Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation

BackgroundLower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke.Patients and methodsIn a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment.ResultsOne hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R²: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02).ConclusionsHigher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.

KEY MESSAGE

• Higher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.
• Higher SES is associated with significantly higher utilization of outpatient therapies.
• Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery.
• Article registration: clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT04119479","term_id":"NCT04119479"}}NCT04119479.

     

体外循环时心肌组织黏附分子的表达及抑肽酶对其的影响

目的　观察体外循环前后P -选择素及细胞间黏附分子 - 1(ICAM 1)的表达 ,并探讨抑肽酶对其表达的影响。方法　 2 0例行体外循环心内直视手术的先天性心脏病患儿 ,治疗组 10例 ,预充液中加入抑肽酶 10万kIU/kg ;对照组 10例 ,未用抑肽酶。于体外循环前后各取右心耳组织 ,采用免疫组化法检测心肌组织中P -选择素、ICAM 1及髓过氧化物酶 (MPO)的表达水平。结果　两组P -选择素、ICAM 1及MPO免疫组化灰度值术后均较术前增高 (P <0 .0 1) ;术后治疗组中其升高幅度明显低于对照组 (P <0 .0 1)。结论　体外循环心肌组织黏附分子P -选择素及ICAM 1表达增加。抑肽酶可以通过抑制这些黏附分子的表达 ,从而减轻炎症反应     

儿童下肢截肢及其功能康复的流行病学与临床特征

目的 分析儿童下肢截肢及其康复的流行病学特点与临床特征,阐述儿童截肢的原因及截肢后并发症的情况。方法 选择2016年1月至2021年3月北京博爱医院收治的下肢截肢儿童51例,分析截肢原因与截肢后并发症的相关性。结果 创伤性截肢占58.82%,主要原因为交通事故(70%);疾病性截肢占41.18%,主要原因为先天性肢体畸形(80.95%)。创伤性截肢后发生残端并发症的可能性较预期更高(P <0.05);疾病性截肢后发生残端并发症的可能性较预期更低(P <0.05)。结论 交通事故是儿童创伤性截肢的主要原因,其临床特征是不良残端发生率高,主要原因是软组织异常,大部分病例需要通过残端修整术改善不良残端而达到装配假肢恢复行走的目的。先天性胫骨假关节是儿童疾病性截肢的主要原因,往往经历长期的保肢治疗后仍不能避免截肢的结局。     

水中抗阻训练对类风湿关节炎居家患者手足关节功能康复的影响

目的 探讨水中抗阻训练对类风湿关节炎居家患者手足关节功能康复的影响.方法 将风湿免疫科门诊就诊的类风涅关节炎患者71例根据就诊日期单双日分为观察组(n=35)和对照组(n=36).对照组接受常规护理及关节功能训练;观察组在对照组基础上实施水中抗阻训练,每天训练30～60 min,每周至少训练3d.比较两组干预前后双手握...     

老年高血压病的综合性康复治疗研究进展

从药物治疗、非药物治疗、健康教育等综合性康复治疗方面对老年性高血压的研究现状进行了分析和概述。     

Occupational Therapy Practice in Hospital-based Stroke Rehabilitation?

Abstract

Background: Occupational therapy after stroke represents a complex intervention. Objective: The aim of this observational study was to document the content of occupational therapy stroke rehabilitation in an Australian general rehabilitation ward. Methods: A behavioural mapping tool recorded 22 occupational therapy sessions at five-minute intervals for nine participants with stroke (mean age 70.6 years, 88.9% female). Results: The mean session length was 41 minutes. The focus of therapy was predominantly at body functions (mean 16.5 minutes) and motor and perceptual impairments were addressed most often. Conclusion: The overall amount of occupational therapy provided was consistent with session lengths reported from effective stroke units and recommended by stroke guidelines. However, the results highlight the difficulties for occupational therapists working within the hospital environment, including practice that was largely restricted to the level of impairment and basic activities of daily living.     

Study on factors associated with changes in quality of life of demented elderly persons in group homes

The purpose of the present study was to attempt to identify changes in quality of life (QOL) and factors associated with them shortly after demented elderly residents entered a group home. The subjects were 25 demented elderly persons who had entered a group home within the previous 3 months. Their QOL and factors associated with it were evaluated on two occasions, at baseline and 3 months later. An objective scale for dementia, the Quality of Life Questionnaire for Dementia (QOL-D), was used to evaluate their QOL. The results showed a significant change between the QOL-D scores at baseline and 3 months later, and changes in housekeeping item scores were extracted as factors associated with changes in QOL-D. These findings suggest that the QOL score rises soon after entering a group home, and that the acquisition of roles within the group home may influence the increase in QOL.     

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