An investigation of the factors that influence functional improvement in stroke rehabilitation

Survey of patients with stroke in the Kitakyushu Area, Japan: a 12-year retrospective analysis of the critical pathway

OBJECTIVES

We aimed to clarify the incidence, clinical profile, outcome, and activities of daily living of patients with stroke using the Kitakyushu clinical pathway database and to investigate the characteristics of patients with stroke in the Kitakyushu medical area in Japan.

MATERIALS AND METHODS

The clinical data of patients with stroke registered in the Kitakyushu database between April 1, 2009 and December 31, 2021 were retrospectively examined. The National Institutes of Health Stroke Scale was used to classify stroke severity. A descriptive analysis of basic variables, including age, stroke type, length of hospital stay, and activities of daily living, according to stroke severity was conducted.

RESULTS

There were 7,487 acute care hospital patients and 5,441 rehabilitation hospital patients. Compared with patients in similar cities in Japan, patients in the Kitakyushu area tended to be older at the time of stroke onset with a higher proportion of cases of hemorrhagic stroke. Length of hospital stay in both acute and rehabilitation hospitals increased with stroke severity. The Functional Independence Measure gain was highest in patients with moderate disability.

CONCLUSIONS

Compared with patients in similar cities in Japan, in the Kitakyushu area, patients with stroke were older and the proportion of patients with hemorrhagic stroke was higher. Stroke rehabilitation therapy is effective for patients with moderately severe stroke.

Long-Term Clinical Trajectory of Patients with Subarachnoid Hemorrhage: Linking Acute Care and Neurorehabilitation

BACKGROUND

Despite improvements in the critical care management of subarachnoid hemorrhage (SAH), a substantial number of patients still suffer from disabilities. In most areas of the world, longitudinal follow-up is not routinely performed, and the patient's trajectory remains unknown.

METHODS

We prospectively collected data of 298 consecutive patients with spontaneous SAH and evaluated clinical trajectories at discharge, 3 months, and 1 year after SAH. In a subgroup of patients transferred to a local neurorehabilitation center (Rehab-Hochzirl), we studied the effects of rehabilitation intensity on clinical trajectories. Any decrease in the modified Rankin Scale (mRS) was defined as an improvement, with mRS ≤ 2 indicating good outcome. We used multivariate generalized linear models to investigate associations with clinical trajectories.

RESULTS

Out of the 250 surviving patients, 35% were transferred directly to Rehab-Hochzirl (n = 87 of 250; mRS at discharge = 4), 11% were transferred to another rehabilitation center (n = 27 of 250; mRS = 1), 1% were transferred to a nursing home (n = 3 of 250; mRS = 5), 21% were transferred to their country of origin (n = 52 of 250; mRS = 4), and 32% (n = 79 of 250; mRS = 1) were discharged home. Functional outcome improved in 57% (n = 122 of 215) of patients during the first 3 months, with an additional 16% (35 of 215) improving between 3 and 12 months, resulting in an overall improvement in 73% (n = 157 of 215) of survivors. After 1 year, 60% (n = 179 of 250) of patients were functionally independent. A lower Hunt and Hess scale score at intensive care unit admission, younger age, a lower mRS at intensive care unit discharge, fewer days on mechanical ventilation, and male sex were independently associated with better functional recovery. Although the subgroup of patients transferred to Rehab-Hochzirl were more severely affected, 60% (52 of 87) improved during inpatient neurorehabilitation.

CONCLUSIONS

Our results indicate ongoing functional improvement in a substantial number of patients with SAH throughout a follow-up period of 12 months. This effect was also observed in patients with severe disability receiving inpatient neurorehabilitation.

Risk factors for unfavorable clinical course of the early recovery period of ischemic stroke in young and middle-aged patients

Background. This study was carried out due to persistent increase in the incidence of ischemic stroke in people of working age and insufficient knowledge of risk factors affecting its clinical course in the early recovery period in young and middle-aged patients.The aim. To identify and to study variants of the clinical course of the early recovery period of ischemic stroke in young and middle-aged patients; to determine the risk factors for its unfavorable course.Materials and methods. We carried out a longitudinal prospective study, which involved 145 patients with ischemic stroke in its early recovery period. The main risk factors for cardiovascular diseases were analyzed. Dynamic observation of these patients allowed us to determine five variants of the clinical course of the ischemic stroke early recovery period – regressive, regressive with residual mild focal neurological symptoms, stable, slowly progressive and rapidly progressive.Results. Regressive course was observed in 58 (40 %) patients; regressive course with residual mild focal neurological symptoms – in 66 (45.5 %) patients; stable course – in 9 (6.2 %) patients; slowly progressive course – in 8 (5.5 %) patients, rapidly progressive course – in 4 (2.8 %) patients. The following risk factors had statistically significant affect on the unfavorable course of the disease: more pronounced motor, sensory and speech disorders at the time of patient’s admission to the hospital and at the end of the ischemic stroke early recovery period; severity of ischemic stroke according to the National Institutes of Health Stroke Scale (NIHSS); damage to the carotid basin of the brain; ischemic heart disease; irregular intake or patient’s refuse of taking prescribed antiplatelet, lipid-lowering, antihypertensive therapy (p < 0.05).Conclusions. Defining the variant of the clinical course of the ischemic stroke early recovery period in young and middle-aged patients and risk factors for its unfavorable course is important in determining tactics and further neurorehabilitation measures.