Factors predicting satisfactory home care after stroke

This study prospectively investigated factors predicting optimal poststroke home care. One hundred and thirty-five first occurrence stroke patients and their primary support persons were evaluated during the initial hospitalization after stroke and again one year poststroke. Discriminant function analysis was used to identify two groups from the baseline data: home care situations which were rated optimal and those which were not. Group membership was predicted and validated with 72.6% accuracy. Patients at risk for less than optimal home care had caregivers who were (1) more likely to be depressed, (2) less likely to be married to the patient, (3) below average in knowledge about stroke care, and (4) reporting more family dysfunction. Our findings suggest that caregiver-related problems can have a collective effect on rehabilitation outcome and that treatment should reduce caregiver depression, minimize family dysfunction, and increase the family's knowledge about stroke care.     

脑卒中与血浆同型半胱氨酸水平的关系

背景：很多研究表明高同型半胱氨酸血症可能是导致脑卒中发病的独立危险因素。目的：探讨高同型半胱氨酸血症与脑梗死和脑出血发生之间的关系，并分析可能影响同型半胱氨酸水平的相关因素。设计：病例-对照实验。单位：浙江大学医学院附属第二医院神经内科。对象：选择2003—01/11在浙江大学医学院附属第二医院的住院患者57例，其中脑卒中57例（脑出血组21例，脑梗死组36例），并以同期到本院作体检的健康人28例作为对照组。方法：所有被试者均晨起空腹抽取静脉血2mL，测定血浆同型半胱氨酸、维生素B12、叶酸、肌酐等含量，并对所有患者进行临床神经功能缺损程度评分，脑出血组患者根据CT摄片计算出每例患者的血肿体积。主要观察指标：①各组被试者血浆同型半胱氨酸水平。②血浆同型半胱氨酸水平与叶酸，维生素B12，临床神经功能缺损程度评分及血肿体积的相关性。结果：57例脑卒中患者和28例健康者全部进入结果分析。①脑梗死组、脑出血组男性和女性同型半胱氨酸的水平均高于同性别对照组[（25．2&;#177;21．4），（18．3&;#177;10．9），（11．5&;#177;2．9）μmol/L：（22．8&;#177;18．9），（14．7&;#177;7．4），（10．8&;#177;2．6）μmol/L，P〈0．05～0．01]。脑梗死组和脑出血组基本接近（P〉0．05）。②脑梗死组、脑出血组患者同型半胱氨酸水平与叶酸水平呈极显著负相关（r=-0．442，-0．531，P〈0．05），与维生素B12,水平无显著相关性（r=-0．086，-0．111，P〉0．05）。脑梗死组同型半胱氨酸水平与临床神经功能缺损程度评分无显著相关性（r=-0．139，P〉0．05），脑出血组同型半胱氨酸水平与临床神经功能缺损程度评分和血肿体积无显著相关性（r=0．225，0．425，P〉0．05）。结论：高同型半胱氨酸血症是脑梗死和脑出血的危险因素。血浆同型半胱氨酸水平与叶酸水平呈负相关，与维生素B12、临床神经功能缺损程度评分、血肿体积无显著相关。     

脑卒中与血同型半胱氨酸水平的关系

目的探讨脑卒中与同型半胱氨酸 (Hcy)的关系。 方法选取脑卒中患者 5 7例 ,其中脑出血 (CH)组 2 1例 ,脑梗死(CI组 ) 3 6例 ,另选正常对照 2 8例 ,分别测定血浆Hcy、VitB12 、叶酸、肌酐浓度 ,对所有患者进行临床神经功能缺损指数 (CNDS)评定 ,并测定CH组的血肿体积 (HV)。结果CI组和CH组的Hcy水平均比对照组高 (P <0 0 5或P <0 0 1) ,而CI组和CH组之间比较无显著性差异。CI组和CH组Hcy与叶酸水平呈高度显著负相关性 (r =-0 44 2 ,P =0 0 0 7)或显著负相关 (r =-0 5 3 1,P= 0 0 13 ) ,均与VitB12 水平无显著相关性。结论高Hcy血症与脑卒中关系密切 ;血浆Hcy水平与叶酸水平呈负相关 ,与VitB12 相关不显著。     

脑卒中与血浆同型半胱氨酸水平的关系

背景很多研究表明高同型半胱氨酸血症可能是导致脑卒中发病的独立危险因素.目的探讨高同型半胱氨酸血症与脑梗死和脑出血发生之间的关系,并分析可能影响同型半胱氨酸水平的相关因素.设计病例-对照实验.单位浙江大学医学院附属第二医院神经内科.对象选择2003-01/11在浙江大学医学院附属第二医院的住院患者57例,其中脑卒中57例(脑出血组21例,脑梗死组36例),并以同期到本院作体检的健康人28例作为对照组.方法所有被试者均晨起空腹抽取静脉血2 mL,测定血浆同型半胱氨酸、维生素B12、叶酸、肌酐等含量,并对所有患者进行临床神经功能缺损程度评分,脑出血组患者根据CT摄片计算出每例患者的血肿体积.主要观察指标①各组被试者血浆同型半胱氨酸水平.②血浆同型半胱氨酸水平与叶酸,维生素B12,临床神经功能缺损程度评分及血肿体积的相关性.结果57例脑卒中患者和28例健康者全部进入结果分析.①脑梗死组、脑出血组男性和女性同型半胱氨酸的水平均高于同性别对照组[(25.2±21.4),(18.3±10.9),(11.5±2.9)μ mol/L;(22.8±18.9),(14.7±7.4),(10.8±2.6)μ mol/L,P＜0.05-0.01].脑梗死组和脑出血组基本接近(P＞0.05).②脑梗死组、脑出血组患者同型半胱氨酸水平与叶酸水平呈极显著负相关(r=-0.442,-0.531,P＜0.05),与维生素B12水平无显著相关性(r=-0.086,-0.111,P＞0.05).脑梗死组同型半胱氨酸水平与临床神经功能缺损程度评分无显著相关性(r=-0.139,P＞0.05),脑出血组同型半胱氨酸水平与临床神经功能缺损程度评分和血肿体积无显著相关性(r=0.225,0.425,P＞0.05).结论高同型半胱氨酸血症是脑梗死和脑出血的危险因素.血浆同型半胱氨酸水平与叶酸水平呈负相关,与维生素B12、临床神经功能缺损程度评分、血肿体积无显著相关.     

Relationship between the independence level of individual motor-related functional independence measure items and its total score in patients after hip fracture: an ordinal logistic modelling study

[Purpose] The independence level of activities of daily living during the recovery period should be predicted to plan a rehabilitation program. This study aimed to assess the relationship between the independence levels of individual motor-related Functional Independence Measure (FIM-motor) items and total FIM-motor score in patients after hip fracture. [Participants and Methods] This study retrospectively analyzed 40 patients who had stayed in a convalescent rehabilitation hospital after hip fracture. The FIM-motor score was assessed for each patient on admission, after 2 and 4 weeks of hospitalization, and at discharge. [Results] The median FIM-motor scores were 52.5 on admission and 83.0 at discharge. The results of ordinal logistic modeling were statistically significant for all 13 FIM-motor items. The independence levels for transfer to toilet and bed/chair/wheelchair were proportionally distributed across the entire range of total FIM-motor scores. However, a weak relationship was observed between the scores for bladder and bowel management and total FIM-motor scores. Although eating and grooming were relatively easy items, stair-climbing and locomotion were difficult. [Conclusion] The relationship between the independence level of individual FIM-motor items and the total FIM-motor score varied widely. This knowledge might be useful while scheduling rehabilitative treatments for patients after hip fracture.     

中青年脑卒中患者希望水平与功能锻炼依从性的关系

目的 探讨中青年脑卒中患者希望水平及其功能锻炼依从性的关系.方法 选择2021年1月—2021年3月合肥市某三甲医院康复科患者62例为研究对象,通过问卷星发放问卷进行调查,问卷内容包括Herth希望量表和脑卒中患者功能锻炼依从性量表.结果 患者希望水平总分为35.40±4.29分,功能锻炼依从性总分为39.61±6.9...     

Vulnerability of family caregivers in terminal palliative care at home; balancing between burden and capacity

This paper reports on a grounded theory interview-based study with 13 family members aged 28-80 years caring for terminally ill people at home (with a life expectancy of 3 months or less) in the Netherlands. The project was approved by the ethics committee of the Maastricht University Hospital. The aim of this study was to explore the experiences of family caregivers, their needs for home care, and which health services they receive. Data were analysed using the constant comparative method. 'Vulnerability' was identified as the core category. Caring for a terminally ill person at home requires continuous balancing between care burden and capacity to cope. Whether or not the carer will succeed in keeping in optimum balance is dependent on a number of factors impinging on the caregiver's vulnerability. Care burden, restricted activities, fear, insecurity, loneliness, facing death, lack of emotional, practical and information-related support were identified from the data as factors having the potential to increase the caregiver's vulnerability, and may be risk factors for fatigue and burnout. Continuing previous activities, hope, keeping control, satisfaction and good support are factors which may decrease the caregiver's vulnerability, and may protect against fatigue and burnout. The experiences of the caregivers in our study showed that the support from informal and professional caregivers was not sufficient. Education and practical tools may make professionals more sensitive for the vulnerable position of family caregivers, even when these caregivers do not show their vulnerability.     

脑卒中病人居家主要照顾者负荷水平与社会支持度的相关性研究

目的　寻求脑卒中病人居家主要照顾者负荷水平与社会支持度之间的关系。方法　选取 79例脑卒中病人居家主要照顾者 ,用自编脑卒中病人居家主要照顾者负荷量表和自编脑卒中病人居家主要照顾者社会支持量表评定。结果　脑卒中病人居家主要照顾者负荷水平和社会支持度之间存在着负性相关 (r =- 0 .5 1,P <0 .0 1)。结论　提高脑卒中病人居家主要照顾者的社会支持度可以有效地降低其负荷水平 ,促进主要照顾者的身心健康 ,并最终提高照顾脑卒中病人的质量。     

Relationship between usual physical, cognitive and social activities and functional recovery at hospital discharge after acute stroke.

OBJECTIVE: To assess the relationship between lifestyle prior to the event and functional recovery at hospital discharge after acute stroke. DESIGN: Cohort study. PATIENTS: A sample of 191 patients with first stroke episode (87.4% ischaemic). METHODS: Severity of the event at admission was measured by the Modified National Institutes of Health Stroke Scale. The Frenchay Activity Index was used to evaluate the patients' previous lifestyles. Functional recovery was assessed using the Modified Rankin scale on discharge from hospital. A Rankin score < or = 2 was the main outcome. RESULTS: At discharge, 37.2% of the patients were functionally independent. A receiver operating characteristic curve analysis established a value of > or = 18 on the Frenchay Activity Index scale as the best cut-off point to predict favourable outcome (specificity 62%; 95% confidence interval (CI) 54-69% and a sensibility of 60%; 95% CI 49-69%) with an area under the curve of 0.65 (95% CI 0.57-0.71). There was a positive association between Frenchay Activity Index > or = 18 and a Rankin score < or = 2, after controlling for potential confounders (odds ratio 2.62; 95% CI 1.21-5.66; p = 0.001). CONCLUSION: This result emphasizes the protective effect of mental, physical and social activity for the prevention of functional damage after an acute cerebrovascular event.     

血清miR-219水平与急性缺血性脑卒中后轻度认知功能障碍的关系

目的 检测miR-219在急性缺血性脑卒中(AIS)患者血清中的水平,探讨miR-219与AIS后轻度认知功能障碍的关系.方法 选择2018年11月至2019年10月在该院神经内科住院的AIS患者185例为研究对象,按照认知功能评价分为轻度认知功能障碍组和无认知功能障碍组.另选取体检健康者170例作为对照组,采用实时荧光定量PCR检测各组研究对象血清中miR-219水平,用二分类Logistic回归分析影响AIS患者发生轻度认知功能障碍的危险因素,用受试者工作特征(ROC)曲线分析血清miR-219水平对AIS患者发生轻度认知功能障碍的预测价值.结果 185例AIS患者中,有轻度认知功能障碍95例,无认知功能障碍90例.轻度认知功能障碍组糖尿病比例明显高于无认知功能障碍组,差异有统计学意义(P<0.05);对照组、无认知功能障碍组、轻度认知功能障碍组AIS患者血清miR-219水平依次升高,两两比较,差异有统计学意义(P<0.05);二分类Logistic回归分析显示,糖尿病、血清miR-219水平高是AIS患者发生轻度认知功能障碍的独立危险因素;ROC曲线分析结果显示,血清miR-219水平预测AIS患者发生轻度认知功能障碍的ROC曲线下面积为0.818,最佳截断值为1.34.结论 miR-219在AIS患者血清中明显高表达,是影响AIS后轻度认知功能障碍发生的危险因素,对其有一定预测价值.     

Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study

Abstract

Purpose: To examine whether Functional Independence Measure (FIM) scores on admission can predict the future care levels of patients after acute stroke. Methods: In this multicenter retrospective cohort study, we enrolled post-acute stroke patients and assessed stroke subtypes, self-care abilities using FIM scores, and discharge destination. Patients’ care levels were assessed according to the Long-Term Care Insurance (LTCI) system (0–5: slight impairment to bedridden), the national insurance plan for care in Japan, at discharge. We divided patients into two groups according to LTCI care levels (0–2 versus 3–5) to compare their clinical characteristics using multivariate logistic regression analysis. The trial was registered with the UMIN Clinical Trials Registry (UMIN000012653). Results: Of the 1261 patients (47% female, mean age 75 years), 492 (39%) fulfilled LTCI care levels 0–2. FIM scores on admission were significantly correlated with LTCI care levels (p?<?0.001). On multivariate analysis, age and FIM scores on admission were found to be independent predictors of LTCI care levels 0–2. Conclusions: FIM scores on admission after stroke can independently predict later care requirements. Early prediction of LTCI care levels may contribute to the early supported discharge and improve the efficiency of healthcare planning.

• Implications for Rehabilitation

• There is a clear relationship between Functional Independence Measure (FIM) scores and the care levels certified by the Long-Term Care Insurance (LTCI) system, a national healthcare and insurance system in Japan.

• FIM scores on admission can predict future LTCI care levels required for patients after acute stroke.

• Early prediction of LTCI care levels may contribute to early supported discharge, improve the efficiency of stroke management and assist healthcare planning.

     

脑卒中后白质完整性与上肢运动功能的关系

目的 应用扩散张量成像技术测量偏瘫患者内囊后肢的各向异性(FA)值,分析皮质脊髓束完整性与患侧上肢运动功能的关系.方法 选择17例亚急性期脑卒中后偏瘫患者,测量患侧及健侧内囊后肢FA值,并计算FA非对称比值,临床检测包括上肢运动功能指标(WMFT)及运动功能、平衡、感觉及关节功能综合评价指标(FM),利用线性相关分析FA非对称比值与患手FM 评分、WMFT 非对称比值及log WMFT之间的相关关系.结果 患手运动功能评分与内囊后肢FA非对称比值显著相关,FA非对称性比值与患手FM(R~2＝0.655,P＜0.002)呈线性负相关,与WMFT非对称性比值(R~2＝0.649,P＜0.002)、lg WMFT(R~2＝0.636,P＝0.002)以及握力非对称性比值(R~2＝0.414,P=0.02)均呈线性正相关.结论 偏瘫患者亚急性期皮质脊髓束完整性与上肢运动功能显著相关;利用扩散张量成像技术可早期监测皮质脊髓束的完整性.     

脑卒中患者自我效能水平与其肢体功能康复进程的相关研究

目的 了解脑卒中后肢体运动功能障碍患者自我效能水平与其肢体康复进程的相关性.方法 采用一般资料问卷和自我效能量表,对103倒住院行肢体运动功能康复训练的脑卒中患者进行调查.结果 脑卒中后肢体运动功能障碍患者的自我效能呈中低水平的占73.79％;分层回归分析表明,脑卒中后肢体运动功能障碍患者自我效能水平与其肢体运动功能达到Ⅱ级以上康复呈显著相关.结论 增强脑卒中患者的自我效能,有助于促进其肢体功能康复.     

Relationship between oxygen cost of walking and level of walking disability after stroke: An experimental study

Background and Purpose

Since physical inactivity is the major risk factor for recurrent stroke, it is important to understand how level of disability impacts oxygen uptake by people after stroke. This study investigated the nature of the relationship between level of disability and oxygen cost in people with chronic stroke.

Methods

Level of walking disability was measured as comfortable walking speed using the 10‐m Walk Test reported in m/s with 55 ambulatory people 2 years after stroke. Oxygen cost was measured during 3 walking tasks: overground walking at comfortable speed, overground walking at fast speed, and stair walking at comfortable speed. Oxygen cost was calculated from oxygen uptake divided by distance covered during walking and reported in ml?kg^?1?m^?1.

Results

The relationship between level of walking disability and oxygen cost was curvilinear for all 3 walking tasks. One quadratic model accounted for 81% (95% CI [74, 88]) of the variance in oxygen cost during the 3 walking tasks:

Discussion

The oxygen cost of walking was related the level of walking disability in people with chronic stroke, such that the more disabled the individual, the higher the oxygen cost of walking; with oxygen cost rising sharply as disability became severe. An equation that relates oxygen cost during different walking tasks according to the level of walking disability allows clinicians to determine oxygen cost indirectly without the difficulty of measuring oxygen uptake directly.     

居家痴呆病人照顾者家庭功能与照顾负担的关系分析

[目的]探讨居家痴呆病人照顾者家庭功能与照顾负担之间的关系。[方法]选取痴呆的居家病人63例及病人照顾者63名,采用家庭关怀度指数问卷(APGAR)和照顾者负担问卷(CBI)评价照顾者家庭功能和照顾负担。[结果]63例病人照顾者中,家庭功能良好20名(31.7%),APGAR评分8.65分±1.37分,家庭功能障碍43名(68.3%),APGAR评分2.81分±1.85分。痴呆病人照顾者家庭功能良好者,其时间依赖性负担、发展受限性负担、社交性负担和身体性负担均轻于有家庭功能障碍的照顾者,差异有统计学意义(P<0.05)。痴呆病人其照顾者的家庭适应度、合作度、成长度、情感度和亲密度得分均与CBI总分呈负相关(P<0.01)。[结论]居家痴呆病人照顾者家庭功能越差其照顾负担越重,为减轻居家痴呆病人照顾者的负担,需通过多种方式加强社会支持,以弥补家庭支持的不足。