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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
A Journal on Physical Medicine and Rehabilitation after Pathological Events
Official Journal of the , , , ,
In association with
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Europa Medicophysica 2001 September;37(3):153-9
Ictus, comorbidity and outcome: the role of the indwelling bladder catheter
Iona L. G., Varnier A., Bianchi L., Polentarutti S., Deotto E.
From the U. O. Riabilitazione, Azienda Ospedaliera «Santa Maria della Misericordia», Udine
Background. Acute phase stroke care represents a major component in rehabilitation stroke services. Constrained by limited access to resources, hospitals have had to apply selection criteria to identify subjects that could potentially benefit most from treatment. Common prognostic factors in patient selection are age, site and severity of the lesion, comorbidities, impaired cognition, urinary incontinence and albumenia levels. We decided to verify the prognostic value of several of these variables and comorbidities.
Methods. A series of 117 patients consecutively admitted to our rehabilitation unit from June 1999 to May 2000 with diagnosed hemiparesis or hemiplagia in stroke were assessed. Within 24 hours from admission to our unit the patients received thorough clinical assessment, routine blood chemistry tests (hemochrome, glycemia, proteinemia, albuminemia) and function evaluation, comprising Mini Mental State (MMS), Barthel Index (BI), Functional Independence Measure (FIM), and Face Scale (FS). All function tests were repeated on discharge.
Results. Albuminemia levels showed a positive correlation with MMS, BI and motor and cognitive FIM subscales, whereas no significant correlations were found with FS scores. On discharge the only remaining positive correlation was between albuminemia levels on admission and cognitive FIM subscale scores. Statistically significant positive correlations were found between the number of comorbidities and length of stay (LOS; r=0.35, p<0.001; Spearman’s rho 0.38, p<0.001) and disability scales.
Conclusions. Given the importance of negative prognostic features such as initial severity of the disability, age, nutritional state and presence of indwelling catheter, rehabilitation efforts must be directed toward a more appropriate management of micturion dysfunction which includes removal of the indwelling catheter. This indication is based on our observation that in our case series greater attention to the dietary program reduced the prognostic weight of hypoalbuminemia.