This paper describes results of a qualitative study that explored barriers to research participation among African American adults. A purposive sampling strategy was used to identify African American adults with and without previous research experience. A total of 11 focus groups were conducted. Groups ranged in size from 4–10 participants (N = 70). Mistrust of the health care system emerged as a primary barrier to participation in medical research among participants in our study. Mistrust stems from historical events including the Tuskegee syphilis study and is reinforced by health system issues and discriminatory events that continue to this day. Mistrust was an important barrier expressed across all groups regardless of prior research participation or socioeconomic status. This study illustrates the multifaceted nature of mistrust, and suggests that mistrust remains an important barrier to research participation. Researchers should incorporate strategies to reduce mistrust and thereby increase participation among African Americans.

Constraint-induced movement therapy (CIMT) was equally as effective but not superior to an equal dose of traditional therapy during inpatient stroke rehabilitation. Higher intensity CIMT resulted in less motor improvement at 90 days, indicating an inverse dose-response relationship. Motor intervention trials should control for dose, and higher doses of motor training cannot be assumed to be more beneficial, particularly early after stroke.

Objective-To estimate minimal clinically important difference values of several upper extremity measures early after stroke.Design-Data in this report were collected during the VECTORS trial, an acute, single-blind randomized controlled trial of Constraint Induced Movement Therapy. Subjects were tested at the pre-randomization baseline assessment (average of 9.5 days post stroke), and the first post-treatment assessment (25.9 days post stroke). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based minimal clinically important difference values were calculated separately for the affected dominant upper extremities and the affected non-dominant upper extremities for each of the 6 tests. Setting-Inpatient rehabilitation hospital.Participants-Fifty-two people with hemiparesis post stroke. Results-Minimal clinically important difference values for grip strength were 5.0 and 6.2 kg for the affected dominant and non-dominant sides respectively. Minimal clinically important difference values for the ARAT were 12 and 17 points, for the WMFT Function score were 1.0 and 1.2 points, and for the MAL How well score were 1.0 and 1.1 points for the two sides respectively. Minimal clinically important difference values were indeterminate for the dominant (composite strength), the non-dominant (WMFT Time score) or for both affected sides (duration of use) for the other measures. Interventions-Not applicable. Main Outcome Measures-EstimatedCorresponding Author: Catherine E. Lang, PT, PhD, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park, St. Louis, MO 63108, Fax: 314.286.1410, Office: 314.286.1945 We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, if applicable, we certify that all financial and material support for this research (eg, NIH or NHS grants) and work are clearly identified in the title page of the manuscript. NIH Public Access

For patients with acute ICH, admission to a neuro vs. general ICU is associated with reduced mortality rate.

No abstract

No abstract

Background and Purpose-Although several factors have been identified that predict outcome after intracerebral hemorrhage (ICH), no previous study has investigated the impact of hydrocephalus. The purpose of this study was to determine whether the presence of hydrocephalus after ICH would predict mortality and functional outcome. Methods-Patients with spontaneous supratentorial ICH were identified in our prospectively collected database to determine the following: age, sex, race, past medical history; Glasgow Coma Scale (GCS) score and blood pressure on admission; use of mechanical ventilation, mannitol, and ventriculostomy; and medical complications. CT scans performed within 24 hours of hemorrhage were retrospectively analyzed to determine lesion size and location, pineal shift, cisternal effacement, intraventricular hemorrhage (IVH), and hydrocephalus. Outcome was determined with use of hospital disposition (dead, nursing home, rehabilitation, home) and functional outcome (Functional Independence Measure [FIM]) at 3 months. Patients with and without hydrocephalus were compared and univariate and multivariate analyses performed to determine whether hydrocephalus was an independent predictor of mortality. Data are presented as meanϮSD. Results-Of the 81 patients studied, 40 had hydrocephalus. Those with hydrocephalus were younger (57Ϯ15 versus 67Ϯ15 years), had lower GCS scores (8.2Ϯ4.2 versus 11Ϯ2.9), were more likely to have ganglionic or thalamic hemorrhages, and were intubated more frequently (70% versus 27%). Hospital mortality was higher in patients with hydrocephalus (51% versus 2%), and fewer patients went home (21% versus 35%). Those who died had higher hydrocephalus scores (9.67Ϯ7.1 versus 5.75Ϯ4.5). Outcome was no different if a ventriculostomy was placed. The final logistic regression model included hydrocephalus score, gender, GCS, and pineal shift, and it correctly predicted 85% of patients as dead or alive. Multivariate analyses indicated that hydrocephalus is an independent predictor of mortality. Conclusions-We conclude that hydrocephalus is an independent predictor of mortality after ICH. (Stroke.1998;29:1352-1357.)

The purposes of this report were to: 1) determine the amount of upper extremity use in people with hemiparesis post stroke during their inpatient rehabilitation stay, and 2) to examine the relationships between upper extremity use and impairments and activity limitations at this early time point after stroke. We studied 34 subjects with mild-to-moderate acute hemiparesis (mean time since stroke = 9.3 days) and 10 healthy control subjects. Upper extremity use was measured over 24 hours using bilateral wrist accelerometers. Upper extremity impairments and activity limitations were measured using standard clinical techniques and tests. We found that healthy control subjects use their dominant and nondominant upper extremities 8-9 hours per day. Hemiparetic subjects used their affected and unaffected upper extremities substantially less than control subjects, 3.3 and 6.0 hours per day, respectively. Seven of ten impairment level measures and each of the activity level measures were related to affected upper extremity use. The impairment measures that were related to upper extremity use were those measures that assessed the ability to activate muscles (ie active range of motion and force production) and the measurement of shoulder pain. Our data show that affected upper extremity use is minimal during the inpatient rehabilitation stay, especially given that patients in this setting are required to have 3 hours of therapy per day. We speculate that accelerometer measurements of upper extremity use could be used in a variety of settings and that the objective information they provide would be of great value to clinicians as they select treatments and evaluate progress.