Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Introduction
Previous qualitative and cross-sectional research has identified a strong sense of mental defeat in people with chronic pain who also experience the greatest levels of distress and disability. This study will adopt a longitudinal experience sampling design to examine the within-person link between the sense of mental defeat and distress and disability associated with chronic pain.

Methods and analysis
We aim to recruit 198 participants (aged 18–65 years) with chronic pain, to complete two waves of experience sampling over 1 week, 6 months apart (time 1 and time 2). During each wave of experience sampling, the participants are asked to complete three short online surveys per day, to provide in-the-moment ratings of mental defeat, pain, medication usage, physical and social activity, stress, mood, self-compassion, and attention using visual analogue scales. Sleep and physical activity will be measured using a daily diary as well as with wrist actigraphy worn continuously by participants throughout each wave. Linear mixed models and Gaussian graphical models will be fit to the data to: (1) examine the within-person, day-to-day association of mental defeat with outcomes (ie, pain, physical/social activity, medication use and sleep), (2) examine the dynamic temporal and contemporaneous networks of mental defeat with all outcomes and the hypothesised mechanisms of outcomes (ie, perceived stress, mood, attention and self-compassion).

Ethics and dissemination
The current protocol has been approved by the Health Research Authority and West Midlands—Solihull Research Ethics Committee (Reference Number: 17/WM0053). The study is being conducted in adherence with the Declaration of Helsinki, Warwick Standard Operating Procedures and applicable UK legislation.

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Stroke, Ahead of Print. BACKGROUND:Stroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose.METHODS:Adults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons.RESULTS:Of 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses.CONCLUSIONS:Rehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.

Objectives
Up to a quarter of the world’s population experience chronic pain, which, in addition to interfering with daily activities and waking function, is often associated with poor sleep. Individuals experiencing poor sleep are often encouraged to implement sleep hygiene strategies. However, current sleep hygiene strategies have not been developed considering the unique challenges faced by individuals with chronic pain and therefore they might not be as effective in this population. The aim of this scoping review is to map the state of the existing literature examining sleep hygiene strategies in individuals with chronic pain.

Design
This scoping review included a search of four online databases (Medline, Embase, PsycINFO and CINAHL) to identify articles examining the use of sleep hygiene strategies in populations with chronic pain.

Results
Thirty articles investigated at least one sleep hygiene strategy in individuals with chronic pain, with improvements to sleep reported for six sleep hygiene strategies (education, exercise, limiting alcohol use, limiting tobacco use, prebed state and sleep environment). However, the timing of these strategies was often not reported which limits the degree to which these strategies can be generalised for use as a presleep strategy.

Conclusion
This scoping review examined the existing literature focusing on sleep hygiene strategies for people with chronic pain. There are limitations to the methodology of the existing literature and gaps in our understanding of sleep hygiene strategies in some chronic pain conditions that must be addressed in future research before the effectiveness of these strategies can be understood.

Stroke, Volume 54, Issue Suppl_1, Page A117-A117, February 1, 2023. Background:Unnecessary admissions fuel rising healthcare costs and take away resources from higher acuity patients without evidence of increased safety.Purpose:The purpose of this quality improvement project was to determine if the care diversion for transient ischemic attack (TIA), from inpatient to a nurse practitioner (NP)-led specialty clinic, resulted in no increase in stroke incidence at 90 days.Methods:The sample included all adults (18 years or older) presenting to the emergency department (ED) with TIA at low-to-moderate risk for stroke. Risks were defined by the ABCD2score and non-invasive vessel imaging. Patients who met the criteria were discharged and evaluated by a stroke NP at the TIA clinic within seven days. These patients were compared to those who were admitted to the hospital prior to clinic launch. Chart reviews were conducted to determine stroke incidence at 90 days post TIA. Descriptive statistics were used to evaluate clinical variables, and Fisher’s Exact test was used to assess difference in stroke rates. Patient satisfaction score was collected using the existing institutional survey.Results:Eighty-one participants were included, 40 in the clinic group and 41 in the admission group. The mean ages in the clinic group and the admission group were 72.8 and 75.2 years, respectively (p=0.37). Females comprised 45% of patients in the clinic group, compared to 51.2% in the admission group (p=0.58). The mean ABCD2scores were 4.08 and 3.95 in the clinic and admission groups, respectively (p=0.63). The median clinic follow-up time was six days. There was no stroke incidence in the clinic group and one incidence in the admission group (p=1.0) within 90 days of index TIA. Patient satisfaction score of the NP was 92.6%.Conclusions:In conclusion, referral to an NP-led clinic in patients with low-to-moderate risk TIA was equally safe as hospital admission.

Stroke, Volume 54, Issue Suppl_1, Page A26-A26, February 1, 2023. Introduction:Plavix resistance is an independent risk factor for thromboembolic complications following carotid artery stent (CAS) placements. The VerifyNow P2Y12 assay is the best studied in gauging for Plavix responsiveness. Its performance is affected when hematocrit (HCT) value is

Stroke, Volume 54, Issue Suppl_1, Page AWMP4-AWMP4, February 1, 2023. Background:In stroke patients with large vessel occlusion and extensive early ischemic change, the role of bridging thrombolysis prior to endovascular thrombectomy (EVT) is still to be determined.Aim:To examine the impact of ischemic change on the efficacy and safety of bridging thrombolysis in patients treated with EVT.Methods:Consecutive anterior circulation EVT patients from a prospectively collected registry were included in this retrospective analysis. Alberta stroke programme early CT scores (ASPECTS) were evaluated from initial non-contrast CT scan with lower score indicating larger areas of early ischemic change. Outcome measures included symptomatic intracranial hemorrhage and functional independence (modified Rankin scale score 0-2) at day 90. Multivariable logistic regression models with interaction terms between ASPECTS and bridging thrombolysis were created. ASPECTS was treated as numeric variable in the primary analysis and trichotomized (ASPECTS ≤5, 6-8, 9-10) in a sensitivity analysis.Results:872 EVT patients (384 female, mean ± SD age of 67 ± 15, baseline NIHSS 16 [IQR 11-20], median ASPECTS 8 [range 2-10]) were included. 436 (50%) received bridging intravenous thrombolysis with alteplase. There was no significant main effect of ASPECTS on sICH (main effect OR 0.73 95%CI 0.45-1.21, p=0.24) and no modifying effect of thrombolysis (interaction p=0.65). With decreasing numeric ASPECTS, the probability of functional independence reduced (main effect OR 1.34 95%CI 1.20-1.49, p

Stroke, Volume 54, Issue Suppl_1, Page A61-A61, February 1, 2023. Introduction:It is standard to observe acute ischemic stroke (AIS) patients under high intensity monitoring (HIM) for the first 24 hours after intravenous thrombolysis (IVT). However, HIM is resource intensive and may not be necessary for every AIS patient. This study evaluates the safety and efficacy of low-intensity monitoring (LIM) for a subset of low-risk AIS patients who received IVT.Methods:Data from patients discharged from 2 hospitals between April 2020-April 2022 admitted to LIM post-IVT were retrospectively abstracted from patient records. Patients under age 18, arrival NIHSS ≥17, presence of large vessel occlusion, need for endovascular therapy, uncontrolled high blood pressure or unstable neuro exam (change in NIHSS of 4 or more within the 1st hour) were excluded. Primary outcomes were transfer back to HIM, instances and treatment of high blood pressure (HBP), in-hospital stroke mortality, discharge disposition and 90-day mRS. Population characteristics of age, sex, race, medical history, transfers to hub prior to LIM admission, discharge mRS and door-to-needle times were also examined.Results:Among 173 patients who met inclusion criteria, 1 (.6%) patient was transferred back to HIM and no patients died from in-patient stroke-related causes. Most patients were discharged home (80.9%) with a median 90-day mRS score of 1 (IQR: 0, 2, Table 1).Conclusion:LIM can reduce resource intensity of stroke care and free up critical care beds, which can result in less cost for the hospital and the patient. We conclude that LIM is safe and effective and could be the standard of care for low-risk AIS patients treated with IVT.

Stroke, Volume 54, Issue Suppl_1, Page AWMP55-AWMP55, February 1, 2023. Background:Current guidelines encourage early vascular imaging to assess for large vessel occlusions (LVO) in patients presenting with NIHSS ≥ 6 to establish candidacy for mechanical thrombectomy (MT). In patients with low NIHSS, the benefit of early vascular imaging is uncertain. Cortical signs such as aphasia, neglect or visual field deficits on the exam have been used to identify patients with LVO. Still, the utility of these clinical signs in low NIHSS is unknown.Methods:This is a retrospective analysis of all acute ischemic stroke patients who presented directly to our comprehensive stroke center (CSC) from December 1, 2020-May 31, 2021. All patients had CT angiography (CTA) or MR angiography (MRA) of the head and neck with timing at the discretion of the treating neurologist.Results:Of the 167 patients [median age 70 IQR (58-78), 50% female, 64% African-American], 85 (51%) presented with NIHSS of 0-5. Compared to patients with NIHSS ≥ 6, patients with NIHSS of 0-5 were younger (median age 66 vs. 70, p= 0.039) and had less congestive heart failure (0.6% vs. 4.8%, p=.014). Upfront CTA with initial non-contrast CT head was done less in patients with NIHSS 0-5 (65% vs. 85%, p=.002). Patients with NIHSS 0-5 had fewer LVO (13% vs. 44%, p

Stroke, Volume 54, Issue Suppl_1, Page AWP78-AWP78, February 1, 2023. Introduction:Stroke is a leading cause of economic burden in the Low Middle Income countries (LMIC’s). We want to study the outcome of acute strokes treated under Government scheme with minimal package (For Ischemic Stroke – 257 USD & For hemorrhagic stroke – 399 USD), but offered evidence-based stroke care other than thrombolysis.Methods:From January 2021 to March 2021, a total of 350 cases were treated in our Ankineedu stroke center. Out of these 125 (36%) acute stroke patients are treated under subsidized economical stroke care from admission to discharge. In-patient mortality, 3 months follow up and 1 year follow up recorded. All patients received standard medical treatment in Stroke unit with Antiplatelets, statins, DVT prophylaxis, Antihypertensives, dysphagia assessment, physiotherapy and Neurosurgery when required. All basic stroke investigations done – CT scan, MRI scan, MR Angio, Neck vessel doppler, Lipids, Renal Function test, RBS, ECG and ECHO. All patients discharged on secondary prevention. Average length of stay is 10 days.Results:There were 94 men and 31 women, age ranged from 18 years to 85 years (median 55 yrs). Type of stroke: Ischemic Stroke -74% and Haemorrhagic stroke – 26%, 4 patients (3.2%) underwent Neurosurgery. Risk factors: Hypertension – 82 (66%), Diabetes – 45 (36%), Cardiac problems – 17 (13.6%), Smoking – 20 (16%), Alcohol – 15 (12%). Total In-house mortality 5 (4%) and the remaining patients outcome at 3 months – Good outcome with modified rankin scale (mRS) 0-2 in 83 patients (66%), Fair Outcome with mRS (3-4) – 35 (28%), 1 patient (0.8%) bedridden and 1 patient (0.8%) died at home. Out of 125 patients, 60 patients (48%) came for 1 year follow up, of these 88% had mRS (0-2), 12% had mRS (3-5).Conclusion:In resource poor countries we can offer basic stroke care model to all needy patients with reasonable outcome. However, the follow up needs to be strengthened.

Stroke, Volume 54, Issue Suppl_1, Page ATP231-ATP231, February 1, 2023. Introduction:Low hemoglobin is associated with stroke and poor cerebrovascular outcomes. It is unclear whether hemoglobin concentrations directly impact cerebrovascular health. Thus, we sought to investigate the role of hemoglobin concentration on cerebral hypoxia and blood brain barrier (BBB) function in murine models of anemia.Hypothesis:Low hemoglobin will cause relevant cerebral hypoxic changes and impair BBB function.Methods:Two different models of anemia and their respective controls were generated from 30 8-week-old, female C57/BL6 mice. The separate cohorts generated included: 1) an acute anemia model cohort via anti-TER119 injection (red blood cell hemolysis) compared to IgG control injected mice; 2) chronic anemia model cohort via iron-deficient chow compared to iron replete diet control. Hemoglobin concentrations were assessed using modified Drabkin assays. Mice were euthanized by intracardiac perfusion with saline and fixative and the brain was dissected and processed for histological analysis of vascular permeability (IgG), microglia number and activation (Iba1 and CD68), response to hypoxia (HIF1α) and endothelial markers of BBB function (GLUT1). Statistical analyses were performed using two-tailed Student’s t-tests.Results:Hemoglobin concentrations were lower in our separate anemia model mice compared to their respective controls (acute anemia: 5.5 ± 4.02 vs 13.1 ± 1.69, p=0.007; chronic anemia: 7.9 ± 1.05 vs 11.9 ± 2.31, p=0.0006). Postmortem histological analyses revealed stronger microglial activation (p

Stroke, Volume 54, Issue Suppl_1, Page ATP48-ATP48, February 1, 2023. Background:Emergency Department (ED) transfers to tertiary centers are a critical component of stroke systems of care, yet little is known about the status of the transfer networks used to execute this process. Our objective is to characterize these transfer networks and assess rates of acute treatments among transfers to identify potential targets for improving organization of stroke systems of care.Methods:Using the 2017 US Centers of Medicare and Medicaid Inpatient and Outpatient Fee-for-Service files, we captured patients with inpatient ischemic stroke claims based on ICD 10 codes. We defined ED-hospital transfers as: 1) any outpatient ED claim ≤48 hrs prior to the inpatient stroke claim, 2) ED discharge status indicating an acute care hospital, and 3) originating and receiving facilities with different NPI numbers. We characterized the structure of transfer networks and acute treatment rates (based on ICD 10 codes and DRGs for thrombolysis and thrombectomy) using descriptive statistics.Results:We identified 225,177 patients with inpatient stroke claims. Of these, 7,907 (3.5%) had an ED-hospital transfer, involving 2083 different acute care hospitals. Amongst EDs that transferred a patient, the median number of receiving hospitals was 1 (IQR 1; range [1,7]) and the median volume of transferred patients was 3 (IQR 5; range [1,53]). Amongst hospitals that had stroke patients transfer in, the median number of originating EDs was 2 (IQR 5; range [1,28]) and the median volume of transferred patients was 5 [IQR 14; 1-158]. Amongst all ED-hospital transfer pairs, the median volume of transferred patients was 2 (IQR 2; range[1,53]). Amongst transferred patients, 60% received thrombolysis and 16% received mechanical thrombectomy.Conclusions:We found wide variation in the volumes of ED-hospital transfers for acute stroke, with a large number of these transfers occurring between hospitals with low transfer volumes. Given that high volume centers generally have better outcomes and the majority of identified transfers received acute therapies, a better understanding of the clinical circumstances driving these low-volume transfer connections is needed.

Stroke, Volume 54, Issue Suppl_1, Page AWP154-AWP154, February 1, 2023. Introduction:Conventional MRI (cMRI) is not routinely available post-mechanical thrombectomy (MT), which can preclude accurate infarction assessment. Our objective was to evaluate the use of low-field portable MRI (pMRI) for bedside evaluation post-MT, including its use as a post-procedural baseline monitor.Methods:Low-field pMRI was used to obtain bedside imaging in post-MT patients between December 2021 to August 2022 at Yale-New Haven Hospital. All pMRI exams were conducted in the standard ferromagnetic environment of the IR suite. Volumetric analyses were performed by a neuroradiologist using 3D Slicer software. If cMRI was not available for comparison, a CT was used. Patients’ charts were reviewed for pre-revascularization MAP and occurrences of MAP dropping by 10% and 20% from individual baselines between the time of pMRI and delayed imaging.Results:A total of 25 patients (64% females, median age 77 years-old [IQR 69.5-84.5]) underwent bedside pMRIs in the IR suite post-MT. The median time from last known normal to access was 6 hours [IQR 4-17]. The median pMRI examination time was 30 minutes [IQR 17-32]. Of the 24 patients with available delayed imaging, 7 (29.2%) had infarct progression compared to immediate post-MT pMRI, while 15 patients (62.5%) had stable/decreased stroke volume. Two patients (8.3%) had parenchymal hemorrhage type 2 and were excluded from further analysis. There was no statistically significant difference between the proportions of favorable TICI scores (85.7% in the infarct progression group vs. 92.3% in the stable/decreased infarct group, p=1.00). Patients with infarct progression had comparable pre-revascularization MAP compared to those with stable/decreased delayed infarct volume (mean of 100.3±4.6 vs. 101.9±15.9 respectively, p=0.727) but had more occurrences of MAP dropping by 10% and 20% of their baseline between the time of pMRI and delayed imaging (mean of 35.0±23.3 vs. 14.7±11.3 occurrences, p=0.011; and mean of 21.7±16.5 vs. 8.5±9.5 occurrences, p=0.026, respectively).Conclusions:The use of low-field MRI in the post-MT setting can facilitate benchmark brain monitoring and serial examinations to evaluate the impact of potential physiological perturbations that may impact ongoing brain injury.

Stroke, Volume 54, Issue Suppl_1, Page AWMP36-AWMP36, February 1, 2023. Introduction:Persistent pain after stroke significantly impacts patients’ function, ability to participate in rehabilitation, and quality of life. We examined characteristics of stroke survivors discharged with pain.Methods:The sample consisted of 824 stroke patients admitted to a large, urban university based acute care facility in Texas with a completed pain assessment (numeric rating scale or Behavior Pain Scale) at discharge. Descriptive analysis of means and frequency distributions was conducted using a two-sided t-test for continuous variables and a Chi-squared test for categorical variables. Univariable and multivariable logistic regression models were used to determine the association between pain at discharge and type of stroke, adjusting for age, sex, race, smoking status, prevalent hypertension, BMI, and length of stay (LOS). We also tested for statistical interactions between stroke type and age, sex, and race.Results:The mean age was 64 years, with 56% (n=462) being males. Of the 824 stroke patients, 584 (71%) had ischemic stroke while 237 (29%) had hemorrhagic (ICH) stroke. At discharge, 43% (n=358) reported pain. In unadjusted analyses, those reporting pain were younger (p

Stroke, Volume 54, Issue Suppl_1, Page ATMP104-ATMP104, February 1, 2023. Introduction:Post-stroke statin therapy is known to reduce subsequent major vascular events in patients with ischemic stroke. However, the efficacy of statin therapy in acute ischemic stroke patients with low low-density lipoprotein cholesterol (LDL-C) at baseline is not well defined. This study aimed to determine whether statin therapy would be beneficial in stroke patients with low or well-controlled LDL-C at baseline.Methods:We assessed ischemic stroke patients with baseline LDL-C

Stroke, Volume 54, Issue Suppl_1, Page AWP50-AWP50, February 1, 2023. Introduction:Stress hyperglycemia is an essential survival response. However, it is associated with poor prognosis after ischemic stroke, and its contribution to collateral failure is not well defined. We investigated whether stress hyperglycemia would be associated with early neurological deterioration (END) in acute large vessel occlusion (LVO) patients who present with mild neurological deficit.Methods:From a multicenter stroke registry, ischemic stroke patients with acute anterior circulation LVO and mild symptoms (NIHSS