Ageing
Henry J. Woodford in Essential Geriatrics, 2022
The Clinical Frailty Scale (CFS) is a practical classification method based on history-taking, examination and clinical judgement.91 This leads to a frailty rating from one to nine. Scores 1 to 3 are classified as non-frail, score 4 ‘vulnerable', score 5 ‘mild frailty' (e.g. requiring assistance with finances, medications or housework), score 6 ‘moderate frailty' (e.g. requiring assistance with some personal care), score 7 ‘severe frailty' (e.g. dependent for all personal care), score 8 ‘very severe frailty' (e.g. life expectancy less than six months) and score 9 ‘terminally ill' but not otherwise frail. This scale also recommends interpreting the severity of dementia as equivalent to the severity of physical frailty. It has some similarities with the modified Rankin Scale (see Appendix A).
Blood Pressure Management in Acute Stroke
Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei in Manual of Hypertension of the European Society of Hypertension, 2019
INTERACT2 was an international, prospective, randomized, open-label, blinded endpoint trial (28). The study randomized 2839 ICH patients with SBP levels between 150−200 mmHg within 6 hours of onset to an intensive (SBP >140 mmHg, achieved within 1 hour and maintained for 7 days) or a guideline-recommended SBP target (SBP >180 mmHg). The choice of antihypertensive treatment was based on the local availability of antihypertensive agents. The composite primary outcome of the study was death or major disability, defined as a modified Rankin Scale (mRS) score of 3–6 at 90 days, whilst the secondary outcomes included ordinal analysis of the primary endpoint, all-cause mortality, health-related quality of life, duration of hospitalization, living in residential care facility, haematoma expansion, neurological deterioration and serious adverse events. At 3 months, the rates of death and severe disability did not differ significantly between the two groups, although the primary outcome was reduced by 25% in the intensive compared to the guideline treatment group. The effects of intensive BP control on the primary outcome were consistent across all prespecified subgroups. However, ordinal analysis demonstrated a significantly favourable functional outcome for patients randomized to intensive BP-lowering treatment compared to their counterparts. Furthermore, intensive BP treatment was safe and associated with significantly better health-related quality of life than standard BP treatment. In contrast, the two groups did not differ significantly in terms of all-cause mortality and haematoma expansion.
Section 2
Abhaya Gupta, Jeremy Playfer, Bim Bhowmick in Measurement Scales Used in Elderly Care, 2017
This systematic assessment tool was developed in 1983 by NIH-sponsored stroke research neurologists.1 The National Institutes of Health Stroke Scale (NIHSS) was designed to standardise and document an easy to perform, reliable and valid neurological assessment for use in stroke treatment research trials. Each item was considered with regard to its value during the first few hours and days after symptom onset. This scale is broader than the disability and handicap scales such as the Modified Rankin Scale. It provides a quantitative measure of key components of a standard neurological examination.
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
Identification of categories of the International Classification of Functioning, Disability and Health in functional assessment measures for stroke survivors: a systematic review
Published in Disability and Rehabilitation, 2020
Soraia Micaela Silva, Thayane Correa Pereira Brandão, Felipe Pereira Da Silva, Cassia Maria Buchalla
The modified Rankin Scale is a single-item scale for assessing levels of functional independence among stroke survivors and consists of six grades. It is the most widely used scale for the assessment of functioning after a stroke [31–33]. Schepers et al. [22] linked the most commonly used stroke outcome measures to the ICF and the original Rankin scale was the only assessment tool for which this was not done because authors considered the concepts to be too broad for linking. In 2015, however, Berzina et al. [26] related the concepts measured by the modified Ranking scale and the broader mRS-systematic interview (mRS-SI) and found 16 ICF categories related to the concepts measured by the mRS. In the present review, the categories related to the mRS were considered, since the mRS-SI has not yet been validated and cross-culturally adapted for use in Brazil. Among all scales addressed in this review, the mRS had the most categories related to environmental factors (eight) and was the only measure linked to category b630. However, Berzina et al. [26] state that the content measured by the mRS may not be related to a specific outcome that would be in accordance with the disability terminology suggested by the World Health Organization. Thus, in order to follow the ICF model, the interpretation of the mRS rating requires caution.
Experiences of patients with stroke and their caregivers with caregiver-mediated exercises during the CARE4STROKE trial
Published in Disability and Rehabilitation, 2020
Judith Vloothuis, Marja Depla, Cees Hertogh, Gert Kwakkel, Erwin van Wegen
Eight patients and nine caregivers were approached to be interviewed. One approached patient had new medical problems and with two approached caregivers an appointment could not be scheduled. The other seven patients and seven caregivers were interviewed. After these 14 interviews, both researchers agreed data saturation was achieved. The age of the participants ranged between 44 and 79 years for the caregivers and between 27 and 76 years for the patients. The modified Rankin Scale ranged from 2 to 5. Participants were interviewed between 4 and 22 months after their participation in the intervention. Even though it was intended to interview participants alone, in two patient-interviews the caregiver wanted to be present and in one caregiver-interview the patient wanted to be present allowing to add information. Characteristics of patients and caregivers can be found in Table 1 and 2.
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