The association between neighborhood social vulnerability and community-based rehabilitation after stroke

 You wouldn't have to solve this problem if you had EXACT 100% RECOVERY PROTOCOLS!  Can't anyone in the stroke medical world think?

The association between neighborhood social vulnerability and community-based rehabilitation after stroke

• Shuqi Zhang,
• Elizabeth R. Mormer,
• Anna M. Johnson,
• Cheryl D. Bushnell,
• Pamela W. Duncan,
• Fang Wen,
• Shweta Pathak,
• Amy M. Pastva,
• Janet K. Freburger &
• Sara B. Jones Berkeley 

BMC Health Services Research volume 25, Article number: 55 (2025) Cite this article

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Abstract

Background

Timely rehabilitative care is vital for functional recovery after stroke. Social determinants may influence access to and use of post-stroke care but have been inadequately explored. The study examined the relationship between the Social Vulnerability Index (SVI) and community-based rehabilitation utilization.

Methods

We included 6,843 adults (51.6% female; 75.1% White; mean age 70.1) discharged home after a stroke enrolled in the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 40 North Carolina hospitals from 2016–2019. Rehabilitation utilization was sourced from administrative claims. Geocoded addresses were linked to 2018 Census tract SVI. Associations between SVI and 90-day rehabilitation use, adjusted for patient’s clinical and socio-economic characteristics, were obtained from generalized estimating equations. We also examined the associations of SVI with therapy setting, types of therapy, intensity of visits, and time to first visit.

Results

Thirty-five percent of patients had at least one physical (PT) or occupational therapy (OT) visit within 90 days, ranging from 32.4%-38.7% across SVI quintiles. In adjusted analysis, there was no dose-reponse relationship between higher summary SVI, nor most of its sub-domains, and 90-day rehabilitation use. Greater vulnerability in household composition and disability was modestly associated with -0.4% (95% CI -4.1% to 3.4%) to -4.3% (95% CI -0.8% to -7.7%) lower rehabilitation use across SVI quartiles. Greater summary and subdomain SVI was associated with higher odds of receiving therapy in the home versus outpatient clinic (OR = 1.88, 1.58 to 2.17 for Q5 vs Q1 summary SVI) and receiving both PT and OT versus a single-type therapy (1.72, 1.48 to 1.97 for Q5 vs. Q1 summary SVI). No differences were observed for therapy intensity or time to therapy.

Conclusion

Use of rehabilitation care was low, and largely similar across levels of SVI and most of its subdomains. Individuals residing in areas of high SVI were more likely to receive therapy in the home and to receive dual therapy, possibly reflecting greater need among these individuals. Future studies should evaluate potential mechanisms for these findings and further identify both patient and community factors that may inform strategies to improve rehabilitation use.

Clinical Trial Number

https://www.clinicaltrials.gov/ NCT02588664 [registration date: 2015–10-23].

Virtual thErapy (STRIVE) Online Platform for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial

So success, you should see a protocol on this quite soon in that publicly available database that doesn't exist since we have fucking failures of stroke associations. You are completely on your own to find this and get it. 

Virtual thErapy (STRIVE) Online Platform for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial

Author links open overlay panelLiamJohnsonPhD^abcMarie-LouiseBirdPhD^deMakiiMuthalibPhD^fgWei-PengTeoPhD^hi

https://doi.org/10.1016/j.apmr.2020.03.011Get rights and content

Objective

To investigate the STRoke Interactive Virtual thErapy (STRIVE) intervention on upper-extremity clinical outcomes in community-dwelling stroke survivors.

Design

Assessor-blinded randomized controlled trial.

Setting

Study screening and testing was conducted in a university clinic. Participants completed the virtual therapy (VT) intervention in a community-based stroke support group setting.

Participants

Of 124 stroke survivors initially assessed, 60 participants were recruited (time poststroke, 13.4±8.9 y). Participants were allocated to either VT or control group using a block randomization design and were stratified by sex.

Interventions

Participants were randomized to receive 8 weeks of VT or usual care. The intervention consisted of approximately 45 minutes of twice weekly VT training on the Jintronix Rehabilitation System.

Main Outcome Measures

Between-group differences in the Fugl-Meyer Upper Extremity scale and Action Research Arm Test score were joint primary outcomes in this study.

Results

Significant between-group differences for the Fugl-Meyer Upper Extremity scale were seen at the end of the intervention (F_{1, 1}=5.37, P=.02, d=0.41). No significant differences were observed with the Action Research Arm Test. No adverse events were reported.

Conclusions

We demonstrated clinically meaningful improvements in gross upper extremity motor function and use of the affected arm after a VT intervention delivered via a community-based stroke support group setting. This data adds to the contexts in which VT can be used to improve upper limb function. Use of VT in community-based rehabilitation in chronic stroke recovery is supported.

Abstract WP188: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Stroke Knowledge, and Other Rehabilitation Outcomes

Well then put it all together into a protocol and distribute it to every one of the 10 million yearly stroke survivors. Just this writeup in a stroke journal is not enough.

Abstract WP188: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Stroke Knowledge, and Other Rehabilitation Outcomes

Joan C Breen

,

Jeanne Andrusin

,

Julie DiCarlo

,

Julia Keenan

,

Paula Fortuna

,

Juliette Rodriguez

,

Hannah Garth

Originally published12 Feb 2020Stroke. ;51:AWP188

Abstract

Background:
Return to driving and employment are goals for many stroke survivors. There are few reports of patient centered outcomes including return to employment, driving, self-efficacy, functional outcomes, stroke knowledge or characteristics of survivors who achieve these goals.
Methods:
Prospective observational study of stroke patients treated in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive, communicative, risk factor/stroke knowledge, self-efficacy, psychosocial, driving and vocational issues.
Results:
190 consecutive patients(117 men, 73 women, average age 62(18-90), 66 aphasic) with baseline modified Rankin Scores of 5(1%); 4(25%); 3(56%); 2(15%); 1(3%), and average NIHSS score of 6(range 0-18) were treated between 12/2011-7/2019. 136 Patients suffered ischemic strokes and 54 had hemorrhages. Locations were: 65 left, 69 right, 26 bilateral hemisphere, 30 brainstem. 41% had MCA territory strokes. Of 104 patients working prestroke, 50% returned to work and an additional 7% were work capable upon completion of program. 95% of patients driving prestroke could not drive on admission. After training, 43%(67/157) returned to driving. Patients had improvements in all 9 domains of Stroke Impact Scale with SIS total score improving an average of 23%. Patients received an average of 33 physical therapy visits with average percent improvement of 72% and 41% on 6” walk and Berg Balance scores. Average percent improvement in Stroke Self Efficacy Scores was 29%. After individualized cardiovascular risk, stroke and medication education sessions with the Nurse Practitioner based on AHA guidelines and Life’s Simple 7’s curriculum, stroke and risk factor knowledge quiz scores improved an average of 29%. Average length of stay was 5(range .5-24) months. Multiple other demographic and outcome measures are collected.
Conclusions:
Outcome data show a community-based team rehabilitation program can successfully combine CV/stroke education with rehabilitation services to maximize patient centered outcomes including return to work, driving, overall stroke recovery, physical functioning, stroke knowledge, and self-efficacy for many types of stroke survivors with moderate to severe disability.

Walking speed as a predictor of community mobility and quality of life after stroke

I could walk much faster than I currently do if my spasticity was cured. Hell, I'd be running by now. 

Walking speed as a predictor of community mobility and quality of life after stroke

Topics in Stroke Rehabilitation , Volume 26(5) , Pgs. 349-358.

NARIC Accession Number: J81270.  What's this?
ISSN: 1074-9357.
Author(s): Grau-Pellicer, Montserrat; Chamarro-Lusar, Andres; Medina-Sasanovas, Josep; Ferrer, Bernat-Carles S..
Publication Year: 2019.
Number of Pages: 10.
Abstract: Study investigated whether gait speed is a predictor of community mobility (CM) and quality of life (QoL) in patients with stroke following a multimodal rehabilitation program (MRP). CM is considered a part of community reintegration that enhances QoL. Achieving an appropriate gait speed is essential in attaining an independent outdoor ambulation and satisfactory CM. This was a baseline control trial with 6-months follow-up in an outpatient rehabilitation setting at a university hospital. Twenty-six stroke survivors completed the MRP (24 one-hour sessions, 2 days per week). The MRP consisted of aerobic exercise, task-oriented exercises, balance exercises and stretching. Participants also performed an ambulation program at home. Outcome variables were: walking speed (10-Meter Walking Test) and QoL (physical and psychosocial domains of Euroquol and Sickness Impact Profile). At the end of the intervention, comfortable and fast walking speed increased by an average of 0.16 and 0.40 meters per second, respectively. After the intervention, all participants achieved independent outdoor ambulation with an increase of 34.14 of walking minutes per day in the community and a decrease of sitting time of 95.45 minutes per day. Regarding QoL, there were increased mean scores on the physical and psychosocial dimensions of Euroquol and the Sickness Impact Profile, respectively. The results suggest that improved walking speed after the MRP is associated with CM and higher scores in QoL. These findings support the need to implement rehabilitation programs to promote increased speed.
Descriptor Terms: AMBULATION, COMMUNITY INTEGRATION, EXERCISE, OUTCOMES, PHYSICAL THERAPY, QUALITY OF LIFE, REHABILITATION, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Grau-Pellicer, Montserrat, Chamarro-Lusar, Andres, Medina-Sasanovas, Josep, Ferrer, Bernat-Carles S.. (2019). Walking speed as a predictor of community mobility and quality of life after stroke.  Topics in Stroke Rehabilitation , 26(5), Pgs. 349-358. Retrieved 8/20/2019, from REHABDATA database.

Community-based Rehabilitation Training after stroke: Results of a pilot randomised controlled trial (ReTrain) investigating acceptability and feasibility

Since this seems to work you can not expect that it will be written into a stroke protocol and distributed around the world.  ABSOLUTELY NOTHING WILL OCCUR, YOU'RE SCREWED.

Community-based Rehabilitation Training after stroke: Results of a pilot randomised controlled trial (ReTrain) investigating acceptability and feasibility

Corresponding author

Associate Professor Sarah Dean,

Psychology Applied to Rehabilitation and Health,

University of Exeter Medical School,

College House

St Luke’s Campus,

Exeter,

EX1 2LU,

Email: s.dean@exeter.ac.uk

01392 722984

Abstract

Objectives: To assess acceptability and feasibility of trial processes and the ReTrain intervention including an assessment of intervention fidelity. 
Design: A two-group, assessor-blinded, randomised controlled trial with parallel mixed methods process and economic evaluations. 
Setting: Community settings across two sites in Devon. 
Participants: Eligible participants were: 18 years old or over, with a diagnosis of stroke and with self-reported mobility issues, no contraindications to physical activity, discharged from National Health Service (NHS) or any other formal rehabilitation programme at least 1 month prior, willing to be randomised to either control or ReTrain and attend the training venue, possessing cognitive capacity and communication ability sufficient to participate. Participants were individually randomised (1:1) via a computer generated randomisation sequence minimised for time since stroke and level of functional disability. Only outcome assessors independent of the research team were blinded to group allocation.  
Interventions: ReTrain comprised (1) an introductory one-to-one session; (2) ten, twice weekly group classes with up to two trainers and eight clients; (3) a closing one-to-one session, followed by three drop-in sessions over the subsequent three months. Participants received a bespoke home-based training programme. All participants received treatment as usual. The control group received an exercise after stroke advice booklet.  
Outcome measures: Candidate primary outcomes included functional mobility and physical activity. Results: Forty-five participants were randomised (ReTrain=23; Control=22); data were available from 40 participants at six months follow-up (ReTrain=21; Control=19) and 41 at nine months follow-up (ReTrain=21; Control=20). We demonstrated ability to recruit and retain participants. Participants were not burdened by the requirements of the study. We were able to calculate sample estimates for candidate primary outcomes and test procedures for process and health economic evaluations.  
Conclusions: All objectives were fulfilled and indicated that a definitive trial of ReTrain is feasible and acceptable.

Registration: ClinicalTrials.gov: trial number NCT02429180.

Funding: The Stroke Association TSA 2014-13