Abstract
Background: The complex nature of stroke sequelae, the heterogeneity in rehabilitation pathways, and the lack of validated prediction models of rehabilitation outcomes challenge stroke rehabilitation quality assessment and clinical research. An integrated care pathway (ICP), defining a reproducible rehabilitation assessment and process, may provide a structured frame within investigated outcomes and individual predictors of response to treatment, including neurophysiological and neurogenetic biomarkers. Predictors may differ for different interventions, suggesting clues to personalize and optimize rehabilitation. To date, a large representative Italian cohort study focusing on individual variability of response to an evidence-based ICP is lacking, and predictors of individual response to rehabilitation are largely unexplored. This paper describes a multicenter study protocol to prospectively investigate outcomes and predictors of response to an evidence-based ICP in a large Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation.Methods: All patients with diagnosis of ischemic or hemorrhagic stroke confirmed both by clinical and brain imaging evaluation, admitted to four intensive rehabilitation units (adopting the same stroke rehabilitation ICP) within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled (expected sample: 270 patients). Measures will be taken at admission (T0), at discharge (T1), and at follow-up 6 months after a stroke (T2), including clinical data, nutritional, functional, neurological, and neuropsychological measures, electroencephalography and motor evoked potentials, and analysis of neurogenetic biomarkers.Statistics: In addition to classical multivariate logistic regression analysis, advanced machine learning algorithms will be cross-validated to achieve data-driven prognosis prediction models.Discussion: By identifying data-driven prognosis prediction models in stroke rehabilitation, this study might contribute to the development of patient-oriented therapy and to optimize rehabilitation outcomes.Clinical Trial Registration: ClinicalTrials.gov, NCT03968627. https://www.clinicaltrials.gov/ct2/show/NCT03968627?term=Cecchi&cond=Stroke&draw=2&rank=2.
Highlights
Stroke is one of the major causes of death and permanent disability in Western countries, with a growing impact on public health [1]
By identifying data-driven prognosis prediction models in stroke rehabilitation, this study might contribute to the development of patient-oriented therapy and to optimize rehabilitation outcomes
Thrombolytic therapy represents a great progress in the treatment of the acute phase of cerebrovascular disease, but only a minority of patients are eligible and can receive it, and, on the whole, this improvement does not balance the steady increase of stroke prevalence, both for the greater longevity of the population and for the lower mortality in the acute phase
Summary
Stroke is one of the major causes of death and permanent disability in Western countries, with a growing impact on public health [1]. In Italy, the implementation of interdisciplinary intensive rehabilitation for stroke survivors is highly diverse across the country. This is due to a remarkable interregional and intraregional heterogeneity in Abbreviations: PSE, post-stroke epilepsy; EEG, electroencephalography; MEP, motor evoked potential; BDNF, brain-derived neurotrophic factor; FDG, Fondazione don Carlo Gnocchi; SRRI, scientific rehabilitation and research institution; ICP, integrated care pathway; IRUs, intensive rehabilitation units; TCT, Trunk Control Test; MUST: Malnutrition Universal Screening Tool; FMA, Fulg– Meyer Assessment scale; ADLs, activities of daily living; mBI, modified Barthel Index; FAC, functional ambulation categories; FAI, Frenchay Activity Index; FWC, functional walking categories; MoCA, Montreal Cognitive Assessment; OCS, Oxford Cognitive Screening; TAM, tibialis anterior muscles; CMAP, compound muscle action potential; TMS, transcranial magnetic stimulation; FA, functional ability; PMIC, Protocollo di Minima per l’Ictus; MMSE, Mini-Mental State Examination; MI, motor index. This paper describes a multicenter study protocol to prospectively investigate outcomes and predictors of response to an evidence-based ICP in a large Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation
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