Dependency in Activities of Daily Living During the First Year After Stroke

Abstract

Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation.Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke.Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed.Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke.Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.

Lysophosphatidylcholines and phosphatidylcholines as biomarkers for stroke recovery

“…To investigate which biomarkers are related to stroke recovery, the BI scores of 40 patients with stroke upon admission and at the 3-month follow-up appointment were collected. As suggested by previous studies ( 18 , 30 , 31 ), these 40 patients were divided with stroke into two groups: ADL independent with a BI score ≥95 and ADL dependent with a BI score ≤90 using the BI score from the 3-month follow-up appointment. Next, a hierarchically clustered heatmap was constructed to present the lipids that were closely linked to these two groups.…”

Development and Implementation of a New Model of Care for Patients With Stroke, Acute Hospital Rehabilitation Intensive SErvices

“…Function-based sessions target ADLs (grooming, self-feeding, toileting, dressing, and/or bathing) or for higher-level patients may simulate instrumental ADLs, such as home management, financial management, medication management, and leisure/work tasks. While performing some of these tasks in the acute care setting can pose a challenge given the environment, research has shown that task-specific training and returning to valued occupations during recovery may be beneficial 16–20 . For example, therapists may have a patient perform grooming tasks by integrating the affected arm at the appropriate level, ranging from a dependent stabilizer to a functional assist.…”

“…While performing some of these tasks in the acute care setting can pose a challenge given the environment, research has shown that task-specific training and returning to valued occupations during recovery may be beneficial. [16][17][18][19][20] For example, therapists may have a patient perform grooming tasks by integrating the affected arm at the appropriate level, ranging from a dependent stabilizer to a functional assist. They may set up the sink so that all supplies are in the affected visual field to promote scanning and attention.…”

Stroke Severity and Level of Dependence Against Risk of Falls in Stroke Patients

“…At the same time, respondents with severe and total dependence were 21.2% of each. Based on the study conducted by Wurzinger (2021), the level of dependency on activity daily living at 3 and 12 months is related to the patient's dependency within 36-48 hours after admission to the hospital. Dependency was identified by some factors, including cognitive impairment and older age.…”

“…Dependency in stroke patients mostly affects daily activities. This is a common impact of post-stroke, and it can be persisted in 35% of stroke patients within the first year of stroke (Wurzinger, 2021). The level of dependence of stroke patients can be assessed using the Barthel index scale.…”