ABSTRACT
Background
Aim
Methods
Findings
Discussion
Conclusion
Keywords
1. Introduction
Ministry of Health and Welfare(2021). Executive Yuan. 2020 Cause of Death Statistics. 〈https://www.mohw.gov.tw/cp-5256-63399-2.html〉.
- Avan A.
- Digaleh H.
- Di Napoli M.
- Stranges S.
- Behrouz R.
- Shojaeianbabaei G.
- et al.
- Donkor E.S.
American Heart Association (2022). Emotional and Behavioral Effects of Stroke. 〈https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke〉.
- Dong L.
- Williams L.S.
- Brown D.L.
- Case E.
- Morgenstern L.B.
- Lisabeth L.D.
- Ytterberg C.
- Cegrell L.
- von Koch L.
- Wiklander M.
- Hu J.
- Ma L.
- Yang Z.Y.
- Avan A.
- Digaleh H.
- Di Napoli M.
- Stranges S.
- Behrouz R.
- Shojaeianbabaei G.
- et al.
National Health Insurance Administration of Taiwan Ministry of Health and Welfare, Executive Yuan (2022). Post-acute Care-Cerebrovascular Diseases (2020.04.10 update). (In Chinese). 〈https://www.nhi.gov.tw/Content_List.aspx?n=5A0BB383D955741C&topn=D39E2B72B0BDFA15〉 [Accessed 5 July 2022].
- Hsien H.H.
- Liou W.C.
- Yang Y.H.
- Weng S.-C.
- Hsu C.-Y.
- Shen C.-C.
- Huang J.-A.
- Chen P.-L.
- Lin S.-Y.
2. Participants, ethics, and methods
2.1 Study design, setting, and participants
Variables | All patients | PAC group (n = 41) | Regular care group (n = 20) | t/x2 | p-value | ||||
---|---|---|---|---|---|---|---|---|---|
n (%) | Mean (SD) | n (%) | Mean (SD) | n (%) | Mean (SD) | ||||
Age (years) | 67.59 (15.64) | 65.00 (15.07) | 72.90 (15.80) | −1.89 | 0.06 | ||||
NIHSS score at admission | 8.00 (4.74) | 8.51 (4.94) | 6.95 (4.25) | 1.21 | 0.23 | ||||
Sex | 1.48 | 0.22 | |||||||
Male | 36 (59.02) | 22 (53.66) | 14 (70.00) | ||||||
Female | 25 (40.98) | 19 (46.34) | 6 (30.00) | ||||||
Marital status | 0.67 | ||||||||
Married | 51 (83.61) | 33 (80.49) | 18 (90.00) | ||||||
Single/divorced/widow | 10 (16.39) | 8 (19.51) | 2 (10.10) | ||||||
Education level | 0.73 | ||||||||
Illiterate | 21 (34.43) | 14 (34.15) | 7 (35.00) | ||||||
Elementary school | 21 (34.43) | 11 (26.83) | 10 (50.00) | ||||||
Junior high school | 6 (9.84) | 5 (12.20) | 1 (5.00) | ||||||
High school or higher | 13 (21.58) | 9 (21.95) | 2 (10.00) | ||||||
Work status before stroke | 3.14 | 0.08 | |||||||
Yes | 25 (40.98) | 20 (48.78) | 5 (25.00) | ||||||
No | 36 (59.02) | 21 (51.22) | 15 (75.00) | ||||||
Type of stroke | 0.29 | ||||||||
Ischaemic | 57 (93.44) | 37 (90.24) | 20 (100.00) | ||||||
Haemorrhagic | 4 (6.66) | 4 (9.76) | 0 (0.00) | ||||||
Location of stroke | 0.03 | ||||||||
Left brain | 23 (37.70) | 19 (46.34) | 4 (20.00) | ||||||
Right brain | 33 (54.10) | 17 (41.46) | 16 (80.00) | ||||||
Diencephalon/pontine | 5 (8.20) | 5 (8.20) | 0 (0.00) | ||||||
Number of strokes | 0.24 | 0.62 | |||||||
First time | 48 (78.69) | 33 (80.49) | 15 (75.00) | ||||||
Second time (inclusive) | 13 (21.31) | 8 (19.51) | 5 (15.00) | ||||||
CCI (0–5) | 1.34 (1.34) | 1.15 (1.20) | 1.75 (1.55) | −1.68 | 0.10 | ||||
BI score at admission (0–85) | 35.16 (22.02) | 35.12 (22.09) | 35.25 (22.45) | −0.02 | 0.98 | ||||
mRS score at admission (2–4) | 3.84 (0.42) | 3.88 (0.33) | 3.75 (0.55) | 0.96 | 0.35 | ||||
Length of stay in PAC (days) | 39.27 (16.02) |
2.2 Hospital-based post-acute care program vs. regular care
2.2.1 Hospital-based post-acute care program
2.2.2 Regular care
2.3 Measurements
2.3.1 Demographics and disease information
2.3.2 Physical function
2.3.3 Depression symptoms
- Sheikh J.I.
- Yesavage J.A.
2.3.4 Quality of life
2.4 Procedure
2.5 Data analysis
3. Results
3.1 Demographics and disease information of stroke survivors
3.2 Changing trends in physical function, depression symptoms, and quality of life of patients
Subject | PAC group (n = 41) | Regular care group (n = 20) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
T0 | T1 | T2 | T3 | T4 | T0 | T1 | T2 | T3 | T4 | |
Physical function | ||||||||||
BI | 35.12 | 42.07 | 49.63 | 65.73 | 73.78 | 35.25 | 37.50 | 46.70 | 48.50 | 50.25 |
mRS | 3.88 | 3.76 | 3.59 | 2.93 | 2.51 | 3.75 | 3.65 | 3.55 | 3.50 | 3.55 |
IADL | – | 3.46 | 4.20 | 5.80 | 7.54 | – | 3.25 | 3.55 | 3.95 | 3.90 |
GDS-15 | 7.76 | 6.46 | 4.66 | 3.41 | 9.30 | 8.15 | 8.80 | 8.55 | ||
SIS V3.0 domain 1–8 | 367.73 | 447.38 | 539.69 | 577.68 | 374.32 | 406.57 | 411.15 | 412.16 | ||
SIS V3.0 domain 9 | 18.78 | 32.20 | 55.37 | 63.41 | 19.00 | 26.00 | 28.50 | 30.50 |
3.2.1 Physical function
3.2.2 Depression symptoms
3.2.3 Quality of life
3.2.4 Differences in physical function, depression symptoms, and quality of life of patients
Predictive variables | B | SE | Wald χ² | p-value |
---|---|---|---|---|
Group × timepoint (BI) | ||||
PACG × T1 | 4.70 | 3.43 | 1.88 | 0.170 |
PACG × T2 | 3.06 | 5.45 | 0.32 | 0.574 |
PACG × T3 | 17.36 | 6.84 | 6.45 | 0.011 |
PACG × T4 | 23.66 | 7.28 | 10.55 | 0.001 |
Group × timepoint (mRS) | ||||
PACG × T1 | −0.02 | 0.09 | 0.06 | 0.810 |
PACG × T2 | −0.09 | 0.24 | 0.15 | 0.703 |
PACG × T3 | −0.70 | 0.25 | 7.65 | 0.006 |
PACG × T4 | −1.17 | 0.26 | 19.40 | <0.001 |
Group × timepoint (IADL) | ||||
PACG × T2 | 0.43 | 0.32 | 1.83 | 0.176 |
PACG × T3 | 1.64 | 0.78 | 4.47 | 0.035 |
PACG × T4 | 3.42 | 0.87 | 15.59 | <0.001 |
Group × timepoint (GDS) | ||||
PACG × T2 | −0.14 | 0.64 | 0.05 | 0.825 |
PACG × T3 | −2.60 | 0.86 | 9.22 | 0.002 |
PACG × T4 | −3.59 | 0.97 | 13.57 | <0.001 |
Group × timepoint (SIS 1–8) | ||||
PACG × T2 | 47.41 | 14.44 | 10.78 | 0.001 |
PACG × T3 | 135.13 | 25.60 | 27.87 | <0.001 |
PACG × T4 | 172.11 | 29.32 | 34.47 | <0.001 |
Group × timepoint (SIS 9) | ||||
PACG × T2 | 6.42 | 4.69 | 1.87 | 0.171 |
PACG × T3 | 27.09 | 6.13 | 19.50 | <0.001 |
PACG × T4 | 33.13 | 6.07 | 29.79 | <0.001 |
3.3 Associated factors affecting the quality of life of patients with stroke
Independent variables | T2 | T3 | T4 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
B | SE | t value | p-value | B | SE | t value | p-value | B | SE | t value | p-value | |
Intercept | 283.46 | 76.18 | 3.72 | <0.001 | 467.62 | 101.18 | 4.62 | <0.001 | 426.54 | 67.44 | 6.33 | <0.001 |
Education level: junior high school or above | −0.16 | 21.87 | −0.01 | 0.994 | 10.47 | 24.86 | 0.42 | 0.675 | 5.97 | 18.37 | 0.33 | 0.746 |
Age | 0.83 | 0.65 | 1.28 | 0.205 | 0.94 | 0.89 | 1.05 | 0.297 | 0.64 | 0.62 | 1.02 | 0.312 |
NIHSS score | −2.17 | 1.59 | −1.36 | 0.179 | ||||||||
Marital status: No | 28.89 | 22.29 | 1.30 | 0.201 | 9.73 | 16.05 | 0.61 | 0.547 | ||||
Work status: Yes | −3.83 | 18.82 | −0.20 | 0.839 | 3.68 | 13.58 | 0.27 | 0.787 | ||||
CCI | 12.71 | 6.10 | 2.08 | 0.042 | 5.75 | 4.13 | 1.39 | 0.169 | ||||
BI | 1.71 | 0.45 | 3.77 | <0.001 | 1.37 | 0.60 | 2.30 | 0.026 | 2.06 | 0.40 | 5.17 | <0.001 |
MRS | 15.75 | 9.39 | 1.68 | 0.099 | −27.05 | 15.76 | −1.72 | 0.092 | −26.53 | 10.89 | −2.44 | 0.018 |
IADL | 14.06 | 3.02 | 4.65 | <0.001 | 7.36 | 2.65 | 2.78 | 0.008 | 6.80 | 1.70 | 4.01 | <0.001 |
GDS-15 | −11.94 | 1.92 | −6.21 | <0.001 | −15.49 | 2.38 | −6.50 | <0.001 | −12.22 | 1.55 | −7.87 | <0.001 |
R2 | 0.839 | 0.888 | 0.950 | |||||||||
Adjusted R2 | 0.818 | 0.869 | 0.941 | |||||||||
F | 39.48 | 45.05 | 107.37 | |||||||||
p-value | <0.001 | <0.001 | <0.001 |
4. Discussion
4.1 Demographics and disease information of stroke survivors
- Chien S.H.
- Sung P.Y.
- Liao W.L.
- Tsai S.W.
- Huang H.C.
- Tsai J.Y.
- Liu T.C.
- Sheng W.Y.
- Lin T.C.
- Lin C.W.
- et al.
- Weng S.-C.
- Hsu C.-Y.
- Shen C.-C.
- Huang J.-A.
- Chen P.-L.
- Lin S.-Y.
- Chien S.H.
- Sung P.Y.
- Liao W.L.
- Tsai S.W.
4.2 Changing trends in physical function, depression symptoms, and quality of life
4.2.1 Physical function
- Huang H.C.
- Tsai J.Y.
- Liu T.C.
- Sheng W.Y.
- Lin T.C.
- Lin C.W.
- et al.
- Chien S.H.
- Sung P.Y.
- Liao W.L.
- Tsai S.W.
- Weng S.-C.
- Hsu C.-Y.
- Shen C.-C.
- Huang J.-A.
- Chen P.-L.
- Lin S.-Y.
- Hsieh C.Y.
- Tsao W.C.
- Lin R.T.
- Chao A.C.
- Huang H.C.
- Tsai J.Y.
- Liu T.C.
- Sheng W.Y.
- Lin T.C.
- Lin C.W.
- et al.
- Peng L.N.
- Lu W.H.
- Liang C.K.
- Chou M.Y.
- Chung C.P.
- Tsai S.L.
- et al.
- Weng S.-C.
- Hsu C.-Y.
- Shen C.-C.
- Huang J.-A.
- Chen P.-L.
- Lin S.-Y.
- Chien S.H.
- Sung P.Y.
- Liao W.L.
- Tsai S.W.
- Hsien H.H.
- Liou W.C.
- Yang Y.H.
- Hsieh C.Y.
- Tsao W.C.
- Lin R.T.
- Chao A.C.
- Huang H.C.
- Tsai J.Y.
- Liu T.C.
- Sheng W.Y.
- Lin T.C.
- Lin C.W.
- et al.
- Peng L.N.
- Lu W.H.
- Liang C.K.
- Chou M.Y.
- Chung C.P.
- Tsai S.L.
- et al.
- Weng S.-C.
- Hsu C.-Y.
- Shen C.-C.
- Huang J.-A.
- Chen P.-L.
- Lin S.-Y.
4.2.2 Depressive symptoms
- Wang S.
- Wang C.X.
- Zhang N.
- Xiang Y.T.
- Yang Y.
- Shi Y.Z.
- et al.
- Dong L.
- Williams L.S.
- Brown D.L.
- Case E.
- Morgenstern L.B.
- Lisabeth L.D.
4.2.3 Quality of life
4.3 Associated factors affecting the quality of life of stroke survivors
- Hsien H.H.
- Liou W.C.
- Yang Y.H.
- Weng S.-C.
- Hsu C.-Y.
- Shen C.-C.
- Huang J.-A.
- Chen P.-L.
- Lin S.-Y.
- Weng S.-C.
- Hsu C.-Y.
- Shen C.-C.
- Huang J.-A.
- Chen P.-L.
- Lin S.-Y.
- Wong H.J.
- Lua P.L.
- Harith S.
- Ibrahim K.A.
5. Limitations and suggestions
6. Practice implications
7. Conclusions
Authorship contribution statement
Funding
Ethical statement
Conflict of interest
References
American Heart Association (2022). Emotional and Behavioral Effects of Stroke. 〈https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke〉.
- Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017.BMC Medicine. 2019; 17191https://doi.org/10.1186/s12916-019-1397-3
- Screening for depression in Parkinson’s disease: the performance of two screening questions.Age and Ageing. 2014; 43: 200-205https://doi.org/10.1093/ageing/aft152
- Outcomes validity and reliability of the modified Rankin Scale: implications for stroke clinical trials: a literature review and synthesis.Stroke. 2007; 38: 1091-1096https://doi.org/10.1161/01.STR.0000258355.23810.c6
- Does depression after stroke negatively influence physical disability? A systematic review and meta-analysis of longitudinal studies.Journal of Affective Disorders. 2019; 247: 45-56https://doi.org/10.1016/j.jad.2018.12.082
- A functional recovery profile for patients with stroke following post-acute rehabilitation care in Taiwan.Journal of the Formosan Medical Association. 2020; 119: 254-259https://doi.org/10.1016/j.jfma.2019.05.013
- Nursing practice in stroke rehabilitation: systematic review and meta-ethnography.Journal of Clinical Nursing. 2014; 23: 1201-1226https://doi.org/10.1111/jocn.12334
- Stroke in the 21st century: a snapshot of the burden, epidemiology, and quality of life.Stroke Research and Treatment. 2018; 20183238165https://doi.org/10.1155/2018/3238165
- Prevalence and course of depression during the first year after mild to moderate stroke.Journal of the American Heart Association. 2021; 10e020494https://doi.org/10.1161/JAHA.120.020494
- Development of a comprehensive assessment toolbox for stroke.Clinics in Geriatric Medicine. 1999; 15: 885-915
- Taiwan guidelines for stroke rehabilitation.Taiwan Rehabilitation Medicine Journal. 2016; 44: 1-9https://doi.org/10.6315/2016.44(1)01
- Quality of life after first-ever stroke: an interview-based study from Blantyre, Malawi.Malawi Medical Journal. 2015; 27: 50-54https://doi.org/10.4314/mmj.v27i2.4
- Post-acute care improves daily activity functions of stroke patients: an effectiveness analysis.Journal of Gerontology and Gerontology of Taiwan. 2015; 10: 159-171https://doi.org/10.29461/TGG.201508_10(3).0003
- Three years of the nationwide post-acute stroke care program in Taiwan.Journal of the Chinese Medical Association. 2018; 81: 87-88https://doi.org/10.1016/j.jcma.2017.09.003
- Does citalopram effectively treat post-stroke depression?: a protocol for systematic review and meta analysis.Medicine. 2020; 99e20608https://doi.org/10.1097/MD.0000000000020608
- Functional recovery of stroke patients with postacute care: a retrospective study in a northern medical center.Journal of the Chinese Medical Association. 2019; 82: 424-427https://doi.org/10.1097/JCMA.0000000000000076
- IBM SPSS statistics for windows, version 22.0.IBM Corp, Armonk, NY2013
- Incidence of depression after stroke, and associated risk factors and mortality outcomes, in a large cohort of Danish patients.JAMA Psychiatry. 2016; 73: 1032-1040https://doi.org/10.1001/jamapsychiatry.2016.1932
- Validity and reliability of a Malay version of the Lawton Instrumental Activities of Daily Living Scale among the Malay speaking elderly in Malaysia.Australian Occupational Therapy Journal. 2018; 65: 63-68https://doi.org/10.1111/1440-1630.12441
- Post-acute care for stroke—a retrospective cohort study in Taiwan.Patient Preference and Adherence. 2017; 11: 1309-1315https://doi.org/10.2147/PPA.S136041
- Assessment of older people: self-maintaining and instrumental activities of daily living.The Gerontologist. 1969; 9: 179-186
- Predicting clinical instability of older patients in post-acute care units: a nationwide cohort study.Geriatrics and Gerontology International. 2014; 14: 267-272https://doi.org/10.1111/ggi.12083
- Reliability and validity of the Stroke Impact Scale 3.0. In Taiwanese stroke patients.Formosan Journal of Physical Therapy. 2016; 41: 28-36https://doi.org/10.6215/FJPT.PTS1433262535
- Functional evaluation: the Barthel Index.Maryland State Medical Journal. 1965; 14: 61-65
- Post-stroke depression: a 2020 updated review.General Hospital Psychiatry. 2020; 66: 70-80https://doi.org/10.1016/j.genhosppsych.2020.06.011
- Nursing practice in stroke rehabilitation: perspectives from multi-disciplinary healthcare professionals.Nursing and Health Sciences. 2020; 22: 28-37https://doi.org/10.1111/nhs.12641
Ministry of Health and Welfare(2021). Executive Yuan. 2020 Cause of Death Statistics. 〈https://www.mohw.gov.tw/cp-5256-63399-2.html〉.
- Prevalence and predictors of post-stroke mood disorders: a meta-analysis and meta-regression of depression, anxiety and adjustment disorder.General Hospital Psychiatry. 2017; 47: 48-60https://doi.org/10.1016/j.genhosppsych.2017.04.001
National Health Insurance Administration of Taiwan Ministry of Health and Welfare, Executive Yuan (2022). Post-acute Care-Cerebrovascular Diseases (2020.04.10 update). (In Chinese). 〈https://www.nhi.gov.tw/Content_List.aspx?n=5A0BB383D955741C&topn=D39E2B72B0BDFA15〉 [Accessed 5 July 2022].
- Functional outcomes, subsequent healthcare utilization, and mortality of stroke postacute care patients in Taiwan: a nationwide propensity score-matched study.Journal of the American Medical Directors Association. 2017; 18: 990.e7-990.e12https://doi.org/10.1016/j.jamda.2017.06.020
- Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke.European Stroke Journal. 2018; 3: 157-164https://doi.org/10.1177/2396987317753444
- Quality of life after stroke rehabilitation discharge: a 12-month longitudinal study.Disability and Rehabilitation. 2021; 43: 2332-2341https://doi.org/10.1080/09638288.2019.1699173
- Geriatric Depression Scale (GDS): recent evidence and development of a shorter version.Clinical Gerontologist: The Journal of Aging and Mental Health. 1986; 5: 165-173https://doi.org/10.1300/J018v05n01_09
- Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2017; 48: e30-e43https://doi.org/10.1161/STR.0000000000000113
- Optimizing cutoff scores for the Barthel Index and the modified Rankin Scale for defining outcome in acute stroke trials.Stroke. 2005; 36: 1984-1987
- Burden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years.Stroke. 2020; 51: 2418-2427https://doi.org/10.1161/STROKEAHA.120.029606
- The association between post-stroke depression, aphasia, and physical independence in stroke patients at 3-month follow-up.Frontiers in Psychiatry. 2018; 9374https://doi.org/10.3389/fpsyt.2018.00374
- Combined functional assessment for predicting clinical outcomes in stroke patients after post-acute care: a retrospective multi-center cohort in central Taiwan.Frontiers in Aging Neuroscience. 2022; 14834273https://doi.org/10.3389/fnagi.2022.834273
- Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview.Stroke. 2005; 36: 777-781https://doi.org/10.1161/01.STR.0000157596.13234.95
- Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2016; 47: e98-e169https://doi.org/10.1161/STR.0000000000000098
- Health-related quality of life profiles and their dimension-specific associated factors among Malaysian stroke survivors: a cross sectional study.Health and Quality of Life Outcomes. 2021; 19210https://doi.org/10.1186/s12955-021-01847-0
- The need for post-acute care for stroke patients in Taiwan.Taiwan Gong Gong Wei Sheng Za Zhi. 2012; 31 (in Chinese)251
- The effects of enhanced physical therapy on post-acute stroke patients.Formosan Journal of Physical Therapy. 2016; 41: 165-166
- Development and validation of a geriatric depression screening scale: a preliminary report.Journal of Psychiatric Research. 1982; 17: 37-49https://doi.org/10.1016/0022-3956(82)90033-4
- Depression symptoms 6 years after stroke are associated with higher perceived impact of stroke, limitations in ADL and restricted participation.Scientific Reports. 2022; 127816https://doi.org/10.1038/s41598-022-11097-9
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