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      Functional Capacity Scale as a new tool for early functional assessment in patients after surgical treatment of intracranial aneurysms: A prospective study involving 128 patients

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          Summary

          Background

          Functional assessment of a patient focuses on the assessment of independence in activities of daily living. The aim of the study was to verify the usefulness of a new tool ( Functional Capacity ScaleFCS) for early functional assessment of patients after surgical treatment of an intracranial aneurysm.

          Material/Methods

          The study was conducted in the Neurosurgical Department and Clinic, CM in Bydgoszcz, NCU, within a group of 128 patients after surgical treatment of an intracranial aneurysm. Direct observation and measurement were used in the study. In clinical assessment, the Hunt and Hess Scale was applied. For the final functional assessment, the Functional Capacity Scale (FCS), the Glasgow Outcome Scale, the Functional Index “Repty”, the Barthel Index, and the Rankin Scale were used.

          Results

          The study shows that on the day of discharge almost 60% of patients are independent or slightly dependent on others for functional capability, and 15% are significantly or totally dependent. FCS significantly correlates with FIR (0.93, p<0.001), GOS (0.89, p<0.01), RS (−0.88, p<0.01) and BI (0.82, p<0.001).

          Conclusions

          1. Fifty percent of patients with intracranial aneurysm assessed at the early postoperative stage leave the ward as functionally capable of performing everyday activities. 2. There are significant correlations between FCS and the other scales used for functional assessment. 3. There is a significant relationship between functional capacity of the patient on the day of discharge and clinical condition before the surgical treatment.

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          Most cited references32

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          International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion.

          Two types of treatment are being used for patients with ruptured intracranial aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative safety and efficacy of these approaches had not been established. Here we present clinical outcomes 1 year after treatment. 2143 patients with ruptured intracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in the UK and Europe, took part in the trial. They were randomly assigned to neurosurgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome was death or dependence at 1 year (defined by a modified Rankin scale of 3-6). Secondary outcomes included rebleeding from the treated aneurysm and risk of seizures. Long-term follow up continues. Analysis was in accordance with the randomised treatment. We report the 1-year outcomes for 1063 of 1073 patients allocated to endovascular treatment, and 1055 of 1070 patients allocated to neurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 patients allocated to neurosurgery, an absolute risk reduction of 7.4% (95% CI 3.6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 years and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebleeding was higher. In patients with ruptured intracranial aneurysms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival benefit continues for at least 7 years. The risk of late rebleeding is low, but is more common after endovascular coiling than after neurosurgical clipping.
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            Cerebral vascular accidents in patients over the age of 60. II. Prognosis.

            J. Rankin (1957)
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              Handbook of Neurosurgery

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                Author and article information

                Journal
                Med Sci Monit
                Med. Sci. Monit
                Medical Science Monitor
                Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                International Scientific Literature, Inc.
                1234-1010
                1643-3750
                2012
                01 November 2012
                : 18
                : 11
                : CR680-CR686
                Affiliations
                [1 ]Neurological and Neurosurgical Nursing Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
                [2 ]Neurosurgical Department and Clinic Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
                [3 ]Neurotraumatology Department Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
                Author notes
                Robert Œlusarz, Neurological and Neurosurgical Nursing Department CM, NCU, Technikow 3 St., 85-094 Bydgoszcz, Poland, e-mail: zpielnin@ 123456cm.umk.pl
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                883547
                10.12659/MSM.883547
                3560615
                23111745
                e56e8f56-53f5-403c-86ad-74ed60451923
                © Med Sci Monit, 2012

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                : 04 November 2011
                : 15 May 2012
                Categories
                Clinical Research

                aneurysm,subarachnoid hemorrhage,functional capacity scale

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