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Latest & greatest articles for stroke
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on stroke or other clinical topics then use Trip today.
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Prescription of Pharmacotherapy and the Incidence of Stroke in Patients With Symptoms of Peripheral Artery Disease Background and Purpose- Current guidelines recommend prescription of a number of medications to prevent cardiovascular events in patients with peripheral artery disease (PAD). The impact that these medications have on the incidence of stroke in PAD patients has not been thoroughly investigated. This study aimed to investigate the association of prescription of antihypertensive (...) drugs, antiplatelet medications, and statins, as well as cardiovascular disease risk factors, with stroke incidence in patients with symptoms of PAD. Methods- A database search was completed to identify studies reporting the incidence of stroke and prescription of antihypertensive drugs, antiplatelet medications, and statins in patients with PAD symptoms. A random-effects model was used to meta-analyze the incidence of stroke in patients with symptoms of PAD and in subgroups with intermittent
CHA2DS2-VASc Score and Stroke Prediction in Atrial Fibrillation in Whites, Blacks, and Hispanics Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-VASc score is widely used for stroke prediction in atrial fibrillation. Among patients with atrial fibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score
Early Prediction of Malignant Brain Edema After Ischemic Stroke Background and Purpose- Malignant brain edema after ischemic stroke has high mortality but limited treatment. Therefore, early prediction is important, and we systematically reviewed predictors and predictive models to identify reliable markers for the development of malignant edema. Methods- We searched Medline and Embase from inception to March 2018 and included studies assessing predictors or predictive models for malignant (...) brain edema after ischemic stroke. Study quality was assessed by a 17-item tool. Odds ratios, mean differences, or standardized mean differences were pooled in random-effects modeling. Predictive models were descriptively analyzed. Results- We included 38 studies (3278 patients) with 24 clinical factors, 7 domains of imaging markers, 13 serum biomarkers, and 4 models. Generally, the included studies were small and showed potential publication bias. Malignant edema was associated with younger age (n
Refining Prediction of Atrial Fibrillation-Related Stroke Using the P2-CHA2DS2-VASc Score In people with atrial fibrillation (AF), periods of sinus rhythm present an opportunity to detect prothrombotic atrial remodeling through measurement of P-wave indices (PWIs)-prolonged P-wave duration, abnormal P-wave axis, advanced interatrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that the addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF (...) -related ischemic stroke.We included 2229 participants from the ARIC study (Atherosclerosis Risk in Communities) and 700 participants from MESA (Multi-Ethnic Study of Atherosclerosis) with incident AF who were not on anticoagulants within 1 year of AF diagnosis. PWIs were obtained from study visit ECGs before development of AF. AF was ascertained using study visit ECGs and hospital records. Ischemic stroke cases were based on physician adjudication of hospital records. We used Cox proportional hazards
Interventions for treating urinary incontinence after stroke in adults. Urinary incontinence can affect 40% to 60% of people admitted to hospital after a stroke, with 25% still having problems when discharged from hospital and 15% remaining incontinent after one year.This is an update of a review published in 2005 and updated in 2008.To assess the effects of interventions for treating urinary incontinence after stroke in adults at least one-month post-stroke.We searched the Cochrane (...) Incontinence and Cochrane Stroke Specialised Registers (searched 30 October 2017 and 1 November 2017 respectively), which contain trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearched journals and conference proceedings.We included randomised or quasi-randomised controlled trials.Two review authors independently undertook data extraction, risk of bias assessment
Effects of Electromechanical Exoskeleton-Assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial To assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed, and capacity.Randomized controlled trial.University rehabilitation hospital.Individuals (N=40) with stroke who could stand alone.Patients were randomly assigned to control (...) significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the 2 groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events
The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physical therapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.Single blind randomized controlled trial.Outpatient clinics and inpatient wards at tertiary care (...) neurology center.Adult patients with acute middle cerebral artery territory ischemic stroke.60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physical therapy for four weeks followed by home physiotherapy for one year.Fugl Meyer Assessment upper limb score (FMA
Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training Background and Purpose- Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could (...) in balance and independent daily living than the general health education + TOBT participants. Conclusions- Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals with a history of stroke. Clinical Trial Registration- URL: http://clinicaltrials.gov . Unique identifier: NCT02937532.
Dual-Task Exercise Reduces Cognitive-Motor Interference in Walking and Falls After Stroke Background and Purpose- Functional community ambulation requires the ability to perform mobility and cognitive task simultaneously (dual-tasking). This single-blinded randomized controlled study aimed to examine the effects of dual-task exercise in chronic stroke patients. Methods- Eighty-four chronic stroke patients (24 women; age, 61.2±6.4 years; time since stroke onset, 75.3±64.9 months) with mild (...) during serial-3-subtractions and verbal fluency task. Secondary outcomes included the Activities-specific Balance Confidence Scale, Frenchay Activities Index, and Stroke-specific Quality of Life Scale. The above outcomes were measured at baseline, immediately after, and 8 weeks after training. Fall incidence was recorded for a 6-month period posttraining. Results- Only the dual-task group exhibited reduced dual-task interference in walking time posttraining (forward walking combined with verbal
Stride management assist exoskeleton vs functional gait training in stroke: A randomized trial To test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke.Fifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton (...) had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029).Gait training with the SMA improved walking speed in persons with chronic stroke
Canagliflozin and Stroke in Type 2 Diabetes Mellitus Background and Purpose- This study reports the detailed effects of canagliflozin on stroke, stroke subtypes, and vascular outcomes in participants with and without cerebrovascular disease (stroke or transient ischemic attack) at baseline from the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program. Methods- The CANVAS Program, comprising 2 similarly designed and conducted clinical trials, randomly assigned 10 142 participants (...) with type 2 diabetes mellitus and high cardiovascular risk to canagliflozin or placebo. Its primary outcome was a composite of major adverse cardiovascular events. The main outcome of interest for this report was fatal or nonfatal stroke. Additional exploratory outcomes were stroke subtypes and other vascular outcomes defined according to standard criteria. Results- There were 1 958 (19%) participants with prior stroke or transient ischemic attack at baseline. These individuals were older, more
Giving oxygen routinely after a stroke does not improve outcomes Giving oxygen routinely after a stroke does not improve outcomes Discover Portal Discover Portal Giving oxygen routinely after a stroke does not improve outcomes Published on 3 January 2018 doi: There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability to do everyday tasks or live (...) independently. There were no oxygen-related adverse events reported. Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Therefore, giving oxygen to reduce the potential damage may appear to make sense. Guidelines from NICE and the British Thoracic Society recommend that people are not routinely given oxygen after a stroke unless their oxygen levels drop. This large NIHR
Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Discover Portal Discover Portal Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Published on 14 February 2018 doi: People (...) with peripheral arterial disease who took rivaroxaban plus aspirin daily over an average of 21 months reduced their risk of cardiovascular death, heart attack or stroke from seven to five in every 100 people treated compared with those given aspirin alone. The rivaroxaban plus aspirin group also reduced their risk of major limb problems or amputation but increased their risk of bleeding from one to two for every hundred people treated. Peripheral arterial disease is a condition in which the arteries
Mechanical clot removal for stroke reduces disability at two years Mechanical clot removal for stroke reduces disability at two years Discover Portal Discover Portal Mechanical clot removal for stroke reduces disability at two years Published on 1 August 2017 doi: Timely mechanical removal of the blood clots from inside vessels in the brain after a stroke reduces disability and improves quality of life at two years compared with usual care. Over a third of those in the thrombectomy group had (...) signs of stroke enables early medical attention. The procedure is currently planned for 24 specialist centres in England and will be available around the clock to facilitate urgent diagnosis and effective treatment. Share your views on the research. Why was this study needed? Stroke is the fourth leading cause of death in the UK and the leading cause of disability. There are over 100,000 strokes in the UK each year, costing the NHS in England around £1.7 billion. Eighty five per cent of strokes
Group rehabilitation activities improve walking after stroke Group rehabilitation activities improve walking after stroke Discover Portal Discover Portal Group rehabilitation activities improve walking after stroke Published on 12 September 2017 doi: Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT (...) involves stroke survivors practising different activities at workstations in sight of each other. This Cochrane review identified 17 trials of group-based CCT, given at least weekly for four weeks, compared with other physical therapies or no intervention. Those receiving CCT showed clinically meaningful improvements in walking distance and speed, as well as independence and balance. Regular multidisciplinary team rehabilitation is a central component of post-stroke care. However, there are no specific
Head position after acute stroke does not affect disability outcomes Head position after acute stroke does not affect disability outcomes Discover Portal Discover Portal Head position after acute stroke does not affect disability outcomes Published on 3 October 2017 doi: Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival to 90 days, which (...) was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position. The results of this large international randomised controlled trial are likely to be applicable to adults with different types of stroke in varied settings. As lying position did not affect outcomes, this suggests that clinicians can be guided by patients’ clinical condition, preferences
Carers of stroke survivors voice an unmet need for practical and emotional support Carers of stroke survivors voice an unmet need for practical and emotional support Discover Portal Discover Portal Carers of stroke survivors voice an unmet need for practical and emotional support Published on 22 August 2017 doi: The carers of stroke survivors express a need to be recognised by hospital rehabilitation teams as partners in care. Carers emphasised that their deep knowledge can contribute to joint (...) decision making about the care of their spouse or family member. This research suggests that considering carers’ needs for support, information and training into care planning could ease the distress currently reported. This review describes how family, friends and spouses often felt emotionally overwhelmed, excluded from important discussions about the stroke survivor’s rehabilitation or unsupported in adapting to their caring role. The review included studies from ten diverse countries
Intensive speech therapy helps stroke survivors with persistent communication difficulties Intensive speech therapy helps stroke survivors with persistent communication difficulties Discover Portal Discover Portal Intensive speech therapy helps stroke survivors with persistent communication difficulties Published on 18 July 2017 doi: Intensive speech and language therapy begun six months or more after a stroke improved verbal communication, language comprehension and self-reported quality (...) of life for those with persistent communication difficulties (chronic aphasia). The therapy in this trial consisted of around 30 hours over three weeks. Participants who received low-intensity therapy (around one hour per week) whilst on a waiting list did not improve during that time. NICE guidelines recommend speech and language therapy immediately after a stroke and if the person still experiences communication difficulties six months after their stroke, but do not specify the intensity