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

Thursday, June 22, 2017

Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment


Who gives a shit about predicting recovery? Do the right thing and create 100% recovery for all stroke patients. That is non-negotiable, you lazy fucking idiots.

http://journal.frontiersin.org/article/10.3389/fneur.2017.00275/full?
imageTerence J. Quinn1*, imageMartin Taylor-Rowan1, imageAishah Coyte1, imageAllan B. Clark2, imageStanley D. Musgrave2, imageAnthony K. Metcalf3, imageDiana J. Day4, imageMax O. Bachmann2, imageElizabeth A. Warburton4, imageJohn F. Potter2,3 and imagePhyo Kyaw Myint2,3,5
  • 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
  • 2Norwich Medical School, University of East Anglia, Norwich, United Kingdom
  • 3Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, United Kingdom
  • 4Lewin Stroke & Rehabilitation Unit, Addenbrooke’s Hospital, Cambridge, United Kingdom
  • 5Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
Background and purpose: The modified Rankin Scale (mRS) was designed to measure poststroke recovery but is often used to describe pre-stroke disability. We sought to evaluate three aspects of pre-stroke mRS: validity as a measure of pre-stroke disability; prognostic accuracy and association of pre-stroke mRS scores, and process of care.
Methods: We used data from a large, UK clinical registry. For analysis of validity, we compared pre-stroke mRS against other markers of pre-stroke function (age, comorbidity index, care needs). For analysis of prognostic accuracy, we described univariable and multivariable models comparing pre-stroke mRS and other prognostic variables against a variety of outcomes (early and late mortality, length of stay, institutionalization, incident complications). Finally, we described association of pre-stroke mRS and components of evidence-based stroke care (early neuroimaging, admission to stroke unit, assessment of swallow).
Results: We analyzed data of 2,491 stroke patients. Concurrent validity analyses suggested statistically significant, but modest correlations between pre-stroke mRS and chosen variables (rho >0.40; p < 0.0001 for all). Every point increase of pre-stroke mRS was associated with poorer outcomes for our prognostic variables (unadjusted p < 0.001). This association held when corrected for other covariates. For example, pre-stroke mRS 4–5 odds ratio (OR): 6.84 (95% CI: 4.24–11.03) for 1 year mortality compared to mRS 0 in adjusted model. There was a difference between pre-stroke mRS and treatment, with higher pre-stroke mRS more likely to receive evidence-based care.
Conclusion: Results suggest that pre-stroke mRS has some concurrent validity and is a robust predictor of prognosis. This association is not explained by the influence of pre-stroke mRS on care pathways.

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