Biomedical subjects

Robert Côté

Publications and source records attributed to Robert Côté.

6 recordsLinked to original sources

PubMed2006

The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke. DESIGN: Two-centre, observer-blinded, stratified, block-randomized controlled trial. SETTING: General community. PATIENTS: Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003. INTERVENTIONS: The experimental intervention involved practice of functional, unilateral and bilateral tasks that were designed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks. Members in both groups participated in three sessions a week for six weeks. MAIN OUTCOME MEASURE(S): The primary test of arm function was the Box and Block Test. Secondary tests included the Nine-Hole Peg Test, maximal grip strength, the Test d'Evaluation des Membres supérieurs des Personnes Agées (TEMPA) and the Stroke Rehabilitation Assessment of Movement. RESULTS: Results are for the more affected arm. Baseline performance on the Box and Block Test was an average of 26 blocks (standard deviation (SD) = 16) in the experimental group (n = 47) and 26 blocks (SD = 18) in the control group (n = 44). These values represent approximately 40% of age-predicted values. Values for the postintervention evaluation were an average of 28 (SD = 17) and 28 (SD = 19) blocks for the experimental and control group respectively. No meaningful change on other measures of arm function was observed. CONCLUSIONS: A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke.

Activities of Daily Living↗

PubMed2005

Predictive value of soluble intercellular adhesion molecule-1 for risk of ischemic events in individuals with cerebrovascular disease.

BACKGROUND AND PURPOSE: Cellular adhesion molecules may play a critical role in the inflammatory process leading to atherosclerosis. The purpose of this study was to determine whether soluble intercellular adhesion molecule-1 (sICAM-1) is a predictor of future ischemic events in high-risk individuals and also whether it is associated with carotid artery stenosis. METHODS: We conducted a prospective study of sICAM-1 concentration in 3 groups: (1) subjects with recent (< 7 days) ischemic stroke or TIA, (2) asymptomatic subjects with carotid stenosis > or = 50% and (3) asymptomatic individuals with vascular risk factors. Subjects were followed for a minimum of 3 years. sICAM-1 levels were compared between the groups and correlated with the risk of ischemic events and the degree of carotid artery stenosis. RESULTS: We studied 275 subjects. Mean sICAM-1 levels were significantly higher in those with recent ischemic stroke or TIA compared to those with risk factors alone. During follow-up, ischemic events occurred almost nine times more frequently in subjects in group 1 compared to group 3. sICAM-1 concentration was not predictive of future ischemic events (OR 1.001, 95% CI 0.998-1.004). There was no significant association between sICAM-1 concentration and carotid artery stenosis (OR 1.001, 95% CI 0.999-1.004). CONCLUSIONS: Mean sICAM-1 levels were higher in subjects with recent cerebral ischemia. No association between sICAM-1 and carotid artery stenosis was observed. Neither baseline nor subsequent sICAM-1 levels were predictive of the risk of future ischemic events.

Aged↗

PubMed2003

Costs and caregiver consequences of early supported discharge for stroke patients.

BACKGROUND AND PURPOSE: Early supported discharge (ESD) for stroke has been shown to yield outcomes similar to or better than those of conventional care, but there is less information on the impact on costs and on the caregiver. The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care. METHODS: We conducted a randomized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home. RESULTS: Acute-care costs incurred before randomization when patients were medically ready for discharge averaged $3251 per person. The costs for the balance of the acute-care stay, from randomization to discharge, were $1383 for the home group and $2220 for the usual care group. The average cost of providing the 4-week home intervention service was $943 per person. The total cost generated by persons assigned to the home group averaged $7784 per person, significantly lower than the $11 065 per person for those assigned to usual care. A large proportion of the cost differential between the 2 groups arose from readmissions, for which the usual care group generated costs more than quadruple those of the home intervention group. CONCLUSIONS: Providing care at home was no more (or less) expensive for those with greater functional limitation than for those with less. Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care, even caregivers of persons with major functional limitations. For persons recovering from stroke and their families, ESD provides a cost-effective alternative to usual care.

Adult↗

PubMed2002

Activity, participation, and quality of life 6 months poststroke.

OBJECTIVES: To estimate the extent of activity and participation of individuals 6 months poststroke and their influence on health-related quality of life (QOL) and overall QOL, information that would be useful in identifying services that stroke patients would need in the community. DESIGN: Inception cohort study. SETTING: Ten acute care hospitals in metropolitan areas of the province of Quebec. PARTICIPANTS: Persons with first-ever stroke, either ischemic or hemorrhagic. In parallel, a population-based sample of community-dwelling individuals without stroke, frequency matched in age and city district, were also recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Stroke subjects were interviewed by telephone at 6-month intervals for 2 years of follow-up. The community-dwelling individuals without stroke were also followed. RESULTS: A total of 434 persons were interviewed approximately 6 months poststroke. Their average age +/- standard deviation was 68.4+/-12.5 years; the average age of the 486 controls was 61.7+/-12.4 years. The stroke group scored on average 90.6/100 on the Barthel Index; 39% reported a limitation in functional activities, 54% reported limitations with higher-level activities of daily living such as housework and shopping, and 65% reported restrictions in reintegration into community activities. By using the Medical Outcomes 36-Item Short-Form Health Survey (SF-36), persons with stroke rated their physical health 7 points lower than healthy peers; also, 7 of the 8 subscales of the SF-36 were affected by stroke. CONCLUSION: Almost 50% of the community-dwelling stroke population lived with sequelae of stroke such that, unless there was a full-time and able-bodied caregiver at home, they needed some form of home help. A large proportion also reported lack of meaningful activity, indicating a need for organized support groups for people with stroke; otherwise, boredom will lead to depression and worsening of function, affect, health status, and QOL.

Activities of Daily Living↗

PubMed2002

Meeting the nutritional needs of patients with severe dysphagia following a stroke: an interdisciplinary approach.

Dysphagia is a common problem with individuals who have experienced a stroke. The interdisciplinary stroke team noted delays in clinical decision-making, or in implementing plans for patients with severe dysphagia requiring an alternative method to oral feeding, such as enteral feeding via Dobhoff (naso-jejunum) or PEG (percutaneous endoscopic gastrostomy) tubes, occurred because protocols had not been established. This resulted in undernourishment, which in turn contributed to clinical problems, such as infections and confusion, which delayed rehabilitation and contributed to excess disability. The goal of the project was to improve quality of care and quality of life for stroke patients experiencing swallowing problems by creating a dysphagia management decision-making process. The project began with a retrospective chart review of 91 cases over a period of six months to describe the population characteristics, dysphagia frequency, stroke and dysphagia severity, and delays encountered with decision-making regarding dysphagia management. A literature search was conducted, and experts in the field were consulted to provide current knowledge prior to beginning the project. Using descriptive statistics, dysphagia was present in 44% of the stroke population and 69% had mild to moderate stroke severity deficit. Delays were found in the decision to insert a PEG (mean 10 days) and the time between decision and PEG insertion (mean 12 days). Critical periods were examined in order to speed up the process of decision-making and intervention. This resulted in the creation of a decision-making algorithm based on stroke and dysphagia severity that will be tested during winter 2002.

Aged↗

PubMed1986

Family correlates of temperament continuity and change across middle childhood.

This paper reports on continuity and change of extreme traits of temperament from age seven to 12 in subgroups selected from a large random sample and on the association of continuity with certain aspects of family functioning. Results suggest a definite degree of stability of extreme temperament over time. Implications of the findings are discussed and directions for future research suggested.

Child↗