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: monique. Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. Current stroke research suggests that there are differences between females and males regarding incidence, stroke risk factors, stroke severity, outcome, and mortality. The few studies that have investigated sex differences in rehabilitation 8—12 months poststroke found that males are more independent, compared to females.
To investigate if there is a difference in the improvement of independence in activities of daily living ADL between females and males in the acute phase first 2 weeks of stroke rehabilitation in a Danish population. A prospective cohort study enrolling patients admitted to the hospital's rehabilitation ward with a stroke diagnosis from January 1,to March 17, Baseline and follow-up data regarding the primary outcome, Barthel index, were analyzed using an adjusted linear mixed model.
The study included patients 83 females. Females were older at admission and more males lived with a partner. No differences in stroke severity or any of the risk factors were found. There were no differences between female and male scores at baseline. In the adjusted linear mixed model, quantifying the difference between follow-up and baseline Barthel score, females increased their Barthel score by In a homogeneous sample of stroke survivors undergoing specialized h stroke rehabilitation for 11—14 days, females were more dependent in ADL than males.
Inthere were Research suggests that there are differences between females and males regarding stroke incidence, risk factors, and stroke severity. The incidence of stroke is higher in males than females Appelros et al. However females are older at the onset of stroke, have more severe strokes, are more often unmarried, are more frequently institutionalized, and more functionally dependent before stroke Appelros et al.
The literature suggests sex differences regarding mortality with studies having reported differing mortality rates in favor of both females and males Appelros et al. Few studies have investigated sex differences in functional outcome of rehabilitation after stroke.
Gargano and Reeves and Paolucci et al. Adams et al. Chau et al. These sex differences in rehabilitation outcomes have, however, only been investigated in a late phase at approximately 8 weeks to 12 months poststroke Adams et al. It is not known whether the differences are detectable early during rehabilitation. Both are free of charge. If sex differences are present from early on, it could imply that in-hospital stroke rehabilitation should be tailored differently for females and males to obtain equivalent improvements of independency.
The hypothesis of this study was that females were more dependent than males in ADL at the beginning of rehabilitation and that this difference is measurable with the Barhel index after 2 weeks of stroke rehabilitation. Therefore, the aim of this study was to investigate if there was a difference in improvement of independency in ADL between females and males in the first 2 weeks of stroke rehabilitation in a Danish population with acute stroke.
The World Health Organization definition of stroke Hatano, was used; however, patients with spontaneous subarachnoid hemorrhage were not included in this study, as these patients are primarily treated in neurosurgical departments during the acute phase and not in stroke departments in Denmark Dansk selskab for apopleksi, Our Department of Neurology has a catchment area of approximately inhabitants.
The stroke diagnoses were made by a neurologist based on clinical and radiological examinations. Computerized tomography scans and supplementary magnetic resonance imaging scans were performed to distinguish between hemorrhagic and ischemic strokes. Patients admitted to the acute stroke ward were evaluated by a multidisciplinary team physicians, physiotherapists, occupational therapists, speech therapists, nurses, and neuropsychologists and were considered eligible for the stroke rehabilitation ward when their poststroke level of functioning was equivalent to the Modified Rankin Scale level 3—5 in combination with substantial discrepancies between physical and cognitive function before and after the onset of stroke.
Patients who were institutionalized prior to the stroke or patients with a severe stroke, expected to lead to palliative care were not eligible for specialized rehabilitation. Rehabilitation was initiated within the first 2 days of admission to the acute stroke ward.
Rehabilitation covers a wide array of different therapeutic approaches, including the Bobath and Affolter concept, Facial Oral Tract Therapy, strength training, balance training, and cardiovascular training.
Patients received a combination of individual treatment sessions and group exercises. Individual treatment sessions with physiotherapists and occupational therapists duration of 30 to 60 min were offered four to seven times a week in accordance with the patient's needs and abilities. Patients who were able to participate in group sessions were offered those two to eight times a week, in addition to the individual sessions.Robin Wright scandalizes her village The Playboys HD 18+
Group exercises focused on either training of the affected upper extremity, sitting, or standing balance, strength and endurance, or activity-based training, such as preparing a meal and setting a dining table. Rehabilitation is thought of as a h concept where all health professionals support the patients in achieving their rehabilitation goals. The multidisciplinary team attempts to integrate rehabilitative approaches into all everyday activities, including both bodily, activity, and participatory aspects, with the common aim of supporting and enhancing the patient's self-care capability and independence.
The admitting physician assessed stroke severity using Scandinavian Stroke Scale SSS on which a high score indicates few neurological symptoms and thereby a less severe stroke Scandinavian Stroke Study Group, Primary and secondary outcomes were assessed within 48 h of admission by a physiotherapist and occupational therapists baseline tests and again at 11—14 days after the baseline tests.
All assessments and treatments of the patients in this study were common practice, and therefore there was no need for approval from a Danish ethics committee. All data were retrospectively retrieved from the electronic medical records.
The primary outcome was independency in ADL after stroke measured by the Barthel index. Barthel index is a measurement of a patient's ability to perform 10 everyday activities personal hygiene, bathing, feeding, toileting, stair climbing, dressing, bladder and bowel control, ambulation, and transfer.
The score ranges from 0 to where a high score indicates independency Shah et al. Barthel index is reliable and valid in stroke populations Duffy et al. The Assessment of Motor and Process Skills is an international, cross-cultural, and standardized assessment of ADL that evaluates a patient's performance on two known daily activities e.
The two known activities are selected in collaboration with the patient. Reliability has been found to be excellent and validity to be moderate to excellent in stroke populations Poulin et al. A high score means that the patient's overall balance is good Berg et al. The Functional Oral Intake Scale is an ordinal scale ranging from 1 to 7, which illustrates the patient's ability to swallow.
A score of 7 indicates a normal oral diet and 1 indicates no oral intake. The scale has not yet been fully validated, but the initial evaluation shows it is a reliable and valid scale Crary et al. The Motor Assessment Scale MAS was developed for patients with stroke and consists of eight items giving a score ranging from 0 to 6, where 6 indicates good quality of movement Carr et al. MAS has been found reliable and valid in a population of acute stroke patients Carr et al.
The 10 meters walk test 10MWT was developed to monitor improvement in patients suffering a stroke. In this study, the fast-speed version of the test was used Watson, Both versions of the test have been found reliable in a population of stroke survivors Kollen et al. Sex differences in baseline characteristics and primary Barthel and secondary outcomes measured at baseline and follow-up were examined using the two-sample t -test or the Wilcoxon ed-rank test when appropriate for quantitative outcomes and the Chi-square or Fisher's exact test for categorical outcomes.
Bonferroni adjustment of the p -values for the secondary outcome variables was made to for multiple testing at baseline and follow-up. To for repeated measures, the association between sex and the Barthel index over time baseline and follow-up was investigated using a linear mixed model.
The model included a random intercept for each patient. The fixed part included an interaction between sex and test occasion.
Analyses were performed unadjusted and adjusted for potential confounders: age, stroke severity, type of residence, marital status, atrial fibrillation, diabetes, peripheral arterial disease, and acute myocardial infarction. All data were analyzed with the statistical software SAS version 9. A total of patients 83 females were transferred to the hospital's rehabilitation ward during the study period Figure 1.First Date Sex Fail
Females were older than males mean age No differences in severity of stroke were found median SSS 43 vs. There were no differences in the distribution of ischemic or hemorrhagic strokes between the sexes. All patients resided in their own homes, except for five women of whom two were admitted from a temporary stay at another rehabilitation facility, and three lived in senior or protected housing.
Place of residence was therefore not considered a confounder in this study. No differences were found in consumption of alcohol, history of smoking, diabetes, acute myocardial infarction, atrial fibrillation, peripheral arterial disease, hypertension, stroke, or transient ischemic attack Table 1.
The total length of stay and discharge residence were not statistically ificantly different amongst the sexes Table 1. The proportion of missing values were equally distributed among females and males not shown. There were no differences between female and male scores at baseline or follow-up when considering the Bonferroni adjustment Table 2. The mean difference in the Barthel index was borderline ificant mean score females vs. Not all males and females were assessed at follow-up, but the proportions of missing values were equally distributed among the sexes, apart from the 10MWT, where more males than females had been tested.
The most common reason for the 10MWT to not have been done was that the patient was unable to walk, indicating greater difficulties in walking ability in females, compared to males. Figure 2 shows the estimated mean Barthel scores for each sex at each test occasion. In the adjusted model Table 3females increased the Barthel score by The Barthel score decreased 0.
Barthel increased with 1. Living alone versus with a partner did not seem to relate to differences in the Barthel index 1. history of diabetes, peripheral arterial disease, atrial fibrillation, and acute myocardial infarction was not associated with the Barthel in the adjusted model.
This study investigated differences in improvement in ADL between females and males in the first 2 weeks of stroke rehabilitation. This study shows that females increased their Barthel scores less than males.Independence sex dates
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