Disability In Stroke Survivors Research Articles

The Effect of Task-Oriented Training and Progressive Resisted Exercise on Upper Limb Function and Quality of Life in Chronic Stroke Patients

Introduction: Stroke is defined as a neurological deficit subjected to acute focal injury of the Central Nervous System (CNS) due to vascular cause. The cause may be several embracing cerebral infarctions. Stroke is the third leading cause of death and the most common cause of disability among adults. Many studies have shown that motor impairment is a common factor leading to disability in stroke survivors. Improving the deficient motor power and strategies will reduce motor disability (Task-oriented training is given mainly for improving Functional performance). Need for the Study: Studies have shown a significant effect on motor function post-stroke with several techniques like conventional exercise, Proprioceptive Neuromuscular Facilitation (PNF), and Brunnstorm techniques. The effect of the treatment was significant because the weak muscles were strengthened, and the tight muscles were relaxed. However, there is a scarcity in the literature related to the effect of task-oriented training on motor performance in subjects with chronic stroke. Hence this study is undertaken. Methods: The study was carried out in the OPD of the College of Physiotherapy- Dayananda Sagar University-Bangalore on a sample size of 40 subjects for 6 months. It was a randomised clinical trial where subjects were split into two groups with task-oriented training and Progressive Resisted Exercises (PRE). The therapy was 30 minutes/session for 5 days /week for 4 weeks. Results: Task-oriented training showed significant changes within the group from pre- and post-trial and between the group effects, thus demonstrating it to be more significant in enhancing motor performance compared to mere strengthening exercises. Conclusion: The current study demonstrates that task oriented training compared to Progressive Resisted Exercises (PRE) works efficiently in improving upper limb functions and quality of life. The improvement in motor performance varied but the Chedoke Arm and Hand Activity Inventory and Stroke Impairment Scale showed quite significant improvement post-rehabilitation with task-oriented training compared to Progressive Resisted Exercise.

Impact of Environmental Factors on Post-Stroke Disability: An Analytical Cross-Sectional Study

ObjectivesIdentify how environmental barriers and facilitators are associated with disability in stroke survivors. Materials and MethodsAn analytical, cross-sectional study was conducted involving individuals in the chronic stage of stroke. The dependent variable was disability, which was assessed using the World Health Organization Disability Assessment Schedule (WHODAS-2.0). Environmental factors (independent variable) were evaluated using the Measure of the Quality of the Environment (MQE). Multiple linear regression analysis was performed to estimate the impact of the environment on disability following a stroke. ResultsSeventy-five individuals (mean age: 54.2 + 9.8 years) were analyzed. The most frequent environmental facilitators were related to technology, social networks, and public services. The main barriers were related to the physical environment. Environmental barrier was a predictor of both overall disability [F(1.73) = 4.24; R2=0.06; β = −0.23; t = −2.06; p=0.04] and participation [F(1.73) = 10.45; R2=0.13; β = −0.35; t = −3.23; p = 0.01]. Environmental facilitators were not correlated with disability. ConclusionEnvironmental barriers explained 13% of the variation in restrictions to social participation and were also a significant predictor of overall disability. The main barriers were related to the physical environment. Identifying environmental factors related to disability in stroke victims can assist in the planning of guided therapy.

What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK

BackgroundLevels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors.MethodsFace to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’.ResultsIndividuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals.ConclusionsThe disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation.

Diabetes and obesity are associated with disability in community-dwelling stroke survivors: A cross-sectional study of 37,955 Behavioral Risk Factor Surveillance System respondents

ABSTRACT Purpose. Stroke increases risk for disability. Obesity and diabetes also increase risk for disability in the general population, but their association with disability in stroke survivors is unknown. We examined disability risk associated with obesity and diabetes in stroke survivors across six disability types: hearing, vision, cognition, mobility, and basic and instrumental activities of daily living (ADLs). Materials and Methods. Data from 37,955 community-dwelling US stroke survivors aged ≥18 years were analyzed from the 2017 and 2018 Behavioral Risk Factor Surveillance System. Linear regression was used to calculate prevalence of each disability type. Survivors were stratified by obesity versus normal weight and diabetes vs no diabetes, and logistic regression was used to calculate adjusted odds ratios (AOR) for each disability type, adjusted for demographic information. Results. Prevalences of disability types ranged from 14.2% to 36.0%. Among survivors with obesity, odds were elevated for mobility (AOR: 1.68) and basic ADL (AOR: 1.55) disability. Among survivors with diabetes, odds were elevated for all disability types (AOR range: 1.15–1.71). Conclusion. Stroke survivors with obesity or diabetes experience increased risk for disability compared to survivors without these chronic conditions. Interventions for managing disability, obesity, and diabetes concomitantly may be warranted and deserve further consideration.

OCCUPATION-BASED INTERVENTION IN STROKE REHABILITATION: PERSPECTIVES OF OCCUPATIONAL THERAPY PRACTITIONERS

BACKGROUND AND AIMS The occupation-based intervention has shown effective recovery in overall disability of stroke survivors, yet the concept is unexplored among Pakistani occupational therapists. Therefore, this study is aimed to explore their perception regarding occupation-based intervention in stroke rehabilitation. METHODOLOGY A self-administered questionnaire designed in Google Docs was distributed online via email and social media applications to record participants’ responses regarding occupation-based approaches in post-stroke rehabilitation. RESULTS A total number of 150 occupational therapists were enrolled in the study comprised 135 females and 15 males from 18 to 44 years of age. It was revealed that 53.3% therapists had taken an average of 45 minutes of clinical practice sessions on occupation-based intervention, 64.7 % believed to be well trained in the occupation-based approach. Moreover, 69.3% stated that their professional practice in post-stroke rehabilitation is generally based on the biomedical model, yet 39.3% of therapists have no clarity of this concept. CONCLUSION It was concluded that most occupational therapists understand the concept of occupation-based intervention. However, only a few were trained and implementing the approach in stroke rehabilitation, while the rest were found to have insufficient knowledge regarding this practice.

Abstract P50: Obesity and Diabetes Are Associated With Increased Risk for Disability Among Community-Dwelling Stroke Survivors

Introduction: Stroke-related disability is common. Obesity and diabetes are associated with disability in the general population, but the elevated risk of disability in stroke survivors who also experience these conditions has not been reported. The purpose of this study was to examine prevalence of 6 disability types among stroke survivors stratified by obesity and diabetes statuses. Methods: Data from 37,955 non-institutionalized stroke survivors aged >18 years from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS), a U.S.-based annual telephone survey, were analyzed. Self-reported disability types included deaf or difficulty hearing (deaf); blind or difficulty seeing (blind); difficulty concentrating, remembering, or making decisions (cognition); difficulty walking or climbing stairs (mobility), difficulty dressing or bathing (dressing); and difficulty doing errands alone (alone). Prevalence of disability types were computed using linear regression, and odds ratios (adjusted for demographic characteristics) among survivors with obesity (vs. normal weight) and diabetes (vs. no diabetes) were computed using logistic regression. Results: Prevalence of obesity and diabetes were 35.7% (95% CI: 29.5%-41.8%) and 24.8% (95% CI: 21.3%-28.3%), respectively. Prevalence was highest for mobility (36.0%), cognition (33.7%) and alone (28.3%) disability types. Compared to survivors with normal weight, survivors with obesity had elevated AORs for mobility (1.68) and dressing (1.55) disability; and compared to survivors without diabetes, survivors with diabetes had elevated AORs for all disability types (range: 1.17-1.71) (see Table). Conclusion: Obesity and diabetes increase risk for self-reported disability above the risk associated with stroke alone. Tailored interventions for stroke survivors with these conditions may be needed for decreasing disability and improving quality of life, and should be developed and explored.

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.

Incidence and risk factors of vascular dementia in Thai stroke patients

BackgroundBesides disability in stroke survivors, vascular cognitive impairment (VCI) can prevent these patients from living independently. The purpose of this study is to look for the incidence and risk factors of vascular dementia in Thai patients with stroke. MethodsAdults patients with ischemic stroke were prospectively included. Cognitive assessment was performed at 3–6 months after stroke onset. Montreal Cognitive Assessment (MOCA)- Thai version was used to evaluate cognitive function, with the cutoff point of 24/25 of MOCA to define cognitive impairment/normal cognition. Vascular mild cognitive impairment (VMCI) and vascular dementia (VAD) were diagnosed in those with cognitive impairment. Epidemiologic data, Apolipoprotein E (ApoE) status, and stroke characteristics were compared between patients with and without VAD. ResultsThere were 180 patients with the mean age of 65 years. Median time after stroke onset to have cognitive assessment was 6 months. Ninety patients (50%) had VMCI. VAD was diagnosed in 49 patients (27%). Mean Thai version of mental state examination (TMSE) and MOCA scores in patients with VAD were 20 and 12, respectively. Multivariate analysis showed that older age (OR 4.994, 95%CI 1.602–15.565, p-value = 0.006), lower education (OR 10.306, 95%CI 3.162–33.586, p-value < 0.001), history of stroke (OR 4.959, 95%CI 1.036–23.741, p-value = 0.045) and moderate to severe cerebral white matter lesions (OR 5.555, 95%CI 1.710–18.041, p-value = 0.004) were associated with VAD. ApoE 4 allele was found in 25% of the patients, but the presence did not show any association with the increased risk of VAD. ConclusionsVAD occurred in 27% of the stroke patients. Older age, low education level, history of stroke, and the presence of moderate to severe white matter lesions were associated with the increased risk of VAD.

Obesity and diabetes are jointly associated with functional disability in stroke survivors

BackgroundStroke is the most common cause of complex disability. Obesity and diabetes increase risk for functional disability in the general population, but their contribution to functional disability in stroke survivors is unknown. ObjectiveTo investigate the joint association of obesity and diabetes with functional disability in stroke survivors. MethodsCross-sectional data from 34,376 stroke survivors from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys were examined. Weighted and age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for sociodemographic characteristics) with 95% confidence intervals (CIs) were calculated to compare prevalence and odds for self-reported functional disability, stratified by obesity-diabetes status (i.e., neither condition, obesity only, diabetes only, both conditions). ResultsPrevalence of functional disability increased across obesity-diabetes categories in the total sample: neither condition (45.4%, 95% CI: 43.4%–47.4%), obesity only (55.3%, 95% CI: 52.7%–58.0%), diabetes only (60.8%, 95% CI: 57.5%–64.1%), and both conditions (70.3%, 95% CI: 67.7%–72.9%). Compared to respondents with neither condition, those with both obesity and diabetes had 2.62 (95% CI: 2.23–3.08) higher odds for functional disability; odds were also increased for respondents with obesity only (1.52, 95% CI: 1.32–1.76) and diabetes only (1.71, CI: 1.45–2.01). ConclusionsOur findings indicated a joint effect of obesity and diabetes on functional disability that exceeded either condition alone, placing stroke survivors with both health conditions at greatest risk for diminished functional capacity. Recognizing obesity and diabetes as modifiable risk factors may be useful for identifying stroke sub-populations that could benefit from lifestyle intervention.

Alteration in ankle kinematics during uneven surface ambulation in stroke survivors: An exploratory observational study

BACKGROUND: Impaired walking ability is a common disability in stroke survivors and is a known risk factor of fall. Navigation of uneven terrain is essential for rural residents of regions in much of the developing world even for basic activities of daily living. AIMS: This is a preliminary exploratory study to evaluate kinematic gait parameters of the ankle joint in stroke survivors in comparison to typical adults. MATERIALS AND METHODS: Seven chronic adult stroke survivors and seven age-matched typical adults were recruited for the study. Measurement of ankle and subtalar joint kinematics at different events of the gait cycle was recorded and analyzed using a motion analyzing software, Kinovea 0.8.15. Settings and Design: This is a prospective pilot study. Statistical Analysis Used: Descriptive statistics. RESULTS: During different events of the gait cycle, a large difference in range of motion in ankle and subtalar joints was noticed between stroke survivors and typical participants on pebbles and sand. CONCLUSIONS: The impact of gait deviations on joint kinetics is a future direction that will inform rehabilitation professionals on strategies to prevent joint loading, leading to dysfunction. Early intervention strategies to improve joint kinematics on different surfaces can potentially reduce the risk of fall, making the patient safe to ambulate on uneven terrains.

Quality of Life and Disability in Stroke Survivors

Background: With advancing treatment of stroke patients, their mortality has decreased but morbidity and disability has increased. Hence, it becomes increasingly important to find the measures to improve these areas. The study aims to assess the quality of life (QOL) and disability in stroke survivors at least six months post stroke.&#x0D; Methods: Descriptive, cross sectional design was used to assess the QOL and disability in stroke patients attending Neuromedicine and Neurosurgery out-patient departments of Kathmandu Medical College. Data was collected purposively using interview from 155 respondents. QOL was assessed using Health Related Quality of Life in Stroke Patients (HRQOLISP-40) and disability was measured by using World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Analysis was done using Pearson’s correlation and Mann Whitney U test.&#x0D; Results: The QOL was found to be best in the ‘ecosocial’ and worst in the ‘soul’ domain. In disability, patients scored the best in ‘Getting along with people’ and ‘self-care’ domains and worst in the ‘life activities: school/ work’ domain. Respondents with hemorrhagic stroke, only one admission and those who did not exercise had better QOL. Patients with less than 10 years of formal education, those not earning and those with comorbidities had more disability. Correlation analysis showed better QOL with lesser age, higher monthly family income and higher Barthel index whereas higher disability was found in respondents with higher age and lower Barthel index.&#x0D; Conclusions: Disability in stroke patients needs to be addressed inorder to improve their QOL. The domains affected should be given attention during rehabilitation of stroke patients.

Hyponatremia as Parameter in Admission and Discharge Disability of Stroke Survivors, Babol, North of Iran

Hyponatremia as Parameter in Admission and Discharge Disability of Stroke Survivors, Babol, North of Iran

The Association between Stroke, Integrated Stroke Systems, and the Employability and Productivity of Canadian Stroke Survivors

Background: Integrated stroke systems have been associated with reduced disability in stroke survivors, but their impact on employability and productivity (hours worked/week and hourly wages) of stroke survivors is unclear. Methods: We used Canadian Community Health Surveys (2000–2014) to conduct a quasi-experimental study with the aim of determining the impact of stroke on employability and productivity, and whether the implementation of integrated stroke systems was associated with improvements in the employability and productivity of adult Canadian stroke survivors. Multivariable generalized Poisson regression models were used to determine the effect of stroke on employability; multivariable Heckman models were used to estimate the effect of stroke on productivity. A difference in differences analysis was used to determine the impact of stroke systems on the primary outcomes. Results: The study sample included 400,797 respondents, of whom 5,786 (1.4%) were stroke survivors. Compared to the general population, stroke survivors were less likely to be employed (adjusted incidence rate ratio 0.62, 95% CI 0.59–0.66) and earned an hourly wage that was 5.3% lower (95% CI 1.1–9.3) and worked an average of 1.9 fewer hours per week (95% CI 0.9–2.9). Over the study period, the employability of stroke survivors improved but not productivity. After accounting for temporal changes in overall employment, there was no association between the implementation of integrated stroke systems and either employability or productivity. Conclusion: Employability of stroke survivors improved over the study period but remained lower than the general population, with no differences in provinces with and without integrated stroke systems.

Applying Framingham Risk Score 2008 to Predict the 10-Year Risk of Cardiovascular Disease in a Group of Office Workers in Hanoi, Vietnam

Applying Framingham Risk Score 2008 to Predict the 10-Year Risk of Cardiovascular Disease in a Group of Office Workers in Hanoi, Vietnam

Development of an EMG-Controlled Serious Game for Rehabilitation.

A majority of the seven million stroke survivors in the U.S. have hand impairments, adversely affecting performance of a variety of activities of daily living, because of the fundamental role of the hand in performing functional tasks. Disability in stroke survivors is largely attributable to damaged neuronal pathways, which result in inappropriate activation of muscles, a condition prevalent in distal upper extremity muscles following stroke. While conventional rehabilitation methods focus on the amplification of existing muscle activation, the effectiveness of therapy targeting the reorganization of pathological activation patterns is often unexplored. To encourage modulation of activation level and exploration of the activation workspace, we developed a novel platform for playing a serious game through electromyographic control. This system was evaluated by a group of neurologically intact subjects over multiple sessions held on different days. Subjects were assigned to one of two groups, training either with their non-dominant hand only (unilateral) or with both hands (bilateral). Both groups of subjects displayed improved performance in controlling the cursor with their non-dominant hand, with retention from one session to the next. The system holds promise for rehabilitation of control of muscle activation patterns.

Predictors of caregiver burden after stroke in Nigeria: Effect on psychosocial well-being.

Background:Family caregivers (CGs) are critical to the care and recovery of stroke survivors (SSs), particularly in the community. However, little is known about their psychosocial well-being, especially in developing countries. In this study, we assessed CG burden, psychiatric morbidity, quality of life (QoL), and predictors of burden.Materials and Methods:We recruited 150 dyads of CGs/SSs from two outpatient clinics in Nigeria. Data were collected through sociodemographic/clinical questionnaire, the Zarit caregiver burden interview, the World Health Organization QoL-BREF, and the Mini-International Neuropsychiatric Interview. Disability in SSs was graded with the Modified Rankin Scale.Results:Compared to CGs who were mostly females (86.7%) with a mean age of 42.8 (±12.6) years, SSs were older with a mean age of 61.6 (±12.5) years and were mainly males (62.7%). The mean CG burden score was 31.6 (±10.5) and eight in 10 CGs, 124 (82.7%) reported moderate-to-severe burden scores. Mental disorders in the form of depression and/or anxiety disorders were diagnosed in 26 (17.3%) CGs. Significant predictors of high-burden scores (P < 0.05) were incontinence in SSs, psychological symptoms in SS, worse poststroke disability, and performance of more CG tasks (B = 8.3, 4.5, 3.9, and 3.5, respectively). CGs QoL scores correlated negatively with burden scores, with medium-to-large effect sizes (r = −0.4–−0.6) across QoL spheres.Conclusion:In this study, psychosocial burden in CGs was indexed by various determinants and impacted QoL negatively. Given the integral role of CGs to the care of SSs in the community, mental health services, psychosocial support programs, and stratification based on known vulnerability factors seems viable options for intervention, assessment, and planning.

Complications as important predictors of disability in ischemic stroke

BackgroundStroke is the main cause of disability and death in many countries. The high incidence of disability in stroke survivors requires special attention to determine various predictive factors of disability. This study aimed to identify the various predictive factors of disability in ischemic stroke.MethodsThis study was a cross sectional study on 4510 ischemic stroke patients. Each patient’s data had been recorded in the electronic stroke registry of Bethesda Hospital. Ischemic stroke diagnosis was confirmed by brain CT scan, which was interpreted by a neurologist and a radiologist. Disability was assessed using the modified Rankin scale. Predictors of disability were assessed. Multiple logistic regression analysis was used to analyse the data. ResultsThe subjects were predominantly males, &gt;60 years of age, and suffered stroke for the first time. The incidence of disability was 31.5% (1420/4510). Multiple logistic regression analysis showed that the presence of complications (OR: 6.43; 95% CI: 4.74-8.73; p&lt;0.001), decreased level of consciousness (OR: 4.82; 95% CI: 3.95-5.90; p &lt;0.001), onset ³3 hours (OR: 1.93; 95% CI: 1.52-2.45; p&lt;0.001), recurrent stroke (OR: 1.63; 95% CI: 1.39-1.90; p&lt;0.001), and age &gt;60 years (OR: 1.55; 95% CI: 1.35-1.79; p&lt;0.001) were independent predictive factors of disability.ConclusionWe demonstrated that a substantial proportion of patients with ischemic stroke become disabled. And the presence of complications was the most predictive factor of disability in ischemic stroke.

IMPACT OF PRESSURE WORKLOAD EXERCISES ON FUNCTIONAL ACTIVITIES OF HEMIPLEGIC PATIENTS

OBJECTIVES Stroke is the progressive neurological disorder with the global prevalence of around 2.67%. Many patients with hemiplegic stroke encounter mobility restriction, particularly having difficulty with independent walking. Pressure Workload exercises will help to improve active daily living (ADLs), balance problems and muscular weakness in stroke patients. The present study aims to identify the effects of pressure workload exercises on reducing functional limitations and disability in stroke survivors. METHOD A Randomized control trial (RCT) was conducted on sixty (60) patients recruited from the outpatient departments of different hospitals in Karachi. The patients were randomly assigned in one of the two groups after making the initial assessment on Barthel index. Control group received conventional physiotherapy treatment including active or active assisted range of motion exercises, stretching of upper and lower limbs, weight bearing and balancing exercises whereas the experimental group received pressure workload exercises of upper and lower limbs and 20 minutes gait training. RESULTS Pressure workload exercise significantly improves functional activities and quality of life (QoL) of hemiplegic patients (p&lt;0.05).

Identification of the components associated with functioning using the international classification of functioning, disability and health comprehensive core set for stroke in Indian stroke survivors

Objectives: Rehabilitation interventions are expected to ensure best possible recovery and minimize functional disability in stroke survivors. However, not many studies have investigated patterns of recovery and outcomes after stroke in low-income countries. The objective of this study is to identify the biological, psychological, and social components associated with functioning over time in Indian stroke patients using the International Classification of Functioning, Disability and Health (ICF)-based tools and the Functional Independence Measure (FIM).Methods: The functioning profile of stroke survivors who received a standard multi-disciplinary rehabilitation was prospectively assessed using the ICF and the FIM at admission (baseline), at 12 & 24 weeks. Descriptive analyses were performed to identify changes in the frequencies of ICF categories and qualifiers from admission to follow-up.Results: One hundred and twenty-seven participants (mean age of 56 years) with mean FIM score 68 at baseline participated and completed the study. The mean FIM score at follow-up was 108. The numbers and frequency of ICF categories for activities and participation reduced after rehabilitation. More numbers of environmental factors were identified as barriers at follow-up (15 out of 33) compared to baseline. Within the components of Activities and Participation, significant improvement in functioning was found in 43 out of 51 categories.Conclusion: The results show a reduction in frequencies in ICF activities and participation categories corresponding to basic activities of daily living. Categories corresponding to employment and social integration showed little or no improvement.

Post-stroke disability and its predictors among Nigerian stroke survivors

BackgroundDespite stroke is a major cause of disability, the predictors of the disability among stroke survivors has not been sufficiently delineated. ObjectiveTo assess post-stroke disability and determine its predictors among Nigerian stroke survivors. MethodsThis study involved 121 consecutive stroke survivors with at least 3 months of stroke from two tertiary health institutions in South-Western Nigeria. The World Health Organization Disability Assessment Schedule was used to assess their disability. Socio-demographic and clinical variables were obtained through interview and from their hospital records respectively. Poisson regression was used to examine the predictors. ResultsModerate disability level (44.1 ± 20.5) was observed among the participants. Prevalence of post-stroke disability was high in nine items with scores ranged between 62.0% and 90.1%. There was moderate prevalence of post-stroke disability in 3 items (44.6%–52.1%). When adjusted for sex, prevalence of post-stroke disability followed the same pattern. Being a male and having the affectation of dominant right limbs had 1.08 and 1.46 more likelihood of having disability while being gainfully employed after stroke had 0.81 less likelihood of having disability. Every additional unit of diastolic blood pressure and stroke duration were associated with estimated 0.4% and 0.2% less disability while every one year increased in age was associated with 0.5% increase in disability. ConclusionDisability in stroke survivors is determined by having right dominant limb affected, increase in blood pressure, longer stroke duration, increase in age and being a male. However, disability in stroke survivors decreases with the stroke survivors engaging in productive lifestyle.