Post-stroke Disability Research Articles

Assessing the effect of using biomechanics visualisation software for ankle-foot orthosis tuning in early stroke

Gait dysfunction is the most commonly reported post-stroke disability [1]. One of the interventions that can assist with stroke gait rehabilitation is an ankle-foot orthosis (AFO) [2]. When an AFO has been made a fitting and tuning session (AFO-F/T) is required to ensure it is optimally aligned for the patient in question using different heights of heel wedge. This causes subtle biomechanical changes in the gait patterns in terms of ground reaction force vector alignment and lower limb segment orientation [3], which are not necessarily perceptible to the naked eye. While 3D gait analysis can offer a method of measuring such changes, it is also thought to be somewhat inaccessible [4]. The hypothesis is that bespoke biomechanics visualisation software to make 3D gait analysis data more interpretable (see Figure 1 for sample visualisations), and would improve the process of AFO tuning for stroke patients to provide better patient outcomes.

Perispinal etanercept for post-stroke neurological and cognitive dysfunction: scientific rationale and current evidence.

There is increasing recognition of the involvement of the immune signaling molecule, tumor necrosis factor (TNF), in the pathophysiology of stroke and chronic brain dysfunction. TNF plays an important role both in modulating synaptic function and in the pathogenesis of neuropathic pain. Etanercept is a recombinant therapeutic that neutralizes pathologic levels of TNF. Brain imaging has demonstrated chronic intracerebral microglial activation and neuroinflammation following stroke and other forms of acute brain injury. Activated microglia release TNF, which mediates neurotoxicity in the stroke penumbra. Recent observational studies have reported rapid and sustained improvement in chronic post-stroke neurological and cognitive dysfunction following perispinal administration of etanercept. The biological plausibility of these results is supported by independent evidence demonstrating reduction in cognitive dysfunction, neuropathic pain, and microglial activation following the use of etanercept, as well as multiple studies reporting improvement in stroke outcome and cognitive impairment following therapeutic strategies designed to inhibit TNF. The causal association between etanercept treatment and reduction in post-stroke disability satisfy all of the Bradford Hill Criteria: strength of the association; consistency; specificity; temporality; biological gradient; biological plausibility; coherence; experimental evidence; and analogy. Recognition that chronic microglial activation and pathologic TNF concentration are targets that may be therapeutically addressed for years following stroke and other forms of acute brain injury provides an exciting new direction for research and treatment.

Infection in long term care facility in the kingdom of Bahrain.

Infections in long term care facilities (LTCF) are common and are considered a major cause of mortality and morbidity. Endemic infections and outbreaks are observed in LTCF. Of particular concern is the growth of multi-drug resistant organisms. A study was conducted in the Kingdom of Bahrain concerning infections among the residents in a LTCF. The aim was to define the rate, type and outcomes of institutional infections. The different treatment modalities and antimicrobials used were evaluated. Our facility cares for the elderly and a heterogeneous group of patients from different populations (e.g., mentally retarded, bedbound due to various disabilities and other forms of consciousness impairment such as post stroke disability, cerebral palsy and anoxic brain damage). The initial span of six months was changed to seven months to increase the sample size and improve the data analysis. This was a prospective study conducted in Muharaq Geriatric Hospital in the Kingdom of Bahrain. The study was conducted over seven months from January 2013 to July 2013 on 104 patients. During that period, patients with new positive cultures from different sites were included. The clinical features, microbiological features and outcomes of the bacteremic episodes were included. The information was collected by a questionnaire created by the research team. From a total of 104 patients staying in the LTFC, 19 had positive cultures from different sites at different times. The study showed that infections are common, especially urinary tract infections.

The association between socioeconomic status and disability after stroke: Findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry

BackgroundStroke is the leading cause of disability among adults in the United States. The association of patients’ pre-event socioeconomic status (SES) with post-stroke disability is not well understood. We examined the association of three indicators of SES—educational attainment, working status, and perceived adequacy of household income—with disability 3-months following an acute ischemic stroke.MethodsWe conducted retrospective analyses of a prospective cohort of 1965 ischemic stroke patients who survived to 3 months in the Adherence eValuation After Ischemic stroke – Longitudinal (AVAIL) study. Multivariable logistic regression was used to examine the relationship of level of education, pre-stroke work status, and perceived adequacy of household income with disability (defined as a modified Rankin Scale of 3–5 indicating activities of daily living limitations or constant care required).ResultsOverall, 58% of AVAIL stroke patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. After adjusting for demographic and clinical factors, stroke survivors who were unemployed or homemakers, disabled and not-working, retired, less educated, or reported to have inadequate income prior to their stroke had a significantly higher odds of post-stroke disability.ConclusionsIn this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke. The results may have implications for public health and health service interventions targeting stroke survivors at risk of poor outcomes.

Stroke Risk Factors, Course and Long-Term Functional Outcome of First-Ever Stroke in Women

BACKGROUND: Recently, many studies regarding stroke in men and women showing differences in its incidence and course have been conducted, but the cause of sex differences remains unclear.AIM: The objective of study was to assess the incidence of selected stroke risk factors, the course and long-term consequences of first-ever stroke in women.MATERIAL AND METHODS: 304 women and 207 men with first-ever stroke were studied. We assessed: age at which stroke occurred; presence of hypertension, lipid disorders, coronary disease, atrial fibrillation, diabetes, carotid/cerebral artery stenoses; stroke aetiology, state on days 1 (NIHSS) and 90 (Rankin).RESULTS: The age at which first-ever stroke occurred was higher in women (p = 0.030). Atrial fibrillation occurred more frequently in them (p = 0.0007). Hypertension and coronary disease occurred less commonly in women under 55 (p = 0.038 and 0.035 respectively). In women < 55, lipid disorders (p = 0.004) and diabetes (p = 0.018) were observed more rarely, they were more common in > 55 group (p = 0.042 and 0.023). In women, carotid artery stenoses were less common (p = 0.07), cardiogenic stroke more common (p = 0.001). They were in worse neurological state both on day 1 (p = 0.001) and 90 (p = 0.033) of disease.CONCLUSIONS: Cardiogenic stroke is significantly more common in women. Women exhibit more severe post-stroke disability, resulting in more frequent use of institutional care.

Stroke Risk Factors, Course and Long-Term Functional Outcome of First-Ever Stroke in Women

BACKGROUND: Recently, many studies regarding stroke in men and women showing differences in its incidence and course have been conducted, but the cause of sex differences remains unclear.AIM: The objective of study was to assess the incidence of selected stroke risk factors, the course and long-term consequences of first-ever stroke in women.MATERIAL AND METHODS: 304 women and 207 men with first-ever stroke were studied. We assessed: age at which stroke occurred; presence of hypertension, lipid disorders, coronary disease, atrial fibrillation, diabetes, carotid/cerebral artery stenoses; stroke aetiology, state on days 1 (NIHSS) and 90 (Rankin).RESULTS: The age at which first-ever stroke occurred was higher in women (p = 0.030). Atrial fibrillation occurred more frequently in them (p = 0.0007). Hypertension and coronary disease occurred less commonly in women under 55 (p = 0.038 and 0.035 respectively). In women 55 group (p = 0.042 and 0.023). In women, carotid artery stenoses were less common (p = 0.07), cardiogenic stroke more common (p = 0.001). They were in worse neurological state both on day 1 (p = 0.001) and 90 (p = 0.033) of disease.CONCLUSIONS: Cardiogenic stroke is significantly more common in women. Women exhibit more severe post-stroke disability, resulting in more frequent use of institutional care.

CP-037 Thrombolysis performed within three hours following stroke reduces disability and costs: an economic model to estimate savings

BackgroundStroke is the second leading cause of death and the leading cause of disability worldwide. In Italy, there are approximately 200,000 new cases each year, of which about 80% are...

Post stroke disposition from a Geriatric-Rehabilitative Stroke Care Area: an Italian experience

A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6), after stroke functional status (mRankin≥3), poor pre-stroke functional level (mRankin≥3) and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ‰¥3. Disposition to a skilled longterm ward of older patients with pre-stroke disability seemed positive on an economic ground but further studies are mandatory to understand the consequences in terms of functional recovery and social costs.

Quality indicators in acute stroke care: a prospective observational survey in 13 Italian regions

Quality monitoring has great relevance in stroke care. The Project "How to guarantee adherence to effective interventions in stroke care" aimed to estimate adherence to acute-phase guidelines in stroke care in Italy. A prospective observational study was performed in 27 hospitals of 13 Italian Regions. Adherence to 15 process indicators was evaluated, comparing also stroke units (SU) with conventional wards. An overall score of care, defined as the sum of achieved indicators, was calculated. A multilevel hierarchical model described performance at patient, hospital and regional level. Overall, 484 consecutive stroke patients (mean age, 73.4 years; 52.7 % males) were included. Total score ranged from 2 to 15 (mean 8.5 ± 2.4). SU patients were more often evaluated with the National Institutes of Health Stroke Scale (NIHSS) within 24 h, had more frequently an assessment of pre- and post-stroke disability, and a CT scan the same or the day after admission. Regional-hospital- and patient-level variability explained, respectively, 25, 34, and 41 % of total score variance. In multivariate models, patients >80 years vs. younger showed a change in total score of -0.45 (95 % CI -0.79 to -0.12), and those with NIHSS ≥14 vs. ≤5 of -0.92 (95 % CI -1.53 to -0.30). A negative change means a worse adjusted average adherence to process indicators. SU admission increased total score of 1.55 (95 % CI 0.52-2.58). Our data confirm the need of quality monitoring in stroke care. Although SU patients showed a better adherence to quality indicators, overall compliance was unsatisfactory.

Extending the Continuum of Care Poststroke

Opportunities for individuals poststroke to continue to exercise once formal rehabilitation has ended are limited and in many cases do not exist. Given the incidence of recurrent stroke, and the known and important role exercise plays in reducing stroke risk factors, extending the continuum of care beyond outpatient and home health services to include life-long fitness opportunities for those living with poststroke disability is needed. This article first describes the creation of a partnership between a health care system and a local fitness center to provide an affordable, accessible, safe, community-based exercise program for individuals poststroke and the subsequent development of the flagship program. The second section of this article describes the program's current operations. This includes the referral process, the physical therapists' role in the program's structure and operation, and both program and participant outcomes. This article is intended to provide a roadmap for others who desire to extend the continuum of care for stroke survivors in their community so that these individuals may remain healthy in the presence of disability and reduce their risk for recurrent stroke.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A47) for an overview of the Stroke Wellness Exercise Program.

Modern treatment strategies in patients with vascular comorbidity Part 1. Correcting tissue energy deficiency

The first paper of the series on the treatment of patients with vascular comorbidity (VC) is focused on the role and therapeutic potential of the correction of free radical processes (FRP) as pathogenetic factors of multifocal vascular pathology. Aim. To analyse the effects of VC on the incidence and outcomes of cerebral stroke (S), in order to create therapeutic algorithms of FRP correction. Material and methods. This prospective study included 634 S patients. The following factors were analysed: pre-stroke disability due to various VC variants; VC effects on the clinical course, as well as in-hospital and post-discharge outcomes; and FRP specifics in various VC variants. Results. VC was registered in 97% of S patients; in 45,3%, it resulted in pre-stroke disability. FRP parameters, reflecting the progression of tissue energy deficiency, differed significantly in patients with coronary heart disease, myocardial infarction, atrial fibrillation, and diabetes mellitus. Based on these findings, the therapeutic algorithms for effective energy deficiency correction have been created. Conclusion. The analysis of pre- and post-stroke disability and prevention of repeat events in cardiovascular patients has demonstrated the need for a more active implementation of modern multidisciplinary preventive programs.

Effects of Art Therapy Using Color on Purpose in Life in Patients with Stroke and Their Caregivers

PurposePatients with stroke suffer from physical disabilities, followed by mental instability. Their caregivers also suffer from mental instability. The present study attempted to address the degree and the change of the level of Purpose in Life (PIL) in patients with stroke and caregivers by applying art therapy using colors.Materials and MethodsTwenty-eight stroke patients with a good functional recovery or a moderate disability and their 28 caregivers were selected and evaluated. The period of the study between the stroke and color therapy was more than 6 months. Patients and caregivers were divided into the color therapy (28) and control groups (28). A questionnaire, which measures the level of PIL was conducted separately for patients and caregivers prior to the first session of color therapy (2 hours per week, total 16 sessions). The final examination was performed 5 months after the last color therapy session.ResultsThere was significant difference between before and after color therapy when the level of PIL was measured both in patients and caregivers (p<0.01). These were the same between the color therapy group, compared with the control group (p<0.01). As color therapy progressed to the late phase, patients and caregivers applied increasing number of colors and color intensity.ConclusionThese results prove that color therapy will improve PIL of the patients with post-stroke disability and caregivers. Furthermore, color therapy would be a useful adjuvant for improving the quality of life of the patients with stroke and their caregivers.

Poststroke fatigue following minor infarcts

To explore the potential relationship between fatigue following strokes and poststroke mood, cognitive dysfunction, disability, and infarct site and to determine the predictive factors in the development of poststroke fatigue (PSF) following minor infarcts. Ninety-nine functionally active patients aged less than 70 years with a first, nondisabling stroke (NIH Stroke Scale score ≤6 in acute phase and ≤3 after 6 months, modified Rankin Scale score ≤1 at 6 months) were assessed during the acute phase and then at 6 (T1) and 12 months (T2) after their stroke. Scores in the Fatigue Assessment Inventory were described and correlated to age, gender, neurologic and functional impairment, lesion site, mood scores, neuropsychological data, laboratory data, and quality of life at T1 and T2 using a multivariate logistic regression analysis in order to determine which variables recorded at T1 best predicted fatigue at T2. As many as 30.5% of the patients at T1 and 34.7% at T2 (11.6% new cases between T1 and T2) reported fatigue. At both 6 and 12 months, there was a significant association between fatigue and a reduction in professional activity. Attentional-executive impairment, depression, and anxiety levels remained associated with PSF throughout this time period, underlining the critical role of these variables in the genesis of PSF. There was no significant association between the lesion site and PSF. This study suggests that attentional and executive impairment, as well as depression and anxiety, may play a critical role in the development of PSF.

Cognitive impairment in lacunar strokes: the SPS3 trial.

Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. All English-speaking participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (National Clinical Trial 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z scores using published norms. Those with impairment (z ≤ -1.5) in memory and/or nonmemory domains were classified as having mild cognitive impairment (MCI). Among the 1,636 participants, average z scores on all tests were < 0, with the largest deficits seen on tests of episodic memory (range of means, -0.65 to -0.92), verbal fluency (mean, -0.89), and motor dexterity (mean, -2.5). Forty-seven percent were classified as having MCI (36% amnestic, 37% amnestic multidomain, 28% nonamnestic). Of those with modified Rankin score 0-1 and Barthel score = 100, 41% had MCI. Younger age (odds ratio [OR] per 10-year increase, 0.87), male sex (OR, 1.3), less education (OR, 0.13-0.66 for higher education levels compared to 0-4 years education), poststroke disability (OR, 1.4), and impaired activities of daily living (OR, 1.8) were independently associated with MCI. In this large, well-characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.

Growing Burden of Stroke in Pakistan: A Review of Progress and Limitations

Stroke rates in middle-aged people are five to ten times higher in Pakistan, India, Russia, China, and Brazil, compared with the United Kingdom or United States. South Asia is home to 20% of the world's population and has one of the highest burdens of cardiovascular disease in the world. With an aging population, there is an expected increase in the number of stroke cases and a corresponding increase in the burden of stroke in developing countries including South Asian countries like Pakistan. Limited data from prior studies in developing countries indicate that stroke epidemiology differs between these and Western countries. These differences include a higher incidence of stroke at younger ages, a higher prevalence of hemorrhagic stroke, and higher age-specific prevalence rates of stroke in women. The reasons for these differences in stroke epidemiology in developing countries are not clear. This may be explained by higher prevalence of established stroke risk factors, or potential nontraditional risk factors such as water pipe smoking, use of daldaghee or naswaar, and paan chewing; hepatitis and rheumatic heart disease may also contribute to these differences. Acute and long-term stroke treatment has shown limited progress in Pakistan like other developing countries because of poor awareness of patients and general physician on stroke symptomatology, management of stroke risk factors, lack of specialized stroke units in the country, very low utilization of thrombolytic therapy because of financial constraints and, above all, poor knowledge of physicians on the role of rehabilitation and its different aspects in the management of post stroke disability.

Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial

Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community. A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months. The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support successful translation of acupuncture therapy for post-stroke hemiplegic patients in community hospital use. This trial was registered in Chinese Clinical Trial Registry with the registration number ChiCTR-TRC-11001347.

Abstract 90: Socioeconomic Status Is Associated With Disability Following Acute Ischemic Stroke: Findings From The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry

Background: Socioeconomic status (SES) is widely recognized as an area of inequity that affects health outcomes. However, social determinants of health are less frequently measured in longitudinal studies of acute stroke patients. The relationship of SES on disability 3-months post-stroke is unknown. Methods: We analyzed ischemic stroke patients in the AVAIL registry who were enrolled at 98 hospitals participating in Get With The Guidelines-Stroke. Patients who died (n=64) or did not complete a modified Rankin Scale (mRS) at 3-months (n=154) were excluded. Multivariable logistic regression was used to examine the relationship of SES (defined by level of education, work status, and perceived adequacy of household income to meet needs) and disability (mRS scores 3-5). Results: Among the 2092 stroke patients who met eligibility criteria, the mean age was 65.5 ± 13.7, 44.2% were female, and 82.7% were White. Fifty seven percent had a high school or less education, 11.4% were not working post-stroke and were home not by choice, and 25.7% were without an adequate household income. A third of the sample had some level of disability at 3-months (34.6% mRS 3-5). Those with disability were more likely to be older, non-White, female, single, less educated, have inadequate income, and were home not by choice. In the multivariable analysis, lower education, inadequate income, and being home but not by choice (compared with those who returned to work) were independently associated with disability (p&lt;0.01; Table ). Conclusion: In this national cohort of stroke survivors, socioeconomic status as measured by level of education, work status, and income were independently associated with post-stroke disability.

The Rankin Scale with Revised Structured Interview: Effect on Reliability, Grading of Disability and Detection of Dementia

The widely used Rankin Scale (1) has three limitations: lack of precise criteria defining each stage, moderate reliability, and low ability to detect disability suggestive of dementia. We produced a study using Rankin Scale with a revised structured interview (2,3) and examined its effect on: • disability rating • ability to detect impaired Instrumental Activities of Daily Living (IADL) characteristic of dementia, and • reliability. Our study was performed in 70 patients (mean age: 64 15·5; Sex male: 37/70; infarct: n = 60) at the poststroke follow-up visit (interval: 185 100 days) in Amiens University Hospital and Beauvais General Hospital. Two of five examiners graded the Rankin Scale rated: • conventionally, • following Barthel Index, and • using the revised structured interview. Retest was performed in a sub-group of 36 randomized patients by telephone interview (42.8 39 days after the faceto-face assessment). Finally, the rela tionship with impairment of IADL and MiniMental Status Examination (MMSE) (4) was examined. The disability rating increased after assessment by Barthel Index (P = 0·03) and further increased after structured interview (P = 0·0001). This was because of the increased detection of disability in 18/46 patients initially rated as Rankin 0 (n = 10), 1 (n = 21), or 2 (n = 15). The structured interview accurately detected the 28 patients with impaired 4IADL and the 22 patients with both MMSE and IADL impairment as all of them had a Rankin score 3 (sensitivity = 1,both).Conversely,sensitivity was lower (P = 0·001, both) for both other ratings (sensitivity of conventional and post-Barthel ratings: 0·75 and 0·786, respectively). Retest by telephone interview showed overall good to excellent agreement with higher Kappa values using structured interview (conventional procedure: kw = 0·822; post-Barthel rating: kw = 0·844; structured interview: kw = 0·924). These results indicate that grading of the Rankin Scale based on structured interview provides more sensitive and reliable assessment of poststroke disability and might improve the diagnosis of poststroke dementia.

Developing an ICF core set for post-stroke disability assessment and verification in Taiwan: a preliminary study

Purpose: The purpose of this study was to develop an ICF core set for post-stroke disability assessment and verification of bio-psycho-social problems. Method: Using the Delphi method, a consensus process was conducted. In total, 24 multidisciplinary experts from different institutions completed the consensus process. The questionnaire for the study comprised 144 ICF second-level, stroke-relevant categories. A 5-point Likert-type scale was used by participants to weight the impact of each category on activities of daily life after a stroke. Consensus of ratings was assessed with Spearman’s rho and semi-interquartile range indices. The core set for post-stroke disability assessment and verification was developed from those categories with a mean score ≥4.0 found in the third round of the Delphi exercise. Results: The core set for post-stroke disability assessment and verification contained 51 categories. Of these, 18 categories were from the component body functions, one from body structures, 22 from activities and participation, and 10 from environmental factors. The mean (standard deviation) Spearman’s rho was 0.72 (0.14), and Cronbach’s α was 0.98. Conclusions: The preliminary core set for post-stroke disability assessment and verification can offer comprehensive information on the performance of daily-life activities of chronic stroke survivors. Further validation is required.Implications for RehabilitationTo identify stroke patients with permanent difficulties in Taiwan, the ICF core set for post-stroke disability assessment and verification (PSDV) focused on chronic stroke survivors in the community.The PSDV core set which is closely linked to the Barthel Index and Functional Independence Measure can offer comprehensive information on activities of daily living in stroke patients in Taiwan.With the PSDV core set, stroke patients with hemineglect or dysphagia can be assessed.

Model of Disablement and Recovery: Knowledge Translation in Rehabilitation Research and Practice

Disablement is a multifactorial and complex process that creates a challenge for both the rehabilitation researcher and the clinical practitioner; however, each seeks to improve quality health outcomes for the adult or child with disability. Knowledge translation (KT) is an approach to evidence-based medicine where various evidence sources are aggregated so that clinical decisions regarding intervention selection and dosing result in beneficial care for an individual. Structural equation modeling was used to test a theoretical model of disablement based on the impairment, activity, and participation categories of the International Classification of Functioning, Disability and Health (ICF) level of functioning. Using available cohort data from a randomized controlled trial of people with poststroke walking disability, exploratory and confirmatory factor analysis revealed that the latent variables-impairment and activity-are separate disablement constructs that limit participation for a person with disability. Path analysis revealed that the direct effect of impairment on participation was not statistically significant; however, the indirect path from impairment to participation through activity was significant (indirect effect). The direct effect of activity on participation was significant. Model assumptions were tested with postintervention data from the same cohort. For people with disability after stroke, the probability that functional tasks could be performed with less effort was greater for those individuals who met or exceeded a physiologic walking threshold after a structured, progressive intervention provided by a physical therapist 6 months earlier. This article discusses how structural equation modeling can be used as a statistical method to explore the causal paths from disability to ability. The knowledge inquiry and synthesis phases of the knowledge-to-action KT framework parallel the essential elements of structural equation modeling; knowledge is created that is theoretically driven, supported by prior research, and analyzed, refined, validated, and tailored to address real-world problems. Using a theoretical framework of disablement with clinical judgment and quantitative research methods, a clinically intuitive model of disablement was validated. The positive dimension is a model of recovery where causal paths lead from disablement to ablement. Innovative approaches in rehabilitation research design along with pragmatic application of research to practice are needed to improve today's health outcomes for people with disability.