Christine Hazelton

Recovery From Poststroke Visual Impairment Evidence From a Clinical Trials Resource

Introduction. Limited evidence suggests that visual impairments may influence outcome after stroke. The degree of recovery from these impairments is poorly characterized. Objectives. To describe recovery and to determine whether visual impairments influence functional outcome and quality of life. Methods. We extracted demographic and outcome data from the Virtual International Stroke Trials Archive (VISTA). We examined horizontal eye movement disorders and hemianopia using the Best Gaze and Visual domains of the National Institutes of Health Stroke Scale (NIHSS) and described recovery at 30 and 90 days. Proportional odds modelling was used to examine the association between impairments at baseline, modified Rankin Scale (mRS), and European Quality of Life Score (EQ-5D) at 90 days. Results. Visual impairments were reported in 7,204/11,900 (60.5%) patients at baseline. Complete recovery occurred in 1,398/3,285 (42.6%) and 3,243/7,204 (45.0%) patients by 30 and 90 days respectively. The burden of persistent visual impairment in survivors was 1,135/4,028 (28.2%) at 30 days and 1,915/9,338 (20.5%) at 90 days. Partial gaze palsy (P < .0001; OR = 0.81; 95% CI = 0.74-0.87), forced deviation (P < .0001; OR = 0.48; 95% CI = 0.43-0.53), and complete homonymous hemianopia (P < .0001; OR = 0.67; 95% CI = 0.62-0.73) at baseline were associated with poor mRS at 90 days. Conclusions. The rate of recovery was greater in the first month after stroke, suggesting a potential time frame for interventions. The associations between visual impairments and poor mRS suggest that these impairments should be considered in multidisciplinary assessments and interventions.

Visual problems after stroke: a survey of current practice by occupational therapists working in UK stroke inpatient settings.

Abstract The primary aim of this study was to explore current practice related to assessments, protocols, referrals, and treatments for visual problems after stroke by occupational therapists (OTs) working in stroke inpatient settings in Scotland. Methods: A questionnaire was designed to gather information about the respondent’s stroke inpatient setting, the vision assessments and protocols used, treatments administered, referrals made, and barriers experienced. One named OT was identified from each stroke inpatient setting in Scotland. Each OT was sent an introductory letter and questionnaire (sent 1 to 3 weeks after introductory letter). Nonresponders were sent a second copy of the questionnaire (2 weeks after first questionnaire). Results: Sixty-one OTs in stroke inpatient settings were sent a questionnaire; 55 (90%) were returned. Only 5 (9%) respondents reported that their unit had a protocol for visual problems after stroke. Forty-nine respondents (89%) reported that they would assess visual attention and visual scanning with every patient or regularly. Other assessments were used less frequently. Forty-five (82%) OTs report delivering treatment to patients with visual neglect and 38 (69%) for visual field problems. Only 6 (11%) OTs report delivering treatment to patients with eye movement problems. OTs’ choice of treatment was similar regardless of the specific visual problem of the patient. Discussion: OTs play a key role in the assessment and management of visual problems in patients after stroke. Protocols or management plans, clear referral pathways, guidelines, and further research are required to avoid inconsistencies in assessment, referral, and management of these patients.

Conservative interventions for urinary incontinence in women: an Overview of Cochrane systematic reviews

This is the protocol for a review and there is no abstract. The objectives are as follows: To synthesise Cochrane reviews of conservative interventions, as described above, for the prevention or treatment of female urinary incontinence. Outcomes are described below.