Rehabilitation Outcomes Of Stroke Patients Research Articles

The Stroke Self-Efficacy Questionnaire Brazil (SSEQ-B): a structural validity analysis

ABSTRACT Background Self-efficacy has been shown to play an important role in rehabilitation outcomes of stroke patients. The Stroke Self-Efficacy Questionnaire Brazil (SSEQ-B) is designed to assess self-efficacy of functional performance after stroke. Objective This research sought to address the structural validity of the SSEQ-B using exploratory and confirmatory factorial analyses. Methods This is a cross-sectional study. We performed a reliability assessment and structural validation of the SSEQ-B in 115 Brazilian stroke survivors living in Rio Grande do Sul or São Paulo. Results: Sample mean age was 62.7 ± 14.2 years. Internal consistency presents a Cronbach’s Alpha (αC) of 0.829. Exploratory factorial analysis using the scree plot method revealed a bifactorial structure, consisting of activity and self-management domains. While confirmatory factorial analysis suggested a trifactorial structure, the loading ranges between factors 1 and 3 were very similar, suggesting they could be collapsed – resulting in the same factors found in the scree plot analysis. Both structures with subscales showed good construct validity. Conclusion SSEQ-B is a valid and reliable measure of stroke self-efficacy. The preferred structure of the SSEQ-B is bifactorial and includes the domains activity and self-management.

Red Cell Distribution Width as a Predictor of Functional Outcome in Rehabilitation of Older Stroke Patients.

BackgroundRed cell distribution width (RDW) is a prognostic marker in vascular diseases. While increased RDW predicts mortality and outcomes after ischemic stroke, evidence regarding its prognostic significance in stroke rehabilitation is lacking. Thus, the present study investigated the relationship of RDW with stroke, orthopedic, and deconditioning rehabilitation outcomes.MethodsThis prospective comparative study included three groups (stroke, orthopedic, and deconditioning) of older adult patients hospitalized for rehabilitation. The patients in each group were divided into two subgroups according to whether they had high (>14.5%) or normal (≤14.5%) RDW levels on admission. Functional outcome was assessed by total and motor FIM (Functional Independence Measure) score changes and efficiency at admission and on discharge.ResultsOf the 234 eligible patients, 108 (46.2%) had high RDW. Of the 50 stroke rehabilitation patients, 13 (26%) had high RDW. FIM change and efficiency scores were significantly lower in patients with high RDW only in the stroke rehabilitation group. However, multiple linear regression analysis showed that high RDW was not independently associated with total and motor FIM gain or total and motor FIM efficiency.ConclusionHigh RDW levels on admission to rehabilitation were associated with poor rehabilitation outcome in stroke patients but were not an independent risk factor for rehabilitation outcomes.

Effects of "internet +" nursing intervention model on rehabilitation outcomes in stroke patients: a Meta-analysis

Objective To systematically assess the effects of internet + nursing intervention model on rehabilitation outcomes in stroke patients so as to provide an evidence-based basis for clinical nurses to carry out internet + nursing service new model in stroke patients. Methods Randomized controlled trials (RCTs) related on effects of internet + nursing intervention model on rehabilitation outcomes in stroke patients were retrieved in China Biological Medicine (CBM) , Chinese National Knowledge Infrastructure (CNKI) , WanFang Data, PubMed, Embase, Cochrane Central Register of Controlled Trials by computer from building database to May 2019. RevMan 5.3 was used to the systematic review for literatures meth the inclusion criteria. Results A total of six literatures were included involving 637 samples. Systematic review showed that internet + nursing intervention model could improve the motor function [MD=13.87, 95%CI (7.93, 19.81) , Z=4.57, P<0.01]and activity of daily living [MD=14.43, 95%CI (6.15, 22.71) , Z=3.41, P<0.01]of stroke patients during rehabilitation. Conclusions Internet + nursing intervention model provides a good channel for rehabilitation and health education for stroke patients after going back to family and community, helps stroke patients to improve motor function during rehabilitation and activity of daily living, but that still exhibits the problems needed to be perfected and solved by medical staff exerting themselves. Key words: Stroke; Rehabilitation; Internet +; Nursing intervention; Meta-analysis

EFFECT OF ROBOTIC TILT TABLE VERS US CONVENTIONAL EXERCIS ES ON REHABILITATION OUTCOME IN STROKE PATIENTS: A FOLLOW UP STUDY.

18Nov 2018 EFFECT OF ROBOTIC TILT TABLE VERSUS CONVENTIONAL EXERCISES ON REHABILITATION OUTCOME IN STROKE PATIENTS: A FOLLOW UP STUDY. Suraj Kumar , Ramakant Yadav and Aafreen. Associate Professor and Head, Department of Physiotherapy, UPUMS, Saifai, Etawah, UP, India. Professor and Head, Department of Neurology, UPUMS, Saifai, Etawah, UP, India. Senior Research Fellow, Department of Physiotherapy, UPUMS, Saifai, Etawah, UP, India.

Translation and validation study for the stroke self-efficacy questionnaire in stroke survivors.

Self-efficacy has been shown to play an important role in rehabilitation outcomes of stroke patients. This study aimed to determine the validity and reliability of a Turkish translation of the Stroke Self-Efficacy Questionnaire. This methodological study was conducted in a private acute stroke unit in Istanbul, Turkey. After obtaining the Institutional Review Board's approval and site consent, a translated version of the 13-item Likert-type scaled questions was tested for language and content validity. A pilot study with 10 patients was followed by recruitment of 130 stroke patient participants, with 50 patients retested after 3weeks. The Stroke Self-Efficacy Questionnaire-Turkish had excellent content validity index and face validity index scores. Confirmatory factor analysis findings revealed a single factor structure that offered good model suitability. Cronbach alpha was 0.93 for the scale and its subgroups. There was no statistically significant difference between the items according to test-retest scores (P>0.05), and a reliability index was over 0.80. The Turkish version of the Stroke Self-Efficacy Questionnaire is a valid and reliable tool, recommended for use in clinical rehabilitation and stroke self-management/self-efficacy interventions.

Rehabilitation outcomes of stroke patients with low left ventricular ejection fraction in the subacute rehabilitation phase

To examine the left ventricular ejection fraction in patients with subacute stroke and compare rehabilitation outcomes between those with decreased left ventricular ejection fraction and those without. Retrospective chart review. A total of 482 consecutive patients with stroke admitted to a convalescent rehabilitation hospital. Patients were assessed using transthoracic echocardiography within 7 days of admission. The patients were divided into a group with low left ventricular ejection fraction and a group with preserved left ventricular ejection fraction. Functional Independence Measure (FIM) scores at admission and discharge, FIM gain, FIM efficiency, and discharge disposition were compared between groups. The low left ventricular ejection fraction group had significantly lower cognitive and total FIM scores on admission than the preserved left ventricular ejection fraction group. The patients in the low left ventricular ejection fraction group tended to be transferred to acute hospitals more frequently. How-ever, the total score of discharge FIM, FIM gain, and FIM efficiency did not differ significantly between the groups when rehabilitation was continued until discharge. Stroke patients with low left ventricular ejection fraction in the subacute phase could achieve almost the same functional outcomes as those of patients with preserved left ventricular ejection fraction. Although the general medical condition should be considered, the finding of low left ventricular ejection fraction did not pose a barrier to successful rehabilitation after stroke.

Control system for neuro-prostheses integrating induced and volitional effort

To increase the rehabilitation outcomes of stroke patients with weak residual muscle activity, a novel control strategy for Functional Electrical Stimulation (FES) was designed and tested during a tracking task. The system includes an electromyography (EMG)-based feedback controller and a trial-to-trial adaptation of the FES support. The first modulates the stimulation intensity to achieve a desired amount of FES-evoked muscle activity corresponding to a desired FES-induced angular support trajectory. The second iteratively updates this trajectory in order to minimize the error between the target displayed to the patient and the measured angle trajectory. This support adaptation only takes place in case the subject actively contributes to the movement. If the estimated volitional effort is too low, FES support is quickly withdrawn to remind the subject to actively contribute to the tracking task. The EMG signal of the stimulated muscle is used to estimate both the FES-induced and the volitional muscle activity. The feasibility of the proposed control scheme was experimentally investigated in one healthy subject by stimulating the medial deltoid muscle to support shoulder abduction. First, the controller was tested simulating different volitional contributions of a potential patient. The control system adjusted the amount of FES-support as expected. Then, the compensation of muscle fatigue by the feedback controller was demonstrated by repeatedly applying the same desired FES-induced angular trajectories, while the subject was asked to be relaxed. As a result, the control system was able to provide the desired support for about 7 minutes until the stimulation intensity saturated.

Using EEG to Predict the Rehabilitation Outcome of Stroke Patients

Interventions: Not Applicable. Main Outcome Measure(s): Performance-based clinical assessments of walking. Results: Item-bank development was accomplished using the first 2 qualitative stages of an 8-stage mixed-methods approach for assessment scale development (Velozo et. al, 2012). Stage 1 involved a comprehensive literature review to identify existing clinical assessment items that examine walking recovery. Walking recovery was defined as the ability to attain both steady-state walking and the ability to make adjustments to task and environmental demands (Patla and Shumway-Cook, 1998). A review of literature identified 15 existing clinical assessments that contained a subset of tasks assessing walking recovery. The total number of tasks identified was 138. Qualitative stage 2 involved eliminating redundant or misfit items (item winnowing) and item categorization based on dimensions of walking (item binning). The 138 tasks were reduced to 44 tasks, which were then grouped into 14 dimensions of walking recovery based on varying task demands (e.g., walking while carrying an object, walking and talking) or environmental demands (e.g., negotiating obstacles, varying terrain). Conclusions: A large bank of 44 items was identified from existing assessments that can comprehensively assess walking recovery post-stroke. Behavioral outcomes will be required to develop and validate a hierarchy of item difficulty in the item-bank. Computerized adaptive testing and item response theory based short forms could be used to reduce testing burden and enhance clinical utility of the item-bank for a comprehensive examination of walking recovery post-stroke.

Rehabilitation Outcomes of Stroke Patients With and Without Diabetes

ObjectiveTo investigate the relation of diabetes comorbidity and the rehabilitation outcomes of patients with stroke. DesignSecondary data analysis. SettingInpatient rehabilitation facilities. ParticipantsPatients with stroke (N=35,243) who received inpatient rehabilitation in 2004 through 2008. InterventionsNone. Main Outcome MeasuresFIM, length of stay, and discharge destination. ResultsMean age ± SD of the sample was 71.0±13.2 years. The percent of the sample of Medicare beneficiaries was 53.8%, whereas 46.2% had other sources of funding. Of the patients in the sample, 34.5% had a comorbidity of diabetes, with 17.2% classified as tier-eligible and 82.8% as nontier eligible. Findings included that patients in this sample with diabetes were admitted for rehabilitation services at a younger age than those without diabetes and support previous studies in which tier-eligible diabetes comorbidities moderated by patient age were found to be significant predictors of stroke rehabilitation outcomes. Furthermore, similar findings remained regardless of payer source. ConclusionsThis study provides additional evidence that diabetes as a comorbidity is significantly related to stroke rehabilitation outcome, but the relation is moderated by patient age.

Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital

Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Few (n = 9; 10%) consumed ≥100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes <50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F = 7.503, P = 0.001; F = 14.558, P < 0.001). Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes.

Early rehabilitation outcome in patients with middle cerebral artery stroke

Although important data on the prognosis and rehabilitation outcome in stroke patients have been reported, data on functional recovery according to stroke subtypes are limited. This retrospective study aimed to evaluate functional outcome in patients with middle cerebral artery (MCA) stroke-the most common subtype of ischemic stroke. The records of stroke patients that underwent the rehabilitation program at our brain injury rehabilitation service between January 2007 and December 2008 were reviewed, and those with MCA stroke were included in the study. Patient demographic and clinical data, and Barthel Index (BI) and Functional Independence Measure (FIM) scores at admission and discharge were collected. The study included 80 MCA stroke patients with a mean age of 63.54 years. FIM and BI scores improved significantly post rehabilitation ( P < 0.05). Age was negatively correlated with both BI and FIM scores at admission and discharge. Length of stay was not correlated with improvement in BI or FIM scores during hospitalization. The patients that had ≤1 month of inpatient rehabilitation had similar outcomes as those that had >1 month of inpatient rehabilitation ( P > 0.05). Length of time after stroke onset was not correlated with BI or FIM scores at admission. Regardless of initial functional status, prediction of discharge functional status was misleading. Physiatrists should keep in mind that functional improvement does not always increase with duration of inpatient therapy.

Quantifying the quality of hand movement in stroke patients through three-dimensional curvature

BackgroundTo more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness.MethodsSixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds.ResultsThere was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements.ConclusionsMeasurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.

Poster 442: Rehabilitation Outcomes of Stroke Patients Treated With Thrombolysis

Poster 442: Rehabilitation Outcomes of Stroke Patients Treated With Thrombolysis

Rehabilitation Outcomes of Stroke Patients Treated With Tissue Plasminogen Activator

To investigate the influence of thrombolysis on functional outcomes after rehabilitation. Systemic thrombolysis with tissue plasminogen activator (tPA) is considered the mainstay of acute stroke therapy and was found to improve short-term outcome. Matched case-controlled design. Inpatient neurology and rehabilitation departments. Thirty-seven patients given tPA and 37 control patients not treated with lytics because of protocol limits. We retrospectively analyzed data from a cohort of stroke patients who were treated with systemic tPA. The rehabilitation outcome of thrombolysis-treated patients was compared with that observed for tPA-ineligible and age- and stroke severity-matched patients treated at the same neurology and rehabilitation departments. Neurological evaluation was assessed with the National Institutes of Health stroke scale (NIHSS). Activity of daily living was measured using the Functional Independence Measure (FIM) instrument. Functional outcome was measured using the modified Rankin scale (mRS). The treatment group included 37 patients given tPA; 37 tPA-ineligible patients served as controls. On admission to rehabilitation, there were no significant differences in functional, neurological, and rehabilitation parameters between the groups. At the end of the rehabilitation period, NIHSS scores were significantly lower in the thrombolysis group (P = .036). More patients in the thrombolysis group reached functional independence defined as mRS < or =2 (20/37 versus 10/37; P = .03). At the end of rehabilitation, total FIM score (mean 102.8 versus 93.9; P = .039), total FIM gain (mean 27.8 versus 21.4; P = .09), and total FIM efficiency scores (0.8 versus 0.43; P = .013) were higher in the thrombolysis group and more patients in this group were discharged home. Although the bulk of neurological improvement occurred before the inpatient rehabilitation, thrombolysis-treated patients continue to improve faster and to a larger extent during the rehabilitation period suggesting that the beneficial effects of thrombolysis continue beyond the acute phase.

Sleep-Related Breathing Disorders and Rehabilitation Outcome of Stroke Patients

Sleep-related breathing disorder (SRBD) is more prevalent in stroke patients than in age- and sex-matched controls, but the relationship between SRBD, functional levels at admission, and subsequent recovery is unclear. We evaluated patients after a first stroke to determine the prevalence of SRBD and the influence of SRBD on the recovery of discharge functional status after a rehabilitation program. In a prospective study, 30 stroke patients were studied by continuous overnight pulse oximetry during sleep for the presence of desaturation events (fall of arterial saturation of > 4% from the baseline). The Respiratory Disturbance Index was defined as number of desaturations per hour of sleep. Functional assessment was done at admission using the FIM instrument. The patients were asked about total hours of sleep and the presence or absence of habitual snoring before and after the stroke. The outcome measure at discharge was the FIM score. On linear regression, after including the FIM score at admission, in the model, the Respiratory Disturbance Index score was negatively correlated with the FIM gain (coefficient, -0.635 +/- 0.27; P = 0.025), and together, the variables explained 20.9% of the total variance (adjusted r2). All patients with an admission FIM score of > or = 70 (only mild functional impairment) had a good outcome (FIM score of > 100 at discharge). However, only two of six of those with FIM scores of < 70 with SRBD (defined as a Respiratory Disturbance Index score of > 10) had significant improvement (> or = 30 points), whereas this occurred in seven of nine of those without SRBD (prevalence ratio, 0.43; 95% confidence interval, 0.13-1.40; P = 0.085) Even after adjusting for the admission functional status, the presence of hypoxic events during sleep predicts a poorer recovery, especially in stroke patients with poor function at admission.

98. Effect of L-Threodops on Rehabilitation Outcome of Stroke Patients Ichiro Miyai , MD (Osaka, Japan), Toshio Saito, MD (Osaka, Japan), Sonoko Nozaki, MD (Osaka, Japan), and Jin Kang, MD (Osaka, Japan

98. Effect of L-Threodops on Rehabilitation Outcome of Stroke Patients Ichiro Miyai , MD (Osaka, Japan), Toshio Saito, MD (Osaka, Japan), Sonoko Nozaki, MD (Osaka, Japan), and Jin Kang, MD (Osaka, Japan

Changes in functional outcome in inpatient stroke rehabilitation resulting from new health policy regulations in Italy

This study was designed to assess whether enforcement of new health policy regulations in Italy limiting fully paid hospital stay to 60 days has actually caused a decrease in rehabilitation outcomes of stroke patients. Final sample included 370 out of 398 consecutive patients hospitalized between 1993 and 1996 for first stroke sequelae. Rehabilitation results were compared between subgroups of patients admitted before and after new Italian regulations. Length of stay was significantly (p < 0.001) shorter in 1996 than in previous years. However, between 1993 and 1996 a significant (p < 0.05) decrease in effectiveness on mobility and a significant (p < 0.05) increase in "low responders" on both daily living activities and mobility was observed. Moreover, in 1995-96 the precocious discharge of patients compromised stabilization of recovery with subsequent functional worsening. After discharge, outpatient rehabilitation treatment was able to conserve achieved mobility status, but not functional status on daily living activities. We suggest revising the present regulation for medical rehabilitation services to one based on FRGs (functional related groups), so that the appropriate treatment can be carried out for each patient.

Orientation in the acute and chronic stroke patient: Impact on ADL and social activities. The copenhagen stroke study

Objectives: To determine the influence of initially lowered orientation on rehabilitation outcome in stroke patients, and how decreased orientation 6 months after stroke influences ADL and social activities. Design: Prospective, consecutive, and community based. Setting: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were completed within the unit. Patients: 524 patients with acute stroke. Main Outcome Measures: Basic ADL assessed by the Barthel Index (BI) at discharge; discharge placement; higher level ADL and social functions assessed by the Frenchay Activity Index (FAI) at a 6-month follow-up. Results: The independent influence of orientation in acute stroke on rehabilitation outcome was analyzed with multiple linear and logistic regression models, using initial stroke severity (Scandinavian Neurologic Stroke Scale), initial BI, age, sex, comorbidity, prior stroke, and marital status as covariates. A one-point decrease in orientation decreased BI with 9 points (coefficient b = 8.66, SE(b) = .18, p = .026). Follow-up examinations 6 month poststroke showed that decreased orientation at this point still exerted a marked, negative influence on ADL and social functions (BI: coefficient b = 12.06, SE(b) = 1.95, p < .0001; FAI: coefficient b = 6.28, SE(b) = 1.42, p < .0001). Conclusion: The level of orientation influences basic ADL and higher level ADL and social activities in acute as well as chronic stroke. This finding suggests that rehabilitation of memory and attention might be relevant in stroke patients with impaired orientation.

Correlation between Albumin Level and Rehabilitation Outcome in Stroke Patients

Correlation between Albumin Level and Rehabilitation Outcome in Stroke Patients

Somatosensory evoked potentials and rehabilitation outcome in stroke patients with hemiinattention syndrome

Somatosensory evoked potentials and rehabilitation outcome in stroke patients with hemiinattention syndrome