Post-stroke pathway analysis and link with one year sequelae in a French cohort of stroke patients: the PAPASePA protocol study

Broussy, Sylvain; Rouanet, François; Lesaine, É.; Domecq, S.; Krêt, Marion; Maugeais, M.; Aly, Florence; Dehail, Patrick; Bénard, Antoine; Wittwer, Jérôme; Salamon, Roger; Sibon, Igor; Saillour-Glénisson, F.

doi:10.1186/s12913-019-4522-2

Cited by 8 publications

(6 citation statements)

References 32 publications

(31 reference statements)

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“…French scientists (Broussy S. and his colleagues) emphasize that today the issue of long-term rehabilitation of patients with stroke is a serious problem of the modern health care system, although we still know little about the recovery process and factors influencing the effectiveness rehabilitation in patients with stroke. That is why there is an urgent need to study them [11].…”

Section: Discussionmentioning

confidence: 99%

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Мєдвєдкова

Dronova

2021

Patologìâ

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The aim of our study was the investigation of the dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke (HHS) in the recovering period of the disease by comprehensive neurological, medical and social research. Materials and methods. 90 patients in the age from 38 to 70 years were studied, 58 men – 64.4 % and 32 women – 35.6 %. The condition of the patients was evaluated by NIHSS, mRS, BI and MSA on the 30th, 180th, 360th day of HHS. Depending on their self-care recovering level the patients were divided in two groups for analysis: the first one was formed with the patients whose self-care level completely was restored on the 360th day (ВІ = 100), and the second one was formed with the patients with BI 95 and less on the 360th day. Results. Structure of indicators according to NIHSS, mRS, ВІ and MSA on the 30th day of disease in these groups was analyzed during rehabilitation, as well as distribution of the patients based on their gender and process lateralization. Analyzing the data of the dynamics of the recovery period of HHS depending on the lateralization of the process and the sex of patients, we can notice that there was no significant difference during the recovery period of HHS depending of the lateralization of the process, for example, in patients with the damaged dominant hemisphere median score of BI was 70 points on the 30th day, patients with the lesion of subdominant hemisphere – 65, and on the 360th days in both groups it was 95 points. There was also no significant difference in the dynamics of neurological deficit and recovery of functional activity depending on the gender of patients. On the 30th day of the disease in the group of patients who fully restored their daily activity on the 360th day of HHS a significantly higher score for BI was determined than in the group with incomplete recovery (80 (70; 85) points against 55 (45; 65) points (P ˂ 0.05)). Although a significantly greater regression of functional disorders was found in the second group of patients (P ˂ 0.05). An analysis of the impact of spasticity on the recovery of self-care level showed a significant negative impact of increased muscle tone on the recovery of self-care (P ˂ 0.05) and reduction of the probability of complete recovery of independence in everyday life with increasing degree of spasticity (P ˂ 0.05). At the same time, no significant factors (sex, age, side of the lesion, etc.) were identified that would affect the development of spasticity in patients with HHS, except for the level of neurological deficit according to NIHSS. When we analyzed the distribution of patients in these two groups by sex, it was revealed that the groups didn't have any significant difference. There was also no significant difference in the study's groups depending of the lateralization of the stroke. Conclusions. It was found that on the 30th day of the disease in 35.6 % of patients the total score on NIHSS ranged from 2 to 6 points, 55.6 % of patients had mRS of 3 points and 48.9 % of patients had severe dependent of outside help in daily life by BI. Significant positive dynamics of recovery on NIHSS, mRS, BI scales on the 180th and 360th day of the disease (P ˂ 0.05) was revealed. The dependence of the indicators of the level of self-care on the 360th day of HHS, on the severity of stroke on the 30th day of the disease (P ˂ 0.01) and on the presence of manifestations of increased muscle tone was established. It was found that patients who had manifestations of spasticity on the 360th day of the disease had a significantly higher score for NIHSS at the onset of the disease, on the 30th day of the disease and on the 360th day of the disease than patients without manifestations of increased muscle tone (P ˂ 0.05). However, no interconnection was found between the indicators of the level of self-care on the 360th day of HHS and the lateralization of the process as well as the sex of patients.

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Section: Discussionmentioning

confidence: 99%

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Мєдвєдкова

Dronova

2021

Patologìâ

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“…In the long run, stroke survivors and their families and caregivers will encounter several challenges: poor quality-of-life, stroke-related disabilities, inadequate sources of rehabilitation, social isolation and inadequate support of care givers, overburdening and burnout of care givers, and inadequate efforts to maintain normal life and professions. 65–67 To meet up to the expectations of patients and families for a good recovery and proper social re-integration, a patient-centric holistic approach of synergistic integrated care is needed involving a multidisciplinary bundle of health care professionals and related services.…”

Section: B: Better Functional and Psychological Status—interventions ...mentioning

confidence: 99%

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

Lip

Boriani

Doehner

et al. 2022

European Heart Journal

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The management of patients with stroke is often multidisciplinary, involving various specialties and healthcare professionals. Given the common shared risk factors for stroke and cardiovascular disease, input may also be required from the cardiovascular teams, as well as patient caregivers and next-of-kin. Ultimately, the patient is central to all this, requiring a coordinated and uniform approach to the priorities of post-stroke management, which can be consistently implemented by different multidisciplinary healthcare professionals, as part of the patient ‘journey’ or ‘patient pathway,’ supported by appropriate education and tele-medicine approaches. All these aspects would ultimately aid delivery of care and improve patient (and caregiver) engagement and empowerment. Given the need to address the multidisciplinary approach to holistic or integrated care of patients with heart disease and stroke, the European Society of Cardiology Council on Stroke convened a Task Force, with the remit to propose a consensus on Integrated care management for optimizing the management of stroke and associated heart disease. The present position paper summarizes the available evidence and proposes consensus statements that may help to define evidence gaps and simple practical approaches to assist in everyday clinical practice. A post-stroke ABC pathway is proposed, as a more holistic approach to integrated stroke care, would include three pillars of management: • A: Appropriate Antithrombotic therapy. • B: Better functional and psychological status. • C: Cardiovascular risk factors and Comorbidity optimization (including lifestyle changes).

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“…Stroke is a pervasive health concern touching approximately 17 million people worldwide each year [1]. The shortterm, medium-term and long-term consequences of stroke are dramatic, with a high mortality rate, requiring particularly heavy daily care [2].…”

Section: Introductionmentioning

confidence: 99%

“…Stroke is a widespread health concern affecting approximately 17 million people worldwide every year (Klamroth‐Marganska, 2018 ). The short‐term, medium‐term, and long‐term consequences of stroke are remarkable, with high mortality and morbidity rates requiring multidisciplinary care on a daily basis (Broussy et al., 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with cognitive impairment at 3, 6, and 12 months after the first stroke among Lebanese survivors

et al. 2022

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Cognitive impairment is a prevalent outcome of stroke, affecting the quality of life and increasing the disability. Its risk factors are unknown in Lebanon. Therefore, the aims of this study were to evaluate the cognitive impairment incidence among Lebanese stroke survivors at 3, 6 and 12 month post stroke, and to identify the associated factors. A multicenter longitudinal prospective study was conducted in 10 hospitals of Beirut and Mount Lebanon among 150 subjects aged ≥ 18 years old between February 2018 until May 2019. The Mini-Mental State Examination assessed the cognitive function. Univariate and Multivariable analyses were performedto identify the predictors of the post stroke cognitive impairment. A p-value <0.05 was considered statistically significant. At 3 month post stroke, 74.8% were cognitively impaired versus 46.7% and 37.6% at 6 and 12 month post stroke respectively. Older age, past smoking, presence of a caregiver, sedentary ≥ 12 hours, aphasia at the time of stroke occurrence, the length of hospital stay, severe stroke, high disability degree, post stroke anxiety and depression, epileptic seizures and physical disorders were the risk factors inducing cognitive decline. Whereas, the high education level, the employment and the history of diabetes mellitus played a protective role for the cognitive function. Findings reveal levels of cognitive impairment post-stroke that are concerning. Thus, primary and secondary prevention is essential to reduce its incidence and to cope with its burden.

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Post-stroke pathway analysis and link with one year sequelae in a French cohort of stroke patients: the PAPASePA protocol study

Cited by 8 publications

References 32 publications

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

Factors associated with cognitive impairment at 3, 6, and 12 months after the first stroke among Lebanese survivors

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