CMAJ • October 24, 2006; 175 (9). doi:10.1503/cmaj.1060067.
© 2006 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Harriss, J. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Harriss, J. P.
Related Collections
Right arrow Stroke

Letters

Granulocyte colony-stimulating factor

Julian P. Harriss

Director of Rehabilitation, Quinte Healthcare Corporation, Belleville, Ont.

Having reviewed the baseline functional stroke scale scores reported by Woei-Cherng Shyu and associates,1 I cannot share the excitement displayed by Cesar Borlongan and David Hess in their accompanying commentary.2 The methodologic limitations of such a small phase 1 study are addressed in the commentary, but I have an additional concern: the 3 patients in the control group were significantly more impaired at the outset than the 7 patients who were randomly assigned to receive the treatment. It is well recognized that presenting impairment, as measured with scales such as the European Stroke Scale (ESS), the ESS Motor Subscale and the Barthel Index, is a strong predictor of ultimate outcome for stroke patients,3–5 regardless of treatment. It is therefore crucial to recognize that patients presenting with the greatest of impairments are likely to improve least; conversely, those with milder impairments are more likely to improve more rapidly and more completely.6,7

Thus, it is not surprising that the 7 patients who were treated (who on average had more than 10% better stroke scale scores at recruitment) ultimately fared better than the 3 patients in the control group.

REFERENCES

  1. Shyu WC, Lin SZ, Lee CC, et al. Granulocyte colony-stimulating factor for acute ischemic stroke: a randomized controlled trial. CMAJ 2006;174(7):927-33.[Abstract/Free Full Text]
  2. Borlongan CV, Hess DC. New hope for stroke patients: mobilization of endogenous stem cells [editorial]. CMAJ 2006;174(7):954-5.[Free Full Text]
  3. Jongbloed L. Prediction of function after stroke: a critical review. Stroke 1986;17:765-75.[Abstract/Free Full Text]
  4. Davidoff G, Karen O, Ring H, et al. Assessing candidates for inpatient stroke rehabilitation: predictors of outcome. Phys Med Rehabil Clin North Am 1991;2:501-16.
  5. Johnston MV, Kirschbloom S, Zorowitz RD, et al. Prediction of outcomes following rehabilitation of stroke patients. NeuroRehabilitation 1992;2:72-97.
  6. Ween JE, Alexander MP, D'Esposito M, et al. Factors predictive of stroke outcome in a rehabilitation setting. Neurology 1996;47(2):388-92.[Abstract/Free Full Text]
  7. Stineman MG, Maislin G, Fiedler RC, et al. A prediction model for functional recovery in stroke. Stroke 1997;28:550-6.[Abstract/Free Full Text]




This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Harriss, J. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Harriss, J. P.
Related Collections
Right arrow Stroke