Thesis (M. Phil.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 57-61).

published_or_final_version / Public Health / Master / Master of Public Health

Background: Stroke has become the second most cause of death and leading cause of disability worldwide. Patients-reported health related quality of life measures are often used in evaluating stroke outcomes. However, many stroke patients can not participate in the outcome assessments due to severe disability or aphasia or cognitive impairment. In this case, proxy respondents can be used as secondary information sources. The principle thing needs to be paid attention to in using proxy’s assessments is the reliability or agreement between patient and proxy. Western studies have shown that the agreement between patient and proxy was moderate to substantial. However, such studies are limited in China. Simply applying overseas research outcomes on local population is not appropriate. Therefore, we conducted this study to find out the agreement between stroke patients and proxy assessments about quality of life in China. Methods: 100 patient-proxy pairs were enrolled in our study. Our study was a hospital-based study. The included patients were 3 months after stroke, and patients with more than moderate aphasia or cognitive impairment were excluded. Proxies were people who knew the patients > 1 year, contacted with the patients ≥ 3 days per week, were responsible for ≥ 2 caregiving tasks, and ≥ 18 years. The Chinese version of Stroke-specific quality of life scale (SS-QoL) was used to assess the stroke patients’ QoL, and proxy version of SS-QoL was used in proxies’ evaluation. The evaluation process of patient and proxy was separately and concurrently. Method of self-reported combined with interview-administered was adopted. Paired t tests or Wilcoxon signed ranks tests were performed to test the systematic differences between patient and proxy. The agreement level between patient and proxy assessments on stroke QoL was estimated by Intraclass correlation coefficient (ICC). Multiple linear regression was performed to find out factors affecting the patient-proxy agreement. Results: Patients were older (61 versus 48 years) and more often male (63% versus 44%). Mean systematic differences ranged from 0.03 to 0.44. Only 3 domains of differences were statistical significant (Language, Personality, and Work/productivity). The strength of agreement between patient and proxy reporting ranged from fair to perfect (ICC: 0.31 to 0.87). Better agreement was observed in more objective domains while worse agreement was reported in more subjective domains. Proxy education was tested to be a significant predictor of the overall patient-proxy score difference, which indicated that higher proxy education level was associated with greater agreement. It was shown that higher overall patient-reported or proxy-reported SS-QoL score was associated with less stroke impairments. Factors of stroke impairments, patient/proxy education level, patient/proxy gender, and stroke type separately have significant impacts on the agreement between patient and proxy in different domains of QoL. Conclusion: Our findings indicate that proxies may provide reliable information for assessments about stroke patients’ quality of life in China. And the outcomes are more appropriate for mind to moderate stroke patients. For further studies, the reliability of proxy information about severe stroke patients should be paid attention to. Research about changes of agreement between patient and proxy along with the disease development process would be focused on. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Cardio-and Cerebrovascular Disease Event Surveillance System (CDESS) was established in Guangzhou in 2013. It provided important information of the stroke hospitalization and set up a platform for further research on stroke. Objective: To describe the characteristics of stroke hospitalizations in Class 2 and 3 hospitals, examine crude and standardized hospitalization rates by age, sex and stroke subtypes, identify problems in the first year database through the analysis and make recommendations for further improvements Design: Case-series study Setting: Guangzhou, China Subjects: 32324 stroke hospitalizations in Class 2 and 3 hospitals Methods: Descriptive statistics were used to describe the distributions of stroke hospitalizations by age, sex and subtypes. Chi-square test, One-way ANOVA and two-independent sample t-test were conducted to compare differences in sex and age in total strokes and 3 main subtypes. Crude rates, age- and sex-specific hospitalization rates were calculated using the 2010 Guangzhou Census population. Age-standardized rates were calculated by direct standardization method using the WHO world population. Results: The mean age±SD for total strokes was 70.33±12.26 for all subjects, 68.95±12.56 for men and 72.19±11.59 for women. CBI and the 75-79 year age group accounted for the largest proportions in total strokes. The mean age of women was significantly greater than men for total stroke. The crude hospitalization rate of total strokes was 275.22 for men, 224.16 for women and 250.85 for all. The age-standardized rate of total strokes was 308.2 in men, 202.2 in women and 253.5 in all. Conclusion: Because the stroke hospitalization data combined first-ever and recurrent strokes, incident hospitalization rates could not be calculated. The present study also could not distinguish fatal hospitalizations from nonfatal ones. Hence, bed days and hospital charges analysis would not yield meaningful results. The CDESS needs to be improved by collecting information to clarify whether the hospitalization is first-ever or recurrent, and the survival status at discharge. The mortality data from death registration in CDC should be used to check with CDESS data for stroke death outside the hospitals Community based studies are needed to identify strokes not admitted into Class 2 and 3 hospitals. The problems identified in CDESS or WHO STEP Stroke should be discussed with other hospitals in China, such as Hangzhou and Shanghai so that the problems can be tackled together. / published_or_final_version / Public Health / Master / Master of Public Health

Not available / text

No description available.

No description available.

There is compelling evidence that regular physical activity is likely to play a role in the secondary prevention of stroke and comorbid coronary artery disease. However, structured physical activity programs are not widely available for people following stroke. Cardiac rehabilitation programs (CRP) are well suited to provide exercise training following traditional stroke rehabilitation. However, people following stroke may be limited by a constellation of neurological deficits that may prevent them from effectively participating in and benefiting from an adapted CRP. Accordingly, the objectives of this work were to 1) examine the utility of cardiopulmonary exercise stress testing (CPET) for developing an exercise prescription in people ≥3 months post-stroke with mild/moderate motor impairments 2) determine ability to achieve minimal recommended exercise training levels reported to elicit health benefits during a single standard CR session following completion of a CRP 3) evaluate the physiological, and cognitive effects of a 24-week CRP of resistance and aerobic exercise and the effect of stroke-recovery-time. It was hypothesized that most patients (>50%) would reach a level of exertion on the CPET that would provide recommended exercise prescription target levels and that individuals would be able to systematically reach these target levels during a CR session. Moreover, the established exercise program would result in physiological and cognitive benefit independent of time-from-stroke. Study 1 demonstrated that most patients achieved a level of exertion during the CPET sufficient to inform an exercise prescription. In Study 2 patients with motor impairments were able to meet or exceed minimal recommended exercise target levels of intensity, duration and energy expenditure. In Study 3 a CRP yielded improvements over multiple domains of recovery (cardiovascular fitness, functional ambulation, sit-to-stand performance, and muscular strength). While those referred ≤1 year and >1 year post-stroke derived benefits from a CRP, those who started earlier (≤1 year) had greater improvements in ambulatory performance. In Study 4 combined aerobic and resistance exercise resulted in improvements in cognitive function. Change in cognition was positively associated with change in fat-free mass and change in anaerobic threshold. In summary people post-stroke are able to effectively participate in and benefit from an adapted CRP.

There is compelling evidence that regular physical activity is likely to play a role in the secondary prevention of stroke and comorbid coronary artery disease. However, structured physical activity programs are not widely available for people following stroke. Cardiac rehabilitation programs (CRP) are well suited to provide exercise training following traditional stroke rehabilitation. However, people following stroke may be limited by a constellation of neurological deficits that may prevent them from effectively participating in and benefiting from an adapted CRP. Accordingly, the objectives of this work were to 1) examine the utility of cardiopulmonary exercise stress testing (CPET) for developing an exercise prescription in people ≥3 months post-stroke with mild/moderate motor impairments 2) determine ability to achieve minimal recommended exercise training levels reported to elicit health benefits during a single standard CR session following completion of a CRP 3) evaluate the physiological, and cognitive effects of a 24-week CRP of resistance and aerobic exercise and the effect of stroke-recovery-time. It was hypothesized that most patients (>50%) would reach a level of exertion on the CPET that would provide recommended exercise prescription target levels and that individuals would be able to systematically reach these target levels during a CR session. Moreover, the established exercise program would result in physiological and cognitive benefit independent of time-from-stroke. Study 1 demonstrated that most patients achieved a level of exertion during the CPET sufficient to inform an exercise prescription. In Study 2 patients with motor impairments were able to meet or exceed minimal recommended exercise target levels of intensity, duration and energy expenditure. In Study 3 a CRP yielded improvements over multiple domains of recovery (cardiovascular fitness, functional ambulation, sit-to-stand performance, and muscular strength). While those referred ≤1 year and >1 year post-stroke derived benefits from a CRP, those who started earlier (≤1 year) had greater improvements in ambulatory performance. In Study 4 combined aerobic and resistance exercise resulted in improvements in cognitive function. Change in cognition was positively associated with change in fat-free mass and change in anaerobic threshold. In summary people post-stroke are able to effectively participate in and benefit from an adapted CRP.

Thesis (MAppSc in Physiotherapy)--University of South Australia, 1997