Topics in Stroke Rehabilitation最新文献

Background: Orthosis satisfaction may be an important parameter that increases orthosis usage and reveals orthosis' positive effect on rehabilitation.

Objectives: To investigate the relationship between lower limb orthosis user satisfaction and quality of life (QOL) and functionality in stroke patients.

Methods: Forty-four stroke patients with a mean age of 56.91 ± 14.08 years were included. Orthosis user satisfaction was evaluated using the Orthotics and Prosthetics Users' Survey (OPUS). QOL was assessed using the Stroke-Specific Quality of Life Scale (SS-QOL). Lastly, functional status was evaluated using the Fugl - Meyer Assessment of Lower Extremity (FMA-LE) and Timed Up and Go Test (TUGT).

Results: The relationships were found between the OPUS total satisfaction and SS-QOL-selfcare (r = -0.412, p = 0.005), and upper extremity (r = -0.401, p = 0.007); OPUS device satisfaction and SS-QOL-selfcare (r = -0.484, p < 0.001) and upper extremity function (r = -0.379, p = 0.011); and OPUS service satisfaction and FMA-LE (r = 0.880, p = 0.001). There was no relationship between the OPUS total satisfaction, service satisfaction, and daily orthosis use time (p > 0.05). While participants' QOL and lower extremity functionality were generally at low, those with better functional status had lower orthosis satisfaction because it made ambulation at home difficult.

Conclusion: Taking patient opinions into account in the orthotic design process will help to eliminate the problems related to comfort and orthotic wear that might affect orthotic satisfaction. The production of more comfortable orthoses might positively affect individuals' use of orthoses and satisfaction. This outcome may be a good starting point for prospective studies.

Objective: In people who have had stroke, are the effects of backward walking comparable with forward walking for improving walking (i.e. speed, cadence, and stride length)? Does the addition of backward walking to forward walking help improve the benefits of forward walking? Are any benefits maintained beyond intervention?

Methods: A systematic review of randomized trials, with adults following stroke, was developed. The intervention of interest was backward walking training, delivered either as a solo intervention or in combination with forward walking training. The outcome measures of interest were walking speed, cadence, and stride length.

Results: The effect of backward walking training is similar as or better than that of forward walking training for improving walking speed (MD 0.16 m/s, 95% CI 0.06 to 0.27), but results for cadence and stride length were very imprecise. The addition of backward walking training to forward walking training provided negligible effects on walking speed (MD 0.03 m/s, 95% CI 0.01 to 0.04), cadence (MD 5 steps/min, 95% CI 1 to 10), and stride length (MD 0.04 m, 95% CI -0.01 to 0.09). Maintenance of effects beyond the intervention period remains uncertain.

Conclusions: This review provided moderate-quality evidence that backward walking training is slightly better than forward walking training for improving walking speed after stroke, but not when it is additional to forward walking training. Large and well-designed trials are warranted to strengthen the evidence regarding backward walking training, especially in the subacute phase after stroke.

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.

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: Little is known about the ideal duration of inspiratory muscle training in stroke patients.

Objective: The aim of this study was to assess the effects of short-term and long-term inspiratory muscle strengthening exercises in stroke patients.

Methods: This study was a prospective, double-blind, randomized controlled trial involving 50 stroke patients. Based on baseline maximum inspiratory pressure (MIP) values, participants were divided into two strata: those with severely weak inspiratory muscle (stratum A) and those with moderately weak inspiratory muscle (stratum B). Within each stratum, individuals were randomly assigned to either the 4-week exercise group, the 8-week exercise group, or the sham group. The exercise groups underwent inspiratory muscle strengthening exercises. The MIP, 6-minute walk test (6MWT), and the Nottingham Extended Activities of Daily Living (NEADL) Index were assessed at baseline, 8, 12, and 24 weeks.

Results: Subjects in Stratum A exhibited notably greater improvement after 8 weeks of training compared to those in Stratum B. Furthermore, both Stratums displayed significantly greater improvement following 8 weeks of training compared to sham training. In Stratum B cases, a significantly higher level of improvement was noted with the 4-week training in comparison to the sham training. A significant increase in NEADL index and 6MWT score was observed during the 24-week follow-up period.

Conclusion: For individuals with moderately weak inspiratory muscle strength, a 4-week exercise program proves sufficient in enhancing inspiratory muscle strength, walking capacity, and daily life activities. However, individuals with severely weak inspiratory muscle strength benefit more from an 8-week treatment.

Introduction: Transcranial direct current stimulation (tDCS) has a priming effect on post- stroke motor rehabilitation.

Objective: We verified whether tDCS combined with task-specific training was superior to nonintervention, task-specific training, or simulated intervention in improving spatio-temporal gait parameters and functional mobility in stroke patients.

Methods: We searched MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Central, Web of Science, and LILACS for articles published until May 2024, using terms related to stroke, tDCS, and task-specific training. The risk of bias was assessed using the PEDro scale. The Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to classify the certainty of the evidence for each outcome. Meta-analysis was performed using a random-effects model.

Results: A total of 1,685 studies were identified, of which 18 were included in the qualitative analysis. Seven studies were included in the meta-analysis; all outcomes were classified as "very low quality." Improvements in walking speed only were associated with tDCS combined with task-specific training (mean difference [MD], 0.06; 95% confidence interval [CI]: 0.04, 0.07; p < 0.001; I  = 0%). There were no differences in other spatio-temporal gait parameters or functional mobility.

Conclusion: This systematic review provides low-quality evidence that tDCS, in combination with task-specific training, increases speed in individuals after stroke. Both interventions, tDCS and task-specific training, are inexpensive and easy to implement; therefore, the mean estimate may be considered clinically worthwhile, although the CIs spans both clinically trivial and worthwhile effects.

Registration: International Prospective Register of Systematic Reviews (PROSPERO; number CRD42023396021).

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.

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: 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: 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.