Topics in Stroke Rehabilitation最新文献

Background: The frailty index (FI) has been reported as a useful measure for assessing premorbid conditions in stroke patients; however, its significance in evaluating post-stroke status remains unclear.

Aims: This study aims to clarify the role of FI as a tool for assessing post-stroke conditions.

Methods: This retrospective cohort study included stroke patients admitted to an acute-care hospital. The FI, based on the cumulative deficit model and comprising comorbidities, symptoms, and functional limitations, was assessed using 33 items at discharge from the acute-care hospital. The primary outcome was the mRS at three months post-onset. Multiple logistic regression was performed with poor functional outcomes as the dependent variable and mRS at discharge, FI at discharge, and both as explanatory variables. The cutoff value of FI for poor functional outcomes was also determined using a receiver operating characteristic (ROC) curve.

Results: A total of 241 patients with acute stroke were included in the final analysis. The median length of hospital stay was 14 days (IQR 9-20). In the adjusted model including both FI and mRS at discharge, FI at discharge was significantly associated with poor outcomes (aOR = 3.43, 95% CI = 1.66-7.09, p < 0.001). The cutoff value of FI for poor functional prognosis derived from the ROC curve was 0.288 (sensitivity 0.816, specificity 0.911).

Conclusions: Our findings indicate that post-stroke FI is independently associated with poor outcomes. It is important to incorporate FI in addition to traditional assessment tools to predict post-stroke prognosis.

Background: Insomnia is a common problem after a stroke, affecting daily life and the recovery process. Among the many Traditional Chinese Medicine(TCM) nursing techniques, it is still unknown which measures are most effective.

Objective: To evaluate the efficacy of different TCM nursing techniques on post-stroke insomnia(PSI) by network meta-analysis(NMA).

Methods: A search was conducted across ten databases to identify randomized controlled trials (RCTs) investigating TCM nursing techniques for patients with PSI, up to April 25, 2024. The quality of the literature was assessed using the bias risk assessment tool recommended in Cochrane Handbook 5.1.0.The NMA was performed using Stata software. Intervention efficacy was ranked using Surface Under the Cumulative Ranking Curve (SUCRA) values.

Results: A total of 4, 334 articles were identified, and 46 studies were finally included. A total of 20 TCM nursing techniques were included. In terms of clinical effectiveness rate, auricular acupressure combined with gua sha performed best (SUCRA = 74.3%), while acupoint application was the best intervention for improving PSQI score (SUCRA = 84.4%).

Conclusions: TCM nursing techniques can effectively improve sleep in patients with PSI. However, caution is warranted due to the heterogeneity of the included studies, risk of bias, and limited sample sizes in some studies. In the future, more large-sample, high-quality randomized controlled studies are needed to provide more evidence-based evidence for clinical healthcare professionals.

Trial registration: The core protocol of this study was registered at PROSPERO database (CRD42024585602) on September 2024.

Background: Ipsilesional arm motor deficits post stroke vary with the side of brain damage. Although stroke leads to both cognitive and motor impairments that can affect movement performance, the lateralized effects of cognition on motor control remain unclear.

Objectives: To examine whether changes in cognitive processes post stroke affect ipsilesional arm motor performance differently depending on the side of brain damage.

Methods: We designed a cognitively challenging upper limb reaching task on the Kinereach virtual reality motion tracking system to examine ipsilesional arm movement in 15 chronic stroke survivors with severe hemiparesis (6 left hemisphere damage, 9 right hemisphere damage; age 58 years +/- 3.09 SEM). Participants completed 170 trials in which they needed to internalize a set of pictorial instructions in order to locate and reach for the correct target.

Results: We found that reaction time and movement error each increased with increased cognitive load (p < 0.0001). With increased cognitive load, there were differences between groups with respect to reaction time (p = 0.012), spatial efficiency of hand paths (p = 0.017), and movement accuracy (p = 0.032).

Conclusion: We found evidence of lesion side differences with respect to key measures of ipsilesional arm motor performance during a reaching task with an added cognitive challenge. Thus, these findings suggest that rehabilitation strategies should be tailored based on the side of lesions to better address hemisphere-specific motor and cognitive impairments, particularly considering that day-to-day tasks involve both motor and cognitive processes.

Background: Patients who have experienced strokes are prone to secondary muscle atrophy and sarcopenia, making the evaluation of muscle mass essential for effective rehabilitation. This study aimed to define cutoff values for quadriceps muscle thickness (QMT) when identifying low muscle mass, to address current gaps in noninvasive assessment methods for patients with stroke.

Methods: This cross-sectional study included patients with strokes. QMT on the non-paretic side was measured via ultrasonography. Patients were categorized into groups with low and normal muscle mass levels, based on the skeletal muscle index. The QMT cutoff value for identifying low muscle mass was determined using a receiver operating characteristic curve. Logistic regression analysis assessed the association between low muscle mass and the cutoff values.

Results: This study included 167 participants (mean age: 72.0 [interquartile range: 62.0-79.0] years; 58.1% males). The prevalence of low muscle mass was 68.9% (n = 115). The QMT cutoff values for identifying low muscle mass were determined as 64.556 mm for males and 54.764 mm for females, with area under the curve values of 0.881 and 0.884, respectively. These values were independently associated with low muscle mass, irrespective of covariates, with an odds ratio of 14.60 (95% confidence interval: 5.42-39.20; p < 0.001).

Conclusions: QMT represents a helpful measure for identifying low muscle mass in patients with strokes. Our findings suggest that incorporating QMT into routine assessments may improve sarcopenia management in patients with strokes.

Objective: Fear of progression (FoP) among stroke patients is closely associated with post-traumatic stress disorder (PTSD), perceived social support, and coping styles. However, there is still limited research on the mechanism of interaction among these four factors. The purpose of this study was to investigate the mediating role of coping styles and perceived social support in the relationship between FoP and PTSD among stroke patients.

Methods: The study included 240 stroke patients and utilized a cross-sectional design. Data was collected using a general data questionnaire, the Fear of Progression-Questionnaire-Short Form (FoP-Q-SF), the Perceived Social Support Scale (PSSS), Medical Coping Modes Questionnaire (MCMQ), and the Post-traumatic Stress Disorder Check-list-Civilian Version (PCL-C). Structural equation modeling was used to assess the mediating relationship between PSSS and MCMQ between FoP and PTSD.

Result: A total of 112 (46.7%) patients exhibited mental dysfunction with FoP scores ≥34, and 89 (37.1%) patients presented with a PTSD score of at least 38 had certain PTSD symptoms. FoP was negatively correlated with PSSS and facing coping styles, and positively correlated with PTSD and yielding coping styles. PSSS, facing coping styles, and yielding coping styles partially mediated the relationship between FoP and PTSD, accounting for 42.69% of the total effect.

Conclusion: PTSD can impact FoP directly or indirectly through perceived social support, confrontation, and submissive coping styles. Therefore, it is important to urge patients to reasonably use social support and coping styles to increase well-being, and strive to mitigate the ongoing impact of PTSD symptoms, and reduce the risk of FoP.

Background: The 2-Minute Walk Test (2MWT) is a simple and reliable test used by clinicians to assess gait function in people with stroke (pwST). No studies established the minimal clinically important difference (MCID) of the 2MWT.

Objective: To determine the MCID of the 2MWT in subacute pwST using data from a longitudinal cohort study.

Methods: PwST within 180 days of stroke onset were recruited from the Italian National Health System (NHS) rehabilitation services across the country. Participants underwent physical therapy to improve balance and gait according to their specific needs. The 2MWT was used to assess gait performance at the beginning (T0) and after a minimum of 10 rehabilitation sessions (T1). The Global Perceived Effect (GPE), Activities-specific Balance Confidence Scale (ABC) and the ABC_gait were used to assess balance confidence and the perceived effect of the intervention at T1.

Results: 51 pwST (69 ± 12 years; 66.7% males) were included in the analysis. Statistically significant improvements were observed in 2MWT, ABC, and ABC_gait scores after rehabilitation using the Wilcoxon signed-rank test. Using an anchor-based approach the receiver operating characteristic (ROC) curves were calculated to establish the MCID. The MCID of the 2MWT was 31 meters with an Area under the curve (AUC) = 0.74 [0.60-0.89], a specificity of 71% and a sensitivity of 63%.

Conclusions: An improvement of 31 meters on the 2MWT can be considered clinically significant in subacute pwST undergoing rehabilitation. This study provides valuable insights for clinicians to assess walking performance in pwST and determine clinically meaningful changes post-rehabilitation.

Background: Body mass index (BMI) of patients with ischemic stroke (IS) has been associated with prognosis and disability in studies in the United States. Although the Asian population is leaner, the optimal BMI for stroke-related disability remains unknown.

Objectives: To clarify the association between BMI and disability in patients with IS from a national database in Japan.

Methods: The present study included 522,421 patients with IS identified in the JROAD-DPC database from April 2016 to March 2020. We used the WHO classification of BMI, which divides Asia-Pacific patients into five groups, to categorize BMI and the modified Rankin Scale (mRS) to assess stroke-related disability at admission and discharge. After multiple imputation for missing values, we conducted a multiple mixed-effect logistic regression analysis for poor mRS score (>2) in September 2023. In addition, we created a restricted cubic spline model between the odds ratio (OR) for poor mRS and BMI.

Results: The mRS score worsened during hospitalization in 60.1% of the patients with IS, and 45.7% had a poor mRS score at discharge. Overweight patients had the lowest OR of having a poor mRS score (OR: 0.898, 95% confidence interval: 0.895-0.902). The spline curve for the OR for poor mRS score was U-shaped with a BMI of 24.7 kg/m²as the apex value.

Conclusion: The present study revealed a U-shaped relationship between BMI and stroke-related disability, with overweight patients having the lowest OR for disability at discharge.

Background: In stroke patients with tracheotomy, reduced lung function heightens pulmonary infection risk. Body position can affect lung function; however, its impact in stroke patients with tracheostomy remains unclear.

Objective: To investigate the influence of five body positions on pulmonary function in stroke patients with tracheotomy.

Methods: Pulmonary function was assessed in five body positions (supine, supine 30°, supine 60°, sitting, and prone) in 47 stroke patients who underwent tracheotomy. Diaphragmatic excursion during quiet breathing (DE_Q), diaphragmatic thickening fraction during quiet breathing (DTF_Q), and diaphragmatic excursion during coughing (DE_C) were measured using ultrasound. Peak cough flow (PCF) was measured using an electronic peak flow meter.

Results: Different positions had a significant impact on DE_Q, DE_C, and PCF in stroke patients with tracheotomy, although not on DTF_Q. DE_Q showed no significant differences between supine 60°, sitting, and prone positions. Both DE_C and PCF reached their maximum values in the sitting position. In the sub-group analysis, DE_Q in females did not show significant differences across different positions. Both males and females exhibited significantly higher PCF in the sitting compared to supine position. The lung function of obese patients was significantly better in the sitting than in the supine and supine 30° position. Regardless of the patient's level of consciousness and whether the brainstem was injured, lung function in the sitting position was significantly higher than in the supine position.

Conclusions: Body posture influences lung function in stroke patients with tracheotomy. Patients should adopt a sitting position to enhance pulmonary function.

Background: Stroke survivors usually present sedentary lifestyles and fail to comply with the World Health Organization physical activity recommendations. Reliable, low-cost, and fast tools are needed to monitor physical activity levels in this population.

Objectives: This study aimed to evaluate the content and face validity, construct validity, and test-retest stability of the International Physical Activity Questionnaire Short-Form (IPAQ-SF) in stroke survivors.

Methods: One hundred and twenty stroke survivors able to walk independently and preserved comprehension and communication abilities (61 ± 12 years, 35% female) were involved in this psychometric study. Participants completed the interview form of the IPAQ-SF via standardized videoconference twice, one week apart, under identical conditions, to evaluate test-retest stability. Correlations between IPAQ-SF and the caloric expenditure during the minutes of activity registered with the Fitbit Inspire 2 activity tracker wristband and 6-Metre Timed Walk (6MTW) were explored to assess construct validity.

Results: The IPAQ-SF showed good content and face validity. "Moderate" to "strong" correlations were found with the Fitbit Inspire 2 (rho: 0.40 to 0.63), while "weak" to "moderate" correlations were found with the 6MTW (rho: 0.35 to 0.50). Test-retest stability was "moderate" to "excellent" (κ: 0.844 to 0.881; ICC: 0.533 to 0.917).

Conclusions: The IPAQ-SF demonstrated satisfactory content and construct validity, and stability in stroke survivors, supporting its clinical and research utility when the data collection is conducted by trained evaluators using a standardized interview protocol in large samples.

Background: Combinations of rehabilitation therapies are widely used in patients with post-stroke hemiplegia. A combination of acupuncture and MOTOmed had been shown to promote the recovery of post-stroke hemiplegia patients. We conducted a systematic review of evidence from studies that investigated the use of acupuncture combined with MOTOmed for rehabilitation of patients with post-stroke hemiplegia.

Objective: To estimate the rehabilitation effect of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia.

Methods: Randomized controlled trials (RCTs) of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia were retrieved from nine databases. Risk-of-bias assessments were conducted using the Cochrane Risk-of-bias Tool. Meta-analysis of outcome measures was performed using RevMan 5.4 software. And we followed the PRISMA 2020 guidelines.

Results: Eighteen studies involving 1637 participants were included. Compared with conventional rehabilitation, acupuncture, or MOTOmed movement therapy alone, acupuncture combined with MOTOmed movement therapy increased the scores of Fugl-Meyer Assessment Scale-lower extremity (FMA-LE), Berg Balance Scale (BBS), Functional Ambulation Categories scale (FAC), Maximal Walking Speed test (MWS), gait parameters of 3D gait analysis, Barthel Index (BI), Modified Barthel Index (MBI), total effective rate, and the levels of neurotrophic factors (NGF, BDNF and NT-3) in serum, while reduced the scores of Clinic Spasticity Index (CSI) and National Institutes of Health Stroke Scale-Lower Extremity (NIHSS-LE) (p < 0.05 for all).

Conclusion: Acupuncture combined with MOTOmed movement therapy has better efficacy than conventional rehabilitation, acupuncture, or MOTOmed alone in patients with post-stroke hemiplegia. This combination therapy can promote the rehabilitation of these patients.