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.
Circadian preference and stroke characteristics: A descriptive study
Published in Chronobiology International, 2022
Eveli Truksinas, Cristina Frange, Giuliano da Paz, Eliana Lottenberg Vago, Monica Levy Andersen, Sergio Tufik, Fernando Morgadinho Santos Coelho
The Morningness-Eveningness Questionnaire (MEQ) was used to establish circadian preference, with scores ≤41 indicating evening types; ≥59 indicating morning types; and scores between 42–58 indicating intermediate types (Benedito-Silva et al. 1990; Horne and Ostberg 1976). As we used a self-report questionnaire, we use the term circadian preference (CP) rather than chronotype. The modified Rankin scale (mRS) was used to determine the degree of disability or dependence in the daily activities of the participants. The scale runs from 0 to 6, with 0 describing participants without symptoms; grade 1, participants without significant disability despite symptoms; grade 2, slight disability; grade 3, moderate disability; grade 4, moderately severe disability; grade 5, severe disability and grade 6, death (Wilson et al. 2002). After matching, the results of the MEQ questionnaires, comorbidities, age, gender, and the results of a full-night polysomnography (PSG) examination were gathered for the control group.
Prevalence of upper-limb spasticity and its impact on care among nursing home residents with prior stroke
Published in Disability and Rehabilitation, 2020
Christine T. Shiner, Angela Vratsistas-Curto, Valerie Bramah, Steven G. Faux, Yuriko Watanabe
The Abbey Pain Scale [19], a non-verbal measure of behavioral observation, was used to assess the presence/absence and severity of pain for all participants. Here, observed physiological changes and pain-related behavior such as vocalization, changes in facial expression and/or body position were scored on a 4-point scale from “absent” to “severe” (0–3), resulting in a total score out of 18, with higher scores indicating more pain. Where possible, the Numerical Pain Rating Scale [20,21] was also completed with participants with adequate comprehension and expressive communication. Participants were asked to rate the intensity of their pain on a scale from 0 (no pain) to 10 (worst pain imaginable). The Modified Rankin Scale [22] was used to assess participants’ overall degree of disability on a scale from 0 (no symptoms), to 5 (severe disability requiring constant nursing care), where increasing scores represent increasing levels of dependence and disability.
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
Related Knowledge Centers
- Activities of Daily Living
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