Responsiveness of functional health status measures frequently used in stroke research

PURPOSE: To compare the responsiveness of several functional health status measures frequently used in stroke research, namely the Barthel Index (BI), Functional Independence Measure (FIM), Frenchay Activities Index (FAI) and Stroke-Adapted Sickness Impact Profile 30 (SA-SIP 30). METHOD: Patients with a first-ever supratentorial stroke admitted for inpatient rehabilitation were included. Complete datasets for 163 patients were available for analysis. Floor/ceiling effects and responsiveness, quantified by effect sizes, were studied for the periods between rehabilitation admission and six months post stroke (subacute phase) and between six and 12 months post stroke (chronic phase). RESULTS: Effect sizes in the subacute phase were similar and were classified as large for the BI, FIM total and FIM motor score. The FIM cognitive score showed a considerable ceiling effect and had the smallest effect size in the subacute phase. In the chronic phase, the FAI and SA-SIP 30 detected the most changes and had moderate effect sizes. CONCLUSIONS: BI, FIM total and FIM motor score, FAI and SA-SIP 30 were responsive measures. We recommend the use of the BI in the subacute phase and the use of the FAI and SA-SIP 30 in the chronic phase, especially for the stroke rehabilitation population.     

Health literacy and functional health status in Korean older adults

Aims and objectives. The aim of the study was to investigate the relationships of health literacy to chronic medical conditions and the functional health status among community‐dwelling Korean older adults. Background. In the literature, limited health literacy has been reported to have adverse effect on health outcomes. However, the link between health literacy to health status among Korean older adults needs to be clarified. Design. A cross‐sectional survey. Methods. A cross‐sectional survey of 103 community‐dwelling Korean older adults was conducted from June 2007–September 2007. Health literacy was measured using the Korean Functional Health Literacy test and functional health status was measured using the subscales of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Results. Individuals with a low health literacy had significantly higher rates of arthritis and hypertension. After adjusting for age, education and income, older individuals with low health literacy had higher limitations in activity and lower subjective health. In a model adjusting for age and income only, older individuals with low health literacy were more likely to report lower levels of physical function and subjective health and higher levels of limitations in activity and pain. Conclusions. Among community‐dwelling Korean older adults, limited health literacy is associated independently with higher rates of chronic medical conditions and lower subjective health status. Relevance to clinical practice. Nurses are key to providing health education to older adults. The understanding of the relationship of health literacy to health status is essential to develop communication and health education efforts for older adults in nursing practice.     

Factors predicting the health status of caregivers of stroke survivors: A cross‐sectional study

In this cross‐sectional study, we aimed to determine factors influencing the health status of caregivers of stroke survivors. A total of 126 caregivers of stroke survivors were recruited from three outpatient clinics in Thai Nguyen National General Hospital, Vietnam, from November 2016 to March 2017. Data were collected through six instruments: a demographic questionnaire, the Modified Barthel Index, the Zarit Burden Interview Scale, the Multidimensional Scale of Perceived Social Support, the Family Caregiver Conflict Scale, and the Short Form‐36 Health Survey. Stepwise multiple regression was employed to analyze the data. Caregiver burden, patient's functional status, caregiver's age, and social support together explained 80.3% of the variations in health status of caregivers of stroke survivors. Caregiver burden was the strongest predictor of health status of these caregivers. Based on the findings, nurses should take caregiver's age, functional status of stroke survivors, caregiver burden, and social support into consideration when preparing family caregivers to provide care for stroke survivors. To reduce perceived caregiver burden, family support interventions should be embraced to enhance health status of the caregivers of stroke survivors.     

动态功能连接分析在脑卒中近5年的应用现状

脑卒中是一种影响脑网络的疾病,功能磁共振成像技术广泛用于研究卒中损伤后大脑的功能变化和网络重组。动态功能连接是一种新兴的分析方法,用以表征静息状态下大脑功能连接的动态特性。动态功能连接在近5年应用于脑卒中领域,主要用于探索全脑不同网络、感觉运动网络以及语言网络的功能连接属性。研究表明卒中发生后大脑网络功能连接呈现一些重复出现的密集或稀疏的连接状态并具有不同的时间变异特征,为研究脑卒中提供了新的视角,具有潜在的优势。本研究主要综述动态功能连接在脑卒中的应用现状,包括卒中后全脑网络研究、感觉运动网络研究、语言网络研究等方面。     

Comparison of the Orpington Prognostic Scale (OPS) and the National Institutes of Health Stroke Scale (NIHSS) for the prediction of the functional status of patients with stroke

Purpose. The aim of our study is to compare the Orpington Prognostic Scale (OPS) and the National Institutes of Health Stroke Scale (NIHSS) and to evaluate whether they help us estimate the future functional status of patients with stroke.

Method. Twenty-five patients with stroke were administered the OPS and NIHSS on the 7th day of stroke in order to define the severity of the disease, and the Barthel Index was performed in order to evaluate the functional status and the activities of daily living (ADL) at the 1st, 3rd, and 6th months.

Results. Both scales were statistically correlated (P = 0.0001). When the predictability of these scales in terms of the ADL and functional status was evaluated, the regression coefficient at the 1st month was ?14.746, R² = 0.58, P < 0.0001 and ?4.885, R² = 0.50, P < 0.0001 for OPS and NIHSS, respectively, the same coefficient at the 3rd month was ?12.482, R² = 0.41, P = 0.001 for OPS and ?3.280, R² = 0.23, P = 0.016 for NIHSS, and at the 6th month it was ?11.662, R² = 0.38, P = 0.001 for OPS and ?2.997, R² = 0.20, P = 0.02 for NIHSS.

Conclusion. In patients with stroke, OPS and NIHSS had significant contribution to the estimation of the functional status and OPS was more effective than NIHSS.     

首发脑卒中患者出院后一周的心理状态与社会参与的相关性分析

目的：调查首发脑卒中患者出院后一周的心理健康状况和社会参与水平,并探讨两者的相关性。方法：采用医院焦虑和抑郁量表（HADS）和自主参与问卷（IPA）对271位首发脑卒中患者进行调查。结果：首发脑卒中患者出院后一周的社会参与总分为（61.14±13.44）分;各条目均分为（2.45±0.54）分。研究对象的焦虑得分为（8.43±4.88）分,阴性为152例,阳性为119例（43.9%）;抑郁得分为（8.48±4.79）分,阴性为145例,阳性为126例（46.5%）。研究对象的心理状况得分与社会参与得分成正相关（P〈0.01）。结论：心理状况和社会参与密切相关,在康复护理中应关注患者的心理状况,缓解其负性情绪,以改善其社会参与障碍。     

Responsiveness of the EAT-10 to Clinical Change in Head and Neck Cancer Patients with Dysphagia

Abstract

Purpose: This retrospective study evaluated the external responsiveness of the Eating Assessment Tool-10 (EAT-10) to clinical changes in a single cohort (n?=?105) treated with chemoradiotherapy (CRT) or radiotherapy (RT) for head-and-neck cancer.

Method: Patients completed the EAT-10 four times: (I) Within two weeks of commencing (C)RT, (II) in the final week of (C)RT, (III) two weeks post-(C)RT and (IV) following discharge from speech-language pathology services. Data was compared to their oral intake status, using the Functional Oral Intake Scale (FOIS).

Result: Using Cohen’s d, changes in the EAT-10 and FOIS were comparable, however, a difference was observed at data-point IV. At data-points I, II and III, the EAT-10 had a strong negative correlation with the FOIS (Spearman’s ρ=??0.81, ?0.80 and ?0.81 resp.). At data-point IV the correlation strength decreased (Spearman’s ρ=??0.69). Fisher’s Z transformation found no statistically significant correlation coefficient differences between data-points I, II and III. A significant difference in correlation was found between these data-points and data-point IV (p?=?0.027; p?=?0.039 and p?=?0.022 resp.). A very high internal consistency was found (Cronbach’s α?>?0.95) for all data-points.

Conclusion: This study’s results indicate that the EAT-10 has weaknesses in the external responsiveness and has redundancy of its question items.     

高血压合并脑卒中患者健康知识与健康行为的现状及其相关性

目的探讨高血压合并脑卒中患者健康知识与健康行为水平的相关性,为健康教育提供依据。方法采用便利抽样法,应用脑卒中健康知识问卷（strokeknowledgequestionnaire,SKQ）及健康促进生活方式量表Ⅱ（health—promoting lifestyle profile,HPLPII）调查广州市2所三级甲等医院106例高血压与336例脑卒中患者,336例脑卒中患者中包括脑卒中住院患者112例、首发和复发脑卒中门诊患者分别为115例和109例。结果各组SKQ总分介于61．43—70．99分,HPLPⅡ总分介于2．22—2．59分。除了复发脑卒中门诊组外,患者SKQ与HPLPⅡ呈正相关。结论高血压合并脑卒中患者健康知识及行为均不理想,健康知识水平高的患者健康行为水平较高,在卒中一、二级预防健康教育中应引起关注。     

急性脑卒中患者功能结局的预测

目的：探讨影响急性脑卒中患者预后的主要因素和临床神经功能缺损程度评分量表（CNS）,改良巴氏指数评分（MBI）,功能综合评定量表评分（FCA）评分的相关性.方法：100例急性脑卒中患者随机分成康复组（50例）和对照组（50例）,除进行常规的神经内科治疗外,康复组患者在急性期（病程21天内,病情稳定48h）至病程6个月进行规范的康复治疗,包括运动疗法、作业疗法和言语治疗等.收集关于患者人口特征、病史、体格检查、急性期CNS、MBI、FCA评分等资料.病程6个月时FCA评分作为功能结局,资料采用直线相关分析、逐步回归分析.结果：直线相关分析表明急性期CNS、MBI评分与病程6个月时FCA评分相关,逐步回归分析发现急性期CNS、MBI评分和是否经过规范康复治疗是患者病程6个月时FCA评分的预测因素.结论：急性期CNS、MBI评分和康复治疗可以预测脑卒中患者病程6个月时的功能结局,患者急性期MBI评分是病程6个月时的功能结局最主要的预测因素.     

Responsiveness and minimally important differences for selected Persian-version of outcome measures used in patients with patellofemoral pain syndrome

Abstract

Purpose: To investigate the responsiveness and determine the minimally important differences (MID) of Persian versions of the Kujala patellofemoral scale (KPS), lower extremity functional scale (LEFS), and functional index questionnaire (FIQ) in patients with patellofemoral pain syndrome (PFPS). Method: Outcome measures including the Persian KPS, LEFS, and FIQ were administered to 233 patients at baseline and then again 4 weeks after physiotherapy. Moreover, the 7-point global rating scale was completed by the patients at 4 weeks. Responsiveness was evaluated using the correlation analysis and the receiver operating characteristics (ROC) method. Results: Correlation analysis showed that the relationship of all outcome measures with the global rating scale falls within the fair range of relationship (Gamma?=?0.26–0.40). Moreover, the results of ROC analysis showed that the all outcome measures have acceptable high responsiveness index. Furthermore, the MIDs of 9.5, 4.5, and 1.5 points were obtained for the Persian KPS, LEFS, and FIQ, respectively. Conclusions: The Persian-versions of all outcome measures are responsive for evaluating change following physiotherapy intervention. The MID values obtained in this study will help the clinicians and researchers to determine if a patient with PFPS has experienced a true change following a physiotherapy intervention.

• Implications for Rehabilitation

• Persian-versions of the KPS, LEFS, and FIQ can be used as three “responsive” outcome measures in clinical studies of patients with patellofemoral pain syndrome (PFPS).

• These assessment tools have clinical relevance for rehabilitation specialists working on patients with PFPS.

• The minimally important differences provide valuable information for the clinicians and researchers to make decision about the identification of a clinical change in health status of patients with PFPS.

     

脑卒中患者自测健康状况及其相关因素研究

目的：了解脑卒中患者的自测健康状况及其人口统计学的影响因素,为促进脑卒中患者的心理康复治疗提供参考依据。方法应用自测健康评定量表（self-rated health measurement scale version1.0,SRHMS）,在调查员的现场指导下采用自主填写方式对206名脑卒中患者进行调查。结果①脑卒中患者生理健康（BZT）、心理健康（MZT）、社会健康（SZT）、自测健康总得分（ ZCZT）均显著低于国内常模水平（ P ＜0.001）;既往有无卒中史及高血压病史的患者BZT、MZT、SZT、ZCZT存在显著差异（ P ＜0.01）;经济贫困与非贫困者BZT、MZT、SZT、ZCZT存在明显差异（ P ＜0.05）;有宗教信仰与无宗教信仰的患者MZT、SZT及ZCZT存在明显差异（ P ＜0.05）,而BZT差异无统计学意义（ P ＞0.05）;不同性别、年龄、婚姻状态、文化程度脑卒中患者的SRHMS得分差异均无统计学意义（ P＞0.05）。②PearSon及多因素线性回归分析显示,既往卒中史、宗教信仰、经济状况是SRHMS得分的相关影响因素（ P＜0.05）。结论脑卒中患者的自测健康状况明显偏差,既往有卒中病史、贫困、有宗教信仰是脑卒中患者自测健康的主要影响因素。     

应用烟酸复方片治疗的脑卒中患者心理健康状况调查

目的探讨脑卒中患者应用烟酸复方片（MK-0524A）治疗后的心理健康状况,并提出针对性的护理干预对策。方法对94例应用MK-0524A治疗的脑卒中患者采用症状自评量表（SCL-90）进行心理状况调查。结果94例应用MK-0524A治疗的脑卒中患者的SCL-90量表的评定结果总分（131．53±13．829）分,高于中国常模（129．96±38．76）分,差异有统计学意义（t=1．102,P〈0．01）,躯体化、抑郁、敌对、恐怖及焦虑5项因子得分与中国常模比较差异均有统计学意义（P〈0.01或P〈0.05）;患者的年龄、职业对患者的心理健康有不同程度的影响（P〈n05）。结论脑卒中患者不仅有生理疾患,还有不同程度的心理隋绪问题,应对其心理健康状况多加关注,必要时实施心理护理及干预,促进患者的躯体及心理健康,提高患者的生活质量。     

老年人健康状况及保健需求调查

目的了解老年人的健康状况及对医疗保健的需求,为老年人的健康保健及医疗服务提供参考依据。方法随机对来我院参加健康知识讲座的324名老年人进行问卷调查。调查内容包括健康状况、健康相关行为、医疗服务利用情况、卫生保健需求4个方面。结果老年人身体状况普遍欠佳,在被调查的老年人中,有81.6%的老年人患有高血压、心脏病、糖尿病或其他慢性病;有23.2%的老年人曾因病住院。吸烟、饮酒及少运动是影响老年人身体健康的主要因素。为老年人改善环境、增加安全性、提供日间护理、社区护理、提供健康知识教育是绝大多数老年人的保健需求。结论针对老年人的健康状况及需求,应多提供针对老年人的健康知识讲座,开展健康教育活动,加强社区保健服务,使他们了解自己的健康状况、熟悉自身所患疾病的相关知识,加强自我保健意识,去除不良习惯,以达到免除疾病、减少病痛、增进健康的目的。     

Role of ankle foot orthoses in functional stability of individuals with stroke

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p?<?0.05). Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.

• Implications for Rehabilitation

• Functional stability is impaired in individuals with stroke.

• Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.

• Individuals with stroke improved their functional stability while they were provided with AFOs.

• Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

     

Racial disparities in stroke functional outcomes upon discharge from inpatient rehabilitation facilities

Purpose.?Analyse racial disparities in clinical outcomes after stroke in inpatient rehabilitation facilities (IRF).

Methods.?Analyses based on data from a multi-center prospective observational cohort study on inpatient stroke rehabilitation in six IRFs from across the United States. Multivariate models examined racial disparities in functional outcomes upon discharge, taking into account patient characteristics and detailed information on processes of care.

Results.?In the moderate stroke group (N?=?397), functional scores on admission were not significantly different between African-Americans and whites. In the severe stroke group (N?=?335), whites showed significantly lower functional scores at admission [Functional Independence Measurement, (FIM)], mean scores, 44 versus 49 for African-Americans, p?<?0.001). Multivariate analyses predicting discharge motor FIM score found no significant differences between African-American and white stroke patients (p?=?0.2194 and p?=?0.3547 in the moderate and severe stroke group, respectively).

Conclusion.?Controlling for patient characteristics, therapy intensity and processes of care results in non-significant differences between African-Americans and whites in motor FIM scores upon discharge. The absence of significant differences in recovery while patients were on the rehabilitation unit suggests that racial disparities in long-term functional recovery after stroke are likely to have originated before or after the inpatient rehabilitation stay.     

急性脑卒中早期康复的功能变化与费用的随机对照研究

目的:探讨早期康复对急性脑卒中患者功能变化的影响及相关费用的分析和评价。方法:80例急性脑卒中患者随机分成康复组(40例)和对照组(40例),除进行常规的神经内科治疗外,康复组患者在急性期(病后1个月内,病情稳定48h)至病后6个月进行规范的康复治疗,包括运动疗法、作业疗法和言语治疗等,并对每组患者在入组时、病后3个月和6个月时的功能状况采用改良Barthel和综合功能评定(FCA)进行评测。比较两组在病后3个月和6个月的相关费用,包括直接医疗费用、直接非医疗费用、间接费用等,并进行了成本—效果分析。结果:病后3个月和6个月两组患者的功能状况均有不同程度的改善,其中康复组患者功能改善程度较大,差异有显著性意义(P<0.05)。病后3个月康复组38例的费用总和为$889104.2(23397.5±14176.4),对照组38例的费用总和为$737686.1(19412.8±20897.6),差异有显著性意义(P<0.05);病后6个月康复组38例的费用总和为$1087417.5(28616.2±22009.1),对照组为$901915.2(23734.6±22687.0),差异无显著性意义(P>0.05)。MBI或FCA积分每增加1分在康复组所需的总费用和直接医疗费用相对较低。结论:早期规范的康复治疗可以改善急性脑卒中的功能状况。     

时间护理在脑卒中患者功能康复中的应用效果研究

目的探讨时间护理促进脑卒中患者功能康复的效果。方法将本院收治的80例脑卒中患者随机分为对照组(常规护理)和观察组(时间护理),比较2组的肢体运动功能、BMI评分、NDF评分、疗效以及再次入院的情况。结果观察组出院1 d前的肢体运动功能、生活功能高于对照组,神经缺损情况轻于对照组,差异有统计学意义(P0.05)。观察组总治疗有效率高于对照组,住院时间短于对照组,再次入院及2次以上入院的发生率低于对照组,差异有统计学意义(P0.05)。结论时间护理能够提高脑卒中患者的康复效果,减少再次入院的发生。     

脑卒中患者健康教育的需求与对策

目的 了解脑卒中患健康教育的需求。方法 采用自行设计问卷,调查300例脑卒中患的健康教育需求。结果 患最需要了解的教育内容是发病原因及用药常识,分别占95％、93％;最需要的健康教育方式是宣传手册和讲课,分别占39％、20％。结论 根据病员对健康教育需求和最需要的教育方式采取相应对策,才能收到健康教育效果。