Activities, participation and satisfaction one-year post stroke

Prestroke Physical Activity Matters for Functional Limitations: A Longitudinal Case-Control Study of 12,860 Participants

OBJECTIVE

In the chronic phase after a stroke, limitations in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) initially plateau before steadily increasing. The benefits of prestroke physical activity on these limitations remain unclear. To clarify this relationship, the effect of physical activity on the long-term evolution of functional limitations in a cohort of people with stroke compared to a cohort of matched adults without stroke was examined.

METHODS

Longitudinal data from 2143 people with stroke and 10,717 adults without stroke aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; eight data collection waves). Physical activity was assessed in the prestroke wave. Functional limitations were assessed in the poststroke waves. Each person with stroke was matched with five adults without stroke who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADLs and IADLs, chronic conditions, and country of residence, before any of the participants from either cohort had experienced a stroke.

RESULTS

Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the beneficial effect of physical activity being stronger in people with stroke (b = -0.345; 95% CI = -0.438 to -0.252) than in adults without stroke (b = -0.269; 95% CI = -0.269 to -0.241).

CONCLUSION

The beneficial effect of prestroke physical activity on ADL limitations after stroke is stronger than its effect in matched adults without stroke followed for a similar number of years.

IMPACT

Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, prestroke levels of physical activity can inform the prognosis of functional dependence in people with stroke.

Enriched music-supported therapy for individuals with chronic stroke: a randomized controlled trial

OBJECTIVE

Many stroke survivors still present with upper-limb paresis six months post-stroke, impacting their autonomy and quality of life (QoL). We designed an enriched Music-supported Therapy (eMST) program to reduce disability in this population. We evaluated the eMST's effectiveness in improving functional abilities and QoL in chronic stroke individuals compared to the conventional motor program Graded Repetitive Arm Supplementary Program (GRASP).

METHODS

We conducted a pragmatic two-arm parallel-group randomized controlled trial with a 3-month follow-up and masked assessment. The eMST involved playing instruments during individual self-administered and group music therapy sessions. The GRASP consisted of self-administered motor exercises using daily objects. Both interventions were completed at home with telemonitoring and involved four one-hour weekly sessions for 10 weeks. The primary outcome was upper-limb motor function measured with the Action Research Arm Test. Secondary outcomes included motor impairment, daily life motor performance, cognitive functions, emotional well-being, QoL, self-regulation, and self-efficacy. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted including participants who discontinued the intervention and those who completed it entirely, respectively.

RESULTS

Fifty-eight chronic stroke patients were randomized to the eMST-group (n = 26; age: 64.2 ± 12.5; 6 [23.1%] females; 2.8 ± 2.9 years post-stroke), and the control group (n = 32; age: 62.2 ± 12; 8 [25%] females; 1.8 ± 6.2 years post-stroke). The eMST-group had more participants achieving a clinically relevant improvement in motor impairment post-intervention than the control group for the ITT (55% vs 21.6%; OR = 4.5 (95% CI 1.4-14); p = .019) and PP analyses (60% vs 20%; OR = 6 (95% CI 1.5-24.7); p = .024), sustained at follow-up. The eMST-group reported greater improvements in emotion (difference = 11.1 (95% CI 0.8-21.5; p = 0.36) and participation (difference = 10.3 (95% CI 0.6-25.9); p = 0.41) subscales of QoL, and higher enjoyment during the sessions (difference = 1 (95% CI 0.3-1.5); p = 0.12). No changes were found in other outcomes.

CONCLUSION

eMST demonstrated superiority over conventional motor rehabilitation program in enhancing upper-limb functions and QoL in chronic stroke individuals.

TRIAL REGISTRATION

ClinicalTrials.gov (ID: NCT04507542).

Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter

BACKGROUND

People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown.

OBJECTIVES

To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia.

METHODS

Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital.

RESULTS

Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89).

CONCLUSIONS

Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required.

Differences in Daily Activity Performance Between Inpatient Rehabilitation Facility and Home Among Stroke Survivors

BACKGROUND

Stroke survivors are one of the largest consumer groups of rehabilitation services. Despite improvement in daily activities while in inpatient rehabilitation, many have difficulty performing daily activities at home after discharge. The difference in performance between a standard clinical context and at home is poorly understood.

OBJECTIVE

To better understand differences in activity performance during transition from inpatient rehabilitation facility (IRF) to home, we examined daily activity performance scores from 2 different environments (IRF and home) at the same time point (discharge).

METHODS

This was a cross-sectional analysis using baseline data from a randomized controlled trial. Participants were stroke survivors aged ≥50 who planned to discharge home from the IRF. The Functional Independence Measure and Section GG codes (both converted to International Classification of Functioning, Disability, and Health scores) were conducted per protocol first at home and then in the IRF at discharge (≤3 days apart, order not randomized).

RESULTS

Among 57 participants, activity scores at home were significantly worse than scores at IRF discharge. Over 40% of participants had discharge scores indicating no-to-mild impairment for shower/tub transfer, walking, and going up/down stairs, while home visit scores indicated moderate-to-complete impairment for those activities. The greatest differences in scores were for shower/tub transfer (median difference 1.5, 95% CI 1.00-2.00) and going up/down stairs (median difference 1.50, 95% CI 1.00-2.00).

CONCLUSION

The environment plays an important role in stroke survivors' functioning at home. Future studies should further examine how the environment impacts activity performance upon returning home following stroke.

Factors Related to the Quality and Stability of Partner Relationships After Stroke: A Systematic Literature Review

OBJECTIVE

To provide an overview of the current state of knowledge on factors related to relationship quality and relationship stability after stroke.

DATA SOURCES

Cumulative Index to Nursing and Allied Health (CINAHL), Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on November 15, 2022, for literature on factors associated with (1) relation quality and (2) relation stability after stroke.

STUDY SELECTION

English quantitative and qualitative studies investigating factors associated with relation quality and/or stability after stroke were included. Three reviewers independently assessed eligibility. Consensus meetings were held in case of divergent opinions. A total of 44 studies were included.

DATA EXTRACTION

Information regarding study objectives and characteristics, participant demographics, independent and dependent variables, and main findings was extracted. Study quality was rated using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and/or the Critical Appraisal Skills Programme Checklist for Qualitative Research. Both were administered by the lead reviewer and checked by the second reviewer. Identified factors are described and presented according to the domains of the International Classification of Functioning, Disability, and Health model.

DATA SYNTHESIS

Thirty-seven factors related to relationship quality after stroke were identified, covering the domains of body functions and structures (eg, cognitive problems), activities (eg, decrease in physical intimacy), participation (eg, being socially active), environment (eg, medication side effects), and personal factors (eg, hypervigilance). Eight factors related to relationship stability were identified, covering the domains of participation (agreement on reciprocal roles) and personal factors (eg, quality of prestroke relation).

CONCLUSIONS

Relationship quality and stability after stroke are related to a multitude of factors. Future research should confirm the relevance of factors found in a few studies of suboptimal quality; explore possible associations between relationship stability and factors falling in the domains of body functions and structure, activity, and environmental factors; and explicitly explore potential positive effects of stroke on relationships.

Lifespace and occupational participation following acquired brain injury during driving disruption: a mixed methods study

PURPOSE

To examine the lifespace of participants referred for occupational therapy driving assessment following acquired brain injury, to understand how, why, where and with whom access and participation in community-based occupations is occurring during the period of driving disruption.

MATERIALS AND METHODS

The mixed methods, convergent research design utilised a travel diary and Lifespace Mobility Assessment-Composite quantitative elements and semi-structured interviews analysed qualitatively with an interpretive description lens.

RESULTS

Forty-eight participants (56.25% male) aged between 26 and 65 years, left home on average once/day, primarily to conduct instrumental activities of daily living, health management, and social participation community-based occupations. Most reported restricted lifespace (54.2%) requiring assistance to conduct community occupations (68.1%). Support was primarily provided by family members (80.3%). Analysis of semi-structured interviews (n = 15) created three themes that shaped participant occupational experience during driving disruption: (i) changes to occupational participation; (ii) reliance on others for community access and participation; and (iii) trying to move forward.

CONCLUSION

The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace, changing how, why, where and with whom participation in community-based occupations occurs. Rehabilitation facilitating occupational adaptation process to enhance community access capacity is indicated.

Synergistic efficacy of repetitive peripheral magnetic stimulation on central intermittent theta burst stimulation for upper limb function in patients with stroke: a double-blinded, randomized controlled trial

BACKGROUND

Non-invasive techniques such as central intermittent theta burst stimulation (iTBS) and repetitive peripheral magnetic stimulation (rPMS) have shown promise in improving motor function for patients with stroke. However, the combined efficacy of rPMS and central iTBS has not been extensively studied. This randomized controlled trial aimed to investigate the synergistic effects of rPMS and central iTBS in patients with stroke.

METHOD

In this study, 28 stroke patients were randomly allocated to receive either 1200 pulses of real or sham rPMS on the radial nerve of the affected limb, followed by 1200 pulses of central iTBS on the ipsilesional hemisphere. The patients received the intervention for 10 sessions over two weeks. The primary outcome measures were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT). Secondary outcomes for activities and participation included the Functional Independence Measure-Selfcare (FIM-Selfcare) and the Stroke Impact Scale (SIS). The outcome measures were assessed before and after the intervention.

RESULTS

Both groups showed significant improvement in FMA-UE and FIM-Selfcare after the intervention (p < 0.05). Only the rPMS + iTBS group had significant improvement in ARAT-Grasp and SIS-Strength and activity of daily living (p < 0.05). However, the change scores in all outcome measures did not differ between two groups.

CONCLUSIONS

Overall, the study's findings suggest that rPMS may have a synergistic effect on central iTBS to improve grasp function and participation. In conclusion, these findings highlight the potential of rPMS as an adjuvant therapy for central iTBS in stroke rehabilitation. Further large-scale studies are needed to fully explore the synergistic effects of rPMS on central iTBS.

TRIAL REGISTRATION

This trial was registered under ClinicalTrials.gov ID No.NCT04265365, retrospectively registered, on February 11, 2020.

Biomechanical Assessment Methods Used in Chronic Stroke: A Scoping Review of Non-Linear Approaches

Non-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.

Pre-stroke physical activity matters for functional limitations: A longitudinal case-control study of 12,860 participants

Objective

In the chronic phase after a stroke, limitations in activities of daily living (ADLs) and instrumental ADL (IADLs) initially plateau before steadily increasing. The benefits of pre-stroke physical activity on these limitations remain unclear. To clarify this relationship, we examined the effect of physical activity on the long-term evolution of functional limitations in a cohort of stroke survivors and compared it to a cohort of matched stroke-free adults.

Methods

Longitudinal data from 2,143 stroke survivors and 10,717 stroke-free adults aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; 8 data collection waves). Physical activity was assessed in the pre-stroke wave. Functional limitations were assessed in the post-stroke waves. Each stroke survivor was matched with 5 stroke-free adults who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADL and IADL, chronic conditions and country of residence, before any of the participants from either cohort had experienced a stroke.

Results

Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the effect of physical activity being stronger in stroke survivors (b = -0.345, 95% CI = -0.438 to -0.252) than in stroke-free adults (b = -0.269, 95% CI = -0.269 to -0.241).

Conclusion

The beneficial effect of pre-stroke physical activity on ADL limitations after stroke is stronger than its effect in matched stroke-free adults followed for a similar number of years.

Impact

Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, pre-stroke levels of physical activity can inform the prognosis of functional dependence in stroke survivors.

Investigating the Telerehabilitation With Aims to Improve Lower Extremity Recovery Poststroke Program: A Feasibility Study

OBJECTIVE

The purpose of this study was to examine the feasibility of a progressive virtual exercise and self-management intervention, the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke program (TRAIL), in individuals with stroke.

METHODS

A single group pre-post study design was used. Thirty-two participants were recruited who were aged 19 years or older, had a stroke within 18 months of the beginning of the study, had hemiparesis of the lower extremity, and were able to tolerate 50 minutes of activity. Participants completed TRAIL, a synchronous exercise and self-management program delivered via videoconferencing. Participants received 8 telerehabilitation sessions over 4 weeks that were 60 to 90 minutes, with a trained physical therapist in a ≤2 to 1 participant-to-therapist ratio. Feasibility indicators in the areas of process (recruitment and retention rates, perceived satisfaction), resources (treatment fidelity and adherence, participant and assessor burden, therapist burden), management (equipment, processing time), and scientific indicators (safety, treatment response, treatment effect) were collected throughout the study using a priori criteria for success. The treatment effect was examined on the Timed "Up & Go" test, the virtual Fugl-Meyer Lower Extremity Assessment, the 30-Second Sit-to-Stand Test, the Functional Reach, the Tandem Stand, the Activities-Specific Balance Confidence Scale, the Stroke Impact Scale, and the Goal Attainment Scale.

RESULTS

Forty-seven individuals were screened, of which 32 (78% male; median age of 64.5 years) were included for the study from 5 sites across Canada. Nine feasibility indicators met our study-specific threshold criteria for success: retention rate (0 dropouts), perceived satisfaction, treatment fidelity, adherence, therapist burden, equipment, and safety. In terms of treatment response and effect, improvements were observed in Timed "Up & Go" test (Cohen d = 0.57); Fugl-Meyer Lower Extremity Assessment (d = 0.76); 30-Second Sit-to-Stand Test (d = 0.89); and Goal Attainment Scale (d = 0.95).

CONCLUSION

The delivery of TRAIL, a lower extremity stroke rehabilitation program using videoconferencing technology, is feasible and appears to have positive influences on mobility, lower extremity impairment, strength, and goal attainment.

IMPACT

Community-based telerehabilitation programs, such as TRAIL, could extend the continuum of care during the transition back to community postdischarge or during global disruptions, such as Coronavirus Disease 2019 (COVID-19). Delivery of synchronous lower extremity rehabilitation via videoconferencing to community-dwelling stroke survivors is feasible.

The mediating effect of anxiety on the association between residual neurological impairment and post-stroke participation among persons with and without post-stroke depression

Previous research has reported that residual neurological impairment and emotional factors play a role in regaining successful participation post-stroke. The objective of this study was to investigate the mediating impact of anxiety on the association between residual neurological impairment and participation in survivors with and without post-stroke depressive symptoms. Participants (N = 79) were classified into 2 categories, those with post-stroke depressive symptoms (N = 40) and those without post-stroke depressive symptoms (N = 39). Variables measured in this study: residual neurological impairment (NIH Stroke Scale Score), participation (Reintegration to Normal Living Index), depressive symptoms (Patient Health Questionnaire-9), and trait anxiety (State-Trait Anxiety Inventory). A regression-based mediation analysis was conducted for each group of participants. The majority of participants had some level of anxiety. Residual neurological impairment predicted participation in stroke survivors both with (β = -.45, p = .003) and without (β = -.45, p = .004) post-stroke depressive symptoms. Anxiety mediated this relationship in participants with depressive symptoms (β = -.19, 95% CI = -.361 ∼ -.049), but not in participants without depressive symptoms (β = -.18, 95% CI = -.014 ∼ .378). Depressive and anxious symptoms should both be addressed to best facilitate participation by stroke survivors.

The presence of anhedonia in individuals with subacute and chronic stroke: an exploratory cohort study

Background

Anhedonia refers to the diminished capacity to experience pleasure. It has been described both as a symptom of depression and an enduring behavioral trait that contributes its development. Specifically, in stroke patients, anhedonia has been closely linked to depression, resulting in reduced sensitivity to everyday pleasures and intrinsic motivation to engage in rehabilitation programs and maintain a healthy active lifestyle. This condition may hinder patients' recovery, diminishing their autonomy, functioning, and quality of life.

Objective

We aimed to explore the prevalence and level of anhedonia and those variables that might be associated in patients with both ischemic and hemorrhagic stroke at subacute and chronic phases of the disease.

Methods

We conducted an exploratory cohort study with a sample of 125 patients with subacute and chronic stroke presenting upper-limb motor deficits. We measured participants' level of anhedonia with four items from the Beck Depression Inventory-II that describe the symptoms of this condition: loss of pleasure, loss of interest, loss of energy, and loss of interest in sex. We also collected demographic and clinical information and evaluated motor and cognitive functions as well as levels of depression, apathy, and various mood states. The results were compared to a sample of 71 healthy participants of similar age, sex, and level of education.

Results

Stroke patients demonstrated a significantly higher prevalence (18.5-19.7%) and level of anhedonia compared to the healthy controls (4.3%), regardless of stroke phase, level of motor impairment, and other clinical variables. Furthermore, post-stroke anhedonia was associated with lower levels of motivation and higher levels of negative mood states such as fatigue and anger in the long term. Importantly, anhedonia level was superior in stroke patients than in healthy controls while controlling for confounding effects of related emotional conditions.

Conclusion

This study provides novel evidence on the prevalence, level and factors related to anhedonia post-stroke. We emphasize the importance of assessing and treating anhedonia in this population, as well as conducting large-scale cohort and longitudinal studies to test its influence on long-term functional and emotional recovery.

Outside the Laboratory Assessment of Upper Limb Laterality in Patients With Stroke: A Cross-Sectional Study

BACKGROUND

The rehabilitation of upper limb sensorimotor performance after stroke requires the assessment of daily use, the identification of key levels of impairment, and monitoring the course of recovery. It needs to be answered, how laboratory-based assessments and everyday behavior are connected, which dimension of metrics, that is, volume, intensity, or quality, is most sensitive to reduced function, and what sensor, that is, gyroscope or accelerometer, is best suited to gather such data.

METHODS

Performance in laboratory-based sensorimotor tests, as well as smartwatch-derived kinematic data of everyday life relative upper limb activity, during 1 day of inpatient neurorehabilitation (Germany, 2022) of 50 patients with stroke, was cross-sectionally assessed and resulting laterality indices (performance ratios) between the limbs were analyzed using ANCOVAs and principal component analysis.

RESULTS

Laboratory-based tests revealed the strongest laterality indices, followed by smartwatch-based (intensity>quality>volume) metrics. Angular velocity-based metrics revealed higher laterality indices than acceleration-based ones. Laterality indices were overall well associated; however, a principal component analysis suggested upper limb impairments to be unidimensional.

CONCLUSIONS

Our findings suggest that the use of sensors can deliver valid information of stroke-related laterality. It appeared that commonly used metrics that estimate the volume of use (ie, energy expenditure) are not the most sensitive. Especially reached intensities could be well used for monitoring, because they are more dependent on the performance of the sensorimotor system and less on confounders like age. The unidimensionality of the upper limb laterality suggests that an impaired limb with reduced movement quality and the inability to reach higher intensities will be used less in everyday life, especially when it is the nondominant side.

Daily steps, walking tests, and functioning in chronic stroke; comparing independent walkers to device-users

BACKGROUND AND PURPOSE

Community mobility post-stroke is important for gaining independence in daily activities. Walking devices can facilitate mobility, but it remains unclear whether individuals who use a walking device walk as many daily steps as those who do not require a device. It is also unclear whether these groups differ in their independence in daily living. This study aimed (1) to compare daily steps, walking tests, and independence in basic and instrumental activities of daily living (IADL) six months post-stroke between individuals who walk independently and individuals who use a walking device, (2) within each group to assess correlations between daily steps and walking tests, independence in basic and IADL.

METHODS

Thirty-seven community-dwelling individuals with chronic stroke; 22 participants used a walking-device and 15 participants walked independently. Daily steps were calculated as a 3-day mean by hip accelerometers. Clinical walking tests included the 10-m-walk-test, Timed Up & Go and 'Walking While Talking'. Daily living was assessed using the Functional-Independence Measure and the IADL questionnaire.

RESULTS

Daily steps of the device-users were significantly lower than the independent-walkers (195-8068 versus 147-14010 steps/day) but independence in daily living was not significantly different. Different walking tests correlated with daily steps for device-users and independent-walkers.

CONCLUSIONS

This preliminary investigation in chronic stroke revealed that device-users walk significantly fewer daily steps but are as independent in daily living as independent-walkers. Clinicians should differentiate between individuals with and without a walking device and the use of different clinical walking tests to explain daily steps should be considered. Further research is needed to assess the impact of a walking device post-stroke.

Feasibility of Augmenting Cognitive Strategy Training With Non-Invasive Brain Stimulation

Many individuals post-stroke have difficulty identifying if or how they can continue performing meaningful daily life tasks. The objective of this study was to evaluate the feasibility of metacognitive strategy training (MCST) and transcranial direct current stimulation (tDCS) in chronic stroke. A case series design was used. Participants completed 12 intervention sessions over 4 weeks consisting of 20 min of tDCS and 45 min of MCST to address occupational performance goals. Feasibility outcomes of acceptability and safety/tolerability were evaluated and measures of occupational performance were administered pre- and post-intervention. Participants perceived the intervention to be highly acceptable and relevant to their needs. Large improvements were observed for performance and satisfaction with goals trained (Hedge's g = 2.07 and 2.11, respectively) and untrained (Hedge's g = 1.25 and 1.43, respectively) within the intervention. An intervention combining MCST with tDCS was feasible to administer and positively received by stakeholders; further research is warranted.

Community-based group rehabilitation program for stroke patients with dysphagia on quality of life, depression symptoms, and swallowing function: a randomized controlled trial

BACKGROUND

Community-based exercise programs have demonstrated potential for implementation in older adults; however, it remains imperative to ascertain whether this strategy will yield comparable benefit in stroke patients with dysphagia.

METHODS

This was a single blinded, randomized, matched pairs clinical trial. Sixty-four stroke patients with dysphagia were recruited from patients who had been discharged the Rehabilitation Department of the Third Affiliated Hospital of Sun Yat-sen University. A single blinded, randomized and controlled trial was conducted. Participants were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Patients in the intervention group received health education followed by swallowing function training in community public spaces for 5 days every week over an eight-week period (60 minutes per day). Patients in the control group received swallowing rehabilitation training, and booster educational information about dysphagia, as well as instructions on how to improve quality of life. Swallowing function (Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA)), depressive symptoms (Geriatric Depression Scale-15), and quality of life (Swallowing-Quality of Life, SWAL-QOL) were assessed before and after all the treatment.

RESULTS

Before treatment, the two groups did not differ statistically. After the intervention, the swallowing function (SSA and FOIS) showed a significant improvement in both groups (All p < 0.001). But there was no significant difference in Functional Oral Intake Scale change between groups (P = 0.479). Compared with the control group, the intervention group had a significant improvement in depressive symptoms (P = 0.002), with a greater reduction in the number of depressed patients (13 to 6).The control group showed no significant improvements in depressive symptoms or a reduction in the number of depressed patients before and after treatment (P = 0.265, 14 to 12). The Swallowing-Quality of Life scores showed significant improvement in both the intervention and control group (P < 0.001). Specifically within Swallowing-Quality of Life sub-domains, greater changes were observed in symptoms and frequency (P < 0.001), communication (P = 0.012), and sleep (P = 0.006) for participants in the intervention group. And the cost-effectiveness of group rehabilitation surpasses that of rehabilitation training.

CONCLUSION

Community-based group rehabilitation program is more effective than traditional treatment in improving patients' depressive symptoms and quality of life, as well as being more cost-effective.

Associations between participation and personal factors in community-dwelling adults post-stroke

PURPOSE

To examine associations between post-stroke participation and personal factors, including demographic characteristics, self- and threat appraisals, and personality variables.

METHODS

An exploratory cross-sectional study with purpose-designed survey was completed online or via mail. The survey was comprised of demographic and health-related questions and multiple questionnaires, including the Stroke Impact Scale Version 3.0 (SISv3) (participation/perceived recovery), Community Integration Questionnaire (CIQ) (participation), Head Injury Semantic Differential III (pre- vs post-stroke self-concept/self-discrepancy), Appraisal of Threat and Avoidance Questionnaire (threat appraisal), Life Orientation Test - Revised (optimism) and Relationships Questionnaire (adult attachment style) that measured variables of interest. Sixty-two participants, aged 24-96 years who had experienced a stroke (one or multiple events) and had returned to community living, completed the survey. Associations were examined using correlations, and univariate and multiple linear regression analyses.

RESULTS

Regression analysis showed that greater participation, measured using the CIQ, was associated with younger age, female gender, lower self-discrepancy and higher perceived recovery, explaining 69% of the variability in CIQ participation. Further, greater participation on the SISv3 was associated with lower self-discrepancy and higher perceived recovery, explaining 64% of the variability in SISv3 participation.

CONCLUSIONS

Results indicate that personal factors, particularly self-appraisals like self-concept/self-discrepancy, in combination with perceived recovery may be important in explaining a large portion of variance in post-stroke participation. Specifically, findings highlight the interrelatedness of self-concept change, perceived recovery and post-stroke participation. Further longitudinal research is needed to clarify the directionality of these associations throughout the hospital-to-home transition.

Stroke and cognitive impairment: understanding the connection and managing symptoms

Stroke is a leading cause of long-term disability worldwide, and cognitive impairment is a common consequence of stroke. Understanding the connection between stroke and cognitive impairment is crucial for effectively managing symptoms and improving patients' quality of life. This abstract provides an overview of the relationship between stroke and cognitive impairment and explores strategies for managing cognitive symptoms in stroke survivors. A comprehensive review of relevant literature was conducted to examine the association between stroke and cognitive impairment. Various factors contributing to cognitive impairment after stroke were explored, including the location and severity of the stroke, vascular risk factors, and underlying mechanisms. Evidence-based strategies for managing cognitive symptoms in stroke survivors were also analyzed, such as cognitive rehabilitation, pharmacological interventions, and lifestyle modifications. The review revealed a strong link between stroke and cognitive impairment. The location and severity of the stroke play a significant role in determining the specific cognitive deficits experienced by individuals. Vascular risk factors, including hypertension, diabetes, and atrial fibrillation, contribute to cognitive decline after stroke. Mechanisms such as cerebral hypoperfusion, white matter damage, and neuroinflammation also play a role. Cognitive rehabilitation programs have shown promising results in improving cognitive function, while certain medications may help manage specific cognitive symptoms. Lifestyle modifications like physical exercise and a healthy diet have been associated with better cognitive outcomes in stroke survivors.

Stroke survivors' preferences on assessing patient-reported outcome measures

BACKGROUND

To assess quality of life and unmet needs after stroke, patient-reported outcome measures (PROMs) have gained increasing attention. However, patients' perspectives on assessing PROMs remain unclear, potentially hindering implementation into clinical practice. Therefore, this study explored patients' preferences on assessing PROMs after ischemic stroke.

METHODS

A paper-based questionnaire was sent to stroke survivors treated at the Department of Neurology, University of Leipzig, Germany. Health-related quality of life (HRQoL, EQ-5D-5L) and preferences regarding different aspects of data collection to assess PROMs were investigated and linked to socio-demographic and medical characteristics.

RESULTS

158 persons were contacted and 80 replies were subsequently analyzed. Mean age was 70.16 years and mean HRQoL was 68.79 (visual analogue scale with a theoretical maximum of 100). Participants showed positive attitudes towards PROMs as they saw potential to improve care of other patients (n = 66/79; 83.54%) or to improve their own situation (n = 53/74; 71.62%). Participants preferred an annual interview after stroke (n = 39/80; 48.75%) and would preferably spend 15-30 min (n = 41/79; 51.90%) to answer a written survey (n = 69/80; 86.25%). The initially treating clinic was preferred as initiator of such surveys (n = 43/79; 54.43%). Stratification revealed that participants with more than 1 h of daily digital media usage preferred email as way of communication.

CONCLUSIONS

For the first time, this study showed individual preferences on assessing PROMs after ischemic stroke, focusing on the way, time interval, duration, and initiation site of surveys. These insights might help to successfully implement PROMs after stroke and subsequently detect unmet needs and deficits in stroke care.

Participation and Its Association With Health Among Community-Dwelling Adults With Chronic Stroke

IMPORTANCE

Little is known about the severity of participation restrictions among people living in the community with chronic stroke. Even less is known about the association between participation and health in this population.

OBJECTIVE

To describe participation among people with chronic stroke and examine the association between participation and physical and mental health.

DESIGN

Secondary analysis of baseline data from an intervention study.

SETTING

The parent multisite intervention study was conducted in the community, and assessments were administered in participants' homes.

PARTICIPANTS

Thirty-one community-dwelling adults with chronic stroke.

OUTCOMES AND MEASURES

Participation was measured with the Activity Card Sort (percentage of prestroke activities retained) and the Enfranchisement Scale of the Community Participation Indicators. Health was measured with the PROMIS®-29 Physical Health and Mental Health subscales. We calculated descriptive statistics for participation measures and Spearman's ρ correlations between participation and health outcomes.

RESULTS

Participation scores were poor on all measures of participation. Most striking, 94.9% of participants retained less than 80% of their prestroke activities. All measures of participation were modestly correlated with physical health (ρ = .28-.46) and were moderately correlated with mental health (ρ = .42-.63).

CONCLUSIONS AND RELEVANCE

Participation restrictions are prevalent among adults with chronic stroke, with potential implications for mental health. Stronger community-based rehabilitation and support services to enhance participation of this high-risk population are warranted. What This Article Adds: This report highlights the severity of participation restrictions among people with chronic stroke. Moreover, this report shows that people with stroke feel a lack of inclusion in the community and that participation is associated with mental and physical health.

The effect of sequential combination of mirror therapy and robot-assisted therapy on motor function, daily function, and self-efficacy after stroke

Robot-assisted therapy and mirror therapy are both effective in promoting upper limb function after stroke and combining these two interventions might yield greater therapeutic effects. We aimed to examine whether using mirror therapy as a priming strategy would augment therapeutic effects of robot-assisted therapy. Thirty-seven chronic stroke survivors (24 male/13 female; age = 49.8 ± 13.7 years) were randomized to receive mirror therapy or sham mirror therapy prior to robot-assisted therapy. All participants received 18 intervention sessions (60 min/session, 3 sessions/week). Outcome measures were evaluated at baseline and after the 18-session intervention. Motor function was assessed using Fugl-Meyer Assessment and Wolf Motor Function Test. Daily function was assessed using Nottingham Extended Activities of Daily Living Scale. Self-efficacy was assessed using Stroke Self-Efficacy Questionnaires and Daily Living Self-Efficacy Scale. Data was analyzed using mixed model analysis of variance. Both groups demonstrated statistically significant improvements in measures of motor function and daily function, but no significant between-group differences were found. Participants who received mirror therapy prior to robot-assisted therapy showed greater improvements in measures of self-efficacy, compared with those who received sham mirror therapy. Our findings suggest that sequentially combined mirror therapy with robot-assisted therapy could be advantageous for enhancing self-efficacy post-stroke.Trial registration: ClinicalTrials.gov Identifier: NCT03917511. Registered on 17/04/2019, https://clinicaltrials.gov/ct2/show/ NCT03917511.

The relationship between Rating of Everyday Arm-use in the Community and Home (REACH) scale affected arm-use assessment, activity and participation after stroke

BACKGROUND AND OBJECTIVES

While arm function has been traditionally used as a primary goal for upper extremity rehabilitation post-stroke, we propose a simple measure of arm use, which may translate into better activities and participation. The aim was to determine the relationship between arm use and measures of activity and participation.

METHODS

This was a cross-sectional study with evaluative components involving community-dwelling individuals with chronic stroke. The Rating of Everyday Arm-Use in the Community and Home (REACH) Scale was used to assess affected arm use, Barthel Index and activity domain of the Stroke Impact Scale (SIS) for activities, and participation domain of the SIS for participation. The participants were also asked if they resumed driving after the stroke.

RESULTS

Forty-nine individuals (mean age = 70.3 ± 11.5 years, male sex = 51%) living with the effects of a stroke for at least 3 months participated in this study. There was a positive relationship between affected arm use and activities (Barthel Index score - rs  = 0.464; SIS activities - rs  = 0.686), participation (rs  = 0.479), and driving (rs  = 0.581). The Barthel Index scores were higher for individuals with dominant arm hemiparesis (p = 0.003) or left hemisphere lesions (p = 0.005). There was also greater arm use in left hemisphere lesions (p = 0.018).

CONCLUSIONS

Affected arm use in individuals with chronic stroke is related to activities and participation. Given the importance of arm use in activities and participation after stroke, rehabilitation therapists may consider utilizing the REACH Scale, a simple and quick outcome measure, as a means to assess arm use and implement effective interventions for improving arm use.

Predictors of quality of life at 6 months in patients with mild stroke: A prospective observational cohort study

OBJECTIVES

This study aimed to analyze the factors affecting the long-term quality of life of patients with mild stroke and evaluate the differences according to age and sex.

MATERIALS AND METHODS

The Korean Stroke Cohort for functioning and rehabilitation data was used, and patients with mild stroke with a National Institute of Health Stroke Scale score of < 5 were included. Quality of life after 6 months was analyzed using EuroQol-5 dimensions. Demographic and clinical characteristics were evaluated, and factors affecting the quality of life at 6 months were analyzed.

RESULTS

Age, current drinking, marital status, length of stay, and modified Rankin Scale, Fugl-Meyer assessment, Functional Independence Measure, and Geriatric Depression Scale scores affected the quality of life at 6 months in patients with mild stroke. Fugl-Meyer assessment score was a predictor for those aged < 65 years, while the functional ambulatory category was a predictor for those aged ≥ 65 years. Predictors of quality of life, excluding alcohol consumption, were comparable between male and female.

CONCLUSIONS

Among patients aged <65 years, individuals who consumed alcohol, and those who showed better motor function and fewer comorbidities had a higher quality of life. Among patients aged ≥65 years, quality of life was higher in males, younger age, married individuals, those with diabetes, and those with a better walking ability. Among male, individuals who consumed alcohol had a higher quality of life. Rehabilitation treatment should prioritize improving modifiable factors to enhance the quality of life in patients with mild stroke.

Life satisfaction and its influencing factors for bedridden patients with stroke

OBJECTIVES

This study aimed to evaluate the life satisfaction of bedridden patients with stroke and explore its relationship with demographic, social, and medical factors.

MATERIAL AND METHODS

This multicenter cross-sectional study was conducted in two steps. The Longshi scale was used to select the study population and assess patients' ability to perform activities of daily living. Subsequently, a multidimensional questionnaire was used to obtain the participants' information and evaluate their level of life satisfaction. The chi-squared test and binary logistic regression methods were employed to analyze the factors influencing the life satisfaction of bedridden patients with stroke.

RESULTS

A total of 3,639 bedridden patients with stroke were included in this study, of them, only 27.2% reported satisfaction with their current lives. Factors associated with higher life satisfaction include female sex, older age, and primary school education or lower (P<0.05). Patients who had experienced a single stroke episode had chronic diseases, and rated their health as good were more satisfied with their lives than those who did not. The results of the binary logistic regression confirmed that age, education, religion, household income, cohabitation, social participation, number of chronic diseases, self-rated health status, and disability level significantly influenced the life satisfaction of bedridden patients with stroke (P<0.05).

CONCLUSION

Our study showed that the overall life satisfaction of bedridden patients with stroke was low, with several factors influencing their life satisfaction. Therefore, effective measures should be implemented to improve life satisfaction and quality of life.

Measures to ensure safety during telerehabilitation of people with stroke: A scoping review

BACKGROUND

Measures used to prevent adverse events during the implementation of exercise sessions delivered via telerehabilitation can be varied, ranging from simple telephone monitoring to synchronous therapist-led sessions. However, this information is scattered in the literature, as evidence synthesis studies have only addressed the safety, satisfaction, and effectiveness aspects of exercise delivered via telerehabilitation.

AIMS

This scoping review aims to describe that measures are used to ensure safety during exercise sessions delivered to people with stroke through telerehabilitation, as reported by authors of primary studies. Secondarily, it describes the designs most frequently used to notify the effects of telerehabilitation and evidence level, the characteristics of the participants and type of stroke, and the characteristics of telerehabilitation.

SUMMARY OF REVIEW

A scoping review was conducted according to the Joana Briggs Institute (JBI) recommendations. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, and CINHAL was conducted from inception to August 2022, and a review of systematic review references on the topic. We included primary studies that enrolled adults with stroke who underwent exercise delivered via telerehabilitation. Two independent reviewers performed study selection and data extraction, and disagreements were resolved by consensus or a third reviewer. A qualitative analysis of the information was performed. One hundred seven primary studies (3991 participants) published between 2002 and 2022 were included. Most studies were case series (43%) and rated with an Oxford level of evidence of "4" (55.3%). Regarding randomized clinical trials, half included 53 or more participants (IQR 26.75 to 81). Most studies applied the exercises via asynchronous telerehabilitation (55.1%), of which only ten reported measures to avoid adverse events. Some of the measures included assessing the location where exercises are to be performed, only using a seated position, and using live warning systems that prevent or stop exercises when they are risky.

CONCLUSIONS

Reporting of measures implemented to prevent adverse events during exercise delivery via asynchronous telerehabilitation is scarce. Future primary studies should always consider reporting adverse events related to exercise delivery via telerehabilitation and strategies implemented to decrease the incidence of these unwanted safety events.

REGISTRATION NUMBER

INPLASY202290104.

EXERTION: a pilot trial on the effect of aerobic, smartwatch-controlled exercise on stroke recovery: effects on motor function, structural repair, cognition, mental well-being, and the immune system

INTRODUCTION

Motor impairments are the objectively most striking sequelae after stroke, but non-motor consequences represent a high burden for stroke survivors as well. Depression is reported in one third of patients, the fatigue prevalence ranges from 23 to 75% due to heterogenous definitions and assessments. Cognitive impairment is found in one third of stroke patients 3-12 months after stroke and the risk for dementia is doubled by the event. Aerobic exercise has been shown to reduce depressive symptoms, counteract fatigue, and improve cognitive functions in non-stroke patients. Furthermore, exercise is known to strengthen the immune system. It is unknown, though, if aerobic exercise can counteract poststroke depression, fatigue, poststroke dementia and poststroke immunosuppression. Therefore, we aim to analyse the effect of aerobic exercise on functional recovery, cognition, emotional well-being, and the immune system. Reorganization of topological networks of the brain shall be visualized by diffusion MRI fibre tracking.

METHODS

Adults with mild to moderate stroke impairment (initial NIHSS or NIHSS determined at the moment of maximal deterioration 1-18) are recruited within two weeks of stroke onset. Study participants must be able to walk independently without risk of falling. All patients are equipped with wearable devices (smartwatches) measuring the heart rate and daily step count. The optimal heart rate zone is determined by lactate ergometry at baseline. Patients are randomized to the control or the intervention group, the latter performing a heart rate-controlled walking training on own initiative 5 times a week for 45 min. All patients receive medical care and stroke rehabilitation to the usual standard of care. The following assessments are conducted at baseline and after 90 days: Fugl Meyer-assessment for the upper and lower extremity, 6 min-walk test, neuropsychological assessment (cognition: MoCA, SDMT; fatigue and depression: FSMC, HADS-D, participation: WHODAS 2.0 12-items), blood testing (i.e. immune profiling to obtain insights into phenotype and functional features of distinct immune-cell subsets) and cranial magnetic resonance imaging (MRI) with grid-sampled diffusion weighted imaging, white matter fibre tracking and MR spectroscopy.

PERSPECTIVE

This study investigates the effect of smartwatch-controlled aerobic exercise on functional recovery, cognition, emotional well-being, the immune system, and neuronal network reorganization in stroke patients. Trial registration ClinicalTrials.gov NCT Number: NCT05690165. First posted19 January 2023. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05690165.

Occupational Therapy and Activities of Daily Living Interventions to Improve Performance in Activities of Daily Living for Adults With Stroke (2012-2019)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings for occupational therapy and activities of daily living (ADL) interventions to improve ADL outcomes for adults with stroke.

Perceived participation and autonomy structural relationships among related factors in patients with stroke and hypertension in China: A ISM model approach

Aims

To explore the structural relationship between perceived participation and autonomy among older adults with stroke and hypertension in home and community-based services (HCBSs) in the eastern coastal region of China.

Design

An explorative cross-sectional study.

Methods

From July to September 2021, a total of 714 respondents were reported to have stroke and hypertension, and their information was used in the analysis of this study. A multiple linear regression analysis was used to explore the factors influencing factors older adults' perceived participation and autonomy. Using the ISM model, we analyzed the factors affecting social participation in patients with stroke and hypertension and explained the logical relationships and hierarchy among the factors.

Results

The mean score of perceived participation was 58.34 ± 27.57. Age, marital status, health insurance, living status, number of children, chronic diseases, sleep time, frequency of outings, and health utility value were significant factors affecting perceived participation and autonomy with stroke and hypertension patients. Among them, health insurance is the direct factor on the surface, age, number of children, chronic diseases, sleep time, frequency of outings, and health utility value are the intermediate indirect factors, and marital status and living status are the deep-rooted factors.

Conclusion

By the study that the hierarchical structure provides a visualization of interrelationships and interdependences among the influencing factors of perceived participation and autonomy. It also may be a significant complement to traditional variable-entered approaches and construct an optimized multidimensional perspective of participation and autonomy. Future research should focus on optimizing the living environment of older adults with stroke and hypertension to explore the model of rehabilitative intervention and help patients successfully reintegrate into their families/societies.

Personal factors, participation, and satisfaction post-stroke: A qualitative exploration

BACKGROUND

Decreased participation and life satisfaction are common post-stroke. Exploratory studies have indicated associations between these outcomes and personal factors. Information remains limited and experiences of people with stroke are not well-represented or understood.

AIMS/OBJECTIVES

The aim of this study was to explore how personal factors influence experiences of participation and life satisfaction for people with stroke living in the community.

MATERIAL AND METHODS

Qualitative in-depth semi-structured interviews were conducted with eight participants living in the community post-stroke, chosen purposively based on participation and life satisfaction levels. Data were interrogated using interpretative phenomenological analysis.

RESULTS

Three themes were identified: (1) What does participation mean to me? (2) Looking forward or looking back, and (3) Appraisals, avoidance, and "getting on with it". The first acknowledged the multifaceted nature of participation, although it was typically viewed as incorporating active involvement and social interaction. The additional two themes explored impacts of pre/post-stroke self-discrepancies and threat appraisals on participation and life satisfaction outcomes.

CONCLUSIONS AND SIGNIFICANCE

Relationships between participation and personal factors seem to be bidirectional. Life satisfaction appeared to be influenced by rumination on negative self-discrepancies based on difference in pre/post-stroke participation. Findings suggest there may be value in examining the influence of personal factor-related interventions on post-stroke outcomes.

Correlates of participation restrictions and quality of life among Hausa women with post-stroke disabilities

Background

Almost all health professionals refer and use the term participation restrictions in activities of daily living as one of the successful outcomes of stroke rehabilitation. Higher occurrences of stroke-related functional disability among women who suffer stroke tend to affect their quality of life, participation in, and reintegration into the community in general. Hence, the aim of this study is to investigate the correlation of participation restrictions and quality of life of Hausa women post-stroke event.

Method

This study employed a cross-sectional design; 67 post-stroke patients were recruited and assessed for participation using Stoke Impact Scale (SIS 3.0), quality of life was assessed using SSQOL, and MRS was used to assess post-stroke disabilities.

Results

Findings of this study indicate participation to be significantly related to quality of life (r = 0.801, P = 0.000). Participation was significantly related to limb strength (r = 0.606, P = 0.000), mood and emotions (r = 0.399, P = 0.001), ADL (r = 0.733, P = 0.000), mobility (r = 0.564, P = 0.000), and hand function (r = 0.687, P = 0.000). Recovery from stroke was found to be a determinant of participation (r = 0.624, P = 0.000).

Conclusion

Correlates of participation in Hausa women who suffered stroke are quality of life, strength, mood and emotions, ADL, mobility, hand function, and level of recovery from stroke. Both participation and quality of life also inversely correlated significantly with demographic factors of age and stroke severity.

Virtual reality gaming in rehabilitation after stroke - user experiences and perceptions

PURPOSE

The present study explored participants' experiences with and perceptions of using fully immersive head-mounted virtual reality (VR) gaming as rehabilitation after stroke.

METHODS

Four men and three women (median age 64 years) with chronic stroke and varying motor impairment (mild to severe) were interviewed after 10 weeks of VR training on the commercial HTC Vive system, focusing on the upper extremities. Inductive qualitative thematic analysis was performed.

RESULTS

The analysis revealed three main themes: playing the game, benefits and effects, and personalizing the game. Playing the game encompasses both the feeling of being immersed in the game and descriptions of the gaming being motivating and fun. Benefits and effects describe the participants' expectations of potential benefits, the importance of getting feed-back, and the impact in daily life. Personalizing the game includes finding the right game and level, and the participants' need for support to achieve full use of the training.

CONCLUSIONS

Participants with chronic stroke described the fully immersive VR gaming intervention as a fun and motivating way to improve their functioning in everyday life. Qualitative studies are needed to explore how people with stroke perceive VR gaming when it is implemented in real clinical environments.Clinical implicationsVR gaming was perceived as a positive and motivating rehabilitation after stroke.Getting feedback and perceiving benefits are essential parts of VR rehabilitation.Commercial fully immersive VR-games might be an option for stroke rehabilitation when the game can be personalized and support is available.

Factors Affecting the Life Satisfaction of Older People with Care Needs Who Live at Home

The number of older people is increasing rapidly, and the number of older people with care needs who live at home is also increasing in Japan. Maintaining their life satisfaction has been a primary challenge. This study aimed to identify factors affecting the life satisfaction of older people with care needs. The study was conducted among older people using homecare services; 126 participants (mean age, 79.33 ± 7.51 years, 54 male) were included in the analysis. Logistic regression analysis with adjustment for age, sex, and economic status was conducted with life satisfaction as the objective variable and the Japanese version of occupational gaps questionnaire (OGQ-J), sense of coherence, functional independence measure, and environmental factors as explanatory variables. The variables that significantly affected life satisfaction were the OGQ-J (p = 0.0352, OR 0.90, 95% CI 0.81–0.99) and environmental factors (p = 0.0083, OR 4.41, 95% CI 1.52–14.11). This study’s results indicate the importance of focusing on environmental factors and facilitating the participation of older people with care needs in activities they want to do to maintain and improve their life satisfaction.

Music-based intervention drives paretic limb acceleration into intentional movement frequencies in chronic stroke rehabilitation

This study presented a novel kinematic assessment of paretic limb function "online" during the actual therapeutic exercisers rooted within the acceleration domain. Twenty-eight patients at chronic stroke stages participated in an auditory-motor intervention mapping reaching movements of the paretic arm unto surfaces of large digital musical instruments and sound tablets that provided rhythmic entrainment cues and augmented auditory feedback. Patients also wore a tri-axial accelerometer on the paretic limb during the nine-session intervention. The resulting acceleration profiles were extracted and quantified within the frequency domain. Measures of peak power and peak width were leveraged to estimate volitional control and temporal consistency of paretic limb movements, respectively. Clinical assessments included the Wolf Motor Function Test and Fugl-Meyer - Upper Extremity subtest. The results showed that peak power increased significantly from Session 1 to Session 9 within oscillatory frequency ranges associated with intentional movement execution (i.e., 4.5 Hz). Decreases in peak width over time provided additional evidence for improved paretic arm control from a temporal perspective. In addition, Peak width values obtained in Session 1 was significantly correlated with pre-test Fugl-Meyer - Upper Extremity scores. These results highlighted improvements in paretic limb acceleration as an underlying mechanism in stroke motor recovery and shed further light on the utility of accelerometry-based measures of paretic limb control in stroke rehabilitation. The data reported here was obtained from a larger clinical trial: https://clinicaltrials.gov/ct2/show/NCT03246217 ClinicalTrials.gov Identifier: NCT03246217.

Exploring the Multidimensional Participation of Adults Living in the Community in the Chronic Phase following Acquired Brain Injury

This exploratory study aimed to examine multiple aspects of the participation of adults in the chronic phase following acquired brain injury (ABI), considering different disability levels. Our study included 25 adults ≥6 months after ABI (predominantly stroke), living at home, without severe cognitive decline. Primary measures included the Canadian Occupational Performance Measure (subjective participation) and the Mayo-Portland Adaptability Inventory-4 Participation Index (objective participation). The results indicated subjective participation problems in all of the International Classification of Functioning, Disability and Health participation domains. In addition, objective participation was reported as most limited in the areas of leisure and recreational activities, residence, and employment. Both subjective and objective participation profiles varied according to the disability level except for the social and leisure areas, which were found to be similar across all subgroups. However, only partial compatibility was found between the subjective and objective participation aspects. To conclude, our findings indicated that chronic ABI survivors report a variety of subjective and objective participation concerns that varied according to their disability levels. Moreover, the incongruity between the participation aspects suggests that the level of limitation may not necessarily correspond to the importance of a particular participation area. This highlights the need for comprehensive assessments to determine unique individual participation profiles in order to facilitate client-centered interventions supporting the rehabilitation of community-dwelling ABI survivors.

Life satisfaction and its influencing factors of middle-aged and elderly stroke patients in China: a national cross-sectional survey

OBJECTIVES

This study reports the life satisfaction of middle-aged and elderly patients who had a stroke in China, and explores its association with patients' sociodemographic characteristics, health status, lifestyles and family relationship.

DESIGN

Cross-sectional survey.

SETTING AND PARTICIPANTS

The samples of this study were selected from the data of China Health and Retirement Longitudinal Study (CHARLS) in 2018, which covered 28 provinces, 150 countries/districts and 450 village/urban communities. 1154 patients who had a stroke aged 45 and over were included in this study as qualified samples.

OUTCOME MEASURES

Descriptive analysis was used to report sociodemographic characteristics, health status, lifestyles, family relationship and life satisfaction of middle-aged and elderly patients who had a stroke. χ² analysis and binary logistic regression were used to analyse the factors influencing the life satisfaction of the patients who had a stroke.

RESULTS

Overall, 83.1% of patients who had a stroke were satisfied with their lives, although only 8.7% rated their own health as being good. Patients who had a stroke who were male, elderly, married, living with their spouses and having a pension were more likely to report satisfaction with life (p<0.05). Self-rated health, health satisfaction, chronic lung disease, fall, pain, ability to work and family relationships were also significantly associated with life satisfaction (p<0.05). Patients who drank alcohol (86.8% vs 81.7%, p=0.041), had physical activity (84.4% vs 75.6%, p=0.004) and had social activity (85.3% vs 80.8%, p=0.041) were more satisfied with their lives than those who did not. Multivariable analysis confirmed that age, health satisfaction, physical pain, working ability, relationships with spouse and with children had significant effects on life satisfaction of patients who had a stroke (p<0.05).

CONCLUSIONS

Our study indicates the importance of improving the overall health of patients who had a stroke and mediating factors, such as pain management, and work ability, spouse and children relationship in improving the life satisfaction of patients in the poststroke rehabilitation.

The Relationship Between Environmental Exposures and Post-Stroke Physical Activity

INTRODUCTION

Post-stroke physical activity has widespread health benefits. Environmental exposures may shape post-stroke physical activity behavior. This study investigates the relationships between environmental exposures and post-stroke physical activity.

METHODS

Stroke survivors (n=374) from a cohort of Black and White adults with post-stroke accelerometer data (2009-2013) were eligible for this study. Participants' home addresses were linked with secondary data to capture environmental characteristics, including annual density of neighborhood resources (e.g., parks, physical activity facilities, and intellectual stimulation destinations), 2010 neighborhood SES, 2010 neighborhood crime, and daily information on extremely cold days. Post-stroke light physical activity and moderate-to-vigorous physical activity were captured using accelerometers over a 7-day period. Linear regression and 2-part/hurdle models were used to estimate the relationship between the density of neighborhood resources with light physical activity and with moderate-to-vigorous physical activity, respectively. Analyses were conducted in 2021.

RESULTS

A 10% increase in the number of extremely cold days was associated with 6.37 fewer minutes of daily light physical activity (95% CI= -11.37, -1.37). A 1-SD increase in neighborhood SES was associated with greater odds (OR=1.10, 95% CI=1.02, 1.19) of doing any moderate-to-vigorous physical activity. Among participants obtaining any moderate-to-vigorous physical activity, a 1-unit (count/km²) increase in destinations for intellectual stimulation was associated with 0.99 (95% CI=0.02, 1.97) more minutes of daily moderate-to-vigorous physical activity. All other environmental exposures were not associated with post-stroke light physical activity or moderate-to-vigorous physical activity.

CONCLUSIONS

Environmental exposures may facilitate physical activity participation among stroke survivors. This study found that weather, neighborhood SES, and proximity to destinations for intellectual stimulation were associated with physical activity over and above individual factors.

Suitability of accelerometry as an objective measure for upper extremity use in stroke patients

Background

Upper limb (UL) paresis is one of the most common stroke consequences and significantly restricts patients in everyday life. Instruments objectively measuring direct arm use in stroke patients are lacking, but might be helpful to understand patients’ impairment. Aiming to examine whether accelerometry is a suitable objective measure for everyday UL use in stroke patients, we conducted a systematic review on the association between accelerometer-derived measurements and clinical scales.

Methods

Articles were systematically searched in PubMed, Scopus, Cochrane Library, PeDro and LIVIVO through December 12^th, 2021, screened for inclusion by AH, and subsequently independently screened by CK and MK. Disagreements were discussed until consensus. We included English and German peer-reviewed articles dealing with the validity of accelerometers as a measurement of UL use in stroke patients and eligible systematic reviews. Studies exclusively using accelerometry as an outcome parameter, book contributions, conference abstracts and case studies were excluded. Data extraction was conducted by AH and confirmed by CK focussing on study type, objective, accelerometer device, sample size, stroke status, assessments conducted, measurement method, wearing time and key results. We analysed all eligible articles regarding the correlation between accelerometry and other clinical assessments and the validity in accordance with the type of accelerometer.

Results

Excluding duplicates, the initial search yielded 477 records. In the 34 eligible studies accelerometers was used with a predominance of tri-axial accelerometery (n = 12) and only few with two-axial application (n = 4). Regarding measures to examine association to accelerometer data different clinical scales were applied depending on the setting, the degree of impairment and/or the status of stroke. Cut-off values to determine correlations varied largely; most significant correlations are reported for the MAL [Range 0.31- 0.84] and the ARAT [Range 0.15–0.79].

Conclusions

Accelerometers can provide reliable data about daily arm use frequency but do not supply information about the movements´ quality and restrictions on everyday activities of stroke patients. Depending on the context, it is advisable to use both, accelerometry and other clinical measures. According to the literature there is currently no accelerometer device most suitable to measure UL activity. High correlations indicate that multi-dimensional accelerometers should be preferred.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02743-w.

Self-Perceived ADL/IADL Function is Influenced by Residual Neurological Impairment, Aphasia, and Anxiety

BACKGROUND.

Self-perceptions of performance of activities of daily living (ADL) and instrumental activities of daily living (IADL) are reduced following stroke. Research investigating contributing factors is lacking.

PURPOSE.

We examined the extent to which aphasia status, neurological impairment and poststroke depression, and anxiety contribute to self-perceived ADL/IADL function.

METHOD.

Seventy-six community-dwelling individuals at least 6 months poststroke, 44 with and 32 without aphasia, participated in the cross-sectional study. The Stroke Impact Scale (SIS) ADL/IADL domain was the primary outcome measure with aphasia status, residual neurological impairment, depressive symptoms, and anxiety as predictor variables.

FINDINGS

Aphasia status, residual neurological impairment, and anxiety were independent predictors of self-perceived ADL/IADL function, together accounting for more than half the variance. Depression was not associated with ADL/IADL.

IMPLICATIONS.

Clinician awareness of the influence of anxiety on self-perceived ADL/IADL function, particularly for people with aphasia, may lead to future interventions that improve self-perceived ADL/IADL function.

Development and Initial Testing of the Electronic Activity Card Sort (ACS3) Among Community-Dwelling Adults

IMPORTANCE

The Activity Card Sort is a valid, widely used measure of participation. There is a need for remotely delivered measures of participation to support the growing use of telehealth.

OBJECTIVE

To develop and test the concurrent validity and acceptability of the electronic Activity Card Sort (ACS3).

DESIGN

Cross-sectional.

SETTING

Research laboratory.

PARTICIPANTS

Community-dwelling adults.

OUTCOMES AND MEASURES

The Activity Card Sort (ACS) and the ACS3 were administered in randomized order. Relationships between performance on the overlapping items of the ACS and ACS3 were evaluated using Spearman's ρ correlations. Additionally, acceptability of the ACS3 was evaluated using a survey with a 5-point Likert scale.

RESULTS

High correlations were found between each of the four domains (rs ≥ .836) and total current activities score (rs = .863) between the ACS and ACS3. Ratings on the survey indicate high levels of acceptability and usability for the ACS3.

CONCLUSIONS AND RELEVANCE

Findings suggest that performance on the ACS3 is consistent with performance on the ACS. This finding coupled with a high level of acceptability indicates that the ACS3 may be a clinically useful tool for evaluating daily life participation. What This Article Adds: The ACS3 provides an electronic, paperless option for measuring multiple domains of participation in adults.

Feasibility of an Online Langerian Mindfulness Program for Stroke Survivors and Caregivers

Mindfulness is promising for individuals with neurological disorders and their caregivers to improve psychological well-being. The potential application of a Langerian mindfulness intervention, focused on attention to variability, however, is still unknown. The objective of the study was to determine the feasibility (usability, satisfaction, and potential effectiveness on psychological well-being) of an online mindfulness intervention for stroke survivors and caregivers. Using mixed methods, 11 stroke survivors and three caregivers participated in a 3-week, online, Langerian mindfulness intervention. A semi-structured interview assessed the intervention's usability and gathered feedback. Self-reported measures about psychological well-being were documented remotely 3 times (preintervention, postintervention, and 1-month follow-up). Qualitatively, participants were highly satisfied with the intervention and reported subjective benefits, but the usability of the online platform was poor. None of the self-reported measures changed over time. This study provided evidence of feasibility of an online Langerian mindfulness intervention in a new population: stroke survivors and caregivers.

Unmet Needs for Rehabilitative Management in Common Health-Related Problems Negatively Impact the Quality of Life of Community-Dwelling Stroke Survivors

Purpose: Community-dwelling stroke survivors have various unmet needs for rehabilitative management, but there is a lack of in-depth investigations on common health problems after stroke. Moreover, the association between unmet needs and health-related quality of life (HRQoL) has not been thoroughly investigated. This study aimed to investigate the unmet needs for rehabilitative management in common problems after stroke and their associations with HRQoL among community-dwelling stroke survivors. Methods: A face-to-face cross-sectional survey was conducted among community-dwelling stroke survivors visiting outpatient clinics of rehabilitation departments between June and October 2020 in three university-affiliated hospitals. Unmet needs for common problems after stroke were assessed across eight domains based on the post-stroke checklist: spasticity, dysphagia, communication, cognition, ambulation, pain/discomfort, anxiety/depression, and self-care. HRQoL was measured using the EuroQoL-5D three level (EQ-5D). The prevalence of unmet needs for rehabilitative management and their associations with the EQ-5D index were analyzed. Results: Among the 239 participants who responded to the survey, 63% (n = 150) were men. The mean age was 63 ± 13 years, and the mean duration of stroke onset was 55.6 months. Overall, 49% reported at least one unmet need, and the most frequently reported unmet needs were anxiety/depression (20.9%), self-care (20.9%), and pain/discomfort (18.0%). The highest proportion of unmet needs was in the anxiety/depression, communication, and cognition domains. Patients with unmet needs for cognition and pain/discomfort showed a significantly lower EQ-5D index, even after adjusting for age, sex, and modified Rankin scale scores. The total number of unmet needs was significantly correlated with a lower EQ-5D index (Pearson's r = -0.329, p < 0.001) in the multivariate linear regression model. Conclusions: Unmet rehabilitative needs are prevalent among community-dwelling stroke survivors, and the proportion of unmet needs was high among non-physical domains such as anxiety/depression. The number of unmet needs is an independent negative predictor of HRQoL. Systematic approaches to identify unmet needs and provide appropriate rehabilitative management are required in long-term stroke survivors.

Apathy and residual neurological impairment are associated with community reintegration after mild stroke

This study investigated the influence of apathy and positive social support on community reintegration after stroke. A prospective, correlational, cross-sectional design was used. 85 community dwelling participants with and without aphasia were included (≥ 18 years of age, first stroke, ≥ 6 months post-stroke). The Reintegration to Normal Living Index (RNL) measured poststroke participation. The Apathy Evaluation Scale (AES) and Positive Social Interaction domain of the Medical Outcomes Study Social Support Survey assessed apathy and social support respectively. NIH Stroke Scale measured residual neurological impairment. Apathy, social support, and stroke impairment together were strongly associated with the RNL and accounted for 51% of total variance in the RNL. The AES and NIHSS were independent predictors of the RNL, though positive social interaction failed to reach significance. Persons with and without apathy differed significantly on the RNL. Therefore, stroke rehabilitation should address apathy as a potential target for intervention. Future research should determine factors that mediate the relationship between poststroke apathy and community reintegration.

Physical activity dimensions after stroke: patterns and relation with lower limb motor function

Background

Stroke survivors show deteriorated physical functioning and physical activity levels. Physical activity levels of stroke survivors are generally low. It is increasingly recognized that physical activity is a multidimensional construct that cannot be captured in a single outcome. In-depth insight into multidimensional physical activity patterns may guide the development and timing of targeted rehabilitation interventions. This longitudinal cohort study explored how multidimensional physical activity outcomes develop during recovery in the subacute phase after stroke and if changes in physical activity were correlated to recovery of lower limb motor function.

Methods

Patients were recruited during inpatient rehabilitation. At 3, 12, and 26 weeks post-onset, motor function was measured by the Fugl-Meyer Lower Extremity Assessment (FMA-LE). Physical activity was measured with the Activ8 accelerometer in multiple outcomes: counts per minute during walking (CPM_walking; a measure of Intensity), number of active bouts (Frequency), mean length of active bouts (Distribution) and % of waking time in upright positions (Duration). Generalized estimating equations (GEE) were used to study changes in physical activity over time and the relation with the change in lower limb motor recovery.

Results

Thirty-nine patients (age 56 ± 9, 77% male, 89% ischemic stroke) were included. GEE models showed a significant main effect of time for PA Intensity (+ 13%, p = 0.007) and Duration (+ 64%, p = 0.012) between 3 and 12 weeks. Motor function did not show a significant effect in all PA models across the 3 timepoints (p > 0.020). A significant interaction effect of time × motor function was observed (p < 0.001).

Conclusions

Patterns of PA recovery depend on the PA dimensions: PA Intensity and Duration increased mostly between 3 and 12 weeks post-stroke, whereas Frequency and Distribution did not show substantial changes. Further, no strong associations with motor recovery and high inter-individual variability were documented, which underlies the need to consider factors specific to the disease, the individual patient and the context.

High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study

BACKGROUND

Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased.

METHOD

A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26).

RESULTS

Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained.

CONCLUSIONS

A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted.

TRIAL REGISTRATION

This feasibility study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000764730 ).

Adaptive sports for promoting physical activity in community-dwelling adults with stroke: A feasibility study

BACKGROUND

Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports.

METHODS

Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports.

RESULTS

At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation.

CONCLUSION

Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke.

Seeking healthcare services post-stroke: a qualitative descriptive study exploring family caregiver and stroke survivor perspectives in an asian setting

Aim

Exploration of the healthcare journey post-stroke is incomplete without acknowledging the crucial role of family caregivers. With limited literature documenting the role of caregivers in the healthcare journey post-stroke, we aimed to describe the healthcare experiences of family caregivers and stroke survivors across different caregiver identities in Singapore.

Methods

We conducted a qualitative descriptive study involving semi-structured interviews with transcripts analysed using thematic analysis. 26 stroke survivors and 35 family caregivers purposively sampled from multiple settings.

Results

Findings were summarized into seeking care and experience of healthcare encounters. Seeking care comprised of the following themes: factors influencing seeking care, decision to seek care and role of caregiver in seeking care. Experience of healthcare encounters comprised of the following themes: service around the patient, service with care and role of caregiver in healthcare encounters.

Conclusion

Multi-dimensional role of caregivers in healthcare experience emerged as a major finding. Unique to our Asian context, as per the participants’ accounts, family caregivers seemed to be central in healthcare decision-making for stroke survivors, with adult-child caregivers commonly reported being engaged in collaborative decision-making. While spousal caregivers preferred a relational healthcare experience, adult-child caregivers preferred a transactional one. Practical implications include equipping caregivers with skillset to make healthcare decisions, provision of supportive decision-making environment for caregivers and reinforcing communication aspects in the medical, nursing and allied healthcare curriculum to improve healthcare experience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02463-7.

Support system diversity among family caregivers of stroke survivors: a qualitative study exploring Asian perspectives

BACKGROUND

Caregiving is a global phenomenon which is bound to increase in tandem with the aging population worldwide. Stroke is a condition common in older people that requires complex caregiving necessitating provision of adequate support to the caregivers. Past literature consists of limited accounts of types and organization of support arrangements needed by different caregivers. We aimed to describe the support system of caregivers of stroke survivors in Singapore, highlighting differences across the different caregiver identities (i.e. spouse, adult-child, etc.).

METHODS

We conducted a qualitative descriptive study in the community setting involving 61 purposively sampled and recruited stroke survivors and caregivers. Semi-structured interviews were conducted, and transcripts were analysed using thematic analysis.

RESULTS

Our findings were summarized across the following 4 themes: 1) cultural influence and caregiving; 2) caregiver support system with the following sub-themes: 2.1) dyadic caregiver support type, 2.2) extended caregiver support type, 2.3.) distributed caregiver support type and 2.4) empowering caregiver support type; 3) breaks in care of stroke survivor and 4) complex relationship dynamics. We operationalized the caregiver support system as comprising of type, people and activities that enable the caregiver to participate in caregiving activities sustainably. While spouse caregivers preferred dyadic and extended support systems positioning themselves in a more central caregiving role, adult-child caregivers preferred distributed support system involving family members with paid caregivers playing a more central role.

CONCLUSIONS

Our findings highlight caregiver identity as a surrogate for the differences in the caregiver support systems. Practical implications include imparting relationship-building skills to the stroke survivor-caregiver dyads to sustain dyadic support system and educating clinicians to include differences in caregiving arrangements of stroke survivors in practising family-centred care.

Sensory Modulation and Participation in Daily Occupations in Stroke Survivors

Background. Stroke may alter sensory modulation and restrict participation in daily occupations. Although studies highlight the relationship between altered sensory modulation and reduced participation, this relationship in stroke survivors has not been studied enough. Purpose. To examine the prevalence of altered sensory modulation among stroke survivors; to compare sensory modulation and participation between stroke survivors and healthy controls; to estimate the relationship between sensory modulation and participation among stroke survivors. Method. Thirty stroke survivors and 30 healthy controls, aged 18-70, completed the MoCA, the Adolescent-Adult Sensory Profile and the Activity Card Sort. Findings. Altered sensory modulation was more prevalent among stroke survivors. Their participation was significantly restricted as compared to healthy controls. Lower tendency to seek sensory input predicted lower participation in social activities. Implications. Occupational therapists should screen for altered sensory modulation in stroke survivors and understand their impacts on participation, in order to improve intervention outcomes.

Designing an app for home-based enriched Music-supported Therapy in the rehabilitation of patients with chronic stroke: a pilot feasibility study

OBJECTIVE

After completing formal stroke rehabilitation programs, most patients do not achieve full upper limb motor function recovery. Music-supported Therapy (MST) can improve motor functionality post stroke through musical training. We designed a home-based enriched Music-supported Therapy (eMST) program to provide patients with chronic stroke the opportunity of continuing rehabilitation by themselves. We developed an app to conduct the eMST sessions at home with a MIDI-piano and percussion instruments. Here, we tested the feasibility of the eMST intervention using the novel app.

METHOD

This is a pilot study where five patients with chronic stroke underwent a 10-week intervention of 3 sessions per week. Patients answered feasibility questionnaires throughout the intervention to modify aspects of the rehabilitation program and the app according to their feedback. Upper limb motor functions were evaluated pre- and post-intervention as well as speed and force tapping during daily piano performance.

RESULTS

Patients clinically improved in upper limb motor function achieving the Minimal Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) in most of motor tests. The app received high usability ratings post-intervention.

CONCLUSION

The eMST program is a feasible intervention for patients with chronic stroke and its efficacy should be assessed in a clinical trial.

Life satisfaction after stroke and the association with upper extremity disability, sociodemographics, and participation

INTRODUCTION

Remaining disability after stroke can reduce a person's life satisfaction. Because previous studies of life satisfaction show inconsistent results, there is a need for more knowledge regarding perceived life satisfaction after stroke and associated factors.

OBJECTIVE

To assess perceived life satisfaction after stroke in relation to Swedish reference values; and the association with upper extremity disability, sociodemographics, and participation.

DESIGN

Cross-sectional study.

SETTING

University hospital.

PARTICIPANTS

Seventy-five persons (72% male) with mild to moderate disability in a stable phase after stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11), which includes one global item Life as a whole and 10 domain-specific items. Global life satisfaction and explanatory factors were evaluated in two multivariate logistic regression models.

RESULTS

Fifty-three percent of the participants were satisfied with Life as a whole. Highest satisfaction was found for Family life (78%) and Partner relationship (77%) and lowest satisfaction for Vocational situation (32%), Sexual life (25%), and Physical health (23%). Life as a whole and most domain-specific items showed a significantly lower proportion of satisfied persons compared to Swedish reference values. In the first regression model with factors of upper extremity disability, manual ability was the strongest explanatory variable for Life as a whole (p value = .032, Nagelkerke R Square 0.117). In the second regression model, participation, social, and working status were the final explanatory variables (p value = .006, Nagelkerke R Square = 0.207).

CONCLUSION

Our findings indicate that persons with mild to moderate disability after stroke perceive overall less satisfaction with Life as a whole and domain-specific items than the general Swedish population. To increase a person's life satisfaction after stroke, rehabilitation interventions should target a variety of aspects including enhancing functioning of upper extremity, reducing participation restrictions, and providing support regarding social and vocational situation.