Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence

Journal article


Marsden, Jenny, Gibson, Lorna Mary, Lightbody, Catherine Elizabeth, Sharma, Anil Kumar, Siddiqi, Mashood and Watkins, Caroline. (2008). Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence. Age and Ageing. 37(2), pp. 142 - 150. https://doi.org/10.1093/ageing/afm198
AuthorsMarsden, Jenny, Gibson, Lorna Mary, Lightbody, Catherine Elizabeth, Sharma, Anil Kumar, Siddiqi, Mashood and Watkins, Caroline
Abstract

Background: bone loss post-stroke can lead to an increased risk of fracture. Fractures compound the effects of a stroke, resulting in greater dependency for the individual and an increased burden for health and social care. Objectives: to identify risk factors for bone loss post-stroke and appraise bone loss or fracture risk reduction interventions. To develop a research agenda that informs the design and development of risk reduction strategies. Design: an integrative review. Methods: the search strategies used in Medline, Embase, AMED and CINAHL from 1966 to July 2006 identified 530 records. Ninety-nine papers with a focus on risk factors or interventions to prevent bone loss or fractures post-stroke were identified. Hand searching and scoping grey literature produced 59 additional papers. Data analysis, including data reduction and data display using matrices, enabled patterns and themes to be derived from differing study designs. Results: risk factors for bone loss post-stroke are reduced mobility, vitamin D deficiency, gender and time since stroke. Early mobilisation post-stroke may reduce bone loss, and so avoid fractures, but evidence is needed. Providing vitamin D supplements and Bisphosphonates in post-stroke patients tends to reduce bone loss, but larger treatment trials are required. Conclusions: the evidence base for bone loss management post-stroke is limited. Large, prospective, multi-centre, longitudinal studies are needed to clarify optimum treatments to reduce post-stroke bone loss, and test the effects on clinical outcomes. A ‘skeletal health’ checklist to aid implementation of treatments within stroke rehabilitation has been suggested but not yet developed.

Keywordscerebrovascular accident; hemiplegia; fractures; osteoporosis bone density; elderly
Year2008
JournalAge and Ageing
Journal citation37 (2), pp. 142 - 150
PublisherOxford University Press
ISSN0002-0729
Digital Object Identifier (DOI)https://doi.org/10.1093/ageing/afm198
Page range142 - 150
Place of publicationUnited Kingdom
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Combined conservative interventions for urge, stress or mixed incontinence in adults (protocol)
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Changing stroke mortality trends in middle-aged people : An age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England
Sutton, C, Marsden, J, Watkins, Caroline, Leathley, M and Dey, P. (2010). Changing stroke mortality trends in middle-aged people : An age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England. Journal of Epidemiology and Community Health. 64(6), pp. 523 - 529. https://doi.org/10.1136/jech.2008.086785
Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis
French, Beverley, Thomas, Lois, Leathley, Michael, Sutton, Christopher, McAdam, Joanna, Forster, Anne, Langhorne, Peter, Price, Chris, Walker, Annette and Watkins, Caroline. (2010). Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine. 42(1), pp. 9 - 15. https://doi.org/10.2340/16501977-0473
Very early rehabilitation or intensive telemetry after stroke : A pilot randomised trial
Langhorne, P, Stott, D, Knight, A, Bernhardt, Julie, Barer, D and Watkins, Caroline. (2010). Very early rehabilitation or intensive telemetry after stroke : A pilot randomised trial. Cerebrovascular Diseases. 29(4), pp. 352 - 360. https://doi.org/10.1159/000278931
Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis
French, Beverley, Thomas, Lois, Leathley, Michael, Sutton, Christopher, McAdam, Joanna, Forster, Anne, Langhorne, Peter, Price, Chris, Walker, Annette and Watkins, Caroline. (2010). Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine. 42(1), pp. 9 - 15. https://doi.org/10.2340/16501977-0473
Stroke knowledge and awareness : An integrative review of the evidence
Jones, Susanne, Jenkinson, A, Leathley, M and Watkins, Caroline. (2010). Stroke knowledge and awareness : An integrative review of the evidence. Age and Ageing. 39(1), pp. 11 - 22. https://doi.org/10.1093/ageing/afp196;10.1093/ageing/afp196
Nursing patients with neurological problems
Watkins, Caroline Leigh. (2009). Nursing patients with neurological problems. In In G. Castledine and A. Close (Ed.). Oxford handbook of adult nursing pp. 435 - 484 Oxford University Press. https://doi.org/10.1093/med/9780199231355.003.0013
Repetitive task training for improving functional ability after stroke
French, Beverley, Thomas, Lois H., Leathley, Michael John, Sutton, Christopher J., McAdam, Joanna J., Forster, Anne, Langhorne, Peter J., Price, Christopher I.M., Walker, Andrew and Watkins, Caroline L.. (2009). Repetitive task training for improving functional ability after stroke. Stroke: a journal of cerebral circulation. 40(4), pp. 98 - 99. https://doi.org/10.1161/STROKEAHA.108.519553
Psychological intervention poststroke: ready for action?
Watkins, Caroline and French, Beverley. (2009). Psychological intervention poststroke: ready for action? Stroke. 40(9), pp. 2951 - 2952. https://doi.org/10.1161/STROKEAHA.109.562348
Treatment of stroke: Acting on the symptoms
Jones, Stephanie, Leathley, Michael J. and Watkins, Caroline Leigh. (2008). Treatment of stroke: Acting on the symptoms. Asian Hospital and Healthcare Management.
Treatment of urinary incontinence after stroke in adults (review)
Thomas, Lois H., Cross, S., French, B., Leathley, M. J., Sutton, C. J. and Watkins, Caroline Leigh. (2008). Treatment of urinary incontinence after stroke in adults (review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004462.pub3
Engaging service users in the development of stroke services: An action research study
Jones, Stephanie P., Auton, Malcolm F., Burton, Christopher R. and Watkins, Caroline L.. (2008). Engaging service users in the development of stroke services: An action research study. Journal of Clinical Nursing. 17(10), pp. 1270 - 1279. https://doi.org/10.1111/j.1365-2702.2007.02259.x
Acute stroke management: An online course
Jones, Stephanie, McLoughlin, A. and Watkins, Caroline. (2008). Acute stroke management: An online course. Journal of Paramedic Practice: the clinical monthly for emergency care professionals. 3(6), pp. 322 - 326.
A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness
French, Beverley, Leathley, Michael John, Sutton, Christopher J., McAdam, Joanna J., Thomas, Lois H., Forster, A., Langhorne, Peter J., Price, Christopher I.M., Walker, Annette and Watkins, Caroline. (2008). A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness. Health Technology Assessment. 12(30), pp. 1 - 140. https://doi.org/10.3310/hta12300