Toileting independence is important for patients to maintain self-esteem and to return home. Unaffected grip strength and trunk functions have been noted in earlier studies to be associated with toileting independence in stroke patients. The objective of this study was to explore appropriate indices and calculate cutoff values with regard to unaffected grip strength and trunk functions that could be completed in a short time for estimating toileting independence in stroke patients. Methods: The subjects were 37 stroke patients, each of whom scored at least 21 points in the Revised Hasegawa's Dementia Scale. The patients were divided into independent and non-independent toileting groups by FIM ® scores related to toiling items ("Toileting" and "Toilet transfer"). Logistic regression and receiver operating characteristic curve were used to elucidate items that showed an association with the presence or absence of toileting independence, and to calculate cutoff values of grip strength and trunk function from the Stroke Impairment Assessment Set as variables. Results: Grip strength was significantly associated with toileting independence. The cutoff value was 3 points (sensitivity, 74%; specificity, 71%; receiver operating characteristic area under the curve, 0.730). Discussion: Because grip strength can be quickly measured, calculated grip strength cutoff values can estimate a patient's ability for toileting independence. However, the cutoff value shown in the present study may be applicable to only patients with good trunk function.

This study was aimed at determining the cutoff values of activities of daily living (ADL) and the combination of related factors associated with high caregiver burden that induces depression among caregivers. The study participants included 50 pairs of home-based rehabilitation users and their primary caregivers. They were classified into two groups: high-burden and low-burden groups according to the short version of the Japanese version of the Zarit Caregiver Burden Interview score of ≥13 or ≤12, respectively. The cutoff values of ADL and the combination of related factors associated with high caregiver burden were examined using the receiver operating characteristic curve and decision tree analyses. The cutoff value associated with high caregiver burden was 5 points for the controlling bladder item of the Barthel index (BI) (sensitivity: 90%, specificity: 70%). Regarding the decision tree, the controlling bladder item of BI (≤5 or 10 points) was selected as the first layer and the recipient’s age (≤78 or ≥79 years) as the second layer. High caregiver burden was identified in 85.7% of the caregivers in whom the score of controlling bladder of BI was ≤5 points and the patient was aged ≤78 years. A score of ≤5 points for the controlling bladder item of BI along with young recipient age was associated with high caregiver burden that induces depression among caregivers. This approach is useful to identify caregivers with high caregiver burden who are at risk for depression.

Several previous studies have reported the balance cut-off value associated with activities of daily living independence in patients who suffered a stroke; however, the cut-off value may change over time post a stroke. If these cut-off values after the stroke are clarified according to the period, they will become more appropriate target values for rehabilitation. This retrospective observational study included 157 first-stroke patients. The area under the receiver operating characteristic curves were calculated using an independent/dependent group of activities of daily living items serving as dependent variables and the Berg balance scale scores serving as independent variables. Measurements were made at 1-, 2-, and 3-month after the stroke. Cutoff values were calculated if the receiver operating characteristic curves were >0.9. The Berg Balance Scale cutoff value for classifying the independence of toileting was 43 points at the 1-month, 42 points at the 2-month, and 39 points at the 3-month after stroke. The cutoff values for dressing was 44 points at the 1-month, 41 points at the 2-month, and 41 points at the 3-month after stroke. The cutoff values for stair-climbing ability were 53 points at the 2-month and 49 points at the 3-month after stroke. Our results indicated the cut-off values of balance associated with activities of daily living independence at each time point at 1, 2, and 3 months after the onset of stroke were clarified, and these are expected to help set the target value for rehabilitation considering the time post the onset of stroke in convalescence rehabilitation wards