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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
The ECASS III trial randomised 821 people (mean age 65) and found that thrombolysis was effective between 3 and 4.5 hours from stroke onset.25 A favourable outcome (not dead or severely disabled (modified Rankin Score < 2 [mRS – see appendix A]) was found in 52% of the treatment group compared to 45% of the controls (OR 1.34; 95% CI 1.02–1.76; NNT = 14). SICH occurred in 2.4% with rt-PA and 0.3% with placebo. This trial excluded people aged over 80.
Subarachnoid Hemorrhage
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Dominic A. Harris, Ajith J. Thomas
The ISAT is a multicenter, randomized trial performed in 43 centers primarily located in Europe and Canada. It compared the safety and efficacy of endovascular coiling versus neurosurgical clipping in patients with ruptured intracranial aneurysms at 2 months and 1 year. The primary measure was the proportion of patients dead or disabled as defined by the modified Rankin Scale (mRS) of 3–6. The secondary outcome measure was re-breeding. Trial enrollment was terminated early on the basis of an interim analysis, but follow-up continued. Of the 9559 eligible patients, 2143 (21.5%) were randomized. 23.7% of patients with endovascular coiling versus 30.6% with neurosurgical clipping were dependent or dead at 1 year (RR 0.774, [0.658–0.911], p = 0.0019)—an absolute risk reduction of 6.9%. One-year case fatality rates were similar for the two treatment groups (8.1% endovascular vs. 10.1% neurosurgery). Risk of rebreeding was low, although more common in the endovascular group at one year with no effect on mortality.
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The severity of the stroke also can be assessed by the modified Rankin Scale score (mRS), which quantifies disability, and to some extent, handicap (Table 12.15). Other scores of disability and handicap include the Barthel Index, Functional Independence Measure (FIM), Stroke Impact Scale (SIS), and Short Form (SF)-36.
Importance of core stability for coordinated movement of the human body in stroke rehabilitation
Published in Neurological Research, 2022
The study was carried out in *blinded*. Thirty-three subjects after stroke (17 with ischemic cerebral stroke and 16 with cerebellar), (aged 44–83 years; mean 64.82 ± 11.23) and 22 subjects with degenerative disc disease of the lumbar spine (neurologically healthy controls) (aged 44–74 years; mean 48.36 ± 15.47) were prospectively recruited from patients of the *blinded*. The National Institute for Health Stroke Scale (NIHSS) [21] was used to identify the neurological deficit, and the modified Rankin scale [22–24] was used to evaluate the patients’ overall physical impairment. Study group was past stroke 5–7 weeks, with stable trunk (the Trunk Control Test 74–100 points) [25,26], muscle tension measured with Modified Ashworth Scale (MAS = 1/1 +) [27], unassisted walking (modified Rankin scale = 3), with slight neurological deficits (NIHSS ≤7). The control group was past episode 12–14 weeks, highly functional, Rankin scale = 0, without pain, with stable trunk (the Trunk Control Test 100 points), tension of muscles measured with Modified Ashworth Scale (MAS = 0) [25–27].The clinical evaluation of patients after a stroke was performed by the physician admitting the patient to the clinic on the day of admission.
Clinical factors associated with trunk control after stroke: A prospective study
Published in Topics in Stroke Rehabilitation, 2021
Laís Geronutti Martins, Rafael Dalle Molle da Costa, Lorena Cristina Alvarez Sartor, Juli Thomaz de Souza, Fernanda Cristina Winckler, Taís Regina da Silva, Gabriel Pinheiro Modolo, Hélio Rubens De Carvalho Nunes, Silméia Garcia Zanati Bazan, Luis Cuadrado Martin, Gustavo José Luvizutto, Rodrigo Bazan
Participants with lower modified Rankin scale scores at hospital discharge in this study presented satisfactory trunk control at 90 days. In this study, it was also established that the cutoff point for predicting worse trunk control was an mRS score of ≥3 at hospital discharge. The modified Rankin Scale is the most widely used outcome measure in stroke trials and is strongly associated with global deficiency (in particular, physical deficiency) and with the necessity for assistance after a stroke, given that its score is highly associated with participants’ ability to perform basic and instrumental activities of daily life.35 The higher the Rankin score is, the worse the functional capacity, indicating that the patient needs assistance in most activities of daily living, which is reflected in participants with poor trunk control.36
Dosage and predictors of arm practice during inpatient stroke rehabilitation: an inception cohort study
Published in Disability and Rehabilitation, 2021
Angela Vratsistas-Curto, Catherine Sherrington, Annie McCluskey
Participants were recruited between October 2011 and January 2013. Figure 1 shows the flow of participants through the study. A total of 905 people were screened with all 74 people assessed as being eligible consenting for the study. A further 26 people were excluded due to cognitive or communication impairment but were still eligible for collection of usual care data, giving a total of 100 participants. A single influential outlier was identified and removed from the sample leaving 99 participants in the analysis (10.9% of people screened). Characteristics of the included participants on admission to the stroke unit are presented in Table 1. Supplementary Table S1 provides demographic data on the full sample prior to removal of the influential outlier. The average age of the 99 participants (including those with cognitive impairment) was 75.8 years (standard deviation (SD)=12.4). The median modified Rankin Scale score on admission indicates a moderately severe level of disability. Length of stay on the unit varied, with a range from 4 to 124 days, and an average of 36.9 days (SD = 30.0, median = 28.0, IQR = 39.5).