Aims: This study aimed to determine the predictive factors for functional recovery and home discharge in stroke patients receiving in-hospital rehabilitation.Methods: This study included a consecutive series of 174 stroke patients (average age 73.0 ± 10.8) admitted to the convalescent rehabilitation ward at Azumino Red Cross Hospital in Japan after acute rehabilitation. The main outcome measures were functional recovery (functional independence measure [FIM] at discharge and Montebello rehabilitation factor score [MRFS]) and home discharge.Results: Total FIM improved from 72.6 ± 27.6 to 87.7 ± 29.9 during the hospital stay (P < 0.001). The average MRFS was 0.34 ± 0.31. Of the 174 patients, 151 were discharged home (87%). Age, stroke type, premorbid independence, motor FIM, and cognitive FIM at admission showed a significant association with FIM at discharge, while age, premorbid independence, motor FIM at admission, and cognitive FIM at admission were statistically significant predictors of MRFS. Female sex, not living with family, premorbid independence, and neglect were negatively associated with home discharge.Conclusions: Premorbid disability and cognitive dysfunction at admission were both negatively associated with functional recovery and home discharge in patients undergoing inpatient stroke rehabilitation. Geriatr Gerontol Int 2012; 12: 215-222.

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Aims: Our purpose was to compare recipient and caregiver perception of the quality of life (QoL) of people with dementia in residential care facilities and to identify the factors associated with their perception of QoL. Methods: Residents’ QoL was evaluated by both the patient and the caregiver, using the Quality of Life in Alzheimer’s Disease and several other indices. Results: The correlation between the self-rated QoL score and the staff-rated QoL score was low. Conclusions: The staff tended to underestimate QoL. The main determinants of QoL were the functional status and depression. Improving physical function and mood may be beneficial in providing a better QoL.

Social participation was associated with long-term improvement in activities of daily living, indicating that interventions targeting social function are important for maintaining and further improving activities of daily living in stroke survivors. Health-related quality of life was correlated with activities of daily living and depression; therefore, interventions targeting these parameters are important in improving the quality of life of stroke survivors.

Aim:The aim of this study was to investigate the long-term mortality, daily living activities, social activity, and symptoms of depression, in post-stroke patients discharged to their homes from a convalescent rehabilitation ward, and to determine the relationship between demographic variables and long-term outcome.Methods: This study included 252 consecutive stroke patients (140 men; mean age, 72.4 ± 10.8 years) who had been admitted to a convalescent rehabilitation ward for inpatient rehabilitation. Follow-up assessment was made by postal questionnaire for up to >1 year after discharge, and included the modified Rankin scale, Frenchay activities index (FAI), and Geriatric Depression Scale.Results: Of the 192 respondents (76.2%), 160 (83.3%) were living at home. Eighty-three (51.8%) were independent. Cumulative post-stroke mortality at 1 and 3 years was 3.7% and 19.4%, respectively.Mean total FAI score was 26.5 ± 10.9, suggesting that social inactivity was common. The estimated prevalence of depression was 21.6%. Coronary artery disease and motor functional independence measures were significantly associated with mortality, whereas age, recurrent stroke, severity of paralysis, and motor functional independence measures were significant predictors of independence. In the crosssectional logistic model, depression symptoms were inversely associated with FAI score. Conclusions:The mortality rate of patients discharged to their home following inpatient rehabilitation is relatively low. Social inactivity and depression symptoms, however, remain common during the chronic phase, and the severity of depression and restriction of participation were interrelated.

Aim: Malnutrition during hospitalization affects the functional recovery and postdischarge destinations of elderly stroke patients. However, insufficient studies exist about nutritional status during hospitalization in the acute stroke phase in this population. This study determined factors of nutritional status changes during hospitalization in elderly patients in the acute phase of stroke, and investigated the relationship between nutritional status changes and improved activities of daily living and postdischarge destination. Methods: This retrospective observational study included 205 acute-phase stroke patients admitted to Shinshu University Hospital from 2010-2016. Multiple regression analysis was conducted to determine relationships between nutritional status changes, patient characteristics, and improved activities of daily living. Binomial logistic regression analysis was used to determine the relationship between the postdischarge destination and nutritional status changes. Results: Prevalence of malnutrition was 42% at admission and 76% at discharge. Factors affecting nutritional status changes at admission included Geriatric Nutritional Risk Index (b = ¡0.35, P < .001) and Barthel Index/feeding (b = 0.22, P = .002), and factors during hospitalization included age (b = ¡0.21, P < .001), ischemic stroke (b = 0.16, P = .008), and National Institute of Health Stroke Scale score (b = ¡0.29, P < .001). Significant associations of changes in geriatric nutritional risk index occurred with improved activities of daily living during hospitalization (b = 0.26, P < .001) and discharge to home (odds ratio = 1.11, 95% confidence interval: 1.03-1.19, P = .008). Conclusion: Many elderly patients in the acute phase of stroke with malnutrition exhibited worsening conditions during hospitalization, which was negatively associated with their activities of daily living abilities and postdischarge destinations. Nutritional status changes and associated factors must be evaluated during hospitalization in this patient population.

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Objective Upper limb paralysis, which is a sequela of stroke, limits patients’ activities of daily living and lowers quality of life. The objective of this study was to examine the effects of peripheral nerve stimulation on hemiparetic upper limb functional recovery in chronic stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation and occupational therapy. Methods The subjects were chronic stroke patients who participated in a two-week inpatient programme including repetitive transcranial magnetic stimulation and occupational therapy. There were two groups of patients: the peripheral nerve stimulation group (11 patients who underwent peripheral nerve stimulation) and the control group (11 patients who previously participated in the same inpatient programme but without peripheral nerve stimulation, selected via propensity score matching). The peripheral nerve stimulation group had 1 h of peripheral nerve stimulation on the median and ulnar nerves during occupational therapy. The outcome measures were the Wolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log. Results Wolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log showed significant improvement after the intervention in the peripheral nerve stimulation group. Particularly, the Fugl-Meyer Assessment hand score significantly improved in the peripheral nerve stimulation group compared to that in the control group (median change: 2 versus 0; p = 0.021, r = 0.49). Conclusion The combined use of peripheral nerve stimulation with occupational therapy after repetitive transcranial magnetic stimulation may result in a better functional recovery of in hemiparetic upper limb. Peripheral nerve stimulation with stimulation above the sensory threshold and below the motor threshold is easy to combine with occupational therapy upper limb function training and is therefore clinically useful.