Stroke-specific Quality Of Life Score Research Articles

Effects of Circuit Class Training Versus Individual, Task Specific Training on Upper Extremity Function in Chronic Stroke Patients

Background: Stroke is a leading contributor to disability globally, emphasizing the need for effective rehabilitation techniques. Circuit class training (CCT) and individual, task-specific training (ITST) have emerged as potential approaches for enhancing upper extremity function in stroke survivors. Comparative analyses of their efficacy, especially among chronic stroke patients, are scant. Objective: This study aimed to evaluate and compare the impacts of CCT and ITST on upper extremity spasticity, motor function, and quality of life in individuals with chronic stroke. Methods: In a randomized controlled trial, 36 chronic stroke patients were allocated to either CCT or ITST groups. Participants were aged 45-70 years, had experienced a single stroke episode, and were at least 6 months post-stroke, with specific inclusion criteria regarding spasticity and motor function levels. The interventions were delivered for 1.5 hours daily, five days a week, over eight weeks. Outcomes were measured using the Modified Ashworth Scale (MAS) for spasticity, Functional Independence Measure for Upper Extremity (FMA-UE) for motor function, and Stroke-Specific Quality of Life (SS-QOL) scale for quality of life, analyzed using SPSS version 25. Results: Post-intervention, both CCT and ITST participants exhibited significant improvements in their outcomes. MAS scores showed a reduction in spasticity, with average improvements not significantly differing between the groups. FMA-UE scores increased by an average of 10 points in both groups, indicating enhanced motor function without a significant difference between the groups (p > 0.05). SS-QOL scores improved by an average of 20 points in each group, reflecting better quality of life, with no significant intergroup difference observed. Conclusion: The study concludes that CCT and ITST are equally effective in ameliorating upper extremity spasticity, motor function, and quality of life among chronic stroke patients. The selection between CCT and ITST can thus be personalized based on patient preferences, available resources, and logistical considerations, maintaining rehabilitation efficacy.

Tongdu Xingshen acupuncture and moxibustion combined with cognitive training in treatment of post-stroke mild cognitive impairment: a randomized controlled trial

To compare the clinical effect of Tongdu Xingshen (promoting the governor vessel and regaining consciousness) acupuncture and moxibustion combined with cognitive training and the simple cognitive training for post-stroke mild cognitive impairment (PSMCI). Eighty-four patients with PSMCI were randomly divided into an observation group and a control group, with 42 cases in each group (3 cases in the observation group and 2 cases in the control group dropped off). The observation group was treated by Tongdu Xingshen acupuncture and moxibustion combined with cognitive training, acupuncture was given at Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), etc., and moxibustion was given at Shenting (GV 24) , Baihui (GV 20), Shendao (GV 11), Fengfu (GV 16) and Xinshu (BL 15). The control group was only given cognitive training. All the above treatment was given once a day, 5 times a week, for 4 consecutive weeks. The scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activity of daily living (ADL) and stroke-specific quality of life (SS-QOL) were compared between the two groups before treatment, after treatment, 4 weeks and 12 weeks after treatment. After treatment, 4 weeks and 12 weeks after treatment, the MoCA, MMSE and SS-QOL scores of the two groups were all higher than those before treatment (P<0.05), and the ADL scores were lower than those before treatment (P<0.05). In the observation group, the MoCA and MMSE scores were higher than those of the control group after treatment, 4 weeks and 12 weeks after treatment (P<0.05), and the SS-QOL score was higher than that of the control group 12 weeks after treatment (P<0.05). Both Tongdu Xingshen acupuncture and moxibustion combined with cognitive training and simple cognitive training can improve cognitive function, daily living ability and quality of life in patients with PSMCI, and the combined therapy is superior to simple cognitive training in improving cognitive function and long-term quality of life in patients with PSMCI.

Feasibility, safety and outcomes of an online, remotely supervised neuropilates class in a post stroke patient: A case study

Neuropilates, that is, the practice of pilates in a patient with a neurological condition, may benefit post stroke patients through improving their strength, postural control, alignment and stability, with previous studies showing significant improvements in balance and gait parameters post pilates interventions. This case study aimed to investigate the feasibility and outcomes of an online, remotely supervised one to one pilates class, once a week for 6 weeks with a post stroke patient. Outcomes measured included gait and balance through the “Timed Up and Go (TUG)” test, the “Five Times Sit to Stand (5TSTS)” test, the “Activities specific Balance Confidence (ABC) scale” and the “Tinetti” balance and gait assessment. Quality of life was also measured by the “Stroke Specific Quality of Life (SSQOL)” Scale and muscle tone was measured through use of the “Modified Ashworth Scale (MAS)”. Feasibility was assessed qualitatively based on information gathered from the client satisfaction questionnaire and the patient’s tolerance of the programme. Results demonstrated that the patient enjoyed and tolerated the programme well with modifications and that he would prefer online exercise training over face to face in the future. The patient improved his TUG score and his SSQOL score beyond the minimal detectable change. Smaller improvements were also seen in the 5TSTS test, the ABC scale and the Tinetti assessment. Mixed results were seen for muscle tone. Typical neuropilates exercise sets for post stroke patients in standing and seated positions are given as well as advice and protocols for ensuring high levels of safety with online exercising.

Acupuncture for insomnia after ischemic stroke: an assessor-participant blinded, randomized controlled trial.

To date, there has been little focus on research into acupuncture for insomnia after ischemic stroke. Insomnia is one of the most common sequelae after ischemic stroke, and it is the most unrecognized modifiable risk factor. To evaluate the efficacy and safety of acupuncture for insomnia after ischemic stroke. In this assessor-participant blinded, randomized, controlled trial, 144 ischemic stroke patients with insomnia meeting Diagnostic and Statistical Manual of Mental Disorders (fifth edition, DSM-5) criteria were assigned to verum or sham acupuncture treatment (n = 72 per group) for three sessions per week over 4 weeks. The outcomes were the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), stroke-specific quality of life (SSQoL), and Hospital Anxiety and Depression Scale (HADS) scores. Multiple objective sleep variables were recorded using actigraphy. Assessment was conducted at baseline, and thereafter once biweekly for the 4-week treatment and at 4 weeks of follow-up. The verum acupuncture group had significantly greater improvements than the sham acupuncture group in sleep quality from 2 weeks into treatment throughout the follow-up, indicated by ISI scores and actigraphic variable SE (sleep efficiency). This greater improvement was also observed in the PSQI after 4 weeks of treatment throughout follow-up, as well as actigraphic variable TST (total sleep time), SSQoL and HADS scores at the end of treatment, and SSQoL and depression scores at follow-up. There was no significant difference between groups in the actigraphic variable SA (sleep awakenings). Adverse events were mild in severity, and their incidence was not significantly different between the two groups. Acupuncture appears to be efficacious, in terms of improving insomnia, related quality of life, and affective symptoms, for patients with ischemic stroke. ChiCTR-IIC-16008382 (Chinese Clinical Trial Registry).

Effects of Physiotherapy-Based Training and Involvement of Informal Caregivers on Selected Rehabilitative Outcomes of Stroke Survivors

Background and Objectives: The purpose of this study was to determine the effects of physiotherapy-based training and involvement of informal caregivers (ICGs) on selected rehabilitative outcomes of stroke survivors (SSs). Methods: Seventy-one (71) pairs of ICGs and SSs, which is 142 participants, comprising 39 pairs in the study group (STG) and 32 pairs in the control group (CTG) completed the study. The mean ages of ICGs in the STG and the CTG were 38.82 ± 15.37 years and 39.16±15.01 years respectively, with no significant difference (p &gt; 0.05) between them. The mean ages of SSs in the STG and the CTG were56.21±10.91 years and 60.03±12.11 years respectively, with no significant difference (p &gt; 0.05) between them. The ICGs in the STG had a physiotherapy-based training the ICGs in the CTG had no such training. All the SSs in both groups received conventional physiotherapy. Barthel Index (BI}, Stroke Impact Scale (SIS), and Stroke Specific Quality of Life (SSQoL) were used to evaluate the SSs at baseline and after the 12thweek of treatment. Statistical analyses involved both descriptive and inferential statistics. The level of significance was set at p&lt;0.05. Results: There was a higher significant improvement (p= 0.001) in the BI score of the STG than that of the CTG (p= 0.012). SIS scores showed significant improvement in the SSs’ strength (p= 0.001); ability to use the hand (p=0.004); balance, and participation (p=0.000). SSQoL scores showed there were significant improvement in the SSs’ family roles (p= 0.002); language (p=0.005); mobility (p= 0.003); self-care, social roles and upper limbs (p=0.000). The male ICGs had a positive impact on the SSQoL outcome (p= 0.025), strength (p= 0.010), and balance (p= 0.013) of the SSs. The ICGs’ age had a positive relationship with the SSs’ ability to use the hand (p= 0.018), and participation (p= 0.020). ICGs as family members had a positive impact on the SSs quality of life and activity level. In the CTG, SIS scores showed significant improvement in strength (p= 0.005); activity (p=0.002); balance (p=0.019); ability to use the hand (p=0.003) and participation (p=0.001). SSQoL scores showed there was significant improvement in the SSs’ mobility (p= 0.019); selfcare, social roles and upper limbs (p= 0.000). Conclusion: The findings of this study reveal that physiotherapy-based training and involvement of Informal caregivers had significant effects on physical function such as walking, stair climbing, and bathing as well as the quality of life of stroke survivors.

Use of the International Classification of Functioning, Disability and Health (ICF) to expand and standardize the assessment of quality-of-life following a stroke: proposal for the use of codes and qualifiers

Purpose Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF). Methods An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 – no impairment to .4 – complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers. Results The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations. Conclusions The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health. Implications for rehabilitation Proposal for qualifying concepts related to body functions, activity & participation, and environmental factors in a simple, standardized manner. The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors. Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care. The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.

Effect of a Nurse-Led Education Program for Stroke Patients on Sleep Quality and Quality of Life: A Randomized Controlled Study.

Nurse-led education and follow-up for stroke patients may facilitate management and improve quality of life. This study investigated the effect of a nurse-led education program for stroke patients on sleep and life quality. A total of 92 stroke patients (46 in the intervention group, 46 in the control group) aged 18 to 75 years who were independently mobile (less than or equal to one assistive device) and had no other neurologic or psychiatric disorders or history of sleep disorder prior to stroke were included. Patients randomized to the intervention group completed a 20-week education and follow-up program including information about stroke, rehabilitation, adaptation to daily life, and the importance of sleep quality. In the posttest, the intervention group had significantly higher sleep quality and stroke-specific quality of life scores than the control group. This study may serve as a guide for nurses who work with stroke patients.

Efficacy and Safety of Panax Notoginseng Saponins (Xueshuantong) in Patients With Acute Ischemic Stroke (EXPECT) Trial: Rationale and Design.

Background: Although revascularization treatment is recommended as the first-line therapy for patients with non-minor acute ischemic stroke (AIS), it only benefits a minority of patients. Previous studies have reported the positive effects of Panax notoginseng saponins (PNS) (Xueshuantong lyophilized powder) on AIS, however, there have been no rigorous trials. This study aims to assess the efficacy and safety of PNS therapy for patients with AIS. Methods: The Evaluation of Xueshuantong in Patients with acutE ischemiC sTroke (EXPECT) trial is a multicenter, randomized, placebo-controlled, double-blind study aiming to enroll 480 patients in China. Eligible patients with AIS within 72 h of symptom onset will randomly receive either PNS or PNS placebo for 10 days and subsequently be followed up to 90 days. The primary outcome will be a change in the National Institute of Health Stroke Scale (NIHSS) score from baseline to 10 post-randomization days. The secondary outcomes include early neurological improvement (proportion of patients with NIHSS score 0–1), and Patient-Reported Outcomes Scale for Stroke score at 10 post-randomization days, the proportion of patients with life independence (modified Rankin Scale score of 0–1), the proportion of patients with a favorable outcome (Barthel Index ≥90), and Stroke-Specific Quality of Life score at 90 days. Adverse events or clinically significant changes in vital signs and laboratory parameters, regardless of the severity, will be recorded during the trial to assess the safety of PNS. Conclusions: To our knowledge, this study is the first double-blind trial to assess the efficacy and safety of PNS in patients with AIS. Findings of the EXPECT trial will be valuable in improving evidence regarding the clinical application of PNS therapy in patients with AIS ineligible for revascularization treatment in the reperfusion era.

Feasibility of context-specific activities for improving physical activity levels among Indian adults with stroke

Purpose To design and test the feasibility of context-specific activities for improving physical activity (PA) levels among Indian adults with stroke. Methods Context-specific activities were developed after a thorough literature search and inputs from five adults with stroke and five experts. Following which 17 adults with stroke were recruited. Participants were asked to choose at least three activities from the list of context-specific activities and to perform them every day for one month. Participants' pre and post-intervention PA levels and quality of life (QoL) were assessed using the physical activity scale for individuals with physical disabilities (PASIPD) and stroke specific quality of life (SSQoL). At the end of the program, participants were also interviewed to explore their experiences with the program. Results The list of context-specific activities included 45 activities under aerobic, strengthening, and balance domains. Fifteen participants [mean (SD) age 56.94 (9.87)] completed the one-month intervention. Intervention adherence rate was 86.6%. No adverse events were noted, and participants were satisfied with the program. PASIPD and SSQoL (MD − 6.52) scores showed significant improvement post-intervention. Conclusions Context-specific activities are designed for Indian adults with stroke. Context-specific activities are feasible, safe and help to improve PA and QoL.

A Comparison of the effect of resistance training on upper extremity motor function, motor recovery, and quality of life in sub-acute stroke participants

Background and Objectives: Previous literature could not find sufficient evidence to support the use of resistance training (RT) protocol and its effect on stroke. Most of the studies were small and of moderate quality. Recommended in previous study that well-design randomized controlled trials with structured protocol are needed to determine the optimal exercise prescription. Hence, the objective of this study was to design a structured protocol of RT for sub-acute ischemic stroke subjects with moderate upper limb impairments. The primary aim of this study was to find the effect of RT on upper extremity (UE) motor recovery, motor function, and secondary aim was to find the effect of RT on health-related quality of life in stroke participants. Materials and Methods: There was total number of 40 participants, out of which 20 were in RT group and 20 were in conventional therapy (CT) group. Both the RT group and CT group received the same usual care rehabilitation programs for 30 min, and additionally, had each of their own therapies for 50 min per session, 5 days a week for 8 weeks. The action reach arm test (ARAT), manual muscle testing (MMT), Fugl-Meyer assessment (FMA), and stroke-specific quality of life (SS-QOL) were used as an outcome measure to assess gross manual dexterity, motor recovery of UE, and quality of life at preintervention and postintervention. Results: At baseline, participants of both group showed no significant differences regarding ARAT, MMT, FMA, and SS-QOL scores but after 8 weeks of intervention, participants of both group showed statistically significant improvements in all the variables measured (P < 0·05). Moreover, participants of the RT group had greater improvement in all variables compared to CT group. Conclusion: The present study confirms that structured protocol used for RT is an effective treatment technique to improve UE motor recovery, motor function, and quality of life in stroke participants compare to CT. It is cost-effective, easy, and safe method for rehabilitation and most important can be easily administered at home by the participants.

A study to compare the effectiveness of mirror therapy and neuromuscular electrical stimulation on upper-extremity motor recovery, motor function, and quality of life in subacute stroke subjects: A randomized controlled trial

Objective: Mirror therapy (MT) and neuromuscular electrical stimulation (NMES) are both effective treatments for impaired upper limbs following stroke. The purpose of this study was to compare the effects of the MT and NMES on upper-limb motor recovery, motor function, and quality of life in subacute stroke patients. Materials and Method: Forty poststroke patients within 1 month of duration were assigned to the MT group (n = 20) or the NMES group (n = 20). Both the MT group and NMES group received the same conventional rehabilitation programs and additionally had each of their own therapies for 30 min, 5 days a week for 3 weeks. The action research arm test (ARAT), Fugl-Meyer assessment (FMA), Modified Ashworth scale (MAS), and Modified Barthel index (MBI) were used as an outcome measure to assess changes in upper-limb motor recovery and motor function at pre- and postintervention. Health-related quality of life was assessed by stroke-specific quality of life (SS-QOL) questionnaire at pre- and postintervention. Results: At the baseline, patients of both the groups showed no significant differences regarding ARAT, FMA, MAS, MBI, and SS-QOL scores, but after 3 weeks of intervention, patients of both the group showed statistically significant improvements in all the variables measured (P < 0.05). Conclusion: The present study confirms that MT and NMES are both effective treatment techniques to improve upper-extremity motor recovery, motor functioning, and quality of life in subacute stroke patients except for improvement in spasticity. However, MT is cost-effective, easy, and safe method for rehabilitation and most important can be easily administered at home by the patients.

Measurement properties of all versions of the Stroke Specific Quality of Life Scale (SS-QOL) 2.0: a systematic review protocol.

The aim of this review is to critically appraise and summarize the quality of the measurement properties of all versions of the Stroke Specific Quality of Life Scale (SS-QOL) version 2.0. The Stroke Specific Quality of Life Scale version 2.0 was developed as a comprehensive measure in assessing the quality of life of stroke survivors. The shortened version and cross-culturally translated versions are further developed in different countries. A systematic review will clarify the levels of reliability and validity of all versions. The population of interest for this review will include adult stroke survivors of either sex diagnosed with a stroke (ischemic or hemorrhagic) who have no other comorbidities affecting their quality of life. The SS-QOL version 2.0 will be the specific instrument of interest, and the quality of life of stroke survivors will be the construct of interest in this review. The measures of reliability, validity, and responsiveness will be assessed as outcomes. Only the studies evaluating the reliability, validity, and responsiveness of all versions of the SS-QOL 2.0 will be included in the review. A literature search will be conducted for published studies in MEDLINE and Embase, and unpublished data in Google Scholar and ProQuest Dissertations and Theses. After a three-step search strategy, study selection will be done by two reviewers independently. Then, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology will be applied for assessment of methodological quality, data extraction, and synthesis. PROSPERO CRD42020211727.

Studi Epidemiologi Kualitas Hidup Penderita Paska Stroke di RSUD Propinsi Nusa Tenggara Barat

troke is a leading cause of mortality and morbidity in Indonesia. Post stroke patients has a higher disability hence results in poor quality of life compared with normal population. In Indonesia, studies related to the quality of life of post-stroke patients are scarce, so studies are required to explore the quality of life of post-stroke patients, particularly in West Nusa Tenggara. Aim of this study is to determine the epidemiology of quality of life for post-stroke patients in West Nusa Tenggara. Methods of this study is An Observational with cross-sectional design was performed in population of post-stroke patients admitted to West Nusa Tenggara General Hospital. The quality of life of post stroke patient was evaluated with SSQOL (Stroke Specific Quality of Life) questionnaire. The collected data was analyzed by the appropriate test. Result of this study is the average age of subject is 60.33±10.68 years. Hypertension is a major risk factor of stroke. The average SSQOL score is 177.02±45.75. SSQOL assesses 4 dimension are physical, functional, psychological and social health. Based on the physical dimension, the average score is 17.00, the functional dimension, the average score is 14.91, the psychological dimension, the average score is 13.17 and the social health dimension the average score is 13.44. The quality of life for post-stroke patients in West Nusa Tenggara General Hospital is good.

Intervention effect of motor guided imagery on sleep disorders and anxiety, depression in patients with stroke

Objective To evaluate the effect of motor guided imagery to improve the sleep quality and the emotional state in patients with stroke. Methods Totally 100 patients were randomly divided into experimental group(n=50) and control group(n=42). The control group received the routine medicine treatment and nursing measures in neurology, while the experimental group received motor guided imagery training therapy.The Pittsburgh sleep quality index scale(PSQI)were used to evaluate sleep quality, the Hospital Anxiety and Depression Scale (HADS) were used to evaluate emotional state and the Stroke Specific Quality of Life (SS-QOL) were used to evaluate quality of life before and after intervention. Results After one- or five-week intervention, the total score of PSQI and the scores of HADS in the experimental group ((4.95±1.94), (3.91±1.63), (12.92±2.58), (7.26±4.49))were lower than those in the control group((10.81±3.23), (7.93±3.20), (18.45±3.03), (12.07±5.48)), and the differences were statistically significant(P<0.05). Intergroup effect, time effect and interaction effect of PSQI score and HADS score showed significant in two groups(P<0.05). After one- or five-week intervention, the total score of SS-QOL in the experimental group((194.12±18.98), (213.66±17.95)) were higher than those in the control group((156.81±18.39), (194.12±25.41)), and the differences were statistically significant(P<0.05). The inter-group effect, time effect and interaction effect of SS-QOL score in both groups were significant(P<0.05). Conclusion The motor guided imagery training can effectively improve the sleep quality, the emotional state and quality of life in stroke patients. Key words: Motor guided imagery; Stroke; Post-stroke sleep disorders; Anxiety; Depression; Quality of life

Abstract TP304: Stroke-Specific Quality of Life as an Independent Outcome in Intracerebral Hemorrhage

Introduction: Quality of life (QoL) is important to patients and decision makers. However, little is known about QoL in intracerebral hemorrhage (ICH) survivors. The purpose of this study is to investigate the relationship between clinical characteristics, measures of disability, and the stroke-specific quality of life (SS-QoL) among ICH survivors. Methods: Sixty-eight ICH subjects were prospectively enrolled at Yale-New Haven Hospital from July 2015 to February 2017. The SS-QoL, modified Rankin Scale (mRS), and Barthel Index (BI) were obtained by phone interview at 3 (n=15), 6 (n=43), and 12 (n=10) months post ICH. The SS-QoL is a self-reported, 12-domain assessment utilizing 5-point Likert scales. SS-QoL domain scores are the mean of individual scores in each domain. A summary score was calculated as the mean of all 12 domain scores with a range of 1-5. Higher scores indicate better QoL. SS-QoL scores ≥4, BI scores ≥ 90, and mRS ≤ 2 were considered good. Logistic regression was used to investigate associations between covariates and QoL. Results: The mean SS-QoL summary score was 3.8 (SD 0.80) at a mean follow up time of 6 months. Fifty-three percent of subjects reported a good QoL, compared to 66% and 78% of subjects with a good outcome on the mRS and BI, respectively. Subjects scored highest in the self-care (mean score 4.2) and vision (4.3) domains of the SS-QoL and lowest in the energy (3.2), social (3.3), and thinking (3.4) domains. Known predictors of outcome after ICH including age, sex, race/ethnicity, admission GCS, ICH location, ICH volume, and IVH extension were not associated with SS-QoL scores. Conclusion: The SS-QoL provides information on domains that are not captured by the mRS and the BI and is not associated with traditional predictors of outcome after ICH. These data support further studies on the use of QoL as an outcome independent of disability measures.

Enlarged perivascular spaces are associated with health-related quality of life in patients with acute ischemic stroke.

This study explored the association between enlarged perivascular spaces (EPVS) and the health-related quality of life (HRQoL) in patients with acute ischemic stroke. This was an observational study of consecutively screened patients with acute ischemic stroke from March 2010 to March 2015. EPVS were rated in the basal ganglia and the centrum semiovale with a validated scale. The HRQoL was assessed 3months after the stroke onset using the Stroke-Specific Quality of Life (SSQoL). Linear regression models were used to study the association between EPVS and HRQoL. The study included 648 patients (mean age 65.8years; 40.0% women) with mild to moderately severe stroke (median NIHSS score 2), of whom 640 (98.8%) exhibited signs of small vessel disease. The median EPVS scores in the basal ganglia and the centrum semiovale were 1 each. In linear regression analysis, EPVS in the basal ganglia were associated with a lower total SSQoL score (P=0.02) and lower mobility (P=0.01), mood (P=0.03), and self-care (P<0.01). EPVS in the centrum semiovale were associated only with a lower SSQoL work/productivity subscore (P=0.002). EPVS are associated with lower HRQoL in patients with mild to moderate acute ischemic stroke. Early identification and intervention of EPVS may improve HRQoL in stroke survivors.

Abstract TP114: Cognition Independently Affects Quality of Life in Carotid Occlusive Disease

Objective: To determine whether cognition among those with carotid occlusive disease independently affects Quality of Life (QoL). Introduction: Carotid occlusion may result in stroke, TIA, and reduction in cognition. QoL has been studied in stroke patients but less is known about QoL in patients with carotid occlusive disease without stroke or significant depression. Methods: Subjects, selected from an NIH study of carotid occlusive treatment, included those with with history of TIA or a remote history of minor stroke, and excluded those with a history of stroke within 4 months prior, major deficits in ADL’s, and dementia. Because the relationship between depression and OoL is well-established, we excluded with moderate-severe depression. Patients underwent cognitive examination (memory, language, motor, executive function skills), completed depression and QOL questionnaires (Center for Epidemiological Studies-Depression (CES-D), Stroke Specific Quality of Life (SSQOL), and were rated for stroke severity (NIHSS). Age-corrected Z-scores for cognitive tests were calculated and averaged into a composite cognitive Z-score (Cog-Z). The SSQOL scores were averaged across subgroup domains. Correlation analyses were performed to determine univariate relationships between the variables, with significant values put into in a regression model to predict SSQOL. Results: Among 24 subjects (mean age=58.38 (2.01); 10 women), mean Cog-Z was –1.06 SD (Low Average range), mean CES-D score was 10.77 (normal range), mean NIHSS was 0.46 (normal range), and the mean SSQOL score was 3.92 (needing “a little help”). The correlations between NIHSS, history of prior stroke, and SSQOL were nonsignificant. In a regression model including Cog-Z and CES-D, Cog-Z was an independent predictor of SSQOL (Beta=.389, p=.038). Conclusions: In patients with carotid occlusive disease without major stroke, cognitive scores were independently associated with QOL. Even minor reductions in cognition influenced QoL and were distinct from the influence of depression. These data further establish the clinical relevance of cognitive decline among patients with cerebrovascular conditions.

Effect of acupuncture on insomnia following stroke: study protocol for a randomized controlled trial.

BackgroundThe incidence, mortality, and prevalence of stroke are high in China. Stroke is commonly associated with insomnia; both insomnia and stroke have been effectively treated with acupuncture for a long time. The aim of this proposed trial is to assess the therapeutic effect of acupuncture on insomnia following stroke.MethodsThis proposed study is a single-center, single-blinded (patient-assessor-blinded), parallel-group randomized controlled trial. We will randomly assign 60 participants with insomnia following stroke into two groups in a 1:1 ratio. The intervention group will undergo traditional acupuncture that achieves the De-qi sensation, and the control group will receive sham acupuncture without needle insertion. The same acupoints (DU20, DU24, EX-HN3, EX-HN22, HT7, and SP6) will be used in both groups. Treatments will be given to all participants three times a week for the subsequent 4 weeks. The primary outcome will be the Pittsburgh Sleep Quality Index. The secondary outcomes will be: the Insomnia Severity Index; sleep efficacy, sleep awakenings, and total sleep time recorded via actigraphy; the National Institutes of Health Stroke Scale; the Stroke-Specific Quality of Life score; the Hospital Anxiety and Depression Scale. The use of estazolam will be permitted and regulated under certain conditions. Outcomes will be assessed at baseline, 2 weeks after treatment commencement, 4 weeks after treatment commencement, and at the 8-week follow-up.DiscussionThis proposed study will contribute to expanding knowledge about acupuncture treatment for insomnia following stroke. This will be a high-quality randomized controlled trial with strict methodology and few design deficits. It will investigate the effectiveness of acupuncture as an alternative treatment for insomnia following stroke.Trial registrationChinese Clinical Trial Registry identifier: ChiCTR-IIC-16008382. Registered on 28 April 2016.

Construct validity of the items on the Stroke Specific Quality of Life (SS-QOL) questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health

Purpose: Analyze the construct validity and internal consistency of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the ICF as well as analyze the ceiling and floor effects.Methods: One hundred subjects were analyzed: 85 community-dwelling and 15 institutionalized individuals. The analysis of construct validity was performed using classic psychometrics: (1) the comparison of known groups (individuals without restriction to participation vs. those with restriction to participation) using the Mann–Whitney test and (2) convergent validity – correlation between the scores on the SS-QOL items that address participation and the subscale scores of measures used to evaluate the similar constructs and concepts [the Short-Form Health Survey (SF-36), Functional Independence Measure (FIM) and grip strength test]. Spearman’s correlation coefficients were calculated for this analysis. Cronbach’s α was used for the analysis of internal consistency and both the ceiling and floor effects were analyzed. The level of significance for all analyses was α = 0.05.Results: The a priori hypotheses regarding construct validity were partially demonstrated, as only five of the eight domains exhibited positive moderate to strong correlations (r > 0.40) with measures that address constructs similar to those addressed on the SS-QOL questionnaire. The items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The ceiling and floor effects were considered adequate for the total SS-QOL score, but beyond acceptable standards for some domains.Conclusions: The 26 items of the SS-QOL questionnaire measure a multidimensional construct and therefore do not only address participation. However, the items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation.Implications for rehabilitationThe 26 items of the SS-QOL questionnaire demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation.The present findings can guide healthcare professionals regarding the selection of an assessment tool for the evaluation of post-stroke participation.The findings can lead to consistent and standardization evaluations, which facilitates comparisons and discussion on functional health and social participation after stroke.

Determinants of disease-specific health-related quality of life in Turkish stroke survivors.

Stroke is a worldwide cause of morbidity and mortality that affects health-related quality of life. In this study, our objective was to identify determinants of disease-specific health-related quality of life in Turkish stroke survivors. A total of 114 consecutive patients who experienced a stroke at least 6 months earlier were studied. Health-related quality of life was measured using Stroke-specific Quality of Life (SS-QoL) consisting of 12 domains. Demographic and clinical data were collected, including age, sex, marital status, years of education, time since stroke, whether the patient received rehabilitation before enrollment, stroke etiology, whether the dominant hand was affected or not, presence of vision defect, neglect, aphasia, and dysarthria. The patients were assessed by the functional independence measure (FIM) and the Mini-Mental State Examination. A multiple linear regression analysis was carried out using a stepwise method to determine the predictors of 12 domains and the total score of the SS-QoL. The domains of work, social roles, mobility, and self-care had the lowest SS-QoL scores, whereas the highest scores were for the domains of personality, thinking, language, and vision. The total SS-QoL score was explained by the total FIM and Mini-Mental State Examination. Among the 12 domains, the mobility domain was explained the best (R=0.50) by motor FIM, previously received rehabilitation, and age, followed by the language domain (R=0.37) explained by the presence of aphasia and dysarthria, and previously received rehabilitation. The domains of mood (R=0.13) and upper extremity (R=0.19) were explained the worst. The results indicated that functional independence, age, cognitive status, and receiving a rehabilitation program were the primary determinants of the SS-QoL.