Stroke severity and functional outcome at hospital discharge among thrombolyzed patients: a pilot study
DOI:
https://doi.org/10.34024/rnc.2022.v30.12782Keywords:
Stroke, Thrombolytic therapy, PhysiotherapyAbstract
Introduction. Stroke is a major cause of morbidity and mortality worldwide. Thrombolysis is the main treatment in the acute phase and can substantially improve the functional prognosis of survivors. Objectives. To investigate the correlation of the stroke severity in the first hours after thrombolysis with the functional level at hospital discharge. Method. This is a longitudinal observational study conducted in a reference public hospital. Patients were assessed after thrombolysis with the National Institutes of Health Stroke Scale (NIHSS), and seven days after admission, or at discharge from the unit, with the Postural Assessment Scale for Patients after Stroke (PASS) and the Modified Rankin Scale (MRS) to determine the functional outcome. The Spearman test was used to analyze the correlation. Results. The sample included 34 patients, mostly male (55.9%) and aged ≥60 years (61.8%). A negative correlation was observed between the severity of stroke after thrombolysis and PASS at hospital discharge (Rho=-0.427; p=0.022), indicating that individuals with more severe stroke, even after thrombolysis, have on average worse postural control at hospital discharge. Regarding MRS, a positive association was observed (Rho=0.532; p=0.002), indicating that more severe strokes lead, on average, to the worst functional outcomes at discharge. Conclusion. The severity of ischemic stroke at hospital admission is associated to functional outcome and postural control of patients at discharge.
Metrics
References
Hankey GJ. Stroke. Lancet 2017;389:641-54.
https://doi.org/doi:10.1016/S0140-6736(16)30962-X
Donkor ES. Stroke in the 21 (st) century: a snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat 2018;2018:3238165. https://doi.org/10.1155/2018/3238165
Paley L, Williamson E, Bray BD, Hoffman A, James MA, Rudd AG, et al. Associations between 30-day mortality, specialist nursing, and daily
physician ward rounds in a national stroke registry. Stroke 2018;49:2155-62. https://doi.org/10.1161/STROKEAHA.118.021518
Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and
territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204-22. https://doi.org/10.1016/S0140-6736(20)30925-9
Rabinstein AA. Update on treatment of acute ischemic stroke. Continuum 2020;26:268.
https://doi.org/10.1212/CON.0000000000000840
Muhl L, Kulin J, Dagonnier M, et al. Mobilization after thrombolysis (rtPA) within 24 hours of acute stroke: what factors influence inclusion of patients in A Very Early Rehabilitation Trial (AVERT)? BMC Neurol. 2014;14(1):163. Doi: https://doi.org/10.1186/s12883-014-0163-6
Rha J-H, Saver JL. The Impact of Recanalization on Ischemic Stroke Outcome. Stroke 2007;38:967-73.
https://doi.org/10.1161/01.STR.0000258112.14918.24
Nakao M, Izumi S, Yokoshima Y, Matsuba Y, Maeno Y. Prediction of life-space mobility in patients with stroke 2 months after discharge from rehabilitation: a retrospective cohort study. Disabil Rehabil 2020;42:2035-42. https://doi.org/10.1080/09638288.2018.1550533
Ferla F, Grave M, Perico E. Physical Therapy in the treatment of trunk control and balance of patients after stroke. Rev Neurocienc 2015;23:211-7. https://doi.org/10.4181/RNC.2015.23.02.1014.7p
Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, et al. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil 2015;37:1316-23. https://doi.org/10.3109/09638288.2014.963706
Silva SM, Corrêa FI, Faria CD, Buchalla CM, Silva PF, Corrêa JC. Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools. J Phys Ther Sci 2015;27:1665-70. https://doi.org/10.1589/jpts.27.1665
Ekker MS, Verhoeven JI, Vaartjes I, van Nieuwenhuizen KM, Klijn KJM, Leeuw FE. Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology 2019;92:e2444-54. https://doi.org/10.1212/WNL.0000000000007533
Cincura C, Pontes-Neto OM, Neville IS, Mendes HF, Menezes DF, Mariano DC, et al. Validation of the National Institutes of Health Stroke Scale, Modified Rankin Scale and Barthel Index in Brazil: The Role of Cultural Adaptation and Structured Interviewing. Cerebrovasc Dis 2009;27:119-22. https://doi.org/10.1159/000177918
Yoneyama S, de Melo Roiz R, Oliveira T, Oberg T, Lima N. Validação da versão brasileira da escala de avaliação postural para pacientes após acidente vascular encefálico. Acta Fisiátrica 2008;15:96-100. https://doi.org/10.11606/issn.2317-0190.v15i2a102920
Reznik ME, Yaghi S, Jayaraman MV, et al. Baseline NIH Stroke Scale is an inferior predictor of functional outcome in the era of acute stroke intervention. Int J Stroke 2018;13:806-10.
https://doi.org/10.1177/1747493018783759
Wu Z, Zeng M, Li C, Qiu H, Feng H, Xu X, et al. Time-dependence of NIHSS in predicting functional outcome of patients with acute ischemic stroke treated with intravenous thrombolysis. Postgrad Med J 2019;95:181-6. https://doi.org/10.1136/postgradmedj-2019-136398
Satumanatpan N, Tonpho W, Thiraratananukulchai N, Chaichanamongkol P, Lekcharoen P, Thiankhaw K. Factors Associated with Unfavorable Functional Outcomes After Intravenous Thrombolysis in Patients with Acute Ischemic Stroke. Int J Gen Med 2022;15:3363-73. https://doi.org/10.2147/IJGM.S362116.
Thorpe ER, Garrett KB, Smith AM, Reneker JC, Phillips RS. Outcome Measure Scores Predict Discharge Destination in Patients With Acute and Subacute Stroke. J Neurol Phys Ther 2018;42:2-11. https://doi.org/10.1097/NPT.0000000000000211
Elwood D, Rashbaum I, Bonder J, Pantel A, Berliner J, Yoon S, et al. Length of Stay in Rehabilitation is Associated with Admission Neurologic Deficit and Discharge Destination. PMR 2009;1:147-51.
https://doi.org/10.1016/j.pmrj.2008.10.010
Schlegel D, Kolb SJ, Luciano JM, Tovar JM, Cucchiara BL, Liebeskind DS, et al. Utility of the NIH Stroke Scale as a Predictor of Hospital Disposition. Stroke 2003;34:134-7.
https://doi.org/10.1161/01.STR.0000048217.44714.02
Huang Y-J, Lin G-H, Lee S-C, Hsieh C-L. A Comparison of the Responsiveness of the Postural Assessment Scale for Stroke and the Berg Balance Scale in Patients With Severe Balance Deficits After Stroke. J Geriatr Phys Ther 2020;43:194-98.
https://doi.org/10.1519/JPT.0000000000000247
Huang Y, Wang W, Liou T, Liao C, Lin L, Huang S. Postural Assessment Scale for Stroke Patients Scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward. J Rehabil Med 2016;48:259-64. https://doi.org/10.2340/16501977-2046
Lesser M, Borst J, Dekerlegand J. Use of the Postural Assessment Scale for Stroke Patients in Determining Acute Care Discharge Recommendations. J Acute Care Phys Ther 2017;8:79-85. https://doi.org/10.1097/JAT.0000000000000057
Lutski M, Zucker I, Shohat T, Tanne D. Characteristics and Outcomes of Young Patients with First-Ever Ischemic Stroke Compared to Older Patients: The National Acute Stroke ISraeli Registry. Front Neurol 2017;8:421. https://doi.org/10.3389/fneur.2017.00421
Santana NM, Figueiredo FWS, Lucena DMM, Soares FM, Adami F, Cardoso LCP, et al. The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings. BMC Res Notes 2018;11:735. https://doi.org/10.1186/s13104-018-3842-3
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Francisco Robson Oliveira, Marilucia Reis dos Santos, Isabella Pereira Rosa de Castro, Alana das Mercês Silva, Lemuel Victor da Silva Bernardes, Carla Ferreira do Nascimento, Jorge Luís Motta dos Anjos
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
Accepted 2022-10-05
Published 2022-11-16
