Comparison of responsiveness of the Barthel Index and modified Barthel Index in patients with stroke

Multidisciplinary Home-Based Palliative Care for People Living with Dementia: Preliminary Findings on Palliative Care Concerns and Caregiver Burden

We describe the complex care needs faced by families in dementia care and specialized multidisciplinary palliative care delivered through home visits as a feasible way to support advancing stages of dementia. Participants with confirmed diagnosis of dementia were enrolled in home-based care as part of the neuropalliative and supportive care services. Disease severity, functionality, palliative care concerns, and caregiver burden were assessed at intake and three months at their homes. Forty-seven participants were enrolled. The mean age of participants was 65.48 (13.12); with more female patients (n = 27; 57%). 34/47 (72%) completed the reassessment. Moderate levels of caregiver burden were reported at 31.57 (17.9), range 18-80 at baseline, which showed a slight increase at three months follow-up, though palliative care concerns significantly reduced (Cohen's d = 1.16). Multidisciplinary home-based palliative care is feasible and can reduce the palliative care concerns in dementia. Further longitudinal studies with robust methodology are needed to explore the specific outcomes.

Analysis of Warm Acupuncture Combined with Rehabilitation Training for Lower Limb Motor Dysfunction in Cerebral Infarction Patients

ObjectiveTo evaluate the efficacy of warm acupuncture combined with rehabilitation training on lower-limb motor dysfunction in cerebral infarction (CI) patients.MethodsSixty CI patients with lower-limb motor dysfunction (Feb 2019 to Apr 2021) were enrolled. The control group received rehabilitation training, while the study group received warm acupuncture plus rehabilitation. The outcomes, including Functional Independence Measure (FIM), 10-meter maximum walking speed (MWS), Berg-balance scale (BBS), Barthel index, and Holden walking ability rating scale, were compared.ResultsThe study group showed significantly better results than the control group. After treatment, the study group's FIM and BBS scores were higher at 1-, 4-, and 6-week follow-ups. MWS scores of the study group improved significantly, while the control group showed less improvement. The Holden walking ability rating scale was also more favorable for the study group.ConclusionWarm acupuncture combined with rehabilitation training significantly improves lower-limb motor dysfunction in CI patients, demonstrating superior outcomes compared to rehabilitation alone.

Repetitive transcranial magnetic stimulation in conjunction with scalp acupuncture in treating poststroke cognitive impairment: a protocol for systematic review and meta-analysis

INTRODUCTION

Approximately 70% of patients with stroke experience varying degrees of cognitive impairment, which imposes a substantial direct and indirect socioeconomic burden. Previous studies have shown that scalp acupuncture (SA) or repetitive transcranial magnetic stimulation (rTMS) in combination with other therapies is effective for poststroke cognitive impairment (PSCI). Limited by interstudy heterogeneity and the limited number of included studies, there is insufficient evidence of the efficacy of rTMS in combination with SA in treating PSCI. Therefore, this protocol aims to investigate the effectiveness of rTMS in conjunction with SA for patients with PSCI through a comprehensive meta-analysis.

METHODS AND ANALYSIS

This study will undertake a comprehensive search across nine distinct databases (Web of Science, Embase, Cochrane Library, PubMed, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, China Biology Medicine and SCOPUS). The primary outcome will encompass the Montreal Cognitive Assessment and the Mini-Mental State Examination. The secondary outcomes are the modified Barthel Index, the Rivermead Behavioral Memory Test and the Digit Span Test. The bias risk assessment tool from the Cochrane Handbook for Systematic Reviews of Interventions will be used to evaluate bias risk, and the GRADE will be applied to gauge the quality of evidence. Furthermore, we plan to perform an analysis of subgroups to investigate the heterogeneity, employ the leave-one-out approach for sensitivity evaluation and use funnel plots and Egger's test to determine publication bias, respectively.

ETHICS AND DISSEMINATION

Ethical approval is not required in systematic review and meta-analysis. The review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42024571762.

Effect of DU meridian acupuncture and temporal three-needle on vascular protection mechanisms in patients with acute cerebral infarction: a randomized controlled evaluator-blinded clinical trial

Background

The incidence of acute ischemic stroke has been rising steadily in China and globally, with its high mortality and disability rates significantly affecting quality of life. As an important adjunct therapy, acupuncture has been widely implemented in stroke management. Emerging studies have investigated the effects of DU meridian and Chong Mai acupuncture on ischemic hemiparesis; however, the vascular protective mechanisms of electroacupuncture therapy targeting these meridians require further elucidation in stroke rehabilitation research.

Objective

This prospective cohort study aims to investigate the clinical efficacy and limitations of DU meridian acupuncture combined with Temporal Triple Needling (Sanjian) therapy in stroke rehabilitation. The intervention's therapeutic potential is evaluated through its modulatory effects on CD14+/CD14- monocyte subpopulations within peripheral blood mononuclear cells (PBMCs), with particular focus on angiogenesis-mediated vascular protection mechanisms.

Methods

Sixty-six patients with acute ischemic stroke will be randomly assigned 1:1 to control (conventional basal therapy, n = 33) and acupuncture (conventional standard stroke care + acupuncture, n = 33) groups for 10 days of intervention. The primary outcome is NIHSS score. The secondary outcomes: BMI and mRS scores, the level of TNF-A and IL-1B in serum, vascular endothelial growth factor (VEGF), Endocan ES, CD14+ and CD14- levels of peripheral blood mononuclear cells.

Discussion

The aim of this study is to investigate whether electroacupuncture targeting the DU meridian combined with Temporal Triple Needling (Sanjian) improves cerebrovascular endothelial function in acute ischemic stroke patients, thereby reducing the NIHSS score and preventing further disease progression. This study also aims to contribute positively to the development of relevant clinical treatment protocols and to facilitate further research into the underlying mechanisms of these effects.

Clinical trial registration

International Traditional Medicine Clinical Trial Registry ITMCTR2024000508.

Effect of tirofiban arterial injection on neurological and endothelial function in acute ischemic stroke patients beyond the thrombolysis time window

OBJECTIVE

To evaluate the efficacy and safety of arterial tirofiban injection in patients with acute ischemic stroke (AIS) beyond the thrombolysis time window.

METHODS

In this retrospective single-center study, clinical data were analyzed from 230 AIS patients treated at the First Hospital of Yulin between July 2021 and January 2023. Patients were divided into two groups: the observation group (n=102) treated with tirofiban combined with dual antiplatelet therapy, and the control group (n=128) that received dual antiplatelet therapy alone. Post-treatment follow-up evaluated neurological function, endothelial function, and safety using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI). Endothelial function was assessed by measuring levels of endothelin-1 (ET-1), nitric oxide (NO), and von Willebrand factor (vWF). Baseline characteristics, treatment protocols, and complications were analyzed to ensure the reliability and scientific rigor of the results.

RESULTS

Compared to the control group, the observation group demonstrated significant improvements in NIHSS, mRS, and BI scores, indicating enhanced neurological function and self-care ability. Endothelial markers (ET-1, NO, and vWF) also significantly improved in the observation group, suggesting a beneficial effect on endothelial function. The overall efficacy rate at 90 days was 86.72% in the observation group, significantly higher than the 74.50% in the control group (P<0.05). In terms of safety, there were no significant differences in the incidence of adverse events between the two groups, indicating that tirofiban is well-tolerated. Multivariate analysis identified age, treatment protocol, and baseline NO levels as independent factors affecting the 90-day prognosis, underscoring the importance of individualized treatment strategies for AIS patients.

CONCLUSION

Arterial injection of tirofiban significantly improves neurological and endothelial function in AIS patients beyond the thrombolysis time window while maintaining a favorable safety profile. These findings support the use of tirofiban in patients who are ineligible for intravenous thrombolysis or endovascular treatment.

Revisiting the "Timed Up and Go" test: a 12-s cut-off can predict Hospitalization Associated Functional Decline in older adults

Early detection of functional decline, a major risk among hospitalized older adults, can facilitate interventions that could significantly reduce it. We aimed to examine the contribution of the Timed Up and Go (TUG) test in predicting Hospitalization Associated Functional Decline (HAFD) among older adults, able to independently ambulate before admission. We used a cross-sectional study design; a total of 310 older adults (age ≥ 65) hospitalized in internal medicine wards between December 2018 and August 2020 were included; exclusion criteria were inability to ambulate, a diagnosis restricting mobility, hospitalization for end-of-life care, or impaired cognition. The Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients' independence in activities of daily living 2 weeks prior hospitalization, and at discharge. The TUG test was performed on admission and to predict significant functional decline (defined by a reduction of three points or more in the Modified Barthel Index), while accounting for demographics, length of hospitalization, comorbidity burden (Charlson's comorbidity index), and cognitive function (ALFI-MMSE). Participants were divided into three groups according to their TUG score-under or over a cut-off score of 12 s, or inability to complete the test. Adjusting for age, comorbidity, cognitive ability, and duration of hospitalization, the group that performed the test in less than 12 s showed no statistically significant change in the Modified Barthel Index, therefore no significant HAFD. The other groups showed a statistically significant decline in function. Risk for significant HAFD is currently underestimated in clinical settings, limited to subjective assessment, and underused in the context of implementing early interventions to prevent HAFD. The TUG may support screening for those at risk of hospitalizing-associated functional decline and could help identify patients suitable for preventative interventions.

Prediction of clinical efficacy of acupuncture intervention on upper limb dysfunction after ischemic stroke based on machine learning: a study driven by DSA diagnostic reports data

Objective

To develop a machine learning-based model for predicting the clinical efficacy of acupuncture intervention in patients with upper limb dysfunction following ischemic stroke, and to assess its potential role in guiding clinical practice.

Methods

Data from 1,375 ischemic stroke patients with upper limb dysfunction were collected from two hospitals, including medical records and Digital Subtraction Angiography (DSA) reports. All patients received standardized acupuncture treatment. After screening, 616 datasets were selected for analysis. A prediction model was developed using the AutoGluon framework, with three outcome measures as endpoints: the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and the Modified Barthel Index (MBI).

Results

The prediction model demonstrated high accuracy for the three endpoints, with prediction accuracies of 84.3% for NIHSS, 77.8% for FMA-UE, and 88.1% for MBI. Feature importance analysis identified the M1 segment of the Middle Cerebral Artery (MCA), the origin of the Internal Carotid Artery (ICA), and the C1 segment of the ICA as the most critical factors influencing the model's predictions. Notably, the MBI emerged as the most sensitive outcome measure for evaluating patient response to acupuncture treatment. Additionally, secondary analysis revealed that the number of sites with cerebral vascular stenosis (specifically 1 and 3 sites) had a significant impact on the final model's predictions.

Conclusion

This study highlights the M1 segment, the origin of the ICA, and the C1 segment as key stenotic sites affecting acupuncture treatment efficacy in stroke patients with upper limb dysfunction. The MBI was found to be the most responsive outcome measure for evaluating treatment sensitivity in this cohort.

Effects of transcranial magnetic stimulation combined with extracorporeal shockwave therapy for poststroke spasticity: study protocol for a randomised controlled trial

INTRODUCTION

Spasticity is a common complication of stroke, which is related to poor motor recovery and limitations in the performance of activities. Both transcranial magnetic stimulation (TMS) and extracorporeal shockwave therapy (ESWT) are effective treatment methods for poststroke spasticity (PSS). However, there is no existing study exploring the safety and effectiveness of TMS combined with ESWT for PSS.

METHODS AND ANALYSIS

This study will be a prospective, single-centre, randomised, factorial, controlled clinical trial. In this trial, 136 patients with PSS will be randomly divided into 4 groups: experimental group 1 (TMS), experimental group 2 (ESWT), experimental group 3 (ESWT+TMS) and control group, 34 patients in each group; all patients received routine rehabilitation. Outcome measures will be assessed by 4 time points: baseline (T0), 2 weeks after initiation of treatment (T1), 4 weeks after initiation of treatment (T2) and follow-up (4 weeks after the end of treatment, T3). The primary outcome is the modified Ashworth scale at T2. The secondary outcomes include the modified Tardieu scale for the degree of spasticity, the Fugl-Meyer assessment scale and range of motion (ROM) for motor function, the stroke-specific quality of life scale (SS-QOL) and modified Barthel index for activities of life, cortical excitability measured by TMS-surface electromyography (EMG), cerebral cortex oxygen concentrations measured by functional near-infrared spectroscopy (fNIRS) and Hmax/Mmax ratio measured by EMG.

ETHICS AND DISSEMINATION

This study protocol was approved by the Ethics Committee of the Army Medical Center of PLA (Approval No. 2024-04) on 24 January 2024. The study will be disseminated through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

This study was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/; unique identifier: ChiCTR2400080862; data: 9 February 2024; study protocol V. 2.0).

Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke

PURPOSE

To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL.

MATERIALS AND METHODS

180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed.

RESULTS

Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001).

CONCLUSIONS

Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.

Examining the effectiveness of motor imagery combined with non-invasive brain stimulation for upper limb recovery in stroke patients: a systematic review and meta-analysis of randomized clinical trials

BACKGROUND

Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are common non-invasive brain stimulation (NIBS) methods for functional recovery after stroke. Motor imagery (MI) can be used in the rehabilitation of limb motor function after stroke, but its effectiveness remains to be rigorously established. Furthermore, there is a growing interest in the combined application of NIBS with MI, yet the evidence regarding its impact on the recovery of upper limb function after stroke is inconclusive. This meta-analysis aimed to demonstrate whether combining the two is superior to NIBS alone or MI alone to provide a reference for clinical decision-making.

METHODS

PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, WANFANG, and VIP databases were searched for randomized controlled trials on the effects of MI combined NIBS in motor function recovery after stroke until February 2024. The outcomes of interest were associated with body functions or structure (impairment) and activity (functional). The primary outcome was assessed with the Fugl-Meyer assessment of the upper extremity (FMA-UE) for motor function of the upper limbs and the modified Barthel Index (MBI) for the ability to perform daily living activities. For secondary outcomes, functional activity level was measured using wolf motor function test (WMFT) and action research arm test (ARAT), and cortical excitability was assessed using cortical latency of motor evoked potential (MEP-CL) and central motor conduction time (CMCT). The methodological quality of the selected studies was evaluated using the evidence‑based Cochrane Collaboration's tool. A meta-analysis was performed to calculate the mean differences (MD) or the standard mean differences (SMD) and 95% confidence intervals (CI) with random-effect models.

RESULTS

A total of 14 articles, including 886 patients, were reviewed in the meta-analysis. In comparison with MI or NIBS alone, the combined therapy significantly improved the motor function of the upper limbs (MD = 5.43; 95% CI 4.34-6.53; P < 0.00001) and the ability to perform activities of daily living (MD = 11.07; 95% CI 6.33-15.80; P < 0.00001). Subgroup analyses showed an interaction between the stage of stroke, the type of MI, and the type of NIBS with the effect of the combination therapy.

CONCLUSION

The combination of MI and NIBS may be a promising therapeutic approach to enhance upper limb motor function, functional activity, and activities of daily living after stroke.

SYSTEMATIC REGISTRATION

PROSPERO registration CRD42023493073.

Post-stroke fatigue and its correlation with family functioning in patients who have experienced a first episode of stroke

Objective

This study aimed to analyse the relevant factors that may affect post-stroke fatigue (PSF) in patients with stroke and further explore the correlation between family functioning and PSF.

Methods

Patients who had experienced a first episode of stroke and were admitted to the Department of Neurology of the First Affiliated Hospital of Wenzhou Medical University were rigorously screened. The general data and family functioning of the patients on admission were collected, and their family adaptation, partnership, growth, affection and resolve scores and their PSF on the 5th day of admission were collected using the fatigue severity scale (FSS). Multiple linear regression analysis was then utilized to explore the factors affecting PSF in patients with stroke.

Results

A total of 220 questionnaires were distributed, and 220 were returned, with 212 valid questionnaires and a valid return rate of 96.4%. These 212 patients had a family functioning score of 6.58 ± 2.00 and an FSS score of 36.62 ± 10.96. Spearman's correlation analysis showed negative correlations between the FSS scores and the adaptation, partnership, growth, affection, resolve and family functioning scores (r = -0.380, -0.505, -0.470, -0.303, -0.281 and -0.712, respectively; p < 0.001). Furthermore, multiple linear regression analysis showed that family functioning (β' = -0.516), marital status (β' = -0.244), household income (β' = -0.185), literacy (β' = -0.181) and activities of daily living (β' = -0.084) were influential factors for PSF in patients with stroke (p < 0.05).

Conclusion

There is a significant negative correlation between family functioning and PSF, suggesting that better family functioning may help mitigate the severity of post-stroke fatigue. Healthcare providers should identify interventions to help patients and families address fatigue, boost disease recovery, promote patients' physical and mental health and improve their quality of life.

Evaluation of Rehabilitation Outcomes in Patients with Chronic Neurological Health Conditions Using a Machine Learning Approach

Background: Over one billion people worldwide suffer from neurological conditions that cause mobility impairments, often persisting despite rehabilitation. Chronic neurological disease (CND) patients who lack access to continuous rehabilitation face gradual functional decline. The International Classification of Functioning, Disability, and Health (ICF) provides a comprehensive framework for assessing these patients. Objective: This study aims to evaluate the outcomes of a non-hospitalized neuromotor rehabilitation project for CND patients in Italy using the Barthel Index (BI) as the primary outcome measure. The rehabilitation was administered through an Individual Rehabilitation Plan (IRP), tailored by a multidisciplinary team and coordinated by a physiatrist. The IRP involved an initial comprehensive assessment, individualized therapy administered five days a week, and continuous adjustments based on patient progress. The secondary objectives include assessing mental status and sensory and communication functions, and identifying predictive factors for BI improvement using an artificial neural network (ANN). Methods: A retrospective observational study of 128 CND patients undergoing a rehabilitation program between 2018 and 2023 was conducted. Variables included demographic data, clinical assessments (BI, SPMSQ, and SVaMAsc), and ICF codes. Data were analyzed using descriptive statistics, linear regressions, and ANN to identify predictors of BI improvement. Results: Significant improvements in the mean BI score were observed from admission (40.28 ± 29.08) to discharge (42.53 ± 30.02, p < 0.001). Patients with severe mobility issues showed the most difficulty in transfers and walking, as indicated by the ICF E codes. Females, especially older women, experienced more cognitive decline, affecting rehabilitation outcomes. ANN achieved 86.4% accuracy in predicting BI improvement, with key factors including ICF mobility codes and the number of past rehabilitation projects. Conclusions: The ICF mobility codes are strong predictors of BI improvement in CND patients. More rehabilitation sessions and targeted support, especially for elderly women and patients with lower initial BI scores, can enhance outcomes and reduce complications. Continuous rehabilitation is essential for maintaining progress in CND patients.

Nutrition-associated markers and outcomes among patients receiving enteral nutrition after ischemic stroke: a retrospective cohort study

BACKGROUND

Early nutrition after acute ischemic stroke is crucial. We explored early enteral nutrition for stroke patients and evaluated changes in blood indicators as a predictor of stroke prognosis.

METHODS

All hospitalized stroke patients receiving enteral nutrition were included in the study. We retrospectively collected the protein, energy, fat, and carbohydrate values for 7 days after admission. Serum albumin, total protein, and hemoglobin values were reviewed at admission and at one week. The main outcome indicators were the Modified Rankin Score, Barthel Index, and Quality of Life at 3 months.

RESULTS

A total of 354 patients (mean age, 70.7 years; 59.0% male) were included. The change in serum albumin at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.001), the Barthel Index (p = 0.004), and the modified Rankin Score (p = 0.029). The change in total protein at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.002), the Barthel Index (p = 0.001), and the modified Rankin score (p = 0.011). The change in hemoglobin values at day 7 relative to at admission was positively correlated with the Barthel Index (p = 0.037 but not with the Quality of Life score (p = 0.237) or the modified Rankin score (p = 0.730).

CONCLUSIONS

Improved nutrition-related blood indicators one week after admission were independently associated with good stroke outcomes. Nutritional support for acute ischemic stroke patients during the early hospitalization stage appears to be advisable.

TRIAL REGISTRATION

This review was a retrospective cohort study. The study was retrospectively registered in the Chinese Clinical Trial Registry (No: ChiCTR2300077228). Registration date: 1/11/2023.

Clinical phenotypes of patients with acute stroke: a secondary analysis

INTRODUCTION

Stroke is a leading cause of mortality worldwide and a major cause of disability having a high burden on patients, society, and caregiving systems. This study was conducted to investigate the presence of clusters of in-hospital patients with acute stroke based on demographic and clinical data. Cluster analysis reveals patterns in patient characteristics without requiring knowledge of a predefined patient category or assumptions about likely groupings within the data.

METHODS

We performed a secondary analysis of open-access anonymized data from patients with acute stroke admitted to a hospital between December 2019 to June 2021. In total, 216 patients (78; 36.1% men) were included in the analytical dataset with a mean (SD) age of 60.3 (14.4). Many demographic and clinical features were included in the analysis and the Barthel Index on discharge was used for comparing the functional recovery of the identified clusters.

RESULTS

Hierarchical clustering based on the principal components identified two clusters of 109 and 107 patients. The clusters were different in the Barthel Index scores on discharge with the mean (SD) of 39.3 (29.3) versus 62.6 (29.4); t (213.87) = -5.818, P <0.001, Cohen's d (95%CI) = -0.80 (-1.07, -0.52). A logistic model showed that age, systolic blood pressure, pulse rate, D-dimer blood level, low-density lipoprotein, hemoglobin, creatinine concentration, the National Institute of Health Stroke Scale value, and the Barthel Index scores on admission were significant predictors of cluster profiles (all P ≤0.029).

CONCLUSION

There are two clusters in hospitalized patients with acute stroke with significantly different functional recovery. This allows prognostic grouping of hospitalized acute stroke patients for prioritization of care or resource allocation. The clusters can be recognized using easily measured demographic and clinical features.

Transcranial direct current stimulation (tDCS) for neurological disability among subacute stroke survivors to improve multiple domains in health-related quality of life: Randomized controlled trial protocol

OBJECTIVES

The primary goal of the current proposal is to fill the gaps in the literature by studying the effectiveness of transcranial direct current stimulation (tDCS) on lifestyle parameters, and physical, behavioral, and cognitive functions among stroke survivors, and understanding the factors that mediate the effects of various domains related to Health-related Quality of life (HRQoL) improvements.

METHODS

Anticipated 64 volunteer subacute stroke survivors (>7 days to 3 months post stroke) aged 40-75 years with National Institutes of Health stroke scale (NIHSS) score of >10 and Mini-Mental State Examination (MMSE) score between 18 and 23 will be randomly assigned at a ratio of 1:1 to receive either: (1) 20 sessions of anodal tDCS or (2) sham tDCS in addition to conventional rehabilitation. Battery driven tDCS will be applied at 2 mA intensity to the dorsolateral prefrontal cortex and primary motor cortex for 20 minutes. The primary endpoints of study will be 36-Item Short Form Survey (SF-36) post intervention at 4 weeks. The secondary outcomes will include Stroke Specific Quality of Life Scale (SS_QOL), Montreal cognitive assessment (MCA), Beck Anxiety Inventory (BAI), Fugl-Meyer Assessment (FMA), 10 m walk test and Modified Barthel Activities of daily living (ADL) Index. At 0.05 level of significance, data normality, within group and between group actual differences will be analyzed with a moderate scope software.

DISCUSSION

Our knowledge of this technique and its use is expanding daily as tDCS motor recovery studies-mostly single-center studies-in either single session or many sessions have been completed and shown positive results. The field is prepared for a multi-center, carefully planned, sham-controlled, double-blinded tDCS study to comprehensively examine its feasibility and effectiveness in enhancing outcomes in stroke population.

CONCLUSION

The function of Transcranial Direct Current Stimulation in aiding stroke recuperation will be ascertained.

Predicting the functional outcome of intensive inpatient rehabilitation after stroke: results from the RIPS Study

BACKGROUND

The complexity of stroke sequelae, the heterogeneity of outcome measures and rehabilitation pathways, and the lack of extensively validated prediction models represent a challenge in predicting stroke rehabilitation outcomes.

AIM

To prospectively investigate a multidimensional set of variables collected at admission to inpatient post-stroke rehabilitation as potential predictors of the functional level at discharge.

DESIGN

Multicentric prospective observational study.

SETTING

Patients were enrolled in four Intensive Rehabilitation Units (IRUs).

POPULATION

Patients were consecutively recruited in the period December 2019-December 2020 with the following inclusion criteria: aged 18+, with ischemic/haemorrhagic stroke, and undergoing inpatient rehabilitation within 30 days from stroke.

METHODS

This is a multicentric prospective observational study. The rehabilitation pathway was reproducible and evidence-based. The functional outcome was disability in activities of daily living, measured by the modified Barthel Index (mBI) at discharge. Potential multidimensional predictors, assessed at admission, included demographics, event description, clinical assessment, functional and cognitive profile, and psycho-social domains. The variables statistically associated with the outcome in the univariate analysis were fed into a multivariable model using multiple linear regression.

RESULTS

A total of 220 patients were included (median [IQR] age: 80 [15], 112 women, 175 ischemic). Median mBI was 26 (43) at admission and 62.5 (52) at discharge. In the multivariable analysis younger age, along with better functioning, fewer comorbidities, higher cognitive abilities, reduced stroke severity, and higher motor functions at admission, remained independently associated with higher discharge mBI. The final model allowed a reliable prediction of discharge functional outcome (adjusted R2=77.2%).

CONCLUSIONS

The model presented in this study, based on easily collectable, reliable admission variables, could help clinicians and researchers to predict the discharge scores of the global functional outcome for persons enrolled in an evidence-based inpatient stroke rehabilitation program.

CLINICAL REHABILITATION IMPACT

A reliable outcome prediction derived from standardized assessment measures and validated treatment protocols could guide clinicians in the management of patients in the subacute phase of stroke and help improve the planning of the rehabilitation individualized project.

Should Patients Be Confident in Their Efficacy in Improving Their Functional Abilities After a Stroke?

Background Patients' self-confidence in their abilities needs to be improved to achieve functional abilities after a stroke. Self-efficacy is a prerequisite for self-management after a stroke. This study aimed to analyze the relationship between self-efficacy and the functional abilities of post-stroke patients. Methodology This was an analytical cross-sectional study conducted over two months. A total of 145 respondents were recruited using the convenience sampling method. Respondents were post-stroke patients who had undergone the post-stroke phase during the first three to six months since the acute stroke. Data collection was performed through questionnaire interviews. Data were analyzed using descriptive analysis and Spearman correlation. Results There was a significant positive relationship between self-efficacy and functional independence (p < 0.05). Conclusions Self-efficacy influences motivation to perform activities of daily living, which can increase the achievement of functional abilities.

Anxiety subtypes in rural ischaemic stroke survivors: A latent profile analysis

AIM

To determine the potential profile classes of anxiety reported by ischaemic stroke survivors in rural China, and to explore the characteristics of patients having different types of post-stroke anxiety.

DESIGN

A cross-sectional survey.

METHODS

A cross-sectional survey was conducted by using convenience sampling to collect data from 661 ischaemic stroke survivors in rural Anyang city, Henan Province, China, from July 2021 to September 2021. The parameters included in the study were the socio-demographic characteristics, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and the Barthel index of daily activity ability. Potential profile analysis was done to recognize subgroups of post-stroke anxiety. The Chi-square test was performed to explore the characteristics of individuals with different types of post-stroke anxiety.

RESULTS

The model fitting indices of stroke survivors supported three classes of anxiety models which were as follows: (a) Class 1, low-level, stable group (65.3%, N = 431); (b) Class 2, moderate-level, unstable group (17.9%, N = 118) and (c) Class 3, high-level, stable group (16.9%, N = 112). The risk factors associated with post-stroke anxiety were female patients, lower levels of education, living alone, lower monthly household income, other chronic diseases, impaired daily activity ability and depression.

CONCLUSIONS

This study identified three different subgroups of post-ischaemic stroke anxiety and their characteristics in patients in rural China.

IMPACT

This study has significance in providing evidence for the development of targeted intervention measures to reduce negative emotions in different subgroups of post-stroke anxiety patients.

PATIENT OR PUBLIC CONTRIBUTION

In this study, the researchers arranged the time of questionnaire collection with the village committee in advance, gathered the patients to the village committee for face-to-face questionnaire survey and collected the household data of the patients with mobility difficulties.

Assessment of Changes in Serum C-Reactive Protein Levels in Patients after Ischemic Stroke Undergoing Rehabilitation-A Retrospective Observational Study

Inflammation plays a key role in the pathogenesis and prognosis of ischemic stroke. C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect the progression of vascular disease. Using a biomarker such as CRP to predict recovery rather than mortality may present clinical value in providing rehabilitation. The primary aim of the study was to analyze changes in serum CRP levels in patients after ischemic stroke during the regenerative-compensatory period and to assess the usefulness of CRP as a potential biomarker during the rehabilitation period. The project was carried out as a retrospective analysis of prospectively collected data from post-stroke patients from the Department of Neurological Rehabilitation of the Regional Specialist Hospital in Wrocław. A group of 52 patients, after their first-ever ischemic stroke with subsequent hemiplegia, was finally qualified to participate in the study. Serum CRP levels were determined during blood laboratory tests. The Modified Rankin Scale (mRS) and Barthel Index (BI) were used to assess functional outcomes. Rehabilitation using neurophysiological methods was applied five days a week (each session lasted 60 min, and the entire period was 42 days). At the first test, serum CRP levels were found to be above 5 mg/L in 19 patients, the second test in 12 patients, the third test in five patients, and the fourth test in 9 patients. Only three patients had values higher than 5 mg/L in all consecutive assessments (p > 0.05). There was a statistically significant increase in BI scores after therapy (p < 0.001) as well as a decrease in the mRS score by 2.2 points (p < 0.001), in CRP values by 5.02 mg/L (p = 0.019), and in cortisol levels by 2.5 nmol/L (p = 0.002). Statistically significant relationships were observed between the CRP levels after rehabilitation and the corresponding mRS scores (rs = 0.29, p = 0.038). Furthermore, the effect of BMI on CRP levels was demonstrated (B = 0.20, p = 0.038). In conclusion, despite demonstrating a significant relationship between CRP levels and corresponding mRS scores, CRP levels alone may not serve as an independent predictor of long-term functional outcomes in ischemic stroke patients undergoing rehabilitation.

Brain-machine interface-based training for improving upper extremity function after stroke: A meta-analysis of randomized controlled trials

Background

Upper extremity dysfunction after stroke is an urgent clinical problem that greatly affects patients' daily life and reduces their quality of life. As an emerging rehabilitation method, brain-machine interface (BMI)-based training can extract brain signals and provide feedback to form a closed-loop rehabilitation, which is currently being studied for functional restoration after stroke. However, there is no reliable medical evidence to support the effect of BMI-based training on upper extremity function after stroke. This review aimed to evaluate the efficacy and safety of BMI-based training for improving upper extremity function after stroke, as well as potential differences in efficacy of different external devices.

Methods

English-language literature published before April 1, 2022, was searched in five electronic databases using search terms including “brain-computer/machine interface”, “stroke” and “upper extremity.” The identified articles were screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.4.1 software. The GRADE method was used to assess the quality of the evidence.

Results

A total of 17 studies with 410 post-stroke patients were included. Meta-analysis showed that BMI-based training significantly improved upper extremity motor function [standardized mean difference (SMD) = 0.62; 95% confidence interval (CI) (0.34, 0.90); I² = 38%; p < 0.0001; n = 385; random-effects model; moderate-quality evidence]. Subgroup meta-analysis indicated that BMI-based training significantly improves upper extremity motor function in both chronic [SMD = 0.68; 95% CI (0.32, 1.03), I² = 46%; p = 0.0002, random-effects model] and subacute [SMD = 1.11; 95%CI (0.22, 1.99); I² = 76%; p = 0.01; random-effects model] stroke patients compared with control interventions, and using functional electrical stimulation (FES) [SMD = 1.11; 95% CI (0.67, 1.54); I² = 11%; p < 0.00001; random-effects model]or visual feedback [SMD = 0.66; 95% CI (0.2, 1.12); I² = 4%; p = 0.005; random-effects model;] as the feedback devices in BMI training was more effective than using robot. In addition, BMI-based training was more effective in improving patients' activities of daily living (ADL) than control interventions [SMD = 1.12; 95% CI (0.65, 1.60); I² = 0%; p < 0.00001; n = 80; random-effects model]. There was no statistical difference in the dropout rate and adverse effects between the BMI-based training group and the control group.

Conclusion

BMI-based training improved upper limb motor function and ADL in post-stroke patients. BMI combined with FES or visual feedback may be a better combination for functional recovery than robot. BMI-based trainings are well-tolerated and associated with mild adverse effects.