Activity among long-term stroke survivors. A study based on an ICF-oriented analysis of two established ADL and social activity instruments

Efficacy analysis of virtual reality-based training for activities of daily living and functional task training in stroke patients: A single-subject study

INTRODUCTION

Virtual reality (VR)-based training for functions such as cognition, upper extremities, balancing, and activities of daily living (ADL) has been used on stroke patients, and its efficacy has been reported. However, no comparison has been made between the efficacy of VR-based training for daily activities that exactly reproduces ADL and functional training. Therefore, this study sought to analyze the difference in independency enhancement of VR-based training for daily activities compared to cognitive and motor functional training.

PATIENT CONCERNS AND DIAGNOSIS

This study was conducted on 4 patients who have been diagnosed with stroke and are currently receiving rehabilitation therapy in G hospital located in the city of Gwangju, using A-B-A'-B' design from single-subject experimental designs.

INTERVENTIONS

Intervention was performed in 2 ways: application of VR-based training for daily activities after the application of cognitive and motor function training; and application of cognitive and motor function training after the application of VR-based training for daily activities. The Assessment of Motor and Process Skills, Computer Cognitive Screening Assessment System, Box and Block Test, and Grip and Pinch Strength Test were used to measure the changes in the performance of daily activities, cognitive function, and upper extremities function.

OUTCOMES

The results confirmed that the performance of daily activities, cognitive function, and upper extremities function was improved after the application of VR-based intervention. In addition, the efficacy of independency enhancement was maximized by the early approach of training for daily activities at the time of VR-based intervention in stroke patients.

CONCLUSIONS

VR-based intervention of training for daily activities and functional training can be considered to benefit the improvement of the performance of daily activities, cognitive function, and upper extremities function in stroke patients. In addition, although functional training was also effective in enhancing independency and functional improvement in stroke patients, an early approach to training for ADL based on tasks with objectives was deemed to be more effective.

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.

Italian translation and cross-cultural validation of an assessment tool for participation in stroke survivors: the Frenchay Activities Index

PURPOSE

Participation needs to be assessed objectively, to state accurate rehabilitation objectives. The Frenchay Activities Index (FAI) is a widely used tool to measure participation in stroke patients. To date, no cross-culturally validated Italian version of FAI is available. This study provides a translation and cross-cultural adaptation of FAI into Italian, assessing its validity and reliability in sub-acute stroke patients.

METHODS

According to international guidelines, a multistep translation and cultural adaptation protocol of forward and backward translations was conducted by qualified linguists and independent native English translators and revised by a healthcare committee. Patients admitted to intensive inpatient rehabilitation after stroke were recruited. Structural validity, reliability (internal consistency, inter- and intra-rater reliability and measurement error), and construct validity were studied.

RESULTS

One hundred and seventy-three patients were included in this study. No significant observations in terms of comprehensibility and conceptual equivalence of the FAI Italian version emerged. The exploratory factorial analysis revealed the presence of two subscales (i.e., domestic chores and work/leisure). The internal consistency resulted good for the first and second subscale (α = 0.821 and 0.716, respectively). Intra- and inter-reliability showed an ICC > 0.90 for both subscales. SEM = 5.75% and 2.33% and MDC = 15.85% and 6.48% were found for the first and second subscale, respectively. Construct validity of first subscale was satisfactory, as 100.0% a priori hypotheses were met, while for the second subscale it was moderate, as 66.6% a priori hypotheses were respected.

CONCLUSION

FAI-I provides a tool for professionals to measure participation in Italian stroke patients in health and social care settings.

Depression symptoms 6 years after stroke are associated with higher perceived impact of stroke, limitations in ADL and restricted participation

Late post-stroke depression symptoms are understudied. This study aimed to investigate depression symptoms 6 years after stroke, and associations with perceived impact of stroke, activities of daily living (ADL), and participation in social and everyday activities. Data was collected in a 6-year follow-up in a longitudinal study of stroke. Assessments included Hospital Anxiety and Depression Scale (HADS) for depression symptoms, Stroke Impact Scale 3.0. for perceived impact of stroke, Barthel Index for ADL, Frenchay Activities Index for participation in social and everyday activities. The research questions were addressed by bivariate analyses (with HADS-D ≥ 4 as cut-off), and hierarchical multiple regression analyses using continuous HADS-D scores. Forty percent of the 105 participants (57% men, age 30-91) showed depression symptoms (HADS-D ≥ 4). Depression symptoms were associated with higher perceived impact of stroke, more dependence in ADL, and more restrictions in participation in social and everyday activities. Most of those with depression symptoms had low scores on HADS, indicating that even mild depression symptoms might be relevant to identify and target in treatment and rehabilitation of long-term consequences of stroke.

Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: A 4-year follow-up study

BACKGROUND

Stroke is a leading cause of long-term disability and is considered a major global health burden.

OBJECTIVES

We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan.

METHODS

We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects.

RESULTS

A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains.

CONCLUSION

Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.

Sex differences in independence in activities of daily living early in stroke rehabilitation

BACKGROUND

Current stroke research suggests that there are differences between females and males regarding incidence, stroke risk factors, stroke severity, outcome, and mortality. The few studies that have investigated sex differences in rehabilitation 8-12 months poststroke found that males are more independent, compared to females.

OBJECTIVES

To investigate if there is a difference in the improvement of independence in activities of daily living (ADL) between females and males in the acute phase (first 2 weeks) of stroke rehabilitation in a Danish population.

METHODS

A prospective cohort study enrolling patients admitted to the hospital's rehabilitation ward with a stroke diagnosis from January 1, 2016, to March 17, 2017. Baseline and follow-up data regarding the primary outcome, Barthel-100 index, were analyzed using an adjusted linear mixed model.

RESULTS

The study included 206 patients (83 females). Females were older at admission and more males lived with a partner. No differences in stroke severity or any of the risk factors were found. There were no differences between female and male scores at baseline. In the adjusted linear mixed model, quantifying the difference between follow-up and baseline Barthel-100 score, females increased their Barthel-100 score by 20.8 points (95% confidence interval (CI) 15.4-26.3) and males with 29.0 points (95% CI 24.6-33.4).

CONCLUSION

In a homogeneous sample of stroke survivors undergoing specialized 24-h stroke rehabilitation for 11-14 days, females were more dependent in ADL than males.

Participation in social and leisure activities while re-constructing the self: understanding strategies used by stroke survivors from a long-term perspective

PURPOSE

To further understand social and leisure (SL) participation after stroke and how it can be supported in a long-term perspective, this study aims to deepen the understanding of strategies used by long-term stroke survivors in relation to SL activities.

MATERIALS AND METHODS

The study has a qualitative design, using a grounded theory approach, and is based on in-depth interviews with 10 persons who had a stroke 15 years ago and four of their family members.

RESULTS

The findings comprise nine different strategies used by the participants. These had two overarching purposes; to protect and re-construct the post-stroke self and to enable participation in valued SL activities despite challenges. The findings are summarized in one overarching theme: "Employing different strategies to balance costs and rewards of engagement in social and leisure activities".

CONCLUSIONS

Strategies for SL participation involves balancing different priorities in life and can change over time as they are continuously influenced by various personal and environmental conditions. These findings contribute to an improved understanding of why and how people hold on to activities, give up activities and find new activities after a stroke. It also highlights the need for a long-term perspective on stroke rehabilitation and support.IMPLICATIONS FOR REHABILITATIONRe-engagement in social and leisure activities after stroke is a long-term process and various types of support may be needed during different stages of recovery and adaptation.Successful rehabilitation interventions build on an understanding of each individual's priorities, goals and strategies and how these may change or manifest over time.Special attention should be given to the individual's perception of costs and benefits in relation to engagement in activities, and the role that it has for the person's identity.By providing knowledge and supporting the use of adequate coping strategies, rehabilitation professionals can help patients find a new and accepted post-stroke identity.

ICU discharge screening for prediction of new-onset physical disability-A multinational cohort study

BACKGROUND

Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge.

METHODS

Multinational prospective cohort study in 10 general ICUs in Sweden, Denmark, and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability 3 months post-ICU, defined as a ≥10 score reduction in the Barthel Index (BI) compared to baseline.

RESULTS

Of the 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea critical care physical assessment tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81-0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61-0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, and positive predictive value for a high-risk group (CPAx score ≤18) was 0.32.

CONCLUSION

The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.

Needs of Stroke Survivors as Perceived by Their Caregivers: A Scoping Review

OBJECTIVE

Caregivers usually are not involved while planning the stroke survivor's medical and rehabilitation goals and interventions. This review aimed to identify the needs of stroke survivors as perceived by their caregivers.

DESIGN

A literature search from 2003 to 2014 was conducted using Medline, CINAHL, PsychINFO, and Google Scholar. Sixty-six studies were included. Most studies excluded did not encompass caregivers' perspectives. Four reviewers screened the titles, abstracts, and full texts of the articles for inclusion. The data extracted from these studies were synthetized into metathemes.

RESULTS

Fifty-two qualitative, ten quantitative survey, and four mixed-methods studies were included in the final synthesis. The studies came from 11 countries. The data synthesis produced following three metathemes: (a) body functional needs, including psychological function, physical function, cognitive function, and uncertainty related to function; (b) activity and participatory needs, including healthy lifestyle, physical activities, speech, independence, cognitive activities, and uncertainty related to activities and participation; and (c) environmental needs, encompassing support, services, safety, accommodation and accessibility, and uncertainty related to environmental factors.

CONCLUSIONS

This scoping review identified a range of needs of stroke survivors as perceived by their caregivers. Incorporating the caregiver's preferences and values into clinical decisions may improve outcomes among stroke survivors.

Long-Term Predictors of Social and Leisure Activity 10 Years after Stroke

Background

Restrictions in social and leisure activity can have negative consequences for the health and well-being of stroke survivors. To support the growing number of people who are ageing with stroke, knowledge is needed about factors that influence such activity in a long-term perspective.

Aim

To identify long-term predictors of the frequency of social and leisure activities 10 years after stroke.

Method

145 stroke survivors in Sweden were followed-up at16 months and 10 years after a first-ever stroke. Data representing body functions, activities & participation, environmental factors and personal factors at 16 months after stroke, were used in multiple linear regression analyses to identify predictors of the activity frequency after 10 years, as assessed by the ‘Community, social and civic life’ sub-domain of the Frenchay Activities Index (FAI-CSC).

Results

At the 10-year follow-up the frequency of social and leisure activities varied considerably among the participants, with FAI-CSC scores spanning the entire score range 0–9 (mean/median 4.9/5.0). Several factors at 16 months post stroke were independently related to the long-term activity frequency. The final regression model included four significant explanatory variables. Driving a car (B = 0.999), ability to walk a few hundred meters (B = 1.698) and extent of social network (B = 1.235) had a positive effect on activity frequency, whereas an age ≥ 75 years had a negative effect (B = -1.657). This model explained 36.9% of the variance in the FAI-CSC (p<0.001).

Conclusion

Stroke survivors who drive a car, have the ability to walk a few hundred meters and have a wide social network at 16 months after a first-ever stroke are more likely to have a high frequency of social and leisure activities after 10 years, indicating that supporting outdoor mobility and social anchorage of stroke survivors during rehabilitation is important to counteract long-term inactivity.