Stroke and Neurodegenerative Disorders: 2. Poststroke Medical Complications

Lombard, Lisa A.; Reddy, Cara Camiolo; Moroz, Alex; Lew, Henry L.; Chae, John; Edgley, Steven R.

doi:10.1016/j.pmrj.2009.01.016

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…Musculoskeletal symptoms are common in individuals suffering from neurological injury. 9 , 10 Chiropractic care primarily addressed spine and extremity-related musculoskeletal pain and joint or regional stiffness. Though chiropractic care delivered in outpatient settings similarly focuses on musculoskeletal conditions, it is often delivered in relative isolation from other health care interventions.…”

Section: Discussionmentioning

confidence: 99%

Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study

Vining

Salsbury

Cooley

et al. 2018

JMDH

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ObjectivesIndividuals rehabilitating from complex neurological injury require a multidisciplinary approach, which typically does not include chiropractic care. This study describes inpatients receiving multidisciplinary rehabilitation including chiropractic care for brain injury, spinal cord injury (SCI), stroke, and other complex neurological conditions.DesignChiropractic services were integrated into Crotched Mountain Specialty Hospital (CMSH) through this project. Patient characteristics and chiropractic care data were collected to describe those receiving care and the interventions during the first 15 months when chiropractic services were available.SettingCMSH, a 62-bed subacute multidisciplinary rehabilitation, skilled nursing facility located in Greenfield, New Hampshire, USA.ResultsPatient mean (SD) age (n=27) was 42.8 (13) years, ranging from 20 to 64 years. Males (n=18, 67%) and those of white race/ethnicity (n=23, 85%) comprised the majority. Brain injury (n=20) was the most common admitting condition caused by trauma (n=9), hemorrhage (n=7), infarction (n=2), and general anoxia (n=2). Three patients were admitted for cervical SCI, 1 for ankylosing spondylitis, 1 for traumatic polyarthropathy, and 2 for respiratory failure with encephalopathy. Other common comorbid diagnoses potentially complicating the treatment and recovery process included myospasm (n=13), depression (n=11), anxiety (n=10), dysphagia (n=8), substance abuse (n=8), and candidiasis (n=7). Chiropractic procedures employed, by visit (n=641), included manual myofascial therapies (93%), mechanical percussion (83%), manual muscle stretching (75%), and thrust manipulation (65%) to address patients with spinal-related pain (n=15, 54%), joint or regional stiffness (n= 14, 50%), and extremity pain (n=13, 46%). Care often required adapting to participant limitations or conditions. Such adaptations not commonly encountered in outpatient settings where chiropractic care is usually delivered included the need for lift assistance, wheelchair dependence, contractures, impaired speech, quadriplegia/paraplegia, and the presence of feeding tubes and urinary catheters.ConclusionPatients suffered significant functional limitations and comorbidity resulting in modifications to the typical delivery of chiropractic care. Chiropractic services focused on relieving musculoskeletal pain and stiffness.

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Section: Discussionmentioning

confidence: 99%

Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study

Vining

Salsbury

Cooley

et al. 2018

JMDH

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“…10 Research indicates that up to 51% of deaths in the first month after an ischemic stroke were due to complications of immobility and over 62% of these complications occurred in the first seven days of the stroke. 8,11 When patients are bedridden and immobile, the most common complications are pressure injuries (PIs), 1,2,8,12,13 pneumonia, 2,8,[13][14][15][16][17][18] deep vein thrombosis (DVT), 2,8,13,[16][17][18][19][20][21] urinary tract infections (UTIs), 1,13,17,18,22 and constipation. 13,16 These complications present barriers to optimal recovery and positive post-stroke outcomes and, when non-fatal, increase the length of hospital stays as well as the cost of hospital care.…”

Section: Introductionmentioning

confidence: 99%

The effects of a standardized nursing intervention model on immobile patients with stroke: a multicenter study in China

Liu

Zhu

Cao

et al. 2019

European Journal of Cardiovascular Nursing

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Background: Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke. Aims: To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke. Methods: A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals. Results: In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals. Conclusions: A structured and systematic SNIM benefited immobile stroke patients’ clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.

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Cost-effectiveness of an intervention to improve the quality of nursing care among immobile patients with stroke in China: A multicenter study

Liu

Zhu

Song

et al. 2020

International Journal of Nursing Studies

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Stroke and Neurodegenerative Disorders: 2. Poststroke Medical Complications

Cited by 3 publications

References 41 publications

Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study

Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study

The effects of a standardized nursing intervention model on immobile patients with stroke: a multicenter study in China

Cost-effectiveness of an intervention to improve the quality of nursing care among immobile patients with stroke in China: A multicenter study

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