Dataset Information

The Impact of One's Sex and Social Living Situation on Rehabilitation Outcomes After a Stroke.

ABSTRACT:

Objective

The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation.

Design

A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ?5 and <5, was the primary outcome measure. A two-step generalized linear mixed model was used to measure the effect of sex on each functional independence measure item while controlling for many clinical and sociodemographic covariates.

Results

After adjusting for sociodemographic and clinical factors, females had higher odds of reaching a supervision level for 14 of 18 functional independence measure items. Males had higher odds of reaching a supervision level on 2 of 18 functional independence measure items. Individuals who lived alone before their stroke had higher odds of reaching a supervision level than individuals who lived with a caregiver or with family for all functional independence measure items.

Conclusions

When sociodemographic and clinical factors are controlled, females are more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who live alone before their stroke have higher odds of discharging at a supervision level or better.

SUBMITTER: Hay CC

PROVIDER: S-EPMC6920562 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The Impact of One's Sex and Social Living Situation on Rehabilitation Outcomes After a Stroke.

Hay Catherine Cooper CC Graham James E JE Pappadis Monique R MR Sander Angelle M AM Hong Ickpyo I Reistetter Timothy A TA

American journal of physical medicine & rehabilitation 20200101 1

<h4>Objective</h4>The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation.<h4>Design</h4>A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ≥5 and <5, was the pr ...[more]

PMID: 31343498

Similar Datasets

Project description:BackgroundStroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability.ObjectivesTo systematically evaluate existing evidence, from published systematic reviews of meta-analyses, of subacute physical rehabilitation interventions in (ADLs) for stroke patients.MethodsUmbrella review on meta-analyses of RCTs ADLs in MEDLINE, Web of Science, Scopus, Cochrane, and Google Scholar up to April 2018. Two reviewers independently applied inclusion criteria to select potential systematic reviews of meta-analyses of randomized controlled trials (RCTs) of physical rehabilitation interventions (during subacute phase) reporting results in ADLs. Two reviewers independently extracted name of the 1st author, year of publication, physical intervention, outcome(s), total number of participants, and number of studies from each eligible meta-analysis. The number of subjects (intervention and control), ADL outcome, and effect sizes were extracted from each study.ResultsFifty-five meta-analyses on 21 subacute rehabilitation interventions presented in 30 different publications involving a total of 314 RCTs for 13,787 subjects were identified. Standardized mean differences (SMDs), 95% confidence intervals (fixed and random effects models), 95% prediction intervals, and statistical heterogeneity (I and Q test) were calculated. Virtual reality, constraint-induced movement, augmented exercises therapy, and transcranial direct current stimulation interventions resulted statistically significant (P < .05) with moderate improvements (0.5 ≤ SMD ≤ 0.8) and no heterogeneity (I = 0%). Moxibustion, Tai Chi, and acupuncture presented best improvements (SMD > 0.8) but with considerable heterogeneity (I2 > 75%). Only acupuncture reached "suggestive" level of evidence.ConclusionDespite the range of interventions available for stroke rehabilitation in subacute phase, there is lack of high-quality evidence in meta-analyses, highlighting the need of further research reporting ADL outcomes.

Project description:Brain-computer interfaces (BCIs) are an emerging novel technology for stroke rehabilitation. Little is known about how dose-response relationships for BCI therapies affect brain and behavior changes. We report preliminary results on stroke patients (n = 16, 11 M) with persistent upper extremity motor impairment who received therapy using a BCI system with functional electrical stimulation of the hand and tongue stimulation. We collected MRI scans and behavioral data using the Action Research Arm Test (ARAT), 9-Hole Peg Test (9-HPT), and Stroke Impact Scale (SIS) before, during, and after the therapy period. Using anatomical and functional MRI, we computed Laterality Index (LI) for brain activity in the motor network during impaired hand finger tapping. Changes from baseline LI and behavioral scores were assessed for relationships with dose, intensity, and frequency of BCI therapy. We found that gains in SIS Strength were directly responsive to BCI therapy: therapy dose and intensity correlated positively with increased SIS Strength (p ≤ 0.05), although no direct relationships were identified with ARAT or 9-HPT scores. We found behavioral measures that were not directly sensitive to differences in BCI therapy administration but were associated with concurrent brain changes correlated with BCI therapy administration parameters: therapy dose and intensity showed significant (p ≤ 0.05) or trending (0.05 < p < 0.1) negative correlations with LI changes, while therapy frequency did not affect LI. Reductions in LI were then correlated (p ≤ 0.05) with increased SIS Activities of Daily Living scores and improved 9-HPT performance. Therefore, some behavioral changes may be reflected by brain changes sensitive to differences in BCI therapy administration, while others such as SIS Strength may be directly responsive to BCI therapy administration. Data preliminarily suggest that when using BCI in stroke rehabilitation, therapy frequency may be less important than dose and intensity.

Project description:PurposeIndependent health impacts of sex or social circumstances are well-studied, particularly among older adults. Less theorized or examined is how combinations or intersections of these underpin differential health effects. Nevertheless, and often without naming it as such, an intersectional framework aligns with studies of social determinants of health, life-course epidemiology and eco-epidemiology. In this systematic review we examined and aimed to identify research methods used to operationalize, whether intentionally or inadvertently, interconnected effects of sex and social locations on health outcomes for 45+ year olds.MethodsUsing broad search terms, numerous databases, and following Prisma guidelines, 732 of 9214 papers initially identified, met inclusion criteria for full review.ResultsOf the 501 papers included after full review, methods used in considering intersections of sex and social circumstances/location(s) included regression (112 of 365 papers), growth curves (7 of 22), multilevel (15 of 25), decomposition (6 of 9), mediation (10 of 17), structural equation modelling (23 of 25), and other (2 of 3). Most (n = 157) approximated intersectional analyses by including interaction terms or sex-stratifying results.DiscussionFew authors used the inherent strength of some study methods to examine intersecting traits. As even fewer began with an intersectionality framework their subsequent failure to deliver cannot be faulted, despite many studies including data and methodologies that would support intersectional analyses. There appeared to be a gap, not in analytic potential but rather in theorizing that differential distributions of social locations describe heterogeneity within the categories 'men' and 'women' that can underlie differential, gendered effects on older adults' health. While SEM, mediation and decomposition analyses emerged as particularly robust methods, the unexpected outcome was finding how few researchers consider intersectionality as a potential predictor of health.

Dataset Information

The Impact of One's Sex and Social Living Situation on Rehabilitation Outcomes After a Stroke.

Objective

Design

Results

Conclusions

Publications

The Impact of One's Sex and Social Living Situation on Rehabilitation Outcomes After a Stroke.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets