Relationship between recovery of motor function and neuropsychological functioning in cerebral infarction patients: the importance of social functioning in motor recovery

Early Rehabilitation and Nursing Intervention (ERNI) Accelerates the Recovery of Patients With Ischemic Stroke

BACKGROUND

Ischemic stroke, a severe disease with high disability and mortality, causes an overburden in society and demands more effective treatments. Early rehabilitation and nursing intervention (ERNI) helps the postoperative recovery of patients with hypertensive intracerebral hemorrhage. However, the effect of ERNI on the recovery of people after ischemic stroke remains unclear.

METHODS

Patients were treated with the ERNI program; subsequently, Mini-Mental State Examination, National Institute of Health stroke scale, Fugl-Meyer Assessment Scale, Daily living activity assessment, and Quality of life test were performed after the treatment of ERNI to evaluate the influence of ERNI on the cognitive function, motor function, and life quality of patients after ischemic stroke.

RESULTS

We observed that following the treatment of ERNI, cognitive, neurological, and motor functions, daily life qualities, and life quality in the ERNI-treated group were significantly better than that in the control group.

CONCLUSION

ERNI promoted the recovery of neurological function and improved the life qualities of patients after ischemic stroke.

Test-Retest Reliability and Responsiveness of the Computerized Adaptive Test of Social Functioning in Persons With Stroke

OBJECTIVE

To examine the test-retest reliability, minimal detectable change (MDC), responsiveness, and efficiency of the Computerized Adaptive Test of Social Functioning (Social-CAT) in patients with stroke.

DESIGN

Repeated-assessments design.

SETTING

A department of rehabilitation of a medical center.

PARTICIPANTS

In total, 31 patients with chronic stroke and 65 patients with subacute stroke were recruited.

INTERVENTION

Not available.

MAIN OUTCOME MEASURE

Social-CAT.

RESULTS

The Social-CAT showed acceptable test-retest reliability (intraclass correlation coefficient, 0.80) and small random measurement error (MDC%: 18.0%). However, heteroscedasticity was found (r between the means and the absolute change scores: 0.32), so the MDC% adjusted cut-off score is recommended for determining real improvement. Regarding responsiveness, the Social-CAT showed large differences (Kazis' effect size and standardized mean response: 1.15 and 1.09, respectively) in subacute patients. Regarding efficiency, the Social-CAT required an average of 5 items and less than 2 minutes for completion.

CONCLUSIONS

Our findings indicate that the Social-CAT is a reliable and efficient measure with good test-retest reliability, small random measurement error, and good responsiveness. Thus, the Social-CAT is a useful outcome measure for routine monitoring of the changes in social function of patients with stroke.

Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan

BACKGROUND

Maintenance of activities of daily living (ADL) during acute hospitalization is an important treatment goal, especially for elderly inpatients with diseases that often leave disabilities, such as cerebral infarction. However, studies assessing risk-adjusted ADL changes are limited. In this study, we developed and calculated a hospital standardized ADL ratio (HSAR) using Japanese administrative claims data to measure the quality of hospitalization care for patients with cerebral infarction.

METHODS

This study was designed as a retrospective observational study using the Japanese administrative claim data from 2012 to 2019. The data of all hospital admissions with a primary diagnosis of cerebral infarction (ICD-10, I63) were used. The HSAR was defined as the ratio of the observed number of ADL maintenance patients to the expected number of ADL maintenance patients multiplied by 100, and ratio of ADL maintenance patients was risk-adjusted using multivariable logistic regression analyses. The c-statistic was used to evaluate the predictive accuracy of the logistic models. Changes in HSARs in each consecutive period were assessed using Spearman's correlation coefficient.

RESULTS

A total of 36,401 patients from 22 hospitals were included in this study. All variables used in the analyses were associated with ADL maintenance, and evaluations using the HSAR model showed predictive ability with c-statistics (area under the curve, 0.89; 95% confidence interval, 0.88-0.89).

CONCLUSIONS

The findings indicated a need to support hospitals with a low HSAR because hospitals with high/low HSAR were likely to produce the same results in the subsequent periods. HSAR can be used as a new quality indicator of in-hospital care and may contribute to the assessment and improvement of the quality of care.

Application of a hospital–community–family trinity rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction

BACKGROUND

Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system. The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals, communities, and families for patients.

AIM

To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.

METHODS

From January 2021 to December 2021, 88 patients with cerebral infarction were divided into a study (n = 44) and a control (n = 44) group using a simple random number table. The control group received routine nursing and motor imagery therapy. The study group was given hospital–community–family trinity rehabilitation nursing based on the control group. Motor function (FMA), balance ability (BBS), activities of daily living (BI), quality of life (SS-QOL), activation status of the contralateral primary sensorimotor cortical area to the affected side, and nursing satisfaction were evaluated before and after intervention in both groups.

RESULTS

Before intervention, FMA and BBS were similar (P > 0.05). After 6 months’ intervention, FMA and BBS were significantly higher in the study than in the control group (both P < 0.05). Before intervention, BI and SS-QOL scores were not different between the study and control group (P > 0.05). However, after 6 months’ intervention, BI and SS-QOL were higher in the study than in the control group (P < 0.05). Before intervention, activation frequency and volume were similar between the study and the control group (P > 0.05). After 6 months’ intervention, the activation frequency and volume were higher in the study than in the control group (P < 0.05). The reliability, empathy, reactivity, assurance, and tangibles scores for quality of nursing service were higher in the study than in the control group (P < 0.05).

CONCLUSION

Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction, improving their quality of life.

The mediating effect of social functioning on the relationship between social support and fatigue in middle-aged and young recipients with liver transplant in China

Objective

The objective of the study was to explore the relationship between social support and fatigue as well as the mediating role of social functioning on that relationship.

Background

Psychosocial factors such as social support and social functioning may influence patients’ fatigue symptoms. There is limited evidence on the relationship between social support, social functioning, and fatigue in liver transplant recipients.

Methods

A total of 210 patients with liver transplants from two tertiary hospitals were enrolled in the current study. Questionnaires used include one for general demographic data, the Perceived Social Support Scale (PSSS), Social Disability Screening Schedule (SDSS), and Fatigue Symptom Inventory (FSI).

Results

A total of 126 (60%) recipients reported fatigue. Gender, residence, BMI, and liver function were the primary factors affecting fatigue. Social support was positively correlated with social functioning and was negatively correlated with fatigue. The effect of social support on fatigue was partially mediated by social functioning (35.74%).

Conclusion

The fatigue of liver transplant recipients should be attended to. The higher the social support, the lower the fatigue of liver transplant recipients. Social support may also reduce fatigue through social functioning. The liver transplant team should help the liver transplant recipient establish a social support system, restore social functioning, and reduce fatigue symptoms.

Effects of All-Inclusive and Hierarchical Rehabilitation Nursing Model Combined with Acupuncture on Limb Function and Quality of Life in Elderly Patients with Cerebral Infarction during Convalescence

Objective

To investigate effects of all-inclusive and hierarchical rehabilitation nursing model combined with acupuncture on limb function and quality of life in elderly patients with cerebral infarction during convalescence.

Methods

Eighty elderly patients with cerebral infarction who were treated in our hospital (February 2018–February 2020) and met the inclusion and exclusion criteria were chosen as the research objects, and their materials were analyzed in the way of retrospective study. They were equably randomized into observation group and reference group. Based on the acupuncture treatment, the patients in the observation group and the reference group were given routine rehabilitation nursing and all-inclusive and hierarchical rehabilitation nursing respectively for three months. The simplified Fugl-Meyer Assessment (FMA) scores, Modified Edinburgh-Scandinavian Stroke Scale (MESSS) scores, Activities of Daily Living Scale (ADL) scores, and Stroke-Specific Quality of Life Scale (SS-QOL) scores in the two groups before and after intervention were recorded, and the changes of limb function, neurological function, and living quality of the patients in the two groups were analyzed.

Results

Compared with the reference group, the observation group after intervention achieved prominently higher FMA score (P < 0.001), markedly lower MESSS score (P < 0.001), and signally higher SS-QOL scores (P < 0.05). After intervention, the observation group achieved obviously higher ADL score than the reference group (68.88 ± 8.91 vs 59.00 ± 8.38, P < 0.001).

Conclusion

The all-inclusive and hierarchical rehabilitation nursing model combined with acupuncture can accelerate the recovery of neurological function of the elderly patients with cerebral infarction, enhance the rehabilitation of their limb function, and markedly improve their quality of life. Therefore, this model has referential significance in clinic.

Practical Machine Learning Model to Predict the Recovery of Motor Function in Patients with Stroke

BACKGROUND

Machine learning (ML) is an artificial intelligence technique in which a system learns patterns and rules from a given data.

OBJECTIVES

The objective of the study was to investigate the potential of ML for predicting motor recovery in stroke patients.

METHODS

We analyzed data from 833 consecutive stroke patients using 3 ML algorithms: deep neural network (DNN), random forest, and logistic regression. We created a practical ML model using the most common data measured in almost all rehabilitation hospitals as input data. Demographic and clinical data, including modified Brunnstrom classification (MBC) and functional ambulation classification (FAC), were collected when patients were transferred to the rehabilitation unit (8-30 days) and 6 months after stroke onset and were used as input data. Motor outcomes at 6 months after stroke onset of the affected upper and lower extremities were classified according to MBC and FAC, respectively. Patients with an MBC of <5 and an FAC of <4 at 6 months after stroke onset were considered to have a "poor" outcome, whereas those with MBC ≥5 and FAC ≥4 were considered to have a "good" outcome.

RESULTS

The area under the curve (AUC) for the DNN model for predicting motor function was 0.836 for the upper and lower limb motor functions. For the random forest and logistic regression models, the AUCs were 0.736 and 0.790 for the upper and lower limb motor functions, respectively. The AUCs for the random forest and logistic regression models were 0.741 and 0.795 for the upper and lower limb motor functions, respectively.

CONCLUSION

Although we used simple and common data that can be obtained in clinical practice as variables, our DNN algorithm was useful for predicting motor recovery of the upper and lower extremities in stroke patients during the recovery phase.

Internet+Continuing Nursing (ICN) Program Promotes Motor Function Rehabilitation of Patients With Ischemic Stroke

BACKGROUND AND PURPOSE

Ischemic stroke is a severe disorder with high rates of death and recurrence that causes disability in patients and for which there is currently no effective treatment. Internet-based rehabilitation helps patients with disability recover at home with the help of their household or family members in a nonclinical setting. However, the effects of the internet+continuing nursing (ICN) program on the recovery of patients after ischemic stroke remains unknown.

METHODS

In the present study, patients were treated with an ICN-based rehabilitation training program; subsequently, the Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life were performed to evaluate the effects of the ICN program on patient self-confidence to persist with rehabilitation, functional exercise compliance, motor function, ability to live independently and quality of life following ischemic stroke.

RESULTS

We observed that, after the ICN intervention for 6 weeks and 3 months, the scores of Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life in the ICN-treated group were significantly higher compared with those in the control group.

CONCLUSION

These results suggested that the ICN program may promote the recovery of patients after ischemic stroke.

Motor Function and Activities of Daily Living Recovery after Cardiogenic Internal Carotid Artery Infarction: A Retrospective Cohort study

OBJECTIVES

this study determines recovery in physical activity and activities of daily living in the early stages after cardiogenic internal carotid artery infarction.

MATERIALS AND METHODS

this retrospective comfort study compares assessment data for 334 patients: 150 patients had atherosclerotic infarction (67 internal carotid artery, 87 middle cerebral artery) and 180 had cardiogenic infarction (32 internal carotid artery infarction, 148 middle cerebral artery). We used Brunnstrom recovery score, posture assessment scale for stroke, and functional independence measure.

RESULTS

on initial assessment, median Brunnstrom recovery for the cardiogenic internal carotid artery infarction group was I-II in the upper limb, I in the finger, I-II in the lower limb, and IV or higher in all other groups. The median Postural Assessment Scale for Stroke score for the cardiogenic internal carotid artery infarction group was 0; all other groups scored 14 or higher. The median Functional Independence Measure for the cardiogenic internal carotid artery infarction group was 18 (maximum of 100) and the median score for other infarct groups was 25-50 (maximum 126), with P < .01. After a month, final assessment results for the cardiogenic internal carotid artery infarction group were much lower than for the other groups. Only both internal carotid artery infarctions were compared. Atherosclerotic infarctions showed recovery across assessments, except understanding, onset, and memory (P < .01), and cardiogenic infarctions did not change from the initial assessment in all criteria assessed.

CONCLUSIONS

adapting cardiogenic internal carotid artery infarction as a stroke recovery model is difficult.