Background Post-stroke fatigue (PSF) is a common and distressing problem after stroke. It impedes patients’ participation in daily activities and is associated with higher risks of institutionalisation and death following stroke. Despite its high prevalence and detrimental consequences, little research has been conducted to develop effective treatments for PSF. Psychological interventions are effective in treating fatigue in other conditions such as cancer and chronic fatigue syndrome. This thesis described the development of a psychological intervention for PSF. Methods This thesis was based on the theoretical, modelling and part of the piloting phases of the Medical Research Council (MRC) framework for designing and evaluating complex interventions. This intervention was developed in collaboration with a multidisciplinary group of stroke clinicians, clinical psychologists, a psychotherapist, and stroke survivors. Both qualitative and quantitative methods were used. Systematic reviews were conducted to explore the natural history of PSF and to identify potential targets for a psychological intervention for PSF. The format of the intervention was adapted from existing psychological interventions for cancer-related fatigue and chronic fatigue syndrome. The intervention was delivered by a clinical psychologist (i.e. the therapist) to 12 patients with PSF (i.e. the participants) to test its acceptability and feasibility in the local health system. After the feasibility study, the intervention was refined according to the feedback from the participants and the therapist. A Cochrane review of interventions for PSF was updated to identify any new evidence that could inform future studies. Results Systematic reviews suggested that PSF often occurred early after stroke and persisted over time (which justified the need for interventions for PSF) and that PSF was associated with distressed mood, lower self-efficacy, reduced physical activity and sleeping problems (which were potential targets for the treatment of PSF). Based on interventions that have been used to treat fatigue in other conditions, these psychological and behavioural factors could be addressed by psychological interventions that challenge patients’ thoughts and behaviours (i.e. the cognitive behavioural therapy, CBT). Thus a manualised CBT was developed for PSF. This CBT was delivered to each participant individually, through six face-to-face treatment sessions over a period of 12 weeks, followed by a telephone-delivered review session one month later. Both the participants and the therapist gave favourable opinions on the acceptability of the intervention. The recruitment and follow-up procedures were feasible in the local health system. Following the feedback from participants and therapist, the intervention manual was refined for future use, where the last two treatment sessions will be combined to a single session and the review session will be delivered in person by the therapist. There were statistically significant improvements in fatigue, mood, mobility, and participation in social activity from baseline to three months after the end of treatment. The updated Cochrane review concluded that there was insufficient evidence to recommend any specific intervention for PSF; psychological interventions are one type of interventions worth being investigated in future trials. Conclusions PSF is associated with distressed mood, lower self-efficacy, reduced physical activity and sleeping problems, which are potential targets for the treatment of PSF. Although there was insufficient evidence to recommend any intervention for the treatment of PSF, psychological interventions are one type of promising interventions worth future investigation. The promising results from this uncontrolled feasibility study support the need for a subsequent exploratory randomised controlled trial (RCT) of this brief psychological intervention.

No description available.

No description available.

Submitted by FABRICIO DINIZ DE LIMA null (fabriciodz@hotmail.com) on 2017-09-22T15:45:56Z No. of bitstreams: 1 Dissertacao_final_impresso.pdf: 2611089 bytes, checksum: 6e32f987f7522184fd5a8e5f764906ed (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-27T19:07:04Z (GMT) No. of bitstreams: 1 lima_fd_me_bot.pdf: 2611089 bytes, checksum: 6e32f987f7522184fd5a8e5f764906ed (MD5) / Made available in DSpace on 2017-09-27T19:07:04Z (GMT). No. of bitstreams: 1 lima_fd_me_bot.pdf: 2611089 bytes, checksum: 6e32f987f7522184fd5a8e5f764906ed (MD5) Previous issue date: 2017-08-23 / Introdução: O acidente vascular cerebral (AVC) é uma grave condição neurológica, que acomete pessoas do mundo inteiro, com elevada morbimortalidade e incapacidade funcional, tendo como principal manifestação o déficit motor, tornando a reabilitação imperativa. No entanto, alguns fatores comuns podem dificultar o sucesso da reabilitação, como a sarcopenia, que pode provocar prejuízo trófico e metabólico no hemicorpo denominado não afetado, correlacionando-se ao comprometimento funcional. Este trabalho busca avaliar alterações tróficas, metabólicas e funcionais no lado ipsilateral, em pacientes com AVC isquêmico, a fim de averiguar a correlação entre a sarcopenia e déficit funcional. Pacientes e métodos: Foram avaliados parâmetros antropométricos e morfológicos, realizados estudos de bioimpedância e executada a dinamometria em 21 pacientes com AVC isquêmico de circulação anterior em 2 momentos distintos: fases aguda (até 48 h após o ictus) e crônica (90 dias após o ictus). Resultados: 21 pacientes foram incluídos (57% do sexo masculino; média de idade de 67,09 anos, variando de 26 a 84 anos). Todos receberam avaliação contínua da equipe multiprofissional durante o estudo. Não houve redução estatisticamente significativa da massa muscular, quantidade de proteína, água, minerais, gordura e metabolismo basal e nem melhora da força muscular ipsilateral dos pacientes após 90 dias do ictus (p < 0,05). Conclusão: Não houve redução trófico-metabólica e nem piora funcional estatisticamente significativas no lado corporal ipsilateral ao infarto dos pacientes avaliados. A assistência precoce e contínua da equipe multiprofissional durante os primeiros 90 dias após o ictus conferiu aos pacientes um prognóstico de melhora funcional contralateral significativa, ao avaliar-se mRS, NIHSS, MRC e dinamometria. / Background: The stroke is a severe neurological condition, which affect worldwide people, causing high morbimortality and disability, whose main manifestation is weakness, making rehabilitation crucial. Although common factors may difficulty the successfully rehabilitation, such as sarcopenia, that causes trophic and metabolic impairment in the healthy body side, correlating to the functional damage. This study aims to evaluate trophic, metabolic and functional changes in the impaired body side in patients with ischemic stroke in order to find a correlation between sarcopenia and functional impairment. Patients and methods: We evaluated anthropometric and morphological parameters, performing bioimpedance and dynamometer studies in 21 patients with anterior circulation ischemic stroke in 2 distinct moments: the acute (ultil 48 h after ictus) and chronic phases (90 days after ictus). Results: 21 patients were included (57% men; mean age, 67,09 years; age range, 26 to 84 years). All patients were assisted continually during the study. They did not present ipsilateral muscle mass, protein, water, minerals and fat quantity decrement statistically significant neither enhanced strength 90 days post-stroke (p < 0,05). Conclusion: Patients evalueted did not present reduction statistically significant trophic and metabolic neither functional worse in the ipsilateral body side after unilateral stroke. The early and continuous assistance provided by rehabilitation team during the first 90 days post-ictus improved the functional prognostic in the contralateral side, according to mRS, NIHSS, MRC and dynamometry.

Hypoxia-ischemia (HI) insults can have profound effects on the immature brain, impairing development and leaving survivors with lifelong physical and cognitive deficits. Improvements in neonatal care have resulted in more newborns surviving HI, but effective treatments for the long-term consequences of this disorder have yet to be established. Using the Rice-Vannucci model of hypoxia-ischemia at postnatal day (PND) 7, we investigated the effects of metformin and enriched rehabilitation on short and long-term motor and cognitive outcome in both male and female Sprague-Dawley rats. A battery of behavioural tests was used to assess early development and motor function from PND 8-21, while long-term motor and cognitive function was assessed from PND 49 onwards. Metformin, administered from PND 8-49, improved several aspects of early development that were compromised following HI (weight gain, neurological reflexes). However, it worsened motor impairments in the adhesive strip removal task and Montoya staircase. Enriched rehabilitation, beginning at PND 21, improved motor function in the adhesive strip removal task, open field and Montoya staircase. Additionally, it enhanced cognition in the Barnes maze and Morris water maze. Our results indicated that, despite early beneficial effects on development, metformin was not effective at improving long-term outcome. Enriched rehabilitation led to significant improvements in several aspects of motor and cognitive function, even when administered 2 weeks post-injury. This data suggests that enriched rehabilitation, but not metformin, may be a valuable intervention for treating behavioural impairments resulting from episodes of perinatal hypoxia-ischemia.

Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T13:51:18Z (GMT). No. of bitstreams: 1 Mota_LucasBrino_M.pdf: 1462710 bytes, checksum: b2e1fbb17a6de58bc91748c2bcb073f8 (MD5) Previous issue date: 2009 / Resumo: A escala de avaliação de Acidente Vascular Cerebral (AVC) da Chedoke McMaster (CM) foi desenvolvida baseada nos estágios de recuperação motora de Brunnstrom, 1970 e avalia o paciente hemiplégico em duas partes: Inventário do comprometimento Físico e Inventário de capacidades. O primeiro determina a presença e a gravidade de incapacidades físicas comuns em seis dimensões: dor no ombro, função do braço, mão, perna, pé e tronco. O segundo avalia as atividade funcionais e é divida em dois índices: função motora grossa e caminhada. O objetivo do presente estudo foi elaborar uma versão brasileira da escala de avaliação de AVC da Chedoke McMaster e avaliar a concordância inter e intra-examinador, a validade concorrente e a consistência interna. Realizou-se a tradução e adaptação cultural, treinamento dos avaliadores e pré teste. Posteriormente a escala foi testada em 26 pacientes que apresentavam hemiplegia secundária ao AVC. O nível de concordância inter-examinador e intra-examinador foi excelente (CCI>0,75; p<0,001) para todos os itens e apresentou alta consistência interna (0,79). O item total da Escala de Fugl Meyer (EFM) mostrou forte correlação com o item total do instrumento de medida estudado (r=0,715; p=0,001), bem como com o inventário de capacidades da CM com a Escala de Equilíbrio de Berg (EEB) (r=0,943; p<0,001), Índice de Barthel (r=0,919; p<0,001) e Medida de Independência Funcional (MIF) (r=0,717; p<0,001). Houve alta consistência interna para todos os itens com exceção do domínio ombro, este apresentou valor inferior a 0,4. Houve efeito teto para o domínio ombro e efeito solo para mão, braço e ombro. O presente instrumento traduzido e adaptado apresentou concordância assim como sua versão original, mostrou-se de fácil aprendizagem e aplicabilidade, além de avaliar o paciente em toda sua abrangência física, especialmente no desempenho de suas funções e não apenas na sua incapacidade física / Abstract: The Chedoke McMaster Assessment Stroke (CMAS) was developed based on the Brunnstrom motor recovery stages, and it is a two part measure consisting of a Physical Impairment Inventory and a Disability Inventory. First the impairment inventory determines the presence and severity of common physical impairments in six dimensions: shoulder pain, postural control, Arm, Hand, Leg and Foot; according to the seven stages of motor recovery (Brunnstrom). Then the Disability Inventory measures functional outcomes, and is made up of two indices, the gross motor function index and the walking index. The objective of the study was to develop a Brazilian version of the Chedoke McMaster Assessment Stroke and to evaluate the intra rater and inter rater reliability and the validity of the internal consistence of this version scale. The translations, cultural adaptations, evaluator training and pre-test were performed, and then a test evaluation of 26 stroke subjects. There was a high level of intra rater and inter rater reliability (CCI>0,75; p<0,001) and high internal consistency (0,79) for all the measures of the scale. The total Fugl-Meyer score showed strong correlation with the total score of the Chedoke McMaster Stroke Assessment (r= 0,715; p=0,001). The impairment and disability inventory of the CM showed strong correlation with the Berg Balance Scale (r=0,943; p<0,001), Barthel Index (r=0,919; p<0,001) and Functional Independence Measure (r=0,717; p<0,001). There was also a high internal consistency for all the dimensions of the CM, with exception of the shoulder dimension, that showed a value lesser than 0,4. There was a ceiling effect for the left shoulder dimension and a floor effect for the hand, arm and shoulder. The adaptation and translation of the CM scale in the present study showed agreement with the original version, demonstrated to be easy of learn and apply, and also to be able to evaluate the patient physical condition in a complete way, not only the physical impairment but also its functional performance / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O estudo teve como objetivo construir e validar as definiÃÃes constitutivas e operacionais do resultado Mobilidade e dos seus indicadores presentes na ClassificaÃÃo dos Resultados de Enfermagem (NOC, 2010). Estudo do tipo metodolÃgico, realizado em trÃs etapas: anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica do instrumento. Para a seleÃÃo das produÃÃes utilizou-se o acesso on-line a cinco bases de dados: Scopus, Pubmed, Cinahl, Cochrane e Lilacs, com os descritores: Mobility, Stroke, nursing e suas sinonÃmias nas lÃnguas portuguesa e espanhola. Identificaram-se 1.521 artigos e apÃs seleÃÃo criteriosa resultaram 49 artigos. Entre os diferentes paÃses, destacam-se os artigos publicados no Canadà (26,7%), sobretudo das produÃÃes a partir de 2001 (95,9%) por fisioterapeutas (34,6%), em unidades de reabilitaÃÃo (61,5%). Os atributos identificados para Mobilidade foram: andar, ficar em pÃ, sentar, colocar a perna de um lado para outro, virar-se, iniciar e parar a locomoÃÃo, subir escadas, funÃÃo motora, transferÃncia e habilidade motora. Para LimitaÃÃo da mobilidade: hemiplegia, hemiparesia, dÃficit na marcha e habilidade motora diminuÃda. TambÃm foi construÃdo um caso modelo e um caso contrÃrio e identificados antecedentes e consequentes para Mobilidade e LimitaÃÃo da mobilidade. ApÃs a anÃlise de conceito nesta etapa foi possÃvel propor um instrumento com as definiÃÃes constitutivas e operacionais para os indicadores do resultado Mobilidade empregando alguns princÃpios da psicometria. Este foi submetido à avaliaÃÃo de 23 enfermeiros especialistas que atenderam aos critÃrios adaptados de Fehring (1994). Os dados foram compilados no programa Microsoft Office Excel 2007 e analisados pelo SPSS versÃo 19.0. A maioria dos especialistas era do sexo feminino (95,7%), trabalhava no Estado do Cearà (76,0%) em instituiÃÃo de ensino superior e em hospitais (56,5%), era mestre (78,3%) e tinha experiÃncia de trabalhos com mobilidade e/ou AVC. Observou-se que os indicadores Correr, Saltar, Rastejar e Movimentos realizados com facilidade apresentaram para a maioria dos critÃrios da psicometria proporÃÃes estatisticamente inferiores a 85%. AlÃm disso, a maior parte dos enfermeiros sugeriu a retirada destes indicadores por julgÃ-los nÃo representativos para pacientes que tiveram AVC. Assim, estes indicadores foram excluÃdos ao se construir o instrumento para ser aplicado na etapa de validaÃÃo clÃnica do instrumento. A coleta de dados da terceira etapa ocorreu no ambulatÃrio de neurologia de um hospital de referÃncia para tratamento de pacientes com AVC no Cearà e todos os aspectos Ãticos foram respeitados em todas as etapas do estudo. ApÃs a confirmaÃÃo da presenÃa do diagnÃstico de enfermagem Mobilidade fÃsica prejudicada em pacientes que tiveram AVC pela pesquisadora do estudo, uma dupla de enfermeiras aplicou o instrumento com as definiÃÃes constitutivas e operacionais construÃdas e validadas nas duas primeiras etapas do estudo enquanto a outra dupla aplicou o mesmo instrumento sem as definiÃÃes. Ao analisar as avaliaÃÃes entre as enfermeiras, houve similaridade entre a dupla de avaliadores que utilizou o instrumento com as definiÃÃes constitutivas e operacionais para todos os indicadores e entre a dupla que utilizou o instrumento sem estas definiÃÃes ao aplicar os testes estatÃsticos de Friedman e o Coeficiente de CorrelaÃÃo Intraclasse. Ao aplicar este coeficiente para os indicadores EquilÃbrio, Andar, Movimento das articulaÃÃes e Desempenho no posicionamento do corpo identificou-se maior correlaÃÃo entre as avaliadoras que empregaram as definiÃÃes quando comparadas com as que nÃo utilizaram. Jà para os indicadores Marcha, Movimento dos mÃsculos, Desempenho na transferÃncia e CoordenaÃÃo, foi maior a concordÃncia entre as enfermeiras que nÃo adotaram as definiÃÃes. Mas, de forma geral, observou-se que para a maioria dos indicadores houve maior concordÃncia entre a dupla que usou o instrumento com as definiÃÃes constitutivas e operacionais. No entanto, recomenda-se a realizaÃÃo de outras pesquisas de validaÃÃo com o resultado de enfermagem Mobilidade tanto em paciente com AVC como em diversas outras situaÃÃes clÃnicas. Esta pesquisa poderà contribuir para o aperfeiÃoamento da taxonomia da NOC. / The study aimed at identifying and validating the constitutive and operational definitions of the mobility outcome and its indicators present in the Nursing Outcomes Classification (NOC 2010). The study was of methodology type and was performed in three stages: concept analysis, validation by specialists and clinical validation of the instrument. For the selection of productions it was used the online access to five databases: Scopus, PubMed, Cinahl, Lilacs and Cochrane, with the descriptors: mobility, stroke, nursing and their synonyms in both Portuguese and Spanish languages. 1521 articles were identified in all the databases searched and a careful selection resulted in 49 articles. Amongst the fifteen different countries, we highlight the articles published in Canada (26.7%), especially works from 2001 (95.9%) by physiotherapists (34.6%) in rehabilitation units (61.5 %). The attributes identified for Mobility were: walking, standing, sitting, placing the leg side to side, turning around, start and stop walking, climbing stairs, motor function, transfer and motor skill. For Mobility limitation: hemiplegia, hemiparesis, gait deficit and decreased motor skills. It was also created a sample case and an opposite case and were identified antecedents and consequences for both terms Mobility and Mobility limitation. After the concept analysis stage, it was brought forward an instrument with the constitutive and operational definitions for the indicators of the Mobility outcome by using the principles of psychometrics. This instrument was assessed by 23 specialist nurses who met the criteria adapted from Fehring (1994). The data were compiled into a spreadsheet program Microsoft Office Excel 2007 and analyzed by SPSS version 16.0. Most specialists was female (95.7%), worked in the State of Cearà (76.0%) in institution of higher education and hospitals (56.5%), was a master (78.3%) and had experience working with mobility and / or stroke. It was noted that the following indicators: Run, Jump, Crawl and Movements performed with ease showed ratios statistically less than 85% for most of the psychometrics criteria. Moreover, most of the nurses suggested the removal of these indicators by judging they were not representative for patients who had strokes. Thus, these indicators were excluded when defining the instrument to be applied in the clinical validation of the instrument stage. The data collection for the third stage took place in the neurology first-aid room of a referral hospital for treatment of patients with stroke in Cearà State and all ethical aspects have been followed at all stages of the study. After the researcher of the study confirmed the existence of the Impaired physical mobility nursing diagnosis in patients who had stroke, a pair of nurses applied the instrument with the constitutive and operational definitions identified and validated in the first two stages of the study while another pair used the same instrument without the definitions. As for the analysis of the nurses evaluations, there was similarity amongst the pair of evaluators who used the instrument with the constitutive and operational definitions for all indicators and amongst the pair who used the instrument without these definitions in applying the statistical tests from Fridman and the Intraclass Correlation Coefficient. With the use of this coefficient to such indicators: Balance, Walking, Joint movement and Body positioning performance, it was found a higher correlation between the evaluators who used the definitions as compared to those who did not. As for the following indicators: Gait, Muscle movement, Performance in the transfer and coordination, the agreement was higher amongst the nurses who did not adopt the definitions. But overall, it was observed that for most indicators there was greater agreement amongst the pair who used the instrument with the constitutive and operational definitions. However, it is recommended to execute other validation researches with the Mobility nursing outcome in patients with stroke and in several other clinical situations as well. This research may contribute to the improvement of the NOC taxonomy.

Abstract Alcohol drinking may exercise both beneficial and untoward effects on the haemostatic and fibrinolytic systems. It may also predispose individuals to arterial thrombosis and trigger embolism in the brain. The aim here is to examine these problems. Methods used for evaluating platelet function were platelet aggregation and associated thromboxane B2 release, shear-induced platelet aggregation, and measurement of urinary prostaglandins. Changes in fibrinolytic system were evaluated by measuring plasminogen activator inhibitor type 1. The combined effects of alcohol drinking, physical exercise, eating a meal and circadian rhythms in healthy volunteers were examined in three experimental studies. Case-control studies were used for assessing the mechanism and etiology of ischaemic brain infarction triggered during alcohol intoxication. Alcohol drinking did not potentiate the effects of physical exercise on platelet function. Sleeping while under acute intoxication resulted in a significant activation of platelets, as shown by increased urinary excretion of a thromboxane metabolite. On the other hand, ingestion of a moderate dose of red wine seemed to attenuate platelet aggregation measured ex vivo, irrespective of whether the wine was consumed with a meal or alone. However, both red wine and a larger acute dose of alcohol in fruit juice inhibited fibrinolytic activity. In a case-control study, platelet count and function were evaluated in 426 consecutive patients hospitalized on account of acute brain infarction. Compared with the hospital-based controls, a higher than normal platelet count was observed immediately after admission. Heavy drinkers showed both higher and lower than normal platelet counts more often than the other patients with brain infarction. The changes in platelet function among the heavy drinkers reflected their recent drinking habits. Another case-control study indicated that recent heavy drinking of alcohol was an independent risk factor for cardiogenic embolism to the brain. Recent heavy drinking also seemed to predispose subjects to some other types of ischaemic brain infarction such as artery to artery embolism due to large-artery atherosclerosis and cryptogenic stroke, but these observations need to be confirmed in larger studies. In conclusion, the results show some untoward effects of acute heavy drinking of alcohol, which could contribute to the onset of brain infarction either as triggering or as predisposing factors. On the other hand, drinking of a moderate dose of red wine did not have any clear untoward effect on healthy human volunteers.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Palliative care is a vague and often confusing term used to describe a type of treatment model for chronic and life-threatening illnesses. WHO describes palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness by: early identification, impeccable assessment, and treatment of pain, physical, psychosocial and spiritual. The aim of this study is to explore the perceptions of physiotherapists on palliative care in order to contribute to the understanding of the role of physiotherapists to the care of stroke patient in Zambia. The objectives of this study are to explore physiotherapists’ knowledge on palliative care, their perceptions on management of palliative care as well as explore its application in the rehabilitation of stroke patients; and lastly to make recommendations on guidelines based on the outcomes of this study. Method: an exploratory study, using qualitative design was used. Data collection techniques were in-depth individual interviews and FGDs that consisted of purposively sampling of physiotherapists working; at four selected hospitals and a rehabilitation centre in Lusaka. Audio recording from the interviews was transcribed verbatim for each session by an independent person. The study employed thematic content analysis for data analysis. The data was classified systematically by means of coding to identify key factors or issues such as concepts, categories, themes and the relationship between them. Results indicated that all participants in the current study perceived palliative care as a medical care for the chronic and terminal ill patient in whom stroke patient and family will benefit if it is applied in the early stages of the disease trajectory; as well as it does improve the patient and family quality of life. Furthermore they emphasized on multidisciplinary team and holistic approaches in order to achieve all its tenets. Conclusion: the study had succeeded in exploring the physiotherapists’ perceptions on palliative care and contributed to the understanding of the role of physiotherapy to the care of stroke patients in general.

Class of 2013 Abstract / Specific Aims: The purpose of this study was to assess the clinical and economic predictors associated with rural emergency department visits in stroke patients. Methods: The current research was a retrospective, observational, cohort study. Multivariate regression was used to assess data from the Agency for Healthcare Research and Quality (AHRQ) 2009 Nationwide Emergency Department Sample (NEDS). Inclusion criteria were at least 18 years of age and rural ED admission with principle diagnoses of stroke. Main Results: Significant results for risks included: Intubation for increased mortality (OR = 17.432, p = 0.001), increased length of stay (IRR = 1.643, p = 0.018) and increased charges (exp β = 2.289, p = < 0.001); myocardial infarction for increased mortality (OR = 1.969, p = 0.006), decreased charges (exp β = 0.862, p = 0.013) and decreased length of stay (IRR = 0.853, p = 0.001); moderate to severe liver disease for increased mortality (OR = 62.691, p = 0.001) and reduced length of stay (IRR = 0.517, p = 0.025); congestive heart failure for increased mortality (OR 1.978, p = 0.003) and increased charges (exp β = 1.118, p = 0.039); non-specific cancer (OR = 2.447, p = 0.017) and metastatic cancer (OR = 4.799, p = 0.016) for mortality; hemiplegia/paraplegia for increased charges (exp β = 1.173, p = < 0.001). Conclusion: The current study found a better understanding of national estimates of burden of illness to further define clinical decision rules for stroke in rural emergency departments.