[Show abstract][Hide abstract] ABSTRACT: Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily living (ADL) during the first month after ischemic stroke in inpatient (United States) and outpatient (Brazil) rehabilitation settings.This is a prospective cohort comparison study. Twenty patients from each country were selected using identical inclusion criteria.The study measures employed were the UE portion of the Fugl-Meyer scale, the Action Research Arm test, the National Institutes of Health Stroke Scale and Barthel Index. Changes from baseline to the end of treatment, efficiency and effectiveness of each treatment were compared.Both populations exhibited significant improvement between the first and second evaluations in the four outcome scales (p<0.0001). There were no differences between the two rehabilitation settings on any of the four dependent measures (p>0.05).Substantially different treatment approaches after ischemic stroke led to similar results in UE function, global impairment and ADL. Further studies in larger populations should be performed in order to confirm the present results.
[Show abstract][Hide abstract] ABSTRACT: Stroke is the main cause of death in Brazil and no prospective population-based study has been conducted in the country. The purpose of this study was to determine the incidence of stroke, stroke subtypes, case fatality, and prognosis after 1 year of follow-up in the city of Matão, Brazil.
Using overlapping methods of case ascertainment, all stroke cases that occurred in the city of Matão (population, 75,053) from November 1, 2003 to October 31, 2004 were followed-up at 1 month and 1 year after the episode. Standard criteria for population-based stroke studies were followed.
Of 141 suspect stroke cases identified, 81 were first-ever-in-a-lifetime strokes. All patients underwent a CT scan. The crude annual incidence rate per 100,000 per year was 108 (95% CI, 85.7-134.1) and the rate adjusted for sex and age to the Segi population was 137 (95% CI, 112.0 to 166.4) per 100,000 inhabitants per year. Ischemic stroke occurred in 69 (85.2%) subjects, intracerebral hemorrhage in 11 (13.6%), and subarachnoid hemorrhage in 1 (1.2%). The 30-day case fatality rate was 18.5 and the 1-year case fatality rate was 30.9%. After 1 year of follow-up, 43% of the patients were independent in activities of daily living, 49.4% had independent gait, and 15.9% had a recurrent stroke.
The present results are similar to those obtained in other stroke population-based studies. Future studies in Matão will provide the opportunity to discover ways to decrease the stroke burden in Brazil.