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Wu J, Zhang Y, Wang J, Zhang Q, Jiang J, Jiang Q, Zhou Y. Bidirectional association between cardiovascular disease and hip fracture: a systematic review and meta-analysis. BMC Cardiovasc Disord 2025; 25:366. [PMID: 40369408 PMCID: PMC12080214 DOI: 10.1186/s12872-025-04823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Accepted: 05/05/2025] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND The aim of this study was to comprehensively analyze the bidirectional association between cardiovascular disease (CVD) and hip fracture (HF). METHODS We searched PubMed, EMBASE, Web of Sciences, Cochrane Library, ScienceDirect and China National Knowledge Infrastructure for relevant studies. The Newcastle-Ottawa scale was used to evaluate the risk of bias. We conducted random effects model for meta-analysis and subgroup analysis of different ethnic groups. Sensitivity analysis and publication bias of this study were also evaluated. This study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses. RESULTS This research included 18 cohort studies and case-control studies with a total sample of 1,854,441 individuals. The results showed ischemic heart disease might increase the risk of HF (OR = 1.41, 95%CI[1.05, 1.89], I2 = 96%). Stroke might be a risk factor for HF (OR = 2.23, 95%[1.18, 4.19], I2 = 97%), and HF might likewise be a risk factor for Stroke ( OR = 2.22, 95% CI [1.81, 2.71], I2 = 78%). Heart failure might increase the risk of HF (OR = 2.89, 95%CI [1.22, 6.85], I2 = 91%), and HF might increase the risk of heart failure (OR = 2.74, 95%CI [1.27, 5.89], I2 = 92%). Hypertension might increase the risk of HF (OR = 1.55, 95%CI[1.34, 1.8], I2 = 87%), and HF might increase the risk of hypertension (OR = 3.75, 95%CI[3.3, 4.26], I2 = 98%). Cerebrovascular disease (OR = 1.96, 95%CI[1.61, 2.4], I2 = 79%) and diseases of arteries, arterioles, and capillaries (OR = 1.58, 95%CI[1.49, 1.68], I2 = 0%) might increase the risk of HF. HF might increase the risk of myocardial infarction (OR = 2, 95%CI[1.17, 3.41], I2 = 97%) and CVD-related death (OR = 1.78, 95%CI[1.05, 3.02], I2 = 50%). Subgroup analyses showed that among Asians IHD might not raise the risk of HF (OR = 1.33, 95% CI [1.00, 1.78], I2 = 95%). In caucasians, IHD might also not raise HF risk (OR = 1.52, 95%CI [0.64, 4.56], I2 = 95%). CONCLUSIONS This study supports possible bidirectional associations between CVD and HF, but more mechanistic studies of CVD and HF were warranted. However, high heterogeneity and potential confounding by unmeasured variables warrant cautious interpretation.
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Affiliation(s)
- Jinyi Wu
- Fudan University School of Public Health, Xuhui, Shanghai, China
- Fudan University Center for Tropical Disease Research, Shanghai, China
- Wuhan fourth hospital, Qiaokou, Wuhan, China
- Orthopedic Clinical Research Center of Hubei Province, Qiaokou, Wuhan, China
| | - Yan Zhang
- Jiading District Center for Disease Control and Prevention, 1055 Hongde Road, Shanghai, 201821, China
| | - Junwen Wang
- Wuhan fourth hospital, Qiaokou, Wuhan, China
- Orthopedic Clinical Research Center of Hubei Province, Qiaokou, Wuhan, China
| | - Qingsong Zhang
- Wuhan fourth hospital, Qiaokou, Wuhan, China
- Orthopedic Clinical Research Center of Hubei Province, Qiaokou, Wuhan, China
| | - Jun Jiang
- Fudan University School of Public Health, Xuhui, Shanghai, China
- Fudan University Center for Tropical Disease Research, Shanghai, China
| | - Qingwu Jiang
- Fudan University School of Public Health, Xuhui, Shanghai, China
- Fudan University Center for Tropical Disease Research, Shanghai, China
| | - Yibiao Zhou
- Fudan University School of Public Health, Xuhui, Shanghai, China.
- Fudan University Center for Tropical Disease Research, Shanghai, China.
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Zhu Z, Xu F, Li Q, Wan X. Gait spatio-temporal characteristics during obstacle crossing as predictors of fall risk in stroke patients. BMC Neurol 2025; 25:111. [PMID: 40102826 PMCID: PMC11916317 DOI: 10.1186/s12883-025-04131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 03/07/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND Spatio-temporal parameters provide reference information for the gait variations of stroke patients during obstacle crossing. Analyzing these gait spatio-temporal characteristics of patients during obstacle crossing can assist in assessing the risk of falls. The aim of this study was to analyze the variances in gait spatio-temporal characteristics during obstacle crossing between stroke patients with and without a history of falls, to explore spatio-temporal parameters for assessing fall risk, and to construct a regression model for predicting patients' fall risk. METHODS Thirty-three patients with unilateral brain injury from stroke who were discharged from rehabilitation were included. These patients were categorized into a falls group (with a history of falls) and a non-falls group (without a history of falls) based on whether they had experienced a fall in the previous six months. A Qualisys motion capture system was used to record the marker positions when crossing an obstacle 4 cm in height with the affected leg as the leading limb, and gait spatio-temporal parameters were calculated and obtained. Univariate analysis and logistic regression models were used to compare the gait spatio-temporal parameters of the two groups. RESULTS 17 participants were categorised into the falls group and 16 into the non-falls group. The single support phase of leading limb, post-obstacle swing phase of trailing limb, obstacle-heel distance of leading limb, and obstacle-heel distance of trailing limb were significantly smaller in the fall group compared to the non-fall group (P < 0.05). The gait spatio-temporal parameter ultimately included in the fall risk prediction model was the obstacle-heel distance of leading limb (OR = 0.819, 95%CI = 0.688-0.973, P = 0.023). The overall correct classification rate from this model was 69.7%, and the area under the curve (AUC) was 0.750 (P = 0.014). CONCLUSION Abnormalities in gait spatio-temporal parameters during obstacle crossing in stroke patients can contribute to an increased risk of falls. The fall risk prediction model developed in this study demonstrated excellent predictive performance, indicating its potential utility in clinical settings.
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Affiliation(s)
- Zihao Zhu
- School of Sport Science, Beijing Sport University, Beijing, 100084, China
- Key Laboratory for Performance Training & Recovery of General Administration of Sport of China, Beijing, 100084, China
| | - Feng Xu
- Department of Rehabilitation, People's Hospital of Queshan, Zhumadian, 463200, China
| | - Qiujie Li
- School of Sport Science, Beijing Sport University, Beijing, 100084, China
- Key Laboratory for Performance Training & Recovery of General Administration of Sport of China, Beijing, 100084, China
| | - Xianglin Wan
- School of Sport Science, Beijing Sport University, Beijing, 100084, China.
- Key Laboratory for Performance Training & Recovery of General Administration of Sport of China, Beijing, 100084, China.
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Zhang L, Wang J, Dong X, Dove A, Sakakibara S, Liu X, Wang C, Wang Z, Welmer AK, Xu W. Injurious Falls before, during, and after Stroke Diagnosis: A Population-based Study. J Am Med Dir Assoc 2025; 26:105465. [PMID: 39828242 DOI: 10.1016/j.jamda.2024.105465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/03/2024] [Accepted: 12/11/2024] [Indexed: 01/22/2025]
Abstract
OBJECTIVES We aimed to examine changes in the incidence of injurious falls before, during, and after stroke, and to identify risk factors of injurious falls before and after stroke diagnosis. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Within the Swedish Twin Registry, 4431 participants (aged 66.5 ± 10.3 years) with incident stroke and 4431 stroke-free controls (aged 66.5 ± 10.3 years) were identified and matched with cases according to birth year and sex. Cases and controls were retrospectively and prospectively followed for a total of 21 years. METHODS Information on the onset of stroke and injurious falls was ascertained from medical records in the National Patient Registry. Data were analyzed using conditional Poisson regression and generalized estimating equation models. RESULTS During the 4 to 10 year pre-stroke period, the standardized incidence rates of injurious falls were 4.29-7.53 per 1000 person-years in stroke and 3.97-7.47 per 1000 person-years in control groups. The incidence of injurious falls among participants with stroke was significantly higher compared with non-stroke controls beginning 3 years before stroke [incidence rate ratio (IRR), 1.27; 95% confidence interval (CI), 1.02-1.59], peaked during the year of stroke diagnosis (IRR, 2.55; 95% CI, 2.17-3.01), and declined 4 years after stroke (IRR, 1.42; 95% CI, 1.14-1.77) until reaching a similar level as the controls (IRRs around 1.11-1.56). Former/current smoking, heavy drinking, and overweight were associated with increased falls during the pre-stroke period, and being single and heart disease with falls during the post-stroke period. CONCLUSIONS AND IMPLICATIONS Among people with stroke, incidence of injurious falls is significantly elevated already 3 years before stroke diagnosis and lasting until 4 years post-stroke. Risk factors for falls differ pre-stroke and post-stroke. Taking preventive measures may be beneficial in managing both stroke and fall-related risks.
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Affiliation(s)
- Lulu Zhang
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiao Wang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaokang Dong
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Abigail Dove
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sakura Sakakibara
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Xinkui Liu
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengzeng Wang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Hospital Management Departments, Institute for Hospital Management of Henan Province, Zhengzhou, Henan, China
| | - Zhida Wang
- NHC Key Lab of Hormones and Development and Tianjin Key Lab of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Institute of Endocrinology, Tianjin, China.
| | - Anna-Karin Welmer
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Weili Xu
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Chen P, Liu TW, Ng SSM. Assessing the fall risk with Stay Independent Questionnaire in people with stroke. Front Neurol 2025; 15:1476313. [PMID: 39830205 PMCID: PMC11738773 DOI: 10.3389/fneur.2024.1476313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 12/13/2024] [Indexed: 01/22/2025] Open
Abstract
Objectives This study aimed to assess the psychometric properties of the Chinese version of the Stay Independent Questionnaire (C-SIQ) in evaluating individuals with stroke. Design The study adopted a cross-sectional design. Setting The research was conducted at a university-based neurorehabilitation center. Participants The study included a total of 100 individuals with stroke and 49 healthy older adults. Methods On Day 1, both individuals with stroke and healthy older adults underwent assessments using the C-SIQ. Additionally, individuals with stroke were evaluated using the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), ankle dorsiflexion and plantarflexion strength, Berg Balance Scale (BBS), Timed-Up and Go Test (TUG), 10-meter walk test (10 mWT), Activities-specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), and Community Integration Measure (CIM). On Day 2 (7 days after Day 1), individuals with stroke were reassessed using the C-SIQ. Results Individuals with stroke exhibited a higher C-SIQ score (6.22 ± 2.98) compared to healthy older adults (1.59 ± 2.01). The C-SIQ demonstrated good test-retest reliability (intraclass correlation coefficient = 0.847) and internal consistency (Cronbach's alpha = 0.709). The Minimal Detectable Change in C-SIQ score was calculated as 3.05. Exploratory factor analysis revealed four factors with eigenvalues ≥1.0, explaining 57.17% of the total variance. The C-SIQ score exhibited significant correlations (ranging from -0.553 to 0.362) with completion times of the TUG and 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. A cut-off score of 2.5 was identified as the optimal threshold for discriminating fall risk between individuals with stroke and healthy controls. Conclusion The C-SIQ emerges as a reliable and valid tool for evaluating fall risk in individuals with stroke, showcasing strong correlations with key measures such as TUG times, 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. The C-SIQ demonstrated good test-retest reliability and internal consistency. Exploratory factor analysis revealed that this is a four factors assessment tool. The identified cut-off score of 2.5 effectively distinguishes fall risk between individuals with stroke and healthy controls.
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Affiliation(s)
- Peiming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - T. W. Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Kowloon, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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Jeong JS, Noh Y, Cho SW, Hsieh CY, Cho Y, Shin JY, Kim H. Association of higher potency statin use with risk of osteoporosis and fractures in patients with stroke in a Korean nationwide cohort study. Sci Rep 2024; 14:30825. [PMID: 39730536 PMCID: PMC11680841 DOI: 10.1038/s41598-024-81628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/27/2024] [Indexed: 12/29/2024] Open
Abstract
This population-based cohort study aimed to evaluate the risk of osteoporosis and fractures associated with higher-potency statin use compared to lower-potency statin use in patients with stroke, using data from the Health Insurance and Review Assessment database of South Korea (2010-2019). Patients who received statin within 30 days after hospitalization for a new-onset stroke (n = 276,911) were divided into higher-potency (n = 212,215, 76.6%) or lower-potency (n = 64,696, 23.4%) statin initiation groups. The primary outcome was a composite of osteoporosis and osteoporotic fractures. Secondary outcomes were individual components of the primary outcome, including osteoporosis, vertebral fracture, hip fracture, and non-hip non-vertebral fracture. Cox proportional hazard models weighted by standardized morbidity ratios were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The risk of the composite outcome (HR 0.95, 95% CI 0.93-0.97), osteoporosis (0.93, 0.90-0.96), vertebral fracture (0.95, 0.91-0.99), and hip fracture (0.89, 0.84-0.95) were significantly lower in higher-potency statin users, while the risk for non-hip non-vertebral fracture was not significant (0.98, 0.95-1.02). The use of higher-potency statins compared to lower-potency statins was associated with a lower risk of osteoporosis, vertebral fracture, and hip fracture in patients with stroke.
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Affiliation(s)
- Jin Sook Jeong
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, Gyeonggi-do, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, Gyeonggi-do, South Korea
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yongtai Cho
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, Gyeonggi-do, South Korea.
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
| | - Hoon Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, Gyeonggi-do, South Korea.
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
- Department of Biopharmaceutical Convergence, Sungkyunkwan University, Suwon, Republic of Korea.
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Ma Y, Gao Q, Shao T, Du L, Gu J, Li S, Yu Z. Establishment and validation of a nomogram for predicting the risk of hip fracture in patients with stroke: A multicenter retrospective study. J Clin Neurosci 2024; 128:110801. [PMID: 39168063 DOI: 10.1016/j.jocn.2024.110801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE There are currently no models for predicting hip fractures after stroke. This study wanted to investigate the risk factors leading to hip fracture in stroke patients and to establish a risk prediction model to visualize this risk. PATIENTS AND METHODS We reviewed 439 stroke patients with or without hip fractures admitted to the Affiliated Hospital of Xuzhou Medical University from June 2014 to June 2017 as the training set, and collected 83 patients of the same type from the First Affiliated Hospital of Harbin Medical University and the Affiliated Hospital of Xuzhou Medical University from June 2020 to June 2023 as the testing set. Patients were divided into fracture group and non-fracture group based on the presence of hip fractures. Multivariate logistic regression analysis was used to screen for meaningful factors. Nomogram predicting the risk of hip fracture occurrence were created based on the multifactor analysis, and performance was evaluated using receiver operating characteristic curve (ROC), calibration curves, and decision curve analysis (DCA). A web calculator was created to facilitate a more convenient interactive experience for clinicians. RESULTS In training set, there were 35 cases (7.9 %) of hip fractures after stroke, while in testing set, this data was 13 cases (15.6 %). In training set, univariate analysis showed significant differences between the two groups in the number of falls, smoking, hypertension, glucocorticoids, number of strokes, Mini-Mental State Examination (MMSE), visual acuity level, National Institute of Health stroke scale (NIHSS), Berg Balance Scale (BBS), and Stop Walking When Talking (SWWT) (P<0.05). Multivariate analysis showed that number of falls [OR=17.104, 95 % CI (3.727-78.489), P = 0.000], NIHSS [OR=1.565, 95 % CI (1.193-2.052), P = 0.001], SWWT [OR=12.080, 95 % CI (2.398-60.851), P = 0.003] were independent risk factors positively associated with new fractures. BMD [OR = 0.155, 95 % CI (0.044-0.546), P = 0.012] and BBS [OR = 0.840, 95 % CI (0.739-0.954), P = 0.007] were negatively associated with new fractures. The area under the curve (AUC) of nomogram were 0.939 (95 % CI: 0.748-0.943) and 0.980 (95 % CI: 0.886-1.000) in training and testing sets, respectively, and the calibration curves showed a high agreement between predicted and actual status with an area under the decision curve of 0.034 and 0.109, respectively. CONCLUSIONS The number of falls, fracture history, low BBS score, high NIHSS score, and positive SWWT are risk factors for hip fracture after stroke. Based on this, a nomogram with high accuracy was developed and a web calculator (https://stroke.shinyapps.io/DynNomapp/) was created.
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Affiliation(s)
- Yiming Ma
- Harbin Medical University, Harbin, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qichang Gao
- Harbin Medical University, Harbin, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tuo Shao
- Harbin Medical University, Harbin, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Du
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jiaao Gu
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Song Li
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhange Yu
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Lee JH, Han K, Cheon DY, Lee M. Association Between Changes in Smoking Habits and Incident Fracture After Acute Ischemic Stroke. J Am Heart Assoc 2024; 13:e034779. [PMID: 38804231 PMCID: PMC11255617 DOI: 10.1161/jaha.124.034779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Survivors of stroke, particularly the older population, are at an increased risk of falls and incident fractures. Smoking is a widely recognized risk factor for fractures. However, the association between changes in smoking habits before and after an index stroke and increased risk of fracture remains unelucidated. METHODS AND RESULTS Using the Korean National Health Insurance program, patients with ischemic stroke between 2010 and 2016 were enrolled. Individuals were classified by smoking habits: "never smoker," "former smoker," "smoking quitter," "new smoker," and "sustained smoker." The primary outcome was the composite outcome of the vertebral, hip, and any fractures. Multivariable Cox proportional hazards regression analysis was conducted, using the never-smoker group as the reference. Among 177 787 patients with health screening data within 2 years before and after ischemic stroke, 14 991 (8.43%) patients had any fractures. After multivariable adjustment, the sustained smokers had a significantly increased risk of composite primary outcomes of any, vertebral, and hip fractures (adjusted HR [aHR], 1.222 [95% CI, 1.124-1.329]; aHR, 1.27 [95% CI, 1.13-1.428]; aHR, 1.502 [95% CI, 1.218-1.853], respectively). Additionally, the new smoker group exhibited a similar or higher risk of any fractures and hip fractures (aHR, 1.218 [95% CI, 1.062-1.397]; aHR, 1.772 [95% CI, 1.291-2.431], respectively). CONCLUSIONS Sustained smokers had a significantly increased risk of vertebral and hip fractures after an ischemic stroke. The risk of any hip fractures was higher in new smokers after ischemic stroke. As poststroke fractures are detrimental to the rehabilitation process of patients with stroke, physicians should actively advise patients to stop smoking.
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Affiliation(s)
- Jeen Hwa Lee
- Division of Cardiology, Department of Internal MedicineHallym University Dongtan Sacred Heart HospitalHwaseongKorea
| | - Kyung‐Do Han
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulKorea
| | - Dae Young Cheon
- Division of Cardiology, Department of Internal MedicineHallym University Dongtan Sacred Heart HospitalHwaseongKorea
| | - Minwoo Lee
- Department of NeurologyHallym University Sacred Heart HospitalAnyangKorea
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Armat MR, Mortazavi H, Akbari H, Baghizade S. The Effect of Resistance Exercises Using an Elastic Band on Balance and Fear of Falling in Older Adults With Diabetic Peripheral Neuropathy: A 16-week Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:733-741. [PMID: 38218307 DOI: 10.1016/j.apmr.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The current study aimed to investigate the effect of resistance training using an elastic band on balance and fear of falling in older adults with diabetic peripheral neuropathy. DESIGN The study was a clinical controlled trial with a repeated measure design. SETTING Iranian Diabetes Foundation of Mashhad. PARTICIPANTS The participants were 51 older adults with diabetic peripheral neuropathy and balance impairment (N=51). INTERVENTIONS Participants were randomly assigned to 2 groups; 1 group received balance training using an elastic band and the other group just received balance training. MAIN OUTCOME MEASURES The main outcomes were balance and fear of falling that were measured using Berg Balance Scale and a short version of the Fall Efficiency Scale-International, respectively. RESULTS The results showed that balance resistance training with and without using an elastic band significantly enhances balance and reduces fear of falling in diabetic older adults suffering from balance issues. However, balance resistance training using an elastic band had a significantly better effect on the balance and fear of falling in the participants. The best results were obtained after week 12 (48 sessions of balance training). CONCLUSION Balance rehabilitation programs may include an elastic band in balance resistance training for 12 weeks (3-4 sessions a week) for enhancing balance in diabetic older adults suffering from balance impairment.
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Affiliation(s)
- Mohammad Reza Armat
- Geriatric Care Research Center, Department of Medical-Surgical Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hamed Mortazavi
- Geriatric Care Research Center, Department of Medical-Surgical Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hadi Akbari
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| | - Saeedeh Baghizade
- School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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10
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Zhang Z, Chi J, Xu Z, Hadeed M, Knox H, Cui Q. Outcomes Following Hemiarthroplasty for Femoral Neck Fracture in Patients Who Have Hemiparesis. J Arthroplasty 2023; 38:2342-2346.e1. [PMID: 37271234 DOI: 10.1016/j.arth.2023.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Hemiparesis increases the risk of femoral neck fracture (FNF) in the elderly, which frequently necessitates hemiarthroplasty. There are limited reports on the outcomes of hemiarthroplasty in patients who have hemiparesis. The purpose of this study was to evaluate hemiparesis as a potential risk factor for medical and surgical complications following hemiarthroplasty. METHODS Hemiparetic patients who have concomitant FNF and underwent hemiarthroplasty with at least 2 years of follow-up were identified using a national insurance database. A 10:1 matched control cohort of patients who did not have hemiparesis was created for comparison. There were 1,340 patients who have and 12,988 patients who did not have hemiparesis undergoing hemiarthroplasty for FNF. Multivariate logistic regression analyses were used to evaluate rates of medical and surgical complications between the 2 cohorts. RESULTS Aside from increased rates of medical complications including cerebrovascular accident (P < .001), urinary tract infection (P = .020), sepsis (P = .002), and myocardial infarction (P < .001), patients who have hemiparesis also experienced higher rates of dislocation within 1 and 2 years (Odds Ratio (OR) 1.54, P = .009; OR 1.52, P = .010). Hemiparesis was not associated with higher risk of wound complications, periprosthetic joint infection, aseptic loosening, and periprosthetic fracture, but was associated with higher incidence of 90-day ED-visits (OR 1.16, P = .031) and 90-day readmission (OR 1.32, P < .001). CONCLUSION While patients who have hemiparesis do not have increased risk of implant-related complications other than dislocation, they are at increased risk of developing medical complications following hemiarthroplasty for FNF.
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Affiliation(s)
- Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia; Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhixiu Xu
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Michael Hadeed
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Haeli Knox
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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11
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Li J, Shi L, Sun J. The pathogenesis of post-stroke osteoporosis and the role oxidative stress plays in its development. Front Med (Lausanne) 2023; 10:1256978. [PMID: 37928460 PMCID: PMC10625412 DOI: 10.3389/fmed.2023.1256978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Cardiovascular disease and osteoporotic fractures (OF) are the main diseases affecting the health of middle-aged and elderly people. With the gradual increase of population aging in China and even the world, the incidence of the two and the prevalence of high-risk groups are also showing a continuous upward trend. The relationship between the two, especially the impact of cardiovascular disease on the risk and prognosis of OF, has attracted more and more attention. Therefore, it is of great significance to fully understand the pathogenesis of cardiovascular and cerebrovascular diseases and the resulting osteoporosis and to provide targeted interventions to prevent the occurrence of diseases and fractures. This article reviews the relationship between one of the Cardiovascular disease-stroke and related therapeutic drugs and the risk of OF, and the role of oxidative stress in its pathophysiological mechanism by reviewing relevant domestic and foreign literature in recent years, in order to gain a more comprehensive understanding of the association between stroke and OF, and then provide a basis and reference for screening high-risk groups of fractures and reducing the burden on the health system caused by the disease.
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Affiliation(s)
- JinYan Li
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Lin Shi
- Weifang People's Hospital, Weifang, China
| | - JianMin Sun
- School of Clinical Medicine, Weifang Medical University, Weifang, China
- Weifang People's Hospital, Weifang, China
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12
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Kwon JY, Park K, Song JM, Pyeon SY, Lee SH, Chung YS, Lee JM. Risk Factors and Prognosis of Stroke in Gynecologic Cancer Patients. Cancers (Basel) 2023; 15:4895. [PMID: 37835590 PMCID: PMC10572068 DOI: 10.3390/cancers15194895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
Increased life expectancy and cancer prevalence rates expose patients to a higher risk of developing other comorbidities such as stroke. This study aimed to evaluate the risk factors for and prognosis of stroke in patients with gynecological cancers. A single-center retrospective cohort study was conducted on patients with cervical, endometrial, and epithelial ovarian cancers. Patients were classified into three groups based on the period of stroke onset: at least one year before cancer diagnosis, within one year before cancer diagnosis to six months after the last treatment date, and six months after the last treatment date. Among the 644 patients, stroke occurred in 54 (8.4%). In univariate analysis, stroke was significantly associated with overall survival. In contrast, in multivariate analysis, stroke was significantly associated with age and hypertension, but not with overall survival. Age, pulmonary thromboembolism/deep vein thrombosis, histological grade, and tumor stage were significantly associated with overall survival. Therefore, it is important to establish an appropriate examination and treatment plan for patients with gynecologic cancers using a multidisciplinary approach that incorporates the patient's age, medical condition, and tumor characteristics rather than excessively considering the adverse effects of stroke on cancer prognosis.
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Affiliation(s)
- Ji Young Kwon
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea; (J.Y.K.); (K.P.); (J.M.S.); (S.Y.P.); (Y.S.C.)
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Kena Park
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea; (J.Y.K.); (K.P.); (J.M.S.); (S.Y.P.); (Y.S.C.)
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jeong Min Song
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea; (J.Y.K.); (K.P.); (J.M.S.); (S.Y.P.); (Y.S.C.)
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seung Yeon Pyeon
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea; (J.Y.K.); (K.P.); (J.M.S.); (S.Y.P.); (Y.S.C.)
| | - Seon Hwa Lee
- Medical Big Data Research Center, Research Institute of Clinical Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea;
| | - Young Shin Chung
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea; (J.Y.K.); (K.P.); (J.M.S.); (S.Y.P.); (Y.S.C.)
| | - Jong-Min Lee
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea; (J.Y.K.); (K.P.); (J.M.S.); (S.Y.P.); (Y.S.C.)
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13
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Cheon DY, Han KD, Lee JH, Yu KH, Choi BY, Lee M. Impact of changes in physical activity and incident fracture after acute ischemic stroke. Sci Rep 2023; 13:16715. [PMID: 37794067 PMCID: PMC10551008 DOI: 10.1038/s41598-023-44031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023] Open
Abstract
Stroke survivors are at an increased risk of falls and fractures. Physical activity is inversely associated with the fracture risk in the general population. However, the association between incident fracture risk and changes in habitual physical activity before and after an index stroke remains unclear. This study attempted to explore the association between incident fracture risk and changes in physical activity after stroke. Using the claims database of the National Health Insurance Program in Korea, participants with their first ischemic stroke between 2010 and 2016 were enrolled in the study. The participants were divided into four groups according to changes in physical activity habits evaluated using two consecutive self-reported questionnaires before and after stroke, if available: persistent non-exercisers, exercise dropouts, new exercisers, and persistent exercisers. The primary outcome was a composite of vertebral, hip, and other fractures. We performed multivariable Cox proportional hazard regression analysis and provided adjusted hazard ratios and 95% confidence intervals for each outcome. Among 202,234 participants included from 1,005,879 datasets, 16,621 (8.22%) experienced any type of fracture as the primary outcome. After multivariable adjustment, exercise dropouts (n = 37,106), new exercisers (n = 36,821), and persistent exercisers (n = 74,647) had a significantly reduced risk of any type of fracture (aHR 0.932, 95% CI 0.893-0.973; aHR 0.938, 95% CI 0.900-0.978; aHR 0.815, 95% CI 0.780-0.852, respectively) compared to the persistent non-exercisers (n = 53,660). Furthermore, regardless of pre-stroke exercise status, those who exercised ≥ 1000 metabolic equivalents of tasks post-stroke had a significantly reduced risk of fractures. Initiating or continuing moderate-to-vigorous regular physical activity after acute ischemic stroke was associated with a significantly lower risk of incident fractures, including hip, vertebral, and other types.
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Affiliation(s)
- Dae Young Cheon
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jeen Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bo Young Choi
- Department of Physical Education, Hallym University, Chuncheon, Korea.
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
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14
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Zhang N, Guo L, Yu Y, Chen S, Gao L, Hou X, Tian F, Wu S. New-onset stroke on the risk of hip fracture: the Kailuan cohort study in China. BMC Public Health 2023; 23:925. [PMID: 37217860 DOI: 10.1186/s12889-023-15787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
PURPOSE Stroke is a documented risk factor for hip fracture(HF). However, no data is currently available on this issue in mainland China, we therefore assessed the risk of hip fracture after new-onset stroke using a cohort study. METHODS This study included 165,670 participants without a history of stroke at baseline from the Kailuan study. All participants were followed biennially until December 31, 2021. During follow-up, a total of 8,496 new-onset stroke cases were identified. For each case subject, four control subjects was randomly selected, matched for age (± 1 years) and sex. The final analysis comprised 42,455 pair-matched cases and controls. A multivariate Cox proportional hazard regression model was used to estimate the effect of new-onset stroke on the risk of hip fracture. RESULTS During an average follow-up of 8.87 (3.94) years, a total of 231 hip fracture cases occurred, 78 cases in the stroke group and 153 cases in the control group, with incidence rates of 1.12 and 0.50 per 1000 person-years, respectively. The cumulative incidence of the stroke group was higher than that of the controls (P < 0.01). The adjusted hazard ratio (95% confidence interval) of hip fractures in the stroke group was 2.35 (1.77 to 3.12) (P < 0.001) to controls. After stratifying by gender, age, and body mass index, the higher risk was revealed in female (HR 3.10, 95 CI: 2.18 to 6.14, P < 0.001), age < 60 years old (HR 4.12, 95% CI: 2.18 to 7.78, P < 0.001), and non-obesity (BMI<28 kg/m2) (HR 1.74, 95% CI:1.31 to 2.31, P < 0.001) subgroup. CONCLUSIONS Stroke significantly increases the risk of hip fracture, strategy for protecting stroke patients from falls and hip fractures should be emphasized in poststroke long-term management, particularly the female, age < 60 years old, and non-obese patients.
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Affiliation(s)
- Nan Zhang
- Department of orthopedics, Kailuan General Hospital, Tangshan, Hebei, China
| | - Lu Guo
- the School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Yaohui Yu
- the School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Lishu Gao
- Department of Endocrinology, Tangshan People's Hospital, Tangshan, Hebei, China
| | - Xiaoli Hou
- the School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Faming Tian
- the School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China.
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China.
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15
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Kim J, Park EC. Associations of stroke with all-cause and cause-specific mortality: A population-based matched cohort study. J Public Health (Oxf) 2023; 45:66-74. [PMID: 35220438 DOI: 10.1093/pubmed/fdac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the specific associations between stroke and all-cause and cause-specific mortality among Korean adults. METHODS We used data extracted from the Korean National Health Insurance claims database from 2002 to 2013, including information on individuals with or without stroke aged 20 years and older. Patients with intracerebral hemorrhage, ischemic stroke or unspecified stroke were classified as stroke patients, while a reference population matched in terms of sex and age were also selected. The outcomes were all-cause mortality, natural causes of death (i.e. all natural causes, death by stroke and death by other diseases) and suicide. Survival analysis was performed using the Cox proportional hazards model. RESULTS Of the 73 150 eligible participants-including 14 630 stroke patients and 58 520 age- and sex-matched controls-11 121 (15.2%) died during the study period. Of them, 10 513 participants (94.5%) died of natural causes, including 1653 (14.5%) who died due to stroke and 8860 (79.7%) who died due to other diseases. Two hundred and fifty patients (2.2%) died by suicide. Stroke patients showed higher adjusted hazard ratios (HR) for all-cause (HR = 6.48, 95% CI, 3.87-10.86), all-natural-cause (HR = 2.68, 95% CI, 2.53-2.84), stroke (HR = 21.16, 95% CI, 17.49-25.61), other disease (HR = 1.69, 95% CI, 1.58-1.81) and suicide mortality (HR = 3.34, 95% CI, 2.24-4.98) than those without stroke. The effect size of stroke for suicide mortality was greater than that for other causes of mortality (except stroke mortality). CONCLUSIONS Stroke was associated with a higher risk of all-cause, natural cause and suicide mortality; stroke was more strongly associated with risk of suicide mortality than with any mortality for any other causes. From a policy standpoint, these results suggest the need for greater supportive care to prevent unnatural deaths among stroke patients.
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Affiliation(s)
- Juyeong Kim
- Department of Public Health, Sahmyook University, Seoul 01795, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 10711, Republic of Korea
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16
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Hjelholt TJ, Johnsen SP, Brynningsen PK, Andersen G, Pedersen AB. Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study. J Bone Miner Res 2023; 38:278-287. [PMID: 36533810 PMCID: PMC10107617 DOI: 10.1002/jbmr.4760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/21/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Considerable uncertainty prevails regarding risk factors for recurrent fracture among older patients with hip fracture. We aimed to investigate the relationship between prefracture stroke history, baseline mobility, and the risk of recurrent hip fracture. This cohort study was based on the Danish Multidisciplinary Hip Fracture Registry, 2011-2018 (n = 48,230). We estimated cumulative incidence (competing risk of death) of recurrent hip fracture and major osteoporotic fractures within 1 and 2 years comparing patients with/without prefracture stroke history. Analyses were performed overall and stratified on baseline mobility status (good mobility: Cumulated Ambulation Score ≥ 5 versus poor mobility: Cumulated Ambulation Score < 5). Using Cox regression, adjusted cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were obtained. The 1-year cumulative incidence was 4.6% (95% CI: 3.9-5.4) among patients with stroke history and 4.3% (95% CI: 4.1-4.5) among patients without stroke history. For patients with good mobility, the cumulative incidence of recurrent hip fracture was 5.8% (95% CI: 4.3-7.5) versus 3.7% (95% CI: 3.4-4.0) for patients with versus without stroke history. Corresponding numbers for patients with poor mobility were 4.4% (95% CI: 3.6-5.5) and 5.0% (95% CI: 4.7-5.3). Stroke history was associated with an adjusted HR of 1.55 (95% CI: 1.15-2.10) for recurrent fracture among patients with good mobility. In contrast, no association was observed among patients with poor mobility (adjusted HR 0.88 [95% CI: 0.70-1.10]). The associations were attenuated after 2 years of follow-up and for major osteoporotic fractures. In conclusion, stroke history was associated with slightly higher risk of recurrent fracture among patients with first-time hip fracture in the overall analysis, although the CI included a null result. The association was modified by baseline mobility: Patients with stroke history and good mobility had a markedly higher risk, whereas patients with stroke and poor mobility did not. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Thomas J Hjelholt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.,Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg Ø, Denmark
| | | | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
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17
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Staring WHA, van Duijnhoven HJR, Roelofs JMB, Zandvliet S, den Boer J, Lem FC, Geurts ACH, Weerdesteyn V. Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke. Front Sports Act Living 2022; 4:1008236. [DOI: 10.3389/fspor.2022.1008236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
IntroductionPeople with stroke often exhibit balance impairments, even in the chronic phase. Perturbation-based balance training (PBT) is a therapy that has yielded promising results in healthy elderly and several patient populations. Here, we present a threefold approach showing changes in people with chronic stroke after PBT on the level of recruitment of automatic postural responses (APR), step parameters and step quality. In addition, we provide insight into possible correlations across these outcomes and their changes after PBT.MethodsWe performed a complementary analysis of a recent PBT study. Participants received a 5-week PBT on the Radboud Fall simulator. During pre- and post-intervention assessments participants were exposed to platform translations in forward and backward directions. We performed electromyography of lower leg muscles to identify changes in APR recruitment. In addition, 3D kinematic data of stepping behavior was collected. We determined pre-post changes in muscle onset, magnitude and modulation of recruitment, step characteristics, and step quality. Subsequently, we determined whether improvements in step or muscle characteristics were correlated with improved step quality.ResultsWe observed a faster gastrocnemius muscle onset in the stance and stepping leg during backward stepping. During forward stepping we found a trend toward a faster tibialis anterior muscle onset in the stepping leg. We observed no changes in modulation or magnitude of muscle recruitment. Leg angles improved by 2.3° in forward stepping and 2.5° in backward stepping. The improvement in leg angle during forward stepping was accompanied by a −4.1°change in trunk angle, indicating a more upright position. Step length, duration and velocity improved in both directions. Changes in spatiotemporal characteristics were strongly correlated with improvements in leg angle, but no significant correlations were observed of muscle onset or recruitment with leg or trunk angle.ConclusionPBT leads to a multi-factorial improvement in onset of APR, spatiotemporal characteristics of stepping, and reactive step quality in people with chronic stroke. However, current changes in APR onset were not correlated with improvement in step quality. Therefore, we suggest that, in addition to spatiotemporal outcomes, other characteristics of muscle recruitment or behavioral substitution may induce step quality improvement after PBT.
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18
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Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment. Rehabil Nurs 2022; 47:202-209. [PMID: 36210496 DOI: 10.1097/rnj.0000000000000389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment. DESIGN/METHODS The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis. RESULTS Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors (p < .001). CONCLUSION Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment. CLINICAL RELEVANCE Balance training combined with containing mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.
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Abdollahi M, Whitton N, Zand R, Dombovy M, Parnianpour M, Khalaf K, Rashedi E. A Systematic Review of Fall Risk Factors in Stroke Survivors: Towards Improved Assessment Platforms and Protocols. Front Bioeng Biotechnol 2022; 10:910698. [PMID: 36003532 PMCID: PMC9394703 DOI: 10.3389/fbioe.2022.910698] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background/Purpose: To prevent falling, a common incident with debilitating health consequences among stroke survivors, it is important to identify significant fall risk factors (FRFs) towards developing and implementing predictive and preventive strategies and guidelines. This review provides a systematic approach for identifying the relevant FRFs and shedding light on future directions of research. Methods: A systematic search was conducted in 5 popular research databases. Studies investigating the FRFs in the stroke community were evaluated to identify the commonality and trend of FRFs in the relevant literature. Results: twenty-seven relevant articles were reviewed and analyzed spanning the years 1995-2020. The results confirmed that the most common FRFs were age (21/27, i.e., considered in 21 out of 27 studies), gender (21/27), motion-related measures (19/27), motor function/impairment (17/27), balance-related measures (16/27), and cognitive impairment (11/27). Among these factors, motion-related measures had the highest rate of significance (i.e., 84% or 16/19). Due to the high commonality of balance/motion-related measures, we further analyzed these factors. We identified a trend reflecting that subjective tools are increasingly being replaced by simple objective measures (e.g., 10-m walk), and most recently by quantitative measures based on detailed motion analysis. Conclusion: There remains a gap for a standardized systematic approach for selecting relevant FRFs in stroke fall risk literature. This study provides an evidence-based methodology to identify the relevant risk factors, as well as their commonalities and trends. Three significant areas for future research on post stroke fall risk assessment have been identified: 1) further exploration the efficacy of quantitative detailed motion analysis; 2) implementation of inertial measurement units as a cost-effective and accessible tool in clinics and beyond; and 3) investigation of the capability of cognitive-motor dual-task paradigms and their association with FRFs.
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Affiliation(s)
- Masoud Abdollahi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
| | - Natalie Whitton
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
| | - Ramin Zand
- Department of Neurology, Geisinger Neuroscience Institute, Danville, PA, United States
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY, United States
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, and Health Engineering Innovation Center, Abu Dhabi, United Arab Emirates
| | - Ehsan Rashedi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
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20
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Dai D, Tu S, Gao Z. Development and validation of a machine learning-based model for postoperative ischemic stroke in middle-aged and elderly patients with hip or knee arthroplasty. Medicine (Baltimore) 2022; 101:e29542. [PMID: 35905266 PMCID: PMC9333551 DOI: 10.1097/md.0000000000029542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Postoperative ischemic stroke in middle-aged and elderly patients with hip or knee arthroplasty remains a major postoperative challenge, little is known about its incidence and risk factors. This study sought to create a nomogram for precise prediction of ischemic stroke after hip or knee arthroplasty. Discharge data of all middle-aged and elderly patients undergoing primary hip or knee arthroplasty from May 2013 to October 2020 were queried. These patients were then followed up over time to determine their risk of ischemic stroke. Clinical parameters and blood biochemical features were analyzed by the use of univariable and multivariable generalized logistic regression analysis. A nomogram to predict the risk of ischemic stroke was constructed and validated with bootstrap resampling. Eight hundred twenty-eight patients were included for analysis; Fifty-one were diagnosed with ischemic stroke. After final regression analysis, age, the neutrophil-to-lymphocyte ratio (NLR), a standard deviation of red blood cell distribution width, American Society of Anesthesiologists, low-density lipoprotein, and diabetes were identified and were entered into the nomogram. The nomogram showed an area under the receiver operating characteristic curve of 0. 841 (95% confidence interval [CI], 0.809-0.871). The calibration curves for the probability of ischemic stroke showed optimal agreement between the probability as predicted by the nomogram and the actual probability (Hosmer-Lemeshow test: P = .818). We developed a practical nomogram that can predict the risk of ischemic stroke for middle-aged and elderly patients with hip or knee arthroplasty. This model has the potential to assist clinicians in making treatment recommendations.
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Affiliation(s)
- Danfeng Dai
- Department of Orthopedics, The First People’s Hospital of Linping District, Hangzhou City, Zhejiang Province, China
| | - Sijia Tu
- Department of Orthopedics, The First People’s Hospital of Linping District, Hangzhou City, Zhejiang Province, China
| | - Zhichao Gao
- Department of Orthopedics, The First People’s Hospital of Linping District, Hangzhou City, Zhejiang Province, China
- *Correspondence: Gao Zhichao, Department of Orthopedics, the First People’s Hospital of Linping District, Hangzhou City 311100, Zhejiang Province, China (e-mail: )
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21
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Changcheng C, Li YR, Chen CT. Assistive Mobility Control of a Robotic Hip-Knee Exoskeleton for Gait Training. SENSORS (BASEL, SWITZERLAND) 2022; 22:5045. [PMID: 35808539 PMCID: PMC9269733 DOI: 10.3390/s22135045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
In this paper, we present an assistive mobility control for a robotic hip-knee exoskeleton intended for gait training. The robotic hip-knee exoskeleton is designed with an active flexion/extension and a passive abduction/adduction at each hip joint and an active flexion/extension at each knee joint to comply with the movement of lower limbs. While facilitating walking with the robotic exoskeleton, model-free linear extended state observer (LESO)-based controllers are proposed for gait control, in which the LESO is used to deal with each user's different lower limb parameters and unknown exerted torques. Walking and ascending experiments were conducted to evaluate the performance of the proposed methods, and the results are shown with respect to walking parameters. Moreover, a preliminary study for an extended application to the recovery of normal gaits that relieves the freezing of gait (FOG) in Parkinson's disease (PD) patients is also investigated in the paper.
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Affiliation(s)
| | | | - Chun-Ta Chen
- Correspondence: ; Tel.: +886-2-7749-3528; Fax: +886-2-2358-3074
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22
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Chronological Evaluation of Gait Ability and Posture Balance after Adult Spinal Deformity Surgery. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adult spinal deformity (ASD) is highly prevalent in persons older than 65 years, affecting more than 30% of the total population. There are many important reports that describe excellent postoperative results for ASD surgery. However, there is no report that describes a chronological evaluation of gait ability and spinal balance after ASD surgery. The present prospective study aimed to determine the recovery time of gait and spinal balance ability after adult spinal deformity (ASD) surgery. Patients with ASD (n = 25: mean age, 73.0 years) who underwent corrective surgery and preoperative and postoperative gait and spinal balance ability evaluation. Spinal radiographs and gait analysis data (static balance; single-leg standing, dynamic balance; time-up and go test, gait ability; 10 m walk velocity) were acquired preoperatively, 1 month, 6 months, and 12 months after surgery. The radiographic parameters of the spine and pelvis (lumbar lordosis; LL, pelvic tilt; PT, sagittal vertical axis; SVA, pelvic incidence; PI) were measured. The mean postoperative SVA, LL, PT, and PI-LL became 30.0 mm, 50.1 degrees, 14.1 degrees, and 0.35 degrees, respectively. Preoperatively, all spinal balance and gait ability were worse than the normal threshold (one-leg standing; 14.2 s vs. 15.0 s, time-up and go test; 13.9 s vs. 13.5 s, 10-m walk speed; 0.91 m/s vs. 1.00 m/s). At 12 months after surgery, all spinal balance and gait ability became normal or improved (single-leg standing; 14.7 s, time-up and go test; 11.0 s, 10-m walk speed; 1.09 m/s). The ODI at one-year follow-up improved from 46.8 ± 12.6% to 27.8 ± 18.1%. In conclusion, gait and spinal balance analysis revealed that ASD patients could not recover gait and spinal balance ability one month after surgery. At 12 months after surgery, gait ability and dynamic spinal balance became better than preoperative levels. However, the static spinal balance was at the same level as that of preoperative status.
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23
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Hjelholt TJ, Johnsen SP, Brynningsen PK, Pedersen AB. The Interaction Effect Between Previous Stroke and Hip Fracture on Postoperative Mortality: A Nationwide Cohort Study. Clin Epidemiol 2022; 14:543-553. [PMID: 35509521 PMCID: PMC9058007 DOI: 10.2147/clep.s361507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Thomas J Hjelholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, DK-8200, Denmark
- Correspondence: Thomas J Hjelholt, Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus N, DK-8200, Denmark, Tel +45 871 68219, Email
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg Ø, DK-9220, Denmark
| | - Peter K Brynningsen
- Department of Geriatrics, Aarhus University Hospital, Aarhus N, DK-8200, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, DK-8200, Denmark
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24
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Bone mineral density and risk of cardiovascular disease in men and women: the HUNT study. Eur J Epidemiol 2021; 36:1169-1177. [PMID: 34515906 PMCID: PMC8629874 DOI: 10.1007/s10654-021-00803-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/30/2021] [Indexed: 11/17/2022]
Abstract
The association between bone mineral density (BMD) and cardiovascular disease (CVD) is not fully understood. We evaluated BMD as a risk factor for cardiovascular disease and specifically atrial fibrillation (AF), acute myocardial infarction (AMI), ischemic (IS) and hemorrhagic stroke (HS) and heart failure (HF) in men and women. This prospective population cohort utilized data on 22 857 adults from the second and third surveys of the HUNT Study in Norway free from CVD at baseline. BMD was measured using single and dual-energy X-ray absorptiometry in the non-dominant distal forearm and T-score was calculated. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from adjusted cox proportional hazards models. The analyses were sex-stratified, and models were adjusted for age, age-squared, BMI, physical activity, smoking status, alcohol use, and education level. Additionally, in women, we adjusted for estrogen use and postmenopause. During a mean follow-up of 13.6 ± 5.7 years, 2 928 individuals (12.8%) developed fatal or non-fatal CVD, 1 020 AF (4.5%), 1 172 AMI (5.1%), 1 389 IS (6.1%), 264 HS (1.1%), and 464 HF (2.0%). For every 1 unit decrease in BMD T-score the HR for any CVD was 1.01 (95% CI 0.98 to 1.04) in women and 0.99 (95% CI 0.94 to 1.03) in men. Point estimates for the four cardiovascular outcomes ranged from slightly protective (HR 0.95 for AF in men) to slightly deleterious (HR 1.12 for HS in men). We found no evidence of association of lower distal forearm BMD with CVD, AF, AMI, IS, HS, and HF.
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25
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Xie L, Yi SX, Peng QF, Liu P, Jiang H. Retrospective study of effect of whole-body vibration training on balance and walking function in stroke patients. World J Clin Cases 2021; 9:6268-6277. [PMID: 34434993 PMCID: PMC8362547 DOI: 10.12998/wjcc.v9.i22.6268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dysfunction in stroke patients has been a problem that we committed to solve and explore. Physical therapy has some effect to regain strength, balance, and coordination. However, it is not a complete cure, so we are trying to find more effective treatments.
AIM To observe the effect of whole-body vibration training (WVT) on the recovery of balance and walking function in stroke patients, which could provide us some useful evidence for planning rehabilitation.
METHODS The clinical data of 130 stroke participants who underwent conventional rehabilitation treatment in our hospital from January 2019 to August 2020 were retrospectively analyzed. The participants were divided into whole-body vibration training (WVT) group and non-WVT (NWVT) group according to whether they were given WVT. In the WVT group, routine rehabilitation therapy was combined with WVT by the Galileo Med L Plus vibration trainer at a frequency of 20 Hz and a vibration amplitude of 0+ACY-plusmn+ADs-5.2 mm, and in the NWVT group, routine rehabilitation therapy only was provided. The treatment course of the two groups was 4 wk. Before and after treatment, the Berg balance scale (BBS), 3 m timed up-and-go test (TUGT), the maximum walking speed test (MWS), and upper limb functional reaching (FR) test were performed.
RESULTS After 4 wk training, in both groups, the BBS score and the FR distance respectively increased to a certain amount (WVT = 46.08 ± 3.41 vs NWVT = 40.22 ± 3.75; WVT = 20.48 ± 2.23 vs NWVT = 16.60 ± 2.82), with P < 0.05. Furthermore, in the WVT group, both BBS score and FR distance (BBS: 18.32 ± 2.18; FR: 10.00 ± 0.92) increased more than that in the NWVT group (BBS: 13.29 ± 1.66; FR: 6.16 ± 0.95), with P < 0.05. Meanwhile, in both groups, the TUGT and the MWS were improved after training (WVT = 32.64 ± 3.81 vs NWVT = 39.56 ± 3.68; WVT = 12.73 ± 2.26 vs NWVT = 15.04 ± 2.27, respectively), with P < 0.05. The change in the WVT group (TUGT: 17.49 ± 1.88; MWS: 6.79 ± 0.81) was greater than that in the NWVT group (TUGT: 10.76 ± 1.42; MWS: 4.84 ± 0.58), with P < 0.05.
CONCLUSION The WVT could effectively improve the balance and walking function in stroke patients, which may be good for improving their quality of life.
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Affiliation(s)
- Lei Xie
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Shi-Xiong Yi
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Qi-Feng Peng
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Pei Liu
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Heng Jiang
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
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Jones JS, Kimata R, Almeida OP, Hankey GJ. Risk of Fractures in Stroke Patients Treated With a Selective Serotonin Reuptake Inhibitor: A Systematic Review and Meta-Analysis. Stroke 2021; 52:2802-2808. [PMID: 34167325 DOI: 10.1161/strokeaha.120.032973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Joshua S Jones
- Medical School, Faculty of Health and Medical Sciences (J.S.J.), The University of Western Australia, Perth, Australia
| | - Rina Kimata
- School of Pharmacy, Curtin University, Perth, Western Australia, Australia (R.K.)
| | - Osvaldo P Almeida
- Medical School (O.P.A.), The University of Western Australia, Perth, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences (G.J.H.), The University of Western Australia, Perth, Australia
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The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126615. [PMID: 34205457 PMCID: PMC8296367 DOI: 10.3390/ijerph18126615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
Background: Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) (n = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) (n = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients (n = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention).
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28
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Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MSF, Mackenzie L. Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation. Front Public Health 2021; 9:611793. [PMID: 33748063 PMCID: PMC7965966 DOI: 10.3389/fpubh.2021.611793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
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Affiliation(s)
- Husna Ahmad Ainuddin
- Center of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura S. F. Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
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29
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Hu H, Wang D, Li L, Yin H, He G, Zhang Y. Role of microRNA-335 carried by bone marrow mesenchymal stem cells-derived extracellular vesicles in bone fracture recovery. Cell Death Dis 2021; 12:156. [PMID: 33542183 PMCID: PMC7862274 DOI: 10.1038/s41419-021-03430-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 01/30/2023]
Abstract
Mesenchymal stem cells (MSCs) have the potential to reduce healing time and treat nonunion in fracture patients. In this study, bone marrow MSCs-derived extracellular vesicles (B-EVs) were firstly extracted and identified. CD9-/- and normal mice were enrolled for the establishment of fracture models and then injected with B-EVs. Osteoblast differentiation and fracture recovery were estimated. The levels of osteoblast-related genes were detected, and differentially expressed microRNAs (miRs) in B-EVs-treated normal fracture mice were screened and verified. The downstream mechanisms of miR were predicted and assessed. The loss-of functions of miR-335 in B-EV and gain-of-functions of VapB were performed in animal and cell experiments to evaluate their roles in bone fracture. Collectively, B-EVs promoted bone fracture recovery and osteoblast differentiation by releasing miR-335. miR-335 downregulation in B-EVs impaired B-EV functions in fracture recovery and osteoblast differentiation. miR-335 could target VapB, and VapB overexpression reversed the effects of B-EVs on osteoblast differentiation. B-EV treatment activated the Wnt/β-catenin pathway in fracture mice and osteoblasts-like cells. Taken together, the study suggested that B-EVs carry miR-335 to promote bone fracture recovery via VapB and the Wnt/β-catenin pathway. This study may offer insights into bone fracture treatment.
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Affiliation(s)
- Haifeng Hu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Dong Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lihong Li
- Department of Clinical Laboratory, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Haiyang Yin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Guoyu He
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yonghong Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
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Interventions for preventing falls in people post-stroke: A meta-analysis of randomized controlled trials. Gait Posture 2021; 84:377-388. [PMID: 33476831 DOI: 10.1016/j.gaitpost.2020.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/22/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are a serious challenge facing individuals post-stroke. In the past decades, various fall prevention interventions have been developed. It remains unknown if any of these interventions are effective in reducing falls in this population. Such a knowledge gap could impede the effort of preventing falls in people post-stroke. RESEARCH QUESTIONS 1) Are there effective interventions to prevent falls among people in the post-acute and chronic stages of stroke? and 2) How do fall prevention interventions change three key fall risk factors in this population: balance, mobility, and lower limb strength? METHODS Eleven databases were searched for randomized controlled trials which included falls in people post-stroke as an outcome measure. Information on the participants, training protocol, and outcome measures were collected for each study. The primary outcome is the number of fallers and the explanatory variables included mean difference and standard deviation for fall risk factors. Studies were quality appraised using the Physiotherapy Evidence Database scale and the funnel plot. RESULTS Thirteen studies enrolling 1352 participants were identified. Effect size quantified by the odds ratio (OR) for falls and standardized mean difference (SMD) for fall risk factors were calculated. Overall no intervention appears to be significantly more effective in preventing falls than placebo training (OR = 0.88 with a range of [0.23 3.66]; 95 % confidence interval = [0.64 1.21], p = 0.44). All interventions showed little effect in improving the fall risk factors (SMD = -0.01 to 0.06 and p-value = 0.38-0.86), except one (the combined treadmill and overground walking) which significantly improved mobility. SIGNIFICANCE Currently no program is effective in reducing falls in people post-stroke. Future studies should measure falls as a primary outcome based on a consistent definition of falls and reliable approaches to collect falls data.
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31
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Effect of Cognitive Function on Balance and Posture Control after Stroke. Neural Plast 2021; 2021:6636999. [PMID: 33574837 PMCID: PMC7861954 DOI: 10.1155/2021/6636999] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/01/2021] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
Hemiplegic gait is the most common sequela of stroke. Patients with hemiplegic gait are at a risk of falling because of poor balance. The theory of cognitive-motor networks paved the way for a new field of research. However, the mechanism of the relationship of cognition with gait or posture control networks is unclear because of the dynamic characteristics of walking and changing postures. To explore differences in the balance function and fall risk between patients with and without cognitive impairment after stroke, we utilized the Berg balance scale, Timed “Up and Go” test, and 10 m walking test. Patients were divided into two groups: the observation group (16 patients, female 6 and male 10), comprising patients with cognitive impairment after stroke, and the control group (16 patients, female 7 and male 9), comprising patients without cognitive impairment after stroke. We found that patients with cognitive impairment had worse balance function and a higher risk of falls. They needed a longer time to turn around or sit down. Our findings indicated that posture control in turning around and sitting down required more cognitive resources in daily life.
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32
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Effective Combined Assessments of Weight Bearing Ratio and Four Square Step Test in Predicting Falls in Discharged Stroke Patients. J Stroke Cerebrovasc Dis 2021; 30:105582. [PMID: 33387890 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We aimed to determine whether combined assessments of single movement tasks could predict falls in community dwelling people with stroke and it was more precision than the berg balance Scale consists of 14 movements. METHODS This prospective cohort study performed at five rehabilitation hospitals in Japan. Participants comprised 78 patients with ambulatory stroke. The single movement task assessments performed at discharge and included the weight bearing ratio, the 30-second chair standing test, the one-leg standing time, the four square step test and the timed up and go test. The results were used to derive a logistic regression equation to predict falls within 6 months from discharge. Area under the curve was used to compare prediction accuracy between the logistic regression equation and the berg balance Scale. RESULTS Overall, fifteen participants experienced a fall. The weight bearing ratio of the unaffected side and four square step test were observed to be significant assessments identified from the logistic regression analysis. The Area under the curve of the combined tests of weight bearing ratio of the unaffected side and four square step test was 0.78, which was higher than the than that of the berg balance Scale (0.70). CONCLUSIONS This study found that a combined assessment using single movement tasks including the weight bearing ratio of the unaffected side and four square step test predicted falls in people with stroke post-discharge more precisely than the berg balance Scale.
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Yuan J, Zhu G, Zhao Y, Huang J. Effect of hip fracture on prognosis of acute cerebral infarction. Clinics (Sao Paulo) 2021; 76:e3059. [PMID: 34909940 PMCID: PMC8634741 DOI: 10.6061/clinics/2021/e3059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Hip fractures are a worldwide public health problem. The incidence of hip fracture is high among the elderly, and it is an important cause of death and disability in this population. This observational study aimed to investigate the effect of acute hip fracture on the recovery of neurological function and the prognosis of patients with acute cerebral infarction, as well as whether surgical treatment of combined acute fracture can improve the prognosis of patients. METHODS Thirty patients with acute cerebral infarction combined with acute hip fracture, who were hospitalized in two hospitals between January 1, 2013 and December 31, 2019, were included. The patients did not undergo surgical treatment. The control group included patients with common acute cerebral infarction without hip fracture admitted in the same period. The neurological function recovery, hospitalization period, half a year recovery rate, incidence of complications, and one-year mortality rate between the two groups were compared. Eleven patients with acute cerebral infarction combined with hip fracture, who underwent surgical treatment, were selected and compared with those in the non-surgery group. RESULTS Compared with patients with common acute cerebral infarction, the National Institutes of Health Stroke Scale score of those with acute cerebral infarction combined with hip fracture was higher (7.2±5.4 vs. 5.6%±4.3, p=0.034), the hospitalization period was prolonged (16.1±8.9% vs. 12.2±5.3, p=0.041), and the half a year recovery rate was lower (26.7% vs. 53.3%, p=0.016). Additionally, the incidence of pulmonary infection and lower extremity deep vein thrombosis was increased (30% vs. 11.7%, p=0.03; 6.7% vs. 0, p=0.043). The one-year mortality rate of patients with hip fracture was higher than that of patients with common cerebral infarction (23.3% vs. 6.7%, p=0.027). Compared with the non-surgical group, the good recovery rate after half a year of surgical treatment of the group with cerebral infarction and acute hip fracture had an increasing trend, while the hospitalization cycle, incidence of complications, and one-year mortality rate were all decreased, although this was not statistically significant. CONCLUSIONS Acute cerebral infarction combined with hip fracture leads to worse neurological recovery, prolonged hospitalization period, increased complications, decreased patient prognosis, and increased one-year mortality. Surgical treatment improves the prognosis of patients with acute cerebral infarction. These findings may provide insights into the management of acute cerebral infarction.
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Affiliation(s)
- Jiawen Yuan
- Department of Neurology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Gang Zhu
- Department of Neurology, Shanghai Putuo District Central Hospital, Shanghai 200062, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
- Corresponding authors. E-mails: /
| | - Jiankang Huang
- Department of Neurology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeastern University, Nanjing 211200, China
- Corresponding authors. E-mails: /
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Labenz C, Wörns MA, Adarkwah CC, Galle PR, Schattenberg JM, Kostev K. Proton pump inhibitors increase risk of bone fractures in men with cirrhosis: a population-based study. Aliment Pharmacol Ther 2020; 52:1042-1050. [PMID: 32729625 DOI: 10.1111/apt.16008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bone fractures are a frequent complication in patients with cirrhosis. Proton pump inhibitors (PPIs) are among the most frequently prescribed medications and may impair bone quality and quantity. AIMS To investigate whether PPI use predisposes patients with cirrhosis to bone fractures. METHODS We performed a population-based case-control study exploring a sample of patients with cirrhosis derived from the Disease Analyzer database. In total, 1795 cirrhotic patients with fractures were compared to 10 235 cirrhotic patients without fractures. PPI use overall and the cumulative PPI dose 5 years prior to the index date were analysed. To estimate the association between PPI use and fractures, logistic regression analyses were performed taking cofounding factors into consideration. RESULTS PPI use was more frequently seen in cirrhotic patients with fractures compared to controls (67.0% vs 53.4%, P < 0.001). In regression analyses, PPI use was associated with bone fractures after adjusting for important confounders (OR 1.34, 95% CI 1.20-1.51, P < 0.001). Importantly, the strongest effect of PPIs on bone fractures was seen in men and patients below 70 years of age. On further sensitivity analyses, we observed a dose-dependent effect for all PPIs with the strongest effect in cirrhotic patients receiving a dose of >50 000 mg during the 5 years prior to index date (OR 1.63, 95% CI 1.32-2.03). CONCLUSIONS PPI use was associated with bone fractures in a dose-dependent fashion in patients with cirrhosis. PPI use in these patients should be based on a careful risk-benefit assessment.
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Affiliation(s)
- Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Charles C Adarkwah
- Department of Health Services Research and General Practice, Faculty of Life Sciences, University of Siegen, Siegen, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Metabolic Liver Research Program, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Crosstalk of Brain and Bone-Clinical Observations and Their Molecular Bases. Int J Mol Sci 2020; 21:ijms21144946. [PMID: 32668736 PMCID: PMC7404044 DOI: 10.3390/ijms21144946] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
As brain and bone disorders represent major health issues worldwide, substantial clinical investigations demonstrated a bidirectional crosstalk on several levels, mechanistically linking both apparently unrelated organs. While multiple stress, mood and neurodegenerative brain disorders are associated with osteoporosis, rare genetic skeletal diseases display impaired brain development and function. Along with brain and bone pathologies, particularly trauma events highlight the strong interaction of both organs. This review summarizes clinical and experimental observations reported for the crosstalk of brain and bone, followed by a detailed overview of their molecular bases. While brain-derived molecules affecting bone include central regulators, transmitters of the sympathetic, parasympathetic and sensory nervous system, bone-derived mediators altering brain function are released from bone cells and the bone marrow. Although the main pathways of the brain-bone crosstalk remain ‘efferent’, signaling from brain to bone, this review emphasizes the emergence of bone as a crucial ‘afferent’ regulator of cerebral development, function and pathophysiology. Therefore, unraveling the physiological and pathological bases of brain-bone interactions revealed promising pharmacologic targets and novel treatment strategies promoting concurrent brain and bone recovery.
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Northuis CA, Crandall CJ, Margolis KL, Diem SJ, Ensrud KE, Lakshminarayan K. Association between post-stroke disability and 5-year hip-fracture risk: The Women's Health Initiative. J Stroke Cerebrovasc Dis 2020; 29:104976. [PMID: 32689623 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/11/2020] [Accepted: 05/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fractures are a significant post-stroke complication. We examined predictors of hip fracture risk after stroke using data from the Women's Health Initiative (WHI). In particular, we examined the association between post-stroke disability levels and hip fracture risk. METHODS The WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. Trained physicians adjudicated stroke events and hip fractures. Our study included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Scale of good recovery, moderately disabled, or severely disabled and survived more than 7 days post-stroke. Hip fracture-free status was compared across disability levels. Secondary analysis examined hip fracture risk while accounting for competing risk of death. RESULTS Average age at time of stroke was 74.6±7.2 years; 84.3% were white. There were 124 hip fractures among 4,640 stroke survivors over a mean follow-up time of 3.1±1.8 years. Mortality rate was 23.3%. Severe disability at discharge (Hazard Ratio (HR): 2.1 (95% Confidence Interval (CI): 1.4-3.2), but not moderate disability (HR: 1.1 (95%CI: 0.7-1.7), was significantly associated with an increased risk of hip fracture compared to good recovery status. This association was attenuated after accounting for mortality. White race, increasing age and higher Fracture Risk Assessment Tool (FRAX)-predicted hip fracture risk (without bone density information) were associated with an increased hip fracture risk. After accounting for mortality, higher FRAX risk and white race remained significant. CONCLUSION Severe disability after stroke and a higher FRAX risk score were associated with risk of subsequent hip fracture. After accounting for mortality, only the FRAX risk score remained significant. The FRAX risk score appears to identify stroke survivors at high risk of fractures. Our results suggest that stroke units can consider the incorporation of osteoporosis screening into care pathways.
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Affiliation(s)
- Carin A Northuis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Carolyn J Crandall
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA.
| | | | - Susan J Diem
- Division of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN.
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN.
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
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Yang C, Ghaedi B, Campbell TM, Rutkowski N, Finestone H. Predicting Falls Using the Stroke Assessment of Fall Risk Tool. PM R 2020; 13:274-281. [PMID: 32515060 DOI: 10.1002/pmrj.12434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Falls in the inpatient stroke population are common, resulting in increased morbidity and slow rehabilitation progress. Falls may result from stroke-specific neurologic deficits; however, assessment of these deficits is lacking in many fall screening tools. OBJECTIVE To compare the ability to predict falls of the Stroke Assessment of Fall Risk (SAFR) tool, which includes items related to stroke-specific neurologic deficits, and the commonly used Morse Fall Scale, which does not include these items. DESIGN Prospective cohort study. SETTING Inpatient tertiary stroke rehabilitation unit. PARTICIPANTS Patients (N = 220) with acute stroke. MAIN OUTCOME MEASURES Falls were captured by the medical records from January 2017 to September 2018. Logistic regression analysis evaluated both screening tools for predicting falls by calculating sensitivity, specificity, area under the receiver operating characteristic (AUC-ROC) curve, and odds ratio (OR). We compared SAFR and Morse mean scores between fallers and non-fallers using t-tests. RESULTS Forty-eight (21.8%) patients experienced ≥1 fall. SAFR, but not Morse, scores showed a statistically significant difference between fallers and non-fallers (P = .001 vs P = .24, respectively). Higher SAFR score was associated with higher odds of falls (OR 1.36, 95% CI [1.12, 1.64]), whereas Morse was not (OR 1.04, 95% CI [0.97, 1.12]). SAFR showed a statistically significant difference in hemi-neglect between fallers and non-fallers (P = .03). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for Morse, respectively. SAFR positive predictive value and negative predictive value were 36.5% and 84.1%, respectively, similar to Morse (28.6% and 81.8%). The AUC-ROC was 0.65 for SAFR and 0.56 for Morse. CONCLUSIONS SAFR was significantly associated with fall risk and had better discrimination between fallers and non-fallers than Morse. The neurologic-specific hemi-neglect component of SAFR, a component not present on the Morse, was a fall risk factor. Further research evaluating the predictive value of fall scales that include neurologic deficits is needed.
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Affiliation(s)
- Christine Yang
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, ON, Canada
| | - Bahareh Ghaedi
- Department of Physical Medicine and Rehabilitation, Bruyère Research Institute, Ottawa, ON, Canada
| | - T Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, ON, Canada
| | | | - Hillel Finestone
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, ON, Canada
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Başgöz B, İnce S, Safer U, Naharcı Mİ, Taşçı İ. Low bone density and osteoporosis among older adults with Alzheimer's disease, vascular dementia, and mixed dementia: A Cross-sectional Study With Prospective Enrollment. Turk J Phys Med Rehabil 2020; 66:193-200. [PMID: 32760897 PMCID: PMC7401688 DOI: 10.5606/tftrd.2020.3803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/27/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES This study aims to examine bone mineral density (BMD) and osteoporosis in older adults with dementia compared to those with a normal cognitive status and to evaluate the type, severity, and duration of dementia. PATIENTS AND METHODS Between May 2013 and May 2017, a total of 363 participants aged ≥65 years (136 males, 227 females; mean age 78.4±5.4 years; range 66 to 99 years) with and without Alzheimer's disease (AD), vascular dementia (VaD), or mixed dementia (AD-VaD) were included in this single-center, prospective, cross-sectional study. The dementia group included 93 patients with dementia and the control group included 270 age- and sex-matched healthy individuals. We used dual-energy X-ray absorptiometry (DXA) to measure BMD of the lumbar spine, total hip, and femoral neck. RESULTS Controlled for age and sex, demented and non-demented participants had a similar BMD (g/cm2) at lumbar spine [F (1, 358):0.83, p=363], but lower BMD values of total hip [F (1, 359):10.26, p=0.001] and femoral neck [F (1, 359):15.21, p<0.001] in the patients with dementia. Adjusted percentage of osteoporosis and low bone mass based on total hip and femoral neck T-scores were also significantly higher in the patient group. The mean BMD values, frequency of osteoporosis, and low bone mass did not significantly differ according to the subtype of dementia, sex, and disease duration or severity. CONCLUSION Our study results show that demented elders have a lower BMD and higher frequency of osteoporosis at the hip, but not at the lumbar spine, irrespective of sex and type of dementia. Based on these results, we can speculate that not only AD, but also VaD and AD-VaD may be associated with bone loss at the hip.
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Affiliation(s)
- Bilgin Başgöz
- Department of Internal Medicine, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
| | - Semra İnce
- Department of Nuclear Medicine, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
| | - Umut Safer
- Department of Geriatrics, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Mehmet İlkin Naharcı
- Department of Geriatrics, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
| | - İlker Taşçı
- Department of Geriatrics, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
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Mizrachi N, Treger I, Melzer I. Effects of mechanical perturbation gait training on gait and balance function in patients with stroke: A pre-post research study. J Clin Neurosci 2020; 78:301-306. [PMID: 32389546 DOI: 10.1016/j.jocn.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 11/16/2022]
Abstract
Patients with stroke (PwS) demonstrate impaired gait and balance, and asymmetric gait, placing them at high risk of falls. We aimed to investigate the effects of a single training session that included mechanical external perturbation which resists forward movement of the paretic leg during its swing phase of walking on gait and balance in PwS. In a pre-post pilot study, gait asymmetry and balance function were assessed in 22 first-event chronic PwS (i.e., unilateral hemiparesis). PwS underwent tests during baseline and one week later, after participating in a single training session that resisted forward stepping during the swing phase of walking with a device secured around the patient's waist and connected diagonally to the patient's foot by a tension cord. Ground reaction forces and center of pressure were sampled during treadmill gait to assess step length asymmetry. Performance-oriented mobility assessment (POMA), a two-minute walk test (2MWT), and the voluntary step execution test were also measured. We found no significant improvement in step length asymmetry. However, POMA scores, as well as voluntary step execution tests improved with a moderate effect size. It seems that applying diagonal resistance force to the swinging leg resulted in insufficient horizontal force. However, the improvement in the preparation phase, i.e., better weight-bearing abilities during the voluntary stepping, may be due to the compression force applied to the lower limb joints thus providing proprioceptive training. This suggests that proprioceptive training may improve gait performance in stroke patients in a very short training period.
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Affiliation(s)
- Nama Mizrachi
- Physical Therapy Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iuli Treger
- Rehabilitation Department, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itshak Melzer
- Physical Therapy Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Campo M, Toglia J, Batistick-Aufox H, O'Dell MW. Standardized Outcome Measures in Stroke Rehabilitation and Falls After Discharge: A Cohort Study. PM R 2020; 13:265-273. [PMID: 32358887 DOI: 10.1002/pmrj.12396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Individuals with stroke discharged from inpatient rehabilitation units (IRUs) are at increased risk for falls. In IRUs, standardized outcome measures (SOMs) have been used to predict falls, but the results have been mixed. OBJECTIVE To examine the relationship between SOMs and the risk of falls in individuals with stroke within 6 months of discharge from an IRU. DESIGN Prospective cohort study with 6-month follow-up. SETTING IRU that was part of a large, urban academic medical center. PARTICIPANTS Individuals with stroke who underwent rehabilitation. MAIN OUTCOME MEASURES Self-reported falls within 6 months of discharge. RESULTS The study included 105 participants who were discharged to their homes after inpatient rehabilitation and who responded to a 6-month follow-up (57% response rate) phone call. Twenty-nine participants (28%) reported falling. Significant odds ratios (ORs), adjusted for age, sex, and stroke severity, were found for the following measures: Berg Balance Scale (OR 0.95, 95% confidence interval [CI] 0.92-0.99), Activity Measure for Post-Acute Care basic mobility (OR 0.89, 95% CI 0.81-0.97), Motricity Index (OR 0.96, 95% CI 0.94-0.98), Functional Independence Measure mobility subscale (OR 0.89, 95% CI 0.80-0.98), and Trunk Control Test (OR 0.97, 95% CI 0.95-0.99). Areas under the curve ranged from .64 to .71. In samples of 82 to 90 patients who could complete the tests, gait speed, the Functional Reach Test, the 6-minute Walk Test, and Timed Up and Go did not result in significant ORs. CONCLUSIONS At discharge, SOMs were associated with the odds of falls within 6 months. The multifactorial nature of falls will continue to make prediction challenging but SOMs can be helpful. Lower extremity strength deserves more attention as a risk factor.
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Affiliation(s)
- Marc Campo
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY
| | | | - Michael W O'Dell
- Clinical Rehabilitation Medicine, Weill Cornell Medicine, New York City, NY
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Brief Report: Aging Attenuates the Association Between Coronary Artery Calcification and Bone Loss Among HIV-Infected Persons. J Acquir Immune Defic Syndr 2020; 82:46-50. [PMID: 31107297 DOI: 10.1097/qai.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Studies among HIV-uninfected persons (mostly in their sixth decade of life) show that detectable coronary artery calcium (CAC) is independently associated with low bone mineral density (BMD), suggesting a possible common pathogenic mechanism. AIM We assessed the relationship between CAC and BMD, which has not been well described among younger to middle-aged HIV-infected persons. METHODS We studied participants with baseline CAC and BMD measures from a prospective cohort of HIV-infected persons enrolled in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) during 2004-2006. We used logistic regression to assess the association between detectable CAC (>0 Agatston score) and BMD (g/cm, T-score), and adjusted for known traditional and HIV-related risk factors. RESULTS Among 472 participants (76% male, 30% non-Hispanic black, median age 41 years, and 71% with HIV RNA < 400 copies/mL), the majority had no detectable CAC (82%), but had baseline osteopenia (53%) or osteoporosis (10%). In univariate analysis, participants with detectable CAC had lower femoral neck/total hip T-scores, lower femoral neck/total hip/lumbar spine BMD, and higher rates of osteopenia/osteoporosis. After adjustment for age, all associations were no longer significant; adjustment for traditional risk factors excluding age and HIV-related variables failed to attenuate these associations. CONCLUSIONS We found aging attenuates the association between detectable CAC and BMD in this cohort. Aging remains an important contributor to non-AIDS-defining illnesses. These data reinforce the importance of developing screening and prevention strategies for aging HIV-infected persons given their excess risk across a wide spectrum of end-organ complications.
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Yang F, Butler AJ. Efficacy of Controlled Whole-Body Vibration Training on Improving Fall Risk Factors in Stroke Survivors: A Meta-analysis. Neurorehabil Neural Repair 2020; 34:275-288. [PMID: 32106762 DOI: 10.1177/1545968320907073] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Controlled whole-body vibration (CWBV) training has been applied to people with stroke. However, it remains inconclusive if CWBV reduces fall risk in this population. Objective. To (1) assess the immediate and retention effects of CWBV training on fall risk factors in people at postacute and chronic stages of stroke and (2) examine if CWBV dosage is correlated with the effect size (ES) for 3 fall risk factors: body balance, functional mobility, and knee strength. Methods. Twelve randomized controlled trials were included. ES was calculated as the standardized mean difference, and meta-analyses were completed using a random-effects model. Results. CWBV training may lead to improved balance and mobility immediately after training (ES = 0.27, P = .03 for balance; ES = 0.34, P = .02 for mobility) but not at the 3-month follow-up test (ES = 0.02, P = .89 for balance; ES = 0.70, P = .11 for mobility). CWBV affects knee strength capacity with mild ES (ES = 0.08 and 0.11, respectively, for immediate and retention effect; P ≥ .68 for both). Metaregression indicated that the immediate ES is strongly correlated with training dosage for balance (r = 0.649; P = .029) and mobility (r = 0.785; P = .036). Conclusions. CWBV training may benefit balance and mobility immediately, but the training effect may not persist among people with stroke. Additionally, the CWBV dosage correlates with the ES for body balance and mobility. More high-quality studies are needed to determine the retention effects of CWBV training.
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Affiliation(s)
- Feng Yang
- Georgia State University, Atlanta, GA, USA
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The Epidemiology of Hip Fracture among Subjects with Pyogenic Liver Abscess (PLA): A Nationwide Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5901962. [PMID: 32104699 PMCID: PMC7037889 DOI: 10.1155/2020/5901962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/28/2019] [Indexed: 11/17/2022]
Abstract
Pyogenic liver abscess (PLA) is a potentially fatal disease that can stimulate prominent systemic inflammation. Osteoporotic hip fracture is a major complication of systemic inflammation. This study tried to determine the epidemiology of hip fractures among PLA patients. All subjects admitted due to PLA during 1999∼2010 were assessed, excluding the subjects with a history of high energy trauma, malignancy, and previous hip fracture. We matched the control subjects to PLA patients according to age, gender, and the coding of osteoporosis by 1 : 4 ratio. The PLA patients had a 1.17-fold risk of hip fracture than the controls (aHR = 1.17, 95% CI = 1.07–1.29) after adjusting for gender, age, and comorbidities. Considering death as the competing event of suicide, the PLA patients had 1.10-fold suicide risk (aHR = 1.10, 95% CI: 1.00–1.21) than the control subjects under the competing risks regression model. The cumulative incidence of hip fracture was higher in the PLA cohort (log-rank test, p < 0.001). When compared to the controls, the fracture risk was 18.4-fold (aHR = 18.4, 95% CI = 13.0–26.1) for the PLA patients admitted 2-3 times per year and 46.0-fold (aHR = 46.0, 95% CI = 31.2–67.8) for the PLA patients admitted ≧4 times per year. The impact of PLA is more prominent among the subjects aged <45 years (aHR = 2.81, 95% CI = 1.42–5.56). Preventive measures for hip fracture might be warranted for PLA patients.
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Korall AM, Feldman F, Yang Y, Cameron ID, Leung PM, Sims-Gould J, Robinovitch SN. Effectiveness of Hip Protectors to Reduce Risk for Hip Fracture from Falls in Long-Term Care. J Am Med Dir Assoc 2019; 20:1397-1403.e1. [DOI: 10.1016/j.jamda.2019.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/22/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
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Seamon BA, Kautz SA, Velozo CA. Rasch Analysis of the Activities-Specific Balance Confidence Scale in Individuals Poststroke. Arch Rehabil Res Clin Transl 2019; 1. [PMID: 32313881 PMCID: PMC7170337 DOI: 10.1016/j.arrct.2019.100028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To examine the psychometric properties of the Activities-specific Balance Confidence (ABC) scale using Rasch analysis for individuals poststroke. Design Retrospective cohort. Setting Data was extracted from the Locomotor Experience Applied Post-Stroke phase 3, multisite, randomized controlled clinical trial. Participants Community-dwelling, ambulatory, older adults (N = 406) (mean age ± SD, 61.97±12.76y; 45.07% female) approximately 2 months poststroke. Intervention None. Main Outcome Measures We examined unidimensionality, local dependence, rating-scale structure, item and person fit, person-item match, and separation index of the ABC scale. Results Confirmatory and exploratory factor analysis showed the ABC scale was adequately unidimensional and 3-item pairs had local dependence. A collapsed 5-category rating scale was superior to the 101-category scale. The hardest item was "walking outside on an icy sidewalk," the easiest item was "getting into or out of a car," and no items misfit. The ABC scale had high person reliability (0.93), despite 10.5% of individuals misfitting the expected response pattern. Mean ability level of the sample was slightly lower (-0.56 logits) than the mean item difficulty indicating that the ABC scale adequately matched our sample's balance confidence. The ABC scale did not have a floor or ceiling effect and separated individuals into 5 statistically distinct strata (separation index = 3.71). Conclusions The Rasch model supports the use of the ABC scale to measure balance confidence in individuals poststroke. The consistency of our results with previous Rasch analyses on the ABC scale demonstrates the instrument responds similarly across multiple populations; community-dwelling older-adults, outpatient orthopedic physical therapy, stroke, Parkinson disease, and lower-limb amputation. Recommendations include collapsing the rating scale and developing a computerized-adaptive test version of the scale to enhance clinical utility.
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Affiliation(s)
- Bryant A Seamon
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Steven A Kautz
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Craig A Velozo
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.,Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
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Smith EE, Fang J, Alibhai SM, Cram P, Cheung AM, Casaubon LK, Kapoor E, Austin PC, Kapral MK. Derivation and External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke in a Canadian Cohort. JAMA Neurol 2019; 76:925-931. [PMID: 31081876 DOI: 10.1001/jamaneurol.2019.1114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance The risk for low-trauma fracture is increased by more than 30% after ischemic stroke, but existing fracture risk scores do not account for history of stroke as a high-risk condition. Objective To derive a risk score to predict the probability of fracture within 1 year after ischemic stroke and validate it in a separate cohort. Design, Setting, and Participants Prognostic study of a cohort from the Ontario Stroke Registry, a population-based sample of adults in Ontario, Canada, who were hospitalized with ischemic stroke from July 1, 2003, to March 31, 2012, with 1 year of follow-up. A population-based validation cohort consisted of a sample of 13 698 consecutive stroke admissions captured across 5 years: April 2002 to March 2003, April 2004 to March 2005, April 2008 to March 2009, April 2010 to March 2011, and April 2012 to March 2013. Exposures Predictor variables were selected based on biological plausibility and association with fracture risk. Age, sex, and modified Rankin score were abstracted from the medical records part of the Ontario Stroke Audit, and other characteristics were abstracted from administrative health data. Main Outcomes and Measures Incidence of low-trauma fracture within 1 year of discharge, based on administrative health data. Results The Fracture Risk after Ischemic Stroke (FRAC-Stroke) Score was derived in 20 435 patients hospitalized for ischemic stroke (mean [SD] age, 71.6 [14.0] years; 9564 [46.8%] women) from the Ontario Stroke Registry discharged from July 1, 2003, to March 31, 2012, using Fine-Gray competing risk regression. Low-trauma fracture occurred within 1 year of discharge in 741 of the 20 435 patients (3.6%) in the derivation cohort. Age, discharge modified Rankin score (mRS), and history of rheumatoid arthritis, osteoporosis, falls, and previous fracture were associated with the cumulative incidence of low trauma fracture in the derivation cohort. Model discrimination in the validation cohort (n = 13 698) was good (C statistic, 0.70). Discharge mRS was an important discriminator of risk (relative integrated discrimination improvement, 8.7%), with highest risk in patients with mRS 3 and 4 but lowest in bedbound patients (mRS 5). From the lowest to the highest FRAC-Stroke quintile, the cumulative incidence of 1-year low-trauma fracture increased from 1.3% to 9.0% in the validation cohort. Predicted and observed rates of fracture were similar in the external validation cohort. Analysis was conducted from July 2016 to January 2019. Conclusions and Relevance The FRAC-Stroke score allows the clinician to identify ischemic stroke survivors at higher risk of low-trauma fracture within 1 year of hospital discharge. This information might be used to select patients for interventions to prevent fractures.
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Affiliation(s)
- Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Shabbir M Alibhai
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment, University Health Network, Toronto, Ontario, Canada
| | - Peter Cram
- ICES, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
| | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment, University Health Network, Toronto, Ontario, Canada
| | - Leanne K Casaubon
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, University Health Network, Toronto, Ontario, Canada
| | - Eshita Kapoor
- Medical Student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Moira K Kapral
- ICES, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment, University Health Network, Toronto, Ontario, Canada
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Salehi Omran S, Murthy SB, Navi BB, Merkler AE. Long-Term Risk of Hip Fracture After Ischemic Stroke. Neurohospitalist 2019; 10:95-99. [PMID: 32373271 DOI: 10.1177/1941874419859755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose Data are lacking on the long-term risk of hip fracture among patients with ischemic stroke. A better understanding of the contemporary incidence of hip fracture after ischemic stroke could benefit patient care by promoting strategies to prevent this disabling complication in stroke survivors. Methods We performed a retrospective cohort study using inpatient and outpatient claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included patients ≥66 years of age who were hospitalized with acute ischemic stroke, defined through a validated diagnostic code algorithm. We excluded patients who had a prior or concurrent hip fracture diagnosis at the time of ischemic stroke. The primary outcome was hip fracture requiring hospitalization. Survival statistics were used to calculate crude incidence rates, and the Kaplan-Meier method was used to calculate cumulative rates. Results Among the 1 772 550 beneficiaries in our sample, 60 099 were diagnosed with an acute ischemic stroke without prior or concomitant hip fracture. During 4.5 (±2.2) years of follow-up, the incidence of hip fracture was 1.6 (95% confidence interval [CI]: 1.5-1.6) per 100 person-years in patients with acute ischemic stroke versus 0.6 (95% CI: 0.6-0.6) per 100 person-years in patients without acute ischemic stroke. The cumulative 5-year rate of hip fracture was 7.6% (95% CI: 7.2%-8.0%) among patients with acute ischemic stroke versus 2.8% (95% CI: 2.8%-2.9%) among the remaining Medicare beneficiaries. Conclusion We found that among elderly Medicare beneficiaries with acute ischemic stroke, nearly 1 in 12 developed a hip fracture over the next 5 years.
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Affiliation(s)
- Setareh Salehi Omran
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.,Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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48
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Osteoporose und Multimorbidität. Z Gerontol Geriatr 2019; 52:433-439. [DOI: 10.1007/s00391-019-01569-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/24/2019] [Indexed: 12/18/2022]
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Lee KB, Lee JG, Kim BJ, Kim JY, Lee KJ, Han MK, Park JM, Kang K, Cho YJ, Park HK, Hong KS, Park TH, Lee SJ, Oh MS, Yu KH, Lee BC, Cha JK, Kim DH, Kim JT, Lee J, Hong JH, Sohn SI, Kim DE, Choi JC, Yeo MJ, Kim WJ, Chae JE, Lee JS, Lee J, Bae HJ. The Epidemiology of Fracture in Patients with Acute Ischemic Stroke in Korea. J Korean Med Sci 2019; 34:e164. [PMID: 31172697 PMCID: PMC6556443 DOI: 10.3346/jkms.2019.34.e164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/22/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population. METHODS Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures. RESULTS Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17-1.30), women (HR, 1.74; 95% CI, 1.54-1.97), previous fracture (HR, 1.72; 95% CI, 1.54-1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27-1.63) were independent risk factors of post-stroke fracture. CONCLUSION The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.
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Affiliation(s)
- Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jung Gon Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun Yup Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keon Joo Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon Ku Han
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yong Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hong Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Keun Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Joon Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Jeong Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Dong Eog Kim
- Department of Neurology, Dongguk University Ilsan Hopital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Min Ju Yeo
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Wook Joo Kim
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Jae Eun Chae
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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David SM, Chan K, Inderjeeth C, Raymond WD. Rehabilitation Indices associated with sustaining a minimal trauma fracture within 12 months of a stroke in Western Australia. Australas J Ageing 2019; 38:107-115. [PMID: 30806020 DOI: 10.1111/ajag.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify Rehabilitation Indices associated with a minimal trauma fracture (MTF) within 12 months poststroke. METHODS Retrospective case-control study. Stroke survivors with MTF were matched 5:1 with stroke survivors without MTF. Logistic regression determined whether Rehabilitation Indices, such as Physiotherapy Ambulation score (PhysioAmb), were associated with a MTF within 12 months poststroke. RESULTS Forty-three stroke survivors (mean age: 79.8; 55.81% female) experienced a MTF (median time to MTF of 1.79 years [IQR 0.70, 4.48]). Those with a MTF within 12 months had lower PhysioAmb (4.53 vs 8.29) and Berg Balance Scale (BBS; 12.25 vs 40.57) scores on admission, lower BBS score on discharge (30.33 vs 49.29) and a greater change in PhysioAmb (+5.67 vs +3.24) and BBS scores (+21.50 vs +8.71) after rehabilitation, all P < 0.05. Greater changes in PhysioAmb score increased the odds of a MTF within 12 months by 18%. CONCLUSION Rehabilitation Indices are associated with a MTF within 12 months poststroke.
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Affiliation(s)
- Shivlal M David
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,North-West Area Rehabilitation and Aged Care Service - Osborne Park Hospital Campus, Perth, Western Australia, Australia.,Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Kien Chan
- North-West Area Rehabilitation and Aged Care Service - Osborne Park Hospital Campus, Perth, Western Australia, Australia
| | - Charles Inderjeeth
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,North-West Area Rehabilitation and Aged Care Service - Osborne Park Hospital Campus, Perth, Western Australia, Australia.,Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Warren D Raymond
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,University of the West, Perth, Western Australia, Australia
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