Abstract
Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.
Highlights
Various physical and perceptual dysfunctions such as motor paralysis, sensory disturbance, muscle weakness, and visuospatial deficits can negatively impact an individual’s independence in the activities of daily living (ADL)
We presumed that sensory disturbances deteriorate balance functions, which reduces the independence in ADL and the motor function of the affected upper limb
The indices of goodness of fit using the path model described in Fig 1 were χ2 = 0.326 (P = 0.568), Goodness Fit Index (GFI) = 0.999, Adjusted Goodness Fit Index (AGFI) = 0.968, Comparative Fit Index (CFI) = 1.000, Root Mean Square Error of Approximation (RMSEA) = 0.000, with all indices fulfilling the established criteria
Summary
Various physical and perceptual dysfunctions such as motor paralysis, sensory disturbance, muscle weakness, and visuospatial deficits can negatively impact an individual’s independence in the activities of daily living (ADL). Other studies have reported that balance functions in stroke patients are associated with independence in ADL [3] and the motor functions of the affected upper limb [4]. When integrating this information, we presumed that sensory disturbances deteriorate balance functions, which reduces the independence in ADL and the motor function of the affected upper limb. We presumed that sensory disturbances deteriorate balance functions, which reduces the independence in ADL and the motor function of the affected upper limb This reasoning suggests that the various dysfunctions caused by a stroke are hierarchical, and these dysfunctions induce complex effects on ADL. To the best of our knowledge, there are no published reports that investigate the hierarchical relationships between various dysfunctions and ADL
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