Outcome assessment of stroke convalescence using multiple scales based on different dimensions

BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ’) of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACU-MOXIBUSTION OF DIFFERENT ACUPOINT GROUPS IN STROKE PATIENTS IN CONVALESCENCE STAGE

Objective: To observe and compare clinical therapeutic effect of acupuncture and moxibustion at different acupoint groups in stroke patients in the convalescence stage. Methods: Sixty stroke patients were evenly randomized into yin-meridian group and yang-meridian group. On the basis of the treatment with Chinese and Western medicines, these stroke patients of two groups were treated mainly by acupuncture of acupoints of yin meridians such as Jiquan (极泉HT 1), Tongli (通里HT 5), Neiguan (内关PC 6), etc., and those of yang meridians as Jianyu (NFDA1 LI 15), Quchi (曲池 LI 11), Shousanli (手三里LI 10), etc. respectively. After 30 days’ treatment, the therapeutic effect was evaluated by using American National Institutes of Health Stroke Scale (NIHSS), Hamilton Depression (HAMD) Rating Scale, Mini-Mental State Examination (MMSE), Barthel Index and Activities of Daily Living (ADL) Scale. Results: Following treatment, the therapeutic effect of yin-meridian group was significantly superior to that of yang-meridian group in improving stroke patients’ neurological deficits [Level B: 50% (15/30) vs 20% (6/30)] and ADL [Level Ⅱ: 40% (12/30) vs 13.3% (4/30)]. No significant difference was found between two groups in the neurological impairment domains. Conclusion: Acu-moxibustion of acupoints of yin meridians is superior to acupoints of yang meridians in improving stroke patients’ neurological impairment and daily living activities.

Clinical Effect of Fuyang Prescription in Treatment of Ischemic Stroke during the Convalescent Stage:An Analysis of 25 Cases

[Objectives]The paper was to investigate the clinical effect of Fuyang prescription in the treatment of yang deficiency syndrome in the convalescent stage of ischemic stroke(IS)and its mechanism of action.[Methods]A total of 50 patients with yang deficiency syndrome in the convalescent stage of IS were randomly divided into treatment group and control group,with 25 patients in each group.The patients in the treatment group were given basic treatment combined with Fuyang prescription,and those in the control group were given basic treatment combined with Buyang Huanwu decoction;the course of treatment was 28 d for both groups.The activities of daily living(ADL)score,National Institutes of Health Stroke Scale(NIHSS)score,quality of life score,TCM syndrome score,and safety in both groups were observed before treatment and at 14 and 28 d post treatment,and their clinical outcome was evaluated.[Results]There was a significant difference in overall response rate between the treatment group and the control group[92.00%(23/25)vs 76.00%(19/25),P<0.05].After treatment,both groups had significant changes in ADL score,NIHSS score,quality of life score,and TCM syndrome score,and there were significant differences in these indices between the two groups at the same time point after treatment(P<0.05 or P<0.01).There were no significant changes in routine blood,routine stool,routine urine,and liver/renal function in either group after treatment.[Conclusions]Fuyang prescription has a marked clinical effect in the treatment of yang deficiency syndrome in the convalescent stage of IS,with significantly better clinical effect than Buyang Huanwu decoction,and it provides clinical evidence for the traditional Chinese medicine theory of yang supporting in the treatment of IS in the convalescent stage.

Observation on the Curative Effect of"Hand and Foot 12 Needle Acupuncture"on Stroke in Convalescent Period of Phlegm-Dampness Constitution

Objective:To observe the clinical effects of"hand and foot 12 needle acupuncture"on stroke in convalescent period of phlegm-dampness constitution.Methods:The 90 patients were divided into the treatment group(n=45)and the control group(n=45)according to the random number table method.The control group received basic Western medicine treatment+rehabilitation treatment of Western medicine,and the treatment group was additively treated with"hand and foot 12 needle acupuncture"on the basis of the control group.NIHSS score,MRS score and Barthel index(BI)before and after treatment were observed in the two groups,and the clinical efficacy of the two groups was compared.Results:The clinical efficacy of stroke patients in the convalescent period of phlegm-dampness constitution after treatment:the total effective rate of the treatment group was 93.33%,and the total effective rate of the control group was 66.67%.After statistical processing,the clinical efficacy of the treatment group was significantly better than the control group;NIHSS score,MRS score and Barthel index(BI)were better than the control group,and the differences were statistically significant(P<0.05).Conclusion:"Hand and foot 12 needle acupuncture"treatment of phlegm-dampness constitution convalescent stroke clinical effect is remarkable.