Cargando…

Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities

BACKGROUND: Many stroke recovery interventions are most beneficial when started 2-14d post-stroke, a time when patients become eligible for inpatient rehabilitation facilities (IRF) and neuroplasticity is often at its peak. Clinical trials focused on recovery need to expand the time from this plasti...

Descripción completa

Detalles Bibliográficos
Autores principales: Taleb, Shayandokht, Lee, Jenny Ji-hyun, Duncan, Pamela, Cramer, Steven C., Bahr-Hosseini, Mersedeh, Su, Michael, Starkman, Sidney, Avila, Gilda, Hochberg, Arielle, Hamilton, Scott, Conwit, Robin A., Saver, Jeffrey L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10280859/
https://www.ncbi.nlm.nih.gov/pubmed/37340330
http://dx.doi.org/10.1186/s12883-023-03251-1
_version_ 1785060889927352320
author Taleb, Shayandokht
Lee, Jenny Ji-hyun
Duncan, Pamela
Cramer, Steven C.
Bahr-Hosseini, Mersedeh
Su, Michael
Starkman, Sidney
Avila, Gilda
Hochberg, Arielle
Hamilton, Scott
Conwit, Robin A.
Saver, Jeffrey L.
author_facet Taleb, Shayandokht
Lee, Jenny Ji-hyun
Duncan, Pamela
Cramer, Steven C.
Bahr-Hosseini, Mersedeh
Su, Michael
Starkman, Sidney
Avila, Gilda
Hochberg, Arielle
Hamilton, Scott
Conwit, Robin A.
Saver, Jeffrey L.
author_sort Taleb, Shayandokht
collection PubMed
description BACKGROUND: Many stroke recovery interventions are most beneficial when started 2-14d post-stroke, a time when patients become eligible for inpatient rehabilitation facilities (IRF) and neuroplasticity is often at its peak. Clinical trials focused on recovery need to expand the time from this plasticity to later outcome timepoints. METHODS: The disability course of patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) enrolled in Field Administration of Stroke Therapy Magnesium (FAST-MAG) Trial with moderate-severe disability (modified Rankin Scale [mRS] 3–5) on post-stroke day4 who were discharged to IRF 2-14d post-stroke were analyzed. RESULTS: Among 1422 patients, 446 (31.4%) were discharged to IRFs, including 23.6% within 2-14d and 7.8% beyond 14d. Patients with mRS 3–5 on day4 discharged to IRFs between 2-14d accounted for 21.7% (226/1041) of AIS patients and 28.9% (110/381) of ICH patients, (p < 0.001). Among these AIS patients, age was 69.8 (± 12.7), initial NIHSS median 8 (IQR 4–12), and day4 mRS = 3 in 16.4%, mRS = 4 in 50.0%, and mRS = 5 in 33.6%. Among these ICH patients, age was 62.4 (± 11.7), initial NIHSS median 9 (IQR 5–13), day 4 mRS = 3 in 9.4%, mRS = 4 in 45.3%, and mRS = 5 in 45.3% (p < 0.01 for AIS vs ICH). Between day4 to day90, mRS improved ≥ 1 levels in 72.6% of AIS patients vs 77.3% of ICH patients, p = 0.3. For AIS, mRS improved from mean 4.17 (± 0.7) to 2.84 (± 1.5); for ICH, mRS improved from mean 4.35 (± 0.7) to 2.75 (± 1.3). Patients discharged to IRF beyond day14 had less improvement on day90 mRS compared with patients discharged between 2-14d. CONCLUSIONS: In this acute stroke cohort, nearly 1 in 4 patients with moderate-severe disability on post-stroke day4 were transferred to IRF within 2-14d post-stroke. ICH patients had nominally greater mean improvement on mRS day90 than AIS patients. This course delineation provides a roadmap for future rehabilitation intervention studies.
format Online
Article
Text
id pubmed-10280859
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-102808592023-06-21 Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities Taleb, Shayandokht Lee, Jenny Ji-hyun Duncan, Pamela Cramer, Steven C. Bahr-Hosseini, Mersedeh Su, Michael Starkman, Sidney Avila, Gilda Hochberg, Arielle Hamilton, Scott Conwit, Robin A. Saver, Jeffrey L. BMC Neurol Research BACKGROUND: Many stroke recovery interventions are most beneficial when started 2-14d post-stroke, a time when patients become eligible for inpatient rehabilitation facilities (IRF) and neuroplasticity is often at its peak. Clinical trials focused on recovery need to expand the time from this plasticity to later outcome timepoints. METHODS: The disability course of patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) enrolled in Field Administration of Stroke Therapy Magnesium (FAST-MAG) Trial with moderate-severe disability (modified Rankin Scale [mRS] 3–5) on post-stroke day4 who were discharged to IRF 2-14d post-stroke were analyzed. RESULTS: Among 1422 patients, 446 (31.4%) were discharged to IRFs, including 23.6% within 2-14d and 7.8% beyond 14d. Patients with mRS 3–5 on day4 discharged to IRFs between 2-14d accounted for 21.7% (226/1041) of AIS patients and 28.9% (110/381) of ICH patients, (p < 0.001). Among these AIS patients, age was 69.8 (± 12.7), initial NIHSS median 8 (IQR 4–12), and day4 mRS = 3 in 16.4%, mRS = 4 in 50.0%, and mRS = 5 in 33.6%. Among these ICH patients, age was 62.4 (± 11.7), initial NIHSS median 9 (IQR 5–13), day 4 mRS = 3 in 9.4%, mRS = 4 in 45.3%, and mRS = 5 in 45.3% (p < 0.01 for AIS vs ICH). Between day4 to day90, mRS improved ≥ 1 levels in 72.6% of AIS patients vs 77.3% of ICH patients, p = 0.3. For AIS, mRS improved from mean 4.17 (± 0.7) to 2.84 (± 1.5); for ICH, mRS improved from mean 4.35 (± 0.7) to 2.75 (± 1.3). Patients discharged to IRF beyond day14 had less improvement on day90 mRS compared with patients discharged between 2-14d. CONCLUSIONS: In this acute stroke cohort, nearly 1 in 4 patients with moderate-severe disability on post-stroke day4 were transferred to IRF within 2-14d post-stroke. ICH patients had nominally greater mean improvement on mRS day90 than AIS patients. This course delineation provides a roadmap for future rehabilitation intervention studies. BioMed Central 2023-06-20 /pmc/articles/PMC10280859/ /pubmed/37340330 http://dx.doi.org/10.1186/s12883-023-03251-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Taleb, Shayandokht
Lee, Jenny Ji-hyun
Duncan, Pamela
Cramer, Steven C.
Bahr-Hosseini, Mersedeh
Su, Michael
Starkman, Sidney
Avila, Gilda
Hochberg, Arielle
Hamilton, Scott
Conwit, Robin A.
Saver, Jeffrey L.
Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities
title Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities
title_full Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities
title_fullStr Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities
title_full_unstemmed Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities
title_short Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities
title_sort essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10280859/
https://www.ncbi.nlm.nih.gov/pubmed/37340330
http://dx.doi.org/10.1186/s12883-023-03251-1
work_keys_str_mv AT talebshayandokht essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT leejennyjihyun essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT duncanpamela essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT cramerstevenc essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT bahrhosseinimersedeh essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT sumichael essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT starkmansidney essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT avilagilda essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT hochbergarielle essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT hamiltonscott essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT conwitrobina essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities
AT saverjeffreyl essentialinformationforneurorecoveryclinicaltrialdesigntrajectoryofglobaldisabilityinfirst90dayspoststrokeinpatientsdischargedtoacuterehabilitationfacilities