Biomedical subjects

Stephanie Studenski

Publications and source records attributed to Stephanie Studenski.

23 records · Page 2Linked to original sources

PubMed2002

Evaluation of proxy responses to the Stroke Impact Scale.

BACKGROUND AND PURPOSE: The purposes of this study were to compare proxy-patient responses on each domain of the Stroke Impact Scale (SIS) and the SIS-16, estimate the bias, and evaluate the validity of proxy scores. METHODS: Two hundred eighty-seven patient and proxy pairs from the Kansas City Stroke Registry participated in the study. All patients were assessed in their home or nursing facility between 90 and 120 days after stroke with the use of the modified Rankin Scale Motricity Index (strength), Barthel Index (activities of daily living), Lawton assessment (instrumental activities of daily living), Folstein Mini-Mental State Examination (cognition), and the SIS. Eligible proxies were individuals who were aged > or =18 years, had known the patient for at least 1 year, and saw the patient at least once each week. All proxy interviews were conducted within 7 days of (before or after) the patient's interview. RESULTS: Three hundred seventy-seven patients from the Kansas City Stroke Registry were eligible for the study. Seventy-seven patients or proxies refused participation. Thirteen patients of the consenting patient-proxy pairs were too aphasic or cognitively impaired to complete the interviews and were dropped from the study. Proxies scored patients as more severely affected than patients scored themselves on the SIS-16 and in 7 of 8 domains of the full SIS (5 were statistically significant at alpha=0.05). The proxy bias toward overrating the severity of the patient's condition tended to increase as the severity of the stroke increased. However, the magnitude of the biases between patient and proxy means, as measured by effect size, was small (range, -0.1 to 0.4). The strength of the agreement, as measured by intraclass correlation coefficients, between proxy and patient ranged from 0.50 to 0.83. Agreement was best for the observable physical domains. Both patient and proxy scores in all domains were significantly different across Rankin categories. Concurrent validity for both patient and proxy correlations with the Folstein Mini-Mental State Examination, Barthel Index, Lawton instrumental activities of daily living, and Motricity Index was good to excellent (range, 0.37 to 0.78). CONCLUSIONS: Proxies provide valid information for assessment of stroke outcomes. There are significant differences between patient and proxy reporting on SIS domains and the SIS-16. However, the observed biases are small and not clinically meaningful.

Activities of Daily Living↗

PubMed2002

Co-morbidity adjustment for functional outcomes in community-dwelling older adults.

OBJECTIVE: To characterize relationships between self-reported co-morbidity and functional outcomes in community-dwelling older adults, and to assess whether the impact of co-morbidity persists even after adjustment for baseline functional status. DESIGN: Prospective observational study. We examined associations between self-reported co-morbidity at baseline and functional outcomes at one year, with and without adjustment for baseline functional status. SETTING: Outpatient clinics at a managed care and a Veterans Affairs site. SUBJECTS: Four hundred and fifty-seven community-dwelling older adults representing a broad spectrum of overall health status. MAIN OUTCOME MEASURES: (a) New basic ADL (activities of daily living) problem during follow-up; (b) 10-point decline in the physical function index of the MOS-36 (MOS-PFI). RESULTS: Co-morbidity was associated with adverse functional outcomes in bivariable analyses. After adjustment for age and baseline functional status, an accumulated co-morbidity score provided additional explanatory power for predicting new ADL problems; odds ratios were 2.30 (1.09, 5.09) and 2.96 (1.48, 6.25) for 2 and > or = 3 affected co-morbidity domains, respectively. The impact of baseline status was also important; odds ratios for new ADL problems were 4.77 (2.68, 8.81) when at least one instrumental activity of daily living (IADL) problem was present at baseline, and 15.6 (8.05, 31.3) when at least one basic ADL problem was present at baseline. CONCLUSIONS: Accumulated self-reported co-morbidity has significant negative effects on function at one year; these effects are attenuated but not eliminated by adjustment for baseline status. Co-morbidity adjustment is probably an important design element in clinical research focused on functional outcomes in older adults.

Activities of Daily Living↗

PubMedDate not supplied

Urban-rural patterns of increasing antidepressant use among nursing facility residents.

OBJECTIVE: To characterize changing patterns of antidepressant use in nursing facilities across the urban-rural continuum during the mid-1990s. DESIGN: Retrospective analysis of antidepressant drug codes and demographic/clinical data from the Minimum Data Set (MDS) 1994 to 1997. SETTING: Kansas nursing facilities. PARTICIPANTS: Facility residents aged 65 and older. MEASUREMENTS: We examined (1) admission use and (2) after-admission use for newer and older antidepressants for each year separately, using a 4-stratum system to classify nursing facility location by county, from urban to most rural. Incidence rate ratios were determined for antidepressant use in each stratum using the urban strata as the reference. RESULTS: Remarkable increases in use of newer antidepressants were seen over time in all strata, but use was highest in the urban area. Modest urban-rural gradient effects attenuated over time and were not consistently seen across analyses and years. Tricyclic antidepressant (TCA) use remained largely unchanged over time and at much lower rates than newer agents. However, TCA use was also modestly higher in urban areas. Differences were clearer for use after admission, in contrast with admission use patterns. CONCLUSIONS: Newer antidepressants were rapidly adopted across the urban-rural continuum from 1994 to 1997. Marked increases in both admission and after-admission use of newer antidepressants were seen. Both newer and older antidepressants were used at modestly higher rates in urban areas. Further work is needed to elucidate the patient, prescriber, and facility factors that explain these prescribing patterns.

Aged↗

PubMedDate not supplied

Falls in community-dwelling stroke survivors: an accumulated impairments model.

UNLABELLED: Falling has been identified as a major complication in persons who have had a stroke. The purpose of this study was to investigate the effect of accumulated impairments on the risk of falling in community-dwelling stroke survivors. METHODS: Community-dwelling stroke survivors were identified from the Kansas City Stroke Study, a large cohort study of stroke survivors. We evaluated the subjects within 14 days of stroke onset. Impairments were determined at baseline and were defined as motor = Fugl-Meyer lower-limb score > 28, sensory = sensory score on National Institutes of Health (NIH) Stroke Scale > 0, and visual = hemianopsia score on NIH Stroke Scale > 0. Accumulated impairments were characterized as motor only (n = 101), motor + sensory (n = 88), and motor + sensory + visual (n = 47). The reference group did not possess motor, sensory, or visual impairments. We completed follow-ups at 1 month, 3 months, and 6 months poststroke to determine the fall status of the subjects. RESULTS: Two hundred eighty subjects were included. Falls were reported by 142 subjects (51%) between 1 month and 6 months poststroke. Univariate analysis revealed that the risk of falling for subjects with motor impairment only was odds ratio (OR) = 2.2 (95% confidence interval [CI] 1.05 to 4.70), motor + sensory impairments OR = 3.1 (95% CI 1.46 to 6.79), and motor + sensory + visual impairments OR = 2.4 (95% CI 1.05 to 5.83) as compared to the group with no motor, sensory, and visual impairments. In multiple logistic regression, the risk of falling increased with motor impairment only and motor + sensory impairments. However, the motor + sensory + visual impairments group had a lower risk of falling. Secondary analysis revealed a significant difference in mobility scores (Orpington Prognostic Scale-balance) among individuals with motor impairment only, motor + sensory impairments, motor + sensory + visual impairments, and the reference group. This lower risk of falling in stroke survivors with motor + sensory + visual impairments may be explained by more involved strokes, more impaired balance, and subsequently less mobility, therefore, lowering their risk of falling. In conclusion, community-dwelling persons who have had a stroke are at a higher risk of falling. However, the risk of falling is not linearly related to the number of impairments. Individuals with motor, sensory, and visual impairments are less mobile and less likely to fall than those individuals with motor deficits only or motor and sensory deficits.

Accidental Falls↗

PubMedDate not supplied

Urban-rural differences in amitriptyline use among nursing facility residents.

OBJECTIVE: To characterize patterns of amitriptyline use across the urban-rural continuum. DESIGN: Retrospective analysis of antidepressant drug codes and demographic and clinical data from the Minimum Data Set (MDS), 1994 to 1997. SETTING: Kansas nursing facilities. PARTICIPANTS: Facility residents aged 65 and older. MEASURES: A four-strata system was used to classify nursing facility location by county, from urban to frontier. We examined admission use and after-admission use of amitriptyline across strata for each year separately. Unadjusted and adjusted odds ratios were determined for each stratum, using the urban stratum as the point of reference. RESULTS: Admission use of amitriptyline occurred in 2.3 to 4% of all admissions, and although such use was highest in the most rural stratum, no clear urban-rural gradient was found. In contrast, amitriptyline use 30 days or more after admission demonstrated modest urban-rural gradients in unadjusted and adjusted analyses. In 1997, when adjusted for demographic factors, odds ratios for amitriptyline use were 2.10 (1.54-2.87), 1.68 (1.33-2.13), and 1.49 (1.17-1.90) for the Frontier, Rural, and Densely Settled Rural categories as compared with the Urban reference group. CONCLUSIONS: After admission to Kansas nursing facilities, rural practice patterns for amitriptyline use are less favorable than those in urban areas, and an urban-rural gradient is identified. Further work is needed to identify explanatory patient, facility, and prescriber factors.

Journal Article↗