater number of complications than those who are less dependent.

Repeated Measurements of Arm Joint Passive Range of Motion After Stroke: Interobserver Reliability and Sources of Variation

“…Over time, many patients develop contractures 10, 18 and hypertonia, 19,20 especially in shoulder internal rotators and wrist flexors. Many patients also develop shoulder pain, a condition strongly associated with restricted range of motion.…”

Pressure injury incidence in a university hospital / Incidência de lesão por pressão em um hospital universitário / Incidencia de lesion por presión en un hospital universitario

“…O custo total do tratamento de uma LPP em paciente internado pode variar entre 2.000 e 70.000 dólares por úlcera. Além disso, a existência de uma LPP constitui um fator de risco para óbito no paciente internado (26)(27) . Em relação às medidas de prevenção utilizadas na instituição identificou-se que o suporte nutricional adequado e a manutenção da pele higienizada foram as que prevaleceram e observou-se também que muitas vezes a mudança de decúbito era delegada aos familiares.…”

Effectiveness of Passive Joint Mobilisation for Shoulder Dysfunction: A Review of the Literature

“…Strokerelated shoulder problems have been categorised into frozen shoulder, shoulder-hand syndrome and subluxation (Chard & Hazleman, 1987). The prevalence of shoulder pain post stroke has been reported ranging from 30% to 67% (Sackley et al, 2008;Lindgren et al, 2007). It can impede rehabilitation and has been associated with poorer outcomes and prolonged hospital stay (Turner-Stokes & Jackson, 2002).…”