Post-stroke Disability Research Articles

Cerebellar antibodies in post-stroke sera of acute ischemic stroke patients

<p>Although serum anti-neuronal antibodies are found in acute ischemic stroke (AIS) patients, it is not completely clear whether they are already present before the cerebrovascular event or emerge thereafter.&nbsp;</p>. <p>Sera of 21 consecutive first-ever AIS patients were collected within the first day of AIS (baseline), as well as 1 and 6 months after AIS. Well-characterized and novel anti-neuronal antibodies were investigated by cell-based assays, immunoblotting and indirect immunohistochemistry.</p>. <p>None of the AIS sera collected at different time points showed well-characterized antibodies. In 7 patients, 1- and 6-month sera (but not baseline sera) showed IgG mostly reacting with soma and dendrites of cerebellar Purkinje cells. Antibody-positive patients did not differ in terms of clinical and etiological features.</p>. <p>Our results provide evidence for the antibody-triggering action of AIS. Although anti-cerebellar antibodies are not associated with the severity of stroke, they may potentially contribute to chronic post-stroke complications and disability.</p>.

Clinical Profile And Risk Factors Of Stroke: A Comparative Analytical Study Between Young And Old Onset

Background: With ever-increasing incidence, young-onset stroke is responsible for significant psychosocial and economic burden, primarily due to post-stroke disability in the productive population. Objective: The aim of our study is to assess the profile and risk factors in young-onset stroke compared to those in older patients. Methods: This was a retrospective cross-sectional study. We included all patients with acute stroke, or transient ischemic attack (TIA) treated at Siloam Lippo Village Hospital between October 2021 and February 2022. An independent t-test was conducted for continuous variables with normal distribution and a Mann-Whitney U test for ordinal or continuous variables with non-normal distribution. Pearson's chi-square test was performed for categorical variables. Results: 153 patients with acute stroke and TIA were included. On univariate analysis comparing young and old-onset strokes, significant differences were found in diagnosis (p=0.039), Bamford classification (p=0.022), NIHSS (p=0.014), history of smoking (p=0.012), previous stroke (p=0.045), history of coronary artery disease (p=0.026), and routine antiplatelet use (p=0.018). Conclusion: We found a predominance of hemorrhagic stroke and TIA in the young-onset group, with more common involvement of the anterior circulation. Older onset was associated with a higher NIHSS score. Modifiable risk factors are more common in young-onset stroke, while non-modifiable risk factors are more common in the older population. However, hypertension remains an equally important risk factor in both groups. Our study provides an overview of the profile and risk factors for young-onset stroke. The information obtained can be useful as educational material for the community to prevent young-onset stroke.

Application of structural equation modeling to determine factors influencing cognitive impairment, depression, and fatigue among stroke survivors

This study explored the causal relationships between independent factors (individual factors, stroke characteristics) and post-stroke mental health issues through physiological and behavioral mediating factors. The study design is cross-sectional with a total of 162 stroke survivors treated at Vietnam's National Geriatric Hospital between June and December, 2021. We performed structural equation modeling analysis to calculate the standardization coefficient and correlation coefficient for our hypothesis. The structural model and standardized path coefficients had a goodness-of-fit indexes of Root-MeanSquare Error of Approximation (RMSEA) of 0.089, a comparative fit index (CFI) of 0.997, a Tucker-Lewis Index (TLI) of 0.954, and a standardized root mean-square residual (SRMR) of 0.019. Sleep disorder was positively associated with increasing post-stroke depression (Coef: 4.723; p&lt;0.001) and fatigue status (Coef: 3.846; p&lt;0.001). By contrast, alcohol use disorder was found as a factor that decreased fatigue status (Coef:-4.460; p = 0.005). Furthermore, post-stroke disability severity was significantly related to cognitive impairment (Coef: -3.229; p&lt;0.001), depression (Coef: 1.559; p&lt;0.001), and fatigue (Coef: 1.701; p = 0.002). The severity of post-stroke disability was associated with increasing cognition and mental health problems. Alcohol consumption and sleeplessness were found to be mediating effects between gender and age of stroke patients with changes in post-stroke depression and fatigue.

Pilot RCT Examining Satisfaction and Disability Outcomes of a Technology-Supported Self-Management Intervention in Post-Stroke Individuals

<h3>Research Objectives</h3> To evaluate the participant satisfaction and the preliminary efficacy of a technology-supported self-management intervention to improve post-stroke disability outcomes. <h3>Design</h3> 12-week, two-arm randomized controlled trial. <h3>Setting</h3> Community. <h3>Participants</h3> Twenty-four participants (intervention = 11; control = 13) with mild to moderate stroke (mean age = 59.4 years [SD = 11.7], male = 58%, black = 38%). <h3>Interventions</h3> Intervention group received the interactive Self-Management Augmented Rehabilitation Technologies (iSMART). It is an adjunctive behavioral intervention technology composed of skills training, coaching, and text messaging for improved self-management of chronic conditions and participation strategies. Control group received stroke education materials and phone calls over the 12-week. <h3>Main Outcome Measures</h3> Satisfaction was measured by the Client Satisfaction Questionnaire (CSQ), and the Healing Encounters & Attitudes Lists – Health Care Environment (HEAL-HCE), Patient-Provider Connection (HEAL-PPC) and Treatment Expectancy (HEAL-TEX). Disability outcomes were measured by the Patient Health Questionnaire-9 (PHQ-9), Stroke Impact Scale (SIS), Activity Card Sort (ACS), and Reintegration to Normal Living Index (RNL). <h3>Results</h3> Two iSMART participants withdrew from the study. The iSMART group reported greater satisfaction than the control group (CSQ: d = 0.387; HEAL-HCE: d = 0.454; HEAL-PPC: d = 0.374; HEAL – TEX: d = 0.328). The iSMART group exhibited moderate but the control group exhibited small effects on SIS's mobility (iSMART: d = 0.521, control: d = 0.069), hand function (d = 0.699, d = 0.222), and recovery (d = 0.545, d = 0.171), and RNL (d = 0.652, d = 0.272) scores. Both groups exhibited small effects on other scores. <h3>Conclusions</h3> The iSMART participants reported higher participant satisfaction and greater treatment effects than the control participants, suggesting that the iSMART may hold promise for post-stroke self-management. <h3>Author(s) Disclosures</h3> None disclosed.

Impact of the Alberta Stroke Program CT Score subregions on long-term functional outcomes in acute ischemic stroke: Results from two multicenter studies in China

Abstract Background and Objectives The Alberta Stroke Program CT Score (ASPECTS) is a widely used rating system for assessing infarct extent and location. We aimed to investigate the prognostic value of ASPECTS subregions’ involvement in the long-term functional outcomes of acute ischemic stroke (AIS). Materials and Methods Consecutive patients with AIS and anterior circulation large-vessel stenosis and occlusion between January 2019 and December 2020 were included. The ASPECTS score and subregion involvement for each patient was assessed using posttreatment magnetic resonance diffusion-weighted imaging. Univariate and multivariable regression analyses were conducted to identify subregions related to 3-month poor functional outcome (modified Rankin Scale scores, 3–6) in the reperfusion and medical therapy cohorts, respectively. In addition, prognostic efficiency between the region-based ASPECTS and ASPECTS score methods were compared using receiver operating characteristic curves and DeLong’s test. Results A total of 365 patients (median age, 64 years; 70% men) were included, of whom 169 had poor outcomes. In the reperfusion therapy cohort, multivariable regression analyses revealed that the involvement of the left M4 cortical region in left-hemisphere stroke (adjusted odds ratio [aOR] 5.39, 95% confidence interval [CI] 1.53–19.02) and the involvement of the right M3 cortical region in right-hemisphere stroke (aOR 4.21, 95% CI 1.05–16.78) were independently associated with poor functional outcomes. In the medical therapy cohort, left-hemisphere stroke with left M5 cortical region (aOR 2.87, 95% CI 1.08–7.59) and caudate nucleus (aOR 3.14, 95% CI 1.00–9.85) involved and right-hemisphere stroke with right M3 cortical region (aOR 4.15, 95% CI 1.29–8.18) and internal capsule (aOR 3.94, 95% CI 1.22–12.78) affected were related to the increased risks of poststroke disability. In addition, region-based ASPECTS significantly improved the prognostic efficiency compared with the conventional ASPECTS score method. Conclusion The involvement of specific ASPECTS subregions depending on the affected hemisphere was associated with worse functional outcomes 3 months after stroke, and the critical subregion distribution varied by clinical management. Therefore, region-based ASPECTS could provide additional value in guiding individual decision making and neurological recovery in patients with AIS.

The Experience of Nurses in the Implementation of discharge planning for post-stroke

The Implementation of discharge planning (DP) for stroke patients is very important because of the phenomenon that stroke can cause disability and last for a long time. This study describes the outcome with proper treatment of post-stroke disability can be minimized. The data analyzed in this study is the relationship between family knowledge about stroke to the family readiness in accepting of housing stroke sufferers. The result is there is a significant relationship between family knowledge about stroke and family readiness in accepting of stroke sufferers. So it is important to do for preparing the family readiness by supporting the knowledge on about the next post stroke patient care at home. This study uses a qualitative method by a phenomenological approach through in-depth interviews to 10 nurses in the Stroke Unit. The results of this study through data analysis, obtain 14 themes. Of these fourteen themes, two core themes were obtain discharge planning is the duty and responsibility of nurses and discharge planning helps simplify the treatment process.

Abstract 10210: Citalopram, but Not Fluoxetine May Improve Post-Stroke Recovery

Introduction: Several studies evaluated the role of Selective Serotonin Reuptake Inhibitors (SSRIs) in several aspects of stroke recovery. However, the results of these studies were inconsistent. Hypothesis This study was conducted to assess the hypothesis that SSRIs improve post-stroke recovery. Methods: In this systematic review and meta-analysis, we searched the following databases: PubMed, Cochrane, Scopus and Google Scholar. The studies were included if they were placebo-controlled trials in design and reported SSRIs effects on post-stroke depression, anxiety, disability, dependence, motor abilities and cognitive functions. Results: The search yielded 44 articles that included 16,164 patients and about half of the participants were treated with SSRIs. Our results showed that SSRIs had significant effect on preventing depression (Figure 1: Weighted Mean Difference (WMD)=-7.05; 95%CI: -11.78- -2.31), treating depression (Figure 1; WMD=-1.45; 95%CI: -2.77- -0.14), anxiety (Figure 1: Relative Risk (RR)=0.23; 95%CI: 0.09-0.61), dependence (Figure 1: WMD=8.86; 95%CI:1.23-16.48), motor abilities (Figure 1: WMD=-0.79; 95%CI: -1.42- -0.15) and cognitive functions (Figure 1: WMD=1.00; 95%CI: 0.12-1.89). On the other hand, no significant effect of SSRI on disability was observed. Additionally, we found that treating with SSRIs increased the risk of seizures (RR=1.44; 95%CI:1.13-1.83). Conclusion: Our study showed that SSRIs are effective in preventing and treating depression, improving anxiety, motor function, cognitive function and dependence in post-stroke patients. These benefits were only reproducible with the citalopram sub-analysis but not fluoxetine; further well-conducted placebo-controlled trials are needed to investigate the safety and efficacy of citalopram among post-stroke patients.

Greenspace exposure and poststroke disability: A nationwide longitudinal study

IntroductionExposure to greenspace has been reported to reduce stroke mortality, but there is a lack of evidence regarding poststroke disability. This study aimed to investigate the association between long-term greenspace exposure and the risk of poststroke disability. MethodsBased on the China National Stroke Screening Survey from 2013 to 2019, a total of 65,892 visits from 28,085 stroke survivors with ≥ 2 visits were included in this longitudinal study. Long-term greenspace exposure was assessed by a 3-year average of the Normalized Difference Vegetation Index (NDVI) and the proportion of green land cover according to participants’ residential communities. Poststroke functional status was assessed with the modified Ranking Score (mRS) at each visit; a cutoff score > 2 indicated disability. Fixed effects regressions were used to examine the association of greenspace exposure with continuous mRS scores or binary indicators for disability. ResultsThe annual mean NDVI value was 0.369 (standard deviation = 0.120) for all visits among stroke survivors. With full adjustments, each 0.05 increase in NDVI was associated with a 0.056-unit (95 % confidence interval (CI): 0.034, 0.079) decrease in the mRS score and a 46.6 % (95 % CI: 10.0 %, 68.3 %) lower risk of poststroke disability. An L-shaped curve was observed for the nonlinear associations between NDVI and mRS score or disability. Additionally, each 1 % increase in grasslands, savannas, forest, and croplands was associated with 0.008- (95 % CI: 0.002, 0.014), 0.003- (95 % CI: 0.001, 0.005), 0.001- (95 % CI: −0.015, 0.018), and 0.002-unit (95 % CI: −0.003, 0.007) decreases in the mRS score, respectively. ConclusionsIncreasing greenspace was inversely associated with mRS score. Greenspace planning can be a potential intervention to prevent poststroke disability.

October 2022 Stroke Highlights.

October 2022 Stroke Highlights.

Assessment of risk factors of Depression in the post-stroke phase of the stroke survivor patients: A cross-sectional study

Depression and mood changes are important complications of a stroke. A total of 30% of stroke survivors potentially develop depression, sooner or later. Despite its effect on the quality of life of the patient as well as functional recovery, it is often neglected resulting in a lack of treatment. However, regular antidepressant drugs play no beneficial role in the treatment of PSD. Objective: The present study aim is to the establishment of prevalence and factors responsible for causing post-stroke depression. Methods: The participants included in the study previously had strokes according to the definition given by WHO. Modified Motor Assessment Scale (MMAS) and Depression Anxiety Stress Scale-21 (DASS-21) were administered. Socio-demographic data of all the patients was collected. The risk factors were the laterality of the stroke, duration of the post-stroke phase, functional impairment after the stroke, and gender of the patient. Results: A total of 62 participants were included in the study. A total of 38 (61.29%) of the patients were male and 24 (38.71%) were female. The mean age of the patients was 51.86±5.3 years with a range of 41 to 63 years. Assessment through DASS-21 showed that 46 (74.19%) patients were normal and 16 (25.81%) were detected with depression. The statistically significant risk factors behind post-stroke depression (PSD) were gender and stroke laterality. However, the assessment through MMAS scores shows no significant participation of post-stroke disability and post-stroke duration in PSD. Conclusion: PSD is an important complication followed by stroke. Stroke laterality and gender are significant risk factors for PSD

Modified Rankin scale assessment by telephone using a simple questionnaire

Purpose: The modified Rankin Scale (mRS) is widely used as a measure of post-stroke physical disability in clinical stroke trials; however, it is affected by inter-rater discrepancies. A Japanese version of the simplified mRS questionnaire (J-RASQ) has the potential to overcome the inter-rater discrepancies and might be feasible for clinical surveys. We aimed to determine the reliability of J-RASQ in a telephone survey administered by non-medical staff. Methods: We recruited 103 patients (age = 73 ± 11 years; 57% males) with a history of ischemic stroke who visited the outpatient clinic of the department of neurology at our hospital between March and May, 2021. After obtaining informed consent for participation in the study, a stroke neurologist assessed the mRS score during the visit using the Japanese version of mRS. On the same day, a clerk telephoned the patient or his/her family members to administer the J-RASQ. The percentage of agreement between mRS and J-RASQ scores was evaluated using the kappa coefficient and weighted kappa coefficient. Results: The median time for the telephone survey was 85 s (interquartile range = 70–135 s). The mRS and J-RASQ scores had an agreement of 63.1%, with a kappa statistic of 0.51 (95% confidence interval [CI] = 0.39–0.63). The weighted kappa statistic, which takes into account the extent of disagreement, was 0.81 (95% CI = 0.75–0.88). Conclusion: J-RASQ is easy to administer and reliable for assessment in telephone-based surveys performed by non-medical staff

Long-Term Exposure to Ozone Increases Neurological Disability after Stroke: Findings from a Nationwide Longitudinal Study in China.

Simple SummaryIn China, ozone is a major air pollutant that has been linked to stroke incidence and mortality. However, how long-term exposure to ozone affects the life quality among stroke survivors is unknown. This study presents a longitudinal analysis of nationwide data of Chinese adults, and shows that exposure to ozone can increase the risk of post-stroke disability. Taking ambient O3 under control can delay the progression of neurological disability among stroke survivors.Exposure to ozone (O3) is associated with stroke incidence and mortality. However, whether long-term exposure to O3 is associated with post-stroke neurological disability remains unknown. This study investigated the relationship based on the longitudinal analysis of China National Stroke Screening Survey (CNSSS), which included 65,778 records of stroke patients. All of the analyzed patients were followed-up at least twice. Stroke disability was assessed using the modified Rankin scale (mRS). Long-term exposure was assessed by the peak-season or annual mean of maximum 8-h O3 concentrations for 365 days before the mRS measurement. We used fixed-effect models to evaluate the associations between O3 and mRS score, with adjustment for multiple confounders, and found a 10 µg/m3 increase in peak-season O3 concentration was associated with a 0.0186 (95% confidence interval [CI] 0.0115–0.0256) increment in the mRS score. The association was robust in various subpopulations. For secondary outcomes, for each 10 µg/m3 increment in peak-season O3, the odds ratio of an increased mRS score (vs. unchanged or decreased mRS score) increased by 23% (95% CI 9–37%). A nonlinear analysis showed a sublinear association between O3 exposure and risk for post-stroke disability. A saturation effect was observed at an O3 concentration of more than ~120 μg/m3. Our study adds to evidence that long-term exposure to O3 increases the risk of neurological disability after stroke.

THE EFFECT OF SOMATOSENSORY INPUT BYAPPLICATION OF KINESIOTAPING OVER WRIST IN SUBACUTE AND CHRONIC STROKE PATIENTS

Background: Post-stroke motor function disability is a common complication in patients with stroke and a key contributor to impaired hand function after stroke: Cerebrovascular accident (CVA) is the second most frequent cause of death in the world. Nevertheless, most victims do survive and need treatment, and hand function is one that has to be dealt with in the rehabilitation process. Kinesio Taping (KT) is a bandaging method that can be applied along the muscle fibers to provide stimulation. Studies have shown its efficacy in providing afferent stimuli to weakened muscles, thus eliciting contraction with greater recruiting of motor units and inducing neuroplasticity. Objective: The purpose of this study was to investigate the effects of Kinesio taping on managing motor function of wrist motor performance in patients with sub-acute and chronic stroke. Method: An experimental comparative study design, 30 patients (mean age range40-66) with stroke and randomized 15patients in each group, Group A received conventional therapy and group B received kinesiotape with conventional therapy. Both groups were assessed in week o (before study) and week 5 (end of study) assessment measures were done using Fugl- Meyer scale and nine-hole peg test. Results: A total number of 30 patients were included in both the groups. 15 patients were put in Group A and B respectively. For Group A- treated with conventional therapy had undergone test on day 1(mean of pre-test readings) and after (mean of post-test reading) t=(p&lt;0.0001). For Group B Kinesiotaping of wrist along with Conventional therapy. Total no patients (-M, -F with mean age) had undergone test on day 1(mean of pre-test) and after (mean of post-test) t=(p&lt;0.0001). This study is to compare the Conventional therapy (mean=) and Conventional therapy with kinesiotaping of wrist (mean=) in chronic stroke Patients with two sample t-test for population mean with 5% level of significance. Conclusion: The effect of kinesiotaping along with conventional therapy is significantly better result as compare to conventional therapy on reducing spasticity and improving functional disability in patients with motor dysfunction.

The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study

ObjectiveDelirium, a common complication after stroke, is often overlooked, and long-term consequences are poorly understood. This study aims to explore whether delirium in the acute phase of stroke predicts cognitive and psychiatric symptoms three, 18 and 36 months later.MethodAs part of the Norwegian Cognitive Impairment After Stroke Study (Nor-COAST), 139 hospitalized stroke patients (49% women, mean (SD) age: 71.4 (13.4) years; mean (SD) National Institutes of Health Stroke Scale (NIHSS) 3.0 (4.0)) were screened for delirium with the Confusion Assessment Method (CAM). Global cognition was measured with the Montreal Cognitive Assessment (MoCA), while psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Data was analyzed using mixed-model linear regression, adjusting for age, gender, education, NIHSS score at baseline and premorbid dementia.ResultsThirteen patients met the criteria for delirium. Patients with delirium had lower MoCA scores compared to non-delirious patients, with the largest between-group difference found at 18 months (Mean (SE): 20.8 (1.4) versus (25.1 (0.4)). Delirium was associated with higher NPI-Q scores at 3 months (Mean (SE): 2.4 (0.6) versus 0.8 (0.1)), and higher HADS anxiety scores at 18 and 36 months, with the largest difference found at 36 months (Mean (SE): 6.2 (1.3) versus 2.2 (0.3)).ConclusionsSuffering a delirium in the acute phase of stroke predicted more cognitive and psychiatric symptoms at follow-up, compared to non-delirious patients. Preventing and treating delirium may be important for decreasing the burden of post-stroke disability.

EE483 The Economic Impact of Coronavirus Pandemic on Stroke Care: Direct and Indirect Costs Estimations in Chile

EE483 The Economic Impact of Coronavirus Pandemic on Stroke Care: Direct and Indirect Costs Estimations in Chile

Safety and Efficacy of SSRIs in Improving Poststroke Recovery: A Systematic Review and Meta-Analysis.

BackgroundSeveral studies investigated the role of selective serotonin reuptake inhibitors (SSRIs) in improving poststroke recovery; thus, we have decided to conduct this systematic review and meta‐analysis to investigate the efficacy and safety of SSRIs in poststroke recovery.Methods and ResultsIn this meta‐analysis we searched the following databases: PubMed, Cochrane, Scopus, and Google Scholar. The studies were included if they were placebo‐controlled trials in design and reported SSRIs’ effects on poststroke depression, anxiety, disability, dependence, motor abilities, and cognitive functions. The quality of the included studies was assessed using the revised Cochrane risk‐of‐bias tool for randomized trials. The search yielded 44 articles that included 16 164 patients, and about half of the participants were treated with SSRIs. Our results showed that SSRIs had a significant effect on preventing depression (weighted mean difference [WMD], −7.05 [95% CI, −11.78 to −2.31]), treating depression according to the Hamilton Rating Scale for Depression score (WMD, −1.45 [95% CI, −2.77 to −0.14]), anxiety (relative risk, 0.23 [95% CI, 0.09–0.61]), dependence (WMD, 8.86 [95% CI, 1.23–16.48]), motor abilities according to National Institutes of Health Stroke Scale score (WMD, −0.79 [95% CI, −1.42 to −0.15]), and cognitive functions (WMD, 1.00 [95% CI, 0.12–1.89]). On the other hand, no significant effect of SSRIs on disability was observed. Additionally, we found that treating with SSRIs increased the risk of seizures (relative risk, 1.44 [95% CI, 1.13–1.83]), whereas there was no difference in the incidence of gastrointestinal symptoms or bleeding between SSRIs and a placebo.ConclusionsOur study showed that SSRIs are effective in preventing and treating depression, and improving anxiety, motor function, cognitive function, and dependence in patients after stroke. These benefits were only reproducible with the citalopram subanalysis but not fluoxetine. Further well‐conducted placebo‐controlled trials are needed to investigate the safety and efficacy of citalopram among patients after stroke.RegistrationURL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021285766.

Diagnostic accuracy of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to estimate disability after stroke

Purpose To analyze WHODAS 2.0’s diagnostic capacity and accuracy in stroke survivors. Methods Cross-sectional methodological study, in which individuals with chronic stroke were evaluated. Disability was considered the outcome variable, being evaluated by WHODAS 2.0; the modified Rankin scale (mRS) was used as the parameter variable. Disability was categorized in two levels being: “No or mild disability” (mRS 0–2) and “Moderate to severe disability” (mRS 3–5). To identify the cutoff point, a Receiver-Operating Characteristic (ROC) curve was constructed with a confidence interval (CI) of 95% and considering sensitivity and specificity. Results The cutoff point >39.62 proved acceptable for distinguishing individuals with moderate/severe disability from individuals with no or mild disability (≤39.62 points), with 66.22% sensitivity, 72.41% specificity, positive predictive value (PPV) of 45.45%, and negative predictive value (NPV) of 84.74%. The area under the curve (AUC) was 0.747 (CI 95%: 0.65–0.83; p < 0.001). Conclusion WHODAS 2.0 demonstrated acceptable diagnostic capacity and the cutoff point of 39.62 proved suitable for distinguishing individuals with moderate/severe disability from those with no or mild disability after stroke. Implications for rehabilitation WHODAS 2.0 demonstrated acceptable diagnostic capacity. The WHODAS 2.0 cut-off point of >39.62 allows stratification of post-stroke disability into two different levels (no/mild disability versus moderate/severe disability). These results facilitate clinical decision-making by rehabilitation professionals.

Utility of an obstacle-crossing test to classify future fallers and non-fallers at hospital discharge after stroke: A pilot study

BackgroundExisting clinical assessments of balance and functional mobility have poor predictive accuracy for prospectively identifying post-stroke fallers, which may be due to a lack of ecological complexity that is typical of community-based fall incidents. Research questionDoes an obstacle-crossing test at hospital discharge predict fall status of ambulatory stroke survivors 3 months after discharge? MethodsAmbulatory stroke survivors being discharged home completed an obstacle-crossing test at hospital discharge. Falls were tracked prospectively for 3 months after discharge. Logistic regression examined the relationship between obstacle-crossing at discharge (pass/fail) and fall status (faller/non-faller) at 3 months post discharge. Results45 participants had discharge obstacle test and 3-month fall data. 21 (47 %) participants experienced at least one fall during follow-up, with 52 % of the falls occurring within the first month after discharge. Of the 21 fallers, 14 failed the obstacle-crossing test (67 % sensitivity). Among the 24 non-fallers, 20 passed the obstacle-crossing test (83 % specificity). The area under the receiver operating characteristic curve was 0.75 (95 % CI 0.60–0.90). Individuals who failed the obstacle-crossing test were 10.00 (95 % CI: 2.45–40.78) times more likely to fall in the first 3 months after discharge. The unadjusted logistic regression model correctly classified 76 % of the subjects. After adjusting for age, sex, days post stroke, and post-stroke disability, the odds ratio remained significant at 6.93 (95 % CI: 1.01–47.52) and correctly classified 79.5% of the participants. SignificanceThe obstacle-crossing test may be a useful discharge assessment to identify ambulatory stroke survivors being discharged home who are likely to fall in the first 3 months post discharge. Modifications to improve the obstacle-crossing test sensitivity should be explored further.

Association of Pre-stroke Frailty With Prognosis of Elderly Patients With Acute Cerebral Infarction: A Cohort Study.

BackgroundFrailty is a state of cumulative degradation of physiological functions that leads to adverse outcomes such as disability or mortality. Currently, there is still little understanding of the prognosis of pre-stroke frailty status with acute cerebral infarction in the elderly.ObjectiveWe investigated the association between pre-stroke frailty status, 28-day and 1-year survival outcomes, and functional recovery after acute cerebral infarction.MethodsClinical data were collected from 314 patients with acute cerebral infarction aged 65–99 years. A total of 261 patients completed follow-up in the survival cohort analysis and 215 patients in the functional recovery cohort analysis. Pre-stroke frailty status was assessed using the FRAIL score, the prognosis was assessed using the modified Rankin Scale (mRS), and disease severity using the National Institutes of Health Stroke Scale (NIHSS).ResultsFrailty was independently associated with 28-day mortality in the survival analysis cohort [hazard ratio (HR) = 4.30, 95% CI 1.35–13.67, p = 0.014]. However, frailty had no independent effect on 1-year mortality (HR = 1.47, 95% CI 0.78–2.79, p = 0.237), but it was independently associated with advanced age, the severity of cerebral infarction, and combined infection during hospitalization. Logistic regression analysis after adjusting for potential confounders in the functional recovery cohort revealed frailty, and the NIHSS score was significantly associated with post-stroke severe disability (mRS > 2) at 28 days [pre-frailty adjusted odds ratio (aOR): 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.002] or 1 year (pre-frailty aOR: 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.003).ConclusionsPre-stroke frailty is an independent risk factor for 28-day mortality and 28-day or 1-year severe disability. Age, the NIHSS score, and co-infection are likewise independent risk factors for 1-year mortality.

Association of acute kidney disease with the prognosis of ischemic stroke in the Third China National Stroke Registry

BackgroundAcute kidney disease (AKD) evolves a spectrum of acute and subacute kidney disease requiring a global strategy to address. The present study aimed to explore the impact of AKD on the prognosis of ischemic stroke.MethodsThe Third China National Stroke Registry (CNSR-III) was a nationwide registry of ischemic stroke or transient ischemic attack between August 2015 and March 2018. As a subgroup of CNSR-III, the patients who had serum creatinine (sCr) and serum cystatin C (sCysC) centrally tested on admission and at 3-month, and with 1-year follow-up data were enrolled. Modified AKD criteria were applied to identify patients with AKD during the first 3 months post stroke according to the guidelines developed by the Kidney Disease: Improving Global Outcomes in 2012. The primary clinical outcome was 1-year all-cause death, and secondary outcomes were stroke recurrence and post stroke disability.ResultsFive thousand sixty-five patients were recruited in the study. AKD was identified in 3.9%, 6.7%, 9.9% and 6.2% of the patients by using sCr, sCr-based estimated glomerular filtration rate (eGFRsCr), sCysC-based eGFR (eGFRsCysC), and combined sCr and sCysC-based eGFR (eGFRsCr+sCysC) criteria, respectively. AKD defined as sCr or eGFRsCr criteria significantly increased the risk of all-cause mortality (adjusted HR 2.67, 95% CI: 1.27–5.61; adjusted HR 2.19, 95% CI: 1.17–4.10) and post stroke disability (adjusted OR 1.60, 95% CI: 1.04–2.44; adjusted OR 1.51, 95% CI: 1.08–2.11). AKD diagnosed by eGFRsCysC or eGFRsCr+sCysC criteria had no significant impact on the risk of all-cause death and post stroke disability. AKD, defined by whichever criteria, was not associated with the risk of stroke recurrence in the adjusted model.ConclusionsAKD, diagnosed by sCr or eGFRsCr criteria, were independently associated with 1-year all-cause death and post stroke disability in Chinese ischemic stroke patients.