Safety of Pharmacological Augmentation of Stroke Rehabilitation.
Summary of "Safety of Pharmacological Augmentation of Stroke Rehabilitation."
Background: Based on experimental studies, pharmacological augmentation (PA) of stroke rehabilitation might be reasonable. Whether PA is beneficial in clinical practice is unclear. Methods: We performed an observational study on the use of PA in addition to regular rehabilitative therapies in a stroke rehabilitation unit. Over 20 months, we systematically observed (1) the utilization rate of PA, (2) possible adverse events, and (3) the functional outcome of patients with versus without PA (non-PA). The primary outcome variable was the increase in abilities in activities of daily living during in-hospital rehabilitation as quantified by the delta 'functional independence measure' (FIM). Results: Ninety-seven of 249 (39%) patients had PA. L-Dopa was used in 63 (65%), acetylcholinesterase inhibitors in 33 (34%), and selective serotonin reuptake inhibitors in 31 (32%) PA patients. In 11 (11%) patients, PA was associated with delirium (n = 4), gastrointestinal symptoms (n = 4), electrolyte disorders (n = 2), or incontinence (n = 1). All adverse events were temporary. PA patients did not differ from non-PA patients in age (74 vs. 73 years; p = 0.62), gender ratio, and stroke type (ischemia 85 vs. 82%; p = 0.49). However, compared with non-PA patients, PA patients were more severely affected (median NIH Stroke Scale Score 7 vs. 4; p < 0.001; median FIM 58 vs. 85; p = 0.01). At discharge, the PA group had a higher median ΔFIM compared with non-PA patients (16 vs. 9; p = 0.01). None of the PA patients but 5 (3.3%) of the non-PA patients had died. Conclusion: PA of stroke rehabilitation was used frequently. The absence of safety concerns suggests that there is scope for benefit from PA in stroke rehabilitation. A large randomized controlled trial seems feasible and ethically justified.
Affiliation
Neurorehabilitation Unit, Geriatric Competence Center, Felix Platter-Spital, Basel, Switzerland.
Journal Details
This article was published in the following journal.
Name: European neurology
ISSN: 1421-9913
Pages: 325-330
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21071948
- DOI: http://dx.doi.org/10.1159/000322134
Medical and Biotech [MESH] Definitions
Safety
Freedom from exposure to danger and protection from the occurrence or risk of injury or loss. It suggests optimal precautions in the workplace, on the street, in the home, etc., and includes personal safety as well as the safety of property.
Biomarkers, Pharmacological
Measurable biological parameters that serve for drug development, safety and dosing (DRUG MONITORING).
Rehabilitation Nursing
The diagnosis and treatment of human responses of individuals and groups to actual or potential health problems with the characteristics of altered functional ability and altered life-style. (American Nurses Association & Association of Rehabilitation Nurses. Standards of Rehabilitation Nursing Practice, 1986, p.2)
Food Safety
Activities involved in ensuring the safety of FOOD including avoidance of bacterial and other contamination.
United States Occupational Safety And Health Administration
An office in the Department of Labor responsible for developing and establishing occupational safety and health standards.
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