Topics in Stroke Rehabilitation最新文献

Background: Stroke is one of the leading causes of disability worldwide, with low- and middle- income countries (LMICs) representing 69% of stroke incidence. Technology-based interventions offer potential for improving motor function and rehabilitation adherence; however, their impact in LMICs remains unknown.

Objective: To measure the efficacy of technological interventions compared to conventional physical rehabilitation in improving post- stroke upper limb motor function in LMICs.

Methods: We conducted a systematic review (PROSPERO registration: CRD42020213333) of randomized clinical trials (RCTs) from PubMed, Global Index Medicus, and Physiotherapy Evidence Databases. Studies included stroke survivors receiving technological interventions for upper limb rehabilitation. Effectiveness outcomes included upper limb motor function, performance for activities of daily living, and quality of life. A meta-analysis was performed using mean differences (MD) and 95% confidence intervals (95% CI). Risk of bias was assessed using the Cochrane Collaboration tool for RCTs.

Results: Fifty studies were included after the screening phase, comprising a total of 2646 participants. Nine technological interventions were evaluated, including: virtual reality (40%), robotics (22%), telerehabilitation (10%), among others. Meta-analysis showed significant effect of immersive virtual reality on upper limb function using the Fugl-Meyer Scale (MD 5.65; 95% CI 4.88 to 6.43) and on daily activity performance using the Functional Independence Measure (MD 4,82; 95% CI 2,45-7,19). A significant difference was also found between telerehabilitation and conventional therapy using the modified Barthel index (MD of 3.28; 95% CI 0.86 to 5.70).

Conclusions: Immersive virtual reality and telerehabilitation are effective interventions compared to conventional rehabilitation in LMICs.

Objective: The prognosis of stroke patients is greatly threatened by malnutrition. However, there is no model to predict the risk of malnutrition in hospitalized stroke patients. This study developed a predictive model for identifying high-risk malnutrition in stroke patients.

Methods: Stroke patients from two tertiary hospitals were selected as the objects. Binary logistic regression was used to build the model. The model's performance was evaluated using various metrics including the receiver operating characteristic curve, Hosmer-Lemeshow test, sensitivity, specificity, Youden index, clinical decision curve, and risk stratification.

Results: A total of 319 stroke patients were included in the study. Among them, 27% experienced malnutrition while in the hospital. The prediction model included all independent variables, including dysphagia, pneumonia, enteral nutrition, Barthel Index, upper arm circumference, and calf circumference (all p < 0.05). The AUC area in the modeling group was 0.885, while in the verification group, it was 0.797. The prediction model produces greater net clinical benefit when the risk threshold probability is between 0% and 80%, as revealed by the clinical decision curve. All p values of the Hosmer test were > 0.05. The optimal cutoff value for the model was 0.269, with a sensitivity of 0.849 and a specificity of 0.804. After risk stratification, the MRS scores and malnutrition incidences increased significantly with escalating risk levels (p < 0.05) in both modeling and validation groups.

Conclusions: This study developed a prediction model for malnutrition in stroke patients. It has been proven that the model has good differentiation and calibration.

Objectives: The plantar fascia stretching intervention can correct balance ability and induces a change spatiotemporal parameter doing gait ability. Our objective is to compare the effects of a 4-week program of plantar fascia stretching with those of calf stretching exercise on ankle dorsiflexion passive range of motion (DF-PROM), open and closed eyes static balance ability, gait parameters, and foot and ankle disability index in chronic post-stroke condition.

Methods: Participants were randomized to either the plantar fascia stretching (n = 10) or calf stretching (n = 10) group. Each group performed 5 times per week for 4 weeks and 3 sets of Calf stretch, and Plantar fascia stretch. Each set comprised 10 repetitions. Ankle DF-PROM, open and closed eyes static balance ability, gait parameters, and foot and ankle disability index were measured after 4 weeks of training.

Results: After 4 weeks of training, the plantar fascia stretching group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, ankle DF-PROM, open and closed eyes static balance ability, cadence, and foot and ankle disability index showed greater improvement in the plantar fascia stretching group compared to the calf stretching group (p < 0.05).

Conclusions: This study demonstrated that plantar fascia stretching exercise improved ankle DF-PROM, open and closed eyes static balance ability, cadence, and foot and ankle disability index in chronic post-stroke condition.

Aim: The aim of this study was to evaluate the measurement properties of activity monitoring for a rehabilitation (AMoR) platform for step counting, time spent in sedentary behavior, and postural changes during activities of daily living (ADLs) in a simulated home environment.

Methods: Twenty-one individuals in the post-stroke chronic phase used the AMoR platform during an ADL protocol and were monitored by a video camera. Spearman's correlation coefficient, mean absolute percent error (MAPE), intraclass correlation coefficient (ICC), and Bland-Altman plot analyses were used to estimate the validity and reliability between the AMoR platform and the video for step counting, time spent sitting/lying, and postural changes from sit-to-stand (SI-ST) and sit-to-stand (ST-SI).

Results: Validity of the platform was observed with very high correlation values for step counting (rs = 0.998) and time spent sitting/lying (rs = 0.992) and high correlation for postural change of SI-ST (rs = 0.850) and ST-SI (rs = 0.851) when compared to the video. An error percentage above 5% was observed only for the SI-ST postural change (7.13%). The ICC values show excellent agreement for step counting (ICC3, k = 0.999) and time spent sitting/lying (ICC3, k = 0.992), and good agreement for SI-ST (ICC3, k = 0.859) and ST-SI (ICC3, k = 0.936) postural change. Values of the differences for step counting, sitting/lying time, and postural change were within the limits of agreement according to the analysis of the Bland-Altman graph.

Conclusion: The AMoR platform presented validity and reliability for step counting, time spent sitting/lying, and identification of SI-ST and ST-SI postural changes during tests in a simulated environment in post-stroke individuals.

Background: Inclusion of diverse patient populations in stroke rehabilitation clinical trials is key for generalizability and detecting differences in subgroups. The aim of this study was to assess the reporting and inclusion of race, ethnicity, and sex in publications in post-stroke motor recovery clinical trials over the past 5 years.

Methods: We conducted a systematic review of stroke motor recovery trials conducted only within the United States with at least one control group and published between 2019 and 2023. The percent of racial minorities, ethnicities, and women enrolled in the trials was extracted and calculated for those trials using available data found in the manuscript or on clinicaltrials.gov.

Results: Sixty-eight trials (total of 2,801 participants) met the inclusion criteria and were included in the analysis. 100%, 35%, and 21% of the trials included reported enrollment by sex, race, and ethnicity in the manuscript. All publications reported sex and 38% of the subjects were female. Among the trials reporting race, 59% of the participants were White, followed by 34% Black, 0.4% Native American, 4% Asian, and 3% Other. Among the trials that reported ethnicity, Hispanic or Latino participants were represented as 13% of the total participants.

Conclusions: In the past 5 years, while all stroke rehab trial publications reported data on sex, they underrepresented women. Most publications did not report race or ethnicity. Improvement in reporting of race/ethnicity in stroke motor recovery trials is needed for understanding of progress with inclusion, and improvement in inclusion of women is needed for better generalizability.

Background: Women appear to have a higher risk for long term restrictions in participation than men. This gender difference is poorly understood, as solely biomedical factors have been examined to date.

Objectives: The aims of this study are (1) to map gender differences in participation outcome one year after stroke, and (2) to identify demographic, stroke-related, or psychological predictors of participation for women and men separately.

Methods: A total of 326 patients (mean age 66.5 ± 12.4y, 35.0% women) completed the restriction and satisfaction subscales of the Utrecht Scale of Evaluation of Rehabilitation-Participation (USER-P) at one year after stroke. Bivariate and multiple linear regression analyses were performed.

Results: Women reported worse scores for restrictions in participation compared to men (median 75.4 versus 87.9 respectively, p = 0.001), especially in physical activities such as daytrips and going out. Satisfaction with participation was similar between women and men. Worse cognitive functioning (β = 0.17) was associated with more restrictions in participation in men only, other predictors of restrictions in participation were similar between women and men. The presence of depressive symptoms (β = -0.49) was associated with worse satisfaction with participation in men, whereas an increased stroke severity (β = -0.29) and the presence of maladaptive psychological factors (β = -0.36) were associated with worse satisfaction with participation in women.

Conclusions: Women experience more restrictions in participation compared to men one year after stroke. Taking into account gender-specific predictors of participation in stroke aftercare is important, as different biopsychosocial factors contribute to problems in participation across women and men.

This case report discusses the functional outcomes and multidisciplinary coordination of care for a patient with hemiplegia due to stroke complicated by a migrated inferior vena cava (IVC) filter embedded in the right side of the heart. The patient suffered an acute right-sided stroke with hemorrhagic transformation requiring hemicraniectomy with left hemiplegia. The patient developed a subsequent pulmonary embolism requiring IVC filter placement as anticoagulation was contraindicated due to risk of further intracranial hemorrhage. The IVC filter was later identified bridging the tricuspid valve, and surgical intervention was contraindicated requiring a coordinated plan to delay surgical removal of the filter in order to allow for optimization of the patient's functional and medical status. The patient underwent extensive telemetry monitoring in the intensive care unit to verify no significant cardiac arrhythmia developed with physical activity and was ultimately cleared for admission to acute inpatient rehabilitation. There was a well-coordinated effort between the cardiac, surgical, intensive care, and rehabilitation teams to transition to the inpatient rehabilitation facility to minimize risk and enhance recovery. The patient demonstrated functional improvement throughout rehabilitation and was discharged home with family with eventual surgical removal of the IVC filter. This case highlights the importance of collaboration across multiple disciplines to maximize patient rehabilitation and function, particularly in the context of atypical complications.

Background: Physical activity (PA) is important for people with stroke, but the reliability of PA questionnaires used in this population has been relatively unexplored.

Objective: To compare the internal consistency, test-retest, and absolute reliability of 3 commonly used PA questionnaires in adults with stroke.

Methods: Participants reported their PA levels twice, 2-3 days apart, using the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), International Physical Activity Questionnaire (IPAQ), and Global Physical Activity Questionnaire (GPAQ). Intraclass correlation coefficients (ICC_2,1) were calculated for test-retest reliability, Cronbach's alpha (α) for internal consistency, and standard error of measurement (SEM) and minimal detectable change (MDC₉₅) for absolute reliability.

Results: Twenty-eight people (64.4 years, 50% female, 5.2 years post-stroke) participated. Internal consistency was acceptable for total scores on the IPAQ ($\alpha$ = 0.79) and GPAQ ($\alpha$ = 0.74), but only domain-level scores for the GPAQ ($\alpha$ = 0.71-0.88). In the full sample, test-retest reliability was good for the PASIPD (ICC_2,1 = 0.83) but poor for the IPAQ and GPAQ (ICC_2,1 <0.50). After excluding participants self-reporting true changes in PA, all questionnaires had good test-retest reliability (ICC_2,1 = 0.77-0.88). SEM and MDC₉₅ were lowest for the PASIPD (188.8 and 523.3 MET-minutes/week, respectively).

Conclusions: In adults with stroke, the IPAQ and GPAQ had adequate total-questionnaire internal consistency, and the GPAQ had acceptable domain-level internal consistency. When true change in PA did not occur, test-retest reliability was good for all questionnaires. We suggest clinicians and rehabilitation scientists can use any of the three questionnaires, but may consider the GPAQ due to acceptable internal consistency and test-retest reliability.

Introduction: This longitudinal study aimed to explore the impacts of adopting a healthy lifestyle on self-reported physical and mental health outcomes among Australian females who are living with stroke.

Methods: The study utilized data retrieved from the Australian Longitudinal Study on Women's Health's 1946-51 cohort (from survey 5 conducted in 2007 to survey 9 conducted in 2019), focusing on 531 female stroke survivors. The dependent variables for this study were self-reported physical and mental health status, whereas the independent variables were lifestyle behaviors, including physical activity, smoking, alcohol consumption, and supplement use. Generalized Estimating Equation models were employed to assess the longitudinal associations between a dependent variable and the independent and confounding variables.

Results: The average age of the participants was 58.1 (SD = 1.4) years in survey 5 and 70.5 years in survey 9. The longitudinal analyses revealed that stroke survivors who engaged in moderate/high levels of physical activity had significantly better physical and mental health status than their inactive or sedentary counterparts. Besides, current smokers had significantly poorer physical and mental health status than nonsmokers. In addition, risky/high-risk alcohol consumers had significantly poorer mental health status compared to no/low-risk alcohol consumers.

Conclusions: Our findings suggest that post-stroke individuals can improve their physical and mental health by maintaining a healthy lifestyle. Specifically, targeted and appropriate programs and strategies are needed to promote physical activity and reduce smoking and alcohol consumption in female stroke survivors in order to optimize their overall health and quality of life.

Background: There is a need for practical, easy-to-use and accurately assessing balance tools in stroke patients.

Objectives: This study aimed to compare the psychometric properties of the dual-task Timed Up-and-Go test (cognitive) (DTUG) and the 3-m walk backward test (3MBWT) in stroke patients.

Methods: This study evaluated the practicality, validity, and reliability of the DTUG and the 3MBWT. The test-retest method was used for reliability. The Modified Four Square Step Test (MFSST), the Timed Up-and-Go (TUG), and Berg Balance Scale (BBS) were administered for concurrent validity. A cutoff value was calculated to discriminate between fallers and non-fallers.

Results: The mean practicality times of the tests were 63.58 ± 47.32 sec for DTUG and 37.42 ± 24.036 sec for 3MBWT. Intraclass correlation coefficient of the DTUG and 3MBWT were 0.977, 0.964, respectively which showed excellent test - retest reliability. The DTUG demonstrated strong/very strong correlations with the MFSST (r = 0.724, p < 0.001), TUG (r = 0.909, p < 0.001), and BBS (r = -0.740, p < 0.001). The 3MBWT showed strong correlations with the MFSST (r = 0.835, p < 0.001), the TUG (r = 0.799, p < 0.001), and the BBS (r = -0.740, p < 0.001). The cutoff point was 36.945 s for DTUG and 14.605 s for 3MBWT.

Conclusions: The 3MBWT was a more practical test than the DTUG; however, the DTUG was more discriminative than the 3MBWT in identifying fallers after stroke.

Clinical trial registration number: NCT05211349.

Url: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000BRKZ&selectaction=Edit&uid=U0005GRO&ts=2&cx=z21bhg.