Abstract
OBJECTIVE:The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence.METHODS:This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors.RESULTS:We studied 60 patients with a median age of 68 (34–89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03–1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13–2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78–0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48–0.92], p=0.017).CONCLUSION:The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.
Highlights
Stroke is both the second leading cause of death worldwide and the primary cause of chronic disability in adults [1,2,3,4,5]
The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03–1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13–2.65], p=0.01)
The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78–0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48–0.92], p=0.017)
Summary
Stroke is both the second leading cause of death worldwide and the primary cause of chronic disability in adults [1,2,3,4,5]. USN is more common in right- than lefthemisphere strokes and can contribute to disability [6,7]. The main areas involved in USN are related to the right hemisphere, such as lesions in the right posterior parietal lobe [11,12], and individuals with USN after stroke present with major functional disabilities as well as decreased rates of adherence to rehabilitation programs [13,14,15]. The aim of this study was to evaluate the relationship between the degree of USN during the acute phase of stroke with disability and long-term functional independence. The main hypothesis of this study was that a higher degree of USN during the acute phase of a stroke with disability would predict greater long-term disability
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