This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.

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Guidelines for management of ischaemic stroke and transient ischaemic attack 2008

Principles of Measurement Scales. DEVELOPING AND TESTING QUESTIONNAIRES. Scores and Measurements: Validity, Reliability, Sensitivity. Multi-item Scales. Factor Analysis. Item Response Theory and Differential Item Functioning. Questionnaire Development and Scoring. ANALYSIS OF QoL DATA. Cross-sectional Analysis. Exploring Longitudinal Data. Modelling Longitudinal Data. Missing Data. Quality-adjusted Survival. PRACTICAL ASPECTS AND CLINICAL INTERPRETATION. Clinical Trials. Sample Sizes. Practical and Reporting Issues. Clinical Interpretation. Appendices. References. Index.

Quality of Life: Assessment, Analysis, and Interpretation

Background and Purpose— This guideline provides an overview of the evidence on various established and potential stroke risk factors and provides recommendations for the reduction of stroke risk. M...

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.32.1.280

Primary Prevention of Ischemic Stroke A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association

Diabetes is a chronic, progressively worsening disease associated with a variety of microvascular and macrovascular complications. Cardiovascular disease (CVD) is the main cause of death in these patients.1,2 During the past decade, numerous drugs have been introduced for the treatment of type 2 diabetes that, used in monotherapy or in combination therapy, are effective in lowering blood glucose to achieve glycemic goals and in reducing diabetes-related end-organ disease.

Two such drugs, rosiglitazone and pioglitazone, belong to the class called thiazolidinediones (TZDs).3 Troglitazone, the first agent of this class to be approved, was effective in controlling glycemia but was removed from the market because of serious liver toxicity. Both rosiglitazone and pioglitazone are indicated either as monotherapy or in combination with a sulfonylurea, metformin, or insulin when diet, exercise, and a single agent do not result in adequate glycemic control4 (package insert Avandia [rosiglitazone maleate; GlaxoSmithKline] and Actos5 [pioglitazone hydrochloride; Takeda Pharmaceuticals]). In addition to lowering blood glucose, both drugs may benefit cardiovascular parameters, such as lipids, blood pressure, inflammatory biomarkers, endothelial function, and fibrinolytic status.6,7

These beneficial effects of TZDs on glycemia and cardiovascular risk factors have made them attractive agents in patients with type 2 diabetes who are at high risk for CVD. There is a growing recognition, however, that edema can occur in patients treated with either drug. Because people with diabetes are at increased risk for CVD and many have preexisting heart disease, the edema that sometimes accompanies the use of a TZD can be cause for concern, as it may be a harbinger or sign of congestive heart failure (CHF). An analysis of Medicare beneficiaries hospitalized with the diagnosis of diabetes and CHF indicated that the number of these patients discharged on TZDs had increased from 7.2% to 16.2% over a …

Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure A Consensus Statement From the American Heart Association and American Diabetes Association

Objective: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke.Methods: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics and measures of outcome, a bestresearch synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score).Results: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs). Methodological quality of all RCTs had a median of 5 points on the 10-point PEDro scale (range 2–8 points). Based on high-quality RCTs strong evidence was found in f...

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Improving the sensitivity of the Barthel Index for stroke rehabilitation

This prospective multicenter study identifies the variables significant in the prediction of rehabilitation efficiency, achievement of rehabilitation potential and duration of rehabilitation stay in 258 persons with a first stroke admitted to comprehensive inpatient rehabilitation in Brisbane, Australia, during 1984. All three dependent variables were poorly predicted, with only 17% of the variance in rehabilitation efficiency, only 30% of the variance in achievement of rehabilitation potential, and only 22% of the variance in duration of rehabilitation stay explained. Unlike other reports, we considered most of the major medical (side of paralysis, stroke etiology, site of the lesion, arterial distribution affected, etc.), rehabilitative (initial Barthel Index score, interval from stroke onset to acute-care hospital admission, interval from hospital admission to rehabilitation commencement, neurologic measures, etc.), and demographic (age, years of education, occupation, ethnicity, etc.) variables. The high proportion of unexplained variance is likely to be due to nonmedical factors influencing the selection of patients for rehabilitation.

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.21.2.241

Efficiency, effectiveness, and duration of stroke rehabilitation.

We discuss the functional ability of all 258 surviving patients with first stroke referred for inpatient comprehensive rehabilitation in Brisbane, Australia, during 1984 and derive an equation to predict the discharge Barthel Index score from characteristics assessed at admission to comprehensive rehabilitation. A boundary condition limiting improvement for patients with high admission Barthel Index scores and the lesser improvement observed for low-scoring patients indicate that the relation between initial and discharge Barthel Index scores is nonlinear. A quadratic equation including initial Barthel Index score and six other independent variables selected by stepwise regression analysis explained 61% of the variance in discharge Barthel Index scores.

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.20.6.766

Predicting discharge status at commencement of stroke rehabilitation.

At present many of the activities of daily living indices used in Australia lack essential characteristics of an index yielding desirable results. This study argues that the Barthel Index as modified by Shah, Vanclay and Cooper (1989a) is robust and has the required biometric and psychometric qualities. It presents evidence in support of the use of the Barthel Index as a preferred measure of the activities of daily living function to report therapeutically meaningful and valid information of patient care and stroke rehabilitation outcomes in Australia. It also presents the functional performance on the modified Barthel Index and the outcome of all 258 first stroke patients admitted for inpatient rehabilitation in Brisbane, Australia. Using the Barthel Index as a measure of activities of daily living functions, the study then compares the performances and outcomes of stroke patients between Australia, Japan, the United Kingdom and the United States of America.

Surya Shah

Papers

Improving the sensitivity of the Barthel Index for stroke rehabilitation

Efficiency, effectiveness, and duration of stroke rehabilitation.

Predicting discharge status at commencement of stroke rehabilitation.

The Barthel Index and ADL Evaluation in Stroke Rehabilitation in Australia, Japan, the UK and the USA.

Stroke rehabilitation: australian patient profile and functional outcome