U-Rate-UE; Measuring Perceived Recovery of the Affected Upper Extremity in Adults Post-stroke.

OBJECTIVE: To establish initial validity of "U-Rate-UE", a single-question scale regarding perceived recovery of the stroke affected upper extremity (UE). DESIGN: A retrospective longitudinal study of data collected at rehabilitation admission, 6 weeks, and 6 months since stroke. SETTING: Stroke rehabilitation and community-based. PARTICIPANTS: A convenience sample of 87 individuals, median (interquartile range) age 71.5 (65-80) years, 15.0 (12-20) days post-stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The affected UE was assessed using the Fugl-Meyer Motor Assessment, grip strength, Action Research Arm Test, the Box and Block Test (BBT), and The Rating of Everyday Arm-Use in the Community and Home. Participants also rated how much they perceive that their affected UE recovered from the stroke using U-Rate-UE; 0-100 (no to full recovery). Longitudinal changes in U-Rate-UE ratings were assessed. In addition, at 6 weeks and 6 months post-stroke, the change in BBT was calculated and participants were grouped into achieved/did not achieve the minimal detectable change (MDC). Correlations between U-Rate-UE to the other UE assessments were assessed at all 3 timepoints. RESULTS: Significant changes in U-Rate-UE were seen over time (P<.05). At 6 weeks and 6 months, participants who achieved BBT-MDC rated their recovery significantly higher than participants who did not. U-Rate-UE was moderately-strongly significantly correlated to UE assessments (rho=.61-.85, P<.001). CONCLUSIONS: The U-Rate-UE is supported for use with UE assessments contributing to comprehensive clinical understanding of the recovery of the affected UE in adults post-stroke.

Less-Affected Hand Function Is Associated With Independence in Daily Living: A Longitudinal Study Poststroke.

BACKGROUND AND PURPOSE: The upper extremity (UE) ipsilateral to the brain lesion is mildly affected poststroke. It is unclear whether patients perceive this, and the association between less-affected hand function and independence in activities of daily living (ADL) is unknown. We aimed to (1) assess longitudinal changes in function, dexterity, grip strength, and self-perception of the less-affected UE, (2) compare them to the normative data, and (3) determine the association of both UEs to ADL during the first 6 months poststroke. METHODS: Consecutive adults following a first stroke were assessed on rehabilitation admission (T1), 6 weeks (T2), and 6 months (T3) poststroke onset. Box and block test assessed function of both UEs. The functional dexterity test (FDT) and Jamar Dynamometer assessed dexterity and grip strength of the less-affected UE. The functional independence measure assessed ADL, and instrumental ADL was assessed at T3. Spearman correlations and multiple regression models were used. RESULTS: Participants were assessed at T1 (N=87), T2 (N=82), and T3 (N=68). At T1, less-affected UE deficits were apparent (median [interquartile range] box and block test-45 [35-53] blocks, FDT-44.5 [33.3-60.8] seconds, grip-25.5 [16.2-33.9] kilograms), but only 19.5% of the participants self-perceived this. Less-affected hand function significantly improved with 32% and 33% achieving a minimal clinically important difference for box and block test at T2 and T3, respectively. Dexterity improved significantly between T1 and T2 (P<0.001, no established minimal clinically important difference) and grip strength improved significantly between T2 and T3; 3.4% achieving a minimal clinically important difference (P<0.01). At T3, most participants did not reach the norms (box and block test-67.4 blocks, FDT-32.2 seconds, grip-40.5 kilograms). Both the less- and more-affected UEs explained a large portion of the variance of ADL at all time-points, after controlling for age, days-since-stroke-onset, stroke type, and cognition. CONCLUSIONS: Despite some improvement, the less-affected UE at 6 months poststroke remained below norms, explaining difficulties in ADL and instrumental ADL. Further research is needed.

Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients.

BACKGROUND & AIMS: Malnutrition is common in hip fracture elderly patients. There is no gold standard for screening nutritional risk. We compared the adequacy of 3 screening tools, their association to nutritional measurements and their ability to predict outcome. METHODS: The Mini Nutrition Assessment Short Form (MNA-SF), the Malnutrition Universal Screening Tool (MUST) and the Nutrition Risk Screening 2002 (NRS-2002) were prospectively determined. Length of stay (LOS), complications, 6 months readmission and up-to 36 months mortality were recorded. RESULTS: 215 operated patients were included: 154 (71.6%) were women; mean age was 83.5 ± 6.09 years (66-104). According to the MNA-SF, 95 patients were well-nourished, 95 were at risk of malnutrition and 25 were malnourished. Based on the MUST, 171 patients were at a low risk of malnutrition, 31 at a medium risk, 13 at a high risk. According to the NRS-2002, 134 patients were at a low risk of malnutrition, 70 at a medium risk, 11 at a high risk. A significant relationship between the nutritional groups of the 3 scores (p < 0.001) was found. In all screening tools, body mass index, weight loss and food intake prior to admission were found to be related to the patients' nutritional status (p < 0.001). No differences in LOS and complications were found between the patients' nutritional status of each screening tool; only the MNA-SF predicted that well-nourished patients would have less readmissions during a 6 month follow-up (p = 0.024). During a 36 month follow-up, 79 patients died. According to the MNA-SF, mortality was lower in the well-nourished patients vs. the malnourished (p = 0.001) and at risk of malnutrition patients (p = 0.01). A less significant association was found between the NRS-2002 patients' nutritional status and mortality (p = 0.048). The MUST did not reveal this relationship. CONCLUSIONS: All screening tools were adequate in assessing malnutrition parameters in hip fracture operated elderly patients, however, only the MNA-SF could also predict readmissions and mortality.

Rates, variability, and associated factors of polypharmacy in nursing home patients.

OBJECTIVES: To determine the rate and variability of polypharmacy in nursing home (NH) residents and investigate its relationship to age, sex, functional status, length of stay, and comorbidities. METHODS: We conducted a cross sectional, multicenter study that included six nursing homes. Demographic, clinical characteristics, Charlson comorbidity index (CCI), the number and classes of chronic medications, rate of polypharmacy >5 drugs (per day) and polypharmacy >7 drugs (per day) were recorded. RESULTS: Nine hundred and ninety-three residents were included; 750 (75.5%) fully dependent residents and 243 (24.5%) mobile demented residents requiring institutional care. The mean age was 85.04±7.55 (65-108) years. The mean rates of polypharmacy >5 drugs and polypharmacy >7 drugs were 42.6% and 18.6%, respectively. Differences in polypharmacy >5 drugs and polypharmacy >7 drugs were observed in NHs 24.7%-56% and 4.9%-30.4%, respectively (P<0.001). Mean number of chronic drugs per resident was 5.14±2.60 from 3.81±2.24 to 5.95±2.73 (P<0.001). No differences in polypharmacy were found between sex and fully dependent versus mobile demented residents. The most common medications taken were for gastrointestinal, neurological, and cardiovascular disorders. Regression analysis revealed four independent variables for polypharmacy >5 drugs: groups aged 75-84 and >85 relative to 65-74, odds ratio (OR) 0.46 (95% confidence interval [CI] 0.27-0.78) P=0.004, OR 0.35 (95% confidence interval 0.19-0.53), respectively, P<0.001; length of stay >2 years, OR 0.51 (95% CI 0.36-0.73) P<0.001; CCI, OR 1.58 (95% CI 1.42-1.75) P<0.001; and feeding tube versus normal feeding, OR 0.27 (95% CI 0.12-0.60) P=0.001. CONCLUSION: Rates of polypharmacy in NHs are high with significant variability. Variability rates of polypharmacy, distinct residents' characteristics, and excessive use of certain drug groups may indicate that a decrease in medication is potentially feasible.