Disability Measures in Stroke

Objective We conducted a study to develop an assessment sheet for fall prediction in stroke inpatients that is handy and reliable to help ward staff to devise a fall prevention strategy for each inpatient immediately upon admission. Methods The study consisted of three steps: (1) developing a data sampling form to record variables related to risk of falls in stroke inpatients and conducting a follow-up survey for stroke inpatients from their admission to discharge by using the form; (2) carrying out analyses of characteristics of the present subjects and selecting variables showing a high hazard ratio (HR) for falls using the Cox regression analysis; (3) developing an assessment sheet for fall prediction involving variables giving the integral coefficient for each variable in accordance with the HR determined in the second step. Results and discussion (1) Subjects of the present survey were 704 inpatients from 17 hospitals including 270 fallers.(2) We selected seven variables as predictors of the first fall: central paralysis, history of previous falls, use of psychotropic medicines, visual impairment, urinary incontinence, mode of locomotion and cognitive impairment. (3) We made 960 trial models in combination with possible coefficients for each variable, and among them we finally selected the most suitable model giving coefficient number 1 to each variable except mode of locomotion, which was given 1 or 2. The area under the ROC curve of the selected model was 0.73, and sensitivity and specificity were 0.70 and 0.69, respectively (4/5 at the cut-off point). Scores calculated from the assessment sheets of the present subjects by adding coefficients of each variable showed normal distribution and a significantly higher mean score in fallers (4.94 ± 1.29) than in non-fallers (3.65 ± 1.58) (P = 0.001). The value of the Barthel Index as the index of ADL of each subject was indicated to be in proportion to the assessment score of each subject. Conclusion We developed an assessment sheet for fall prediction in stroke inpatients that was shown to be available and valid to screen inpatients with risk of falls immediately upon admission.

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“…As for determination of ADL, we adopted the Barthel Index (BI). BI measures personal levels of functional independence in ADL [23,24].…”

Section: Methodsmentioning

confidence: 99%

Development of an assessment sheet for fall prediction in stroke inpatients in convalescent rehabilitation wards in Japan

Nakagawa

Sannomiya²,

Kinoshita

et al. 2008

Environ Health Prev Med

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“…The most commonly used primary outcome measure in acute stroke trials is the modified Rankin Scale (mRS),14, 15 at least partly because it is simple to administer, has good reproducibility, and avoids major floor or ceiling effects 16. Although most functional recovery poststroke happens in the first few months,17 recovery beyond 6 months does occur,18 but there are few published data on the relationship between early mRS and long‐term disability.…”

Section: Introductionmentioning

confidence: 99%

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

Ganesh

Luengo-Fernández

Wharton

et al. 2017

JAHA

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BackgroundOutcome in stroke trials is often based on a 3‐month modified Rankin scale (mRS). How 3‐month mRS relates to longer‐term outcomes will depend on late recovery, delayed stroke‐related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3‐month mRS and death/disability at 1 and 5 years in a population‐based cohort study.Methods and ResultsIn 3‐month survivors of ischemic stroke (Oxford Vascular Study; 2002‐2014), we related 3‐month mRS to disability (defined as mRS >2) at 1 and 5 years and/or death rates (age/sex adjusted). Accrual of disability and index‐stroke‐related and nonstroke deaths in each poststroke year was categorized according to 3‐month mRS. Among 1606 patients with acute ischemic stroke, 181 died within 3 months, but 126 index‐stroke‐related deaths and 320 other deaths occurred during the subsequent 4866 patient‐years of follow‐up up to 5 years. Although 69/126 (54.8%) post‐3‐month index‐stroke‐related deaths occurred after 1 year, mRS>2 at 1 year strongly predicted these deaths (adjusted hazard ratio=21.94, 95%CI 7.88‐61.09, P<0.0001). Consequently, a 3‐month mRS >2 was a strong independent predictor of death at both 1 year (adjusted hazard ratio=6.67, 95%CI 4.16‐10.69, P<0.0001) and 5 years (adjusted hazard ratio=2.93, 95%CI 2.38‐3.60, P<0.0001). Although mRS improved by ≥1 point from 3 months to 1 year in 317/1266 (25.0%) patients with 3‐month mRS ≥1, improvement in mRS after 1 year was limited (improvement by ≥1 point: 91/858 [10.6%]; improvement to mRS ≤2: 13/353 [3.7%]).ConclusionsOur results reaffirm use of the 3‐month mRS outcome in stroke trials. Although later recovery does occur, extending follow‐up to 1 year would capture most long‐term stroke‐related disability. However, administrative mortality follow‐up beyond 1 year has the potential to demonstrate translation of early disability gains into additional reductions in long‐term mortality without much erosion by non‐stroke‐related deaths.

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“…As a result the brain is unable to function normally, and CVA is the leading cause of loss of social, mental, physical and functional abilities. Generally, 40% of patients with stroke are functionally challenged and 15-20% of stroke patients have several impairments 1,2) . Stroke patients tend to place 61-80% of their body weight on the sound side, leading to asymmetric posture, and 55-75% of patients experience functional limitation of their upper limbs 3) .…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality Reflection Therapy Improves Motor Recovery and Motor Function in the Upper Extremities of People with Chronic Stroke

Jung

Lee

et al. 2012

J Phys Ther Sci

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Abstract.[Purpose] The main purpose of this study was to investigate the effects of Virtual Reality Reflection Therapy on motor recovery and motor function in the upper extremities of patients with chronic stroke. [Subjects] Nineteen participants patients with chronic stroke were randomly assigned to the experimental group (n=11) and the control group (n=8).[Methods] The experimental group performed a Virtual Reality Reflection Therapy program for 30 minutes a day, 5 days a week, during a 4 week period, in addition to conventional therapy. The control group received conventional therapy and performed sham program. All subjects were evaluated using by the Fugl-Meyer Assessment (upper limb section), the Modified Ashworth Scale (MAS), the Box and Block Test (BBT), the JebsenTaylor Hand Function Test and the Manual Function Test pre-and post-intervention.[Results] The experimental group and the control group effectively increased their upper-extremity motor recovery and motor function. Upperextremity motor recovery and motor function of the experimental group showed more significant increases than those of the control group.[Conclusion] Virtual Reality Reflection Therapy (even as a home treatment) with a conventional program in the early stages of treatment might be beneficial for improving hand function. Future studies need to investigate the effectiveness of Virtual Reality Reflection Therapy with optimal patient selection or duration and intensity of training.

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Disability Measures in Stroke

Cited by 261 publications

References 26 publications

Development of an assessment sheet for fall prediction in stroke inpatients in convalescent rehabilitation wards in Japan

Development of an assessment sheet for fall prediction in stroke inpatients in convalescent rehabilitation wards in Japan

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

Virtual Reality Reflection Therapy Improves Motor Recovery and Motor Function in the Upper Extremities of People with Chronic Stroke

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