Abstract WP161: Early Short Physical Performance Battery (SPPB) Score Can Predict Functional Independence and Death for Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ken-ichi Kumagae ◽  
Kohta Yamauchi ◽  
Risa Hagiwara ◽  
Yasuhiro Koyanagi ◽  
Shuji Arakawa ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Acute Stroke ◽  
Roc Curve ◽  
Assessment Tool ◽  
Functional Independence ◽  
Curve Analysis ◽  
Lower Extremity Function ◽  
Stroke Patients ◽  
Roc Curve Analysis ◽  
Extremity Function

Background and Purpose: Lower extremity function is a strong predictor for functional outcome and death in a variety of pathological status. National Institute of Health Stroke Scale (NIHSS) is a world-wide standard scoring system for stroke patients; however, it is not sufficient to evaluate lower extremity function. Short Physical Performance Battery (SPPB) is a simple assessment tool for lower extremity function, consists of standing balance, walking speed, and repetitive standing (range: 0-12, 12: high function). SPPB can predict adverse events, such as disability and mortality in elderly population, but its disease specific utility for stroke patients is still unknown. The purpose of this study was to determine whether SPPB score predicts functional independence and death for acute stroke. Methods: Between April 2013 and November 2014, 410 consecutive stroke patients admitted within 7 days after the onset. Patients with premorbid modified Rankin Scale (mRS) of 0-2, and evaluated SPPB at 7 th days after the admission were enrolled in this study. Clinical data were analyzed using univariate and multivariate model to assess functional independence (defined as mRS of 0-2) at 3 months and 1 year mortality adjusting covariates to investigate the association between SPPB and functional independence or death. Receiver operating characteristics (ROC) curve analysis was performed for detecting optimal cut-off value. Results: A total of 243 patients (mean age 73.8 years, male 58.4%) were included in this study. Of them, 132 (54.3%) patients were independent at 3 months follow up, and 14 (5.8%) patients have died. Median SPPB score at 7 th days after the admission was 6 (IQR: 1-11). After adjusting age, sex, BMI, NIHSS score on admission, SPPB score at 7 th days after the admission was significantly associated with 3-month functional independence (odds ratio, 1.48; 95%CI, 1.29-1.69; p<0.001) and 1-year death (hazard ratio, 0.36; 95% CI, 0.17-0.74; p=0.005). ROC curve analysis revealed the cut-off point of SPPB for functional independence was 6 (AUC:0.88, 95%CI, 0.83-0.93, p<0.001, sensitivity: 0.83, specificity:0.84). Conclusions: Early SPPB score is a useful assessment tool in predicting functional independence and death for acute stroke patients.

scholarly journals Effectiveness of a Novel Contralaterally Controlled Neuromuscular Electrical Stimulation for Restoring Lower Limb Motor Performance and Activities of Daily Living in Stroke Survivors: A Randomized Controlled Trial

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Ying Shen ◽  
Lan Chen ◽  
Li Zhang ◽  
Shugang Hu ◽  
Bin Su ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Lower Extremity ◽  
Activities Of Daily Living ◽  
Motor Function ◽  
Daily Living ◽  
Neuromuscular Electrical Stimulation ◽  
Lower Extremity Function ◽  
Stroke Patients ◽  
Extremity Function ◽  
Subacute Stroke

Background. Contralaterally controlled neuromuscular electrical stimulation (CCNMES) is a novel electrical stimulation treatment for stroke; however, reports on the efficacy of CCNMES on lower extremity function after stroke are scarce. Objective. To compare the effects of CCNMES versus NMES on lower extremity function and activities of daily living (ADL) in subacute stroke patients. Methods. Forty-four patients with a history of subacute stroke were randomly assigned to a CCNMES group and a NMES group ( n = 22 per group). Twenty-one patients in each group completed the study per protocol, with one subject lost in follow-up in each group. The CCNMES group received CCNMES to the tibialis anterior (TA) and the peroneus longus and brevis muscles to induce ankle dorsiflexion motion, whereas the NMES group received NMES. The stimulus current was a biphasic waveform with a pulse duration of 200 μs and a frequency of 60 Hz. Patients in both groups underwent five 15 min sessions of electrical stimulation per week for three weeks. Indicators of motor function and ADL were measured pre- and posttreatment, including the Fugl–Meyer assessment of the lower extremity (FMA-LE) and modified Barthel index (MBI). Surface electromyography (sEMG) assessments included average electromyography (aEMG), integrated electromyography (iEMG), and root mean square (RMS) of the paretic TA muscle. Results. Values for the FMA-LE, MBI, aEMG, iEMG, and RMS of the affected TA muscle were significantly increased in both groups after treatment ( p < 0.01 ). Patients in the CCNMES group showed significant improvements in all the measurements compared with the NMES group after treatment. Within-group differences in all post- and pretreatment indicators were significantly greater in the CCNMES group than in the NMES group ( p < 0.05 ). Conclusion. CCNMES improved motor function and ADL ability to a greater extent than the conventional NMES in subacute stroke patients.

scholarly journals Association between patient-reported functional measures and incident falls

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wanfen Yip ◽  
Lixia Ge ◽  
Bee Hoon Heng ◽  
Woan Shin Tan
Keyword(s):  
Lower Extremity ◽  
Physical Function ◽  
Assessment Tool ◽  
Multivariable Analysis ◽  
Community Dwelling ◽  
Lower Extremity Function ◽  
Lower Extremity Muscle ◽  
Extremity Function ◽  
Patient Reported ◽  
Function Domain

AbstractLower extremity muscle strength, and functional limitations are important modifiable predictors of falls, but are often examined using performance based measures. We examined the association between self-reported physical function limitations, determined using Late-Life Function and Disability Instrument(LLFDI) and incident falls in community-dwelling elderly individuals. 283 older adults participants were included in this analysis. Physical function limitations were defined as a person’s difficulty in completing items of the lower extremity function domain and composite scores of the LLFDI. Information on falls was obtained through a standardised questionnaire. At one-year follow-up, 15.2% (43) of the participants experienced their first fall. In the multivariable analysis, individuals who reported difficulties in items of lower extremity function domain were more likely to experience a fall (incidence rate ratio[IRR]: ranging between 2.43 and 7.01; all P ≤ 0.046). In addition, decreasing advanced lower extremity function scores (IRR: 1.70, 95% confidence interval[CI]): 1.04, 2.78) and overall function component score (IRR: 2.05, 95% CI: 1.22, 3.44) were associated with higher risk of incident falls. Physical function limitations, determined using LLFDI, were associated with incident falls. Our findings provide further evidence that the LLFDI function component has the potential to be used as a self-assessment tool for fall risk.

scholarly journals Effect of Action Observation Therapy on Lower-extremity Function of Chronic Stroke Patients

2015 ◽  
Vol 30 (2) ◽  
pp. 251-256
Author(s):  
Takeshi FUCHIGAMI ◽  
Atsushi MATSUO ◽  
Hiroaki KOSHIMOTO ◽  
Saori KAWAGUCHI ◽  
Masaki KITAURA ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Action Observation ◽  
Chronic Stroke ◽  
Lower Extremity Function ◽  
Stroke Patients ◽  
Extremity Function

scholarly journals A Novel Virtual Reality Training Strategy for Poststroke Patients: A Randomized Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Naveed Anwar ◽  
Hossein Karimi ◽  
Ashfaq Ahmad ◽  
Nazia Mumtaz ◽  
Ghulam Saqulain ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Virtual Reality ◽  
Physical Therapy ◽  
Lower Extremity ◽  
Randomized Clinical Trial ◽  
Virtual Reality Training ◽  
Lower Extremity Function ◽  
Stroke Patients ◽  
Extremity Function ◽  
Significant Difference

Stroke patients suffer impairments including sensory, motor, visual, and cognitive areas, as well as gait and balance manifestations making activities of daily living difficult. In such conditions, virtual reality training can be a potential rehabilitation tool in comparison to conventional physical therapy to cater to the burden of this disability; hence, this randomized clinical trial compared the effects of virtual reality training and conventional physical therapy on balance and lower extremity function in stroke patients. The sample of 68 poststroke participants from Kanaan Physical Therapy and Spine Clinic, Lahore, Pakistan, were divided into N = 34 cases each using the lottery method with one group given virtual reality training and the other received conventional physical therapy. Each group received 60 minutes intervention, 3 days per week for 6 weeks. The Berg balance scale and the Fugl-Meyer assessment-lower extremity scale were employed for data collection preintervention, immediate postintervention, and 6 weeks postintervention. The statistically significant differences between virtual reality and conventional physical therapy groups for the Berg Balance score ( p < 0.001 ), Fugl-Meyer assessment (FMA)-lower extremity domains of FMA-motor function ( p < 0.001 ), FMA-joint pain, and joint range ( p < 0.001 ); however, there is no significant difference p = 0.202 for time vs. group interaction and significant ( p < 0.001 ) for the time main effect for FMA sensation. Hence, virtual reality training is more effective to restore balance and lower extremity function compared to conventional physical therapy in stroke patients. The results of the study have significant implications for the clinicians with better case management enhancing quality of life of patients along with the dearth of local literature, thus providing base for future research from a developing country’s perspective.

scholarly journals Mediating effects of lower extremity function on the relationship between night sleep duration and cardiovascular disease risk: a cross-sectional study in elderly Chinese without cardiovascular diseases

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046015
Author(s):  
Hui Zhang ◽  
Xiaoyu Chen ◽  
Peipei Han ◽  
Weibo Ma ◽  
Yuanyuan Zhang ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Sleep Duration ◽  
Physical Performance ◽  
Indirect Effect ◽  
Night Sleep ◽  
Lower Extremity Function ◽  
Cvd Risk ◽  
Extremity Function ◽  
Elderly Chinese ◽  
The Relationship

ObjectiveThe purpose of this study is to investigate the mediating effect of physical performance on the relationship between night sleep duration and risk of cardiovascular disease (CVD) in elderly Chinese without CVD.Methods782 participants without CVD over 65 years (average: 70.82±3.86 years, 448 women) were included in this study. CVD risk was calculated by the Framingham Risk Score and participants were divided into four groups of night sleep duration (in hours): <7 hours, ≥7–8 hours, >8–9 hours and >9 hours. Upper extremity function was measured by grip strength and lower extremity function was measured by the Short Physical Performance Battery (SPPB), consisting of balance, 4 m walk and chair stands tests.ResultsAfter adjusting for covariates, long night sleep duration (>9 hours) and CVD risk were significantly positively associated compared with moderate night sleep duration (≥7–8 hours) (β=1.152; 95% CI 0.05 to 2.25). SPPB total score (indirect effect ab=−0.122; 95% CI −0.291 to –0.0008) rather than grip strength partially mediated the relationship between long night sleep duration and CVD risk, in which chair stands played a major mediating role (indirect effect ab=−0.171; 95% CI −0.040 to –0.0006), while balance (indirect effect ab=−0.016; 95% CI −0.100 to 0.063) and 4 m walk (indirect effect ab=0.048; 95% CI −0.066 to 0.201) did not.ConclusionsLower extremity function, especially lower limb muscle strength, partially mediates a positive association between long night sleep duration and CVD risk in the elderly without CVD. Suitable interventions for physical performance and sleep may minimise the risk of subsequent CVD.

Acute heart failure: predicting early in-hospital outcomes

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Santos ◽  
S Paula ◽  
I Almeida ◽  
H Santos ◽  
H Miranda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Acute Heart Failure ◽  
Roc Curve ◽  
Real Life ◽  
Study Data ◽  
Curve Analysis ◽  
Older Age ◽  
Invasive Ventilation ◽  
Roc Curve Analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge. Older age (p &lt; 0.001), lower SBP (p = 0,035) and need of inotropes (p &lt; 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p &lt; 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p &lt; 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p &lt; 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p &lt; 0.001, CI 0.971-0.988), higher urea (OR 1.01, p &lt; 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage. Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p &lt; 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p &lt; 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84). Conclusion In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

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