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Background Home visits prior to inpatient rehabilitation facility (IRF) discharge allow occupational therapists to observe functional abilities among patients with stroke and address barriers that impact daily activities at home. However, home visits prior to IRF discharge are not standard practice due to barriers of time and cost constraints. We explored whether an access visit (visiting the home without the patient) could serve as an alternative to a home visit (with the patient) to anticipate functional abilities at home. Methods We used baseline data from a randomized controlled trial that occurred before and during the COVID-19 pandemic, which caused predischarge home visits to be modified to access visits without the participant. Participants had suffered a stroke and were treated in an IRF, aged ≥ 50, with plans to discharge home. International Classification of Functioning, Disability, and Health (ICF) qualifier scores were compared between participants’ home/access visits and IRF discharge. ICF scores were compared between predischarge home visits and IRF discharge and between access visits and IRF discharge using Wilcoxon signed-rank tests. Differences in ICF scores between home/access and IRF discharge were compared between home and access visits using linear regression models. Results Among 99 participants (58% men, average 67 years old, 60% Black), 57 received a home visit and 42 received an access visit. Both groups had significantly worse ICF scores at the home/access visit compared to IRF discharge for most activities. Differences in scores between home visit and IRF were significantly greater than between access and IRF for bathing, upper and lower body dressing, bed/chair transfer, walking, and navigating stairs. The largest differences between home and access visits were for walking (β = 1.05 95% CI 0.46 to 1.64) and going up and down stairs (β = 0.87 95% CI 0.25 to 1.49). Conclusions Participants with stroke had greater difficulty performing daily activities in both home and access visits than at the IRF, but observed differences were greater for home visits than access visits. While access visits may be beneficial to anticipate functional abilities in the home when home visits cannot occur, visiting the home to directly observe patients’ performance is ideal. Trial registration Registered on 3/26/2018 at clinicaltrials.gov, NCT03485820.

Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retire­ment Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily liv­ing (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were young­er compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comor­bidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of hav­ing increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.Ethn Dis. 2020;30(2):339-348; doi:10.18865/ ed.30.2.339

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2–3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives.

Background Acute ischemic stroke (AIS) is one of the most time-sensitive diseases, which requires prompt medical services. Delayed treatment and resource scarcity during the coronavirus disease 2019 (COVID-19) pandemic may affect the quality of AIS care and increase the risk of adverse outcomes for patients. Methods The study used data from China’s National Medical Quality Database spanning from January 1, 2019, to May 31, 2022. Quality of care was gauged utilizing 15 indicators, featuring 12 quality indicators (QIs) and 3 composite indicators. We used mixed-effects and interrupted time series models to compare care quality pre- and post-pandemic. Utilization rates of 15 indicators were compared across different age and gender groups to evaluate healthcare disparities. Multilevel Logistic regression and structural equation modeling assessed the impact of the 3 composite indicators on outcome (in-hospital mortality or 30-day readmission) during the pandemic. Results Utilization rates for 10 of 12 QIs and three composite indicators declined rapidly after the COVID-19 outbreak, but later improved. The most significant drop was observed for rehabilitation (QI12), with a decrease of 50.06% ( P  < 0.0001). The overall treatment quality (Score) showed a decrease of -14.44% (95% CI -15.62% to -13.26%; P  < 0.0001), and experienced a long-term trend change of 0.58 (95% CI 0.40 to 0.75; P  < 0.0001). Female patients had lower rates for 11 QIs and all composite indicators compared with male patients, with the greatest difference noted in dysphagia screening (66.45% vs. 69.87%, P  = 0.0472). Patients aged 75 years or older had lower rates for 9 QIs and all composite indicators compared with other age groups, with the greatest difference in anticoagulation therapy (difference = 10.01%, P  < 0.0001). High-quality care was significantly associated with lower rates of adverse outcomes (OR = 0.965; 95% CI 0.962 to 0.968; P  < 0.0001). Conclusions The COVID-19 outbreak has deepened the gap between optimal care and clinical practice, which then gradually improved. During the pandemic, high-quality care was important to reduce the risk of adverse outcomes, but there were gender and age differences in the provision of health-care quality.

Outpatient rehabilitation plays a vital role in providing post-discharge care for stroke survivors' optimum recovery. Geographic variability in access to post-stroke rehabilitation care in rural areas is poorly understood. This study used Medicare claims from 2016 to 2019 to estimate incidence of stroke discharges home and compared rehabilitation utilization rates after discharge from acute hospitalization in the state of Texas. We also examined spatial accessibility to post-discharge outpatient rehabilitation centers between rural and urban areas. We supplemented claims results with a survey to better understand locations where outpatient rehabilitation clinics provided services to stroke patients. After discharge from the hospital, patients from rural counties neighboring urban counties had lower adjusted predicted probabilities of using outpatient clinic services compared to urban areas. Patients with primary diagnosis codes of stroke sequelae: adjusted relative rate of 0.84 (CI: 0.76,0.93) with an adjusted rate difference of -0.05 (CI: -0.08, -0.02), cerebral infarction: adjusted relative rate of 0.82 (CI: 0.72,0.91) with adjusted rate difference of -0.04 (CI: -0.06,-0.02), hemorrhagic patients: adjusted relative rate of 0.81 (CI: 0.71,0.91) with an adjusted rate difference of -0.04 (CI: -0.06,-0.01). We did not find discernable differences between rural and urban areas for home health utilization or the combination of outpatient clinic services with home health as a single category. Estimates from a floating-catchment spatial accessibility model scaled from 0 (worst access) to 1 (best access) showed that, compared to urban counties, indices in rural not adjacent to urban counties were -0.16 (CI: -0.23, -0.08) lower and -0.14 (CI: -0.20, -0.08) lower in rural areas in counties adjacent to urban counties. Compared to urban areas, rural areas have lower spatial access to and utilization of outpatient clinic services in the state of Texas.

Stroke has a major impact on survivors and their social environment. Care delivery is advocated to become more client-centered and home-based because of their positive impact on client outcomes. The objective of this study was to explore professionals' perspectives on the provision of Home-Based Stroke Rehabilitation (HBSR) in the Netherlands and on the barriers and facilitators influencing the implementation of HBSR in daily practice. Semi-structured focus groups were conducted to explore the perspectives of health and social care professionals involved in stroke rehabilitation. Directed content analysis was performed to analyze the transcripts of recorded conversations. Fourteen professionals participated in focus groups (n = 12) or, if unable to attend, an interview (n = 2). Participants varied in professional backgrounds and roles in treating Dutch clients post stroke. Barriers and facilitators influencing the implementation of HBSR in daily practice were identified in relation to: the innovation, the user, the organization and the socio-political context. Participants reported that HBSR can be efficient and effective to most clients because it facilitates client- and caregiver-centered rehabilitation within the clients' own environment. However, barriers in implementing HBSR were perceived in a lack of (structured) inter-professional collaboration and the transparency of expertise of primary care professionals. Also, the current financial structures for HBSR in the Netherlands are viewed as inappropriate. In line with previous studies, we found that HBSR is recognized by professionals as a promising alternative to institution-based rehabilitation for clients with sufficient capabilities (e.g. their own health and informal support). Multiple factors influencing the implementation of HBSR were identified. Our study suggests that, in order to implement HBSR in daily practice, region specific implementation strategies need to be developed. We recommend developing strategies concerning: organized and coordinated inter-professional collaboration, transparency of the expertise of primary care professionals, and the financial structures of HBSR.

Poststroke depression (PSD) is a highly prevalent and serious mental health condition affecting a significant proportion of stroke survivors worldwide. While its exact causes remain under investigation, managing PSD presents a significant challenge. This study aimed to evaluate the prevalence and predictors of depression among Bangladeshi stroke victims. A cross-sectional study was carried out with 725 stroke victims who were receiving medical care at three designated tertiary care hospitals in Sylhet from January to December 2023. Depression and disability were measured using the Patient Health Questionnaire-9 and the Modified Rankin Scale. Logistic regression analysis was employed to examine the predictors linked to depression. According to the study, 80.8% of individuals had moderate to severe disability, and 58.1% of them experienced a moderate to severe level of depression. Individuals who had hemorrhagic stroke (AOR 1.31, 95% CI: 0.77-2.25), repeated episodes (AOR 3.41, 95% CI: 1.89-6.14), tobacco use (AOR 1.76, 95% CI: 1.16-2.67), or coexisting health conditions (AOR 1.68, 95% CI: 1.00-2.82) exhibited elevated levels of depression. Participants whose medical expenses covered by relatives or others were six times more likely to experience depressive symptoms (AOR 6.32, 95% CI: 1.61-24.76). Individuals who did not receive rehabilitation services had two times greater odds of being depressed (OR 1.85, 95% CI: 1.23-2.77, p = 0.003). Consequently, individuals with low functional status had eleven times greater levels of depression (AOR 11.03, 95% CI: 7.14-17.04). More than half of the participants in this present study reported moderate to extreme levels of depression which is a serious health issue among Bangladeshi stroke survivors. Understanding the predictors of depression linked to stroke could enhance the effectiveness of therapeutic interventions for this condition. In addition, multidisciplinary teams should work collaboratively to address this serious issue.

Previous studies have suggested that the nutritional status after stroke is independently associated with long-term outcomes and that sarcopenia delays poststroke rehabilitation and worsens the prognosis. However, many stroke patients have a deteriorated nutritional status and a decreased muscle mass in the acute phase. This prospective study included 179 patients who were admitted to the stroke rehabilitation unit. We performed bioelectrical impedance analysis and determined the Geriatric Nutritional Risk Index (GNRI) to assess muscle mass and the nutritional status on admission. Furthermore, we analyzed the activities of daily living using the Functional Independence Measure (FIM) at the time of admission and four weeks later. Furthermore, we evaluated the change in motor FIM items and examined the relationship with the data. Multiple regression analysis revealed that a high muscle rate (skeletal muscle mass/body weight) (odds ratio OR = 2.43), high phase angle (OR = 3.32), and high GNRI (OR = 2.57) were significantly associated with motor FIM items at four weeks in male and female patients. Muscle mass maintenance through nutritional management and early rehabilitation in the acute period of stroke is essential for functional recovery in stroke patients.

Successful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). We conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P’s, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. The inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P’s criteria) and integration of ethical, legal, social, and economic considerations. There are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes. •Extensive search for guidelines in English and Spanish.•Multiple quality measures were used in stroke rehabilitation guidelines.•A comparison of guidelines based on country resources was made.

•This study focused only on disabled stroke patients.•This study included a new variables-intermittent oro-esophageal tube feeding.•This study used sample saturation to ensure reliability of result.•This study developed a nomogram with simplification. Although malnutrition has been shown to influence the clinical outcome of poststroke disabled patients, the associated factors and the prediction model have yet to be uncovered. This study aims to assess the current prevalence and factors associated with malnutrition in poststroke disabled patients and establish a prediction model. A multicenter cross-sectional survey among Chinese poststroke disabled patients (≥18 y old) was conducted in 2021. Information on patients’ basic data, medical history, Barthel Index, dysphagia, and nutritional status was collected. A multivariable logistic regression model was used to identify the factors that influence malnutrition. Nomogram was developed and internal validation was conducted using 5-fold cross-validation. External validation was performed using the data from a preliminary survey. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA) were used to analyze the predictive value of the nomogram. Four hundred fifty-seven cases were enrolled, with the prevalence of malnutrition as 71.77%. Age (aOR = 1.039, 95% CI: 1.006–1.078), pulmonary infection (aOR = 4.301, 95% CI: 2.268–14.464), dysphagia (aOR = 24.605, 95% CI: 4.966–191.058), total intake volume (aOR = 0.997, 95% CI: 0.995–0.999), Barthel Index (aOR = 0.965, 95% CI: 0.951–0.980), and nasogastric tube (aOR = 16.529, 95% CI: 7.418–52.518) as nutrition support mode (compared to oral intake) were identified as the associated factors of malnutrition in stroke-disabled patients (P < 0.05). ROC analysis showed that the area under the curve (AUC) for nomogram was 0.854 (95% CI: 0.816–0.892). Fivefold cross-validation showed the mean AUC as 0.829 (95% CI: 0.784–0.873). There were no significant differences between predicted and actual probabilities. The DCA revealed that the model exhibited a net benefit when the risk threshold was between 0 and 0.4. Age, pulmonary infection, dysphagia, nutrition support mode, total intake volume, and Barthel Index were factors associated with malnutrition in stroke-related disabled patients. The nomogram based on the result exhibited good accuracy, consistency and values.