| 1. |
- Darehed, David, et al.
(författare)
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Death and ADL dependency after scoring zero on the NIHSS
- 2023
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Ingår i: Neurology. - : Wolters Kluwer. - 2163-0402 .- 2163-0933. ; 13:5
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: Of all strokes, mild strokes (defined as 5 points or less on the National Institutes of Health Stroke Scale [NIHSS]) are in the majority. However, up to one-third of patients with mild strokes still exhibit significant deficits 3 months after the stroke. Studies on the presumably mildest strokes, defined by zero points on the NIHSS (0-NIHSS) at admission, are scarce. Hence, we aimed to study patient characteristics and outcomes among patients with 0-NIHSS strokes.Methods: Our retrospective registry-based study included a total of 6,491 adult patients with stroke admitted to 3 different stroke units in Gothenburg, Sweden, from November 2014 to June 2019. Our main outcome was a composite measure including death and activities of daily living (ADL) dependency 3 months after the stroke. Analyses of patient characteristics were followed by adjusted analyses including multiple confounders.Results: In total, 5,945 patients had data on NIHSS at admission, of whom 1,412 (24%) presented with a 0-NIHSS stroke. Among these, the median age was 72 years, 600 (42%) were female, and 86 (6%) had a hemorrhagic stroke. Among previously ADL-independent patients, 65 (6%) were either dead or ADL-dependent 3 months after the stroke. Prestroke physical inactivity (OR 2.48, 95% CI 1.40–4.38) and age (OR 1.05 per gained year, 95% CI 1.02–1.08) significantly increased the risk of death and ADL dependency.Discussion: One of 17 patients has either died or become ADL-dependent 3 months after a 0-NIHSS stroke, stressing that these strokes are not always benign. Older and physically inactive patients are at greater risk of an adverse outcome.
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| 2. |
- Gustafsson, Susanne, et al.
(författare)
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Occupational therapists' and patients' perceptions of ABILHAND, a new assessment tool for measuring manual ability
- 2004
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 11:3, s. 107-117
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore and describe how occupational therapists (OTs) and patients perceived ABILHAND, a new assessment tool for measuring manual ability, in order to evaluate it in terms of content validity and clinical utility in stroke rehabilitation in Sweden. Three main steps were followed to achieve the study goal. First, ABILHAND was translated, and second OTs used ABILHAND with patients admitted for occupational therapy intervention. Finally, in the third step, which aimed to evaluate the content validity and clinical utility of ABILHAND, focus-group interviews were used as a qualitative method of research. The results indicate that ABILHAND might benefit from adjustments to improve content validity. The results also show that standardization for clinical administration is necessary, the production of a manual is essential and the development of a user-friendly computer program for processing data is desirable. An additional finding in this study is an insight into the clinical reasoning of the OTs, which resulted in two conclusions. First, OTs need to discuss and learn more about central concepts in occupational therapy, and second they need to learn more about standardized assessment and how tests are developed and used.
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| 3. |
- Hankey, Graeme J., et al.
(författare)
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Twelve-Month Outcomes of the AFFINITY Trial of Fluoxetine for Functional Recovery After Acute Stroke AFFINITY Trial Steering Committee on Behalf of the AFFINITY Trial Collaboration
- 2021
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Ingår i: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 52:8, s. 2502-2509
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. METHODS: AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization. The primary outcome was function, measured by the modified Rankin Scale, at 6 months. Secondary outcomes for these analyses included measures of the modified Rankin Scale, mood, cognition, overall health status, fatigue, health-related quality of life, and safety at 12 months. RESULTS: Adherence to trial medication was for a mean 167 (SD 48) days and similar between randomized groups. At 12 months, the distribution of modified Rankin Scale categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio, 0.93 [95% CI, 0.76-1.14]; P=0.46). Compared with placebo, patients allocated fluoxetine had fewer recurrent ischemic strokes (14 [2.18%] versus 29 [4.55%]; P=0.02), and no longer had significantly more falls (27 [4.21%] versus 15 [2.35%]; P=0.08), bone fractures (23 [3.58%] versus 11 [1.72%]; P=0.05), or seizures (11 [1.71%] versus 8 [1.25%]; P=0.64) at 12 months. CONCLUSIONS: Fluoxetine 20 mg daily for 6 months after acute stroke had no delayed or sustained effect on functional outcome, falls, bone fractures, or seizures at 12 months poststroke. The lower rate of recurrent ischemic stroke in the fluoxetine group is most likely a chance finding.
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