Functional Independence: A Comparison of the Changes During Neurorehabilitation Between Patients With Nontraumatic Subarachnoid Hemorrhage and Patients With Intracerebral Hemorrhage or Acute Ischemic Stroke

Stabel, Henriette Holm; Pedersen, Asger Roer; Nielsen, Jørgen Feldbæk

doi:10.1016/j.apmr.2016.11.010

Cited by 20 publications

(9 citation statements)

References 33 publications

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“…Even patients with SAH with severe disability at hospital discharge can make significant gains with neurorehabilitation and achieve a moderate level of functional independence. [137][138][139] With the exception of patients who present with neurologic examinations concerning for imminent brain death, it is reasonable to offer state-of-the-art critical care resuscitation and support early in the acute course of SAH should this be consistent with the patient's values and wishes.…”

Section: Prognosis and Long-term Recoverymentioning

confidence: 99%

“…Although high SAH clinical grade and older age remain important predictors for unfavorable long-term outcome in SAH, clinicians must be mindful of the time evolution and imprecision of current SAH prognostic tools, particularly in discussions regarding futility of care. Even patients with SAH with severe disability at hospital discharge can make significant gains with neurorehabilitation and achieve a moderate level of functional independence 137-139 . With the exception of patients who present with neurologic examinations concerning for imminent brain death, it is reasonable to offer state-of-the-art critical care resuscitation and support early in the acute course of SAH should this be consistent with the patient’s values and wishes.…”

Section: Prognosis and Long-term Recoverymentioning

confidence: 99%

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Subarachnoid Hemorrhage

Chou¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW Subarachnoid hemorrhage (SAH) remains an important cause of mortality and long-term morbidity. This article uses a case-based approach to guide readers through the fundamental epidemiology and pathogenesis of SAH, the approach to diagnosis and management, the results of clinical trials and evidence to date, prognostic considerations, controversies, recent developments, and future directions in SAH. RECENT FINDINGS Historically, management of SAH focused on prevention and treatment of subsequent cerebral vasospasm, which was thought to be the primary cause of delayed cerebral ischemia. Clinical and translational studies over the past decade, including several therapeutic phase 3 randomized clinical trials, suggest that the pathophysiology of SAH-associated brain injury is multiphasic and multifactorial beyond large vessel cerebral vasospasm. The quest to reduce SAH-associated brain injury and improve outcomes is shifting away from large vessel cerebral vasospasm to a new paradigm targeting multiple brain injury mechanisms, including early brain injury, delayed cerebral ischemia, microcirculatory dysfunction, spreading cortical depolarization, inflammation, and the brain-body interaction in vascular brain injury with critical illness. Despite multiple negative randomized clinical trials in search of potential therapeutic agents ameliorating the downstream effects after SAH, the overall outcome of SAH has improved over recent decades, likely related to improvements in interventional options for ruptured cerebral aneurysms and in critical care management. Emerging clinical evidence also suggests potential harmful impact of historic empiric treatments for SAH-associated vasospasm, such as prophylactic induction of hypertension, hypervolemia, and hemodilution (triple H therapy). With decreasing mortality, long-term SAH survivorship and efforts to reduce chronic morbidity and to improve quality of life and patient-centered outcome are growing areas of unmet need. Despite existing guidelines, significant variabilities in local and regional practices and in scientific terminologies have historically limited advancement in SAH care and therapeutic development. Large global collaborative efforts developed harmonized SAH common data elements in 2019, and studies are under way to examine how existing variabilities in SAH care impact long-term SAH outcomes. SUMMARY Although the overall incidence and mortality of SAH is decreasing with advances in preventive and acute care, SAH remains a major cause of long-term morbidity in survivors. Significant variabilities in care settings and empiric treatment protocols and inconsistent scientific terminologies have limited advancement in patient care and therapeutic clinical studies. Large consensus efforts are under way to introduce clinical guidelines and common data elements to advance therapeutic approaches and improve patient outcome.

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Section: Prognosis and Long-term Recoverymentioning

confidence: 99%

Section: Prognosis and Long-term Recoverymentioning

confidence: 99%

Subarachnoid Hemorrhage

Chou¹

2021

CONTINUUM: Lifelong Learning in Neurology

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“…The rehabilitation of acute inpatient cases is usually carried out in separate wards or in hospitals that provide care through inpatient rehabilitation facilities, and decisions regarding rehabilitation need to be made early 23,28 . Moreover, recent research has shown that approximately 50% of surviving SAH patients have different levels of injuryrelated neurological impairment and persistent physical, social, emotional, and cognitive di culties that prevent return to independent life and work 5,29 . In general, the longer is the hospital length of stay of SAH patients, the more severe their condition is and the more severe their physical and cognitive impairment is; thus, they are more likely to be assessed for rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of rehabilitation following subarachnoid haemorrhage in China: Findings from the Chinese Stroke Center Alliance

Chen

et al. 2023

Preprint

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Background: Rehabilitation improves functional recovery in subarachnoid hemorrhage (SAH) patients, and assessing patients for rehabilitation is the first step in this process. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation for patients with SAH. Methods: To identify patients hospitalized with SAH and to analyze rehabilitation assessment rates, we used data for 11,234 SAH patients admitted to 861 hospitals from the China Stroke Center Alliance from August 2015 to July 2019. We examined factors for rehabilitation assessment and analyzed the relationship between rehabilitation assessment and outcomes in these patients. Results: Among 11,234 patients with SAH, 6,513 (58.0%) were assessed for rehabilitation. Assessed patients had an increased length of stay (mean±SD days: 17.3±12.5 versus 11.6±10.5, P=49.4), a higher Glasgow Coma Scale (GCS) score on admission (mean±SD GCS score: 12.3±3.8 versus 11.8±4.4, P=12.2), and were more likely to be admitted to the stroke unit (19.6% versus 13.8%, P=15.6). In multivariable analysis, factors associated with an increased likelihood of a rehabilitation assessment (p < 0.05) included a longer length of stay (odds ratio [OR], 1.04; 95% confidence interval (CI), 1.04 to 1.05) and care such as dysphagia screening (OR, 1.88; 95% CI, 1.73 to 2.04), DVT prophylaxis (OR, 1.56; 95% CI, 1.41 to 1.72) and vessel evaluation (OR, 1.80; 95% CI, 1.63 to 1.98). For the multivariate analysis of outcomes, patients undergoing rehabilitation assessment had a longer length of stay (OR, 1.96; 95% CI, 1.81 to 2.12), a higher modified Rankin Scale (mRS) score at discharge (OR, 1.49; 95% CI, 1.36 to 1.64), and higher rates of discharge to a rehabilitation center (OR, 3.23; 95% CI, 1.81-5.75). Conclusion: More than two-fifths of SAH patients were not assessed for rehabilitation. Rates vary considerably among hospital grades, and there is a need to improve adherence to recommended care for SAH patients.

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“…Sample size calculation is based on the results of previous RCTs assessing the effect of geriatric rehabilitation on improvement of the FIM. Accordingly, it is expected that geriatric rehabilitation will induce a 20 points improvement in FIM between admission and discharge [47]. This change has been established as "minimal clinically meaningful" improvement [48].…”

Section: Sample Size Calculation and Statistical Analysismentioning

confidence: 99%

IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors

et al. 2020

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Background: Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants' experiences and functional status at 3 months. Methods: We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and costutility analysis.

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Functional Independence: A Comparison of the Changes During Neurorehabilitation Between Patients With Nontraumatic Subarachnoid Hemorrhage and Patients With Intracerebral Hemorrhage or Acute Ischemic Stroke

Cited by 20 publications

References 33 publications

Subarachnoid Hemorrhage

Subarachnoid Hemorrhage

Assessment of rehabilitation following subarachnoid haemorrhage in China: Findings from the Chinese Stroke Center Alliance

IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors

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