Integrated multidisciplinary assessment of cerebral stroke outcome after treatment in a comprehensive stroke unit

  • Yu.V. FLomin MC Universal Clinic “Oberig”, Kyiv https://orcid.org/0000-0002-7123-3659
  • V.G. Gurianov Bogomolets National Medical University, Kyiv
  • L.I. Sokolova Bogomolets National Medical University, Kyiv
Keywords: cerebral stroke; outcome assessment; integrated assessment system; comprehensive stroke Unit.

Abstract

Objective – to explore the possibility of integral assessment of the stroke outcome and to develop a method of integral assessment of the stroke outcome after in-patient treatment on the level of impairment and and the level of activities of daily living, which were assessed using rating scales and indices.
Materials and methods. The study was conducted at the Stroke Center (SC), Oberig’ multidisciplinary hospital division, which operates according to the principles of Comprehensive Stroke Unit. Patients with a cerebral stroke who were admitted to the SC in 2010–2018 were enrolled. The data of the participants were prospectively entered into a special database and included discharge assessments using 8 valid rating scales and indices. Cluster analysis methods (in particular Kohonen neural networks) were used to design the integral assessment. Statistical analysis of the values ​​of the rating scales and indices in the selected clusters was performed using the Kruskal–Wallis criterion, post hoc comparisons were made using the Dunn multiple comparison criterion.
Results. 852 patients (42.5 % women and 57.5 % men, median age – 66.7 year) were enrolled. 81 % of patients were diagnosed with ischemic stroke, and 19 % had hemorrhagic stroke. According to the chosen method, it is necessary and sufficient to split the data into 4 clusters. All participants in the study according to their assessments at discharge using the set of selected measures could be assigned to one of 4 isolated clusters: K1 (n = 366), K2 (n = 93), K3 (n = 104) or K4 (n = 289). National Institutes of Health Stroke Scale, modified Rankin scale, Barthel Index, Berg Balance Scale та Functional Ambulation Classification were the most significant determinants of the patient cluster. For the 5 measures there have been significant differences (p < 0.001) in the four clusters. The condition of the patients in K4 cluster was the best (p < 0.05), whereas the patients in the K1 cluster were worse (p < 0.05), and the condition of the patients in the clusters K2 and K3 was much worse (p < 0.05) compared with the cluster K4.
Conclusions. Based on the integrated assessments of neurological impairments and activities of daily living all of stroke patients could be assigned to one of four identified clusters. Detecting predictors of poor outcome after in-patient management may help to find ways to improve their prognosis.

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References

Salinas J, Sprinkhuizen SM, Ackerson T et al. An international standard set of patient-centered outcome measures after stroke. Stroke. 2016 Jan;47(1):180-6. doi: 10.1161/STROKEAHA.115.010898.

Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120:439-48. doi: 10.1161/CIRCRESAHA.116.308413.

Aguiar de Sousa D, von Martial R, Abilleira S et al. Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. Eur Stroke J. 2019 Mar; 4(1):13-28. doi: 10.1177/2396987318786023.

Kalkonde YV, Alladi S, Kaul S, Hachinski V. Stroke prevention strategies in the developing world. Stroke. 2018 Dec; 49(12):3092-7. doi: 10.1161/STROKEAHA.118.017384.

GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019 May; 18(5):439-58. doi:10.1016/S1474-4422(19)30034-1.

Porter ME, Lee TH. The strategy that will fix health care. Harvard Bus Rev. 2013;91:50-70. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care

van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry. 1999 Apr;66(4):480-4. doi:10.1136/jnnp.66.4.480

Sacco RL, Kasner SE, Broderick JP et al.; American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Council on Nutrition, Physical Activity and Metabolism. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Jul;44(7):2064-89. doi: 10.1161/STR.0b013e318296aeca.

Zerna C, Thomalla G, Campbell BCV et al. Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke. Lancet. 2018 Oct 6;392(10154):1247-56. doi: 10.1016/S0140-6736(18)31874-9.

Teasell R, Hussein N. Clinical consequences of stroke. Evidence-based review of stroke rehabilitation, 2018. http://www.ebrsr.com/evidence-review/2-clinical-consequences-stroke

World Health Organization. How to use the ICF: A practical manual for using the International Classification of Functioning, Disability and Health (ICF). Geneva: WHO, 2013. https://www.who.int/classifications/drafticfpracticalmanual2.pdf?ua=1

Duncan PW, Jorgensen HS, Wade DT. Outcome measures in acute stroke trials: a systematic review and some recommendations to improve practice. Stroke. 2000;31:1429-38. doi:10.1161/01.str.31.6.1429.

Kasner SE. Clinical interpretation and use of stroke scales. Lancet Neurol. 2006 Jul;5(7):603-12. doi:10.1016/S1474-4422(06)70495-1.

Salter K, Campbell N, Richardson M et al. Outcome measures in stroke rehabilitation. Evidence-based review of stroke rehabilitation, 2013. http://www.ebrsr.com/sites/default/files/Chapter %2020_Outcome %20Measures.pdf

Theofanidis D, Fitsioris X, Iakovos T. Stroke scales and trajectory of recovery: a major concern for patients and nurses alike. Health Science Journal 2015;9(45):1-7. http://www.hsj.gr/medicine/stroke-scales-and-trajectory-of-recovery-a-major-concern-for-patients-and-nurses-alike.php?aid=6883

Kalra L, Fowle AJ. An integrated system for multidisciplinary assessments in stroke rehabilitation. Stroke. 1994 Nov;25(11):2210-4. doi:10.1161/01.str.25.11.2210.

Asplund K, Hulter Еsberg K, Appelros P et al. The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care. Int J Stroke. 2011;6:99-108. doi: 10.1111/j.1747-4949.2010.00557.x.

Gershon RC, Cella D, Fox NA et al. Assessment of neurological and behavioural function: the NIH Toolbox. Lancet Neurol. 2010;9(2):138-9. doi:10.1016/S1474-4422(09)70335-7.

Quatrano LA, Cruz TH. Future of outcomes measurement: impact on research in medical rehabilitation and neurologic populations. Arch Phys Med Rehabil. 2011;92(10 Suppl):S7-S11. doi:10.1016/j.apmr.2010.08.032.

Kwakkel G, Lannin NA, Borschmann K et al. Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke. 2017 Jul;12(5):451-61. doi: 10.1177/1747493017711813.

Carlozzi NE, Goodnight S, Casaletto KB et al. Validation of the NIH Toolbox in idividuals with neurologic disorders. Arch Clin Neuropsychol. 2017 Aug;32(5):555-73. doi: 10.1093/arclin/acx020.

Kohonen T. Self-organized formation of topologically correct feature maps. Biol Cybern. 1982; 43(1):59-69. doi: 10.1007/BF00337288.

Haykin S. Neural Networks and Learning Machines. 3rd ed. NJ, USA: Pearson; 2009. 936 p.

Lyakh Y, Gurianov V, Gorshkov O, Vihovanets Y. Estimating the number of data clusters via the contrast statistic. Journal of Biomedical Science and Engineering. 2012;5(2):95-9. doi:10.4236/jbise.2012.52012


Abstract views: 117
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Published
2019-11-21
How to Cite
FLomin, Y., Gurianov, V., & Sokolova, L. (2019). Integrated multidisciplinary assessment of cerebral stroke outcome after treatment in a comprehensive stroke unit. Endovascular Neuroradiology, 28(2), 50-58. https://doi.org/10.26683/2304-9359-2019-2(28)-50-58