Topics in Stroke Rehabilitation最新文献

Objective: To investigate the minimal detectable change (MDC) and minimal important change (MIC) of the Simple Test for Evaluating Hand Function (STEF) in patients with subacute stroke.

Design and setting: Prospective longitudinal study at a single rehabilitation hospital.

Participants: Fifty-three patients with subacute stroke.

Intervention: Patients received standard stroke rehabilitation, including physical, occupational, and speech therapy. Upper extremity function was assessed using the STEF at admission, the next day, and 4 weeks later.

Main measures: The primary outcome was the STEF score. Additional measures were the Global Rating of Change Scale (GRCS), the Functional Independence Measure (FIM) self-care domain, and the Modified Rankin Scale (mRS). Test - retest reliability and MDC were calculated. MIC was estimated using an anchor-based receiver operating characteristic analysis and an adjusted logistic regression approach.

Results: The STEF showed excellent reliability, with an intraclass correlation coefficient of 0.98 and a MDC₉₅ of 12.7 points. Anchor-based MIC values were 14.5 points for participants' GRCS, 9.0 points for therapists' GRCS, 11.5 points for the FIM self-care domain, and 16.0 points for the mRS. Adjusted predictive values were 7.9, 8.6, 9.5, and 16.6 points, respectively.

Conclusions: A change greater than 12 points on the STEF likely exceeds measurement error. These thresholds support interpretation of patient changes and guide clinical decision-making in subacute stroke rehabilitation.

Introduction: Self-efficacy significantly influences the recovery process following a stroke. A reliable and valid measurement tool is of paramount importance for self-efficacy assessment. The stroke self-efficacy questionnaire (SSEQ) is a specialized measurement tool designed for post-stroke patients.

Aim: The study was conducted to translate the English SSEQ version into and culturally adapt it to the Vietnamese version and to evaluate the reliability and validity of the latter.

Materials and methods: The translation and cultural-adaptation process included translation-back steps according to Beaton's guidelines, content validity index (CVI) was assessed on 10 experts, face validity via pilot on 10 patients, factor analysis on 305 patients, and reliability assessment on 80 replications.

Results: The SSEQ-V achieved CVI = 100%, all patients clearly assessed the form and content suitability, internal reliability reached Cronbach's alpha >0.95, and test-retest reliability reached ICC = 0.979. Factor analysis supported a two-factor structure including daily functional activities and self-management with high fit indices.

Conclusion: The SSEQ-V should be applied in post-stroke patients to develop self-management intervention programs to improve their recovery in Vietnam.

Background: Post-stroke semi-incapacitated patients often experience a strong fear of disease recurrence, which adversely affects their psychological well-being and rehabilitation outcomes.

Objectives: To develop and evaluate the effectiveness of a psychological intervention program aimed at reducing the fear of recurrence in post-stroke semi-incapacitated patients.

Methods: This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Post-stroke semi-incapacitated patients were recruited and assigned to either an intervention group or a control group according to the order of hospital admission. The control group received conventional psychological care, while the intervention group underwent a comprehensive psychological intervention program that included psychological support, cognitive-behavioral therapy (CBT), rehabilitation training, and social support. The psychological status of the patients was assessed using the Fear of Disease Progression Scale, Hospital Anxiety and Depression Scale, and the Chinese version of the Perceived Stress Scale before and after the intervention.

Results: Prior to the intervention, 83.5% of patients reported psychological fear of relapse, 75.5% experienced anxiety, 75.5% had depression, and 70.5% felt stressed. After the intervention, only 41.0% of patients in the intervention group had a psychological fear of relapse, 11.0% had anxiety, 2.0% had depression, and 5.0% perceived stress. The number of patients with psychological conditions was significantly lower in the intervention group compared to the control group (p < 0.001).

Conclusions: The integrated psychological intervention program, which combined psychological support, CBT, rehabilitation training, and social support, was effective in reducing the fear of recurrence in semi-disabled patients after stroke.

Background: Post-stroke dysphagia affects half of survivors and leads to serious complications. Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are primary feeding methods, yet their comparative effectiveness remains controversial.

Objective: This meta-analysis compared PEG versus NGT feeding in post-stroke dysphagia regarding mortality, pneumonia, nutritional outcomes, and length of stay (LOS). Methods Following PRISMA guidelines, we searched MEDLINE, EMBASE, Cochrane Library, and PubMed. Ten studies (N=1,416) were included. Pooled risk ratios (RR) and mean differences (MD) were calculated using random-effects models in R-4.2.1. Quality was assessed via the Downs and Black checklist.

Results: Compared to NGT, PEG showed a 30% reduction in mortality risk (RR 0.70; 95% CI 0.50-0.98; p = 0.039); however, this was not significant in sensitivity analysis restricted to RCTs. PEG also showed a 47% reduction in pneumonia risk (RR 0.53; 95% CI 0.42-0.67; p < 0.001). Nutrition favored PEG, with significantly higher serum albumin (MD +4.56 g/L; 95% CI 1.25-7.87; p = 0.007). No significant differences occurred in mid-arm circumference (p = 0.16) or LOS (p = 0.34). Heterogeneity was moderate for mortality (I² = 47.5%) and low for pneumonia (I² = 0%).

Conclusion: PEG significantly reduces pneumonia risk and may improve nutritional outcomes compared to NGT. Mortality benefits were not confirmed in RCT-only analyses, suggesting possible confounding. Feeding decisions should balance benefits, procedural risks, and patient-specific factors, emphasizing shared decision-making. Further high-quality RCTs are warranted.

Background: Predicting activities of daily living (ADL) in stroke patients optimizes discharge planning, which relies on accurate functional assessment. Recent studies have shown that functional connectivity (FC) of brain networks induced by upper extremity rehabilitation robotic training (UE-RAT) effectively reflects functional status, but its prognostic value for ADL remains unclear.

Objective: Utilize functional near-infrared spectroscopy (fNIRS) to measure FC during UE-RAT and develop machine learning models to evaluate the predictive value of task-FC for ADL.

Methods: This study recruited 86 patients with subacute stroke. Activation and FC features of key brain regions, such as the superior frontal cortex (SFC) and primary motor cortex (M1), were measured in the resting state and during UE-RAT using fNIRS. Concurrently, 38 clinical features were collected. With modified Barthel Index (mBI) ≥75 at discharge as the prediction target, machine learning algorithms such as artificial neural network (ANN) were used to construct resting-state fNIRS model, task-state fNIRS model, clinical model, and combined model, and analyze the importance of the predictor variables based on the Shapley additive interpretation (SHAP).

Results: The combined model constructed by combining clinical and task-state fNIRS features had the best predictive performance (AUC_mean: 0.955, 95% CI: 0.948-0.962). Higher connectivity between the ipsilateral premotor cortex (iPMC) and primary motor cortex (iM1) during the task state, along with higher mBI scores and lower mRS scores, predict significant improvement in functional independence for patients.

Conclusions: UE-RAT induced FC can be a valid biomarker for mBI prediction and can improve the accuracy of rehabilitation prediction.

Background: Independence in toilet‑related activities critically shapes discharge planning and caregiver burden after stroke. Reliable early‑stage prediction models could therefore aid individualized rehabilitation.

Objective: To compare the predictive performance of logistic regression (LR) and five machine learning algorithms - decision tree (DT), support vector machine (SVM), artificial neural network (ANN), k‑nearest neighbors (KNN), and ensemble learning (EL) - for toilet-related independence at discharge.

Methods: We retrospectively analyzed subacute stroke survivors admitted to Tokyo Bay Rehabilitation Hospital from March 2015 to September 2019. Independence was defined as a score ≥ 6 on four Functional Independence Measure (FIM) subitems (toileting, bladder management, bowel management, toilet transfers). Participants' characteristics and FIM subitems were entered as predictors. LR and five machine‑learning algorithms were trained with five‑fold cross‑validation. Model performances were evaluated by the area under the receiver‑operating‑characteristic curve (AUC).

Results: Of 824 participants (mean age 70.9 years), 453 (55%) were independent at discharge. In validation data, SVM (AUC = 0.9223) achieved, followed by LR (0.9202), ANN (0.9201), KNN (0.9072), EL (0.8961), and DT (0.8394). On test data, SVM and LR maintained AUCs of 0.9101 and 0.9078, whereas ANN declined to 0.8922. EL (0.9021) and KNN (0.9020) remained stable; DT (0.7864) performed the lowest. In LR, FIM-Bed to chair transfer was the strongest positive predictor, and age was the strongest negative predictor.

Conclusions: SVM provided the highest accuracy with minimal overlearning. LR offered similar performance and greater interpretability, supporting its clinical use. These models could provide valuable information in stroke rehabilitation.

Background: Self-efficacy is recognized as a key determinant in post-stroke adjustment. Adapting the Stroke Self-Efficacy Questionnaire (SSEQ) into European Portuguese is needed, due to the lack of reliable and valid measures to assess self-efficacy in post-stroke populations within this context.

Objective: To conduct the cross-cultural adaptation of the SSEQ to European Portuguese and investigate its validity, reliability, and interpretability for the European Portuguese stroke population.

Methods: A two-phase study was conducted: i) translation and cultural adaptation of the English version of SSEQ to European Portuguese (SSEQ-PT); and ii) psychometric assessment ofSSEQ-PT. The initial phase encompassed the content index validation by an expert committee with seven professionals and verbal probing by nine stroke survivors. The second phase involved 103 participants and assessed construct validity through Confirmatory Factor Analysis (CFA) and concurrent validity, test-retest reliability, and interpretability measures.

Results: The SSEQ-PT demonstrated adequate content validity and comprehensibility. The original two-factor structure was confirmed through CFA where Chi-Square (χ2)(64) = 114.11, Comparative Fix Index (CFI) = 0.93, Standardized Root Mean Square Residual (SRMR) = 0.06, with factor correlation of 0.63. Adequate construct validity was demonstrated with expected correlations between the SSEQ-PT subscales and selected scales. The activity subscale demonstrated a Cronbach's α of 0.91 and the self-management subscale of 0.80. The total instrument demonstrated an Interclass CorrelationCoefficient (ICC) of 0.87.

Conclusions: The SSEQ-PT proved to be a highly relevant and easily comprehensible measure for assessing self-efficacy in stroke survivors. This study demonstrates that the European Portuguese version of the instrument is valid and reliable for assessing self-efficacy in stroke patients.

Background: The LIFE-H 3.1 is a measure that assesses person-perceived social participation and it has not been psychometrically examined in survivors of stroke.

Objectives: To examine the psychometric properties of the LIFE-H 3.1, including its test - retest reliability, minimal detectable change (MDC) score, convergent and divergent validity, known-group validity, and the optimal cutoff score for distinguishing the level of participation between survivors of stroke and non-stroke older adults.

Methods: Thirty-four survivors of stroke and 30 aged-matched non-stroke controls were recruited. The LIFE-H 3.1 and various health-related outcome measures were administered to the survivors of stroke in Day 1 to examine the correlations between them. Following a 7-day interval (Day 7), the LIFE-H 3.1 assessment was repeated in survivors of stroke to evaluate the test - retest reliability and establish the MDC. In non-stroke older adults (n = 30), LIFE-H 3.1 was administered on Day 1 only to examine the known-group validity to determine the cutoff score of LIFE-H 3.1 for distinguishing the level of participation between survivors of stroke and non-stroke older adults.

Results: The overall LIFE-H 3.1 scale and its subscales demonstrated moderate-to-good test - retest reliability and significant associations with a functional mobility measure and a health-related quality of life measure. We also established the MDC values of LIFE-H 3.1 and its subscales. Moreover, appropriate cutoff scores for person-perceived participation were established that gave LIFE-H3.1 the ability to distinguish between survivors of stroke and non-stroke older adults.

Conclusion: LIFE-H 3.1 is a reliable and valid measure to evaluate the person-perceived social participation of survivors of stroke.

Purpose: Severe stroke survivors respond to mobilization rehabilitation interventions with more varied outcomes than those with less severe stroke. They may face additional risks for impaired blood pressure regulation and extended vulnerability to blood pressure changes, potentially contributing to poor recovery outcomes.The primary aim of this rapid review was to identify and synthesize current evidence investigating the effects of mobilization on blood pressure, for stroke survivors in the acute and early stage of rehabilitation. The secondary aim was to identify potential risks associated with acute mobilization interventions, to inform clinical decisions and guide future research directions.

Materials and methods: A comprehensive search strategy was conducted in five databases supplemented with scrutiny of published stroke guidelines. Inclusion criteria were: severe or moderate stroke injury; acute or early post-stroke (<90 days); mobilization intervention; and reporting blood pressure measures. Data was extracted, tabled, and synthesized using descriptive analysis.

Results: Seven hundred and ten articles were identified, of which seven articles were included. Varied mobilization interventions were described including sitting (n = 4), backrest tilt (n = 1), standing (n = 2), tilt table with or without exercises (n = 2), and supine cycling (n = 1). Large blood pressure changes, most frequently hypotension, were found in a small number of participants, with increasing incidence for more vertical and passive mobilization activities. Blood pressure changes stabilized over time.

Conclusions: Transient blood pressure changes frequently occurred with mobilization. Concerningly, large blood pressure changes occurred for some participants, increasing with verticality and passive nature of mobilization. Further research is needed, to guide optimal mobilization rehabilitation for acute severe stroke survivors.

Background: Communication Partner Training (CPT) is an intervention where multidisciplinary healthcare staff are trained to use supportive strategies to communicate with people with communication disabilities such as aphasia. CPT is an evidence-based recommendation in high-quality international stroke guidelines, but there are large evidence-practice gaps that need to be addressed.

Objectives: This study explored a) current CPT practice, b) barriers and facilitators influencing CPT implementation, and c) preferences on ideal CPT.

Methods: Australian stroke clinicians (speech pathologists: SLPs; the multidisciplinary team: MDT) working with people with aphasia across acute, rehabilitation and community settings completed an online cross-sectional survey based on the Theoretical Domains Framework. Data were analyzed using descriptive statistics, frequency distributions, total barriers scores and qualitative content analysis.

Results: Final analyses included 206 surveys (105 SLPs 105; 101 MDT). Both groups (SLP 98%; MDT 71%) agreed CPT is beneficial to patients with aphasia. However, less than 20% of MDT respondents reported receiving CPT. While 87% of SLPs reported providing CPT, only 36% reported alignment with best practice. Key barriers included insufficient systems-level support, training opportunities and staff availability, and the MDT lacked knowledge and confidence in using communication strategies. Training preferences included flexible delivery, interactive approaches, and protected time.

Conclusions: Current Australian CPT practice does not align with best practice guidelines and the stroke MDT have unmet training needs. Despite SLPs valuing interactive training with demonstration and practice, time constraints often reduce CPT to basic education. A targeted implementation strategy addressing key barriers is needed to sustainably improve healthcare experience and communication outcomes.