Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study

Abstract

Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.

Use of a multilayer perceptron to create a prediction model for dressing independence in a small sample at a single facility

“…We assessed the medical records and gathered information about clinical variables that have been reported to be associated with dressing performance in stroke patients. These variables were age7 ) , dressing performance prior to practice8 ) , trunk function7 ) , visuospatial perception7 ) , and balance9, 10 ) . Cognitive function, which has been reported to affect the degree of ADL improvement11 ) , was also considered as a variable in this study.…”

“…Cognitive function, which has been reported to affect the degree of ADL improvement11 ) , was also considered as a variable in this study. The evaluation methods for each function were decided according to previous studies7,8,9,10,11 ) . We used FIM ® dressing items12 ) , Stroke Impairment Assessment Set (SIAS) vertical items, visuospatial deficit items13 ) , the Berg Balance Scale (BBS)14 ) , and FIM ® cognitive items.…”

Relationship between post stroke duration and balance function necessary for performing activities of daily living independently in stroke patients on the convalescence

“…The relationship between independence in ADLs and balance at 1, 2, and 3 months after stroke onset was examined. We collected and analyzed the scores of toilet, dressing, grooming, and stairs items in the FIM ® instrument 15) , which have been reportedly strongly associated with balance [7][8][9][10][11][12] . As for dressing, the lower score on FIM ® instrument for dressing the upper and lower body was adopted in this study.…”

“…Impaired balance is a well-characterized sequela associated with stroke 1) , and there are several investigations showing a strong association of the impaired balance of these patients with their independence and ability to perform activities of daily living (ADLs) [1][2][3][4][5][6] . The analysis of individual ADLs has also demonstrated an association between balance and the ability to use the toilet 7) , get dressed 8,9) , groom 10,11) , and climb/descend stairs 12) , and the cutoff JAHS 12(1): 24-30, 2021 25 values of balance required for independence in these ADLs have been reported 7,9,10,12) . The cutoff values of balance related to independence in ADLs can be used as a target value for rehabilitation.…”

Relationship between the number of samples and the accuracy of the prediction model for dressing independence using artificial neural networks in stroke patients

“…The FIM ® instrument dressing items consist of the upper and lower bodies; however, the lower scores of both were adopted in this study: ≥6 points indicates independence and ≤5 points indicates dependence. The following were collected as dependent variables: age [8], dressing performance prior to practice [9], trunk function [8,10], visuospatial perception [8], and balance [11,12] upon admission, which have been reportedly associated with dressing performance. The FIM ® instrument score for dressing item was used as an index of dressing performance upon admission, the Stroke Impairment Assessment Set (SIAS) [13] was used as trunk function and visuospatial recognition indices, and the Berg balance scale (BBS) [14] as a balance index.…”