Predictive Validity and Responsiveness of the Functional Ambulation Category in Hemiparetic Patients After Stroke

Effects of an inpatient physical rehabilitation program on body temperature distribution and functionality in individuals with stroke sequel

PURPOSE

About 60% of patients who had a stroke present sensory deficit, especially sensation of cold in the affected limb. Although unpleasant, this sensation has been little explored. The aim of this study was to assess the distribution of body temperature before and after a rehabilitation program and its association with functionality in individuals with stroke sequels.

MATERIALS AND METHODS

This experimental study included 18 patients whose thermal images were captured by an infrared sensor for analysis in 8 regions of interest. Volunteers also underwent functionality tests before and after participating in an inpatient rehabilitation program.

RESULTS

One third of the participants perceived temperature difference between limbs, tough mean discomfort was low (<2 on a scale of 1-10). After the program, patients presented better agility (p < 0,001), less movement impairment (p < 0,001), and better balance (p = 0,03). They exhibited slightly lower skin surface temperature in the affected hemisphere, and this persisted after the intervention. Nevertheless, this did not affect functional performance, as there was no difference in functionality among patients with or without the sensation of cold in the affected side.

CONCLUSION

The inpatient rehabilitation program did not alter the observed superficial temperature difference between body hemispheres but improved physical function of patients.

Effects of a subacute high-intensity rehabilitation program in older adult inpatients following intramedullary nailing for hip fractures

BACKGROUND

Subacute high-intensity rehabilitation programs play an important role in improving impairments and functional limitations in older adults who undergo hip fracture surgery. However, the effects of subacute high-intensive rehabilitation after intramedullary nailing have not been conclusively verified.

OBJECTIVE

This study aimed to determine the effects of subacute high-intensity rehabilitation on pain, motor function, and activities of daily living (ADL) in older adult inpatients after intramedullary nailing for hip fractures.

METHODS

This study included 37 older adult inpatients who had undergone intramedullary nailing for hip fractures at a restorative rehabilitation facility. All patients participated in a subacute high-intensity rehabilitation program consisting of 208 sessions (6-8 sessions/day, 30 min/session, 7 days/week) over 4 weeks during hospitalization. Dependent variables including pain, lower extremity muscle strength, balance, functional ambulation ability, and ADL, were assessed using the Numeric Rating Scale (NRS), Manual Muscle Testing (MMT), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and Modified Barthel Index (MBI), respectively. A paired t-test was used for statistical analysis.

RESULTS

The subacute high-intensity rehabilitation program resulted in significant differences in all dependent variables, including NRS, MMT, BBS, FAC, and MBI scores between the pre- and post-intervention (p < 0.001 to = 0.037).

CONCLUSION

This program improved physical function and independence in older adults after intramedullary nailing for hip fractures. Early implementation of such programs is recommended to enhance recovery, reduce hospital stays, and facilitate a quicker return to daily life.

Recumbent FES-Cycling Exercise Improves Muscle Performance and Ambulation Capacity in Hospitalized Patients: A Randomized Controlled Trial

BACKGROUND

Acquired muscle weakness is a prevalent complication during hospitalization. Supportive technologies, such as functional electrical stimulation cycling (FES-cycling), are increasingly recognized as a tool with the potential to improve physical exercise in patients constrained to bed rest.

METHODS

In this randomized clinical trial, patients admitted to a high-complexity ward exhibiting clinical signs of muscle weakness (e.g., report of loss of strength, gait, or balance deficit due to weakness or restriction to bed) were enrolled. Participants were randomly allocated to a recumbent high-intensity, low-volume FES-cycling exercise or a control group. The primary outcomes measured were torque, power output, stimulation cost (neuromuscular efficiency), and ambulation capacity.

RESULTS

The analysis included 16 patients (eight in each group). Postintervention, the FES-cycling group presented a greater increase in both absolute (4.25 ± 3.15 vs. 0.04 ± 3.49 Nm, p = 0.02) and percentage torque (117 ± 88 vs. 8% ± 53%, p < 0.01) compared to the control. Similarly, the FES-cycling group presented higher absolute (3.91 ± 2.25 vs. 0.57 ± 1.82 watts, p < 0.01) and percentage power (61 ± 36 vs. 10% ± 23%, p < 0.01), along with a higher absolute (-2903 ± 2598 vs. -523 ± 1319 μC/watt, p = 0.03) and percentage stimulation cost (-33 ± 18 vs. -6% ± 1 8%, p = 0.01). Additionally, enhanced ambulation capacity was observed in the FES-cycling group, with 6 patients showing improvement versus 2 in the control group (p = 0.03).

CONCLUSIONS

Recumbent high-intensity, low-volume FES-cycling exercise increased muscle strength, power, and neuromuscular efficiency in hospitalized patients with muscle weakness. Improvements in ambulation capacity were also noted, supporting the intervention potential.

Preliminary results of orthogeriatric management in patients with hip fracture: Impact on functional recovery and survival

INTRODUCTION

Orthogeriatric units have demonstrated improvements in functional recovery and survival in older adults hospitalised for hip fracture. The aim of this study is to present preliminary results of the interdisciplinary orthogeriatric activity at the Surgical Specialty Centre, Hamad Medical Corporation (Doha, Qatar).

METHODS

A prospective observational study was designed to evaluate the activity of the orthogeriatric unit in hip fracture patients between 2022 and 2024.

RESULTS

100 patients were recruited with a mean age of 74.2 (SD 7.8) years, 57% were men, and a mean age-adjusted Charlson comorbidity index (CCI) of 4.4 (SD 1.7). Surgical delay was 1.8 (SD 3.4) days, with only 16% of the total undergoing surgery in more than 48h. The length of stay (LOS) of the enrolled sample was 15.8 (SD 23.1) days. In terms of functional recovery, the Barthel Index (BI) score increased significantly from 34.8 (SD 14.8) points on the first day of hospital admission to 55.7 (20.5) points at discharge, p<0.001; with a relative functional gain of 38.5 (SD 34.3) % and a rehabilitation efficiency (Heinemann Index above 50%) of 34.5%. The Heinemann Index calculated six months after discharge showed a rehabilitation efficiency of 60% of the total sample. Only one patient (1%) died in hospital and 3 (6%) had died at 6 months. Cox regression showed that CCI and LOS increased the risk of mortality, whereas BI score decreased it.

CONCLUSIONS

The introduction of an interdisciplinary orthogeriatric team in Qatar led to improvements in nutritional status, functional recovery and survival.

Can technology-based gait training result in relevant changes of ambulatory function in people with chronic, neurological diagnoses? A longitudinal, cohort study

OBJECTIVES

To determine whether a six-months technology-based gait training results in relevant changes of ambulatory function in a chronic stage after a neurological event. Further, changes in quality of life will be assessed as well as the willingness to pay for technology-based gait training.

DESIGN

Single-center, longitudinal cohort study.

SETTING

One outpatient center specialized in neurological rehabilitation.

PARTICIPANTS

Adults with a chronic neurological diagnosis resulting in residual gait impairments.

INTERVENTION

Six month of technology-based gait training (with Lokomat, Andago, or C-Mill) with a minimal number of trainings of 10 per month.

PRIMARY & SECONDARY OUTCOME MEASURES

Walking performance assessed with the 10-meter walk test, 6-minute walk test and functional ambulation category; quality of life assessed with the EQ-5D-3L and WHODAS 2.0; predicted market share and willingness to pay assessed with a choice-based conjoint analysis survey and direct question.

RESULTS

27 participants completed three months while 20 completed six months of training. Comparing variables at baseline (BL) and after three (M3) and six (M6) months of training, both the walking speed in the 10-meter walk test (BL: 0.46m/s, M3: 0.54 m/s M6: 0.57 m/s) and the distance covered in the 6-minute walk test (BL: 149m, M3: 155m, M6: 159m) showed improvements that were below the clinically relevant change. The quality of life did not indicate a change. The direct willingness to pay was at CHF 80 which resulted in an estimated market share of 55% based on the conjoint analysis.

CONCLUSION

The observed, small changes in ambulatory function in patients with chronic, neurological impairments and the willingness to pay indicates the need to provide technology-based gait training in an outpatient setting.

Reliability and validity of the Japanese version of the Gait Assessment and Intervention Tool

This study aimed to translate the Gait Assessment and Intervention Tool (G.A.I.T.) into Japanese and evaluate its reliability and validity. Translation and adaptation followed established cross-cultural guidelines. To assess reliability and validity of Japanese versions of the G.A.I.T, a cohort design was implemented. Sixty-three stroke patients participated in interrater reliability and validity assessments, and 50 patients in the test-retest evaluation. Reliability and validity were evaluated using intraclass correlation coefficients (ICC) and Pearson's correlation coefficients, respectively. The Japanese G.A.I.T. demonstrated excellent reliability in interrater (ICC = 0.975) and retest (ICC = 0.988). Significant correlations were observed between the G.A.I.T. scores and Fugl-Meyer Assessment-Lower Extremity (r = -0.774), Functional Ambulation Category (r = -0.720), Functional Independence Measure motor scores (r = -0.647), functional independence measure mobility (r = -0.688), and comfortable walking speed (r = -0.839). These findings suggest that the Japanese version of the G.A.I.T. is a reliable and valid assessment tool for evaluating gait coordination in Japanese stroke survivors.

IMPROVING THE PREDICTION OF FUNCTIONAL RECOVERY IN OLDER ADULTS WITH STROKE IN GERIATRIC REHABILITATION USING AN INERTIAL MEASUREMENT UNIT COMBINED WITH THE UTRECHT SCALE FOR EVALUATION OF REHABILITATION

Background

Prediction of functional recovery in older adults recovering from stroke is typically based on observational scales, such as the Utrecht Scale for Evaluation of Rehabilitation (USER). Objectively measuring postural sway using inertial measurement devices (IMU) may complement or improve conventional approaches. The aim of this study was to evaluate whether integrating an IMU with USER data enhances the accuracy of predicting functional recovery at discharge.

Methods

This prospective cohort study included older adults (≥ 65 years) recovering from stroke. Postural sway was assessed using an IMU during 2 different balance conditions and analysed using principal component analysis (PCA). Using 3 different regression models, percentage explained variance was compared to assess predictive performance on functional recovery of USER vs an IMU.

Results

The 71 patients included had a mean age of 78 (SD 7.6) and a median time since stroke of 16 days (IQR 19-60). Of the 71 patients, 12 (16.9%) were unable to perform balance condition 2 due to insufficient balance. Of 35 postural sway features displaying reliability for both balance conditions, 12 were selected for PCA. Incorporation of principal components for both balance conditions in the final model increased the explained variance compared to a model in which only USER-mobility at admission was used to predict delta-USER at discharge (R 2 = 0.61 vs 0.30).

Conclusions

Sitting and standing balance as measured by an IMU improves the prediction of functional recovery at discharge compared to USER alone.

Pain Management in Frail Hip Fracture Patients Receiving Palliative Care: A Descriptive Study

CONTEXT

Adequate pain management in frail hip fracture patients receiving nonoperative treatment has been identified as an important issue. Palliative care could be an option to consider to ensure a comfortable end of life for these patients.

OBJECTIVES

This study aimed to describe pain relief in frail patients admitted to palliative care following a hip fracture, and the pain management strategies used among them.

METHODS

This descriptive monocentric observational study included a retrospective phase, based on a review of medical records, and a prospective phase, by direct observation of patients. Data collection took place within the first five days following admission to palliative care. Pain was assessed with the ALGOPLUS scale. Data on pharmacological and nonpharmacological pain management strategies were collected from medical records.

RESULTS

A total of 61 patients with a mean age of 87 years (±7) and severe frailty were included. The proportion of patients with pain at rest ranged from 30% on day 1 to 10% on day 5, and from 71% to 32% during mobilization. The mean oral morphine equivalent daily dose administered ranged from 13.1 mg (±10.7) to 21.9 mg (±16.2). On average, 75% of patients received co-analgesics, and nonpharmacological strategies were applied in 33% of them over the five-day of data collection period.

CONCLUSION

Pain remains an issue in frail patients with a nonoperated hip fracture, despite the provision of palliative care. Optimizing pain management, particularly ahead of mobilization, remains a crucial and underexplored area to address for this population.

Characterization, Outcomes, and Time to Event Predictors of Urinary Tract Infections Acquired During Postacute Stroke Inpatient Rehabilitation: A Comprehensive Cohort Study

OBJECTIVES

To (1) compare baseline clinical and demographic characteristics of postacute stroke inpatients who were diagnosed with first-time urinary tract infection (UTI) versus inpatients who were not; (2) compare rehabilitation outcomes between both groups; and (3) examine associations between time to UTI event and risk factors.

DESIGN

Retrospective observational cohort study.

SETTING

Institution for inpatient neurologic rehabilitation.

PARTICIPANTS

Inpatients (n=1683) admitted within 3 months poststroke to a rehabilitation facility between 2005 and 2023.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Functional independence measure (FIM), functional ambulation categories (FACs) at admission. Cox proportional hazard models analyzed the association between UTI event timing and risk factors.

RESULTS

Of the (n=1683) included patients, 196 (11.6%) experienced a UTI. In 32.1% of cases, the UTI occurred during the first week after admission to rehabilitation and 47.9% of UTIs occurred during the first 2 weeks. The median (interquartile range) time to UTI was 16 (5-37) days since admission. Most common germs were Escherichia coli (40.5%), Klebsiella pneumoniae (23.7%), and Pseudomonas aeruginosa (6.4%). Patients who acquired a UTI had older age, higher stroke severity, higher proportion of dysphagia, hypertension, neglect, bilateral affectation, atrial fibrillation, hemiplegia, lower levels of functional independence, and lower FAC. We identified no differences in gender, type of stroke (ischemic or hemorrhagic), time to admission, aphasia, diabetes, dyslipidemia, chronic obstructive pulmonary disease, dominant side affected, and educational level between both groups. Patients with UTI presented significantly poorer rehabilitation outcomes including lower discharge FIM and FAC, larger length of stay, lower FIM efficiency, and decreased FIM effectiveness. Multivariable Cox proportional hazards identified hypertension HR=1.60 (1.13-2.27), admission FIM HR=0.98 (0.97-0.99), admission body mass index HR=0.96 (0.93-0.99), and admitted with catheter HR=1.80 (1.22-2.64) as significant predictors of time to first UTI event (Concordance-index=0.754).

CONCLUSIONS

UTIs identification, characterization, and predictive factors can support postacute stroke mitigation strategies to minimize UTI-related complications and optimize rehabilitation outcomes.

Efficacy of telerehabilitation in inpatients with stroke: A pilot randomized controlled trial

Background

Telerehabilitation could be a substitution for regular rehabilitation in an epidemic situation. Furthermore, there is no evidence of the effectiveness of telerehabilitation in stroke inpatients.

Objectives

To assess the effects of telerehabilitation on daily life function, mobility, and quality of life in stroke inpatients.

Methodology

Inpatients with stroke were randomly assigned to either the telerehabilitation group (n = 12) or the control group (n = 12) for 10 treatment sessions.

Results

No significant differences were found in the outcome measures. However, both groups showed significant improvements in the Modified Barthel Index and Postural Assessment Scale for Stroke scores. The telerehabilitation group improved in Functional Ambulation Categories scores, while the control group showed improvement in Patient Health Questionnaire-9 scores.

Conclusion

This pilot study suggests that telerehabilitation may be a feasible alternative during the pandemic. However, due to the small sample size and the potential influence of natural recovery, the findings remain preliminary. Larger studies are necessary to more definitively assess the effectiveness of telerehabilitation compared to conventional rehabilitation.

A wearable ankle-assisted robot for improving gait function and pattern in stroke patients

BACKGROUND

Hemiplegic gait after a stroke can result in a decreased gait speed and asymmetrical gait pattern. Normal gait patterns and speed are typically the ultimate goals of gait function in stroke rehabilitation. The purpose of this study was to investigate the immediate effects of the Gait Enhancing and Motivating System-Ankle (GEMS-A) on gait function and pattern in stroke patients with hemiplegia.

METHODS

A total of 45 eligible participants was recruited for the study. The experimental protocol consisted of overground gait at a comfortable speed under 2 conditions: free gait (FG) without robot assistance and robot-assisted gait (RAG). All measurement data were collected using a 3D motion capture system with 8 infrared cameras and 2 force plates.

RESULTS

Patients in the RAG condition had significantly increased gait speed, cadence, gait symmetry, and peak flexion angle and moment of the paretic ankle joint compared to the FG condition. Moreover, the RAG resulted in higher propulsive forces by altering peak ankle force generation compared with the FG.

CONCLUSION

The findings of this study provide evidence that a newly developed wearable ankle-assist robot, the GEMS-A, is a potentially useful walking assist device for improving gait function and pattern in stroke patients with hemiplegia.

TRIAL REGISTRATION

NCT03767205 (first registration date: 02/12/2018, URL: https://register.

CLINICALTRIALS

gov ).

Comparing the Postural Assessment Scale for Stroke and Berg Balance Scale for predicting community walking ability at discharge in subacute stroke: a prospective cohort study

Background

Balance assessment is crucial for predicting community ambulation outcomes in subacute stroke patients undergoing rehabilitation. This study aims to compare the accuracy of the Postural Assessment Scale for Stroke Patients (PASS) and the Berg Balance Scale (BBS) in predicting community walking ability at discharge from rehabilitation.

Methods

This prospective cohort study included 47 stroke patients admitted to a 4-week inpatient rehabilitation program. Patients were assessed with PASS and BBS at admission. Discharge assessments included the Functional Ambulation Categories and 6-Min Walk Distance tests. Statistical analysis involved calculating the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, likelihood ratios, and cut-off scores.

Results

PASS and BBS demonstrated excellent predictive accuracy, with AUC values of 0.955 (95% CI [0.850-0.994]) for PASS and 0.991 (95% CI [0.906-1.000]) for BBS. Cut-off scores were >28 for PASS and >46 for BBS. Sensitivity was high for both (94.44%, 95% CI [72.7-99.9]), while BBS had superior specificity (96.43%, 95% CI [81.7-99.9]) compared to PASS (85.71%, 95% CI [67.3-96.0]). BBS also had a higher positive likelihood ratio (26.44 vs. 6.61). The difference in AUC values was non-significant (p = 0.093).

Conclusions

PASS and BBS assessed at admission are highly accurate tools for predicting community ambulation at discharge in subacute stroke patients, with BBS demonstrating a slight advantage, particularly in its positive predictive value. These findings support the use of both scales to guide rehabilitative clinical decision-making.

Effect of intensive nutritional support on functional recovery in subacute stroke: A randomized, multicenter, single-blinded trial

BACKGROUND

Nutrition in the subacute phase of stroke may be a critical factor in functional recovery and post-stroke mortality. Nevertheless, the issue of intensive nutritional support for people with subacute stroke remains insufficiently explored.

OBJECTIVES

This study investigated the effects of intensive nutritional support during rehabilitation on functional recovery in the subacute phase of participants with a first-ever stroke.

METHODS

This randomized, single-blinded, parallel-designed study is part of the Korean Stroke Cohort for Functioning and Rehabilitation, a 10-year long-term follow-up of stroke participants. A total of 91 first-ever stroke participants were recruited from 5 hospitals and randomly allocated to the intensive nutrition (IN) group (n = 43) or the conventional nutrition (CN) group (n = 48). All participants received the same comprehensive inpatient stroke rehabilitation. During the three-week intervention period, the IN group received an additional 500 kcal daily by intravenous nutritional infusion, while both groups received usual nutrition. Functional assessments and nutritional status were evaluated at baseline, post-intervention, and 6 months after stroke onset. Repeated measures ANOVA and post-hoc analyses were used for intention-to-treat analysis.

RESULTS

Baseline characteristics were not significantly different between the groups. The dropout rate was significantly higher in the IN group (20 %) than in the CN group (2 %). A repeated measures ANOVA demonstrated significant interactions between time and intervention for the modified Barthel index (P = 0.02, η² = 0.05, small) and nutrition risk screening 2002 (P = 0.03, η² = 0.03, small), indicating significant improvements in the IN group. The modified Barthel Index, Nutrition Risk Screening 2002, and Functional Ambulation Category demonstrated significantly higher changes in the IN group compared to the CN group between time points.

CONCLUSIONS

Intensive nutritional support during comprehensive rehabilitation could provide additional functional improvement in subacute stroke participants. However, alternative methods of intensive nutrition should be explored, as intravenous nutritional infusions were not well-tolerated by some participants.

CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT04259307.

Hands-free Atalante exoskeleton in post-stroke gait and balance rehabilitation: a safety study

BACKGROUND

Stroke often results in gait dysfunction, impairing daily activities and quality of life. Overground robotic exoskeletons hold promise for post-stroke rehabilitation. This study primarily aimed to assess the safety of hands-free Atalante exoskeleton training in post-stroke subjects, with a secondary aim to assess gait and balance.

METHODS

Forty subjects (10.2 ± 12.1 months post-stroke) with gait dysfunction (Functional Ambulation Category [FAC] score ≤ 3) underwent five training sessions over three weeks with a hands-free exoskeleton (Atalante, Wandercraft, France). Safety, the primary outcome, was evaluated by the number and severity of adverse events (AEs), judged by an independent clinical evaluation committee (CEC). A usability test was performed during the fifth training session followed by the exoskeleton use questionnaire. Gait and balance were assessed pre/post-training via walking capacity score (FAC), gait speed by 10-meter walk test (10MWT), walked distance by 6-minute walk test (6MWT), and balance by Berg Balance Scale (BBS). Spasticity was assessed with the Modified Ashworth scale. Anxiety and depression were quantified using the Hospital Anxiety and Depression Scale. Safety outcomes were analyzed using the Wilson, Lee and Dubin methods for proportions, and occurrence rates were computed. Within-group differences were compared using Wilcoxon, McNemar, and Friedman tests, with significance set at P < 0.05.

RESULTS

Thirty-one subjects completed the training sessions, while nine discontinued. The study reported two serious adverse events (SAE) (vertigo, dysarthria) and six AEs, with the CEC concluding that no SAE was linked to the device/study procedure. The average AE rate per session was 2.5 ± 1.4%, including four events possibly linked to the device/study procedure (knee pain [n = 1], skin lacerations [n = 3]), classified as negligible or minor by the CEC. A high proportion (82.6%) successfully completed the usability test and reported satisfaction (90%) on the exoskeleton use questionnaire. For gait and balance, favorable changes were observed in FAC, 10MWT, 6MWT, and BBS scores Post-training (p < 0.05, respectively). Spasticity, anxiety, and depression remained unchanged.

CONCLUSIONS

This study indicates that the hands-free Atalante exoskeleton is safe, feasible, and well-tolerated for gait and balance rehabilitation in post-stroke subjects, warranting larger randomized controlled trials to assess its efficacy.

TRIAL REGISTRATION

Evaluation of the Use of the Atalante Exoskeleton in Patients Presenting an Hemiplegia Due to Cerebrovascular Accident (INSPIRE) trial was registered at ClinicalTrials.gov (NCT04694001, registered on 20201231).

Postural Sway Measurement Using a Body-Worn Movement Sensor in Clinical Stroke Rehabilitation: Exploring Sensitivity to Change and Responsiveness

IMPORTANCE

During rehabilitation, the balance of a person with stroke is commonly monitored using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test. These tests evaluate the ability to maintain balance in an upright position while performing tasks. Currently, clinical practice lacks an adequate assessment of balance impairments like the increased postural sway poststroke. Integrating postural sway measurement with a body-worn inertial measurement unit could offer clinicians an objective and rapid measurement method.

OBJECTIVE

Sensitivity to change and responsiveness of postural sway measurement during stroke rehabilitation were explored.

DESIGN

A longitudinal study was conducted.

SETTING

Data were collected in 5 rehabilitation centers.

PARTICIPANTS

94 people with stroke were included in the study.

INTERVENTION

Sensitivity to change was evaluated by comparing the percentages of participants who exceeded the minimal detectable change for both the conventional and inertial measurement unit tests. Responsiveness was assessed through hypotheses testing, utilizing both a criterion approach (external criterion: a 5-point retrospective Global Rating of Change score) and a construct approach.

RESULTS

At discharge, only 3.2% to 23.9% of the participants showed genuine improvement (ie, had a lower postural sway) on the inertial measurement unit test, compared to 33% to 60% on the conventional tests. In total, 67.4% of the hypotheses were rejected.

CONCLUSIONS

The sensitivity to change and responsiveness of postural sway measurement in people with stroke are limited. Restoring balance to achieve functional independence is not necessarily dependent on, or associated with, the level of postural sway. At present, integrating postural sway measurement into clinical stroke rehabilitation seems to provide no added value for monitoring balance.

RELEVANCE

A novel approach to balance assessment in clinical stroke rehabilitation was investigated. It was found that while most participants improved in terms of functionality and independence, only a small percentage exhibited a significant change in postural sway. Therefore, postural sway may not effectively serve as an indicator of improved movement quality. This insight is crucial for both researchers and clinicians involved in neurorehabilitation.

What are the Key Challenges Faced by Spinocerebellar Degeneration and Multiple System Atrophy Patients in Daily Life?: Insights from a Comprehensive Questionnaire Survey in Japan

BACKGROUND

Patients with spinocerebellar degeneration (SCD) and multiple system atrophy (MSA) encounter various challenges in daily life due to ataxia and other symptoms. A comprehensive understanding of their diverse needs can improve the effectiveness of rehabilitation interventions.

OBJECTIVE

This study aims to identify the daily challenges faced by patients with SCD and MSA in Japan, focusing on differences between ambulatory and non-ambulatory patients.

METHODS

A postal survey was conducted from March to May 2023, targeting members of the Japanese Society of Ataxia Patients diagnosed with SCD and MSA. The questionnaire assessed respondent demographics and symptoms impacting daily life.

RESULTS

From the 283 responses received, 152 were deemed valid for analysis. Non-ambulatory patients reported significantly more difficulties across multiple items in the activities domain. Furthermore, subjective unsteadiness, difficulty speaking, and increased fall risk were identified as having the most significant impact on daily life, regardless of walking ability.

CONCLUSION

These findings highlight the need to adapt rehabilitation approaches for patients with SCD and MSA as their disease progresses, emphasizing comprehensive assessment methods and multidisciplinary care to enhance their quality of life.

Articulated ankle-foot orthoses associated with home-based task-specific training improve functional mobility in patients with stroke: a randomized clinical trial

INTRODUCTION

We compared fixed and articulated ankle-foot orthoses (AFOs) in home-based mobility tasks to assess short-term mobility, dynamic balance, quality of life, anxiety/depression, disability level, stroke severity, autonomy, human functioning, and patient satisfaction.

METHODS

This was a two-arm, parallel-group, randomized controlled trial with concealed allocation, assessor blinding, and a complete case analysis involving patients with chronic stroke. The participants were randomized into two groups: fixed (n = 24) and articulated (n = 23) AFOs. The AFOs were custom-fabricated, and both groups performed four-week home-based mobility tasks five days weekly. Primary outcome measures included changes in balance and mobility assessed using the Tinetti Performance-Oriented Mobility Assessment (POMA), Timed Up and Go (TUG) test, and Functional Ambulation Category (FAC). Secondary outcomes included quality of life, anxiety/depression, disability, stroke severity, autonomy, human functioning, and patient satisfaction.

RESULTS

In a between-group comparison, after adjusting for age, sex, stroke severity, and thrombolysis, the articulated AFO group showed better performance in the TUG test (p = 0.020; d = 0.93), POMA-Gait (p = 0.001; d = 0.53), POMA-Total (p = 0.048; d = 0.98), and FAC (p = 0.003; d = 1.03) than the fixed AFO group. Moreover, significant difference was noted in human functioning (moving around using equipment)between the groups (p = 0.047; d = 92).

CONCLUSION

A program involving home-based mobility tasks and articulated AFOs improved functional mobility after stroke.

Mobility scale for acute stroke patients (MSAS): construct validity and reliability of the Italian scale

BACKGROUND

The Mobility Scale for Acute Stroke Patients (MSAS) was developed to discriminate between the lower levels of mobility in acute stroke patients in the first two weeks post-onset.

OBJECTIVE

The present study aims to develop and validate an Italian version of the MSAS.

METHODS

The English version of the MSAS was translated into Italian according to international guidelines. We recruited 58 patients admitted to a rehabilitation facility within 14 days of the stroke onset and administered the MSAS to test the internal consistency, concurrent validity, reliability, and responsiveness of the scale.

RESULTS

As for internal consistency, Cronbach's alpha showed values equal to 0.96, and the alpha deleted analysis indicated that all the items have reason to exist. Concurrent validity showed statistically significant data for all sub-scales. The Italian version of the MSAS showed significant and high inter-rater reliabilities (all ICCs ≥ 0.75). The MSAS also showed excellent test-retest reliabilities (all ICCs ≥ 0.90). The reactivity of the scale, evaluated through the Student's t-test for paired samples on a sub-sample of 32 patients, showed statistically significant improvements over time for all items and the total scale.

CONCLUSIONS

The results show that the scale is stable and reliable both in the evaluation after 24 h and between different operators. High internal consistency and a strong concurrent validity were found. The scale also proved able to detect the improvement obtained by patients following the rehabilitation treatments.

Associations between objective and self-perceived physical activity and participation in everyday activities in mild stroke survivors

BACKGROUND AND PURPOSE

Stroke survivors present limited levels of physical activity (PA) and participation in everyday activities although the specific interaction between PA and participation in these individuals is still uncertain. This study aimed to analyse the relationship between PA and participation in everyday activities among Spanish mild stroke survivors.

METHODS

A total of 130 mild stroke survivors (61.3 ± 12.4 years, 35% female) with preserved walking ability and without cognitive and communication impairments participated in this cross-sectional study involving several rehabilitation centres from Spain. Self-reported levels of PA were reported by the International Physical Activity Questionnaire - short form (IPAQ-SF). Objective PA measures were monitored with the wristband Fitbit Inspire 2, recording the average steps/day and kilocalories/day. Participation and activity satisfaction levels were measured with the Satisfaction with Daily Occupations-Occupational Balance (SDO-OB) and participation retention through Activity Card Sort (ACS).

RESULTS

ACS total score showed a weak correlation with self-reported PA (rho = 0.324) and moderate correlations with kilocalories/day and average steps/day (rho ≥ 0.581), while stronger correlations were found for the ACS subdomain of instrumental activities (rho ≥ 0.640) compared to the subdomains of leisure activities and social participation (rho ≤ 0.454). SDO-OB participation showed moderate correlations with kilocalories/day, and average steps/day (rho ≥ 0.647), and a weak correlation with self-reported PA (rho = 0.303). Weaker correlations were found for SDO-OB satisfaction with objective PA measures (rho = 0.407) and self-reported PA (rho = 0.254). Relationships between variables were explored by calculating Spearman correlation coefficients.

DISCUSSION AND CONCLUSIONS

The objective and self-reported measures of PA in mild stroke survivors have a bilateral relationship with their current participation levels and the retained instrumental activities of daily living. However, the weaker correlations with leisure and social participation may suggest that promoting PA alone without integrating it into daily activities relevant to the stroke survivor may be insufficient to achieve comprehensive goals during rehabilitation programs.

PEMOCS: effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-a randomized, controlled trial

Purpose

Motor-cognitive exergames may be beneficial for addressing both motor and cognitive residual impairments in chronic stroke, however, effective training schedules are yet to be determined. Therefore, this study investigates the effects of a concept-guided, personalized, motor-cognitive exergame training on cognitive functions and gait in chronic stroke survivors.

Methods

In this single-blind, randomized, controlled trial, stroke survivors (at least six-months post-stroke and able to perform step-based exergaming) were allocated either to the intervention (usual care + concept-guided, personalized, motor-cognitive exergame training) or the control group (usual care only). Global cognitive functioning was primarily targeted, while health-related quality of life (HRQoL), cognitive functions, mobility, and gait were evaluated secondarily. Analyses were performed with linear-mixed effect models.

Results

Effects on global cognitive functioning were non-significant, with no differences between responders (participants exhibiting a clinically relevant change) and non-responders (participants exhibiting no clinically relevant change). Among secondary outcomes, the mobility domain of the HRQoL questionnaire, intrinsic visual alertness, cognitive flexibility, working memory, and outdoor walking speed as well as swing width (unaffected side) showed significant interaction effects in favour of the exergame group.

Discussion

Additional exergaming helped maintaining global cognitive functioning and showed encouraging effects in mobility and cognitive outcomes. Responders and non-responders did not differ in adherence, baseline values or age. Enhancing the frequency and intensity of sessions could unlock more substantial benefits. Adopting a blended therapy approach may be key to maximizing positive effects.

Clinical trial registration

clinicaltrials.gov, identifier NCT05524727.

Examination of effect and responder to real-time auditory feedback during overground gait for stroke: a randomized cross-over study

Real-time auditory feedback for overground gait was developed to simulate realistic gait practice. This study aimed to assess the effects of different auditory feedback conditions and identify patients with stroke who might benefit from auditory feedback based on physical function. Twenty patients with stroke participated in three 6-min gait trials: no feedback (control), auditory feedback focused on increasing ankle plantar flexion (ankle trial), and auditory feedback on increasing lower-leg extension angle (leg trial). Physical function was evaluated using the Short Physical Performance Battery (SPPB); gait function was assessed through gait speed, cadence, stride length, and joint motion using inertial sensors before and after each trial. Gait speed (P = 0.001), stride length (P < 0.001), ankle plantar flexion (P = 0.014), and leg extension angles (P = 0.020) improved significantly over time. Interaction effects between time and trial were observed for stride length (P = 0.001) and leg extension angle (P = 0.003). Among the auditory feedback trials, stride length (P = 0.012), length-time difference (P = 0.003), and leg extension angle (P = 0.008) increased significantly in the leg trial compared with the control trial. SPPB scores were independently associated with the benefit from the leg trial (odds ratio: 2.217, 95% confidence interval: 1.152-4.266, P = 0.017). Real-time auditory feedback focused on leg extension angle during gait may enhance gait speed by improving leg extension and optimizing spatial gait strategies.

Long-term functional outcomes in patients with isolated cerebellar infarction: the KOSCO study

Background

There are relatively few reports on the long-term sequential functional recovery and prognosis in patients with cerebellar infarction. The aim of this study was to investigate the long-term recovery of multifaceted functional outcomes up to 36 months after onset and the functional prognosis of isolated cerebellar infarction.

Methods

This study was a retrospective analysis of the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data up to 36 months after onset. Isolated cerebellar infarction was defined as the presence of lesions in the cerebellum without lesions in other brain parenchyma. We assessed multifaceted functional domains, including motor (Fugl-Meyer Assessment, FMA), ambulatory (Functional Ambulation Category, FAC), cognitive (Korean Mini-Mental State Examination, K-MMSE), swallowing (American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, ASHA-NOMS), and language functions (Short version of the Korean Frenchay Aphasia Screening Test, Short K-FAST), using serial measurements. In addition, functional outcome was assessed with the Functional Independence Measure (FIM) up to 36 months after onset.

Results

Among 390 screened isolated cerebellar infarction patients, a total of 183 patients were included in this study. Cognitive (mean[SD] of K-MMSE 27.6 ± 3.6) and swallowing (ASHA-NOMS 6.8 ± 0.7) functions showed significant improvement up to 3 months (p < 0.05). Motor (FMA 98.8 ± 3.8) and language (ASHA-NOMS 6.9 ± 0.4) functions improved significantly up to 6 months (p < 0.05). Furthermore, ambulatory function (FAC 4.7 ± 0.9) and functional independency (FIM 122.2 ± 12.0) continued to improve up to 12 months (p < 0.05). Vascular territory involving superior cerebellar artery, older age, female sex, and greater initial severity were identified as negative independent prognostic factors predicting functional outcome measured by FIM at 12 months after stroke.

Conclusion

The plateau of recovery in multifaceted functional outcomes varied among patients with cerebellar infarction. Functional independence plateaued at 12 months and showed a relatively favorable prognosis up to 36 months after stroke.

Prognostic accuracy of the Stroke Rehabilitation Assessment of Movement (STREAM) scores on admission for walking independence in stroke patients at discharge and one-month follow-up

Gait prediction is critical in optimizing rehabilitation strategies for stroke survivors. This study evaluates the prognostic utility of the Stroke Rehabilitation Assessment of Movement (STREAM) scores, recorded at admission, for predicting walking ability at discharge and one-month follow-up. We assessed 47 stroke patients using STREAM at admission; walking independence was defined using two criteria: a Functional Ambulation Category (FAC) score >  3 and a 10-Meter Walk Test (10-MWT) speed ≥  0.4 m/s. The predictive validity of STREAM scores was analyzed using the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and cut-off values were computed. The analysis revealed that a STREAM score above 38 at admission significantly predicted independent gait by discharge, evidenced by a high AUC of 0.897. At the one-month follow-up, a cut-off score of 29 continued to predict walking independence, with an AUC of 0.987. The subscores further enhanced predictive accuracy and highlighted the effectiveness of the STREAM assessment as a robust predictor of independent walking in stroke patients. These findings suggest the practicality of using STREAM scores to predict walking independence, which can guide the planning of more effective rehabilitation interventions. Trial registration TCTR20240323004 at www.thaiclinicaltrials.org.

Five-Year Functional Outcomes Among Patients Surviving Aneurysmal Subarachnoid Hemorrhage

Importance

Longitudinal changes in functional levels can provide valuable information about disability. However, longitudinal outcomes in aneurysmal subarachnoid hemorrhage (aSAH) have not been well reported, which could provide insight into appropriate management and information for patients experiencing disability.

Objective

To investigate the 5-year prognosis and functional outcomes of patients with aSAH.

Design, Setting, and Participants

This retrospective cohort study used data of patients with aSAH from the Korean Stroke Cohort for Functioning and Rehabilitation study up to 5 years after onset. Data were collected from August 2012 through May 2015 in 9 different hospitals in Korea. Data were analyzed from September 2023 through January 2024.

Exposure

Patients with aSAH surviving at least 7 days after onset.

Main Outcomes and Measures

Assessments were performed serially from 7 days to 5 years after onset. Prognosis, measured by the modified Rankin scale (mRS) in terms of positive outcome (mRS score of 0 or 1), and mortality were analyzed. In addition, sequential functional outcomes were assessed using the Functional Independence Measure (FIM) in survivors of aSAH at 5 years after onset. Multiple imputation method was used to handle missing data. Wilcoxon signed-rank test and paired t test were used to analyze differences in functional measurements between each follow-up period. Additionally, a generalized mixed-effects model was used to analyze the longitudinal trajectory of the FIM.

Results

A total of 338 patients with aSAH (mean [SD] age, 56.3 [13.0] years; 207 female [61.2%]) were included. Among survivors of aSAH at 7 days, the 5-year mortality rate was 8.3% (28 participants). The distribution of mRS significantly improved until 4 years and then plateaued, with 180 (53.3%) and 77 (22.8%) patients reporting an mRS score of 0 and 1, respectively. FIM showed a significant improvement up to 4 years (mean [SD] score, 118.9 [18.7]) and then plateaued.

Conclusions and Relevance

In this cohort study, the functional outcomes in patients with aSAH continued to improve up to 4 years after onset, with the majority of participants showing favorable outcomes without significant disability, suggesting that proper long-term assessment is needed and appropriate management should be emphasized to maximize potential outcomes of patients with aSAH.

Comparison of Functional Electrical Stimulation Cycle vs. Conservative Rehabilitation on Functional Status and Muscle Features in Stroke Patients

BackgroundFunctional Electrical Stimulation (FES) Cycle is used in the rehabilitation of stroke.ObjectiveThe aim of this study is to investigate the effects of CR and FES cycle therapy on the functional status and muscle features in stroke patientsMethodsThe 1st Group(n = 15) received only CR for 6 weeks, and the 2nd Group(n = 15) received FES cycle 3 days a week for 4 weeks in addition to the CR treatment. Brunnstrom recovery staging(BRS), Fugl-Meyer lower extremity evaluation(FME); Berg Balance Scale(BBS), Functional Ambulation Classification(FAC), Barthel Index(BI), Fatigue Severity Scale(FSS), 6 min walk test(6mWT), knee extensor and knee flexor muscle strengths(KEMS, KFMS) in both groups were assessed before and after treatment(6th week). Pennate angle(PA) and rectus femoris muscle thickness(RFT) were measured.ResultsSignificant improvement was detected in BBS, FAS, BI, FME, 6mWT, KEMS, RFT scores after intra-group treatment compared to before treatment in both groups. Only the 2nd Group showed a significant difference in KFMS, FSS, BRS lower extremity, PA values after treatment compared to before. No significant superiority of the groups over each other was detected.ConclusionsCR and FES Cycle contribute to the improvement of the functional status of the patients, but their superiority over each other was not observed.

Long-term functional outcomes among patients surviving aneurysmal subarachnoid hemorrhage: The KOSCO study

BACKGROUND AND OBJECTIVES

Aneurysmal subarachnoid hemorrhage (aSAH) remains a significant global health concern, and therefore, understanding their functional outcomes is essential. The aim of this study was to investigate the 1-year functional outcomes of patients with aSAH.

METHODS

We retrospectively analyzed data of patients with aSAH from the Korean Stroke Cohort for Functioning and Rehabilitation study, up to 1 year post-onset. The cohort data were collected twice. The first data was collected from August 2012 through May 2015, and the second data was collected from January to December in 2020, from nine different hospitals. Assessments were performed from 7 days to 1 year. Disability, measured by modified Rankin Scale (mRS), was analyzed in terms of good outcome (mRS 0 or 1) and mortality. In addition, functional level was further assessed using Functional Independence Measure (FIM) in aSAH survivors at 1 year post-onset. A subgroup analysis was conducted, with participants further classified into two groups: one with mild-to-moderate disability (mRS 0-3) and another with severe disability (mRS 4 or 5), as reported 7 days after onset. Multiple imputation method was used to handle missing data. In addition, mixed-effects model was used to analyze the trajectory of FIM.

RESULTS

A total of 517 patients with aSAH were included. Of these, 246 (47.6%) showed mild-to-moderate disability and 271 (52.4%) showed severe disability at 7 days. At 1 year after onset, the mortality rate was 6.0% and the good outcome was reported in 76.2% of patients. In aSAH survivors at 1 year, FIM showed a significant improvement over time, with a significant difference demonstrated between the subgroups. Age, initial clinical severity, and cognitive function at 7 days were also identified as significant covariates.

CONCLUSIONS

The majority of patients reporting mild-to-moderate disability at 7 days exhibited good functional outcome, and even among those with severe disability, there was a favorable outcome with continuous improvement in their functional levels. Therefore, proper assessments and effective management should be employed to achieve favorable functional outcomes among aSAH survivors.

Are standing balance and walking ability deficits poststroke related to the integrity of the corticospinal and non-corticospinal tracts? A meta-analysis

BACKGROUND

The importance of corticospinal tract (CST) integrity in upper limb recovery poststroke is well established, but its association with standing balance and walking remains unclear. This meta-analysis aimed to establish the relationship between CST and non-CST motor tract integrity, and clinical scores of standing balance and walking poststroke.

METHODS

In July 2024, five databases were searched for studies, focusing on diffusion MRI metrics and clinical scores of standing balance and/or walking independence poststroke. Meta-analyses were conducted to pool correlation coefficients (r) and group differences (d) based on CST integrity.

RESULTS

Twenty-two studies were included. Cross-sectional analysis showed no correlation (r < .25) between CST metrics and the functional ambulation category (FAC) in the sub-acute phase. Weak prognostic associations were found for CST-FA and CST-FN with FAC. Significant FAC score differences were found between preserved- and disrupted CST groups in the sub-acute (d = .79) and chronic (d = 1.07) phase and for prognostic analysis (d = 1.40). Non-CST metrics showed no cross-sectional associations and mixed prognostic associations.

CONCLUSIONS

CST integrity was not significantly associated with standing balance or walking independence in the sub-acute phase. Early CST integrity showed weak prognostic value for walking at 6 months. Multimodal longitudinal research is needed to improve lower limb recovery prognostics.

Effect of using home-based dynamic intermittent pneumatic compression therapy during periods of physical activity on functional and vascular health outcomes in chronic stroke: A randomized controlled clinical trial

BACKGROUND

Intermittent pneumatic compression (IPC) therapy may benefit stroke patients by eliciting more intensive training sessions that may result in better health, mobility and ultimately quality of life. The purpose of this randomized controlled trial was to assess the effect of using a home-based IPC device on functional outcomes and vascular health in individuals with chronic stroke.

METHODS

Thirty-one stroke survivors (64.3 ± 14.3y; 4.3 ± 2.7y since stroke) completed pre- and post-intervention assessments of functional capacity (six-minute walk test [6MWT], timed-up-and-go, 10m walk test), vascular health (pulse wave analysis, carotid-femoral pulse wave velocity), and physical activity. Following the pre-assessment, individuals were randomly assigned to either a daily, 12-week, home-based IPC group, or to a usual care control (CON) group. Outcomes were assessed using analysis of covariance (ANCOVA), controlling for age and any baseline differences.

RESULTS

Following ANCOVA, a significant increase in 6MWT walking distance was observed post-assessment for the IPC (Mean ±  SD [95%CI]; 188 ±  19 m [177-199m]) but not the CON group (167 ±  19 m [157-178m]) (p <  0.05). A significant reduction in peripheral systolic blood pressure was reported at the post-assessment for the IPC group (136.2 ±  8.0 mmHg [131.9-140.4 mmHg]) but not for CON (142.2 ±  8.0 mmHg [138.1-144.6 mmHg]) (p <  0.05). Similar findings were observed for central systolic blood pressure. Physical activity levels significantly increased at the post-assessment for IPC (1857 ±  879 MET·min-1·week-1 [1390-2325 MET·min-1·week-1]) but not for the CON group (1161 ± 879 MET·min-1·week-1 [677-1645 MET·min-1·week-1]), while for time spent sitting, a significantly greater reduction was observed at the post-assessment for the IPC group (396 ±  86 mins [350-442 mins]) compared to CON (486 ± 86 mins [439-534 mins]) (both p <  0.05).

CONCLUSIONS

The observed improvements in functional mobility, cardiovascular health, increased physical activity and reduced sedentary time demonstrates important clinical implications of 'home-based' IPC therapy as a clinical training aid for stroke rehabilitation. Home-based IPC therapy could serve as an adjunct to conventional rehabilitation, however, further research is needed to determine whether IPC therapy can sustain or improve function over time for individuals in the chronic stage of recovery.

Flexibility, Resistance, Aerobic, Movement Execution (FRAME) training program to improve gait capacity in adults with Hereditary Spastic Paraplegia: protocol for a single-cohort feasibility trial

Background

Hereditary Spastic Paraplegia (HSP) is a heterogeneous group of inherited neurological disorders characterized by progressive weakness and spasticity in the lower limbs, significantly affecting gait capacity (endurance and speed). Although specific interventions have been already investigated, there is currently a lack of comprehensive, structured neurorehabilitation programs to improve gait capacity in adults with HSP. Thus, this protocol aims to explore the feasibility and effectiveness of a composite training targeting flexibility, muscle strength, motor control, balance, and aerobic capacity.

Methods

20 adults diagnosed with HSP will participate in 10 to 16 therapist-guided sessions (intervention), lasting 60 to 120 minutes each, occurring once or twice weekly based on individual preferences. Depending on the number and frequency of sessions, the intervention period may vary in between five to 10 weeks. Upon completion, participants will receive a transfer package (manual, video tutorials) to stimulate long-term exercise at home. Assessments will take place before intervention (T0), at the end of the intervention (T1), and 12 weeks post-T1 (T2). Primary outcomes will focus on feasibility (recruitment, retention, adherence, absence of adverse events, and patient's satisfaction). Secondary outcomes will evaluate improvements in gait capacity and specific contributing factors such as reduced spasticity, increased muscle strength, and improved balance.

Relevance

The significance of this protocol is to provide valuable insights for clinicians regarding the feasibility and potential efficacy of a comprehensive, clinical-oriented program to improve gait capacity in adults with HSP, and inform future translational research studies in the field.

Clinical trial registration

ClinicalTrials.gov, identifier NCT06742697.

Cross-cultural adaptation, reliability and validity of the Turkish version of the stroke exercise preference inventory

Introduction

While studies on version adaptation, validity, and reliability are common, no tools exist in Turkish literature to assess exercise preferences in stroke patients. This research aimed to translate the Stroke Exercise Preference Inventory (SEPI) into Turkish and evaluate its validity and reliability in stroke patients.

Methods

Ninety stroke patients completed the SEPI, Exercise Benefits/ Barriers Scale (EBBS), Behavioral Regulation in Exercise Questionnaire (BREQ-2), Stroke-Specific Quality of Life Scale (SSQoLS), and Frenchay Activities Index (FAI). The SEPI was translated into Turkish using a standard forward-backward translation process. Psychometric properties such as structural and construct validity, test-retest reliability, and internal consistency were assessed.

Results

Reliability analysis demonstrated high internal consistency for SEPI-13, with Cronbach's α values of 0.931. Validity testing revealed a 3-factor structure for SEPI-13, explaining 69.029% of total variance. CFA confirmed the model with acceptable fit indices. Construct validity showed good correlations with EBBS (r = -0.771; p < 0.001) and BREQ-2 (r = from -0.541 to 0.732; p < 0.001) for convergent validity, while divergent validity was supported by weak correlations with SSQoLS (r = 0.165; p = 0.120) and FAI (r = 0.137; p = 0.197). No floor or ceiling effects were observed for SEPI-13.

Discussion

The Turkish SEPI is a reliable and valid tool for assessing exercise preferences in stroke patients, aiding their rehabilitation.

Machine learning techniques for independent gait recovery prediction in acute anterior circulation ischemic stroke

OBJECTIVE

This study aimed to develop and validate a machine learning-based predictive model for gait recovery in patients with acute anterior circulation ischemic stroke.

METHODS

Between May and November 2023, 237 patients with acute anterior circulation ischemic stroke were enrolled. Patients were randomly divided into training and validation sets at a 7:3 ratio. Thirty-one medical characteristics were collected, and the Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to screen predictor variables. Predictive models were developed using the Random Survival Forest (RSF) and COX regression methods. The optimal model was identified based on C-index values. The SHapley Additive exPlanations (SHAP) method was employed to interpret the RSF model globally and locally.

RESULTS

Ten predictors were identified through LASSO regression, including age, gender, periventricular white matter hyperintensities (PVWMH), Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), enlarged perivascular spaces in basal ganglia (BG-EPVS), lacunes, parietal infarction, basal ganglia infarction, and Timed Up & Go (TUG) test score. The C-index values of the COX regression and RSF models were 0.741 and 0.761 in the training set and 0.705 and 0.725 in the validation set, respectively. SHAP analysis of the RSF model identified BG-EPVS, TUG, MoCA, age, and PVWMH as the top five most influential predictors of gait recovery.

CONCLUSION

The RSF model demonstrated superior performance to the COX regression model in predicting gait recovery, offering a reliable tool for clinical decision-making regarding stroke patients' prognoses.

Relationship between postoperative dietary intake and walking ability among older adults with hip fractures: A retrospective study

OBJECTIVE

This study aimed to determine whether total dietary intake assessed in the acute phase after hip fracture surgery is associated with walking ability.

DESIGN

The retrospective observational study.

SETTING

A single institution.

PARTICIPANTS

Patients with hip fractures aged ≥65 years.

MAIN MEASURES

Dietary intake was recorded daily on an 11-point scale using visual plate waste. The primary outcome was walking ability, which was assessed using functional ambulation categories at discharge. We categorised the patients into those with improved walking ability (functional ambulation categories score ≥3) and those without (<3). Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for functional ambulation categories according to total dietary intake during acute hospitalisation.

RESULTS

In total, 182 patients were included with a median age of 85 years; 73.6% were women. The median dietary intake during the first week after surgery, the second postoperative week, and throughout the postoperative period were 24.5, 28.4, and 27.1 kcal, respectively. After adjusting for potential confounders, high total dietary intake (hazard ratio, 1.05; 95% confidence intervals, 1.02-1.09; P = .006) and high dietary intake after the second week (hazard ratio, 1.04; 95% confidence intervals, 1.01-1.08; P = .017) were associated with walking ability.

CONCLUSIONS

Total dietary intake was associated with walking ability at discharge during the acute postoperative period after hip fracture. Dietary intake following the second postoperative week may play a significant role in the recovery of walking ability.

Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report

BACKGROUND

Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements.

PURPOSE

This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS).

CASE DESCRIPTION

A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed.

OUTCOMES

The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability.

CONCLUSION

Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.

Efficacy of virtual reality balance training on rehabilitation outcomes following anterior cruciate ligament reconstruction: A systematic review and meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis is to clarify the rehabilitation efficacy of virtual reality (VR) balance training after anterior cruciate ligament reconstruction (ACLR).

METHODS

This meta-analysis was registered in PROSPERO with the registration number CRD42024520383. The electronic databases PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal Database, and Wanfang Digital Periodical database were systematically searched to identify eligible studies from their inception up to January 2024. The investigated outcomes included International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS), Holden grading, Extensor peak torque (EPT), Flexor peak torque (FPT), knee reaction time, knee reproduction angle difference. The pooled mean difference (MD) and 95% confidence intervals (CIs) were calculated using the random-effects model.

RESULTS

Six RCTs with a total of 464 patients after unilateral ACLR were included for 8-12 weeks of VR balance training intervention. Analysis of the results showed that compared with the conventional rehabilitation control group, the VR balance training group significantly improved the International Knee Documentation Committee (IKDC) score (MD = 3.88, 95%CI: 0.95~6.81), Holden grading (MD = 0.42, 95%CI: 0.33~0.51), Extensor peak torque (EPT) (MD = 12.03, 95%CI: 3.28~20.78)and Flexor peak torque (FPT) (MD = 14.57, 95%CI: 9.52~19.63) in postoperative ACLR patients, and significantly reduced knee reaction time (MD = -0.30, 95%CI: -0.35~-0.25), knee angle reproduction difference at 30° (MD = -0.88, 95%CI: -1.16~-0.61), knee angle reproduction difference at 60° (MD = -0.80, 95%CI: -1.09~-0.50), and VAS score (MD = -0.52, 95%CI: -0.65~-0.39).

CONCLUSION

Since many of the included results are based on low-or very-low-quality evidence, although the results show a certain trend, the conclusion has great uncertainty. In the rehabilitation training following ACLR and lower-limb balance training, the application of VR might be advantageous for the recovery of patients' knee joint function, lower-limb muscle strength, proprioception, and pain management. The level of immersion may influence the rehabilitation outcome. Because of the limitations in data quality and heterogeneity as well as the small sample size, the strength of the conclusions is weakened. These findings should be verified in further large-scale prospective studies.

External Validation and Update of Minimal Important Change in the 6-Minute Walk Test in Hospitalized Patients With Subacute Stroke

OBJECTIVE

To investigate the external validation of the previously reported minimal important change (MIC) in the 6-minute walk test (6MWT) and update it for patients with subacute stroke hospitalized in rehabilitation unit.

DESIGN

Longitudinal study.

SETTING

Rehabilitation unit of a neurosurgical hospital.

PARTICIPANTS

One hundred and seven patients with subacute stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The 6MWT, modified Rankin Scale (mRS), Functional Ambulation Categories (FAC), and Functional Independence Measure (FIM) were assessed at 30 (baseline) and 60 (follow-up) days after stroke onset. Patients were divided into 2 groups according to improvements of mRS by ≥1, FAC by ≥1, or FIM by ≥22. The change in the 6MWT between baseline and follow-up was calculated and patients were divided into 2 groups according to improvements of 6MWT by ≥71 m. External validation was performed using likelihood ratio (LR) between change of 6MWT by ≥71 m and improvement of mRS. An LR+ of >2.0 and LR- of <0.5 was considered valid. The new MIC of the 6MWT was calculated for the mRS, FAC, and FIM using the receiver operating characteristic curve (MICROC) and adjusted predictive modeling method (MICadjusted).

RESULTS

No external validation was achieved (LR+ of 1.41, LR- of 0.77). The MICROC values for mRS, FAC, and FIM were 22.0, 69.0, and 22.0 m, respectively. The MICadjusted values for the mRS, FAC, and FIM were 68.7, 63.1, and 83.1 m, respectively. Only the MIC of the 6MWT for FAC was validated.

CONCLUSIONS

The previously reported MIC of the 6MWT was not suitable for patients with subacute stroke hospitalized in rehabilitation units; however, the newly determined MIC was useful.

Effects of physiotherapy on degenerative cerebellar ataxia: a systematic review and meta-analysis

Background

Evidence of the effectiveness of physiotherapy, including muscle strength training, coordination training, aerobic exercise, cycling regimen, balance training, gait training, and activity of daily living training, in patients with degenerative cerebellar ataxia (DCA) was insufficient for clinical decision making. We aimed to explore clinical outcomes and examine the parameters associated with physical impairment and activity in people with DCA based on preregistration (PROSPERO: CRD42024493883).

Methods

The PubMed, Cochrane Library, CHINAL, and PEDro databases were searched for relevant randomized controlled trials (RCTs). Data extraction, quality assessment, and heterogeneity analyses were conducted. The Grading of Recommendations Assessment, Development, and Evaluation framework (GRADE) was used to assess the quality of evidence, and a meta-analysis was performed.

Results

Eighteen RCTs, which included 398 participants, showed a serious risk of bias (RoB) and low certainty of evidence for this primary outcome. For meta-analysis, 315 patients assessed based on the Scale for Assessment and Rating of Ataxia (SARA) were included. Overall, physiotherapy significantly reduced SARA scores (MD = -1.41, [95% CI: -2.16, -0.66]); the subgroup analysis showed that the following interventions exerted significant effects: multi-aspect training program (5 studies, MD = -1.59, [95% CI: -5.15, -0.03]), balance training (3 studies, MD = -1.58, [95% CI: -2.55, -0.62]), and aerobic training (3 studies, MD = -1.65, [95% CI: -2.53, -0.77]). By contrast, vibration (2 studies, MD = -0.56, [95% CI: -2.05, 0.93]) and dual-task training (1 study, MD = 0.24, [95% CI: -6.4, 6.88]) exhibited no significant effects.

Conclusion

Physical therapy, especially multi-aspect physical therapy such as muscle strengthening, coordination training, gait training, and ADL training, may reduce DCA symptoms. Further, balance and aerobic training can be added to the program. However, the estimated effect size may change in future studies because of the serious RoB, very low certainty of evidence, and high heterogeneity with SARA as the primary outcome. High-quality RCTs are required to establish evidence for the effectiveness of physical therapy in patients with DCA.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=493883, identifier: CRD42024493883.

Validation of a tri-axial accelerometer for measuring physical activity in patients with subacute stroke

Purpose

This study aimed to validate the accuracy of the Active Style Pro HJA-750C (ASP) in measuring metabolic equivalents (METs) during walking and reaching tasks in individuals with subacute stroke using a respiratory gas analyzer as a reference.

Methods

Twenty-three hospitalized patients with subacute stroke participated in this study. They performed sitting and standing reaching tasks, as well as walking while wearing a VO2 Master respiratory gas analyzer and ASP devices on both the paretic and non-paretic sides. The METs values recorded by the ASP were compared with those obtained using a VO2 Master respiratory gas analyzer. Pearson's correlation coefficients were calculated for each task, and Bland-Altman plots were used to assess the agreement between the two methods.

Results

The ASP demonstrated good concurrent validity, with correlation coefficients of 0.71 and 0.74 for the sitting reaching task, 0.75 and 0.79 for the standing reaching task, and 0.83 and 0.85 for walking when the ASP was placed on the paretic and non-paretic sides, respectively. Bland-Altman analysis indicated no significant fixed or proportional errors. The ASP accurately measures METs whether worn on the affected or unaffected side of the waist.

Conclusion

The ASP provides valid measurements of physical activity during walking and reaching tasks in patients with subacute stroke. These findings suggest that ASP is a valuable tool for monitoring physical activity in clinical rehabilitation settings.

Race and ethnic disparities in rehabilitation services and functional recovery post-stroke

Objective

To identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent associations of each of race/ethnicity and rehabilitation to functional recovery post-stroke.

Methods

The Transitions of Care Stroke Disparities Study (TCSD-S) is a prospective cohort study designed to reduce disparities and to optimize the transitions of care for stroke survivors throughout the state of Florida. Participant characteristics were extracted from the American Heart Association's Get-With-The-Guidelines-Stroke dataset. Rehabilitation services, and modified Rankin Scale were recorded via follow up phone calls at 30- and 90-days after hospital discharge. Logistic regression models adjusted for potential confounders were used to determine: 1) race/ethnic differences in rehabilitation services received; 2) race/ethnic differences in functional change from discharge to 30- and 90-days, respectively; and 3) the influence of rehabilitation on functional change from discharge to 30- and 90-days.

Results

Of 1,083 individuals, 43% were female, 52% were Non-Hispanic White (NHW), 22% were Non-Hispanic Black (NHB), and were 22% Hispanic. Individuals who engaged in rehabilitation were more likely to show improvements [aOR=1.820, 95%CI (1.301,2.545)] at 90-days from hospital discharge. Irrespective of rehabilitation services, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve [aOR=0.647, 95%CI (0.425,0.983)] compared to NHW. Additionally, Hispanic individuals were significantly less likely to receive any rehabilitation services [aOR=0.626, 95%CI (0.442,0.886)] and were half as likely to receive outpatient services [aOR=0.543, 95%CI (0.368,0.800)] as compared to NHW.

Conclusions

Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.

Characteristics of subacute stroke patients who achieve earlier independence in real-life walking performance during hospitalization

OBJECTIVE

To identify factors associated with earlier independence in "real-life walking" during hospitalization in subacute stroke patients.

DESIGN

Retrospective cohort study.

SUBJECTS/PATIENTS

Two hundred and six hemiplegic patients.

METHODS

Functional Independence Measure (FIM) walking items were measured biweekly from admission to discharge. Patients were grouped by achieving independent "real-life walking" (FIM-walking score ≥6). Time to independence, stratified by age, FIM motor score (FIM-M), FIM cognitive score (FIM-C), and Functional Ambulation Categories (FAC) scores were compared using Kaplan- Meier plots and log-rank tests. Hazard ratios were calculated via multivariable Cox proportional hazard models.

RESULTS

The median time to independence was 4 weeks, with significant differences (p < 0.05) by age, FIM-M, FIM-C, and FAC stratification. Age ≤64 years (hazard ratio 1.92, 95% confidence interval 1.21-3.06), FIM-C ≥25 (hazard ratio 2.42, 95% confidence interval 1.52-3.86), and FAC ≥3 (hazard ratio 1.98, 95% confidence interval 1.22-3.21) significantly affected earlier walking independence (all p < 0.01). Impeding factors were FIM-M ≤38 (hazard ratio 0.23, 95% confidence interval 0.13-0.40; p < 0.01) and FAC = 0 (hazard ratio 0.184, 95% confidence interval 0.06-0.62; p < 0.01).

CONCLUSION

Early improvement in "real-life walking" was associated with younger age, greater cognitive function, and greater "test-setting walking" ability on admission. Low activities of daily living independence and "test-setting walking" ability hindered early progress.

Conjoint effect of post-discharge physical exercise and co-managed care on health outcomes of older patients with hip fracture in China: A post-hoc factorial analysis

OBJECTIVES

The study aimed to explore the effects of post-discharge physical exercise combined with co-managed care on health the outcomes of older patients with hip fracture.

METHODS

Based on a completed non-randomised controlled trial which evaluated a co-managed care of patients aged 65 years and above with hip fracture, provided by orthopedists and geriatricians within an acute setting, a retrospective post-hoc factorial analysis was further conducted. The analysis observed the health outcomes of older patients with post-discharge physical exercise combined with co-managed care within hospitals compared to those had either post-discharge physical exercise or co-managed care. The collected data included demographics, clinical characteristics, and follow-up information about post-discharge physical exercises and health outcomes at one-month, four-month, and one-year after admission. The health outcomes comprised the cumulative mortality, complications, ambulatory ability (Fracture Mobility Score), and quality of life (the five-level EuroQol five-dimensional questionnaire) at each follow-up visit.

RESULTS

Patients who having the conjoint interventions benefited more reduction of one-year mortality (RR 0.59, 95 %CI: 0.38, 0.80) but no reduction of complications (RR 0.70, 95 %CI: 0.43, 1.14) than each single intervention. Ambulance ability (at one-year follow-up) and quality of life (at four-month follow-up) of patients who having the conjoint interventions were observed a significant improvement against each single intervention.

CONCLUSION

The conjoint intervention with co-managed care and post-discharge physical exercise might contribute more to the quality improvement of hip fracture care in a long run.

Turkish cultural adaptation, validity, and reliability of the stroke activity scale in individuals with Hemiparesis

AIM

The aim of this study was to make the Turkish cultural adaptation of the the Stroke Activity Scale (SAS).

METHOD

This study was designed as a methodological research. The psychometric properties of the SAS scale were evaluated by validity and reliability analyses.

RESULTS

The average age of 84 stroke patients (mean ± SD) was 59.52 ± 14.03 years. Kaiser-Meyer-Olkin (0.816) and Bartlett's Test of Sphericity (χ2 = 288.968, df = 10, p < 0.001) showed that the data set can be factored. A one-factor structure was obtained with Principal Component Analysis (PCA). The factor loads of the items obtained with PCA and Confirmatory Factor Analysis (CFA) were found to be statistically significant. The obtained chi-square statistics (χ2 = 2.227, p = 0.694), normalized chi-square/freedom (χ2/sd) value (0 ≤ 0.557 ≤ 2) and other goodness of fit indices showed good compliance. The positive highly significant correlation (r = 0.846, p < 0.001) between the SAS and Rivermead Mobility Index (RMI) scales confirmed the Concurrent validity. Cronbach's alpha (0.864) value showed high reliability and Intraclass Correlation Coefficient (ICC) value (0.983, p < 0.001) showed excellent agreement.

CONCLUSIONS

In this study, which was conducted for the Turkish adaptation of the SAS scale, the 5-item and 1-factor structure was evaluated as a valid and reliable scale for evaluating the balance abilities of stroke patients living in Turkey.

Monitoring changes in locomotion-related daily life activities in post-stroke patients: the responsiveness of ABILOCO-Benin questionnaire

PURPOSE

To investigate the responsiveness of ABILOCO-Benin questionnaire, a West-African adapted questionnaire of performance in locomotion-related daily-life activities in adults with stroke.

MATERIALS AND METHODS

We conducted a longitudinal study involving 81 stroke patients (mean (SD) age: 54.6 (10.8) years; 58% male, mean (SD) time after stroke onset: 4.3 (2.5) weeks). Participants were assessed at baseline (T1), two-month later (T2), and on average of 1.5 (0.5) years after stroke (T3), with the ABILOCO-Benin questionnaire, functional ambulation classification (FAC), six-minute walking test, ACTIVLIM-Stroke questionnaire, modified Rankin Scale, and Stroke Impairment Assessment Scale. Global-, sub-group- (stable and improved based on FAC scores), and individual-based analysis of changes were performed.

RESULTS

Participants showed significantly larger improvement for all outcomes during the acute phase (T1-T2). Changes in the ABILOCO-Benin measures were significantly correlated with changes in other outcome measures. ABILOCO-Benin questionnaire detected a significant improvement in both the stable and improved groups at both T2 and T3 in the sub-group approach. Individual-based analysis with ABILOCO-Benin measures showed a significantly higher proportion of stable patients (n = 55) and lower proportion of improved ones (n = 23) between T2 and T3 (LR(df) = 15.52(4), p = 0.004).

CONCLUSIONS

ABILOCO-Benin is responsive to changes in adult stroke patients within both acute and chronic phases.

Longitudinal Changes in Factors Associated with Walking Independence at Hospital Discharge in Patients with Stroke: A Retrospective Study

Background/Objectives: Patients with stroke usually have long-term residual gait disability. However, temporal changes in factors associated with gait independence in these patients at the time of hospital discharge have not been clarified. This study aimed to determine changes over time in factors associated with gait independence in patients with stroke at the time of hospital discharge. This would predict that factors associated with the level of walking independence in patients with stroke at discharge from the hospital would show different results depending on the changes over time post-stroke onset. Methods: This retrospective observational study used data from the medical records of patients with stroke with unilateral supratentorial lesions who were admitted and rehabilitated at Tesseikai Neurosurgical Hospital between October 2020 and July 2024. The Functional Ambulation Category (FAC), Stroke Impairment Assessment Set-lower extremity motor items, Trunk Control Test, Mini-Balance Evaluation Systems Test (Mini-BESTest), and Functional Independence Measure cognitive items were assessed monthly for 3 months post-stroke onset. Participants were classified into independent and non-independent walking groups using the FAC. Logistic regression analysis was performed with walking independence at discharge and other assessment indicators as the dependent and independent variables, respectively, to identify factors influencing walking independence at discharge. Independent variables were entered by month from 1 to 3 months. Results: Logistic regression analysis revealed that Mini-BESTest scores at 2 and 3 months post-stroke onset were significantly associated with walking independence at discharge (p < 0.05). Conclusions: This study suggests the importance of assessing the Mini-BESTest scores over time, starting at 2 months post-stroke onset, when determining walking independence in patients with stroke. Providing balance training to patients with low Mini-BESTest scores between 1 and 3 months post-stroke onset may contribute to improved walking independence at discharge.

Comprehensive assessment and progression of health status during neurorehabilitation in survivors of critical illness: a prospective cohort study

BACKGROUND

Critical illness survivors frequently suffer from long-term impairments, often described as post-intensive care syndrome (PICS). PICS encompasses physical, cognitive, and mental impairments. Additionally, the term intensive care unit (ICU)-acquired weakness (ICUAW) was coined for muscle weakness after critical illness. Research on the progression and outcome of individuals affected by PICS and ICUAW is scant. Thus we aimed to assess the health status and its progression during neurorehabilitation in critically ill patients using comprehensive outcome measures, describe the prevalence of PICS, and evaluate factors associated with rehabilitation outcomes.

METHODS

Patients with mixed reasons for critical illness who received ≥ 5 days of mechanical ventilation on the ICU and who were admitted to neurorehabilitation, were eligible to be included in this prospective cohort study. A number of outcomes (patient-reported, clinician-reported, and performance) were assessed after discharge from the ICU (V1) and shortly before discharge from inpatient neurorehabilitation (V2). The prevalence of PICS, defined as having at least one impairment in any PICS dimension), was calculated at V1 and V2. Multiple logistic regressions were conducted to identify factors associated with rehabilitation outcome (poor outcome = modified Rankin Scale > 2) and ICUAW at V2 (MRC sum score < 48).

RESULTS

In total, 250 critical illness survivors (62 ± 14 years, 34% female, median stay on ICU 55 days, median inpatient rehabilitation 65 days) were included. 11 participants (4.4%) died before V2. All outcomes improved significantly during rehabilitation except sensory impairment and pain. PICS was present in 96% at V1 and in 85% at V2, whereby mainly the physical domain (V1: 87%, V2: 66%; ICUAW with MRC sum score < 48) and the cognitive domain (V1:65%, V2:55%; Montreal Cognitive Assessment < 26) were affected. Mental impairment was lower (V1:48%, V2:29%; Hospital Anxiety and Depression Scale > 7), but still affected a considerable number of participants. Accordingly, health-related quality of life was rather low at discharge (0.64 ± 0.28, index value of EQ-5D-5L). MRC sum score at V1, duration of mechanical ventilation, and female gender were significantly associated with a poor rehabilitation outcome. Grip strength in % of reference at V1, age, female gender, and comorbidities were significantly associated with persistent ICUAW at discharge.

CONCLUSIONS

Despite significant improvements during rehabilitation, survivors after critical illness experience a substantial burden of PICS and ICUAW at discharge from rehabilitation care. Survivors of critical illness require long-term follow-up, supportive structures, and tailored long-term multi-disciplinary therapies even after intensive rehabilitation.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00021753. Registered 03 September, 2020. https://drks.de/search/en/trial/DRKS00021753 .

Evidence that robot-assisted gait training modulates neuroplasticity after stroke: An fMRI pilot study based on graph theory analysis

OBJECTIVES

To investigate alterations of whole-brain network after stroke and therapeutic mechanisms of robot-assisted gait training (RAGT).

METHODS

21 stroke patients and 20 healthy subjects were enrolled, with the stroke patients randomized to either control group (n = 11) or robot group (n = 10), and resting-state functional magnetic resonance imaging data were collected. The global network metrics were obtained using graph theory analysis and compared between stroke patients and healthy subjects, and the effect of the RAGT on the whole-brain networks was explored.

RESULTS

Compared to healthy subjects, area under the curve (AUC) for small-worldness (σ), clustering coefficient (Cp), global efficiency (Eg) and mean local efficiency (Eloc) were significantly lower in stroke patients, whereas AUC for characteristic path length (Lp) were significantly higher. Compared with the control group, patients in robot group showed significant improvement in lower limb motor function, balance function and walking function after intervention, with a significant reduction in the AUC of Cp. Moreover, the improvement of walking function was positively correlated with the changes of AUC of σ and Eg, and negatively correlated with the changes of AUC of Cp.

CONCLUSIONS

Small-worldness and network efficiency were significantly reduced after stroke, whereas RAGT decreased characteristic path length and promoted normalization of the whole-brain network, and this change was associated with improvement in walking function. Our findings reveal the mechanism by which RAGT regulates network reorganization and neuroplasticity after stroke.

Functional Recovery in Acute and Subacute Stroke Patients With or Without Post-stroke Fatigue

This study analyzed the impact of post-stroke fatigue (PSF) on functional recovery in acute and subacute stroke patients during inpatient rehabilitation. Medical records of 177 patients were retrospectively reviewed. PSF was assessed using the Fatigue Severity Scale (FSS)-9. Patients were classified into two groups: a PSF group (mean FSS ≥ 4) and a non-PSF group (mean FSS < 4). Stroke severity was measured with the National Institutes of Health Stroke Scale, and functional outcomes were evaluated using Functional Ambulation Category (FAC), Berg Balance Test, Korean version of the Modified Barthel Index (K-MBI), and Mini-Mental State Examination-Korean version (MMSE-K). Statistical significance was set at p < 0.05. The prevalence of PSF was 52.5%. The repeated measures of analysis of variance showed significant "time" effects on FAC (F = 29.726, p < 0.001) and K-MBI (F = 15.348, p < 0.001). A significant "group" effect was observed on MMSE-K (F = 4.571, p = 0.035), and a "time × group" interaction on only K-MBI (F = 4.284, p = 0.041). Multivariable logistic regression analysis showed that improvements in K-MBI scores were independent of initial severity, depression, and age (p = 0.043). PSF affects the recovery of activities of daily living (ADL) in stroke patients, suggesting that regulating early fatigue after stroke positively affects functional recovery.

Falls characteristics experienced by working-age adults during inpatient post-stroke rehabilitation and their impact on length of stay, discharge functional status, ambulation and destination

BACKGROUND

In-hospital falls are frequent post-stroke medical complications and will remain of concern because it may not be possible to prevent all of them. We aimed to i) compare admission clinical and sociodemographic characteristics between fallers and non-fallers ii) determine falls characteristics iii) compare length of stay (LOS), discharge functional independence, ambulation and destination between fallers and non-fallers.

METHODS

A matched case-control study, comparing individuals (n = 302) who fell during inpatient post-acute rehabilitation, matched (on time to admission, age and motor Functional Independence Measure (mFIM)) to individuals (n = 302) who didn´t fall, admitted within 3 months post-injury to a center between 2008 and 2023. Ambulation was assessed using the Functional Ambulation Category (FAC).

RESULTS

Mean age at admission was 50±8 years. No baseline differences were seen between groups in the proportion of patients with aphasia, diabetes, dyslipidemia, hypertension, neglect, atrial fibrillation, dysphagia, dominant side affected, medication for depression, FAC assessment, body mass index and educational level. A first-fall in the first week was experienced by 22.2 % and in the first three weeks by 54.3 %. Most falls occurred at the patients' room (75.1 %) mostly due to distractions (55.3 %) and transferring without help (32.4 %) with 18 % occurring in the bathroom, fallers were alone in 68.6 % of the cases. Fallers had an 8-day longer mean LOS compared to non-fallers, yet there were no differences in discharge mFIM or FAC scores. While non-fallers had a higher proportion of poor mFIM outcomes (28.5 % vs. 17.9 %) and no ambulation (20.7 % vs. 12.4 %), fallers showed greater mFIM gains (26 vs. 22 points). Discharge destinations were similar across both groups.

CONCLUSIONS

Despite no baseline differences, fallers experienced longer stays with comparable independence and ambulation scores at discharge. Most falls occurred in patients' rooms during unsupervised activities. Preventive recommendations have been provided to address these risks and enhance patient safety.

Evaluating Biomarkers of Bone Health After an 8-Week Walking Program in Non-Ambulatory Stroke Survivors: A Pilot Study

Background/Objectives: Stroke survivors have a significantly increased likelihood of developing osteoporosis, a condition characterized by weak and brittle bones as well as an elevated risk of bone fractures. However, previous studies on exercise intervention have mostly been on stroke survivors who are able to walk. The objective of this study was to examine the effect of walking exercise on bone health in non-ambulatory stroke survivors. Methods: This pre- and post-test study enrolled a group of chronic non-ambulatory stroke survivors. They were instructed to complete an 8-week aerobic walking exercise program, three sessions per week. Serum concentrations of osteocalcin (OC) and carboxy-terminal telopeptides of type I collagen (ICTP) were evaluated at baseline and after completing the walking exercise program. In addition, we assessed the ambulation capacity and balance control using the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. Results: A total of 9 out of 10 non-ambulatory stroke survivors who were recruited completed the intervention. The serum concentration of OC significantly increased from 8.51 ± 2.28 ng/mL to 9.39 ± 2.97 ng/mL (p < 0.10). The serum concentration of ICTP significantly increased from 4.45 ± 2.58 ng/mL to 5.31 ± 2.92 ng/mL (p < 0.10). Both FAC and BBS scores significantly improved from 1.0 ± 0 to 1.33 ± 0.5 (p < 0.1) and from 7.22 ± 10.02 to 15.78 ± 14.81 (p < 0.01), respectively. Conclusions: The findings of this pilot study suggest that walking exercise may improve bone health by initiating a bone remodeling process in chronic non-ambulatory stroke survivors.

Effects of physical therapy modalities for motor function, functional recovery, and post-stroke complications in patients with severe stroke: a systematic review update

BACKGROUND

Physical therapy interventions play a crucial role in the daily care of patients recovering from severe stroke. However, the efficacy of these interventions and associated modalities, including duration, intensity, and frequency, have not been fully elucidated. In 2020, a systematic review reported the beneficial effects of physical therapy for patients with severe stroke but did not assess therapeutic modalities. We aim to update the current evidence on the effects of physical therapy interventions and their modalities in relation to the recovery phase in people with severe stroke in a hospital or inpatient rehabilitation facility.

METHODS

We searched CENTRAL, MEDLINE, Web of Science, and three other relevant databases between December 2018 and March 2021 and updated the search between April 2021 and March 2023.

CLINICALTRIALS

gov and ICTRP for searching trial registries helped to identify ongoing RCTs since 2023. We included individual and cluster randomized controlled trials in the English and German languages that compared physical therapy interventions to similar or other interventions, usual care, or no intervention in a hospital or rehabilitation inpatient setting. We screened the studies from this recent review for eligibility criteria, especially according to the setting. Critical appraisal was performed according to the Cochrane risk-of-bias tool 2.0. The data were synthesized narratively.

RESULTS

The update identified 15 new studies, cumulating in a total of 30 studies (n = 2545 participants) meeting the eligibility criteria. These studies reported 54 outcomes and 20 physical therapy interventions. Two studies included participants during the hyperacute phase, 4 during the acute phase,18 during the early subacute phase, and 3 in the late subacute phase. Three studies started in the chronic phase. Summarised evidence has revealed an uncertain effect of physical therapy on patient outcomes (with moderate to low-quality evidence). Most studies showed a high risk of bias and did not reach the optimal sample size. Little was stated about the standard care and their therapy modalities.

DISCUSSION

There is conflicting evidence for the effectiveness of physical therapy interventions in patients with severe stroke. There is a need for additional high-quality studies that also systematically report therapeutic modalities from a multidimensional perspective in motor stroke recovery. Due to the high risk of bias and the generally small sample size of the included studies, the generalizability of the findings to large and heterogeneous volumes of outcome data is limited.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021244285.

Multiple imputation integrated to machine learning: predicting post-stroke recovery of ambulation after intensive inpatient rehabilitation

Good data quality is vital for personalising plans in rehabilitation. Machine learning (ML) improves prognostics but integrating it with Multiple Imputation (MImp) for dealing missingness is an unexplored field. This work aims to provide post-stroke ambulation prognosis, integrating MImp with ML, and identify the prognostic influential factors. Stroke survivors in intensive rehabilitation were enrolled. Data on demographics, events, clinical, physiotherapy, and psycho-social assessment were collected. An independent ambulation at discharge, using the Functional Ambulation Category scale, was the outcome. After handling missingness using MImp, ML models were optimised, cross-validated, and tested. Interpretability techniques analysed predictor contributions. Pre-MImp, the dataset included 54.1% women, 79.2% ischaemic patients, median age 80.0 (interquartile range: 15.0). Post-MImp, 368 non-ambulatory patients on 10 imputed datasets were used for training, 80 for testing. The random forest (the validation best-performing algorithm) obtained 75.5% aggregated balanced accuracy on the test set. The main predictors included modified Barthel index, Fugl-Meyer assessment/motricity index, short physical performance battery, age, Charlson comorbidity index/cumulative illness rating scale, and trunk control test. This is among the first studies applying ML, together with MImp, to predict ambulation recovery in post-stroke rehabilitation. This pipeline reliably exploits the potential of incomplete datasets for healthcare prognosis, identifying relevant predictors.