How Do Recurrent and First-Ever Strokes Differ in Rehabilitation Outcomes?

Ng, Yee Sien; Tan, Khee Giap; Chen, Cynthia; Senolos, Gilmore C; Koh, Gerald Choon-Huat

doi:10.1097/phm.0000000000000502

Cited by 21 publications

(9 citation statements)

References 29 publications

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“…These patients may differ in the amount of pre-stroke comorbidities, as comorbidity is suggested to negatively influence outcome [ 36 ]. In addition, research by Ng and colleagues found that patients with multiple infarcts show spontaneous neurobiological recovery to a lesser extent than patients with a first-ever stroke [ 37 ], suggesting that quality of vascularization is an important issue for recovery. Contrary, a recent prospective cohort study did show that patients with previous or hemorrhagic strokes may also show proportional recovery of the upper extremity [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

et al. 2018

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ObjectiveTo investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).MethodsProspective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax−FMA-LEinitial = 34 –FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.Results175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.ConclusionsProportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design.

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Section: Discussionmentioning

confidence: 99%

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

et al. 2018

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“…Comparison of baseline characteristics between the ICH and IS groups revealed that ICH group had a lower proportion of previous stroke (8.7% vs 22.5%, p=0.02). Since recurrent stroke patients make less functional gains compared with first-ever stroke patients, 38 we excluded patients with previous strokes to avoid the confounding effect, and the ICH group still had greater total BI improvement than the IS group (30 vs 25 , p=0.02); the BI improvement at the late phase of PAC was also greater in the ICH group (ΔBI 6w-final : 12.5 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] vs 10 [0-20], p=0.02) ( Table 3).…”

Section: Patients Who Had First-ever Strokementioning

confidence: 99%

<p>Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program</p>

Chu¹,

Chen²,

Chen³

et al. 2020

NDT

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Background: Tailored rehabilitation programs for stroke patients cannot be made without knowledge of their recovery potential. The aim of this study is to characterize the functional recovery patterns of ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients under post-acute care stroke rehabilitation. Methods: This retrospective study analyzed the data of patients enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) rehabilitation program, which provides an individualized 1-to 3-hour intensive physical, occupational, and speech and language therapy for post-acute stroke patients in Taoyuan Chang Gung Memorial hospital in Taiwan. Our primary endpoint measure was Barthel Index (BI), and secondary endpoint measures included other 12 functional measures. Results: A total of 489 patients were included for analysis. Patients with stroke history had less BI improvement than those who suffered their first-ever stroke. In first-ever stroke patients who had completed 6 to 12 weeks of PAC-CVD program, subcortical ICH patients had greater BI, quality of life, sensation, and balance improvements, and had greater latephase recovery than their IS counterparts. In IS patients, those with age >75 had less BI improvement; those with National Institute of Health Stroke Scale (NIHSS) score 1-5 had greater Motor Activity Log quality of use (MAL-quality) improvement than those with NIHSS score >5; those with Mini-Mental State Examination (MMSE) score ≥24 had greater BI and instrumental activities of daily living (IADL) improvement. Using the general linear model, previous stroke (ß: −6.148, p=0.01) and subcortical ICH (ß: 5.04, p=0.03) were factors associated with BI improvement. Conclusion: Subcortical ICH patients have greater functional improvement and greater latephase recovery than their IS counterparts following PAC rehabilitation. More studies are needed to validate our findings and unravel the underlying mechanisms of stroke recovery to optimize the treatment strategy following a stroke.

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“…1,2 The annual cost of stroke in Europe is estimated to be €20 billion for direct care, €16 billion for informal care and €9 billion due to loss of productivity. 3 Recurrent major cardiovascular events occur in more than 12% of patients over five years, even in patients receiving excellent evidence-based treatment in affluent countries 4 and are associated with poor rehabilitation outcomes, 5 physical disability and cognitive dysfunction. 6 Optimal provision of secondary prevention has the potential to reduce recurrent events by up to 80%, 3 but this requires rapid assessment, appropriate treatment and ongoing follow-up to ensure efficacy and adherence to treatments.…”

Section: Introductionmentioning

confidence: 99%

Availability of secondary prevention services after stroke in Europe: An ESO/SAFE survey of national scientific societies and stroke experts

Webb

Heldner

Sousa

et al. 2018

European Stroke Journal

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Background Recurrent stroke is associated with increased disability and cognitive impairment, but the availability of secondary prevention measures after transient ischaemic attack (TIA) or stroke in Europe is uncertain. This limits prioritisation of investment and development of national stroke strategies. Methods National stroke representatives throughout Europe were surveyed. Consensus panels reported national data if available, or else expert opinion, estimating the availability of each intervention by quintiles of patients, dichotomised for analysis at 60%. Countries were classified into tertiles of gross domestic product per capita. Results Of 50 countries, 46 responded; 14/45 (31%) had national stroke registries and 25/46 (54.3%) had national stroke strategies incorporating secondary prevention. Respondents reported that the majority of TIA patients were assessed by specialist services within 48 hours in 74.4% of countries, but in nine countries more than 20% of patients were seen after more than seven days and usually assessed by non-specialists (7/46 countries). Eighty percent of countries deferred blood pressure assessment to primary care, whilst lifestyle management programmes were commonly available in only 46% of countries. Although basic interventions were widely available, interventions frequently not available to more than 60% of patients included: ambulatory cardiac monitoring (40% countries); prescription (26%) and continuation (46%) of statins; blood pressure control at follow-up (44%); carotid endarterectomy within one month (15%); face-to-face follow-up in hospital (33%); direct oral anticoagulants (21%). Gross domestic product per capita and reimbursement of interventions were the commonest predictors of availability of interventions. Conclusions Provision of secondary prevention varied, with gaps in care prevalent throughout Europe, particularly in lower income countries.

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How Do Recurrent and First-Ever Strokes Differ in Rehabilitation Outcomes?

Cited by 21 publications

References 29 publications

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

<p>Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program</p>

Availability of secondary prevention services after stroke in Europe: An ESO/SAFE survey of national scientific societies and stroke experts

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