Assessment of Functioning and Disability After Ischemic Stroke

Weimar, Christian; Kurth, Tobias; Kraywinkel, Klaus; Wagner, Markus; Busse, O.; Haberl, R.; Diener, Hans‐Christoph

doi:10.1161/01.str.0000022808.21776.bf

Cited by 167 publications

(133 citation statements)

References 35 publications

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“…19 To provide prior information for event transition probabilities, a study by Cannegieter and colleagues 20 involving patients with a mechanical heart valve was used. The probability of permanent disability after a major event was assumed to be 0.30 for thrombotic events [21][22][23] and 0.10 for hemorrhagic events. 24 Costs were taken from the perspective of the health care payer and were reported in 2003 Canadian dollars.…”

Section: Model Inputsmentioning

confidence: 99%

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy

Regier

Sunderji²,

Lynd³

et al. 2006

Canadian Medical Association Journal

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ResearchL ong-term oral anticoagulation therapy with vitamin K antagonists is prescribed as prophylaxis against strokes and other embolic events in patients with atrial fibrillation or a mechanical heart valve. 1,2 Warfarin therapy, however, is complicated by the variability of its biologic effect, its narrow therapeutic index, and the associated thrombotic or hemorrhagic events in the event of over-or underanticoagulation. 2 It has been shown that improved anticoagulant control can be achieved through frequent monitoring of the international normalized ratio (INR), resulting in improved health outcomes. 3 Monitoring the INR and managing warfarin dosing by a primary care physician is the current clinical standard of practice in Canada. 4 Physician management requires patients to visit a laboratory regularly for INR testing. The laboratory reports the INR to the physician, who subsequently contacts the patient with any required change in dosage. An alternative strategy is patient self-management. Self-management entails the measurement of the INR by the patient using a pointof-care device and, when necessary, self-adjustment of the warfarin dose using a nomogram. 4 Several published trials have compared self-management with physician management or management in an anticoagulation clinic. 4-13 It has been found that patients who self-manage check their INR more frequently and are able to maintain a greater proportion of INRs within the therapeutic range compared with those whose therapy is monitored by a physician or in an anticoagulation clinic. [11][12][13] The results of a recent meta-analysis showed a significant reduction in thromboembolic events (odds ratio [OR] 0.45), major hemorrhagic events (OR 0.65) and all-cause mortality (OR 0.61) for those using a self-management or self-test strategy. 14 The results also showed that self-management compared with self-testing alone reduces the occurrence of thromboembolic events (OR 0.27) and death (OR 0.37). 14 These results, together with the greater initial costs of educating patients to self-manage and of the pointof-care device itself, provide the impetus for a formal costeffectiveness analysis.The objective of this study was to evaluate the incremental cost and health benefits of self-managed versus physicianmanaged chronic oral anticoagulation therapy from the perspective of the Canadian health care payer. A Bayesian approach was adopted to facilitate the incorporation of prior knowledge of transition probabilities and for probabilistic sensitivity analysis. Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy Background: Patient self-management of long-term oral anticoagulation therapy is an effective strategy in a number of clinical situations, but it is currently not a funded option in the Canadian health care system. We sought to compare the incremental cost and health benefits of self-management with those of physician management from the perspective of the Canadian health care payer over a 5-year period.

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Section: Model Inputsmentioning

confidence: 99%

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy

Regier

Sunderji²,

Lynd³

et al. 2006

Canadian Medical Association Journal

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“…Depression is a common complication of stroke, occurring in ~33% of patients (1,2); the clinical symptoms of this include feelings of guilt, low self-esteem, reduction in food intake, sleep disorders and fatigue. There are between 1.6-2.0 million new stroke patients in China every year and post-stroke depression (PSD) is closely associated with the increased risk of mortality following a stroke (3).…”

Section: Introductionmentioning

confidence: 99%

Estrogen therapy increases BDNF expression and improves post-stroke depression in ovariectomy-treated rats

Cheng

Jin

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The present study investigated the effect of exogenous estrogen on post-stroke depression. Rats were exposed to chronic mild stress following middle cerebral artery occlusion. The occurrence of post-stroke depression was evaluated according to the changes in preference for sucrose and performance in a forced swimming test. Estrogen therapy significantly improved these neurological symptoms, indicating that estrogen is effective in treating post-stroke depression. Increased brain-derived neurotrophic factor (BDNF) expression was reported in the hippocampus of rats that had been treated with estrogen for two weeks, suggesting that BDNF expression may be an important contributor to the improvement of post-stroke depression that is observed following estrogen therapy. IntroductionDepression is a common complication of stroke, occurring in ~33% of patients (1,2); the clinical symptoms of this include feelings of guilt, low self-esteem, reduction in food intake, sleep disorders and fatigue. There are between 1.6-2.0 million new stroke patients in China every year and post-stroke depression (PSD) is closely associated with the increased risk of mortality following a stroke (3). PSD negatively impacts upon subsequent rehabilitation; in a previous study by Sinyor et al, PSD patients demonstrated greater functional impairment than patients without depression, also scoring lower on behavioral action and functional status (4). The severity of depression is closely associated with health-associated quality of life and functional recovery in stroke survivors (5). PSD patients demonstrate a negative mood during rehabilitation and achieve poorer outcomes during functional recovery therapy. These patients also have greater difficulty in restoring social activities (6). Several studies have described a higher mortality rate in stroke patients with depression (7), and certain studies have reported that PSD patients using antidepressant drugs demonstrate improved ability to function than those without antidepressant therapy. The treatment of depression has been demonstrated to aid functional recovery (8), meaning that the early diagnosis and effective treatment of PSD are crucial to recovery from a stroke.Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family, which regulates neurogenesis (9), apoptosis (10), the expression level of monoamine transmitters (11), and the function and plasticity of synapses (12). Neurotrophins may be key in the development of depression (13); BDNF, for instance, can activate intracellular mitogen-activated protein kinase/extracellular signal-regulated kinase cascade signaling pathways (14), affecting synaptic plasticity (12) and alleviating the symptoms of depression (15), and BDNF may thus be important in the maintenance of emotional stability. Deletion of the BDNF receptor induces a reduction in neurogenesis and increases anxious behavior (16). Additionally, BDNF expression is associated with 5-hydroxytryptamine receptor expression in the brain, particularly the hi...

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“…The mRS has long been utilized in clinical trials as the primary instrument in assessment of functional outcome after stroke and has many advantages, 16 18,19 and inclusion as the standard outcome in high-profile stroke trials. 12 The mRS aligns closely with HRQOL in stroke survivors 20 and with Neuro-QOL scores in hemorrhagic stroke patients, with each step change in mRS associated with approximately 7-point change in mobility T scores.…”

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confidence: 99%

Quality of life in patients with TIA and minor ischemic stroke

et al. 2015

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Objective: We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system.Methods: Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of #5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression.Results: Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS .1 or Barthel Index ,95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months.Conclusions: Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales. Neurology ® 2015;85:1957-1963 GLOSSARY BI 5 Barthel Index; CI 5 confidence interval; DWI 5 diffusion-weighted imaging; HRQOL 5 health-related quality of life; MIS 5 minor ischemic stroke; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio.Patients with TIA and minor ischemic stroke (MIS) account for the majority of stroke patients who present for emergency care in the United States.1 Mild symptoms on presentation is a common reason for exclusion from IV tissue plasminogen activator administration.2 Acute ischemic stroke leads to decreases in health-related quality of life (HRQOL), even among those who have no or minimal poststroke disability.3 Although the outcomes of most patients with minor symptoms, defined by a low NIH Stroke Scale (NIHSS) score, are favorable, approximately 25% of such patients become disabled. 2Stroke outcomes traditionally have utilized disability scales of functional status, which often fail to represent the full effect of disease and treatment. The modified Rankin Scale (mRS) and Barthel Index (BI) are the most frequently used tools to measure disability and handicap after stroke. 4 With National Institute of Neurological Disorders and Stroke funding to address these limitations, Neuro-QOL was developed as a clinically robust and validated patient-reported HRQOL assessment tool for adults and children wit...

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Assessment of Functioning and Disability After Ischemic Stroke

Cited by 167 publications

References 35 publications

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy

Estrogen therapy increases BDNF expression and improves post-stroke depression in ovariectomy-treated rats

Quality of life in patients with TIA and minor ischemic stroke

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