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Monthly Archives: August 2015

Stroke Rehabilitation and Multimorbidity: A Scoping Review Protocol

By Michelle L.A. Nelson

What proportion of the stroke rehabilitation evidence is relevant to patients with multimorbidity?
Current evidence syntheses serving as the foundation for stroke rehabilitation best practice recommendations do not categorize or report data extraction related to multimorbidity. This may be problematic for the design of stroke clinical practice recommendations. Although it may be expected (based on prevalence data) that multimorbid patients were included in reported rehabilitation intervention studies, by not having an explicit understanding of the patients included or excluded in the evidence, we may be faced with a mismatch between the research participants used to generate evidence, the best practice recommendations, and the patient seen in practice.

We are conducting a systematic scoping review of the stroke rehabilitation intervention literature to identify the evidence relevant to patients with multimorbidity.  The study protocol was published in the Journal of Comorbidity [1].  The publication of protocols supports transparency in scoping approaches through the publication of the original proposed study, serving as a baseline from which we can discuss any methodological modifications and subsequently study results.  Additionally, a second contribution of publishing this protocol is providing guidance to other researchers in the key elements of scoping protocols and proposals, a clear gap in the literature we discovered during the development of the funding proposal.

The full article can be accessed at: http://www.jcomorbidity.com/index.php/test/article/view/47

1. Nelson, Michelle LA, et al. Stroke rehabilitation and patients with multimorbidity: a scoping review protocol. J Comorbidity 2015:5(1):1-10. doi: http://dx.doi.org/10.15256/joc.2015.5.47

Stroke, multimorbidity and polypharmacy in a nationally representative sample of patients in Scotland

By Dr Katie Gallacher, Prof Stewart Mercer and Prof Frances Mair

Our paper in BMC Medicine http://www.biomedcentral.com/1741-7015/12/151 examines the prevalence of multimorbidity and polypharmacy in a large, nationally representative sample of primary care patients, comparing those with and without stroke, adjusting for age, gender and deprivation. In this cross-sectional study of 1,424,378 adult participants from 314 primary care practices in Scotland, we analysed data on the presence of stroke and 39 other long-term conditions, as well as prescriptions for regular medications.
We found that both multimorbidity and polypharmacy were markedly more common in those with stroke compared to those without. Additionally, number of morbidities were very high in the stroke group (45% had 4 or more) as were numbers of prescriptions (13% had 11 or more). Both multimorbidity and polypharmacy put patients at risk of treatment burden, defined as the workload of healthcare for patients, and the impact of this on wellbeing. The findings from our study therefore have important implications for the redesign of stroke health services and clinical guidelines.

Relevant outcomes of patient-centered interventions in multimorbidity: an invitation to the NAPCRG forum and a preliminary survey

By Martin Fortin, Moira Stewart, Elizabeth Bayliss, Maxime Sasseville, Paul Little, Stewart Mercer, John Furler, Marjan van den Akker, Susan Smith

An activity organized by the PACEinMM international advisory committee

During the 2015 NAPCRG Annual Meeting to be held October 24-28 in Cancun, Mexico, we will be conducting a three hour forum entitled “Think-tank on outcomes for patient-centered interventions for persons with multimorbidity”. The objectives of the forum are to use a group process 1) to identify a set of relevant outcomes for patient-centered interventions for persons with multimorbidity (MM), 2) to share experiences internationally, and 3) to inform the conduct of interventions for persons with multimorbidity in primary care settings.  The Special Interest Group on Comorbidity/multimorbidity endorses the forum and it is open to all.
In order to prepare for the forum, we are conducting a short survey. The questions assess the relevance of types and domains of outcome measures for interventions in multimorbidity.
Please consider completing the survey. Your input is important even if you do not plan to attend the NPCRG conference. If you do plan to attend, we look forward to meeting you at NAPCRG in Cancun, Mexico next October.

Many thanks for your help.


Methods for identifying 30 chronic conditions: application to administrative data

By Marcello Tonelli

From a list of 40 common chronic conditions, we identified validated algorithms that use ICD-9 CM/ICD-10 data for 30 of these [1]. Algorithms with both positive predictive value and sensitivity ≥70% were graded as “high validity”; those with positive predictive value ≥70% and sensitivity <70% were graded as “moderate validity”. Of the 40 morbidities, we identified 30 that could be identified with high to moderate validity. We then applied the algorithms to a large cohort of Alberta residents to show proof of concept. In our opinion, using a standard set of algorithms could facilitate the study and surveillance of multimorbidity across jurisdictions. We encourage other groups to consider using this scheme in their studies.

1. Marcello Tonelli et al. Methods for identifying 30 chronic conditions: application to administrative data. BMC Medical Informatics and Decision Making. 2015;15:31.