Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients

Abstract

ABSTRACT. Purpose: This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability. Method: This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIM instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables. Result: The multiple logistic regression analysis showed that the FIM instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points. Conclusion: Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients. Key words: toileting assistance, cognitive function, Physical function, FIM instrument (Phys Ther Res 19: 32-38, 2016)C ognitive and physical dysfunctions in stroke patients cause reduction in the activities of daily living (ADLs) 1,2 ) and quality of life (QOL) [3][4][5] . Loss of independence in ADLs of stroke patients leads to emotional distress 6) . Furthermore, family caregivers of elderly persons with stroke have inadequate respite and time to participate in personal activities and social interactions 7) , and they often suffer from somatic symptoms such as hypertension and lower back pain 8 ) . In particular, dependence in toileting leads to somatic and mental stress for both patients and caregivers [8][9][10][11] . In addition, toileting is an important ADL in stroke patients when they return home from hospital 12) . Therefore, it is important for rehabilitation therapists to address and improve toileting performance as soon as possible.The clarification of factors that are related to and that influence independence in toileting is useful when planning effective rehabilitation programs. Previous studies have reported that balance function is associated with the level of independence in overall ADLs [13][14][15] . The Berg Balance Scale (BBS), which is a balance assessment, has been found to be associated with differences in toileting ability between an independent group and a supervision group 16 ) ; however, BBS is not associated with strong differences in ...

Usefulness of the Dual-Task Stepping Test to Determine the Independent Toileting Ability of Patients with Stroke Who Could Perform Stepping in a Seated Position

“…The results of this study demonstrated a relationship between dual-task assessment and toileting ability. Assessments related to toileting ability that included other evaluations, such as the BBS, have also been noted [4][5][6][7][8]. However, unlike our study, other studies have not reported a relationship between dual-task assessments.…”

“…However, it is difficult to determine independence in this area owing to the number of components involved in toileting, such as motor function required to transfer between a toilet and a wheelchair, lower body dressing while standing, cognitive function required to control urination and defecation, and attention required to perform some of these functions simultaneously. The association between toileting ability and several rehabilitation evaluations have been reported, including the evaluation of motor function, Berg balance scale (BBS) [4], the Stroke Impairment Assessment (SIAS) [5], and the Functional Assessment for Control of the Trunk (FACT) [6]. Evaluations of cognitive function, such as the Mini-Mental State Examination (MMSE) [6],…”

“…The association between toileting ability and several rehabilitation evaluations have been reported, including the evaluation of motor function, Berg balance scale (BBS) [4], the Stroke Impairment Assessment (SIAS) [5], and the Functional Assessment for Control of the Trunk (FACT) [6]. Evaluations of cognitive function, such as the Mini-Mental State Examination (MMSE) [6],…”

Interaction between locomotion and three subcategories for patients with stroke demonstrating fewer than 37 points on the total functional independence measure upon admission to the recovery ward

“…However, the results of this study showed no significance in impacting locomotion interaction with other ADLs. These results were considered as follows: Activities of Eating were less than performing dressing that movements close to the center of gravity are required all directions 28) , Dressing L/B-like activities tend to leave from the backrest. Moreover, bowel management-like activities need higher pressure than bladder management and are more difficult.…”

Toileting Abilities Survey as a surrogate outcome measure for cognitive function: Findings from neuronopathic mucopolysaccharidosis II patients treated with idursulfase and intrathecal idursulfase

“…[ 5 , 6 ] Although little research exists on the precise relationship between functional ability and cognition in children, in the elderly, cognitive status has been established as a predictor of functional ability [ 7 ], and impairment in activities of daily living has been shown as predictive of future dementia. [ 8 ] Toileting has been associated with an individual's cognitive abilities in stroke patients [ 9 ], nursing home residents [ 10 , 11 ], community-dwelling elderly [ 7 ], dementia patients. [ 8 ], and Alzheimer's disease patients [ 12 ].…”