Stroke Specific Quality Of Life Research Articles

Effects of a nurse-led motor function rehabilitation training program for patients with ischemic stroke and family caregivers: study protocol for a randomized controlled trial

BackgroundBoth individuals and society bear a considerable burden from ischemic stroke (IS), not only do patients continue suffering from motor dysfunction after discharge from hospital, but their caregivers also undertake the principal responsibility of assisting them in reintegrating into the family and society. To better improve the IS patients’ limb function and daily life activities, their caregivers should also be involved in the training of the motor function rehabilitation during the period transitioning from hospital back home. This study mainly aims to investigate the effects of a nurse-led training for IS patients and their family caregivers on the improvement of the patients’ physical function and the burden of caregivers.Methods/designA randomized controlled trial with blind assessment will be conducted in hospitals and during the follow-ups at home. Fifty-eight pairs of adults diagnosed with ischemic stroke and their primary caregivers will be included. Participants will be randomly given with (1) a nurse-led, home-based motor rehabilitation training participated by caregivers (intervention group) or (2) routine self-care (control group). Both groups will receive assessment and health guidance on the day of discharge, and the intervention group will receive an additional home-based training program and supervision. These two groups will be followed up every week after discharge. The primary results are drawn from the evaluation of physical function and caregiver-related burden, and the secondary results derived from statistics of the modified Barthel index, stroke-specific quality of life, and National Institutes of Health Stroke Scale. Differences between the two groups will be measured by two-way repeated measures ANOVA, considering the data at baseline and at 1-week and 4-week follow-up after training.DiscussionResults may provide novel and valuable information on the effects of this culturally appropriate, caregiver-involved, and home-based rehabilitation training on the physical function of IS patients and caregiver-related burden.Trial registrationChinese Clinical Trial Registry (chictr.org.cn) ChiCTR2300078798. Registered on December 19, 2023.

Quality of Life of Post-Stroke Patients in Aceh, Indonesia

Introduction: The quality of life of stroke survivors is a major concern for healthcare providers due to the physical, psychological, and social issues caused by stroke. This study aims to identify the quality of life of post-stroke patients undergoing outpatient treatment at the neurology clinic of the General Hospital of South Aceh Regency, Indonesia. Methods: This research uses a cross-sectional study design with a sample of 120 respondents. All post-stroke patients undergoing treatment at the clinic were included in the study. Data were collected through face-to-face interviews at the specialized stroke clinic from January to March 2024. The research instrument used was the Indonesian version of the Stroke-Specific Quality of Life (SS-QoL) questionnaire, which has been validated. The reliability test of the SS-QoL resulted in a Cronbach’s Alpha value of 0.920. Data analysis was conducted using a descriptive approach, including frequency distribution, percentage, standard deviation, and SS-QoL scale score distribution. Results: The study found that the majority of stroke patients' quality of life was in the good category, amounting to 77.5%. The quality of life domain indicated that personality was the worst dimension (mean=3.13, SD=0.762), while family role, social role, mood, and energy were the best domains (mean=4.13, SD=0.766). Conclusion: The quality of life of stroke patients undergoing outpatient treatment at the Neurology Clinic of South Aceh General Hospital is predominantly in the good category. Interventions focusing on personality aspects need to be enhanced to further improve patients' quality of life.

Impact of Stroke on the Quality of Life of its Survivors

Introduction: Ischemic Stroke is due to sudden loss of blood circulation to an area of the brain, resulting in loss of neurologic function. The incidence in India ranges between 105-152/100,000 people/year. Despite all the advancements in care, stroke continues to be the 2nd leading cause of mortality and the 1st cause of long-term disability. The activities of daily living of patients with chronic stroke affect their Quality of Life (QoL). The majority of stroke survivors continue to live with disabilities, and this can have a profound impact on their QoL. Aims & Objectives: To assess the impact of stroke on the various domains of the quality of life of its survivors, who are treated by the Department of Neurological Sciences, Christian Medical College, Vellore. Methods: A descriptive study design employing a non-probability purposive sampling technique was used to recruit 90 stroke survivors. Written consent was obtained, demographic and clinical variables were collected using interviews, and the impact of stroke on its survivors was assessed using the Stroke Specific Quality of Life (SS-QoL) scale. Results: The participant's mean age group was 48.92±12.97 ranging between 26 -78 years respectively; 67.8% were males, 34.4% of them were unskilled workers, 66.7% had a thrombotic type of ischemic stroke, 56.7% had a moderate National Institutes of Health Stroke Scale grade at admission, 26.7% and 25.6% had a modified Rankin Score of 2 and 1, respectively. Among the participants, 47.8% of them had a stroke at the ages of 31-50 years, and the majority (91.1%) of them had comorbidities. The majority (44.77%) of them had a moderate QoL. Among the SS-QoL domains, the mean scores were the highest in the vision domain (4±1.26) and the lowest in the energy domain (2.47±1.25). There was a significant association between the QoL of stroke survivors and their socioeconomic status (p=0.033), type of ischemic stroke (p=0.047), and limb involvement (p=0.034). A positive correlation (p=0.00) was observed among various QoL domains. Conclusion: These findings provided not just insight into the impact of stroke on the QoL of its survivors but also emphasized the need to sensitize the healthcare care professionals to provide care during both the acute period and also continue to ensure all the domains of a good QoL is addressed during the follow-up and rehabilitation. Keywords: Ischemic Stroke, Quality of Life, Stroke Survivor

Comparative Study of Vestibular Rehabilitation and Dual Task Training on Balance and Quality of Life in Young Stroke Patients

Question: Is there any impact of vestibular rehabilitation and dual task training alongside conventional therapy on balance and quality of life in young stroke patients.  Design: Quasi-experimental study with treatment duration of 8 weeks. Simple random sampling was used to divide patients into 3 groups.  Participants: 30 subjects in the age group 18-45 years both males and females with diagnoses of unilateral hemiplegia within the previous six months.  Intervention: Group A received vestibular rehabilitation along with conventional therapy; Group B received dual task training alongside conventional therapy and Group C received only conventional therapy. Outcome measures: Assessment using Berg Balance Scale and Stroke Specific Quality of Life was conducted pre- and post-treatment.  Results: The results revealed a significant improvement (p<0.05) in balance and quality of life scores in Group A as compared to Groups B and Group C.  Conclusion: Hence, it was concluded that vestibular rehabilitation along with conventional therapy is more effective in enhancing balance among young stroke patients compared to dual task training along with conventional therapy or conventional therapy alone.  Registration: BFUHS/2K23p-TH/11527.

Acute clinical outcomes predict both generic and specific health-related quality of life six and 12 months after stroke: A one-year prospective study developed in a middle-income country

ObjectiveTo identify acute predictors of generic and specific health-related quality of life (HRQoL) six and 12 months after stroke in individuals from a middle-income country. Material and methodsThis was a prospective study. The dependent outcomes assessed during six and 12 months after stroke included both generic and specific HRQoL (Short Form Health Survey-36 [SF-36] and stroke-specific quality of life [SSQOL]). The predictors were age, sex, education level, length of hospital stay, current living arrangement, stroke severity, functional independence, and motor impairment. Results122 (59.9±14 years) and 103 (59.8±14.71 years) individuals were evaluated six and 12 months after stroke, respectively. Functional independence and sex were significant acute predictors of both generic and specific HRQoL. Functional independence was the strongest predictor (0.149≤R2≤0.262; 20.01≤F≤43.96, p<0.001), except for generic HRQoL at 12 months, where sex was the strongest predictor (R2=0.14; F=17.97, p<0.001). ConclusionGeneric and specific HRQoL in chronic individuals six and 12 months after stroke, from a middle-income country, can be predicted based on functional independence, the strongest predictor, assessed in the acute phase, except for generic HRQoL at 12 months. Functional independence can be modified by rehabilitation strategies and thus should be considered for HRQoL prognoses at chronic phase.

Gait Function and its Association with Functional Independence, Quality of Life, and Community Reintegration in Stroke Survivors.

Background and Aims: The major outcome of stroke rehabilitation is the recovery of the ability to walk. However, a large proportion of stroke survivors are discharged to the community with gait deficiency which impairs their functional independence, and quality of life increasing the burden of care on caregivers especially their lack of functioning in the community. This study assessed the gait functional performance in community-dwelling stroke survivors and explored its association with functional independence, quality of life, and community reintegration in community-dwelling stroke survivors. Materials and methods: This study involved 115(59 males and 56 females) community-dwelling stroke survivors. Their gait functional performance was assessed using the 10-meter walk test (10MWT) while their functional independence was assessed with the functional independence measure (FIM). Their quality of life (QoL) was assessed using the Stroke-specific QoL scale while community functioning and productivity were assessed using the community integration questionnaire (CIQ). Their scores on the assessments were compared with the normative data of their age and sex-matched healthy individuals. Data was analysed using Spearman’s correlation coefficient and Chi-Square at p&lt;.05. Results: Participants’ ages ranged between 27 to 78 years (mean=60.48±37.84 years). More participants (56.7%) had right hemispheric lesions and 43.3% had lesions in the left hemisphere. Their gait function, functional independence performance, QoL, and community reintegration functions were significantly (p&lt;0.05) lower than their age and sex-matched normative data. There was a significant (p&lt;0.05) association and relationship between their gait functional performance and each of the functional independence performance, QoL, community reintegration, and productivity. Conclusion: Gait functional performance in community-dwelling stroke survivors is significantly lower than in age and sex-matched healthy individuals and it is significantly associated with low functional independence performance, low quality of life, poor community functioning, and lack of productivity in stroke survivors, Abnormal gait pattern is related to poor functional independence, poor quality of life and low productivity.

A Study Evaluating the Aspects of Stroke-specific Quality of Life and Severity in Hypertensive Stroke Patients

ABSTRACT Background: A wide range of cognitive and physical effects occur depending on the location and extent of brain damage caused by the stroke. These effects vary widely in terms of severity. There is a strong correlation between quality of life (QoL) scores and the traditional functional outcome measures. The objective is to evaluate stroke patients’ QoL and severity. A total of 196 hypertensive stroke patients across all age groups are included in this prospective observational study. Methods: Stroke-specific QoL Scale (SS-QoL) questionnaires were self-administered, to assess health-related QoL among stroke patients. The severity level was determined using the modified Barthel index (MBI) and Modified Ranking Scales (mRS). Suitable Statistical methods (Pearson Chi-square and Pearson correlation) were applied to analyze the outcomes. Results: A total of 156 hypertensive stroke patients were assessed for SS-Qol and MBI. We observed that patients with hemorrhagic stroke (5.8%) showed excellent QoL (200–249 range) in comparison with that of ischemic stroke patients (4.4%) and correlation between the domains was significant at P &lt; 0.05 level. Majority of 61 (39.1%) patients showed severe dependence and 1% of patients were independent. mRS was assessed on 196 hypertensive stroke patients, our results showed that the majority of 51 (27%) had severe disability followed by 49 (25%) patients who were completely bedridden, and about 40 (20.4%) deaths were encountered. Conclusion: From our study, we conclude that on using SS-QoL scales assessing SS-QoL the results showed that patients who suffered from a stroke were severely affected physically and mentally decreasing the normal lifespan of a patient and causing death.

Health-Related Quality of Life Among Patients With Stroke: A Cross-Sectional Study.

To assess levels and predictive factors of health-related quality of life (HRQOL) among stroke patients. The study employed a cross-sectional predictive correlational design. Levels of HRQOL were assessed using the Stroke-Specific Quality of Life (SS-QOL) scale, and the Hospital Anxiety and Depression Scale was employed to assess psychological aspects among 209 Saudi stroke patients. The analysis included demographic and medical variables to comprehensively explore influencing factors. A two-step hierarchical multiple regression analysis was performed. The overall SS-QOL summary score (49 items) showed a mean score of 94.4 (SD = 8.1), indicating poor functioning. Nine predictor variables were found to significantly predict HRQOL levels, including age (β = -0.212, p ≤ .001), female (β = -5.33, p ≤ .001), unmarried (β = 2.48, p ≤ .001), low gross monthly income (GMI) (β = -9.02, p ≤ .001), medium GMI (β = -8.36, p ≤ .001), having a medical history of hypertension (β = 2.7, p ≤ .01), time since stroke (β = 3.26 p ≤ .001), and being a probable case of anxiety (β = -4.29, p ≤ .001) and/or depression (β = -2.75, p ≤ .001). These variables collectively explained ~76% of the variance in HRQOL scores (adjusted R2 = .762, F (16,192) = 42.6, p ≤ .001). Stroke patients exhibited poor HRQOL levels influenced by various factors. Clinicians should consider these predictors and intervene early to enhance HRQOL among patients at risk, emphasizing the importance of optimizing patient outcomes.

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 &gt; 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.

Abstract 79: Twelve-Year Trends in Ninety-Day Stroke Outcomes and Ethnic Differences From a Population-Based Study

Background: Stroke outcomes may be changing over time with improved acute stroke therapy, secondary prevention, and post-acute care. At the same time, stroke mortality has declined suggesting more people are living with stroke disability. No US population-based data exists on trends in outcomes. The objective was to investigate trends and ethnic differences in 90-day stroke outcomes in a population-based study. Methods: First-ever ischemic strokes in the population-based Brain Attack Surveillance in Corpus Christi Project (2009-2020, n=1,449) were included. 90-day outcomes included function (activities of daily living (ADL)/instrumental ADL), cognition (modified mini-mental state exam), NIHSS, and quality of life (Stroke-Specific Quality of Life (SS-QoL)). Linear regression with multiple imputation and inverse probability weighting was used to model adjusted associations between time, ethnicity, the interaction of time and ethnicity and outcomes. Results: Median age was 66; 61% Mexican American (MA). Trends in 90-day function overtime were roughly quadratic (Figure) and the change in the ethnic difference was significant among reference groups (p-value&amp;lt0.01). Trends in NIHSS were linear with no change in the ethnic difference (p-value=0.51). Trends in cognition were approximately cubic and the change in the ethnic difference was significant within reference groups (p-value=0.03). Trends in QOL were stable with no change in the ethnic difference. Conclusion: Recent improvements in 90-day post-stroke functional and cognitive outcomes in MAs have resulted in reduced disparities. Factors contributing to favorable trends in outcomes in this group should be further studied.

Comparing the Effectiveness of Mindfulness-based Stress Reduction Training and Powell’s Cognitive Rehabilitation on Improving the Quality of Life of Stroke Patients

Background: Stroke is a type of neurological disorder that can be attributed to a central vascular cause. Stroke can affect the patient’s performance in daily activities and quality of life (QoL). Research indicates a decrease in the quality of life in stroke patients due to cognitive and emotional damage. Objectives: The present study compared the effect of two group approaches, mindfulness training based on stress reduction and Powell’s cognitive rehabilitation, on improving the quality of life of stroke patients. Methods: This semi-experimental study used a pretest-posttest design with a control group and a follow-up period. The sample consisted of 36 eligible stroke patients selected in a targeted and simple random manner. The patients were divided into two intervention groups and one control group. The tools used were a demographic information questionnaire and a Stroke-specific QoL (SS-QOL) scale. Data were analyzed with SPSS software (version. 26). Chi-square, repeated measures analysis of variance, and Bonferroni statistical tests were applied at a significance level of P 0.05). The mindfulness intervention had a higher effect on quality of life on average. Still, statistically, none of the interventions were effective in improving quality of life (P &gt; 0.05), and there was no significant difference between the effect of mindfulness-based methods and cognitive rehabilitation on improving quality of life (P &gt; 0.05). Conclusions: Mindfulness training increases behavioral responses related to attention as the basis of all cognitive activities. Also, mindfulness exercises improve cognitive skills and, by affecting the cognitive system, increase the capacity and ability of the information processing system and improve the quality of life.

Effectiveness of Immersive Virtual Reality-Based Hand Rehabilitation Games for Improving Hand Motor Functions in Subacute Stroke Patients.

Stroke rehabilitation faces challenges in attaining enduring improvements in hand motor function and is frequently constrained by interventional limitations. This research aims to present an innovative approach to the integration of cognitive engagement within visual feedback incorporated into fully immersive virtual reality (VR) based games to achieve enduring improvements. These innovative aspects of interaction provide more functional advantages beyond motivation to efficiently execute repeatedly hand motor tasks. The effectiveness of virtual reality games incorporated with innovative aspects has been investigated for improvements in hand motor functions. A randomized controlled trial was conducted, a total of (n=56) subacute stroke patients were assessed for eligibility and (n=52) patients fulfilled the inclusion criteria. (n=26) patients were assigned to the experimental group and (n=26) patients were assigned to the control group. VR intervention involves four VR based games, developed based on hand movements including flexion/extension, close/open, supination/pronation and pinch. All patients got therapy of 24 sessions, lasting 4 days/week for a total of 6 weeks. Five clinical outcome measures were Fugl- Meyer Assessment-Upper Extremity, Action Research Arm Test, Box and Block Test, Modified Barthel Index, and Stroke-Specific Quality of Life were assessed to evaluate patients' performance. Results revealed that after therapy there was significant improvement between the groups (p<0.05) and within groups (p<0.05) in all assessment weeks in all clinical outcome measures however, improvement was observed significantly greater in the experimental group due to fully immersive VR-based games. Results indicated that cognitive engagement within visual feedback incorporated in VR-based hand games effectively improved hand motor functions.

Exploring the Correlation Between Sexual Function, Mental Health, and Quality of Life among Stroke Survivors in South-East Nigeria

Stroke’s multifaceted impact necessitates understanding its effects on survivors’ psychological well-being, daily functioning, and sexual health. This study aimed to investigate the correlation between sexual function, mental health, and quality of life (QoL) among stroke survivors. This cross-sectional survey involved 82 stroke survivors recruited from selected healthcare centers in Nnewi. The stroke-specific QoL scale and Mental health inventory-38 were used to evaluate the QoL and mental health status of the participants, respectively. Male and female sexual functions were assessed using the International Index for Erectile Function and Female sexual index, respectively. Mann–Whitney U test and Spearman’s rank order correlation were used to analyze data. The participants’ mean total QoL score was 112.57±37.67, representing 46% of the maximum possible score, with the highest and lowest scores in vision (68.94%) and social role (24.39%) domains. The participants scored &lt;50% in seven quality-of-life domains. The mean total mental health score was 141.76±13.70, with the highest and lowest scores in anxiety (70.75%) and emotional tie (50.71%) domains, respectively. Males had a mean total sexual function score of 30.80%, with none reaching the 50th percentile, except overall satisfaction (50.61%), while females scored 16.41%, with none reaching the 50th percentile and 0.0% in the pain domain. This study highlights the significant challenges stroke survivors face in QoL, mental health, and sexual function. The findings underscore the need for holistic and tailored interventions addressing these multidimensional aspects of post-stroke care, focusing on improving sexual well-being to enhance overall life satisfaction in male survivors.

Factors predicting stroke specific quality of life in post stroke aphasia

Background: Understanding the factors that predict stroke-specific QoL in post-stroke aphasia patients in Pakistan is crucial for developing targeted interventions and improving the rehabilitation process. Objective: To determine the factors predicting the stroke-specific quality of life in post-stroke aphasia. Methodology: This cross-sectional analytical study was conducted over 18 months from June 2021 to December 2022 at RHS Rehabilitation Centre Islamabad Pakistan. A total of n=134 independent participants with fluent and non-fluent aphasia at least six months post-stroke, and able to follow one-step commands were included in the study through a non-probability convenient sampling technique. The stroke-specific quality of life (SS-QoL) scale was used to assess the quality of life in the participants, while the list of predictors was developed from the literature. SPSS version 21 was used for statistical analysis. Result: A multiple regression was run to predict the quality of life from marital status, gender, family status, patient's socioeconomic status, types of strokes, types of aphasia, and comorbidities. These variables statistically significantly predicted quality of life {F(13,120)=10.366, p&lt;0.001}. All variables cause 47.8% (Adj. R2=0.478) variance in stroke-specific quality of life in aphasia patients. Conclusion: The male gender, married marital status, middle and upper socioeconomic status, ischemic stroke compared to hemorrhagic stroke, fluent aphasia, and cardiac disease compared to other comorbidities positively affect the quality of life in post-stroke aphasia patients. However, age and the family system did not show any impact on the quality of life. Keywords: aphasia; diabetes; quality of life; stroke

Effects of baclofen administered to reduce muscle spasm on balance maintenance, gait ability and quality of life in stroke patients

This study aimed to investigate the impact of Baclofen on balance, gait, functional independence, and quality of life in ischemic stroke patients. Thirty patients diagnosed with ischemic stroke by a rehabilitation medicine specialist were randomly assigned to either an experimental group that underwent exercise therapy in conjunction with Baclofen or a control group that received conventional exercise therapy without Baclofen. In this study, Berg Balance Scale, Timed Up and Go, and 10-Meter Walk Test were used to evaluate balance and walking ability. Functional Independence Measure was employed to assess functional independence, and Stroke-Specific Quality of Life was used to evaluate the quality of life. The experimental results revealed statistically significant improvements in all evaluation measures for both groups when comparing post-test to pre-test. However, in comparisons between groups, all test items in the experimental group that combined Baclofen with exercise therapy were significantly higher than those in the control group. In conclusion, these results suggest that integrating Baclofen into exercise therapy rehabilitation programs could be a promising approach to enhance recovery outcomes for patients recovering from ischemic stroke.

Cultural adaptation and validation of the Arabic version of the short 12-item stroke-specific quality of life scale.

Given the excessive length and inconsistent validity of the existing long stroke-specific quality of life (SS-QOL) scales, there is a need to validate a shorter measuring tool. The aim of this study was to validate the Arabic version of the short 12-item SS-QOL (SS-QOL-12-AR) and examine its validity measures and psychometric properties. Additionally, the study aimed to assess the QOL after stroke and identify the sociodemographic and clinical factors that influence it in Lebanon. A cross-sectional study was conducted. The SS-QOL-12-AR structure was validated, and its reliability and internal consistency were assessed. The scale's specificity and sensitivity were evaluated and then compared with those of other SS-QOL scales. The correlation between each item and the overall scale were examined, and its convergent validity was evaluated. A total of 172 stroke survivors were included. The SS-QOL-12-AR structure was validated with a solution of two factors, with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.850 and a significant Bartlett's test of sphericity (p < 0.001). The Cronbach's alpha of the scale was 0.917. According to ROC curve analysis, the optimal cut-off point for distinguishing between lower and better QOL was 32.50. At this cut-off, the sensitivity and specificity were 70.0% and 71.2%, respectively. The area under the curve was 0.779 (95% CI 0.704-0.855, p < 0.001). The SS-QOL-12-AR demonstrated a strong and highly significant correlation with existing versions of the SS-QOL, confirming its convergent validity. 61.6% of stroke survivors had a lower QOL, which was significantly associated with poor stroke prognosis, increased physical dependence, current smoking, and alcohol abstinence. The SS-QOL-12-AR exhibits strong validity and reliability, demonstrating excellent psychometric properties. The scale holds potential for application in clinical practice and research settings, enabling the measurement of stroke-related consequences and evaluation of management outcomes.

The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye.

The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Measurement Properties of the Stroke-Predischarge Occupational Therapy Assessment.

There is no comprehensive predischarge occupational therapy assessment tool in South Korea. The objective of this study was to determine Stroke-Predischarge Occupational Therapy Assessment (S-POTA) validity and reliability. Twenty-seven occupational therapists (OTs) assessed 97 patients with stroke. Concurrent validity was evaluated by comparing S-POTA scores with stroke-specific quality of life (SS-QOL). Discriminant validity was evaluated by comparing S-POTA scores between outpatient and readmitted groups, and a receiver operating characteristic analysis was conducted. The test-retest was conducted twice in 20 patients, and the inter-rater test was conducted with two OTs per patient. S-POTA positively correlated with SS-QOL. S-POTA rating differs significantly across outpatients and readmitted groups. All S-POTA areas under curve values ranged from .70 to .85, and cut-off points were derived. Cronbach's α for internal consistency was .953, the intraclass correlation coefficient for test-retest was .990, and .987 for inter-rater reliability. The results suggest S-POTA is a reliable tool for efficient implementation of discharge planning.

Impact of Botulinum Toxin Along with Task-Specific Training in Post-Stroke Quality of Life in Focal Hand Dystonia

Objective: To investigate the impact of BOTOX, along with task-specific training, on focal hand dystonia in post-stroke patients and to determine the correlation between quality of life and motor outcomes in upper extremity dystonic patients. Methodology: A quasi-experimental involving 20 patients, study was conducted at Holy Family Hospital (HFH), Chambeli Institute of Rehabilitation in Rawalpindi, and Neurocounsel Clinic in Islamabad. A convenient sampling technique was utilized to select participants for inclusion in the study. Assessments were conducted at four time points: baseline (0 weeks), 4 weeks, 8 weeks, and 12 weeks. The assessment tools used were the Abductor Digiti Minimi Abduction (ADDA) test, Modified Ashworth Scale (MAS), and Stroke-Specific Quality of Life (SS-QoL) questionnaire. Repeated measures ANOVA was employed to analyze mean differences in data across various weeks. The associations between scales were evaluated using Spearman's rho and Pearson correlation coefficients, based on different variables. Results: The mean age was 42.7 ± 10.45 years. The study included 14 males and 6 females. Repeated measures ANOVA indicated a significant difference between MAS scores for upper extremity and quality of life in post-stroke dystonic patients, with a p-value of 0.001**. A strong positive correlation coefficient was found between MAS and SS-QoL through Spearman's correlation analysis, with a p-value of less than 0.05. Conclusion: The administration of Type a Botulinum toxin, coupled with task-specific training, not only exhibited improvements in upper limb motor outcomes but also in the quality of life of focal hand dystonic patients after a stroke.

Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study.

Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. In a cross-sectional study, adult patients (≥ 18years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when thePSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.