Factors Influencing Stroke Survivors’ Quality of Life During Subacute Recovery

School of Allied Medical Professions, The Ohio State University, Columbus, Ohio 43210, USA.
Stroke (Impact Factor: 5.72). 08/2005; 36(7):1480-4. DOI: 10.1161/01.STR.0000170706.13595.4f
Source: PubMed


Health-related quality of life (HRQOL) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery.
Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial (Extremity Constraint-Induced Therapy Evaluation). HRQOL was assessed using the Stroke Impact Scale (SIS), Version 3.0. The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity. Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains.
Age, gender, education level, stroke type, concordance (paretic arm=dominant hand), upper extremity motor function (Wolf Motor Function Test), and comorbidities were associated across SIS domains. Poorer HRQOL in the physical domain was associated with age, nonwhite race, more comorbidities, and reduced upper-extremity function. Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking, and those with an ischemic stroke and concordance reported poorer communication.
Although results may not generalize to lower functioning stroke survivors, individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive, targeted interventions designed to maximize recovery and improve HRQOL.

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Available from: Deborah S Nichols-Larsen, Dec 08, 2015
    • "Stroke is a leading cause of death and long-term disability worldwide [1] [2] and its incidence is on the rise [2]. Importantly, loss of arm function occurs in up to 85% of stroke survivors [3], with a significant long-term impact on activities of daily living, leisure activities and work. Recent evidence suggests that home-based telerehabilitation (TR) is a viable approach for upper extremity (UE) training poststroke when rehabilitation services are not available [4]. "
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    ABSTRACT: Background: Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the internet, can contribute to ensuring that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance. Methods/design: A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups. Discussion: Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services.
    No preview · Article · Dec 2015 · Contemporary clinical trials
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    • "Patients with a neurological disorder such as stroke or cerebral palsy, often suffer from hemiparesis, spasticity and coordination disorders, leading to loss of arm-hand function and consequently loss of arm-hand performance [1] [2] [3] [4] [5]. This limits the execution of ADL, affecting their daily life extremely, and resulting in greater dependency, restricted social participation [6] and decreased quality of life [7]. "
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    ABSTRACT: Neurological patients often encounter arm-hand problems in daily life. Body worn sensors may be used to assess actual performance by quantifying specific movement patterns associated with specific activities. However, signal reliability during activities of daily living should be determined first. Aim is to determine to what extent standardized arm-hand skill performance of both healthy adults and healthy children can be recorded reliably using a combination of multiple sensor devices. Thirty adults (aged>50 years) and thirty-two children (aged between 6-18 years) performed the activities drinking, eating and combing 5 times in a standardized setting. Sensor devices, each containing a triaxial accelerometer, gyroscope and magnetometer were attached to the arms, hands and trunk of the participants. Within-subject and between-subject reliability of the signal patterns amongst skill repetitions was determined by calculating Intraclass-Correlation-Coefficients (ICCs). Median reliability was good to very good for all activities performed (both within and between subjects). Regarding within-subject reliability (instruction-condition), median ICCs ranged between 0.76-0.90 and 0.68-0.92 for the adults and children respectively. For between-subject reliability (instruction-condition), median ICCs ranged 0.75-0.86 and 0.61-0.90 for the adults and children respectively. It can be concluded that the abovementioned sensor system can reliably record activities of daily living in a standardized setting.
    Full-text · Article · Feb 2015 · IEEE Transactions on Neural Systems and Rehabilitation Engineering
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    • "Among these survivors, a large proportion (46% to 95%) remains symptomatic six months after the ischemic stroke event [2]. Loss of arm function adversely affects quality of life [3], and functional motor recovery in affected upper extremities in patients with hemiplegia is the primary goal of physical therapists [4]. Continuous rehabilitation training following subcortical damage in movement disorders can achieve motor function recovery [5]. "
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    ABSTRACT: Objectives. To evaluate whether combining mental practice with physical practice training enhances hand function in patients with stroke. Methods. 10 for treatment and 10 for control were recruited for this pre/posttraining matched case control study. In the treatment group, subjects underwent combining mental practice with physical practice for four weeks. In the control group, subjects only participated in physical practice. Change of hand function and the number of activated voxels of the contralateral somatosensory motor cortex (SMC) acquired by functional magnetic resonance imaging were measured. Results. After training, the Action Research Arm Test score increased by 12.65 for treatment and by 5.20 for control. There was a significant difference in the Action Research Arm Test score between the two groups (P = 0.04). The activated voxels number of the contralateral SMC increased in both groups, but the activated voxels number in the contralateral SMC and the improvement of hand function for treatment were greater than for control. In the treatment group, the number of activated voxels of the contralateral SMC was positively correlated with better hand function scores. Conclusions. Combining mental practice with physical practice may be a more effective treatment strategy than physical training alone for hand recovery in stroke patients.
    Full-text · Article · Nov 2014 · Behavioural neurology
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