Development of a prognostic scale for severely hemiplegic stroke patients in a rehabilitation hospital

Hirano, Yoshitake; Nitta, Osamu; Hayashi, Takeshi; Takahashi, Hidetoshi; Miyazaki, Yasuhiro; Kigawa, Hiroshi

doi:10.1016/j.clineuro.2017.04.020

Cited by 4 publications

(7 citation statements)

References 24 publications

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“…The methodological quality of the two case-control studies 19 , 20 was moderate (scores 5 and 6 out of 9), showing the risk of bias for comparability of cases and controls and the ascertainment of exposure in both studies and for the adequacy of case definition in one study. 19 The methodological quality of cohort studies 8 , 9 , 17 , 18 , 21 – 59 was moderate to high (score from 6 to 9 out of 9, except for one study that score 4 out of 9), 60 showing risk of bias for the comparability of the groups, primarily because no adjustment for confounders was reported, for the representativeness of the exposed cohorts, assessment of outcomes, adequacy of follow-up of cohorts, and ascertainment of exposure ( Supplemental File 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Motor activities of daily living on admission: From 13 studies 20 , 25 – 28 , 31 , 32 , 38 , 39 , 41 , 44 , 49 , 57 assessing the motor Functional Independence Measure, four studies 27 , 31 , 32 , 41 of moderate and high quality (score 9 n = 2, score 8 n = 1, score 7 n = 1) were included in the meta-analysis of odds ratio ( Figure 2(a) ) and showed significant results with high heterogeneity (odds ratio = 1.23, 95% confidence interval: 1.12–1.35, I 2 = 99%). The result was also significant when the outlier 27 was removed (odds ratio = 1.07, 95% confidence interval: 1.03–1.11, I 2 = 95%).…”

Section: Resultsmentioning

confidence: 99%

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Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis

et al. 2023

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Objectives This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation. Data sources A search of PubMed, Embase, CINHAL, The Cochrane Library (Trials), Web of Science, and PEDro were conducted up until May 2023. Methods Two independent reviewers selected studies for population (patients with stroke), predictive factors (physical functioning), outcome (discharge destination), setting (inpatient rehabilitation), and study designs (observational and experimental studies). Predictive factors were identified among assessments of the “body function” and “activity” components of the International Classification of Functioning. Methodological quality was assessed with the Newcastle-Ottawa Scale. The findings used quantitative and narrative syntheses. Meta-analyses were performed with the inverse variance method and the random-effects model using included studies with sufficient data. Results Forty-five studies were included with 204,787 participants. Included studies assessed the association of independence in activities of daily living, walking, rolling, transferring, and balance on admission with a probability of returning home. Motor (odds ratio = 1.23, 95% confidence interval: 1.12–1.35, p < .001) and total (odds ratio = 1.34, 95% confidence interval: 1.14–1.57, p < .001) Functional Independence Measure scores on admission were significantly associated with home discharge in meta-analyses. Additionally, included studies showed that independence in motor activities, such as sitting, transferring, and walking, and scores above thresholds for the Functional Independence Measure and Berg Balance Scale on admission were associated with discharge destination. Conclusion This review showed that higher independence in activities of daily living on admission is associated with home discharge after inpatient stroke rehabilitation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis

et al. 2023

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“…Baseline status was associated with post-rehabilitation prognosis even in patients with hemiplegia. 6 ) In addition, early start of rehabilitation is considered to be important for predicting the effect of rehabilitation, 13 , 25 ) although the definition of early rehabilitation may vary. Recently, increasing evidence has shown that starting rehabilitation within the first 2 weeks of stroke is beneficial.…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between imaging findings and the functional prognosis, 4 , 5 ) status of ADL before the onset, 2 ) and prognosis prediction based on a scoring system have all been evaluated. 6 ) The established prognostic factors for acute stroke rehabilitation are generally accepted to be age and the severity of the onset of paralysis. 7 ) Ween et al reported that patients younger than 55 years or with a Functional Independence Measure (FIM) greater than 80 on admission were almost universally able to return home, while those with a FIM less than 40 were closely associated with discharge to a nursing home.…”

Section: Introductionmentioning

confidence: 99%

Functional Recovery after Rehabilitation in Patients with Post-stroke Severe Hemiplegia

Kurosaki

Tosaka

Ibe

et al. 2022

PRM

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Objectives: Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia. Methods: This study included 50 patients with Brunnstrom recovery stage I–II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed. Results: FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (<70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses. Conclusions: Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.

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“…The verticality item of the SIAS, i.e., the trunk function, influenced outcome in low ADL patients with FIM-M on admission of less than 19. This is thought to be because one of the predictive factors for ADL improvement is whether sitting is or is not possible in severely disabled people [2,12].…”

Section: Effects Of Trunk Function Age and Cognitive Functionmentioning

confidence: 99%

Relationship between Functional Independence Measure (FIM) score on admission and influence of inhibitive factors in a comprehensive inpatient stroke rehabilitation ward

Okamoto

Sonoda

Watanabe

et al. 2018

Jpn J Compr Rehabil Sci

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Objective: Investigate how the influence of inhibitive factors was changed by the status of activities of daily living (ADL). Methods: Subjects were 2,650 stroke hemiplegic patients admitted to our comprehensive inpatient rehabilitation wards. Decision tree analysis was performed in which motor subscore of the Functional Independence Measure (FIM-M) at discharge was set as the target variable. Distribution of the verticality item of the Stroke Impairment Assessment Set, age, and the cognitive subscore of the FIM were calculated for every score of the FIM-M on admission. The FIM-M gain was compared by stratifying trunk function, age, and FIM cognitive subscore with certain ranges of the FIM-M on admission. Results:The FIM-M at discharge and the FIM-M gain were significantly low (p<0.05) in patients with decreased trunk function and low ADL score on admission. Both were significantly low (p<0.05) in patients with relatively wide-ranged ADL scores in elderly patients whose age was 68 years or older, and also significantly low (p<0.05) in low cognitive function patients who needed moderate or severe assistance. Conclusion:These results demonstrated that the influence of inhibitive factors is not uniform but instead differs according to degree of ADL level on admission.

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Development of a prognostic scale for severely hemiplegic stroke patients in a rehabilitation hospital

Cited by 4 publications

References 24 publications

Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis

Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis

Functional Recovery after Rehabilitation in Patients with Post-stroke Severe Hemiplegia

Relationship between Functional Independence Measure (FIM) score on admission and influence of inhibitive factors in a comprehensive inpatient stroke rehabilitation ward

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