Good nursing practice guide results aimed at the care of patients with ischemic stroke or transit ischemic attack. A cohort study.

Good nursing practice guide results aimed at the care of patients with ischemic stroke or transit ischemic attack. 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A cohort study. Emilio Rubén Pego Pérez, Sara Jacobo Vázquez, Lourdes Bermello López, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5862795/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Stroke is one of the leading causes of morbidity and mortality worldwide, classified as ischemic (85%) or haemorrhagic (15%), with transient ischemic attack (TIA) as an additional clinical entity. Advances in therapeutic strategies, including intravenous thrombolysis and mechanical thrombectomy, have significantly improved patient outcomes. However, specialized critical care, particularly nursing interventions, plays a pivotal role in addressing complications such as pressure ulcers, aspiration pneumonia, and falls, which can adversely affect functional recovery. Objective To evaluate adherence to the recommendations of a good nursing practice guide in the care of patients with ischemic stroke or transient ischemic attack (TIA) admitted to the Neurology Unit of the Lucus Augusti Hospital between 2020 and 2022. Method This cohort study included a sample of 745 patients diagnosed with ischemic stroke or transient ischemic attack (TIA) who met the inclusion criteria. Patients received recombinant tissue plasminogen activator (rt-PA) treatment within 4.5 hours of symptom onset and hospital arrival. Baseline computed tomography (CT) scans were evaluated using the Alberta Stroke Program Early CT Score (ASPECTS). Functional outcomes were assessed using the Barthel Index. Descriptive analyses were performed using measures of central tendency, dispersion, and percentages. Differences between groups were analysed using the Chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. Pairwise comparisons were conducted with the Mann-Whitney U test. Results The implementation of a good practice guide facilitated the systematic recording of quality indicators and potentially improved the overall quality of care. Among the patients included, 81.3% experienced an ischemic stroke between 2020 and 2022, with a mean age of 73.3 (± 11.98) years and a Barthel Index score of 78.84 (± 29.42) points at admission. An inverse correlation was observed between functional outcomes and adverse events, including falls (p = 0.001), pain (p = 0.001), and aspiration pneumonia (p = 0.001). Poorer functional outcomes were associated with a higher frequency of these complications and greater pain intensity. Conclusion The implementation of a good nursing practice guide improved care quality standards, particularly in key indicators such as neurological assessment within the first 24 hours, dysphagia screening, pressure injury prevention, pain assessment, and documentation of independence levels at discharge. Significant associations were identified between age and both pain and Barthel Index, as well as between sex and these variables. Additionally, functional outcomes measured by the Barthel Index were inversely correlated with aspiration pneumonia, falls, and pain. ischemic stroke Barthel index falls aspiration pneumonia pressure ulcers dysphagia Background The World Health Organization (WHO) defines stroke as a sudden disturbance in brain function. It is characterized by signs or symptoms lasting more than 24 hours. These symptoms may lead to death due to a vascular cause. 1 , 2 Stroke is most common classified based on its nature into two main categories: ischemic and hemorrhagic. Ischemic stroke, accounting for 85% of cases, results from an alteration in the brain's blood supply, causing a neurological deficit lasting more than 24 hours and leading to tissue necrosis. In contrast, hemorrhagic stroke, which represents the remaining 15%, occurs due to the rupture of a cerebral blood vessel. 1 Subsequently, the concept of transient ischemic attack (TIA) was introduced, defined as a transient episode of neurological dysfunction caused by focal cerebral ischemia without evidence of permanent damage. 1 Ischemic stroke is a leading cause of morbidity and mortality, ranking as the third leading cause of death, the primary cause of disability among adults in developed countries, and the second leading cause of dementia after Alzheimer's disease. Its incidence increases with age, and despite a decline in stroke-related mortality, the aging population has contributed to a rise in its prevalence and associated social costs. 5 Technological advances have led to the development of highly effective therapies for ischemic stroke, such as thrombolytics. Recombinant tissue plasminogen activator (rt-PA), approved by the United States Food and Drug Administration (FDA) in 1996, remains a cornerstone treatment for acute ischemic stroke. Alongside mechanical thrombectomy, rt-PA is one of the few interventions available and is administered to patients within 4.5 hours of symptom onset, provided they meet specific selection criteria. 3 Although intravenous thrombolysis has been established as the gold standard treatment for stroke for over 20 years, mechanical thrombectomy was fully legitimized as a technique for acute stroke treatment starting in 2015, with both therapies potentially being used in combination. 6 – 9 Studies suggest that long-term outcomes in critical care units depend not only on reperfusion therapies but also on patient characteristics and specific care practices. Consequently, critical care units, particularly nursing interventions, can significantly influence functional outcomes in both the short and long term, potentially complementing the benefits of reperfusion. 3 , 10 The Quality in Acute Stroke Care (QASC) trial demonstrated that implementing bundled care interventions for stroke patients significantly improved adherence to evidence-based protocols and patient outcomes. These findings underscore the importance of standardized care practices, aligning with the objectives of this study to evaluate the impact of best practice guidelines in a neurology unit. 11 Nurses in stroke or neurology units are key to addressing risks like pressure ulcers (PU), post-stroke pain (PSP), the risk of aspiration pneumonia (AP), and falls. These aspects are highly relevant to the nursing profession, as they represent preventable and avoidable risks. 12 The Registered Nurses’ Association of Ontario (RNAO) is a globally recognized leader in the development, adoption, sustainability, and evaluation of evidence-based nursing practices. Best practice guidelines are systematically developed documents designed to assist healthcare professionals and patients in making timely healthcare decisions. In 2018, the Healthcare Area of Lugo, A Mariña, and Monforte de Lemos joined the best practice guidelines program, implementing the guideline "Stroke Assessment through Continuous Care" in the neurology and neurosurgery unit of the University Hospital Lucus Augusti (HULA). The goal was to provide nurses with evidence-based recommendations for assessing and screening patients recovering from a stroke through continuous care. 13 This study aims to determine adherence to the recommendations of a good nursing practice guide. The guideline focuses on the care of patients with ischemic stroke or transient ischemic attack admitted to the Neurology Unit of Lucus Augusti Hospital between 2020 and 2022. The secondary objectives are as follows: To analyze the functional outcomes of patients who have experienced ischemic stroke or transient ischemic attack. To compare age with pain levels and the Barthel Index. To correlate sex with the Barthel Index and pain levels. To associate patients’ level of autonomy upon admission with the number of falls, pain levels, and episodes of aspiration pneumonia. Methods Study Design and Patients This is a cohort study involving patients with ischemic stroke or transient ischemic attack (TIA) treated at Lucus Augusti Hospital between January 1, 2020, and November 30, 2022. This study is part of ongoing research conducted by Lucus Augusti Hospital (Lugo, Spain) in collaboration with the Carlos III Health Institute, based on the "Nursing Best Practice Guidelines" developed by the Investén-isciii group. 13 The implementation process of the guideline began in 2018 with a pilot study. The CONSORT 2010 guidelines was used in the design of this study. Four time points were considered to establish quality outcomes: baseline measurement (T0; January–December 2019, as a reference prior to implementation), implementation start (T1; January–December 2020), control (T2; January–December 2021), and consolidation (T3; January–December 2022, focusing on the last month of each quarter). Successful implementation of the guideline was defined as achieving at least 75% of the total recommendations, while the quality department of the center set the target for new indicator records at 80%. Patient Selection Inclusion and exclusion criteria were determined by the hospital protocol. Inclusion criteria: anterior or posterior cerebral occlusion, age > 18 years, and a National Institutes of Health Stroke Scale (NIHSS) score ≥ 6. Patients meeting these criteria, as outlined in the Unit protocol, were treated with rt-PA, provided the time from symptom onset to hospital arrival was < 4.5 hours. The guidelines used were those of the Spanish Society of Neurology. Exclusion criteria: intracranial hemorrhage or pregnancy. Variables and Data Collection The variables in this study include: Sociodemographic: age, sex, and admission date (dd/mm/yyyy). Clinical: type of stroke, neurological assessment, dysphagia evaluation, functional outcome, Barthel Index, aspiration pneumonia, falls, post-stroke pain, and pressure ulcers. Before implementing the guideline recommendations at the center, the associated indicators were not routinely recorded. In 2018, a pilot study was launched to incorporate the recording of seven guideline recommendations, along with clinical training on the use of the required instruments and scales. In 2019, the implementation of at least 75% of the minimum recommendations in the guideline was considered necessary to participate in the Investén-isciii group project, and the evaluation period from January to December 2019 was established as the baseline time (T0) for this study. In 2020, the 75% guideline recommendation threshold was maintained, as no new recommendations were incorporated due to the pandemic. The period from January to December 2020 was considered the implementation time (T1). In 2021, the same percentage was maintained as in previous years, and the period from January to December 2021 was designated as the control time (T2). Finally, in 2022, the percentage increased by adding a new recommendation: caregiver or family education. The period from January to December 2022 was considered the consolidation time (T3). The quality evaluation of the implementation and its indicators was conducted monthly using the CCEC® Program to minimize variability. The data were subsequently entered into the online platform CarEvID + ® in a fully anonymized format. Access to the online platform is restricted to evaluators designated at each center and the program's coordinating center. At Lucus Augusti Hospital, indicators are evaluated based on information exported from the computerized medical record system IANUS®. In addition to the minimum indicators required by the CCEC® Program (75% of the total), the centers may include their own indicators. Description of Implemented Recommendations The guideline's implementation recommendations included: Stroke assessment at admission, after neurological changes, and during referrals was performed by nurses in collaboration with the multidisciplinary team. This includes evaluating consciousness, orientation, motor and sensory functions, balance, speech, pupil response, vital signs, and applying a validated scale. Dysphagia detection upon admission or within 24 hours of the patient being awake and alert, recording the initiation of oral feeding and the development of aspiration pneumonia. This was carried out by a multidisciplinary team. Evaluation of independence level through the assessment of stroke patients' ability to perform activities of daily living was conducted by nurses using the Barthel Index. Fall risk assessment upon admission, review during hospitalization, and recording of fall incidents. This risk was measured by nurses. Pain detection upon admission, detection after a change in condition, and assessment of maximum pain during hospitalization were carried out exclusively by nurses using validated tools. Pressure ulcer risk assessment upon admission, review during hospitalization, and recording of pressure injuries associated with healthcare, and were evaluated by nurses. Description of Instruments National Institutes of Health Stroke Scale (NIHSS) The NIHSS quantifies stroke severity by evaluating neurological deficits, including motor and sensory impairments, speech, and level of consciousness. Scores range from 0 (no deficits) to 42 (severe deficits). Categorization is as follows: asymptomatic (0 points), minimal neurological deficit (1 point), mild neurological deficit (2–5 points), moderate neurological deficit (6–15 points), severe neurological deficit (16–20 points), and very severe neurological deficit (> 20 points). 14 Barthel Index The Barthel Index numerically scores the degree of dependency based on basic needs, such as eating, dressing, and mobility. It ranges from 0 (total dependence) to 100 (complete independence). It evaluates six parameters (eating, dressing, bowel control, bladder control, toileting, and stair use) from 0 to 10 points, two parameters (personal grooming and bathing) from 0 to 5 points, and one parameter (transfers) from 0 to 15 points. The final score ranges from 0 to 100, categorized as follows: <20 points (total dependence), 20–35 points (severe dependence), 40–55 points (moderate dependence), ≥ 60 points (mild dependence), and 100 points (independent). 15 Glasgow Coma Scale The Glasgow Coma Scale is a clinical tool used to assess a person's level of consciousness following a brain injury or trauma. It evaluates three parameters: eye-opening, verbal response, and motor response, assigning scores to each based on the observed level of response. The total score ranges from 3 to 15, with lower values indicating more severe neurological damage. It is widely used in medical emergencies to monitor patient progression and determine the need for interventions. 13 Downton Fall Risk Index The Downton Fall Risk Index assesses the risk of falls in older adults or hospitalized patients. It evaluates factors such as fall history, medication use, sensory deficits, mental state, and mobility. A score of 3 or more indicates high fall risk, allowing for preventive measures. It is useful in clinical settings to identify vulnerable patients and reduce adverse events related to falls. 13 Visual Analog Scale (VAS) The VAS is a simple tool used to measure pain intensity. It consists of a 10 cm line where one end represents 'no pain' (0) and the other 'worst pain imaginable' (10). Patients mark the point that best describes their pain, providing a numerical assessment. It is widely used in clinical practice due to its ease of application and usefulness in monitoring pain progression and treatment effectiveness. 13 Braden-Bergstrom Scale The Braden-Bergstrom Scale assesses the risk of developing pressure ulcers in hospitalized or immobilized patients. It evaluates six factors: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Scores range from 6 (high risk) to 23 (low risk). This scale helps identify vulnerable patients and plan preventive interventions, being widely used in clinical settings to improve care and reduce complications related to immobility. 13 Outcome Measures Functional outcomes were measured using the Barthel Index, categorized into five levels of dependency: total dependence (< 20 points), severe dependence (20–35 points), moderate dependence (40–55 points), mild dependence (60–95 points), and independent (100 points). 16 Statistical and Data Analysis Descriptive analysis was performed using measures of central tendency (mean (M)) and dispersion (standard deviation (SD)) for quantitative variables, and percentages for qualitative variables. To establish correlations between groups, the Chi-square test was used for qualitative variables, and the Kruskal-Wallis test was used for quantitative variables. Differences between groups were analyzed using the Mann-Whitney U test. A 95% confidence interval (CI) was applied, with statistical significance set at p < 0.05. All analyses were performed using the SPSS Inc., version 24.0 statistical package. Ethical Considerations Each institution selected in the call for proposals signs an agreement with Investén-isciii/CECBE/RNAO before starting the evaluation, committing to assess and disseminate the results. This agreement is renewed for each sustainability period. Additionally, participating professionals and evaluators signed a specific confidentiality and commitment agreement under the BPSO® program, in compliance with ethical standards, Law 14/2007 on Biomedical Research, and Regulation (EU) 2016/679 of the European Parliament and Council (April 27, 2016) on data protection and the free movement of personal data. The principal investigator collected the data, accessible only to the project team. No external party could modify them. This project was approved by the Research Ethics Committee (Registration Code 2022/389). The study was conducted in compliance with Good Clinical Practice standards, the Declaration of Helsinki, the Oviedo Convention, as well as data protection regulations and the management of medical records. Data processing was pseudonymized, meaning a data collection notebook was created to store all information in a coded manner. The database generated by the study contained no identifying patient data. Results In this study, the implementation of recommendations from a best practice guideline led to improvements in nursing care quality indicators, surpassing the center's quality objectives, with all indicators exceeding 80% of records. Significant improvements were observed in indicators such as neurological assessment within the first 24 hours, dysphagia assessment within the first 24 hours and pre-ingestion, prevention of pressure injuries, pain assessment, and recording of independence level at discharge when compared to the baseline period (2019). However, in 2019 and 2020, the 80% target was not met for the indicator of dysphagia assessment within the first 24 hours. Additionally, in 2019, the target for pre-ingestion dysphagia assessment was also not achieved. The indicator for recording independence level at discharge showed fluctuations, with 20% of cases lacking records in T1 and T3. In T2 (control), the percentage of missing records decreased to 11.8%. This target was only achieved in 2021, reaching 88.2%, but fell again in 2022 to 78.9% (Table 1 ). The number of ischemic stroke admissions was 310 in 2020, 340 in 2021, and 95 up to November 2022. A descriptive analysis of the sample is presented in the frequency table (Table 2 ). The highest number of strokes occurred in 2021, with a greater prevalence in men (56.4%) compared to women (43.6%). Ischemic stroke was the most common type, representing 81% of cases, while TIA accounted for 19%. The mean Barthel Index score was 78.84 (± 29.42), indicating mild dependency. The categorized results were as follows: <20 points = 6.9%, 20–35 points = 4.7%, 40–55 points = 8.7%, ≥ 60 points = 27.3%, and 100 points = 52.4%. An inverse correlation was identified between age and the variables post-stroke pain (PSP) (p = 0.032) and Barthel Index scores (p = 0.001), as shown in Table 3 . Regarding differences in age groups and Barthel index, an inverse association was found between the 80 years groups (p = 0.001), as well as between the 65–80 years group and the > 80 years group (p = 0.001). Regarding differences in age groups and pain, an inverse relationship was identified between the < 65 years group and the 65–80 years group (p = 0.032), with no differences analyzed between other groups. Significant correlations were found between sex and the variables Barthel Index score (p = 0.001) and PSP (p = 0.005). Women reported experiencing more pain than men, except at the maximum score of 10 points (Table 4 ). Finally, inverse associations were observed between Barthel Index scores and AP (p = 0.001), with a higher occurrence of AP episodes in patients with lower Barthel scores. A relationship between Barthel scores and falls was also identified (p = 0.001), with more falls occurring in patients with lower Barthel scores. Additionally, a comparison between Barthel scores and PSP (p = 0.001) showed higher pain scores on the Visual Analog Scale (VAS) in patients with lower Barthel scores (Table 5 ). Regarding differences in groups and AP, an association was established between the Barthel < 20 points category and the Barthel 20–35 points (p = 0.021), Barthel 40–55 points (p = 0.01), Barthel ≥ 60 points (p = 0.001), and Barthel = 100 points categories (p = 0.001). Differences were also observed between Barthel ≥ 60 points and Barthel = 100 points (p = 0.031). Regarding differences in groups and falls, a significant correlation was found between the Barthel < 20 points and Barthel 20–35 points categories (p = 0.034). Additionally, associations were identified between the Barthel 20–35 points category and the Barthel 40–55 points (p = 0.018), Barthel ≥ 60 points (p = 0.001), and Barthel = 100 points categories (p = 0.001). Finally, for differences in groups and PSP, a correlation was established between the Barthel < 20 points category and the Barthel 40–55 points (p = 0.007), Barthel ≥ 60 points (p = 0.001), and Barthel = 100 points categories (p = 0.001). Differences were also identified between Barthel 20–35 points and the Barthel ≥ 60 points (p = 0.001) and Barthel = 100 points categories (p = 0.001). Lastly, differences were observed between the Barthel 40–55 points and Barthel ≥ 65 points groups (p = 0.045). Discussion This study evaluates the quality indicators following the implementation of the Investén-ISCIII Best Practice Guidelines in the Neurology Unit of Lucus Augusti University Hospital between 2020 and 2022. The implementation of the recommendations from a best practice nursing guide improved quality indicator outcomes in the Neurology Unit, meeting the objectives established by the quality department and enhancing the overall quality of nursing care. Specifically, significant improvements were observed in key indicators such as neurological assessment within the first 24 hours, dysphagia evaluation within the first 24 hours and pre-ingestion, and prevention of pressure ulcers. These findings underscore the positive impact of standardized nursing practices on the quality and safety of patient care. However, it is important to acknowledge that the observed improvements in care quality and patient outcomes cannot be exclusively attributed to the implementation of the guidelines. Factors such as staff training, patient characteristics (e.g., comorbidities and age), and hospital policies likely contributed to these results. Although this study identified significant correlations between the Barthel Index and variables such as aspiration pneumonia, falls, and pain, its design does not permit definitive conclusions about causality. Future research should aim to control these potential confounders through prospective or multicenter studies to more accurately establish causal relationships. It is worth noting that the lack of records regarding independence at discharge requires further investigation. Although improvements were observed from the baseline period compared to the subsequent three time points, there was an improvement during the control phase (T2) and a deterioration during the consolidation phase (T3). This resulted in meeting the target for this indicator in 2021 but failing to do so in 2022. The decline in independence at discharge observed in 2022 may be linked to organizational challenges, including the reinstatement of staff transfers and the integration of personnel requiring additional training following the COVID-19 pandemic. These factors likely disrupted the continuity of care and negatively impacted the quality of nursing practices. Comparatively, other studies have reported similar challenges during periods of staff turnover or resource reallocation, emphasizing the importance of stable and well-trained teams in maintaining high-quality care. To address these challenges, future strategies should include continuous education programs, mentorship systems for new staff, and regular audits of nursing practices. Additionally, enhancing interdisciplinary collaboration and developing contingency plans for periods of high staff mobility could help mitigate the impact of such disruptions on patient outcomes. This aspect warrants additional research and the establishment of operational objectives within the unit to achieve improvement. This is particularly relevant considering that the evaluation of independence through the Barthel Index is a key outcome measure applied to patients who have suffered an ischemic stroke or transient ischemic attack (TIA). Although not the focus of this study, it is worth mentioning that in 2022, staff transfers, which had been suspended during the pandemic, were reinstated. This caused mobility between departments and the incorporation of staff who required training, with only 24 hours available to complete the transition to the new unit. Additionally, it is important to emphasize the improvement in the recording of neurological assessments using the NIHSS scale across all time points compared to the baseline period. Neurological assessment is a functional outcome of the acute post-intervention phase in patients with ischemic stroke or TIA, enabling the early activation of short- and medium-term resources. It will be necessary to continue implementing non-mandatory recommendations from the best practice guidelines to further improve the quality of nursing care. Specifically, in the analyzed unit, recommendations for cognitive status assessment and health education for family members remain to be implemented. This study included 745 patients (56.4% male, 43.6% female) with a mean age of 73.3 (± 11.98) years. The demographic data revealed a similar sex distribution to that reported in other studies, despite differences in sample size. 16 , 17 For example, in the study by Moreno Palacios et al. 18 , the mean age was 88.6 years (range 85–97), with a much smaller sample size (23 women and 18 men) compared to our study, as well as a clear difference in age. The study by Pego Pérez et al. 16 reported comparable findings, with 57% male and 43% female participants, and a mean age of 73.99 (± 11.69) years. Hernández-Bello et al. 19 also found a higher prevalence in men (65.4%) compared to women, with a mean age of 72.84 (± 12.53) years. Regarding functional status, this study focused exclusively on the acute phase, from symptom onset to hospital discharge, which was evaluated using the Barthel Index. The mean Barthel score at discharge was 78.84 (± 29.42) points, indicating mild dependency, with an interquartile distribution of 60 points for the first quartile, 100 points for the second quartile, and 100 points for the third quartile. When compared to other studies, considerable variability in Barthel Index results was observed. For instance, the study by Moreno Palacios et al. 18 reported a mean Barthel score of 80.6 (± 15.1) points before the stroke and 45 (± 34.4) points after the stroke, indicating moderate dependency. In contrast, the study by Pego Pérez et al. 16 showed similar functional outcomes to our study, with a mean Barthel score of 77 (± 28.9) points in 2020 and 73.71 (± 29.8) points in 2021. This study also determined that the SARS-CoV-2 pandemic did not correlate with a worsening of functionality in stroke survivors. In terms of falls, data were collected throughout the hospital stay, revealing that only 0.8% of patients experienced adverse events of this nature. The data also indicated a higher prevalence of falls in men and in patients diagnosed with ischemic stroke compared to TIA. The findings of this study are consistent with those reported in other studies, such as the work by Kai-hoi et al. 20 , which revealed that 11.5% of Chinese patients experienced a fall during hospitalization, with a higher prevalence in men and in ischemic strokes. They concluded that most falls occurred in the patients' rooms and identified dysphagia and Barthel scores between 5 and 15 points as significant risk factors. Similarly, Rabadi et al. 21 reported a 15.5% incidence of falls, with significant differences based on sex and stroke type. This study also analyzed the risk of aspiration pneumonia (AP), identifying significant correlations with age, functional capacity, and dysphagia assessment prior to the initiation of oral feeding. Dysphagia was assessed in 94.6% (n = 705) of the sample and prior to oral feeding in 94.4% (n = 703). A higher incidence of AP was observed in patients who had not undergone dysphagia assessment, with this adverse event occurring in 17% (n = 40) of total cases. Additionally, the results showed that AP was more common in patients with lower Barthel Index scores, with 16.7% (n = 7) of cases occurring in patients with total dependency. In this study, patients were kept on a strict nil-by-mouth diet until dysphagia assessment was performed. Diets were progressively introduced based on patient tolerance. In the study by Pilato et al. 10 , patients were fitted with a nasogastric tube after ischemic stroke treatment, and worse NIHSS scores were identified as predictors of dysphagia risk. Regarding long-term outcomes, worse NIHSS scores, hemorrhagic transformations, and advanced age were correlated with poorer functionality at six months. When compared with other studies, Al-Khaled et al. 22 reported that only 74% of patients underwent dysphagia assessment, with aspiration pneumonia episodes being more frequent in patients who had not been assessed (12.1%). Liang et al. 23 found that 78.7% of patients underwent dysphagia evaluation, with 8.1% developing aspiration pneumonia. They concluded that advanced age, high NIHSS scores, and particularly the presence of dysphagia were risk factors for AP development. The study by Matuja et al. 24 demonstrated that aspiration pneumonia (AP) was the most common medical complication, occurring in 41.3% of patients. Furthermore, the cumulative incidence of AP among the 568 patients sampled was 23.06%. Male patients were found to have 1.71 times higher risk of developing AP compared to female patients. Additionally, patients presenting with vomiting and dysphagia had a significantly higher risk of AP compared to those without these conditions. 25 The prevalence of pressure ulcers (PU) was also analyzed, as they are a common complication in immobilized patients, representing an adverse event that negatively impacts quality of life and serves as a key indicator of nursing care quality. The results showed that only 0.1% of patients developed PU during hospitalization, while 0.6% had PU prior to the ischemic event. Preventive measures were implemented in 99.4% of the population during hospitalization. Other studies, such as Liao et al. 26 , found that 0.8% of patients developed PU during hospitalization, with advanced age, marital status, high NIHSS scores, and high mRS scores identified as risk factors. In their study, PU prevalence was 10%, and preventive measures were implemented in 74% of patients, concluding that PU risk was considerably higher. 27 This study also analyzed post-stroke pain (PSP), identifying no pain in 64.2% (n = 478), mild pain in 15.7% (n = 117), moderate pain in 18.2% (n = 105), and severe pain in 1.9% (n = 14). PSP is a common sequela of stroke that typically develops in the body area corresponding to the cerebrovascular lesion, most often following ischemic stroke but also in cases of hemorrhagic stroke. The pathogenesis of PSP is still unknown, and research on this topic is ongoing. 28 , 29 Inverse correlations were established between age and the Barthel Index, with differences observed between the 80 years groups, as well as between the 65–80 years and > 80 years groups. Regarding age groups and pain, an inverse association was found between the < 65 years group and the 65–80 years group. Relationships were also established between sex and the variables Barthel score and PSP, with women experiencing more pain than men. Inverse correlations were observed between Barthel scores and AP, with more AP episodes occurring in patients with lower Barthel scores. A relationship was also found between Barthel scores and falls, with more falls occurring in patients with lower scores. Finally, an inverse association was established between Barthel scores and PSP, with higher PSP scores observed in patients with lower Barthel scores. Thus, specialized nurses in neurology units should rely on basic nursing practices for planning fundamental scientific care. However, they must continue to develop their specialized identity to adequately address the specific needs of neurological conditions. The findings of this study provide a framework for other hospitals seeking to replicate these improvements in quality indicators. Practical applications include the adoption of standardized nursing practice guidelines supported by comprehensive training programs and ongoing monitoring of quality indicators. To ensure consistency, these guidelines could be mandated at a national level, with adaptations to accommodate regional differences in healthcare systems. Furthermore, long-term follow-up of patients beyond hospital discharge would provide valuable insights into sustained functional recovery and the long-term impact of nursing interventions. Future studies should prioritize the development of longitudinal cohorts to assess outcomes such as independence, quality of life, and rehospitalization rates over extended periods. Limitations This study forms part of a project designed to evaluate care quality through clinical indicators aligned with the recommendations of the Investén Best Practice Guidelines. Consequently, it was not feasible to plan for a broader collection of variables, as the study was limited to those approved by the research ethics committee. The study population consisted of a hospital cohort from a specific community hospital setting, which limits the generalizability of the findings. To test causality, evaluate predictive capacity, and extend the hypotheses to other healthcare systems with differing resources, patient demographics, and care protocols, a larger sample size and a multi-site study would be necessary. The retrospective nature of this analysis introduces potential biases. Selection bias may have arisen from loss to follow-up or the inclusion of patients meeting specific criteria, potentially excluding individuals with differing characteristics. Misclassification bias may also have occurred due to the reliance on retrospective data extracted from medical records, as the accuracy and completeness of these records can vary. Furthermore, the study did not account for potential confounding factors such as comorbidities, medication adherence, or variations in hospital policies, all of which could have influenced the outcomes. Future prospective studies should aim to address these limitations to strengthen the validity of the findings. Finally, direct comparisons with published studies are challenging, if not impossible, due to variations in selection criteria, sample sizes, and patient management protocols. The findings of this study are context-specific and may not be generalizable to other healthcare settings or populations. Multi-center studies with larger sample sizes and prospective designs are recommended to validate these results, explore causal relationships, and ensure broader applicability. Conclusion The implementation of recommendations from best practice guidelines was associated with significant improvements in quality indicators for nursing care in patients with ischemic stroke or transient ischemic attack within the studied context. The study population predominantly exhibited a mild level of dependency. An inverse relationship was identified between age and the variables Barthel Index and pain level. Additionally, a correlation was observed between sex and the variables Barthel Index and pain, warranting further research to elucidate the underlying mechanisms. Lastly, an inverse association was observed between Barthel Index scores and the variables aspiration pneumonia, falls, and pain. Declarations Ethics approval and consent to participate This project was approved by the Research Ethics Committee Santiago-Lugo (Registration Code 2022/389) which is affiliated with Servizo Galego de Saúde (sergas), Santiago de Compostela, A Coruña (España). CP: 15703. All participants were thoroughly informed about the objectives of the study, the procedures involved, and their right to withdraw at any point without any consequences. Written informed consent was obtained from each participant prior to their inclusion in the study. Additionally, we confirm that all experiments involving human subjects were performed in strict compliance with the Declaration of Helsinki and other applicable ethical guidelines. This information has been explicitly included in the "Ethics approval and consent to participate" section of the manuscript. Consent for publication Not applicable All participants signed the mandatory consent form. Availability of data and materials The data that support the findings of this study are available from Bermello López, Lourdes but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Servizo Galego de Saúde (SERGAS). Competing interests All authors declared no competing interests. Funding Ilustre Colegio Oficial de Enfermería de Lugo 02/2024. Authors' contributions ERPP performed the analysis and interpretation of data related to quality indicators in nursing care and was a major contributor to the writing of the manuscript. SJV participated in the study design, data collection, and critical review of the manuscript, providing substantial improvements. LBL supervised the implementation of the recommendations from the good practice guide, contributed to the statistical analysis, and reviewed the manuscript for publication. IRP was responsible for evaluating the functional outcomes of the patients and collaborated in the interpretation of the results. MRMA supported the collection of clinical data and contributed to the review and editing of the manuscript. EGF designed methodological strategies, led the coordination of the project, and substantially reviewed the manuscript. All authors read and approved the final version of the manuscript. Additionally, all have agreed to be accountable for their own contributions and to ensure that any questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Acknowledgements Not applicable Conflict of interests: The authors declared no conflict of interest. References Gutiérrez-Zúñiga R, Fuentes B, Díez-Tejedor E. Ictus isquémico, Infarto cerebral y ataque isquémico transitorio. Medicine. 2019;12(70):4085–96. https://doi.org/10.1016/j.med.2019.01.002 . World Health Organization. 2008. Ginebra, Suiza. Available from: https://www.who.int/es Bermello López ML, Pego Pérez ER, Rodríguez Pérez I. Déficit neurológico y grado de autonomía en pacientes con ictus isquémico, tratados con trombectomía mecánica. Un estudio retrospectivo. Revista Científica de la Sociedad Española de Enfermería Neurológica. 2024. 10.1016/j.sedene.2023.12.003 Sociedad Española de Neurología. El atlas del ictus en España 2019. Weber. 2019:56. Available from: https://www.sen.es/images/2020/atlas/Atlas_del_Ictus_de_Espana_version_web.pdf Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. ¿Ha dejado de disminuir la mortalidad por enfermedades cerebrovasculares en España? Neurología. 2019; 37:550–6. https://doi.org/10.1016/j.nrl.2019.06.001 Pilato F, Silva S, Valente I, Distefano M, Broccolini A, Brunetti V, et al. Predicting factors of functional outcome in patients with acute ischemic stroke admitted to neuro-intensive care unit-A prospective cohort study. Brain Sci. 2020;10(12):911. https://doi.org/10.3390/brainsci10120911 . Alexandre AM, Colò F, Brunetti V, Valente I, Frisullo G, Pedicelli A, et al. Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis. J Neurointerv Surg. 2023;15(e2):e198–203. https://doi.org/10.1136/jnis-2022-019557 . Lambrinos A, Schaink AK, Dhalla I, Krings T, Casaubon LK, Sikich N, et al. Mechanical thrombectomy in acute ischemic stroke: a systematic review. Can J Neurol Sci. 2016;43:455–60. http://dx.doi.org/10.1017/cjn.2016.30 . Derex L, Cho TH. Mechanical thrombectomy in acute ischemic stroke. Francia: Revue neurologique. 2016;173(3):106–13. http://dx.doi.org/10.1016/j.neurol.2016.06.008 . Pilato F, Valente I, Alexandre AM, Calandrelli R, Scarcia L, D'Argento F, et al. Correlation between Thrombus Perviousness and Distal Embolization during Mechanical Thrombectomy in Acute Stroke. Diagnostics. 2023;13(3):431. 10.3390/diagnostics13030431 . Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D'Este C, et al. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Lancet. 2011;378(9804):1699–706. 10.1016/S0140-6736(11)61485-2 . Piñero Sáez S, Sanz Aznarez AC, Ruiz García MV, González García J, Mena Sucunza L, Córcoles Jiménez MP. Implantanción de la Guía de buenas prácticas: valoración del ictus mediante la atención continuada en pacientes hospitalizados. Enferm Clin. 2019;30(3):160–7. https://doi.org/10.1016/j.enfcli.2019.10.026 . Registered Nurses Association of Ontario. Guía de Buenas Prácticas en Enfermería. Cómo enfocar el futuro de la enfermería. Valoración del ictus mediante atención continuada (Actualización 2011). Versión española traducida por Investén-isciii. [Internet]. RNAO: Toronto, Canadá. 2011. Available from: https://rnao.ca/sites/rnao-ca/files/Valoracion_del_ictus_mediante_la_atencion_continuada.pdf Mahoney FI, Barthel DI. Functional evaluation: The Barthel Index. Maryland State Med J. 1965;14:56–61. Available from: https://www.kcl.ac.uk/nmpc/assets/rehab/tools-bi-functional-evaluation-the-barthel-index.pdf Montaner J, Álvarez-Sabín J. La escala de ictus del National Institute of Health (NIHSS) y su adaptación al español. Neurología. 2006;21(4):192–202. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/ibc-048787 Pego Pérez ER, Bermello López L, Marín Arnés MR, Gómez Fernández E, Núñez Hernández MI. Rodríguez Pérez I. Autonomy Outcomes Measured with Barthel Index in Patients with Ischaemic Stroke during SARS-CoV-2 Pandemic. A Descriptive Study. Neurol Neurosurg. 2022;17(3): 555961. 10.19080/OAJNN.2022.17.555961 . Available from: https://juniperpublishers.com/oajnn/pdf/OAJNN.MS.ID.555961.pdf Tejada Meza H, Saldaña Inda I, Serrano Ponz M, Ara JR, Marta Moreno J. Neurología. 2020;38(3):141–9. https://doi.org/10.1016/j.nrl.2020.07.023 . Impacto en los tiempos puerta-aguja de un conjunto de medidas para optimizar la atención hospitalaria del código ictus. Moreno Palacios JA, Moreno Martínez I, Pintor Ojeda A, Nuño Estebez ME, Casado Blanco C, Moreno López J. Evolución funcional tras un ictus en mayores de 85 años. Rehabilitación. 2017;52(1):21–7. https://doi.org/10.1016/j.rh.2017.10.001 . Hernández-Bello E, Castellot-Perales L, Tomás-Aznar C. Valoración de la disfagia con el método exploración clínica volumen-viscosidad en pacientes ingresados tras un accidente cerebrovascular. Rev Cient Soc Esp Enferm Neurol. 2019;49:8–15. https://doi.org/10.1016/j.sedene.2018.08.001 . Kai-hoi S, Wong E, Leung HY, Woo J. Falls among Chinese stroke patients during rehabilitation. Arch Phys Med Rehabil. 2001;28:1219–25. https://doi.org/10.1053/apmr.2001.25094 . Rabadi MH, Rabadi FM, Peterson M. An analysis of falls occurring in patients with stroke on an acute rehabilitation unit. Rehabilitation Nurs. 2008;33(3):104–9. https://doi.org/10.1002/j.2048-7940.2008.tb00213.x . Al-Khaled M, Matthis C, Binder A, Mudter J, Schattschneider J, Pulkowski U, et al. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes. Cerebrovasc Dis. 2016;42:81–9. https://doi.org/10.1159/000445299 . Liang J, Yin Z, Li Z, Gu H, Yang K, Xiong Y, et al. Predictors of dysphagia screening and pneumonia among patients with acute ischaemic stroke in China: findings from the Chinese Stroke Center Alliance (CSCA). Stroke Vascular Neurol. 2022;7:294–301. https://doi.org/10.1136/svn-2020-000746 . Matuja SS, Mlay G, Kalokola F, Ngoya P, Shindika J, Andrew L, et al. Predictors of 30-day mortality among patients with stroke admitted at a tertiary teaching hospital in Northwestern Tanzania: A prospective cohort study. Front Neurol. 2023;13:1100477. https://doi.org/10.3389/fneur.2022.1100477 . Lidetu T, Muluneh EK, Wassie GT. Incidence and Predictors of Aspiration Pneumonia Among Stroke Patients in Western Amhara Region, North-West Ethiopia: A Retrospective Follow Up Study. Int J Gen Med. 2023:1303–15. https://doi.org/10.2147/IJGM.S400420 Liao X, Ju Y, Liu G, Zhao X, Wang Y, Wang Y. Risk Factors for Pressure Sores in Hospitalized Acute Ischemic Stroke Patients. J Stroke Cerebrovasc Dis. 2019;28(7):2026–30. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.033 . Amir Y, Halfens RJG, Logrmann C, Schols JM. Pressure ulcer prevalence and quality of care in stroke patients in an Indonesian hospital. J Wound Care. 2016;22(5):254–60. https://doi.org/10.12968/jowc.2013.22.5.254 . Cheng Y, Wu B, Huang J, Chen Y. Research Progress on the Mechanisms of Central Post-Stroke Pain: A Review. Cell Mol Neurobiol. 2023;1–16. https://doi.org/10.1007/s10571-023-01360-6 . Xiong F, Shen P, Li Z, Huang Z, Liang Y, Chen X, et al. Bibliometric Analysis of Post-Stroke Pain Research Published from 2012 to 2021. J Pain Res. 2023;16:1–20. https://doi.org/10.2147/JPR.S375063 . Tables Table 1. Results in the quality indicators of the recommendations of the Good Practices Guide of the Investén-isciii group. T0 (n=274) T1 (n=310) T2 (n=340) T3 (n=95) p-value Neurological assessment at first 24 hours 0.001 Yes 93.8 (257) 93.9 (291) 96.2 (327) 96.8 (92) No 5.8 (16) 6.1 (19) 3.8 (13) 3.2 (3) Not apply 0.4 (1) 0 (0) 0 (0) 0 (0) Revaluation after neurological deterioration 0.005 Yes 2.9 (8) 1.6 (5) 2.7 (9) 2.1 (2) No 2.2 (6) 1.6 (5) 1.5 (5) 2.1 (2) Not apply 94.9 (260) 96.8 (300) 95.8 (326) 95.8 (91) Dysphagia assessment in the first 24 hours 0.001 Yes 79.9 (219) 9 (28) 96.8 (329) 98.9 (94) No 19.7 (54) 91 (282) 3.2 (11) 0 (0) Not apply 0.4 (1) 0 (0) 0 (0) 1.1 (1) Pre-ingestion dysphagia assessment 0.001 Yes 76.3 (209) 90.7 (281) 96.5 (328) 98.9 (94) No 23.3 (64) 9 (28) 3.2 (11) 1.1 (1) Not apply 0.4 (1) 0.3 (1) 0.3 (1) 0 (0) Fall risk assessment 0.001 Yes 100 (274) 100 (310) 100 (340) 98.9 (94) No 0 (0) 0 (0) 0 (0) 0 (0) Not apply 0 (0) 0 (0) 0 (0) 1.1 (1) Assessment of pressure ulcers 0.001 Yes 98.5 (270) 99.4 (308) 99.4 (338) 98.9 (94) No 1.5 (4) 0.6 (2) 0.3 (1) 0 (0) Not apply 0 (0) 0 (0) 0.3 (1) 1.1 (1) Detection of pain upon admission 0.001 Yes 99.6 (273) 99.7 (309) 100 (340) 100 (95) No 0.4 (1) 0.3 (1) 0 (0) 0 (0) Not apply 0 (0) 0 (0) 0 (0) 0 (0) Determination of the level of independence at discharge 0.004 Yes 56.6 (155) 76.1 (236) 88.2 (300) 78.9 (75) No 43.4 (119) 22.9 (71) 11.8 (40) 21.1 (20) Not apply 0 (0) 1 (3) 0 (0) 0 (0) Data presentation: % (n). T0: baseline time. January-December 2019. T1: implementation time. January-December 2020. T2: control time. January-December 2021. T3: consolidation time. January-December 2022 (last month of each one of the quarters). Table 2. Frequency table with sample characteristics. A. Quantitative variables N Mean Standard Deviation P25 P50 P75 Inferior Limit Superior Limit Age 745 73.3 11.98 66 75 83 28 96 Barthel 611 78.84 29.42 60 100 100 0 100 B. Qualitative variables N % Sex Men Woman 420 325 56.4 43.6 Year 2020 310 41.6 2021 2022 340 95 45.6 12.8 Type of stroke Ischemic TIA 606 139 81.3 18.7 Neurological anamnesis Yes 710 95.3 No 35 4.7 Neurological anamnesis after clinical change Yes 16 2.1 Not apply 717 96.2 No 12 1.6 Dysphagia assessment Yes 705 94.6 No 40 5.4 Functional outcome measure Yes 611 82 No 131 17.6 Not apply 3 0.4 Aspiration pneumonia Yes 17 2.3 No 728 97.7 Oral feeding Yes 743 99.7 No 2 0.3 Oral feeding after dysphagia assessment Yes 703 94.4 No 40 5.4 Falls assessment Yes 744 99.9 Not apply 1 0.1 Post-stroke pain assessment Yes 744 99.9 No 1 0.1 Post-stroke pain assessment after clinical change Yes 268 36 Not apply 477 64 Pressure ulcer assessment Yes 740 99.4 No 4 0.5 Not apply 1 0.1 Number of falls None Any 737 6 98.9 0.8 Pain assessment (VAS) 0 1 2 3 4 5 6 7 8 9 478 25 30 62 40 28 28 9 11 2 64.2 3.4 4 8.3 5.4 7.8 3.8 1.2 1.5 0.3 10 1 0.1 Pressure ulcer during hospitalization No Yes 744 1 99.9 0.1 Pressure ulcer care during hospitalization No Yes 739 6 99.2 0.8 Barthel Index groups < 20 20-35 40-55 ≥ 60 100 42 29 53 167 320 6.9 4.7 8.7 27.3 52.4 Age groups 80 years 175 331 239 23.5 44.4 32.1 VAS= Visual analogic scale. P25=first quartile. P50=second quartile. P75=third quartile. Table 3. Association between age and pain and Barthel (95% CI). Age n (%) p-value 80 years Pain 0 102 (58.3) 223 (67.4) 153 (64) 0.001** 1 5 (2.9) 9 (2.7) 11 (4.6) 2 7 (4) 12 (3.6) 11 (4.6) 3 17 (9.7) 27 (8.2) 18 (7.5) 4 15 (8.6) 11 (3.3) 14 (5.9) 5 9 (5.1) 30 (9.1) 19 (7.9) 6 10 (5.7) 11 (3.3) 7 (2.9) 7 2 (1.1) 4 (1.2) 3 (1.3) 8 6 (3.4) 4 (1.2) 1 (0.4) 9 1 (0.6) 0 (0) 1 (0.4) 10 1 (0.6) 0 (0) 0 (0) Barthel <20 3 (2.1) 11 (4.1) 28 (13.9) 0.009** 20-35 0 (0) 14 (5.2) 15 (7.5) 40-55 4 (2.8) 24 (8.9) 25 (12.4) ≥60 20 (14.2) 72 (26.8) 75 (37.3) 100 114 (80.9) 148 (55) 58 (28.9) ** Kurskal-Wallis test CI=Confidence interval Table 4. Comparison between sex and Barthel and pain (95% CI). Sex p-value Men Woman Barthel <20 18 (5.2) 24 (9.1) 0.001* 20-35 16 (4.6) 13 (4.9) 40-55 22 (6.3) 31 (11.8) ≥60 85 (24.4) 82 (31.2) 100 207 (59.5) 113 (43) Pain 0 295 (70.2) 183 (56.3) 0.001* 1 10 (2.4) 15 (4.6) 2 19 (4.5) 11 (3.4) 3 31 (7.4) 31 (9.5) 4 19 (4.5) 21 (6.5) 5 24 (5.7) 34 (10.5) 6 13 (3.1) 15 (4.6) 7 2 (0.5) 7 (2.2) 8 5 (1.2) 6 (1.8) 9 0 (0) 2 (0.6) 10 1 (0.2) 0 (0) * Chi 2 test IC=Confidence interval Table 5. Association between Barthel and aspiration pneumonia. falls and pain (95% CI). Barthel p-value <20 20-35 40-55 ≥60 100 Aspiration pneumonia Yes 7 (16.7) 0 (0) 1 (1.9) 4 (2.4) 1 (0.3) 0.001* No 35 (83.3) 29 (100) 52 (98.1) 163 (97.6) 319 (99.7) Falls Yes 0 (0) 3 (10.3) 0 (0) 0 (0) 1 (0.3) 0.001* No 42 (100) 26 (89.7) 53 (100) 167 (100) 317 (99.7) Pain 0 12 (28.6) 11 (37.9) 30 (56.6) 118 (70.7) 222 (69.4) 0.001** 1 1 (2.4) 2 (6.9) 1 (1.9) 5 (3) 12 (3.8) 2 2 (4.8) 4 (13.8) 2 (3.8) 7 (4.2) 9 (2.8) 3 5 (11.9) 3 (10.3) 7 (13.2) 12 (7.2) 25 (7.8) 4 7 (16.7) 1 (3.4) 3 (5.7) 7 (4.2) 17 (5.3) 5 10 (23.8) 5 (17.2) 5 (9.4) 9 (5.4) 17 (5.3) 6 4 (9.5) 1 (3.4) 4 (7.5) 3 (1.8) 10 (3.1) 7 1 (2.4) 1 (3.4) 1 (1.9) 2 (1.2) 1 (0.3) 8 0 (0) 1 (3.4) 0 (0) 4 (2.4) 4 (1.3) 9 0 (0) 0 (0) 0 (0) 0 (0) 2 (0.6) 10 0 (0) 0 (0) 0 (0) 0 (0) 1 (0.3) * Chi 2 test ** Kurskal-Wallis test CI= Confidence interval Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5862795","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":434839876,"identity":"e985aa5a-0111-4404-a04c-f4330e13a547","order_by":0,"name":"Emilio Rubén Pego Pérez","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYFACxsYDCUDKAMbnJ0JLA6oWyQYi7DnAgKzF4AAB5fxihxsOPKi4l7idvfcAc0FFrZzxjfSHHxgq6nBqkZydCHTYmeLEnT3nEphnnDlubHYjx1iC4cxhnFoMbgO1JLYlJG64kWPAzNt2LHHbjRw2BsY23M6zh2u5/wao5d+xxM0z0p8xMP7D7TADabgtPEAtDTWJGyQSzIDByIxTi8RtsF8SjHf25BgcnnHsgLHEmTfGEgnHcPuFf3b6w4c/KhJkt7OfMXxcUFMnx98ODLEPNbgdhgIOgxEIJBCngYEB6H4iDR8Fo2AUjIIRBQAqFV3+HGHWcgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Santiago de Compostela","correspondingAuthor":true,"prefix":"","firstName":"Emilio","middleName":"Rubén Pego","lastName":"Pérez","suffix":""},{"id":434839877,"identity":"2be78822-bb67-4259-aa33-4410f278928f","order_by":1,"name":"Sara Jacobo Vázquez","email":"","orcid":"","institution":"Servicio Gallego de Salud","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"Jacobo","lastName":"Vázquez","suffix":""},{"id":434839878,"identity":"01abd43f-786c-4dfd-8d2e-579da783c6b8","order_by":2,"name":"Lourdes Bermello López","email":"","orcid":"","institution":"Servicio Gallego de Salud","correspondingAuthor":false,"prefix":"","firstName":"Lourdes","middleName":"Bermello","lastName":"López","suffix":""},{"id":434839879,"identity":"04289de4-94fa-497a-9009-308f81d508eb","order_by":3,"name":"Isidoro Rodríguez Pérez","email":"","orcid":"","institution":"University of Santiago de Compostela","correspondingAuthor":false,"prefix":"","firstName":"Isidoro","middleName":"Rodríguez","lastName":"Pérez","suffix":""},{"id":434839880,"identity":"339b14dd-5705-403d-ab08-96b6e98e1a12","order_by":4,"name":"María del Rosario Marín Arnés","email":"","orcid":"","institution":"Servicio Gallego de Salud","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"del Rosario Marín","lastName":"Arnés","suffix":""},{"id":434839881,"identity":"92e0fcec-cc9c-4c2f-9a68-9000c8aa7fad","order_by":5,"name":"Eva Gómez Fernández","email":"","orcid":"","institution":"Servicio Gallego de Salud","correspondingAuthor":false,"prefix":"","firstName":"Eva","middleName":"Gómez","lastName":"Fernández","suffix":""}],"badges":[],"createdAt":"2025-01-20 05:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5862795/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5862795/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79422504,"identity":"9d3484ae-c38e-43b2-9fdd-323b9067c06b","added_by":"auto","created_at":"2025-03-28 08:44:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1441178,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5862795/v1/09ae4b7f-5873-4b64-9f1a-11ba08b691c5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Good nursing practice guide results aimed at the care of patients with ischemic stroke or transit ischemic attack. A cohort study.","fulltext":[{"header":"Background","content":"\u003cp\u003eThe World Health Organization (WHO) defines stroke as a sudden disturbance in brain function. It is characterized by signs or symptoms lasting more than 24 hours. These symptoms may lead to death due to a vascular cause.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStroke is most common classified based on its nature into two main categories: ischemic and hemorrhagic. Ischemic stroke, accounting for 85% of cases, results from an alteration in the brain's blood supply, causing a neurological deficit lasting more than 24 hours and leading to tissue necrosis. In contrast, hemorrhagic stroke, which represents the remaining 15%, occurs due to the rupture of a cerebral blood vessel.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSubsequently, the concept of transient ischemic attack (TIA) was introduced, defined as a transient episode of neurological dysfunction caused by focal cerebral ischemia without evidence of permanent damage.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIschemic stroke is a leading cause of morbidity and mortality, ranking as the third leading cause of death, the primary cause of disability among adults in developed countries, and the second leading cause of dementia after Alzheimer's disease. Its incidence increases with age, and despite a decline in stroke-related mortality, the aging population has contributed to a rise in its prevalence and associated social costs.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTechnological advances have led to the development of highly effective therapies for ischemic stroke, such as thrombolytics. Recombinant tissue plasminogen activator (rt-PA), approved by the United States Food and Drug Administration (FDA) in 1996, remains a cornerstone treatment for acute ischemic stroke. Alongside mechanical thrombectomy, rt-PA is one of the few interventions available and is administered to patients within 4.5 hours of symptom onset, provided they meet specific selection criteria.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough intravenous thrombolysis has been established as the gold standard treatment for stroke for over 20 years, mechanical thrombectomy was fully legitimized as a technique for acute stroke treatment starting in 2015, with both therapies potentially being used in combination.\u003csup\u003e\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStudies suggest that long-term outcomes in critical care units depend not only on reperfusion therapies but also on patient characteristics and specific care practices. Consequently, critical care units, particularly nursing interventions, can significantly influence functional outcomes in both the short and long term, potentially complementing the benefits of reperfusion.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e The Quality in Acute Stroke Care (QASC) trial demonstrated that implementing bundled care interventions for stroke patients significantly improved adherence to evidence-based protocols and patient outcomes. These findings underscore the importance of standardized care practices, aligning with the objectives of this study to evaluate the impact of best practice guidelines in a neurology unit.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNurses in stroke or neurology units are key to addressing risks like pressure ulcers (PU), post-stroke pain (PSP), the risk of aspiration pneumonia (AP), and falls. These aspects are highly relevant to the nursing profession, as they represent preventable and avoidable risks.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Registered Nurses\u0026rsquo; Association of Ontario (RNAO) is a globally recognized leader in the development, adoption, sustainability, and evaluation of evidence-based nursing practices. Best practice guidelines are systematically developed documents designed to assist healthcare professionals and patients in making timely healthcare decisions. In 2018, the Healthcare Area of Lugo, A Mari\u0026ntilde;a, and Monforte de Lemos joined the best practice guidelines program, implementing the guideline \"Stroke Assessment through Continuous Care\" in the neurology and neurosurgery unit of the University Hospital Lucus Augusti (HULA). The goal was to provide nurses with evidence-based recommendations for assessing and screening patients recovering from a stroke through continuous care.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study aims to determine adherence to the recommendations of a good nursing practice guide. The guideline focuses on the care of patients with ischemic stroke or transient ischemic attack admitted to the Neurology Unit of Lucus Augusti Hospital between 2020 and 2022.\u003c/p\u003e \u003cp\u003eThe secondary objectives are as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo analyze the functional outcomes of patients who have experienced ischemic stroke or transient ischemic attack.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo compare age with pain levels and the Barthel Index.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo correlate sex with the Barthel Index and pain levels.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo associate patients\u0026rsquo; level of autonomy upon admission with the number of falls, pain levels, and episodes of aspiration pneumonia.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy Design and Patients\u003c/p\u003e \u003cp\u003eThis is a cohort study involving patients with ischemic stroke or transient ischemic attack (TIA) treated at Lucus Augusti Hospital between January 1, 2020, and November 30, 2022. This study is part of ongoing research conducted by Lucus Augusti Hospital (Lugo, Spain) in collaboration with the Carlos III Health Institute, based on the \"Nursing Best Practice Guidelines\" developed by the Invest\u0026eacute;n-isciii group.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The implementation process of the guideline began in 2018 with a pilot study. The CONSORT 2010 guidelines was used in the design of this study. Four time points were considered to establish quality outcomes: baseline measurement (T0; January\u0026ndash;December 2019, as a reference prior to implementation), implementation start (T1; January\u0026ndash;December 2020), control (T2; January\u0026ndash;December 2021), and consolidation (T3; January\u0026ndash;December 2022, focusing on the last month of each quarter). Successful implementation of the guideline was defined as achieving at least 75% of the total recommendations, while the quality department of the center set the target for new indicator records at 80%.\u003c/p\u003e \u003cp\u003ePatient Selection\u003c/p\u003e \u003cp\u003eInclusion and exclusion criteria were determined by the hospital protocol. Inclusion criteria: anterior or posterior cerebral occlusion, age\u0026thinsp;\u0026gt;\u0026thinsp;18 years, and a National Institutes of Health Stroke Scale (NIHSS) score\u0026thinsp;\u0026ge;\u0026thinsp;6. Patients meeting these criteria, as outlined in the Unit protocol, were treated with rt-PA, provided the time from symptom onset to hospital arrival was \u0026lt;\u0026thinsp;4.5 hours. The guidelines used were those of the Spanish Society of Neurology. Exclusion criteria: intracranial hemorrhage or pregnancy.\u003c/p\u003e \u003cp\u003eVariables and Data Collection\u003c/p\u003e \u003cp\u003eThe variables in this study include:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSociodemographic: age, sex, and admission date (dd/mm/yyyy).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eClinical: type of stroke, neurological assessment, dysphagia evaluation, functional outcome, Barthel Index, aspiration pneumonia, falls, post-stroke pain, and pressure ulcers.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e Before implementing the guideline recommendations at the center, the associated indicators were not routinely recorded. In 2018, a pilot study was launched to incorporate the recording of seven guideline recommendations, along with clinical training on the use of the required instruments and scales. In 2019, the implementation of at least 75% of the minimum recommendations in the guideline was considered necessary to participate in the Invest\u0026eacute;n-isciii group project, and the evaluation period from January to December 2019 was established as the baseline time (T0) for this study. In 2020, the 75% guideline recommendation threshold was maintained, as no new recommendations were incorporated due to the pandemic. The period from January to December 2020 was considered the implementation time (T1). In 2021, the same percentage was maintained as in previous years, and the period from January to December 2021 was designated as the control time (T2). Finally, in 2022, the percentage increased by adding a new recommendation: caregiver or family education. The period from January to December 2022 was considered the consolidation time (T3).\u003c/p\u003e \u003cp\u003eThe quality evaluation of the implementation and its indicators was conducted monthly using the CCEC\u0026reg; Program to minimize variability. The data were subsequently entered into the online platform CarEvID\u003csup\u003e+\u003c/sup\u003e\u0026reg; in a fully anonymized format.\u003c/p\u003e \u003cp\u003eAccess to the online platform is restricted to evaluators designated at each center and the program's coordinating center. At Lucus Augusti Hospital, indicators are evaluated based on information exported from the computerized medical record system IANUS\u0026reg;. In addition to the minimum indicators required by the CCEC\u0026reg; Program (75% of the total), the centers may include their own indicators.\u003c/p\u003e \u003cp\u003eDescription of Implemented Recommendations\u003c/p\u003e \u003cp\u003e The guideline's implementation recommendations included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStroke assessment at admission, after neurological changes, and during referrals was performed by nurses in collaboration with the multidisciplinary team. This includes evaluating consciousness, orientation, motor and sensory functions, balance, speech, pupil response, vital signs, and applying a validated scale.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDysphagia detection upon admission or within 24 hours of the patient being awake and alert, recording the initiation of oral feeding and the development of aspiration pneumonia. This was carried out by a multidisciplinary team.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEvaluation of independence level through the assessment of stroke patients' ability to perform activities of daily living was conducted by nurses using the Barthel Index.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFall risk assessment upon admission, review during hospitalization, and recording of fall incidents. This risk was measured by nurses.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePain detection upon admission, detection after a change in condition, and assessment of maximum pain during hospitalization were carried out exclusively by nurses using validated tools.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePressure ulcer risk assessment upon admission, review during hospitalization, and recording of pressure injuries associated with healthcare, and were evaluated by nurses.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDescription of Instruments\u003c/p\u003e\n\u003ch3\u003eNational Institutes of Health Stroke Scale (NIHSS)\u003c/h3\u003e\n\u003cp\u003eThe NIHSS quantifies stroke severity by evaluating neurological deficits, including motor and sensory impairments, speech, and level of consciousness. Scores range from 0 (no deficits) to 42 (severe deficits). Categorization is as follows: asymptomatic (0 points), minimal neurological deficit (1 point), mild neurological deficit (2\u0026ndash;5 points), moderate neurological deficit (6\u0026ndash;15 points), severe neurological deficit (16\u0026ndash;20 points), and very severe neurological deficit (\u0026gt;\u0026thinsp;20 points).\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eBarthel Index\u003c/h2\u003e \u003cp\u003eThe Barthel Index numerically scores the degree of dependency based on basic needs, such as eating, dressing, and mobility. It ranges from 0 (total dependence) to 100 (complete independence). It evaluates six parameters (eating, dressing, bowel control, bladder control, toileting, and stair use) from 0 to 10 points, two parameters (personal grooming and bathing) from 0 to 5 points, and one parameter (transfers) from 0 to 15 points. The final score ranges from 0 to 100, categorized as follows: \u0026lt;20 points (total dependence), 20\u0026ndash;35 points (severe dependence), 40\u0026ndash;55 points (moderate dependence), \u0026ge;\u0026thinsp;60 points (mild dependence), and 100 points (independent).\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eGlasgow Coma Scale\u003c/h3\u003e\n\u003cp\u003eThe Glasgow Coma Scale is a clinical tool used to assess a person's level of consciousness following a brain injury or trauma. It evaluates three parameters: eye-opening, verbal response, and motor response, assigning scores to each based on the observed level of response. The total score ranges from 3 to 15, with lower values indicating more severe neurological damage. It is widely used in medical emergencies to monitor patient progression and determine the need for interventions.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eDownton Fall Risk Index\u003c/h3\u003e\n\u003cp\u003eThe Downton Fall Risk Index assesses the risk of falls in older adults or hospitalized patients. It evaluates factors such as fall history, medication use, sensory deficits, mental state, and mobility. A score of 3 or more indicates high fall risk, allowing for preventive measures. It is useful in clinical settings to identify vulnerable patients and reduce adverse events related to falls.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eVisual Analog Scale (VAS)\u003c/h3\u003e\n\u003cp\u003eThe VAS is a simple tool used to measure pain intensity. It consists of a 10 cm line where one end represents 'no pain' (0) and the other 'worst pain imaginable' (10). Patients mark the point that best describes their pain, providing a numerical assessment. It is widely used in clinical practice due to its ease of application and usefulness in monitoring pain progression and treatment effectiveness.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eBraden-Bergstrom Scale\u003c/h3\u003e\n\u003cp\u003eThe Braden-Bergstrom Scale assesses the risk of developing pressure ulcers in hospitalized or immobilized patients. It evaluates six factors: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Scores range from 6 (high risk) to 23 (low risk). This scale helps identify vulnerable patients and plan preventive interventions, being widely used in clinical settings to improve care and reduce complications related to immobility.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOutcome Measures\u003c/p\u003e \u003cp\u003eFunctional outcomes were measured using the Barthel Index, categorized into five levels of dependency: total dependence (\u0026lt;\u0026thinsp;20 points), severe dependence (20\u0026ndash;35 points), moderate dependence (40\u0026ndash;55 points), mild dependence (60\u0026ndash;95 points), and independent (100 points).\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStatistical and Data Analysis\u003c/p\u003e \u003cp\u003eDescriptive analysis was performed using measures of central tendency (mean (M)) and dispersion (standard deviation (SD)) for quantitative variables, and percentages for qualitative variables. To establish correlations between groups, the Chi-square test was used for qualitative variables, and the Kruskal-Wallis test was used for quantitative variables. Differences between groups were analyzed using the Mann-Whitney U test. A 95% confidence interval (CI) was applied, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were performed using the SPSS Inc., version 24.0 statistical package.\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003eEach institution selected in the call for proposals signs an agreement with Invest\u0026eacute;n-isciii/CECBE/RNAO before starting the evaluation, committing to assess and disseminate the results. This agreement is renewed for each sustainability period. Additionally, participating professionals and evaluators signed a specific confidentiality and commitment agreement under the BPSO\u0026reg; program, in compliance with ethical standards, Law 14/2007 on Biomedical Research, and Regulation (EU) 2016/679 of the European Parliament and Council (April 27, 2016) on data protection and the free movement of personal data.\u003c/p\u003e \u003cp\u003eThe principal investigator collected the data, accessible only to the project team. No external party could modify them.\u003c/p\u003e \u003cp\u003e This project was approved by the Research Ethics Committee (Registration Code 2022/389).\u003c/p\u003e \u003cp\u003e The study was conducted in compliance with Good Clinical Practice standards, the Declaration of Helsinki, the Oviedo Convention, as well as data protection regulations and the management of medical records.\u003c/p\u003e \u003cp\u003eData processing was pseudonymized, meaning a data collection notebook was created to store all information in a coded manner. The database generated by the study contained no identifying patient data.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, the implementation of recommendations from a best practice guideline led to improvements in nursing care quality indicators, surpassing the center\u0026apos;s quality objectives, with all indicators exceeding 80% of records. Significant improvements were observed in indicators such as neurological assessment within the first 24 hours, dysphagia assessment within the first 24 hours and pre-ingestion, prevention of pressure injuries, pain assessment, and recording of independence level at discharge when compared to the baseline period (2019).\u003c/p\u003e\n\u003cp\u003eHowever, in 2019 and 2020, the 80% target was not met for the indicator of dysphagia assessment within the first 24 hours. Additionally, in 2019, the target for pre-ingestion dysphagia assessment was also not achieved. The indicator for recording independence level at discharge showed fluctuations, with 20% of cases lacking records in T1 and T3. In T2 (control), the percentage of missing records decreased to 11.8%. This target was only achieved in 2021, reaching 88.2%, but fell again in 2022 to 78.9% (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe number of ischemic stroke admissions was 310 in 2020, 340 in 2021, and 95 up to November 2022. A descriptive analysis of the sample is presented in the frequency table (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The highest number of strokes occurred in 2021, with a greater prevalence in men (56.4%) compared to women (43.6%). Ischemic stroke was the most common type, representing 81% of cases, while TIA accounted for 19%.\u003c/p\u003e\n\u003cp\u003eThe mean Barthel Index score was 78.84 (\u0026plusmn;\u0026thinsp;29.42), indicating mild dependency. The categorized results were as follows: \u0026lt;20 points\u0026thinsp;=\u0026thinsp;6.9%, 20\u0026ndash;35 points\u0026thinsp;=\u0026thinsp;4.7%, 40\u0026ndash;55 points\u0026thinsp;=\u0026thinsp;8.7%, \u0026ge;\u0026thinsp;60 points\u0026thinsp;=\u0026thinsp;27.3%, and 100 points\u0026thinsp;=\u0026thinsp;52.4%.\u003c/p\u003e\n\u003cp\u003eAn inverse correlation was identified between age and the variables post-stroke pain (PSP) (p\u0026thinsp;=\u0026thinsp;0.032) and Barthel Index scores (p\u0026thinsp;=\u0026thinsp;0.001), as shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Regarding differences in age groups and Barthel index, an inverse association was found between the \u0026lt;\u0026thinsp;65 years group and the 65\u0026ndash;80 years (p\u0026thinsp;=\u0026thinsp;0.001) and \u0026gt;\u0026thinsp;80 years groups (p\u0026thinsp;=\u0026thinsp;0.001), as well as between the 65\u0026ndash;80 years group and the \u0026gt;\u0026thinsp;80 years group (p\u0026thinsp;=\u0026thinsp;0.001). Regarding differences in age groups and pain, an inverse relationship was identified between the \u0026lt;\u0026thinsp;65 years group and the 65\u0026ndash;80 years group (p\u0026thinsp;=\u0026thinsp;0.032), with no differences analyzed between other groups.\u003c/p\u003e\n\u003cp\u003eSignificant correlations were found between sex and the variables Barthel Index score (p\u0026thinsp;=\u0026thinsp;0.001) and PSP (p\u0026thinsp;=\u0026thinsp;0.005). Women reported experiencing more pain than men, except at the maximum score of 10 points (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFinally, inverse associations were observed between Barthel Index scores and AP (p\u0026thinsp;=\u0026thinsp;0.001), with a higher occurrence of AP episodes in patients with lower Barthel scores. A relationship between Barthel scores and falls was also identified (p\u0026thinsp;=\u0026thinsp;0.001), with more falls occurring in patients with lower Barthel scores. Additionally, a comparison between Barthel scores and PSP (p\u0026thinsp;=\u0026thinsp;0.001) showed higher pain scores on the Visual Analog Scale (VAS) in patients with lower Barthel scores (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eRegarding differences in groups and AP, an association was established between the Barthel\u0026thinsp;\u0026lt;\u0026thinsp;20 points category and the Barthel 20\u0026ndash;35 points (p\u0026thinsp;=\u0026thinsp;0.021), Barthel 40\u0026ndash;55 points (p\u0026thinsp;=\u0026thinsp;0.01), Barthel\u0026thinsp;\u0026ge;\u0026thinsp;60 points (p\u0026thinsp;=\u0026thinsp;0.001), and Barthel\u0026thinsp;=\u0026thinsp;100 points categories (p\u0026thinsp;=\u0026thinsp;0.001). Differences were also observed between Barthel\u0026thinsp;\u0026ge;\u0026thinsp;60 points and Barthel\u0026thinsp;=\u0026thinsp;100 points (p\u0026thinsp;=\u0026thinsp;0.031).\u003c/p\u003e\n\u003cp\u003eRegarding differences in groups and falls, a significant correlation was found between the Barthel\u0026thinsp;\u0026lt;\u0026thinsp;20 points and Barthel 20\u0026ndash;35 points categories (p\u0026thinsp;=\u0026thinsp;0.034). Additionally, associations were identified between the Barthel 20\u0026ndash;35 points category and the Barthel 40\u0026ndash;55 points (p\u0026thinsp;=\u0026thinsp;0.018), Barthel\u0026thinsp;\u0026ge;\u0026thinsp;60 points (p\u0026thinsp;=\u0026thinsp;0.001), and Barthel\u0026thinsp;=\u0026thinsp;100 points categories (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eFinally, for differences in groups and PSP, a correlation was established between the Barthel\u0026thinsp;\u0026lt;\u0026thinsp;20 points category and the Barthel 40\u0026ndash;55 points (p\u0026thinsp;=\u0026thinsp;0.007), Barthel\u0026thinsp;\u0026ge;\u0026thinsp;60 points (p\u0026thinsp;=\u0026thinsp;0.001), and Barthel\u0026thinsp;=\u0026thinsp;100 points categories (p\u0026thinsp;=\u0026thinsp;0.001). Differences were also identified between Barthel 20\u0026ndash;35 points and the Barthel\u0026thinsp;\u0026ge;\u0026thinsp;60 points (p\u0026thinsp;=\u0026thinsp;0.001) and Barthel\u0026thinsp;=\u0026thinsp;100 points categories (p\u0026thinsp;=\u0026thinsp;0.001). Lastly, differences were observed between the Barthel 40\u0026ndash;55 points and Barthel\u0026thinsp;\u0026ge;\u0026thinsp;65 points groups (p\u0026thinsp;=\u0026thinsp;0.045).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study evaluates the quality indicators following the implementation of the Invest\u0026eacute;n-ISCIII Best Practice Guidelines in the Neurology Unit of Lucus Augusti University Hospital between 2020 and 2022.\u003c/p\u003e \u003cp\u003eThe implementation of the recommendations from a best practice nursing guide improved quality indicator outcomes in the Neurology Unit, meeting the objectives established by the quality department and enhancing the overall quality of nursing care. Specifically, significant improvements were observed in key indicators such as neurological assessment within the first 24 hours, dysphagia evaluation within the first 24 hours and pre-ingestion, and prevention of pressure ulcers. These findings underscore the positive impact of standardized nursing practices on the quality and safety of patient care. However, it is important to acknowledge that the observed improvements in care quality and patient outcomes cannot be exclusively attributed to the implementation of the guidelines. Factors such as staff training, patient characteristics (e.g., comorbidities and age), and hospital policies likely contributed to these results. Although this study identified significant correlations between the Barthel Index and variables such as aspiration pneumonia, falls, and pain, its design does not permit definitive conclusions about causality. Future research should aim to control these potential confounders through prospective or multicenter studies to more accurately establish causal relationships.\u003c/p\u003e \u003cp\u003eIt is worth noting that the lack of records regarding independence at discharge requires further investigation. Although improvements were observed from the baseline period compared to the subsequent three time points, there was an improvement during the control phase (T2) and a deterioration during the consolidation phase (T3). This resulted in meeting the target for this indicator in 2021 but failing to do so in 2022.\u003c/p\u003e \u003cp\u003eThe decline in independence at discharge observed in 2022 may be linked to organizational challenges, including the reinstatement of staff transfers and the integration of personnel requiring additional training following the COVID-19 pandemic. These factors likely disrupted the continuity of care and negatively impacted the quality of nursing practices. Comparatively, other studies have reported similar challenges during periods of staff turnover or resource reallocation, emphasizing the importance of stable and well-trained teams in maintaining high-quality care. To address these challenges, future strategies should include continuous education programs, mentorship systems for new staff, and regular audits of nursing practices. Additionally, enhancing interdisciplinary collaboration and developing contingency plans for periods of high staff mobility could help mitigate the impact of such disruptions on patient outcomes.\u003c/p\u003e \u003cp\u003eThis aspect warrants additional research and the establishment of operational objectives within the unit to achieve improvement. This is particularly relevant considering that the evaluation of independence through the Barthel Index is a key outcome measure applied to patients who have suffered an ischemic stroke or transient ischemic attack (TIA). Although not the focus of this study, it is worth mentioning that in 2022, staff transfers, which had been suspended during the pandemic, were reinstated. This caused mobility between departments and the incorporation of staff who required training, with only 24 hours available to complete the transition to the new unit.\u003c/p\u003e \u003cp\u003eAdditionally, it is important to emphasize the improvement in the recording of neurological assessments using the NIHSS scale across all time points compared to the baseline period. Neurological assessment is a functional outcome of the acute post-intervention phase in patients with ischemic stroke or TIA, enabling the early activation of short- and medium-term resources.\u003c/p\u003e \u003cp\u003e It will be necessary to continue implementing non-mandatory recommendations from the best practice guidelines to further improve the quality of nursing care. Specifically, in the analyzed unit, recommendations for cognitive status assessment and health education for family members remain to be implemented.\u003c/p\u003e \u003cp\u003eThis study included 745 patients (56.4% male, 43.6% female) with a mean age of 73.3 (\u0026plusmn;\u0026thinsp;11.98) years. The demographic data revealed a similar sex distribution to that reported in other studies, despite differences in sample size.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e For example, in the study by Moreno Palacios et al.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, the mean age was 88.6 years (range 85\u0026ndash;97), with a much smaller sample size (23 women and 18 men) compared to our study, as well as a clear difference in age.\u003c/p\u003e \u003cp\u003eThe study by Pego P\u0026eacute;rez et al.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e reported comparable findings, with 57% male and 43% female participants, and a mean age of 73.99 (\u0026plusmn;\u0026thinsp;11.69) years. Hern\u0026aacute;ndez-Bello et al.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e also found a higher prevalence in men (65.4%) compared to women, with a mean age of 72.84 (\u0026plusmn;\u0026thinsp;12.53) years.\u003c/p\u003e \u003cp\u003eRegarding functional status, this study focused exclusively on the acute phase, from symptom onset to hospital discharge, which was evaluated using the Barthel Index. The mean Barthel score at discharge was 78.84 (\u0026plusmn;\u0026thinsp;29.42) points, indicating mild dependency, with an interquartile distribution of 60 points for the first quartile, 100 points for the second quartile, and 100 points for the third quartile.\u003c/p\u003e \u003cp\u003eWhen compared to other studies, considerable variability in Barthel Index results was observed. For instance, the study by Moreno Palacios et al.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e reported a mean Barthel score of 80.6 (\u0026plusmn;\u0026thinsp;15.1) points before the stroke and 45 (\u0026plusmn;\u0026thinsp;34.4) points after the stroke, indicating moderate dependency. In contrast, the study by Pego P\u0026eacute;rez et al.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e showed similar functional outcomes to our study, with a mean Barthel score of 77 (\u0026plusmn;\u0026thinsp;28.9) points in 2020 and 73.71 (\u0026plusmn;\u0026thinsp;29.8) points in 2021. This study also determined that the SARS-CoV-2 pandemic did not correlate with a worsening of functionality in stroke survivors.\u003c/p\u003e \u003cp\u003eIn terms of falls, data were collected throughout the hospital stay, revealing that only 0.8% of patients experienced adverse events of this nature. The data also indicated a higher prevalence of falls in men and in patients diagnosed with ischemic stroke compared to TIA.\u003c/p\u003e \u003cp\u003eThe findings of this study are consistent with those reported in other studies, such as the work by Kai-hoi et al.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, which revealed that 11.5% of Chinese patients experienced a fall during hospitalization, with a higher prevalence in men and in ischemic strokes. They concluded that most falls occurred in the patients' rooms and identified dysphagia and Barthel scores between 5 and 15 points as significant risk factors. Similarly, Rabadi et al.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e reported a 15.5% incidence of falls, with significant differences based on sex and stroke type.\u003c/p\u003e \u003cp\u003eThis study also analyzed the risk of aspiration pneumonia (AP), identifying significant correlations with age, functional capacity, and dysphagia assessment prior to the initiation of oral feeding. Dysphagia was assessed in 94.6% (n\u0026thinsp;=\u0026thinsp;705) of the sample and prior to oral feeding in 94.4% (n\u0026thinsp;=\u0026thinsp;703). A higher incidence of AP was observed in patients who had not undergone dysphagia assessment, with this adverse event occurring in 17% (n\u0026thinsp;=\u0026thinsp;40) of total cases. Additionally, the results showed that AP was more common in patients with lower Barthel Index scores, with 16.7% (n\u0026thinsp;=\u0026thinsp;7) of cases occurring in patients with total dependency.\u003c/p\u003e \u003cp\u003eIn this study, patients were kept on a strict nil-by-mouth diet until dysphagia assessment was performed. Diets were progressively introduced based on patient tolerance. In the study by Pilato et al.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, patients were fitted with a nasogastric tube after ischemic stroke treatment, and worse NIHSS scores were identified as predictors of dysphagia risk. Regarding long-term outcomes, worse NIHSS scores, hemorrhagic transformations, and advanced age were correlated with poorer functionality at six months.\u003c/p\u003e \u003cp\u003eWhen compared with other studies, Al-Khaled et al.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e reported that only 74% of patients underwent dysphagia assessment, with aspiration pneumonia episodes being more frequent in patients who had not been assessed (12.1%). Liang et al.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e found that 78.7% of patients underwent dysphagia evaluation, with 8.1% developing aspiration pneumonia. They concluded that advanced age, high NIHSS scores, and particularly the presence of dysphagia were risk factors for AP development.\u003c/p\u003e \u003cp\u003eThe study by Matuja et al.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e demonstrated that aspiration pneumonia (AP) was the most common medical complication, occurring in 41.3% of patients. Furthermore, the cumulative incidence of AP among the 568 patients sampled was 23.06%. Male patients were found to have 1.71 times higher risk of developing AP compared to female patients. Additionally, patients presenting with vomiting and dysphagia had a significantly higher risk of AP compared to those without these conditions.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e The prevalence of pressure ulcers (PU) was also analyzed, as they are a common complication in immobilized patients, representing an adverse event that negatively impacts quality of life and serves as a key indicator of nursing care quality. The results showed that only 0.1% of patients developed PU during hospitalization, while 0.6% had PU prior to the ischemic event. Preventive measures were implemented in 99.4% of the population during hospitalization.\u003c/p\u003e \u003cp\u003eOther studies, such as Liao et al.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, found that 0.8% of patients developed PU during hospitalization, with advanced age, marital status, high NIHSS scores, and high mRS scores identified as risk factors. In their study, PU prevalence was 10%, and preventive measures were implemented in 74% of patients, concluding that PU risk was considerably higher.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study also analyzed post-stroke pain (PSP), identifying no pain in 64.2% (n\u0026thinsp;=\u0026thinsp;478), mild pain in 15.7% (n\u0026thinsp;=\u0026thinsp;117), moderate pain in 18.2% (n\u0026thinsp;=\u0026thinsp;105), and severe pain in 1.9% (n\u0026thinsp;=\u0026thinsp;14). PSP is a common sequela of stroke that typically develops in the body area corresponding to the cerebrovascular lesion, most often following ischemic stroke but also in cases of hemorrhagic stroke. The pathogenesis of PSP is still unknown, and research on this topic is ongoing.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eInverse correlations were established between age and the Barthel Index, with differences observed between the \u0026lt;\u0026thinsp;65 years group and the 65\u0026ndash;80 years and \u0026gt;\u0026thinsp;80 years groups, as well as between the 65\u0026ndash;80 years and \u0026gt;\u0026thinsp;80 years groups. Regarding age groups and pain, an inverse association was found between the \u0026lt;\u0026thinsp;65 years group and the 65\u0026ndash;80 years group. Relationships were also established between sex and the variables Barthel score and PSP, with women experiencing more pain than men.\u003c/p\u003e \u003cp\u003eInverse correlations were observed between Barthel scores and AP, with more AP episodes occurring in patients with lower Barthel scores. A relationship was also found between Barthel scores and falls, with more falls occurring in patients with lower scores. Finally, an inverse association was established between Barthel scores and PSP, with higher PSP scores observed in patients with lower Barthel scores.\u003c/p\u003e \u003cp\u003eThus, specialized nurses in neurology units should rely on basic nursing practices for planning fundamental scientific care. However, they must continue to develop their specialized identity to adequately address the specific needs of neurological conditions.\u003c/p\u003e \u003cp\u003eThe findings of this study provide a framework for other hospitals seeking to replicate these improvements in quality indicators. Practical applications include the adoption of standardized nursing practice guidelines supported by comprehensive training programs and ongoing monitoring of quality indicators. To ensure consistency, these guidelines could be mandated at a national level, with adaptations to accommodate regional differences in healthcare systems. Furthermore, long-term follow-up of patients beyond hospital discharge would provide valuable insights into sustained functional recovery and the long-term impact of nursing interventions. Future studies should prioritize the development of longitudinal cohorts to assess outcomes such as independence, quality of life, and rehospitalization rates over extended periods.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003e This study forms part of a project designed to evaluate care quality through clinical indicators aligned with the recommendations of the Invest\u0026eacute;n Best Practice Guidelines. Consequently, it was not feasible to plan for a broader collection of variables, as the study was limited to those approved by the research ethics committee.\u003c/p\u003e \u003cp\u003eThe study population consisted of a hospital cohort from a specific community hospital setting, which limits the generalizability of the findings. To test causality, evaluate predictive capacity, and extend the hypotheses to other healthcare systems with differing resources, patient demographics, and care protocols, a larger sample size and a multi-site study would be necessary.\u003c/p\u003e \u003cp\u003eThe retrospective nature of this analysis introduces potential biases. Selection bias may have arisen from loss to follow-up or the inclusion of patients meeting specific criteria, potentially excluding individuals with differing characteristics. Misclassification bias may also have occurred due to the reliance on retrospective data extracted from medical records, as the accuracy and completeness of these records can vary. Furthermore, the study did not account for potential confounding factors such as comorbidities, medication adherence, or variations in hospital policies, all of which could have influenced the outcomes. Future prospective studies should aim to address these limitations to strengthen the validity of the findings.\u003c/p\u003e \u003cp\u003eFinally, direct comparisons with published studies are challenging, if not impossible, due to variations in selection criteria, sample sizes, and patient management protocols. The findings of this study are context-specific and may not be generalizable to other healthcare settings or populations. Multi-center studies with larger sample sizes and prospective designs are recommended to validate these results, explore causal relationships, and ensure broader applicability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e The implementation of recommendations from best practice guidelines was associated with significant improvements in quality indicators for nursing care in patients with ischemic stroke or transient ischemic attack within the studied context. The study population predominantly exhibited a mild level of dependency. An inverse relationship was identified between age and the variables Barthel Index and pain level. Additionally, a correlation was observed between sex and the variables Barthel Index and pain, warranting further research to elucidate the underlying mechanisms. Lastly, an inverse association was observed between Barthel Index scores and the variables aspiration pneumonia, falls, and pain.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis project was approved by the Research Ethics Committee Santiago-Lugo (Registration Code 2022/389) which is affiliated with Servizo Galego de Sa\u0026uacute;de (sergas), Santiago de Compostela, A Coru\u0026ntilde;a (Espa\u0026ntilde;a). CP: 15703.\u003c/p\u003e\n\u003cp\u003eAll participants were thoroughly informed about the objectives of the study, the procedures involved, and their right to withdraw at any point without any consequences. Written informed consent was obtained from each participant prior to their inclusion in the study.\u003c/p\u003e\n\u003cp\u003eAdditionally, we confirm that all experiments involving human subjects were performed in strict compliance with the Declaration of Helsinki and other applicable ethical guidelines. This information has been explicitly included in the \u0026quot;Ethics approval and consent to participate\u0026quot; section of the manuscript.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAll participants signed the mandatory consent form.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from Bermello L\u0026oacute;pez, Lourdes but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Servizo Galego de Sa\u0026uacute;de (SERGAS).\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eAll authors declared no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eIlustre Colegio Oficial de Enfermer\u0026iacute;a de Lugo 02/2024.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eERPP performed the analysis and interpretation of data related to quality indicators in nursing care and was a major contributor to the writing of the manuscript. SJV participated in the study design, data collection, and critical review of the manuscript, providing substantial improvements. LBL supervised the implementation of the recommendations from the good practice guide, contributed to the statistical analysis, and reviewed the manuscript for publication. IRP was responsible for evaluating the functional outcomes of the patients and collaborated in the interpretation of the results. MRMA supported the collection of clinical data and contributed to the review and editing of the manuscript. EGF designed methodological strategies, led the coordination of the project, and substantially reviewed the manuscript. All authors read and approved the final version of the manuscript. Additionally, all have agreed to be accountable for their own contributions and to ensure that any questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eConflict of interests: The authors declared no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuti\u0026eacute;rrez-Z\u0026uacute;\u0026ntilde;iga R, Fuentes B, D\u0026iacute;ez-Tejedor E. Ictus isqu\u0026eacute;mico, Infarto cerebral y ataque isqu\u0026eacute;mico transitorio. 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Bibliometric Analysis of Post-Stroke Pain Research Published from 2012 to 2021. J Pain Res. 2023;16:1\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/JPR.S375063\u003c/span\u003e\u003cspan address=\"10.2147/JPR.S375063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Results in the quality indicators of the recommendations of the Good Practices Guide of the Invest\u0026eacute;n-isciii group.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eT0 (n=274)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eT1 (n=310)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eT2 (n=340)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eT3 (n=95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eNeurological assessment at first 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e93.8 (257)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e93.9 (291)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e96.2 (327)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e96.8 (92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5.8 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6.1 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3.8 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.2 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eRevaluation after neurological deterioration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.9 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1.6 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2.7 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2.1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.2 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1.6 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.5 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2.1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e94.9 (260)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e96.8 (300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e95.8 (326)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e95.8 (91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eDysphagia assessment in the first 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e79.9 (219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e9 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e96.8 (329)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e98.9 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e19.7 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e91 (282)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3.2 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1.1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003ePre-ingestion dysphagia assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e76.3 (209)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e90.7 (281)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e96.5 (328)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e98.9 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e23.3 (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e9 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3.2 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1.1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eFall risk assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e100 (274)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e100 (310)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e100 (340)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e98.9 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1.1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eAssessment of pressure ulcers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e98.5 (270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99.4 (308)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e99.4 (338)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e98.9 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.5 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.6 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1.1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eDetection of pain upon admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e99.6 (273)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99.7 (309)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e100 (340)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e100 (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eDetermination of the level of independence at discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e56.6 (155)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e76.1 (236)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e88.2 (300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e78.9 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e43.4 (119)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e22.9 (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e11.8 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e21.1 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNot apply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eData presentation: % (n). T0: baseline time. January-December 2019. T1: implementation time. January-December 2020. T2: control time. January-December 2021. T3: consolidation time. January-December 2022 (last month of each one of the quarters).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Frequency table with sample characteristics.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA. Quantitative variables\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2245%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInferior Limit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuperior Limit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2245%;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e11.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3673%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarthel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2245%;\"\u003e\n \u003cp\u003e78.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e29.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2041%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB. Qualitative variables\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWoman\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003cp\u003e325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e340\u003c/p\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e45.6\u003c/p\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of stroke\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIschemic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTIA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e606\u003c/p\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e81.3\u003c/p\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeurological anamnesis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e95.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeurological anamnesis after clinical change\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot apply\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e96.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDysphagia assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e94.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional outcome measure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot apply\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAspiration pneumonia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e97.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral feeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e743\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e99.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral feeding after dysphagia assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e94.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalls assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e99.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot apply\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-stroke pain assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e99.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-stroke pain assessment after clinical change\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot apply\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure ulcer assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e99.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot apply\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of falls\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAny\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e737\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e98.9\u003c/p\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain assessment (VAS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e478\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure ulcer during hospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e744\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e99.9\u003c/p\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure ulcer care during hospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e739\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarthel Index groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 20\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e20-35\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e40-55\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 60\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 65 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e65-80 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 80 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003cp\u003e331\u003c/p\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;VAS= Visual analogic scale. P25=first quartile. P50=second quartile. P75=third quartile.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Association between age and pain and Barthel (95% CI).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026lt;65 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e65-80 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026gt;80 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"11\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e102 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e223 (67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e153 (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"11\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e12 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e17 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e27 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e18 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e15 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e14 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e30 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e19 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarthel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e28 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.009**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e20-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e14 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e15 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e40-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e24 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e25 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e20 (14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e72 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e75 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e114 (80.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e148 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e58 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e** Kurskal-Wallis test\u003c/p\u003e\n\u003cp\u003eCI=Confidence interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison between sex and Barthel and pain (95% CI).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarthel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e20-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e13 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e40-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e22 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e31 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e85 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e82 (31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e207 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e113 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"11\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e295 (70.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e183 (56.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"11\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e15 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e11 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e31 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e31 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e21 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e34 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e13 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e15 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e5 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e6 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Chi\u003csup\u003e2\u0026nbsp;\u003c/sup\u003etest\u003c/p\u003e\n\u003cp\u003eIC=Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Association between Barthel and aspiration pneumonia. falls and pain (95% CI).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"103%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarthel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAspiration pneumonia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e35 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e29 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e52 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e163 (97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e319 (99.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalls\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e42 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e26 (89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e53 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e167 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e317 (99.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"11\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e12 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e11 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e30 (56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e118 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e222 (69.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"11\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e12 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e9 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e5 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e12 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e25 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e17 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e10 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e5 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e5 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e9 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e17 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e10 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e4 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e2 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Chi\u003csup\u003e2\u0026nbsp;\u003c/sup\u003etest\u003c/p\u003e\n\u003cp\u003e** Kurskal-Wallis test\u003c/p\u003e\n\u003cp\u003eCI= Confidence interval\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ischemic stroke, Barthel index, falls, aspiration pneumonia, pressure ulcers, dysphagia","lastPublishedDoi":"10.21203/rs.3.rs-5862795/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5862795/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eStroke is one of the leading causes of morbidity and mortality worldwide, classified as ischemic (85%) or haemorrhagic (15%), with transient ischemic attack (TIA) as an additional clinical entity. Advances in therapeutic strategies, including intravenous thrombolysis and mechanical thrombectomy, have significantly improved patient outcomes. However, specialized critical care, particularly nursing interventions, plays a pivotal role in addressing complications such as pressure ulcers, aspiration pneumonia, and falls, which can adversely affect functional recovery.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate adherence to the recommendations of a good nursing practice guide in the care of patients with ischemic stroke or transient ischemic attack (TIA) admitted to the Neurology Unit of the Lucus Augusti Hospital between 2020 and 2022.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis cohort study included a sample of 745 patients diagnosed with ischemic stroke or transient ischemic attack (TIA) who met the inclusion criteria. Patients received recombinant tissue plasminogen activator (rt-PA) treatment within 4.5 hours of symptom onset and hospital arrival. Baseline computed tomography (CT) scans were evaluated using the Alberta Stroke Program Early CT Score (ASPECTS). Functional outcomes were assessed using the Barthel Index. Descriptive analyses were performed using measures of central tendency, dispersion, and percentages. Differences between groups were analysed using the Chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. Pairwise comparisons were conducted with the Mann-Whitney U test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e The implementation of a good practice guide facilitated the systematic recording of quality indicators and potentially improved the overall quality of care. Among the patients included, 81.3% experienced an ischemic stroke between 2020 and 2022, with a mean age of 73.3 (\u0026plusmn;\u0026thinsp;11.98) years and a Barthel Index score of 78.84 (\u0026plusmn;\u0026thinsp;29.42) points at admission. An inverse correlation was observed between functional outcomes and adverse events, including falls (p\u0026thinsp;=\u0026thinsp;0.001), pain (p\u0026thinsp;=\u0026thinsp;0.001), and aspiration pneumonia (p\u0026thinsp;=\u0026thinsp;0.001). Poorer functional outcomes were associated with a higher frequency of these complications and greater pain intensity.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe implementation of a good nursing practice guide improved care quality standards, particularly in key indicators such as neurological assessment within the first 24 hours, dysphagia screening, pressure injury prevention, pain assessment, and documentation of independence levels at discharge. Significant associations were identified between age and both pain and Barthel Index, as well as between sex and these variables. Additionally, functional outcomes measured by the Barthel Index were inversely correlated with aspiration pneumonia, falls, and pain.\u003c/p\u003e","manuscriptTitle":"Good nursing practice guide results aimed at the care of patients with ischemic stroke or transit ischemic attack. A cohort study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-28 08:28:43","doi":"10.21203/rs.3.rs-5862795/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-20T08:17:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-15T02:12:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134711637864966057704691364381676454482","date":"2025-04-15T00:45:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91492816528626960425399412202482740110","date":"2025-03-29T13:47:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-27T12:37:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-27T03:01:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2025-03-18T19:18:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"32c5f556-f847-473f-836b-8b3cb6e60717","owner":[],"postedDate":"March 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-23T14:38:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-28 08:28:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5862795","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5862795","identity":"rs-5862795","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}