ObjectivesTo systematically review the efficacy of home-based telerehabilitation (HTR) for stroke survivors.MethodsPubMed, EMbase, Web of Science, Joanna Briggs Institute Library, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on HTR for stroke survivors from inception to January 1st, 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 793 patients were included. The results of meta-analysis showed that: after 1 to 2 years of treatment, BI scores (MD=20.22, 95%CI 17.10 to 23.35, P<0.000 01) in HTR group were higher than those in the traditional rehabilitation group. However, there were no statistical differences between two groups in ARAT scores (SMD=0.16, 95%CI ?0.14 to 0.45, P=0.30) after 1 to 2 months of treatment, as well as MBI scores (SMD=0.98, 95%CI ?0.33 to 2.29, P=0.14) and FMA scores (SMD=0.57, 95%CI ?0.08 to 1.23, P=0.09) after 3 months of treatment, and CSI scores (MD=?1.48, 95%CI ?3.90 to 0.94, P=0.23) and BBS scores (MD=1.33, 95%CI ?1.15 to 3.81, P=0.29) after 6 months of treatment. The results of descriptive analysis indicated that there was no statistically significant difference in quality of life between the two groups at 6 months after intervention. However, the HTR group was superior to the traditional rehabilitation group after 2 years of treatment.ConclusionsCurrent evidence shows that, compared with traditional rehabilitation, long-term intervention (1-2 years) with HTR can improve the ability to perform activities of daily living and quality of life of stroke survivors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectiveTo systematically review the dose-response relationship between body mass index (BMI) and the risk of stroke. MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched to collect studies on BMI and the risk of stroke from inception to December 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 16.0 software, and the dose-response relationship between BMI and risk of stroke was analyzed by using restricted cubic spline function and generalized least squares estimation (GLST). ResultsA total of 19 studies involving 3 689 589 patients were included. The results of meta-analysis showed that compared with normal BMI, overweight (RR=1.28, 95%CI 1.19 to 1.39, P<0.01) and obesity (RR=1.41, 95%CI 1.15 to 1.72, P<0.01) had a higher risk of stroke. Dose-response meta-analysis suggested that there was no significant non-linear relationship between BMI and stroke risk (nonlinear test P=0.318), and linear trend showed that the risk of stroke increased by 4% for each unit increase in BMI (RR=1.04, 95%CI 1.03 to 1.05, P<0.01). ConclusionCurrent evidence suggests that increased BMI is associated with an increased risk of stroke. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Stroke is a kind of cerebrovascular disease with high incidence and disability rate. Motor dysfunction and cognitive dysfunction are common dysfunctions of stroke. Rehabilitation treatment can effectively reduce the disability rate of stroke and improve the quality of life. The short-term hospitalization and ambulatory rehabilitation treatment cannot meet the rehabilitation needs of stroke patients. Cloud rehabilitation is one of the ways to solve this problem. This article introduces the definition and application of cloud rehabilitation and artificial intelligence (including assisted rehabilitation assessment and assisted rehabilitation treatment), and summarizes the current problems in the development of stroke cloud rehabilitation in China, so as to promote the construction of remote rehabilitation based on artificial intelligence in China and provide some references for the selection of rehabilitation programs for patients with stroke.
ObjectiveTo investigate the feasibility and effectiveness of motor imagery based brain computer interface with wrist passive movement in chronic stroke patients with wrist extension impairment.MethodsFifteen chronic stroke patients with a mean age of (47.60±14.66) years were recruited from March 2017 to June 2018. At baseline, motor imagery ability was assessed first. Then motor imagery based brain computer interface with wrist passive movement was given as an intervention. Both range of motion of paretic wrist and Barthel index was assessed before and after the intervention.ResultsAmong the 15 chronic stroke patients admitted in the study, 12 finished the whole therapy, and 3 failed to pass the initial assessment. After the therapy, the 12 participants who completed the whole sessions of the treatment and follow up had improved ability of control electroencephalogram, in whom 9 regained the ability to actively extend the affected wrist, and the other 3 failed to actively extend their wrist (the rate of active extending wrist was 75%). The activity of daily life of all the participants did not change significantly before and after intervention, and no discomfort was found after daily treatment.ConclusionIn chronic stroke patients with wrist extension impairment, motor imagery based brain computer interface with wrist passive movement training is feasible and effective.
Objective To Provide statistical references for disease-based payment reform with Diagnosis Related Groups (DRGs). Methods Based on 1 969 stroke inpatients from two hospitals in Chongqing city, we used classification and regression trees (CART) of decision tree to establish classification regulations of the case-mix model for stroke inpatients, and multivariate statistical model to evaluate whether the case-mix could provide a satisfactory prediction to costs for stroke inpatients in comparison with the foreign model. Results ① The classification nodes of our model were surgical procedure, nursing care degree, and hospital infection respectively by which 1 969 stroke inpatients were divided into 5 groups. The classification nodes in foreign model were surgical procedure, age≥50 years, and whether patients would refer to other institutions after leaving the hospitals by which 1 969 stroke inpatients were also classified into 5 groups. ② For medical institutions and the third payers, we found that the data from our model could explain 80.46% of the total costs and 16.58% for individual inpatient, which were higher than that of foreign model (76.87% for medical institutions and the third payers, 9.13% for individuals ). Conclusions Compared with foreign model, our model is more suitable for the situation in China. The study is only based on 1 969 stroke inpatients from south west part of China, so the conclusion needs further studies to confirm.
【摘要】 目的 探討肌電生物反饋治療對腦卒中偏癱患肢上肢腕背伸功能的影響。方法 將36例腦卒中偏癱患者隨機分為治療組和對照組,每組18例。兩組藥物治療相同,對照組進行常規康復治療,治療組在常規康復治療基礎上加肌電生物反饋技術進行治療。觀察兩組治療前后腕背伸時主動關節活動范圍(AROM),腕背伸時肌肉最大收縮時肌電(EMG)閾值。 結果 3個療程后治療組患者腕關節的AROM、EMG閾值均優于對照組(P＜0.001)。 結論 肌電生物反饋治療有助于明顯改善偏癱患者腕背伸功能。【Abstract】 Objective To explore the effect of the electromyographic biofeedback therapy on the extension of wrist joint of the hemiplegic patients after stroke. Methods Thirtysix hemiplegic patients were included and were divided into two groups randomly, including a treatment group and a control group. They were treated with the same drugs and the routine rehabilitation therapy while the patients in the treatment group still received the electromyographic biofeedback therapy additionally. Results After three courses of treatment, the patients in the treatment group had better active range of movement (AROM) of extension of wrist joint and also higher electromyographic (EMG) threshold of maximum contraction of muscle than the patients in the control group (Plt;0.001). Conclusion The electromyographic biofeedback therapy has good effect on improving the function of the wrist of hemiplegic patients after stroke.
Objective To investigate the clinical characteristics of facial palsy after stroke (FPS) in order to enhance the understanding of FPS. Methods Patients with stroke and admitted to hospital from March to June 2015 were selected in this study. They were evaluated by Modified House-Braekmann (MHBN), Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Standardized Swallowing Assessment and Patient Health Questionnaire-9 (PHQ-9) within 48 hours after admitting. According to the MHBN scores, the patients were divided into FPS group and non-FPS group, and the incidences of dysphagia and depression, and the scores of BI, NIHSS, and PHQ-9 were compared between the two group. Six months later, the patients’ prognosis of stroke was assessed by the Modified Rankin Scale. Results A total of 129 patients were enrolled in this study, including 81 (62.8%) with FPS, and 48 (37.2%) without FPS. The incidences of dysphagia and depression in the FPS group (64.2%, 59.3%) were higher than those in the non-FPS group (22.9%, 18.8%), and the differences were statistically significant (P<0.05). The BI, NIHSS, PHQ-9 scores in the FPS group were 41.79±14.19, 11.23±4.62, 11.54±3.43, respectively, while the scores in the non-FPS group were 66.39±19.96, 7.54±3.69, 7.67±2.89, respectively; the differences in the scores between the two groups were statistically significant (P<0.05). Six months later, the patients’ prognosis in the non-FPS group was better than that in the FPS group (67.4%vs. 32.9%, P<0.001). Conclusions There is a high incidence of FPS, and there are high incidences of dysphagia and depression in the FPS patients with stroke. FPS influences the patients’ prognosis, so the understanding and treatment of FPS should be enhanced.
ObjectiveTo explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and provide guidance for rehabilitation assessment and functional prognosis.MethodsThe stroke patients who were hospitalized in Department of Rehabilitation Medicine of Zhongda Hospital of Southeast University between November 2020 and January 2021 were selected. Motor unit number estimation (MUNE) and F wave were examined to evaluate the functional status of motor neuron. The Fugl-Meyer Assessment (FMA) and Modified Ashworth Scale (MAS) were used to evaluate the upper limb motor function. The correlations of electrophysiological parameters with FMA score and MAS score were analyzed respectively.ResultsA total of 42 patients were enrolled, and 16 patients were complicated with carpal flexor spasm on the affected side. Among the 42 stroke patients, the MUNE of the abductor pollicis brevis on the affected side was lower than that on the unaffected side (t=?3.466, P=0.001), and the percentage of F waves with different shapes on the affected side was significantly lower than that on the unaffected side (Z=?5.583, P<0.001). Among the 16 stroke patients with carpal flexor spasm, the F wave amplitude was higher on the affected side than that on the unaffected side (t=2.764, P=0.014), while the F wave latency on the affected side was not statistically significant compared with the unaffected side (Z=?0.595, P=0.552). Among the 42 stroke patients, the affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score (rs=0.377, P=0.014), while the correlation between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant (rs=0.104, P=0.513). Among the 16 stroke patients with carpal flexor spasm, the affected/unaffected side ratio of the F wave amplitude was positively correlated with the MAS score of the carpi flexor muscle (rs=0.550, P=0.027).ConclusionStroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, and which were related to motor function and muscle tone.
ObjectiveTo understand the burden of stroke disease and age-period-cohort effects in China from 1990 to 2021, and to provide scientific basis for formulating relevant prevention and treatment strategies. MethodsBased on GBD 2021 data, the Joinpoint regression model was used to analyze the trend of incidence rate, mortality and DALYs rate of stroke, and the APC model was used to analyze the impact of age, period and birth cohort on the incidence and mortality of stroke. ResultsFrom 1990 to 2021, the standardized incidence rate, standardized mortality rate and standardized DALYs rate of stroke in China showed an overall downward trend, with AAPC of ?0.37% (95%CI ?0.45% to ?0.29%), ?1.79% (95%CI ?1.99% to ?1.59%), and ?1.93% (95%CI ?2.07% to ?1.80%), respectively. The results of the age-period-cohort model showed that the incidence and mortality risks of stroke increased with age. The risk of female onset remained stable in the early stage but increased rapidly in the later stage, while the risk of male mortality showed a slight upward trend. The risk of onset and death generally decreased with the passage of the birth cohort. Hypertension had always been the primary risk factor for stroke, and metabolic factors such as high blood sugar had become the main factors affecting disease burden. ConclusionThe burden of stroke disease in China is still relatively heavy, and differentiated intervention measures should be developed for different age and gender groups based on controllable risk factors, especially focusing on the elderly and male population.
Objective To assess the clinical efficacy of statins for preventing stroke recurrence. Methods We searched The Cochrane Library, PubMed, EMbase, CBM, CSJD, and CJFD for randomized controlled trials on the use of statin drugs to prevent stroke recurrence (up to May 10, 2008), and manually searched key Chinese magazines in the related fields. Two reviewers extracted data independently using a designed extraction form. The quality of included trials was evaluated according to the Cochrane handbook 4.12. RevMan 5.0 software was used for data analysis. Results Six randomized controlled trials involving 9,675 patients were identified. The results of meta-analysis showed that there was no statistical difference in stroke recurrence rate (RR=0.94, 95%CI 0.84 to 1.04, P=0.21) and fatal stroke occurrence (RR=0.77, 95%CI 0.48 to 1.25, P=0.30) between statins and placebo groups, but a significant difference was found between the two groups in transient ischemic attack occurrence (RR=0.80, 95%CI 0.69 to 0.92, P=0.002). Conclusion Current evidence indicates that statin drugs have no superiority to prevent stroke recurrence and fatal stroke occurrence, but can prevent transient ischemic attack.