Use of hospital resources by acute stroke patients.
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Aged↗
Biomedical subjects
D T Wade
Publications and source records attributed to D T Wade.
Outlook after an acute stroke: urinary incontinence and loss of consciousness compared in 532 patients.
Data from a sample of 532 patients seen within seven days of an acute stroke has been analysed to compare the prognostic importance of urinary incontinence with that of a history of any depression of consciousness. Urinary incontinence was more specific and had a higher predictive value. Considering conscious patients with moderate or severe initial disability, after six months 53 per cent of incontinent patients had died and 57 per cent of the survivors were still moderately or severely disabled whereas only 19 per cent of continent patients had died and 80 per cent of survivors made a good recovery. We conclude that early urinary incontinence is an important indicator of poor prognosis, identifying patients who may need extra attention.
Activities of Daily Living↗
Long-term survival after stroke.
A total of 162 patients referred for rehabilitation were followed-up for two years. Using the t test and the chi-square test, 15 variables distinguishing the 107 survivors from the 55 who died were identified. Multiple regression analysis identified three factors that gave a predictive equation which correctly identified 92% of the two-year survivors and 48% of those dying in that time. These factors were the severity of the stroke (represented by the patient's walking ability), the presence of pre-existing cardiovascular disease (indicated by a history of myocardial infarction), and the patient's age. Pre-stroke motivation or fitness may also influence long-term survival. The technique of using multiple regression analysis allows a clearer separation of the important prognostic factors than the more usual comparative statistical methods.
Age Factors↗
Stroke: the influence of age upon outcome.
This study is based upon 162 consecutive patients seen at a rehabilitation unit, and investigates the effect age has upon the manifestations and antecedents of stroke, and its outcome at six months. In this group of patients, age had little influence upon the severity of stroke, the deficits seen initially or the functional ability at six months. However, age had an influence upon the pattern of care given to these patients, in that older patients were likely to stay in hospital longer. There was an increasing proportion of women in the older age groups.
Age Factors↗
Therapy after stroke: amounts, determinants and effects.
This report investigates the amounts of physiotherapy and occupational therapy given to acute stroke patients over the first 6 months, the factors that determine how much therapy a patient receives, and the effects of therapy upon outcome. The study is based on 162 acute stroke patients referred to a stroke rehabilitation unit. In this group the average daily rate of treatment during active rehabilitation, for both therapies combined, was 46 minutes, with a maximum of 42 minutes a day for physiotherapy and 48 minutes a day for occupational therapy. The major factors associated with the amount of therapy given related to the severity of the stroke: more therapy was given to those with lower initial functional ability, worse sitting balance, or greater loss of use of arm or leg. This association with severity probably accounts for the association between therapy and shoulder disease. A minor factor governing the amount of therapy given was the patient's degree of recovery: those who recovered less well received more therapy. It was not possible to demonstrate a specific beneficial effect of therapy.
Activities of Daily Living↗
Stroke: influence of patient's sex and side of weakness on outcome.
This study investigated the importance of the side of weakness and sex of the patient in patient outcome after stroke. It was based upon 162 consecutive acute stroke patients attending a rehabilitation unit. Results suggest that functional recovery was not influenced by the factors investigated, provided that measurements were made at set times poststroke. However, patients with right hemiplegia attended rehabilitation longer so they appeared to have made a better functional recovery when activity of daily living (ADL) ability was measured at discharge. Although right hemiplegia was associated with aphasia and left hemiplegia with spatial disorder and loss of sitting balance, these associations were not strong enough to affect functional recovery. Sex of the patient had no significant effect upon either the frequency of initial deficits or upon outcome, and there was no obvious interaction between the two variables (side and sex) and outcome.
Activities of Daily Living↗
Why admit stroke patients to hospital?
Stroke patients consume nearly one-twentieth of all National Health Service resources, and much of this is attributable to the admission of patients with acute strokes to hospital. However, patients rarely need to be admitted for diagnostic or therapeutic reasons, and rehabilitation given in hospital is sometimes inappropriate. The major reason for admission relates to nursing during the acute illness, yet this could be done at home in more cases than at present. It is suggested that rehabilitation services should be more readily available to patients at home, so that fewer need to be admitted and so that those admitted can return home sooner. This might lead to a more appropriate rehabilitation, less anxiety and depression in the patient and his family, and a more efficient use of limited resources.
Acute Disease↗
An assessment of the value of a domiciliary acre and rehabilitation service for acute stroke.
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Acute Disease↗
Recovery after stroke.
One hundred and sixty-two patients were referred to a rehabilitation unit after an acute stroke. The patterns of recovery of overall functional ability, arm function, walking and speech in 92 of 101 survivors have been analysed. In all modalities the majority of recovery occurs within 3 months; although improvement is seen thereafter it does not reach statistical significance. Possible reasons for the apparent lack of late recovery are discussed.
Activities of Daily Living↗
The hemiplegic arm after stroke: measurement and recovery.
Seven clinical tests have been used to study the recovery of arm function in 92 patients over 2 years following their stroke. These tests are simple and quick, and can be used by any interested observer. They form a hierarchical scale that measures recovery. Statistically significant improvement is only seen in the first 3 months. Fifty-six patients initially had non-functional arms; eight made a "complete recovery" and 14 a partial recovery. The tests described are inadequate on their own because they are not sufficiently sensitive at the upper range of ability. While recovery of lost function does relate to the degree of initial neurological loss in the arm, it seems to be largely independent of the overall severity of the stroke.
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Predicting Barthel ADL score at 6 months after an acute stroke.
In 83 patients with stroke, multiple regression analysis was used to identify 5 variables, measured at the 1st assessment shortly after stroke, that related to the Barthel ADL score at 6 months. The variables were age, the presence of hemianopia or visual inattention, the presence of urinary incontinence, the motor deficit in the affected arm, and the patient's sitting balance. A 2nd equation, based upon the initial Barthel score with age and hemianopia added, was also developed. The success of the 1st equation in predicting the final Barthel score was about 55%, a rate better than that yielded by the 2nd equation, and also better than that produced by adding the average improvement score to the patient's initial score.
Activities of Daily Living↗
Study of stroke patients in a single general practice.
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Aged↗
Neurological emergencies.
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Cerebrovascular Disorders↗
Selected cognitive losses after stroke. Frequency, recovery and prognostic importance.
Data collected in a population-based study on 976 patients suffering an acute stroke have been analysed to discover the frequency of disturbance of selected cognitive functions, particularly orientation, non-verbal reasoning, and copying. Further analysis investigated how these deficits related to other impairments, their prognostic importance, and their recovery. Considering patients assessed within the first week, only 45% were orientated, only 44% could be assessed for IQ and their average score was 94 (SD 16), and only 36% could copy a cross satisfactorily. Seventeen per cent of patients had a reduced level of consciousness preventing assessment, and the other unassessable patients had other impairments such as aphasia preventing assessment. In general failure to pass these tests was associated with evidence of a more severe stroke; the patients had other impairments such as a more severe paralysis. No independent effect of cognitive dysfunction upon recovery could be demonstrated. By 6 months most surviving patients passed all the tests used.
Activities of Daily Living↗
Measuring arm impairment and disability after stroke.
This is a review of the problems of assessing impairments and disabilities affecting the arm after stroke, and of the various published measures already available. In routine clinical practice, motor impairment is best assessed using grip strength or the Motricity Index, and dexterity disability is best assessed using the Nine-Hole Peg Test or Ten-Hole Peg Test. No measures of sensation and tone are specifically recommended, primarily because validity and reliability has not been well established for the measures available. Other more complex tests appropriate for more detailed use in planning treatment or in research are discussed.
Arm↗
Mobility after stroke: reliability of measures of impairment and disability.
This paper investigates the reliability of six measures of impairment and disability related to mobility after stroke: the Rivermead Motor Assessment (RMA, gross function subsection); gait speed (over 5 and 10 m); the motricity index (leg scores only); functional ambulation categories; sitting to standing (by observation); and mobility categories. Twenty-five patients who had suffered a stroke 2-6 years earlier leaving them with mobility disability were seen as part of a home-based physiotherapy trial. Assessments were made by three people on three occasions over 5 weeks. All six measures were reliable in statistical terms. A variation in gait speed of up to 25% and a difference of 3 points in the RMA were the actual limits of reliability.
Activities of Daily Living↗
Influence of cognitive function on social, domestic, and leisure activities of community-dwelling older people.
The Frenchay Activities Index (FAI), a brief scale developed to measure lifestyle in stroke patients, was given to 119 community-dwelling people, aged 70 years or older, in order to obtain a baseline estimate of social, domestic, and leisure activity among older people. Factor analysis identified three main factors, similar in composition to those previously reported. A general linear models regression analysis of selected variables indicated that both fluid intelligence and memory test performance were significantly associated with level of activity. There was no significant association with age or crystallized intelligence in this sample. An apparently strong bias towards higher levels of activity among female respondents was diluted when marital status was included in the equation. This study suggests that the FAI is appropriate for measuring levels of activity in community-dwelling older people and that such activity is related to current cognitive abilities.
Activities of Daily Living↗
Residual mobility problems after stroke.
At final follow-up 2-7 years after their first stroke, 328 survivors from the Oxfordshire Community Stroke Project register were assessed for mobility disability. Patients were classified as being either mobile or immobile, according to defined criteria. Of the 190 immobile patients, only 60 could be entered into a trial of physiotherapy. The major causes of attrition were refusal to participate (97 patients) and the absence of any stroke impairment causing the immobility (18). Arthritis (67) and dementia (39) were common in patients with mobility disability. Immobile patients were older and had suffered a more severe index stroke. This study stresses the relatively low frequency of long-term immobility following stroke directly due to stroke-induced impairments.
Arthritis↗