Sitting balance as an early predictor of functional improvement in association with depressive symptoms in stroke patients

Abstract

The aim of the present study was to assess the relationship between sitting balance at an early stage and activities of daily living (ADL) function in 452 stroke patients. The effect of sitting balance on the two core elements of depression (apathy and depressive mood) was also examined. The ability to maintain a sitting position for 10 min (10-min sitting balance) was assessed, along with ADL using the Functional Independence Measurement, and psychological status using the Zung Selfrating Depression Scale (depressive mood), Apathy Scale (apathy) and Neuropsychiatric Inventory. Proportional-hazards analysis was used to determine the independent effect of post-stroke depression on functional outcome. Comparisons between sitting balance and psychological status were performed using logistic multiple regression analysis. Cox multiple regression analysis showed that significant differences were obtained for the sitting balance (P < 0.0002) and Mini-Mental State Examination scores (P < 0.02) in all six ADL subscales, and for age in four of the six ADL subscales (Dressing-Upper Body and Dressing-Lower Body, Toileting, Walking). Kaplan-Meier survival curves for reaching independence in ADL subscales showed highly significantly differences in achievement rate and time to reach goal for each subgroup on 10-min sitting balance (with or without assistance) and on age (young, <65; elderly, Ն65 years). Ten-minute sitting balance correlated with depressive mood and apathy. A rapid and simple screening method, 10-min sitting balance was related to scores for two core depressive symptoms, lowered mood and apathy, and was predictive of post-stroke ADL outcomes in the rehabilitation unit along with age.

Non-motor Factors Associated with the Attainment of Community Ambulation after Stroke

“…32,33 According to Kwakkel and colleagues, 34 control of the trunk in the first week post-stroke, was an independent variable for predicting comfortable ambulation at 6 months. Hama and colleagues 35 conducted a study with 452 patients, aiming to verify the association of trunk control, depressive symptoms, and functional outcomes. The authors concluded that inefficient trunk control is strongly associated with depression, deficit of initiative and apathy, and predicts a worse functional outcome.…”

‘Insistence on recovery’ as a positive prognostic factor in Japanese stroke patients

“…12,13,16 The BRS scale defines recovery only in broad categories; these categories correlate with progressive functional recovery.…”

“…[11][12][13][18][19][20] Patients completed the AS within 1 month after admission. The AS consists of 14 questions concerning spontaneity, initiation, emotionality, activity level, and interest in hobbies.…”

“…[11][12][13]17 Patients completed the SDS within 1 month after admission. We classified the patients into two groups according to their score: a non-depressed group (SDS score <45 points) and a depressed group (SDS score Ն45 points).…”

“…[12][13][14][15] The maximum total FIM score is 126; the lower the score, the greater the disability. All patients were examined for disability using the FIM (Japanese version) within 1 week after admission and at 1-2-week intervals during hospitalization.…”