Predictors of long-term participation after stroke

Purpose: (1) To explore factors that predict long-term participation after stroke (2?–?4 years after discharge from rehabilitation), and (2) to determine factors that predict both short- and long-term participation.

Methods: Biopsychosocial data of people who had had a stroke were measured at discharge from an intensive rehabilitation unit using valid instruments. Six months later (n?=?102) as well as 2?–?4 years later (n?=?66), social participation of the survivors was measured in their living environments. Participation was estimated with the Assessment of Life Habits (LIFE-H), which includes 12 categories of daily activities and social roles.

Results: From mutivariate regression analyses, the best predictors of long-term participation after stroke appear to be age, comorbidity, motor coordination, upper extremity ability and affect. Age, comorbidity, affect and lower extremity coordination are the best predictors of participation after stroke at both measurement times.

Conclusions: With the exception of age, these factors may be positively modified and thus warrant special attention in rehabilitation interventions.     

Predictors of quality of life among spouses of stroke patients during the first year after the stroke event

BACKGROUND: Stroke, a disease with severe consequences for patients and their families, often lead to psychosocial stress, and a decline in the quality of life (QoL) among carers. Predicting the QoL is essential in the development of effective nursing support interventions. AIM: The aim of the present study was to identify predicting factors for the general QoL among spouses of stroke patients, and to determine whether these predictors change during the first year after the patient's stroke event. DESIGN: One hundred spouses were followed three times during 1 year regarding QoL, own illness, economic situation, well being, life situation, sense of coherence, social network and the patients' ability in activities of daily living (ADL). Stepwise multiple linear regression analyses were conducted for the baseline, 6- and 12-month assessments respectively, with the present QoL as the dependent variable. RESULTS: Over time during the first year after the patients' stroke event, there were significant differences in the spouses perceived general QoL. Life situation and economic situation were the only predictors of the spouses' QoL, which emerged during the entire year after the patient's stroke event, while well being, education, own illness, social network and ADL ability (patient) emerged at one or two occasions. CONCLUSION: The psychosocial factors -- life situation, well being, social network, education and economy -- are important in predicting QoL among spouses of stroke patients, and these predicting factors change over time. Determining the predictors at an early stage, and continuously over time, will help to focus clinical nursing interventions on the spouses' changing needs.     

Determinants of handicap 1 and 3 years after a stroke

A total of 361 consecutive admissions to hospital with acute stroke were followed up to examine the determinants of handicap 1 year and 2–3 years later. Handicap was measured using the London Handicap Scale, and data were collected on initial stroke severity, disability, mood and sociodemographic variables. Ninety-five of 170 survivors returned handicap questionnaires at 1 year, 102 of 149 survivors at 2–3 years, and 58 on both occasions. Mean handicap score decreased slightly between 1 and 2–3 years (45–48 on a 0–100 scale, 95% confidence interval for difference -1 to +7, p = 009). At both 1 and 2–3 years handicap was associated with pre-stroke disability, 1-year score disability, initial stroke severity and mood. Age and sex were associated at 1 year but not at 2–3 years. In multivariate analyses disability, stroke severity and mood were independently associated with handicap. None of the variables examined predicted change in handicap score. The study demonstrates the overriding importance of stroke severity (impairment) and disability in determining handicap. In comparison, social variables were less important.     

早期心理干预对脑卒中偏瘫患者心理健康的影响

INTRODUCTIONHemiplegiaisthemostcommonsequelaeofstroke．Itnotonlyin－fluencesphysicalhealthbutalsoputspsychologicalandspiritualagonyuponitsvictims，whichdoesgreatharmtopatient＇smentalhealth犤１犦．Afterstrokeattack，mostpatientswillexperienceapsy－chologicalcourseofmentalshock，panic，anxietyanddepression．Thisnegativepsychologicalcourseisharmfultomentalhealth，es－peciallyatthebeginningofattack犤２犦．Suchearlynegativepsycho－logicalcoursewillnotonlyleadtodeterioratinginjury，butwillalso…     

脑卒中言语障碍患者心理分析及护理对策

目的通过分析50例脑卒中言语障碍患者的心理变化特点,指导制定相应护理对策以协助患者达到最佳康复效果。方法采用综合医院焦虑?抑郁(HAD)情绪测定表和自制调查问卷对50例脑卒中言语障碍患者进行心理特点分析,比较不同性别、年龄和文化程度患者的心理变化特点,制定相应护理对策。结果本组焦虑情绪占46%,抑郁情绪占38%。因病导致性格改变的比例表现出随年龄增长而增大的趋势。患者均表现出不同程度运动迟滞和动作不协调。男性患者有行为异常表现的比例高于女性患者(89.5%>58.1%)。结论卒中后女性患者较男性患者易产生焦虑和抑郁;60岁以上患者易出现抑郁情绪和情绪波动,60岁以上男性患者易出现性格改变和行为异常。应及时准确掌握患者心理特点,制定相应的护理对策。     

急性缺血性卒中机械取栓术后颅内出血的预测因素分析

目的探讨急性缺血性卒中患者机械取栓术(mechanical thrombectomy,MT)后发生颅内出血(intracranial hemorrhage,ICH)的预测因素。材料与方法回顾性分析2017年1月至2019年6月在本院就诊的急性缺血性卒中患者135例。所有患者均于MT治疗前接受MRI检查,并于治疗后24 h复查头颅CT或MRI评估患者ICH。将ICH分为症状性颅内出血(symptomatic ICH,sICH)和非sICH(无ICH和无sICH)。记录所有患者的MRI数据及临床资料。统计学方法分析急性缺血性卒中患者MT术后发生ICH、sICH预测因素。结果与无ICH组(79例)相比,ICH组(56例)患者具有较高的空腹血糖水平(129.08±18.87与139.77±16.70)、糖化血红蛋白(HbA1c)(5.57±0.34与5.99±0.42)及DWI梗死体积(20.28±26.30与5.99±0.42),两组间比较有统计学差异(t=-7.974,P<0.001;t=-6.421,P<0.001;t=-2.970,P=0.004)。sICH组(18例)患者DWI梗死体积(52.21±50.23)明显大于非sICH组(117例)(24.28±29.99),差异有统计学意义(t=-3.317;P=0.001)。Spearman相关分析显示空腹血糖(r=0.554;P<0.001)、HbA1c(r=0.450;P<0.001)、DWI梗死体积(r=0.309;P<0.001)与ICH呈正相关;DWI梗死体积(r=0.234;P=0.006)与sICH呈正相关。逻辑回归分析结果显示空腹血糖[OR(95%CI):1.233(1.139~1.335),P<0.001]、HbA1c[OR(95%CI):39.121(7.537~203.052),P<0.001]、DWI梗死体积[OR(95%CI):1.025(1.006~1.044),P=0.009]为预测卒中MT术后发生ICH的独立预测因子;DWI梗死体积[OR(95%CI):1.018(1.006~1.030),P=0.004]为预测卒中MT术后发生sICH的独立预测因子。结论综合评估空腹血糖、HbA1c、DWI梗死体积可以有效地预测急性缺血性卒中患者MT术后ICH、sICH的发生,可指导临床个性化治疗、改善预后。     

易化技术配合针炙治疗脑卒中后上肢痉挛

INTRODUCTIONToreleasetheupperextremities(UE)spasmofstrokepatients,weperformedrehabilitationtherapycentralizedonfacilitationandacupunctureon28strokepatients.Comparedwithcontrolgroup(28cases),thetreatmentgroupobtainedbettertherapeuticeffect.MATERIALSANDMETHODSMaterials56inpatientswithstrokerecruitedfromJanuary2001toOctober2002wererandomlydividedintotreatmentgroupandcontrolgroupbyrandomscales,eachgrouphaving28cases.Patientsintreatmentgroupwere50-72yearsofage(meanage:64years)includin…     

The role of positive affect on social participation following stroke

Purpose: To examine the association between positive affect and social participation in adults with first-time stroke after in-patient medical rehabilitation. Methods: A prospective cohort design using information from the Stroke Recovery in Underserved Populations database (SRUP) for the years 2005–2006. Data were collected at discharge from in-patient medical rehabilitation and 3 months post-discharge. Participants were aged 50 and older with first-time stroke (n = 605) and admitted to 1 of 11 in-patient medical rehabilitation facilities across the United States. Primary measures included a positive affect scale and a home and community social participation instrument. Results: The mean age was 71.6 years, 50.3% were women, and 56.5% were married. Results of cumulative logit models showed each 1 point increase in positive affect was significantly associated with a 17% odds of higher social participation (OR: 1.17, 95% CI 1.10, 1.25), after adjusting for demographics, clinical characteristics, and negative affect. Conclusions: High positive affect at discharge from in-patient medical rehabilitation was associated with higher levels of social participation 3 months post-discharge. The significant association between higher positive affect and higher levels of social participation adds to accumulating evidence linking positive affect with beneficial physical and psychological outcomes after an acute event such as stroke.

Implications for Rehabilitation

• This study shows positive affect associated with greater social participation 3 months post-discharge from in-patient medical rehabilitation.

• Positive affect may be a critical factor in the recovery trajectory of the stroke patient.

• The assessment of positive affect during in-patient medical rehabilitation may identify those at risk for poor social participation post-discharge and may lead to the design of innovative interventions aimed at the re-integration of stroke individuals into the community.

     

运动再学习疗法对脑卒中偏瘫患者功能恢复的疗效观察

目的：观察运动再学习疗法对脑卒中偏瘫患者功能恢复的疗效.方法：脑卒中偏瘫患者62例,随机分为观察组33例和对照组29例,观察组给予运动再学习疗法治疗,对照组进行常规康复治疗.采用临床神经功能缺损程度评分（CNS）、简式Fugl-Meyer（FMA）运动功能评价法、改良巴氏指数（MBI）评定,分别评定患者的临床神经功能缺损程度、运动功能和日常生活活动能力.结果：治疗8周后,2组CNS评分均较治疗前明显下降（P＜0.01）,且观察组更低于对照组（P＜0.05）;2组FMA及MBI评分均较治疗前明显提高（P＜0.01）,且观察组更高于对照组（P＜0.05）.结论：两种治疗方法均有助于患者功能恢复,运动再学习疗法较传统康复治疗方法更能有效地促进脑卒中偏瘫患者的功能恢复.     

急性脑卒中患者发生误吸的危险因素分析

摘要 目的：探讨急性脑卒中患者误吸的发生率及其危险因素。 方法：71例急性脑卒中患者根据纤维鼻咽喉镜吞咽功能检查（FEES）的结果分为误吸组和无误吸组。对可能影响卒中后误吸发生的危险因素进行多因素Logistic回归分析。 结果：急性脑卒中患者误吸的发生率为50.7%,36.1%的误吸患者为无症状性误吸。单因素分析显示年龄、脑卒中史和卒中严重程度是卒中后误吸的危险因素(P<0.05)。多因素Logistic回归分析表明严重卒中（OR＝5.778,95%CI 1.123—29.737）和既往有脑卒中史（OR=3.302,95%CI 1.174—9.293）是卒中后误吸的独立危险因素。 结论：误吸是脑卒中急性期的常见问题,严重卒中（NIHSS>10分）和脑卒中史是卒中后误吸的独立危险因素。 关键词 脑血管意外;误吸;危险因素 中图分类号：R743.3,R493 文献标识码：A 文章编号：1001-1242（2010）-02-0131-04     

An observation-based intervention for stroke rehabilitation: experiences of eight individuals affected by stroke

Purpose.?To explore eight individuals’ experiences and responses to taking part in a personalised observation-based intervention for stroke rehabilitation.

Methods.?Eight participants who had experienced a cerebrovascular accident were recruited to a 16-week observation-based intervention. Participants were interviewed face-to-face to explore their responses to, and experiences of, taking part in the intervention. A list of topics, derived from the intervention process and earlier studies provided a provisional structure for the interview. All interviews were transcribed, coded and analysed using inductive content analysis to explore the impact of the observational intervention for these participants.

Results.?Three main themes emerged: physical function, behaviour change and DVD content. Lower order themes were also identified. These included: interaction with the physiotherapist; ability to complete tasks; and increased motivation to (re)engage in activities of everyday living.

Conclusion.?The findings suggest that a programme of action observation, linked to individualised and meaningful motor behaviours can provide a valid intervention for individuals affected by stroke by serving as a motivating agent to (re)engage in activities which they had believed they could not perform following their stroke. There was also evidence for positive affect on psychological wellbeing and motor function.     

脑卒中后头晕与心理因素的相关性

INTRODUCTIONManypost－strokepatientsoftenfeeldizzinessandinvalidafteroutinetherapy．Weemployedpsychologydrugtherapyinthesekindofpa－tientstoobservethecorrelationofdizzinessandpsychologyfactors．MATERIALSANDMETHODSMaterials８２patientswerefromourclinicsanddepartmentandwithcompainofdizzinessfromJune１９９９toFebruary２００２，withcourse１monthto３yearsandwithastrokehistorybeforedizzinessrangingfrom１monthto６months．Therewere５１malesand３１females，agerangingfrom６２to８０years（me…     

Life satisfaction of couples 3 years after stroke

Purpose: To compare the life satisfaction of stroke patients to that of their spouses, and to examine spouses’ variables as determinants of the patients’ life satisfaction. Method: Patients with a first-ever stroke who were admitted to an inpatient rehabilitation centre and their spouses were included (n?=?78 couples). Measurements took place 3 years after the stroke. Life satisfaction was measured using the Life Satisfaction Questionnaire (LiSat-9). Results: More spouses (50%) than patients (28%) were dissatisfied with their life as a whole. Spouses were also more likely to be dissatisfied with all other domains of life satisfaction than patients. The associations between the life satisfaction of patients and of spouses were weak (Cramer’s V 0.00–0.43). In the backward linear regression analysis both patients’ participation in social activities and spouses’ life satisfaction were significantly related to patients’ life satisfaction. A total of 17.8% of the variance of patients’ life satisfaction could be explained by the model. Conclusions: Both spouse and patient in a couple experience decreased life satisfaction in the chronic phase after stroke, spouses even more so than patients. The life satisfaction of stroke patients was significantly related to spouses’ life satisfaction. Family-centred care should be an important part of the rehabilitation process.

Implications for Rehabilitation

• Both spouse and patient in a couple experience decreased life satisfaction in the chronic phase after stroke.

• The life satisfaction of stroke patients was significantly related to spouses’ life satisfaction.

• Family-centred care, in which the spouse is closely involved, should be an important part of the rehabilitation process.

     

急性脑卒中后吞咽障碍的早期临床康复护理

目的探讨早期临床护理对急性脑卒中后吞咽障碍的效果。方法将60例急性脑卒中后吞咽障碍患者按入院时间顺序分实验组30例,对照组30例,对实验组患者生命体征稳定48h后进行早期临床护理、康复训练,两组进行比较。结果早期对吞咽障碍患者进行康复训练效果评分明显高于对照组(P<0.01)。结论急性脑卒中后吞咽障碍患者早期进行临床护理、康复训练,可使患者尽早改善吞咽功能,促进患者早日康复,提高生活质量。     

高血糖对急性缺血性脑卒中亚型预后的影响

目的探讨入院时高血糖对腔隙性脑梗死和非腔隙性脑梗死预后的影响是否一致。方法采用前瞻性队列研究方法,共有248例缺血性卒中患者纳入试验,研究卒中发作8小时内血糖浓度与神经功能预后的关系。有益的终点定义为3个月后改良Rankin量表评分≤2分;根据牛津郡社区卒中计划（OSCP）进行临床分型,并经头颅CT证实为腔隙性脑梗死（n=62）和非腔隙性脑梗死（n=186）;高血糖定义为血糖≥8mmol／L。结果非腔隙性脑梗死组入院时血糖水平、高血压史和意识改变高于腔隙性脑梗死组,差异有统计学意义（P〈0．01或〈0．05）。单因素分析显示,在腔隙性脑梗死组中,与良好预后比较,不良预后与高龄有关,差异有统计学意义（P〈0．05）;在非腔隙性脑梗死组中,与良好预后比较,不良预后与高血糖、高龄、意识改变有关,差异有统计学意义（P〈0．01或〈0．05）。多变量分析显示高血糖与非腔隙性脑梗死预后不良有关（0R=0．71,P=0．008）,但能改善腔隙性脑梗死的预后（0R=2．76,P=0．052）。随着血糖上升,在非腔隙性脑梗死中,有益预后的优势比逐渐下降;而在腔隙性脑梗死中,有益预后与血糖≥8mmol／L有关,但当血糖〉10mmol／L,这种趋势消失。结论高血糖与非腔隙性脑梗死的预后不良有关,但适度高血糖可改善腔隙性脑梗死的预后。     

Predictors of persistent neck pain after whiplash injury

Objective

To establish the aetiological influences of persistent neck pain following a motor vehicle collision and to construct a model for use in the emergency department for identifying patients at high risk of persistent symptoms.

Design

Prospective cohort study. Patients recruited from hospital emergency departments were sent a questionnaire to gather information on various exposures. They were followed up at 1, 3, and 12 months to identify those with persistent symptoms.

Main outcome measure

Persistent neck pain (pain at 1, 3, and 12 months after collision).

Results

The baseline survey included 765 patients. Subsequently, 480 completed a questionnaire at each follow up time point, of whom 128 (27%) reported neck pain on each occasion. Few collision specific factors predicted persistent neck pain. In contrast, a high level of general psychological distress, pre‐collision history of widespread body pain, type of vehicle, whiplash associated symptoms, and initial neck disability best predicted the persistence of symptoms. Furthermore, these factors, in combination, accounted for more than a fivefold increase in the risk of persistent neck pain.

Conclusion

The greatest predictors of persistent neck pain following a motor vehicle collision relate to psychological distress and aspects of pre‐collision health rather than to various attributes of the collision itself. With these factors, and those relating to initial injury severity, it is possible to identify a subgroup of patients presenting with neck pain with the highest risk of persistent symptoms. Thus, it is possible to identify whiplash patients with a poor prognosis and to provide closer follow up and specific attention to management in these individuals.