Frontiers in stroke最新文献

Background: Stroke survivors who receive more rehabilitation therapy achieve better functional outcomes. The amount of rehabilitation that patients receive is, however, limited due to constraints of the healthcare system.

Objective: To assess whether EngageHealth, a mobile device application designed to deliver stroke rehabilitation exercises using asynchronous video recordings, increases the amount of outpatient rehabilitation in stroke patients and improves their upper extremity function and quality of life.

Design: Prospective single-arm study consisting of a 2-week pre-intervention phase without EngageHealth followed by a 4-week intervention period with EngageHealth.

Setting: Ambulatory care.

Participants: Twenty-four stroke patients with upper extremity impairment were recruited at the Stanford Stroke Center outpatient clinic.

Interventions: Participants were instructed to use the EngageHealth application daily.

Main outcome measures: Adherence, user experience, and change in the upper extremity Fugl-Meyer (UE-FM), Quality of Life in Neurological Disorders (Neuro-QoL), and Stroke Impact Scale (SIS).

Results: Of 23 participants, five (22%) used the application for 17 days, six (26%) used the application for 9-16 days, and 12 (52%) used it < 9 days. Sixty-three percent of participants would recommend the application to other stroke survivors, with fifty percent indicating they would continue using the application, if available. During the pre-intervention phase, there were no changes in hand function. During the intervention period, participants improved by 4 points on the UE-FM (P < 0.01), and 15 points in the hand-function domain of SIS (P = 0.03). Videos of participants' exercises were successfully recorded, allowing the clinician to review videos of the participants' completed tasks asynchronously. In-depth interviews revealed that participants viewed the EngageHealth application favorably, and that their perceived usefulness of the exercises affected their motivation.

Conclusions: Use of the EngageHealth application in the home environment may improve upper extremity function in subacute/chronic stroke patients. Additional support strategies should be implemented in future studies to improve adherence. These findings from a prospective single-arm study, support the design of a randomized controlled trial to determine the efficacy of long-term use of the EngageHealth application.

Background: Patients with a positive prehospital stroke severity score and underlying intracerebral hemorrhage (ICH) may be harmed by longer onset-to-admission time. We aimed to investigate the interaction between ICH severity and time from onset to admission on functional outcome.

Methods: This is an individual patient data analysis with data from two randomized prehospital stroke trials using the same prehospital stroke scale. Patients were stratified according to the presence of a positive stroke severity score. They were grouped into early arrivers (admitted ≤ 90 min from onset) and late arrivers (admitted ≥90 min after onset). The primary outcome was a shift toward a better functional outcome on the modified Rankin Scale (mRS).

Results: A total of 212 patients had ICH. A positive stroke severity score was seen in 123 of these patients. Patients with ICH and a positive prehospital stroke severity score had a significantly worse outcome if they arrived 90 min or later at the hospital (adjusted odds ratio [aOR]: 2.02, 95% CI [1.01, 4.12]). This difference was not observed in patients without a positive severity score (aOR: 0.50, 95% CI [0.22, 1.14]). Patients with a positive score also had an increased risk of death or severe dependency (mRS of 5-6) of 9.1 percentage points (95% CI [-1.6%, 19.8%]) per hour if they were diagnosed with ICH.

Conclusion: Longer onset-to-admission time was harmful for patients with ICH and a positive prehospital stroke severity score.

Introduction: Posterior circulation stroke can lead to ataxia, manifesting in a loss of coordination and balance. Patients experience difficulty in activities of daily living and an increased risk of falling, both profoundly affecting quality of life. In individuals with neurodegenerative diseases, coordination exercises have been shown to lead to a reduction in ataxic symptoms. There is, however, limited evidence on the effect of physical therapy, specifically coordination exercises in patients with stroke-related ataxia. We therefore present a study protocol for a prospective trial.

Methods: The purpose of this trial is to investigate the effects of coordination exercises compared to standard physiotherapy on balance and walking in ataxic stroke patients. Therefore, a prospective, single-blinded randomized controlled trial is currently ongoing at the Clinical Department of Neurology, Medical University of Innsbruck, Austria, in collaboration with two local rehabilitation facilities in Austria, Hochzirl Hospital and the Clinic for Rehabilitation Münster. Balance is the primary outcome of the study as assessed using the Berg Balance Scale. Secondary outcomes are concerned with walking, risk and number of falls, independence in daily life, and quality of life, rated using appropriate scales and scores. Patients are allocated applying a 1:1 ratio and a stratified block randomization. In both groups recruited individuals undergo five 45-min treatment sessions per week, totaling 20 sessions of coordination exercises (IG) or standard physiotherapy (CG) over the course of 4 weeks. Data is collected at the baseline (T0), after the 4-week supervised practice (T1), and after another 8 weeks of independent home-based training (T2).

Discussion: This is the first randomized controlled trial investigating the effects of coordination exercises on balance and walking in people with stroke-related ataxia. As stroke guidelines emphasize the limited evidence of treatment for ataxic symptoms, this study aims to contribute further knowledge regarding tailored interventions for these patients.

Clinical trial registration: German Clinical Trials Registry (drks.de). Identifier: DRKS00020825.

Introduction: New classes of antidiabetic drugs reportedly lower the risk of cardiovascular events. This review summarizes the evidence for the effects of these drugs on the risk of stroke in diabetic individuals.

Methods: Multiple databases that report stroke outcome data were scrutinized for clinical trials (from inception to June 25, 2023), compared sodium-glucose cotransporter 2 inhibitors (SGLT2-Is), glucagon-like peptide-1 receptor agonists (GLP1-RAs), and dipeptidyl peptidase-4 inhibitors (DPP4-Is), vs. other antidiabetic drugs and placebo.

Results: Among the 960 identified trials, 259 satisfied the eligibility criteria. Among these, 177 and 82 trials reported at least one or no stroke events, respectively. In total, 208, 19, and 32 trials had a low, unclear, and high risk of bias, respectively. SGLT2-Is use did not decrease the risk of non-fatal hemorrhagic or ischemic stroke (risk ratio (RR) 0.96; 95% CI 0.87 to 1.06; P = 0.42) vs. either active comparators or placebo. GLP1-RAs use significantly decreased stroke risk (RR: 0.84, 95% CI [0.77, 0.93], p = 0.0005) and ischemic stroke (RR: 0.85, 95% CI [0.77, 0.94], p = 0.002) vs. placebo. However, GLP1-RAs use did not decrease hemorrhagic events vs. active comparators or placebo. DPP4-Is use did not decrease the risk of non-fatal hemorrhagic or ischemic stroke (RR: 0.91; 95% CI [0.83, 1.01], p = 0.07) vs. active comparators or placebo. For all classes, fatal stroke risk did not decrease vs. active comparators or placebo, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group scores were moderate.

Discussion: The use of GLP1-RAs, but not SGLT2-Is or DPP4-Is, may decrease non-fatal stroke risk. Considering these results, the findings may inform the treatment of diabetic people at risk of stroke and the design of new antidiabetic interventional trials.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017067889, identifier 42017067889.

Sickle cell disease (SCD) is the most common hereditary blood disorder worldwide, and sickle cell anemia (SCA), the homozygous state of SCD, is the most common and severe variant of the disease. Nigeria has the highest burden of SCA in the world. Hemolysis and vaso-occlusion can lead to a wide range of complications, including stroke which is one of the most devastating manifestations of SCA with significant morbidity and mortality. SCA remains the leading cause of stroke in black children. Without any intervention, strokes occur in approximately 11% of children with SCA before their 20th birthday, with the greatest risk in very young children between 2 and 5 years of age. In resource-constrained countries, where the burden of SCA is highest, stroke is underreported, hence the need to develop strategies for stroke prevention and early detection. Improving awareness among healthcare providers and the community can significantly reduce stroke rates and improve stroke detection. The goal of this manuscript is to discuss the progress that has been made in stroke prevention and detection in children with SCA in Nigeria and outline current challenges and future goals. We believe that our experience will be valuable not only in Nigeria which has the highest burden of SCA globally, but also in other low- and middle-income countries.