Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

2015 ◽  
Vol 46 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Shin Yi Jang ◽  
Min Kyun Sohn ◽  
Jongmin Lee ◽  
Deog Young Kim ◽  
Sam-Gyu Lee ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Stroke Patients ◽  
Nihss Score ◽  
Disease Epidemiology ◽  
Post Stroke ◽  
Obesity Hypertension

Background: The aim of this study was to investigate whether chronic kidney disease (CKD) predicts the outcome of the Functional Independence Measure (FIM) and the Korean version of the modified Barthel Index (K-MBI) 6 months after stroke with adjustment for age, gender, education, smoking, drinking, obesity, hypertension, diabetes mellitus, dyslipidemia, the FIM or K-MBI at discharge and the National Institutes of Health Stroke Scale (NIHSS) score 7 days post stroke. Methods: This study is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation. The sample included 2,037 ischemic stroke patients aged 18 years or older. The FIM and K-MBI scores were assessed at discharge and at 6 months after the onset of stroke. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as an eGFR <60 ml/min/1.73 m2. Results: Overall, the mean age was 65.5 (±12.4) years. The proportion of men was 62.6%. The proportion of CKD cases was 12.7%. The means of the 6-month FIM and K-MBI were 109.8 (±27.9) and 87.0 (±26.4), respectively. In multiple linear regressions, the 6-month FIM after stroke was significantly associated with CKD (-2.85, p < 0.05), age (-0.29, p < 0.01), the FIM at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.71, p < 0.01). Additionally, the post-stroke 6-month K-MBI was significantly associated with CKD (-2.88, p < 0.01), age (-0.27, p < 0.01), the K-MBI at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.55, p < 0.01). Conclusions: This nationwide hospital-based cohort study showed that CKD might predict poor 6-month FIM and K-MBI scores in ischemic stroke patients.

scholarly journals Postural Assessment Scale for Stroke Patients in Acute, Subacute and Chronic Stage: A Construct Validity Study

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 365
Author(s):  
Cecilia Estrada-Barranco ◽  
Roberto Cano-de-la-Cuerda ◽  
Vanesa Abuín-Porras ◽  
Francisco Molina-Rueda
Keyword(s):  
Construct Validity ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Assessment Scale ◽  
Validity Study ◽  
Stroke Patients ◽  
Chronic Stage ◽  
Post Stroke ◽  
Valid Instrument ◽  
Postural Assessment

(1) Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = −0.791), WGS (r = −0.646) and FIM (r = −0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = −0.847), FIM (r = −0.810) and BI (r = −0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months).

scholarly journals Post-stroke Hyperglycemia in Non-diabetic Ischemic Stroke is Related With Worse Functional Outcome: A Cohort Study

2021 ◽  
Vol 45 (5) ◽  
pp. 359-367
Author(s):  
Jin A Yoon ◽  
Yong-Il Shin ◽  
Deog Young Kim ◽  
Min Kyun Sohn ◽  
Jongmin Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Glucose Level ◽  
Functional Outcomes ◽  
Stroke Patients ◽  
Nihss Score ◽  
Post Stroke ◽  
Significant Difference ◽  
Functional Assessments

Objective To investigate long-term and serial functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.Methods The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a large, multi-center, prospective cohort study of stroke patients admitted to participating hospitals in nine areas of Korea. From KOSCO, ischemic stroke patients without diabetes were recruited and divided into two groups: patients without diabetes without (n=779) and with post-stroke hyperglycemia (n=223). Post-stroke hyperglycemia was defined as a glucose level >8 mmol/L. Functional assessments were performed 7 days and 3, 6, and 12 months after stroke onset.Results There were no significant differences in baseline characteristics between the groups, except in the age of onset and smoking. Analysis of the linear correlation between the initial National Institutes of Health Stroke Scale (NIHSS) score and glucose level showed no significant difference. Among our functional assessments, NIHSS, Fugl-Meyer Assessment (affected side), Functional Ambulatory Category, modified Rankin Scale, and Korean Mini-Mental State Examination (K-MMSE) showed statistically significant improvements in each group. All functional improvements except K-MMSE were significantly higher in patients without post-stroke hyperglycemia at 7 days and 3, 6, and 12 months.Conclusion The glucose level of ischemic stroke patients without diabetes had no significant correlation with the initial NIHSS score. The long-term effects of stress hyperglycemia showed worse functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.

Abstract T P127: Look Past the NIHSS! Rehabilitation Metrics that Predict Home Discharge in Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Nneka Ifejika ◽  
Linda Aramburo-Maldonado ◽  
Chunyan Cai ◽  
Melvin R Sline ◽  
Elizabeth A Noser ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Care ◽  
Assisted Living ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Advanced Age ◽  
Nursing Facilities ◽  
Stroke Patients ◽  
Home Discharge

Introduction: The goals of stroke rehabilitation are to restore functional ability and to return patients' home with a good quality of life. There is a paucity of data on stroke rehabilitation tools that both track improvements and help predict the likelihood of home discharge. Hypothesis: Improvement in functional independence measure (FIM) score increases home discharge rates, decreases acute care readmissions and decreases placement in skilled nursing facilities (SNF). Advanced age and infections such as symptomatic UTI (SUTI) negate FIM score improvement. Methods: We merged the prospectively collected Stroke and Neurorehabilitation Registries at our comprehensive stroke center, identifying ischemic stroke patients admitted between January 2011 and November 2013 (n=367). Demographics, rehabilitation metrics and NIHSS were collected. Age, SUTI, discharge FIM and rehabilitation length of stay (LOS Rehab) were included in the multivariate regression. Results: Of 367 ischemic stroke patients, 273 went home, 47 to a SNF, 25 to acute care and 22 to another facility (i.e.,assisted living, board and care). All patients tolerated 3 hours of daily therapy (PT, OT, SLP). Despite median NIHSS values of 9 in both groups (P=0.356), patients with SUTI had lower FIM scores on admission (49.2 ± 13.9 vs. 56.8±15.2; P<0.0001) and discharge (68.5 ± 16.9 vs. 76.3 ± 17.0; P<0.0001). For a one year age increase, there was a 5% increase in SNF admit (OR 1.05, 95%CI 1.02-1.08; P<0.001) compared to home. For a one unit increase in FIM, there was a 4% decrease in another facility admit (OR 0.96, 95% CI 0.93 to 0.99; P<0.01), a 6% decrease in SNF admit (OR 0.94, 95%CI 0.92-0.96; P<0.001) and a 10% decrease in acute care readmit (OR 0.90, 95% CI 0.88-0.94; P<0.0001) compared to home. For a one day increase in LOS Rehab, there was a 19% decrease in acute care readmit (OR 0.81, 95% CI 0.73-0.89; P<0.0001) compared to home, and a 7% increase in home discharge compared to another facility (OR 1.07, 95% CI 1.02 to 1.12; P<0.001). Conclusions: Improved FIM score and increased LOS Rehab were the primary criteria for home discharge after stroke rehabilitation. Advanced age increased the likelihood of SNF placement. SUTI impacted rehabilitation progress, but did not affect discharge to home.

scholarly journals Impact of Polypharmacy on the Rehabilitation Outcome of Japanese Stroke Patients in the Convalescent Rehabilitation Ward

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Eiji Kose ◽  
Riku Maruyama ◽  
Susumu Okazoe ◽  
Hiroyuki Hayashi
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Laboratory Data ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Drug Reactions ◽  
Stroke Patients ◽  
Rehabilitation Outcome

Background. A risk factor associated with stroke onset is chronic kidney disease (CKD). To prevent stroke reoccurrence, it is necessary to strictly manage blood pressure, lipids, and plasma glucose. Therefore, some cases are forced to polypharmacy, elderly patients in particular. Polypharmacy often leads to adverse drug reactions and has the potential to negatively affect the rehabilitation of stroke patients. The aim of the present study was to investigate the effects of polypharmacy using a functional independence measure (FIM).Methods. A total of 144 stroke patients with CKD were included in the present analysis. We divided stroke patients into those taking six or more drugs (polypharmacy group) and those taking less than six drugs (nonpolypharmacy group) upon admission. Patient background features, laboratory data, and FIM scores were compared.Results. FIM-Motor (FIM-M) efficiency, age, and diabetes mellitus were positively associated with polypharmacy. FIM-M efficiency in the polypharmacy group was significantly lower than in the nonpolypharmacy group.Conclusion. Polypharmacy interferes with the effect of rehabilitation in stroke patients with CKD. Pharmacists and doctors should make efforts to optimize medications to be able to respond to the outcome of each patient.

scholarly journals Functional recovery in post-stroke patients on hemodialysis during the convalescent phase: a comparison with those not undergoing hemodialysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takeki Ishida ◽  
Kenichi Kono ◽  
Yuusuke Nishida ◽  
Masahiro Yoshida
Keyword(s):  
Functional Recovery ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Hemodialysis Patients ◽  
Stroke Patients ◽  
Post Stroke ◽  
Rehabilitation Hospital ◽  
Convalescent Phase ◽  
The Difference ◽  
Impaired Motor Function

Abstract Background Low physical fitness is often found in patients undergoing hemodialysis. It may be possible that the recovery of impaired motor function with rehabilitative training might be affected when the patient is on hemodialysis. So far, however, no researcher has clinically investigated this issue in post-stroke patients. The purpose of this study is to clarify the difference of functional recovery during the convalescent phase between post-stroke patients with and without hemodialysis. Methods A cohort of 82 post-stroke hemiparetic patients who were admitted to our rehabilitation hospital, were subjected. On the day of admission and discharge, some clinical parameters including Functional Independence Measure (FIM) and Functional Ambulation Category (FAC) were evaluated for each patient. The changes during the hospitalization and the values at the discharge in these parameters were statistically compared between the patients with and without hemodialysis. Results The FIM motor score at the discharge was significantly lower in hemodialysis patients than non-hemodialysis patients (64.7 ± 21.2 points in hemodialysis patients and 81.8 ± 28.0 points in non-hemodialysis patients, p < 0.05). In addition, the frequency of FAC at the discharge of ≥ 3 was significantly lower in hemodialysis patients than non-hemodialysis patients (40.0% in hemodialysis patients and 72.2% in non-hemodialysis patients, p < 0.05). Conclusion In patients undergoing hemodialysis seem to experience a worse functional recovery during the convalescent phase compared to those not undergoing hemodialysis. We might have to modify the rehabilitative program during the convalescent phase after stroke if the patient was on hemodialysis.

scholarly journals Does cognition influence the functional impairment degree of post-stroke patients?

2020 ◽  
pp. 1-4
Author(s):  
Ozair Argentille Pereira da Silva ◽  
Gabriele Natane de Medeiros Cirne ◽  
Edson Meneses da Silva Filho ◽  
Enio Walker Azevedo Cacho ◽  
Roberta de Oliveira Cacho
Keyword(s):  
Motor Impairment ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Temporal Orientation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Motor Abilities ◽  
Sociodemographic Data ◽  
Cognitive Levels ◽  
Sensory Motor

Background: The post-stroke subjects have several sequelae after the disease, which should be investigated and identified so that the clinical treatment includes these people in all aspects. Objective: To identify if there is a correlation between level of education, cognitive function, functional independence and the sensory-motor abilities of post-stroke subjects. Methods: The sample consisted of 27 post-stroke patients who were evaluated through the following scales: Mini-Mental State Exam (MMSE), Functional Independence Measure (FIM) and Fugl-Meyer Assessment (FMAA) and sociodemographic data collection. Results: A positive and statistically significant correlation was found between MMSE and FIM. When the scores were correlated with education, motor FIM (p = 0.005), total FIM (p = 0.006), temporal orientation MMSE (p = 0.03) and total MMSE (p = 0.01) were statistically significant. Furthermore, a positive correlation but not statistically significant was identified between the cognitive levels and sensory-motor impairment assessed by FMAA. Conclusion: It is concluded that the education of subjects is associated with motor function after stroke. In addition, cognitive impairments interfere with the level of post-stroke functionality, but do not have a direct influence on the degree of sensory-motor impairment.

scholarly journals Impaired kidney function evaluated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is associated with more severe acute ischemic stroke

2017 ◽  
Vol 22 (5) ◽  
pp. 432-434 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Marina Georgaraki ◽  
Stella D Bouziana ◽  
Marianna Spanou ◽  
Stavroula Kostaki ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Kidney Function ◽  
Disease Epidemiology

scholarly journals Cardiovascular risk of sitagliptin in ischemic stroke patients with type 2 diabetes and chronic kidney disease

Medicine ◽  
2018 ◽  
Vol 97 (52) ◽  
pp. e13844 ◽  
Author(s):  
Chung-Yu Liang ◽  
Dong-Yi Chen ◽  
Chun-Tai Mao ◽  
I-Chang Hsieh ◽  
Ming-Jui Hung ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Stroke Patients

scholarly journals Does botulinum toxin improve the function of the patient with spasticity after stroke?

2007 ◽  
Vol 65 (3a) ◽  
pp. 592-595 ◽  
Author(s):  
Eduardo Cardoso ◽  
Glícia Pedreira ◽  
Antônio Prazeres ◽  
Nildo Ribeiro ◽  
Ailton Melo
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Functional Independence Measure ◽  
Botulinum Toxin Type ◽  
Functional Independence ◽  
Functional Improvement ◽  
Stroke Patients ◽  
Early Management ◽  
Post Stroke ◽  
Upper Limb Function

Post-stroke spasticity is an important cause of disability in adults, due to muscle hyperactivity, which results in limb stiffness and muscle spasm. The prognosis for these patients depends on several features such as early management and adequate physical therapy to avoid muscle shortening, pain, and their consequences. Although several papers have shown that intramuscular injections of botulinum toxin type A (BT-A) decreases spasticity in post-stroke patients, few authors have demonstrated functional improvement after this therapy. In order to assess if individualized BT-A injections improves upper limb function in post-stroke spastic patients, we prospectively followed 20 consecutive patients of 18 years of age or more with spastic hemiparesis secondary to stroke. Fulg-Meyer scale modified for upper limbs, measure of functional independence (MFI), Ashworth modified scale, and goniometry were applied in the beginning of the investigation and in the 16th and 32nd weeks. BT-A was applied at baseline and in the 16th week. All subjects were submitted to rehabilitation therapy. All patients showed improvement according to Ashworth modified scale and increase in the range of motion, which were sustained until the 32nd week (p<0.05). The assessment of the first three parameters of the Fulg-Meyer scale and the evaluations of the motor part of the Functional Independence Measure showed statistically improvement until the end of the study. We conclude that proper choice of muscles and individualized doses of BT-A can improve function in selected post-stroke patients.

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