ORCID Profile
0000-0001-5364-2718
Current Organisations
St Vincent's Hospital Melbourne
,
Florey Institute of Neuroscience and Mental Health - Austin Campus
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Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/103697
Abstract: Physical inactivity contributes to accelerated bone loss after stroke, leading to heightened fracture risk, increased mortality, and reduced independence. This paper sought to summarise the evidence for the use of physical activity to protect bone in healthy adults and adults with stroke, and to identify international recommendations regarding any means of bone protection after stroke, in order to guide rehabilitation practice and future research. A search was undertaken, which identified 12 systematic reviews of controlled trials which investigated the effect of physical activity on bone outcomes in adults. Nine reviews included healthy adults and three included adults with stroke. Twenty-five current international stroke management guidelines were identified. High-impact loading exercise appears to have a site-specific effect on the microarchitecture of healthy postmenopausal women, and physical activity has a small effect on enhancing or maintaining bone mineral density in chronic stroke patients. It is not known whether this translates to reduce fracture risk. Most guidelines included recommendations for early mobilisation after stroke and falls prevention. Two recommendations were identified which advocated exercise for the prevention bone loss after stroke, but supporting evidence was limited. Research is required to determine whether targeted physical activity can protect bone from early after stroke, and whether this can reduce fracture risk.
Publisher: Wiley
Date: 13-10-2019
DOI: 10.1111/JDI.12932
Publisher: Elsevier BV
Date: 12-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-03-2021
DOI: 10.1212/WNL.0000000000011647
Abstract: To determine how young stroke survivors want their unmet needs to be addressed, we undertook an international online survey of people living with stroke. Participants self-selected to complete an online survey that included a questionnaire on demographics and stroke-related characteristics, the Young Stroke Needs Screening Tool, and a questionnaire on how they wanted their needs to be met. One hundred seventy-one responses were received (68% female respondents, mean age 45 years, interquartile range 36–51 years). Preferences for methods of meeting needs varied depending on the domain of need and participants' demographic and stroke-related characteristics. Face-to-face contact with a health care professional was a popular means of meeting needs, but methods outside of a traditional health care setting such as a succinct list of tips or peer support were widely acceptable and sometimes preferred. This work provides the impetus for developing alternative methods of meeting young stroke survivors' needs, many of which are not resource intensive or do not require an appointment with a health care professional.
Publisher: Elsevier BV
Date: 12-2011
Publisher: SAGE Publications
Date: 04-10-2012
DOI: 10.1111/J.1747-4949.2011.00645.X
Abstract: Bone loss after stroke is pronounced, and contributes to increased fracture risk. People who fracture after stroke experience reduced mobility and increased mortality. Physical activity can maintain or improve bone mineral density and structure in healthy older adults, likely reducing fracture risk. The purpose of this systematic review was to investigate the skeletal effects of physical activity in adults affected by stroke. A search of electronic databases was undertaken. Selection criteria of trials were prospective and controlled physical activity-based intervention participants with history of stroke, and bone-related outcome measures. Effect sizes were calculated for outcomes of paretic and nonparetic limbs. Three of 349 identified records met the inclusion criteria. Small effect sizes were found in favor of physical activity in adults with chronic stroke ( n=95, 40% female, average age 63·8 years, more than one-year poststroke). Patients in intervention groups had significantly higher changes in femoral neck bone mineral density, tibial cortical thickness and trabecular bone mineral content of the paretic limb, compared with controls ( P ·05). It is not known whether these benefits reduced fracture risk. There are limited studies investigating the skeletal effect of physical activity for adults poststroke. Given the increased risk of, and poor outcomes following a fracture after stroke, randomized trials are warranted to investigate the benefits of physical activity on bone, after stroke. Interventions are likely to be beneficial if implemented soon after stroke, when bone loss appears to be rapid and pronounced.
Publisher: SAGE Publications
Date: 23-12-2015
DOI: 10.1111/IJS.12228
Abstract: Stroke survivors experience accelerated bone loss and increased fracture risk, particularly in paretic weight bearing limbs. Understanding how these changes unfold and their relationship to stroke severity and physical activity could help in the development of targeted interventions to prevent or reduce the severity of these outcomes. The primary aim of this study is to investigate the time course and magnitude of changes in volumetric bone mineral density within the first year after stroke, and to examine relationships with physical activity and motor recovery. This is a prospective, observational study of 43 nondiabetic, nonambulant adults with first ever hemispheric stroke. The primary outcome was the difference in six-month change of total volumetric bone mineral density between paretic and nonparetic distal tibiae, measured at 7% of bone length site using high-resolution peripheral quantitative computed tomography. The secondary outcomes are cortical and trabecular volumetric bone mineral density, cortical thickness, and total and cross-sectional areas of distal tibiae and radii of paretic and nonparetic limbs. Also included are total body and regional bone mineral density derived using dual-energy X-ray absorptiometry, physical activity measured using accelerometry, and motor recovery (Chedoke McMaster Stroke Assessment). Measuring the timing and magnitude of changes to volumetric bone mineral density and bone structure from immediately after stroke, and relationships between these changes with physical activity and motor recovery will provide the basis for targeted interventions to reduce fracture risk in stroke survivors.
Publisher: Elsevier BV
Date: 04-2021
Publisher: American Geophysical Union (AGU)
Date: 07-01-2017
DOI: 10.1002/2016JD025476
Publisher: Public Library of Science (PLoS)
Date: 09-03-2017
Publisher: SAGE Publications
Date: 12-04-2016
Abstract: Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers h er our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research biomarkers of recovery intervention development, monitoring and reporting and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2023
DOI: 10.1161/STROKEAHA.123.043094
Abstract: Fractures are a serious consequence following stroke, but it is unclear how these events influence health-related quality of life (HRQoL). We aimed to compare annualized rates of fractures before and after stroke or transient ischemic attack (TIA), identify associated factors, and examine the relationship with HRQoL after stroke/TIA. Retrospective cohort study using data from the Australian Stroke Clinical Registry (2009–2013) linked with hospital administrative and mortality data. Rates of fractures were assessed in the 1-year period before and after stroke/TIA. Negative binomial regression, with censoring at death, was used to identify factors associated with fractures after stroke/TIA. Respondents provided HRQoL data once between 90 and 180 days after stroke/TIA using the EuroQoL 5-dimensional 3-level instrument. Adjusted logistic regression was used to assess differences in HRQoL at 90 to 180 days by previous fracture. Among 13 594 adult survivors of stroke/TIA (49.7% aged ≥75 years, 45.5% female, 47.9% unable to walk on admission), 618 fractures occurred in the year before stroke/TIA (45 fractures per 1000 person-years) compared with 888 fractures in the year after stroke/TIA (74 fractures per 1000 person-years). This represented a relative increase of 63% (95% CI, 47%–80%). Factors associated with poststroke fractures included being female (incidence rate ratio [IRR], 1.34 [95% CI, 1.05–1.72]), increased age (per 10-year increase, IRR, 1.35 [95% CI, 1.21–1.50]), history of prior fracture(s IRR, 2.56 [95% CI, 1.77–3.70]), and higher Charlson Comorbidity Scores (per 1-point increase, IRR, 1.18 [95% CI, 1.10–1.27]). Receipt of stroke unit care was associated with fewer poststroke fractures (IRR, 0.67 [95% CI, 0.49–0.93]). HRQoL at 90 to 180 days was worse among patients with prior fracture across the domains of mobility, self-care, usual activities, and pain/discomfort. Fracture risk increases substantially after stroke/TIA, and a history of these events is associated with poorer HRQoL at 90 to 180 days after stroke/TIA.
Publisher: Hindawi Limited
Date: 30-10-2018
DOI: 10.1155/2018/8087372
Abstract: Background . The ineffectiveness of most complex stroke recovery trials may be explained by inadequate intervention design. The primary aim of this review was to explore the rationales given for interventions and dose in stroke rehabilitation randomised controlled trials (RCTs). Methods . We searched the Cochrane Stroke Group library for RCTs that met the following criteria: (1) training based intervention (2) % participants who were stroke survivors (3) full peer-reviewed text (4) English language. We extracted data on 16 quality items covering intervention dose (n= 3), trial design (n= 10), and risk of bias (n= 3) and 18 items related to trial method. Logistic regression analyses were performed to determine whether (1) reporting of trial quality items changed over time (2) reporting of quality items was associated with the likelihood of a positive trial, adjusted for s le size and number of outcomes. Results . 27 Cochrane reviews were included, containing 9,044 participants from 194 trials. Publication dates were 1979 to 2013, s le size was median 32 (IQR 20,58), and primary outcome was reported in 49 trials (25%). The median total quality score was 4 (IQR 3,6) and improved significantly each year (OR 1.12, 95% CI 1.07, 1.16, p .001). Total quality score was not associated with likelihood of a positive trial, but trials containing a biological rationale for the intervention were more likely to find a difference in patient outcome (OR 2.18, 95% CI 1.14, 4.19, p=0.02). Conclusion . To develop breakthrough treatments we need to build the rationale for research interventions and testing of intervention dosage. This will be achieved through a collective research agenda to understand the mechanistic principles that drive recovery and identification of clearer targets for clinical trials.
Publisher: Oxford University Press (OUP)
Date: 2012
DOI: 10.2522/PTJ.20100289
Abstract: Previous research has mainly targeted older people with high risk of falling. The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored. This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematically screened as having mild balance dysfunction. This was a community-based, randomized controlled trial with assessors blinded to group allocation. Study participants were older people who reported concerns about their balance but remained community ambulant (n=225). After a comprehensive balance assessment, those classified as having mild balance dysfunction (n=165) were randomized into the trial. Participants in the intervention group (n=83) received a 6-month physical therapist–prescribed balance and strength home exercise program, based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. Participants in the control group (n=82) continued with their usual activities. Laboratory and clinical measures of balance, mobility, and strength were assessed at baseline and at a 6-month reassessment. After 6 months, the intervention group (n=59) significantly improved relative to the control group (n=62) for: the Functional Reach Test (mean difference=2.95 cm, 95% confidence interval [CI]=1.75 to 4.15), the Step Test (2.10 steps/15 seconds, 95% CI=1.17 to 3.02), hip abductor strength (0.02, 95% CI=0.01 to 0.03), and gait step width (2.17 cm, 95% CI=1.23 to 3.11). There were nonsignificant trends for improvement on most other measures. Fourteen participants in the intervention group (23.7%) achieved balance performance within the normative range following the exercise program, compared with 3 participants (4.8%) in the control group. Loss to follow-up (26.6%) was slightly higher than in some similar studies but was unlikely to have biased the results. A physical therapist–prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment.
Publisher: Wiley
Date: 06-2010
DOI: 10.1111/J.1741-6612.2009.00390.X
Abstract: To investigate by randomised trial, health professional facilitated sessions aiming to overcome barriers to physical activity (PA), improve readiness to undertake PA, increase PA participation and improve fitness among older Australian adults from Macedonian and Polish backgrounds. One hundred and twenty-one participants (mean age 70 years, 63% female) were block randomised to the intervention group (three one-hour group education and goal setting sessions over 7 weeks) or control group (one-hour health promotion talk) following baseline assessment, with reassessment approximately 9 weeks later. No significant differences were found between experimental groups in primary (Stages of Change Questionnaire (SocQ), steps per day and Human Activity Profile) or secondary outcomes. This study has highlighted methodological considerations for PA health promotion and research with older adults from culturally and linguistically erse (CALD) backgrounds in a community setting. Investigation of older CALD adults' perceptions of what are 'adequate levels of PA' and methods of increasing PA is warranted.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-02-2020
DOI: 10.1212/WNL.0000000000011106
Abstract: This tertiary analysis from A Very Early Rehabilitation Trial (AVERT) examined fatal and nonfatal serious adverse events (SAEs) at 14 days. AVERT was a prospective, parallel group, assessor blinded, randomized international clinical trial comparing mobility training commenced hours poststroke, termed very early mobilization (VEM), to usual care (UC). Primary outcome was assessed at 3 months. Patients with ischemic or hemorrhagic stroke within 24 hours of onset were included. Treatment with thrombolytics was allowed. Patients with severe premorbid disability or comorbidities were excluded. Interventions continued for 14 days or hospital discharge if less. The primary early safety outcome was fatal SAEs within 14 days. Secondary outcomes were nonfatal SAEs classified as neurologic, immobility-related, and other. Mortality influences were assessed using binary logistic regression adjusted for baseline stroke severity (NIH Stroke Scale [NIHSS] score) and age. A total of 2,104 participants were randomized to VEM (n = 1,054) or UC (n = 1,050) with a median age of 72 years (interquartile range [IQR] 63–80) and NIHSS 7 (IQR 4–12). By 14 days, 48 had died in VEM, 32 in UC, age and stroke severity adjusted odds ratio of 1.76 (95% confidence interval 1.06–2.92, p = 0.029). Stroke progression was more common in VEM. Exploratory subgroup analyses showed higher odds of death in intracerebral hemorrhage and years subgroups, but there was no significant treatment by subgroup interaction. No difference in nonfatal SAEs was found. While the overall case fatality at 14 days poststroke was only 3.8%, mortality adjusted for age and stroke severity was increased with high dose and intensive training compared to usual care. Stroke progression was more common in VEM. Australian New Zealand Clinical Trials Registry, ACTRN12606000185561. This study provides Class I evidence that very early mobilization increases mortality at 14 days poststroke.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 09-2009
DOI: 10.1167/IOVS.08-3294
Abstract: To determine the relationship between the severity of distance and near-vision impairment on vision-specific quality of life (QoL) and depression in residential care residents. Residents from three low-level residential care facilities in Victoria (Australia) were recruited. All participants were assessed for cognitive impairment, distance and near-vision impairment (VI), and depression. Sociodemographic and other clinical data were also collected. The subscales of the Nursing Home Vision-Targeted Health-Related Quality-of-Life questionnaire (NHVQoL) were the main outcome measures and were validated by Rasch Analysis. Seventy-six residents were enrolled. The mean +/- SD of the participants' age was 83.9 +/- 9.9 years, and most were women (n = 44 60%) 46.4% (n = 35) had binocular presenting VI ( 0.05). In linear regression models, distance and near VI was independently associated with poorer QoL on seven of the eight subscales of the NHVQoL scale (P < 0.05). The beta coefficients ranged from -12.3 to -80.2, which suggests that, on average, people with vision loss had poorer QoL, ranging between 12 and 80 points (scale range: 0-100) than did those with no VI. The QoL aspects most affected by vision loss were related to general vision, reading, hobbies, emotional well-being, and social interaction. VI remains a major form of disability in in iduals living in residential care facilities and affects vision-specific functioning and socioemotional aspects of daily living. A larger study is needed to confirm these findings.
Location: Australia
No related grants have been discovered for Karen Borschmann.