| S1
(7)
|
In the postdischarge period (12-month follow-up), the caregivers of elderly patients with stroke who participated in the experimental group provided care of better quality (ß=0.45; p=0.03) than those of the control group; between month 6 and 12 after discharge, the probability of re-hospitalization was higher for control group patients than for the experimental group patients (X2=5.11; p=0.03). Conclusion: early attention and care, training, evaluation and follow-up of patients and their families (caregivers) during hospitalization and after discharge, improve the quality of care provided to patients and reduces re-hospitalization. |
| S2
(8)
|
Considering all domains analyzed related to stroke […], the effect size of the treatment was close to 0 […] for all of them, except for the domain "knowledge and lifestyle", which showed a significant effect resulting from the intervention (p=0.0003). Only the domain "knowledge and lifestyle" improved with the intervention, not demonstrating the superiority of any model ("comprehen-sive postdischarge care management") in relation to others ("organized acute stroke department care with enhanced discharge planning"). However, in both groups, discharge planning and follow-up were guaranteed. |
| S3
(9)
|
The depressive symptoms were associated with a lower health-related quality of life (HRQoL). The ability to perform personal and social activities, the interests, younger age, education (basic, elementary education) and reduced length of stay were associated with higher HRQoL. The perception of participation in their own discharge planning was positively and negatively associated with HRQoL. Several variables contribute to HRQoL in two to three weeks after the discharge, particularly fewer depressive symptoms and involve-ment/participation in social activities (such as outdoor activities and interest-driven activities). The participation in their own discharge planning was positively and negatively perceived by the patients. |
| S4
(10)
|
This comment by Griffiths (E4) regarding the study conducted by Anderson et al. (S5) highlights important aspects related to pa-tients with stroke and the hospital-home transition process (ex.: rehabilitation, length of stay, discharge). It highlights that early discharge does not lead to significantly better results (at month 6) for the patients and it may cause worse results in terms of QoL and mental health for their caregivers. It also reminds that the care provided at stroke centers is more effec-tive than the care provided by general infirmaries. Conclusion: this comment states reduced length of stay (accelerating hospital discharge) may occur without apparent damage to relatively independent patients with stroke; it also states weak evidence of the advantages of early discharge and lower costs related to patients (staying) in the (habitual) general care units; it also states further studies should be conducted on impacts on caregivers […]. |
S5
(11)
[S4.1] |
Study commented by Griffiths [S4], which presents the following results and conclusions: in general, the clinical results at month 6 after randomization, did not differ significantly in the comparison between the groups, but the total length of stay in the ex-perimental group was significantly reduced (15 versus 30 days; p=0.001). The caregivers from the "home rehabilitation" group presented significantly lower levels of mental health (SF-36) […]. |
| S6
(12)
|
The groups were analyzed through different approaches: habitual care versus discharge intervention through care planning (interdis-ciplinary teams) and strict collaboration with primary care units (clinical centers). A significant improvement was presented in all 5 domains evaluated (with each domain showing a positive effect of the interven-tion), leading to a better profile of health and secondary prevention (p <0.0001), at month 3 after CVA and after TIA. Thus, this care management model resulted in significant improvement of the profile of health and secondary prevention at month 3 after discharge. |
| S7
(13)
|
The studies/articles suggest that the stroke survivors and their families have additional education and support needs besides the typical attention, and this intervention may be leveraged by adopting more active (and not reactive) actions, preventing crises or potentially preventable ruptures. This review provides information about the ideal methods of communication and planning and identifies how to benefit from these opportunities. Conclusions: there is much to be performed by the multidisciplinary team; additional investigation and experimental studies […] will allow improved and better-informed clinical practice and develop bet-ter practical guidelines to ensure reduced stress and anxiety of caregivers, at admission and discharge; additional investigation is needed on the effects of education and emotional support provided at hospitals and primary care clinics. |
| S8
(14)
|
Two and a half years after hospital discharge (t3), significantly fewer patients of the experimental group were hospitalized (2 versus 5) or died (4 versus 11) [p=0.010]. Participation in an intensive training/work program and hospital discharge process planning leads to better results in general, even in the long term (t3), representing a significant predictor (the 3rd, related to better functional quality at discharge and younger age) for lower hospitalization and mortality rates. The effects of participation in a program with these characteristics may persist in the long term, leading to care maintenance at home and reducing hospitalization and mortality rates. |
| S9
(15)
|
Despite the numerous results, the study concluded that a well-structured and monitored program, especially in terms of objec-tives and duration (ICP - Integrated Care Pathway), did not show any advantage over a conventional multidisciplinary approach (regarding the functional recovery and indicators of quality of life), in patients with stroke followed up at stroke rehabilitation units. Such indicators of functional recovery and quality of life (QoL) were better and reached more quickly in the group that received a conventional multidisciplinary approach. |
| S10
(16)
|
The results of this study showed that patients with minor stroke and their spouses and caregivers may experience great challenges in postdischarge adaptation. Recovery from a minor stroke may require a reformulation of life plans and priorities, and the inclu-sion of resulting inabilities in current and future situations, for the patients and their spouses and caregivers. In many cases, such adaptations are aggravated by transitions associated with the normal aging process. The study concluded that there is not enough information about the recovery process (and the role of caregivers) of patients with minor stroke in relation to the normal aging process. Therefore, further investigation is required to analyze this transition, to sup-port discharge planning actions performed by nurses and other health professionals. |
| S11
(17)
|
This comment by Stevenson (S11) to the study conducted by Kalra, Evans, Perez et al. (Snot selected) highlights the main results and conclusions, among other important aspects. This comment provided under the title "Training informal caregivers of patients with stroke improved patient and caregiver QoL and reduced costs" states that, at month 12, the patients from the group of trained caregivers improved their mood and quality of life, but no difference was observed in relation to the patients from the usual care group, in terms of mortality, hospitalization and functionality. Regarding the caregivers from the experimental group, they im-proved their mood and QoL, with reduced overload due to care provision, when compared to the control group of usual care […]. In brief, the provision of training to caregivers of patients with stroke improves their QoL and mood/vigor, reduces health care costs without, however, impacts on mortality, hospitalization and functionality of patients, when compared to usual procedures of the caregivers without a specific training. |
| S12
(18)
|
An ongoing experimental study that started in November 2013, and whose last patient was included on August, 1st, 2015. A study with acupuncture acting as an experimental variable in the therapeutic process, which comprises speech/language therapy plus initial therapy (for patients with post-stroke aphasia). |
| S13
(19)
|
An analysis was conducted (a literature review) of 4 central aspects in care provision to patients with stroke (fast evaluation and treatment start; thrombolytic therapy; organized stroke units; early controlled discharge, with community supporting services). The authors state it would be possible to have substantially better results. They indicate it would be possible to reduce the num-ber of annual hospital episodes (3.3%), reduce the number of days in intensive care units (25.9%), reduce the number of days in home care (12.8%), reduce the number of deaths in hospitals (14.9%), and reduce the amount of direct and indirect costs in the country. Conclusion: they state that it would be possible to substantially reduce costs and improve clinical results if the effective and largely known treatment types were more intensively used. |
| S14
(20)
|
This study addresses the problem of stroke in young people (aged 18 to 55 years), relating it to the Fabry disease, in a prospective study whose objective was to estimate and determine the prevalence of Fabry disease in adult and young patients with stroke. Conclusion: they assume that this was the first initiative in the country (at the time) developed to determine the prevalence of a positive result for Fabry disease in young adults with stroke. In addition, this initiative (Canadian Fabry Stroke Screening Initiative) will provide information about recurrent vascular events, inability present at month 6 (via modified Rankin scale), and predisposi-tion of this poorly studied population. |
| S15
(21)
|
This prospective study without any explicitly defined objectives intended to determine long-term effects of intensive rehabilita-tion therapy in patients with CVA. In summary, the results indicated low functionality at month 12 was significantly correlated with longer length of stay, longer time between stroke and being transferred from acute care to a rehabilitation unit, and higher levels of depression at month 12. Conclusion: about half the patients recovered at least one degree in the level of inability mea-sured in the follow-up; however, they emphasize that low functionality at month 12 is associated with longer length of stay (1st admission), delay in rehabilitation program and psychological depression. |
| S16
(22)
|
Approach to the prognostic value of delusion symptoms in patients hospitalized in intensive care units (ICUs), with brain injury caused by intracerebral hemorrhage (not by ischemic stroke). The presence of such symptoms of delusion was associated with higher probability of negative functional results (poor functionality) and lower QoL in the future, in the domains of cognitive-executive function, after corrections for brain damage at admission, age, therapeutic measures (benzodiazepines), among others. Conclusion: they state that, after focal brain injury, the symptoms of delusion are frequent, despite low infection rates and the sedative therapy, and act as predictors of poor functional results and lower QoL. |
| S17
(23)
|
A retrospective study that questions and demonstrates how an intensified thrombolytic therapy (thrombolysis) reduces health care costs (leading to moderate savings) and improves the scores/levels of QoL of patients. Results: the study states the costs (of thrombolysis) make up for the reduced hospital costs of rehabilitation and hospitalization, with corresponding improvement in QoL. An increase of 10% to 50% in thrombolytic therapy in eligible patients potentially corresponds to 8.26% savings in (com-munity) rehabilitation costs and 12.3% savings in hospitalization costs, per patient. |
| S18
(24)
|
The age of patients was significantly related to their QoL. Also, the age and level of instruction of their caregivers were significant-ly related to QoL. The inability of patients at hospital admission and length of stay were associated with QoL, and the inability of patients at hospital admission was also related to the QoL of caregivers. No relation was observed between length of stay and QoL of caregivers. Patient satisfaction with care provision was associated with the QoL of both patients and caregivers. Using the APIM model, which can consists in an Actor - Partner (patient - caregiver) Interdependence Model, the authors conclude that patient satisfaction with care provision was the most important indicator and determinant of QoL of patients and caregivers. |
| S19
(25)
|
Although the study analyzed a particular group of patients - with stroke and Chagas disease, the authors attempted to investigate a correlation between inability and depressive symptoms (associated with stroke) with functional performance and QoL. A cor-relation was observed between the functional scores (mRS and BI), but not with the subscales of QoL; with these subscales, a correlation was observed between the scores in the depression scale, although depression was not associated with basic func-tionality. They also observed a stronger correlation and influence on QoL with the depressive symptoms than with the motor consequences of stroke, although these motor sequelae affect functionality more than the depressive symptoms. |
