Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Wednesday, January 18, 2017

Hospital Variation in Functional Recovery After Stroke

There should be almost zero variation. If we had objective damage diagnosis, 3d size and location, penumbra included. Then we could measure hospitals against each other since they would be using the exact same stroke rehab protocols. But until we get the fossilized leaders out of stroke progress will not be made. They are all waiting for SOMEONE ELSE TO SOLVE THE PROBLEM. Piss on them. Using the Rankin scale as a measurement device for stroke disability is incredibly stupid. It has nothing objective in it at all except for 6 - death.
http://circoutcomes.ahajournals.org/content/10/1/e002391?etoc=
Janet Prvu Bettger, Laine Thomas, Li Liang, Ying Xian, Cheryl D. Bushnell, Jeffrey L. Saver, Gregg C. Fonarow, Eric D. Peterson

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Abstract

Background—Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes.
Methods and Results—Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3–6). Secondary outcomes included functional dependence (mRS score of 3–5), disabled (mRS score of 2–5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%–67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54–0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53–0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses.
Conclusions—One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes.

1 comment:

  1. You're right - this is all meaningless. Day 2 after the stroke, I was at 3, except for needing walking assistance from brace and cane. At 1 month and at 3 months, I was the same. Now, 7 years later, I can do an awful lot more, but I'm still a 3 according to the Rankin scale - because I still need the assistance of a brace OR cane, although I can manage short distances (across the room, for example) without.

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