Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,245 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 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:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
My pet peeve was the car in the rehab center, practice getting in and out was only done on the passenger side, never the driver door or the rear doors.
The
present study aims to describe the chair, bed, and toilet heights in
rehabilitation hospitals and home environments to challenge
rehabilitation clinicians to better prepare stroke survivors for
discharge home. This study uses analysis of secondary outcomes from a
multicentre, phase II randomized controlled trial (HOME Rehab trial) and
additional observation of hospital environment. Data were collected
from six rehabilitation hospitals and the homes of two hundred
first-time stroke survivors who were aged >45 years. Chair, bed and
toilet heights were measured; we measured 936 chairs and beds in
hospital (17%) and home (83%) environments. Mean chair height at home
was 47 cm (SD 6), which was 2 cm (95% CI, 0-4) lower than in the
hospital ward and 5 cm (95% CI, 3-7) lower than in the hospital gym.
Mean toilet height at home was 42 cm (SD 3), which was 3 cm (95% CI,
2-4) lower than in the hospital. Study findings suggest a disparity in
heights between hospitals and home. Although clinicians may be aware of
this disparity, they need to ensure that chair and bed heights within
the hospital environment are progressively made lower to better prepare
stroke survivors for discharge home.
Physical
rehabilitation after stroke aims to prepare stroke survivors for
discharge home. Safe discharge home from rehabilitation includes being
able to sit, transfer, and walk.
Therefore, physiotherapy in rehabilitation is based on the practice of
these essential everyday activities to improve the performance of these
activities in preparation for discharge home.
A common everyday activity practiced in rehabilitation is standing up
from a chair. Over the previous decades, research has described the
biomechanics of standing up from a chair.
One of the important findings is that, as the chair height is
increased, lower limb joint moments are decreased, ie, it requires less
muscular effort to stand from a higher chair.
This knowledge assists rehabilitation therapists in tailoring the
difficulty of standing up to the stroke survivor's ability by modifying
the chair's height.
Rehabilitation
hospitals are modified in design and built specifically for people with
physical disability. The design of rehabilitation hospital environments
usually considers safety, eg, minimizing fall risk, but does not
necessarily consider the potential of the environment to influence
functional outcomes.
This
study aimed to describe the chair, bed, and toilet heights in the home
environment to inform rehabilitation clinicians and consider how they
can better prepare stroke survivors for discharge home. Therefore, the
research questions were (1) what are the heights of chairs, beds, and
toilets in hospital and home environments? and (2) what is the
difference in chair, bed, and toilet heights between rehabilitation
hospitals and home environments?
Methods
Design
Secondary
observational analysis of the hospitals and individuals post-stroke
participating in a discharge planning trial, the HOME Rehab trial.
The HOME Rehab trial is a multicentre, phase III randomized trial
conducted in Australia. The trial compared an enhanced occupational
therapy discharge planning intervention to usual care discharge
planning. Within this trial, environmental measures were taken at stroke
participants’ homes and in the hospital sites’ wards and gyms.
Ethics approval
This
study was approved by the Alfred Health Human Research Ethics Committee
(HREC/17/Alfred/236 [NMA]), and site-specific ethics approval was
obtained at all participating sites. All participants gave written
informed consent before data collection.
Participants, therapists, centers
Six
metropolitan hospitals that had rehabilitation wards, which were sites
in the HOME Rehab trial, were included in the hospital ward and gym
environmental analyses. The hospitals were located across 3 states of
Australia. The rehabilitation wards had a stroke throughput of >20
patients each year.
The home
environmental analysis included the first 200 stroke participants in the
HOME Rehab trial. The stroke participants had all experienced their
first stroke. They were aged >45 years, admitted to rehabilitation,
expected to return to a community (private) dwelling after discharge,
and had no significant prestroke disability (prestroke modified Rankin
Scale score, 0-2).
Measures
A
comprehensive environmental evaluation was completed in rehabilitation
hospital wards, gyms, and homes. In the hospital evaluation, a trained
therapist measured the heights of chairs, plinths, toilets, and beds
using a standardized procedure. In the home evaluation, dining chair,
lounge, toilet, and bed heights were measured by a trained family
member, who also took a photograph of the procedure that a trained
therapist checked. In both environments, the same procedure was used,
and it involved using a tape measure from the floor to the top of the
chair or bed to the nearest millimeter. All chairs and beds were
measured at the height they were found on entry to the room without
adjustment. All chairs and toilets were measured when vacant, and beds
and plinths (therapy mat tables) were measured with a person sitting on
them to account for mattress compression when occupied.
Additionally,
in the rehabilitation environment evaluation, beds or plinths (therapy
mat tables) were measured under further conditions; after measuring at
the height found, they were adjusted to the lowest possible and highest
possible height. Five individual chairs or beds were measured in the
ward and therapy gym areas for each type.
Data analysis
Descriptive
statistics (mean ± SD) were used to describe the average height of each
type of chair or bed in the hospital ward, hospital gym, and home. The
difference in heights was calculated as mean difference and 95% CI.
Results
Height
data were included from 65 chairs, 60 beds/plinths (therapy mat
tables), and 30 toilets across 6 hospitals rehabilitation wards and
gyms. Height data from 200 stroke participant homes were available. The
height of chairs, beds, and toilets in the home and rehabilitation
hospital environments are detailed in table 1.
Table 1Mean
± SD height (centimeters) of chairs, beds, and toilets in each
environment and mean difference (95% CI) between environments.
In
terms of height, the mean ± SD chair height was 47±6 cm, lounge
(recliner) height was 43±5 cm, toilet height was 42±3 cm, and bed height
was 59±9 cm (table 1).
Height of chairs and beds in hospital ward and gym environments
In
the ward, beds were adjustable to a minimum height of 42±12 cm and a
maximum height of 88±9 cm. In the gym, plinths (therapy mat tables) were
adjustable to a minimum height of 46±2 cm and a maximum height of 89±7
cm. The mean toilet height was 45±2 cm.
Difference in heights between hospital and home environments
Bed
height and variability were similar across environments. Toilet height
was 3 cm (95% CI, 2-4) lower in the home than in the hospital. Chair
height was 2 cm (95% CI, 0-4) lower in the home than in the hospital
ward and 5 cm (95% CI, 3-7) lower in the home than in the hospital gym.
See table 1 and figure 1.
Fig 1Mean ± SD height (cm) of chairs in each environment.
The
current study identified that the heights of beds were similar between
environments; however, chairs were lower in the home than those in
hospital environments (mean 2 cm lower). This result is not surprising
because hospitals are purpose-built spaces for people with physical
disability and, therefore, designed to make everyday activities more
manageable for these people.
In addition, chairs in the gyms were even higher, perhaps because very
disabled people are practicing this everyday activity within the gym, so
using a higher height to make standing up more manageable with a focus
on improving technique.
Notably,
there was more variability in heights in the home environment than in
the hospital, eg, the SD of chair heights in homes was more than double
the SD in hospital wards. This suggests that stroke survivors need to be
equipped to be able to stand up from some very low chairs and beds that
will be present in the home environment. Moreover, when accessing the
community or using a car, the height may be even lower than found in the
home.
Strengths and limitations
The
current study has both strengths and limitations. Limitations include
different height measurers in the hospital and home environments.
However, all measurers followed a standard procedure. A significant
strength of the study is the large sample size of stroke survivor homes
and the inclusion of 6 hospitals across 3 states of Australia. This
large sample helps to assure certainty in the results presented in this
study. Further, these are the hospital environments the stroke survivors
accessed before discharge home.
Conclusions
The
findings of the current study suggest clinicians should pay particular
attention to the height of chairs and beds within the hospital
environment. Chair and bed height should be matched to the stroke
survivor and lowered as their ability improves over time.
Kristen N Penland, Cheryl D Bushnell, Amy M Pastva, Matthew A Psioda, Samantha M Levy, Sara B Jones Berkeley, Rica M Abbott, Janet P Bettger, Janet K Freburger, Pamela W Duncan
Background:
Timely rehabilitation after stroke is essential for optimizing
recovery. Patients discharged home can experience unnecessary service
delays and gaps in care. Our aim was to examine sociodemographic
characteristics associated with receipt of rehabilitation services
within 30 days after discharge home in stroke or transient ischemic
attack (TIA) patients.
Methods: COMPASS
is a cluster-randomized pragmatic trial measuring the effectiveness of
the COMPASS model of care vs. usual care on functional status 90 days
after stroke or TIA for patients discharged home. We analyzed data from
369 participants who enrolled in the intervention arm of the COMPASS
trial, completed the post-acute clinic visit within 14 days, and the
30-day call between July 2016 and May 15, 2017. For those who were
referred to rehabilitation services at hospital discharge or at the
clinic visit, receipt of home health (HH) and outpatient (OP)
rehabilitation services was reported by the participant during the
30-day call. Sociodemographic differences between those who did and did
not receive these services were evaluated. We computed adjusted odds
ratios with 95% confidence intervals using logistic regression to
identify factors associated with receipt of rehabilitation services.
Results:
Of the 369 patients, 176 (47.7%) had ascertainment of receipt of
services. Of the 115 patients referred to HH, 50 (43.5%) received it,
and of 85 patients referred to OP therapy, 29 (34.1%) received it. There
were no statistically significant differences in sociodemographic
characteristics related to receipt of HH, but non-whites were less
likely (3 of 20, or 15%) than whites (25 of 64, 34.9%) to receive OP
therapy. After adjustment for NIHSS, ambulatory status at hospital
admission, and age, non-white participants had a 78% decreased odds (OR
0.22; 95% CI 0.05, 0.95; p=0.04) of receiving OP therapy.
Conclusion:
These findings indicate that a significant gap exists between referral
to and receipt of recommended post-acute stroke rehabilitation services.
In addition, despite the small sample size, our results suggest that
there may be a disparity in receipt of OP therapy for non-white patients
relative to white patients.
WHO FUCKING CARES?Survivors
want results, you blithering idiots. Have you never talked to ANY
survivor? And using subjective rating scales is the height of
stupidity. Another lazy meta-analysis rather than working on solving all the problems in stroke.
December 18, 2017 - Stroke survivors with higher scores on widely used outcome measures are more likely to be discharged home from the hospital, while those with lower scores are more likely to go to a rehabilitation or nursing care facility, reports a paper in the January issue of The Journal of Neurologic Physical Therapy (JNPT). The journal is published by Wolters Kluwer.
Standardized rating scales can help to support decisions about discharge destination for stroke patients leaving the hospital, according to the analysis by Dr. Emily Thorpe, PT, DPT, and colleagues of Walsh University, North Canton, Ohio, under the mentorship of Dr. Robert S. Phillips, PT, DPT, PhD, NCS. "These results provide a framework with which to start the plan of care and discharge process in acute and sub-acute settings," the researchers write. Outcome Measure Scores to Predict Stroke Discharge - Pooled Evidence Analysis
In a systematic research review, Dr. Thorpe and colleagues identified nine previous studies of the relationship between standardized outcome measures and discharge destination in patients with stroke. Five studies--including more than 6,000 patients--provided evidence suitable for analysis of pooled data, called meta-analysis.
Meta-analyses assessed the predictive value of two outcome measures. Four studies evaluated the Functional Independence Measure (FIM), which assesses the level of assistance needed to perform daily tasks. The FIM is commonly used in hospitalized patients with a wide range of conditions. Two studies used the National Institutes of Health Stroke Scale (NIHSS), which is specifically designed to assess stroke severity and resulting disability. (One of the studies included both measures.)
Both rating scales were good indicators of the discharge destination for stroke patients, according to the meta-analyses. For each one-point improvement in the FIM score (on a scale from 18 to 126), patients were about eight percent more likely to be sent home from the hospital, rather than to a rehabilitation or nursing facility.
On both the FIM and NIHSS, patients who scored in the "above average" range were 12 times more likely to be discharged to home. In contrast, patients with "average" scores were 1.9 times more likely to be discharged to a care facility.
Patients with "poor" scores on the FIM and NIHSS were 3.4 times more likely to be discharged to an institution. For this group, the discharge destination was more likely to be a skilled nursing facility, rather than to an inpatient rehabilitation center.
Interdisciplinary rehabilitation services are crucial to help stroke patients toward regaining their functional ability and lifestyle. With the aging population and increased spending for stroke management, it's more important than ever to provide efficient care for patients recovering from a stroke. About 20 percent of stroke survivors require institutionalized care beyond three months; many patients need continued assistance after they return home.
Outcome measures such as the FIM and NIHSS are widely used to assess the functional abilities or clinical condition of stroke patients. However, it has been unclear how scores on these rating scales are related to discharge destination.
The new analysis provides evidence-based data to support critical decision-making about discharge destination in stroke patients. "Findings from these meta-analyses are consistent with common sense practice: the better a patient's outcome measure score, the greater the likelihood of home discharge," Dr. Thorpe and coauthors write. The results show the "quantitative impact" of outcome measure scores on discharge decisions.
The researchers emphasize that rating scales such as the FIM and NIHSS are just one factor to consider in determining the best discharge destination for each individual patient after a stroke. Dr. Thorpe and colleagues conclude: "Ultimately, standardized outcome measures should be further used and studied among the post-stroke population to improve healthcare policy and compliment clinical judgment in the task of recommending discharge destinations for patients to receive the necessary care for achieving their optimal function."
The goal should be 100% recovery and return to home. You wouldn't need discharge planning then. The problem is that stroke rehab is a total fucking failure.
You solve that by not having to provide very much of it. And that is by
researching and creating protocols that stop the neuronal cascade of death in the first week.
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Abstract
Background and Purpose—Discharge
planning for inpatients with acute stroke can enhance reasonable use of
healthcare resources, as well as improve clinical outcomes and decrease
financial burden of patients. Especially, prediction for discharge
destination is crucial for discharge planning. This study aimed to
develop an assessment model to identify patients with a high possibility
of discharge to home after an acute stroke.
Methods—We
reviewed the electronic medical records of 3200 patients with acute
stroke who were admitted to a stroke center in Japan between January 1,
2011, and December 31, 2015. The outcome variable was the discharge
destination of postacute stroke patients. The predictive variables were
identified through logistic regression analysis. Data were divided into 2
data sets: the learning data set (n=2240) for developing the instrument
and the test data set (n=960) for evaluating the predictive capability
of the model.
Results—In
all, 1548 (48%) patients were discharged to their homes. Multiple
logistic regression analysis identified 5 predictive variables for
discharge to home: living situation, type of stroke, functional
independence measure motor score on admission, functional independence
measure cognitive score on admission, and paresis. The assessment model
showed a sensitivity of 85.0% and a specificity of 75.3% with an area
under the curve equal to 0.88 (95% confidence interval, 0.86–0.89) when
the cutoff point was 10. On evaluating the predictive capabilities, the
model showed a sensitivity of 88.0% and a specificity of 68.7% with an
area under the curve equal to 0.87 (95% confidence interval, 0.85–0.89).
Conclusions—We
have developed an assessment model for identifying patients with a high
possibility of being discharged to their homes after an acute stroke.
This model would be useful for health professionals to adequately plan
patients’ discharge soon after their admission.
The predictors for failure of home discharge after post-acute inpatient stroke rehabilitation need investigation.
Methods
With
this retrospective case-control study conducted in a stroke
rehabilitation unit in one tertiary hospital, data of 297 eligible
stroke patients regarding patient demographics, family information,
disease and function were collected. The primary outcome was failure of
home discharge.
Results
One
hundred and eighteen of 297 stroke patients (mean age 63 years, 37%
women) failed to discharge home, including 109 admitted to
rehabilitation hospitals and 9 to long-term care facilities. An inverse
trend existed between numbers of daughters and the risk of failure of
home discharge: having three or more daughters significantly lowers the
risks for poor discharge destination (adjusted odds ratio, 0.23, 95%
confidence interval, 0.07–0.72; test for trend, p = 0.002).
Conclusion
Having more daughters independently predicts home discharge after post-acute inpatient stroke rehabilitation.
Keywords
stroke;
rehabilitation;
discharge;
social support;
daughter
1. Introduction
Discharge
disposition is a health issue at the participation level and an
important health outcome which increasingly gathers attention.1
For stroke patients, the first and crucial disposition happens after
discharge from post-acute inpatient rehabilitation ward. Failure to
return home may compromise the quality of lives of stroke patients and
families.2
Understanding its predicting factors helps health professionals to
provide counseling and helps policy makers in improving case referral
and long term care systems.
Previous
studies identified social support and committed caregivers as important
protecting factors for good functional and discharge outcomes.3 Among committed caregivers, spouses are best-recognized.4
While children might be similarly important on disabled parents' care,
their influences are less understood. Daughters are proved to take more
responsibility than sons in direct caregiving for disabled parents.5
Asian families tend to depend more on informal caregiver support than
other ethnic groups and therefore are more suitable for studying such
effects.6
We
hypothesized that stroke patients with more daughters are less likely
to suffer a poor discharge outcome after post-acute inpatient
rehabilitation. Having daughters may be an independent protective
factor.
You'll have to ask what your FIM scores are. https://www.jstage.jst.go.jp/article/ptr/advpub/0/advpub_E9914/_pdf
Atsushi S
ATO
1
, Takaaki FUJITA
2
and Yuichi Y
AMAMOTO
3
1)
Department of Physical Therapy, Yachiyo Rehabilitation College
2)
Tohoku Fukushi University
3)
Northern Fukushima Medical Center
ABSTRACT. Purpose: This study aimed to calculate cut-off values of activities of daily living independence
level for stroke patient home discharge based on the number of family caregivers. Method: The subjects
comprised 1442 stroke patients (26 hospitals) who were
registered of the Japanese Rehabilitation Database.
Receiver operating characteristic curves were used to elucidate the BI and FIM
Ⓡ
instrument scores necessary for home discharge.
Analysis was performed for each subject according to the number of family
caregivers, i.e., no caregiver, one person, two persons or more, and overall. Result: The BI cut-off points that
discriminated between home discharge and other were 65/60 points overall, 75/70 points in patients with no
caregiver, 65/60 points in patients with one caregiver, and 60/55 points in patients with two or more caregivers. The FIM
Ⓡ
instrument cut-off points were 90/89 points overall, 101/100 points in patients with no
caregiver, 87/86 points in patients with one caregiver, and 87/86 points in patients with two or more caregivers. Conclusion: Our results indicated that home discharge for patients with many caregivers was possible
even with low ADL independence levels, and that there was a large difference in cut-off values depending on
the presence or absence of one caregiver.
Marital status would not have been a proxy for caregiver
support in my case. They kinda missed the fact that 100% recovery would be a great predictor of returning home. Cause and effect people, learn about fixing the real problem. http://stroke.ahajournals.org/content/48/Suppl_1/ATMP40
Nneka L Ifejika, Chunyan C Cai, Elizabeth A Noser, James C Grotta, Sean I Savitz
Background:
Interpersonal relationships are understudied components of the stroke
treatment paradigm, which become important when patients require
long-term care. In this study, we analyzed sociodemographic factors that
impact return to home after inpatient rehabilitation (IR).
Methods:
Stroke patients were identified by ICD9/10 code from a prospective
multicenter rehabilitation registry between Jan 2005 & July 2016
(n=6447). Patients were analyzed based upon "Home" vs "Not Home" or
"Married" vs "Not Married" groups. Descriptive statistics were provided
for all patients. Marital status was used as a proxy for caregiver
support. We hypothesized that increased discharge functional
independence measure (FIM), ambulation and no insurance predicted return
to home. A “return home model” was developed using multivariable
regression with a stepwise approach. Odds ratio & 95% CI were
calculated.
Results: 5378 patients
returned Home, 1069 did not return Home. Home patients tended to be
younger, married, ambulatory and minorities, with a discharge FIM>75
(p<0.0001). Aphasia, dysphagia and UTI were significantly higher in
the “Not Home” group (p<0.0001). Married patients had more stroke
risk factors and impairments, indicating increased caregiver needs
(Figure). In the model, being a minority and being a woman increased the
odds of returning home. Advancing age, being widowed, divorced,
separated or never married decreased the odds of returning home. We
confirmed that ambulation, increasing discharge FIM and no insurance
predicted return to home (Figure).
Conclusions:
Being married, a woman or a minority increases the odds of returning
home after inpatient rehabilitation. Caregiver training and social
support for unmarried and male patients are important areas of
improvement. Strategies to ensure the successful transition of stroke
rehabilitation patients to home are needed, including prospective
studies of non-spousal caregiver support.
Completely and totally the wrong conclusion. The solution you would have to propose is that before your stroke you get a caring and loving spouse. The goal should be 100% return to home. You haven't even identified the problem. The problem is that stroke rehab is a total fucking failure. You solve that by not having to provide very much of it. And that is by researching and creating protocols that stop the neuronal cascade of death in the first week. http://www.ncbi.nlm.nih.gov/pubmed/26667264
To identify determinants for discharge destination of older (≥ 70 years) and younger (< 70 years) acute stroke patients.
DESIGN:
Multicentre prospective cohort.
PATIENTS:
A total of 395 patients, within 7 days of clinically evaluated stroke, were included from 6 hospital stroke units.
METHODS:
The
main outcome measure was discharge destination (home vs clinical
rehabilitation). Independent variables were: demographic factors, stroke
characteristics, functional impairments and disabilities, cognition,
comorbidity, and premorbid social participation. Multivariate logistic
regression analysis established the independent strength of the
contribution of possible determinants to discharge destination.
RESULTS:
Seventy-six
percent of younger patients were discharged home, compared with 63% of
older patients. Most of the younger patients discharged to clinical
rehabilitation (71%) had a spouse, whereas only 40% of the older age
group discharged to clinical rehabilitation had a spouse. Multivariate
analysis showed that, besides National Institutes of Health Stroke Scale
and Barthel Index scores, having a spouse was an important determinant
for discharge home in the older age group (adjusted odds ratio 4.77, 95%
confidence interval 2.01-11.31), but not in the younger age group.
CONCLUSION:
The
presence of a spouse is an additional important factor determining
discharge home in older stroke patients. It is important to monitor and
support informal caregivers in order to provide appropriate care for
older community-dwelling stroke patients.
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