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Objectives: To compare the course of generic and specific health-related quality of life (HRQOL) of individuals with stroke, and its physical, mental, and social domains, at three, six, and 12 months after hospital discharge, considering the levels of stroke severity. Methods: This is a longitudinal study, in stroke individuals, assessed during hospital admission by the National Institutes of Health Stroke Scale (NIHSS), and divided into mild (NIHSS ≤3) or moderate/severe (NIHSS ≥4) disease. At three, six, and 12 months after hospital discharge, the individuals were assessed for generic (Short Form Health Survey–36: total score and physical and mental domains) and specific (Stroke Specific Quality of Life Scale: total score and social domain) HRQOL. A 2 × 2 repeated measures analysis of variance (ANOVA) with post-hoc was applied. Results: 146, 122, and 103 individuals were assessed at three, six and 12 months, respectively HRQOL courses showed different behaviors according to stroke severity (3.37≤F ≤ 4.62; 0.010≤p ≤.036). Individuals with mild stroke showed significant changes in the physical domain, with a reduction between three and six months, and an increase between six and 12. Moderate/severe individuals showed a significant increase in all HRQOL variables between three and six months, and a maintenance of values for almost all variables, except for physical domain, which improved significantly between three and six months, and got significantly worse between six and 12. Conclusions: HRQOL during the first year after stroke showed distinct trajectories, being stroke severity an important factor in identifying stroke subjects at risk of HRQOL decline. Clinical Implications: These results demonstrate the importance of considering not only the phase of the stroke, the severity, and the general and specific HRQOL, but also the physical, social, and mainly the mental domain, which has long been neglected, when assessing this population. [ABSTRACT FROM AUTHOR]

determinants of access to rehabilitation professionals after stroke in middle-income countries, where the burden of this disease is higher, are little known. To identify the determinants of access to rehabilitation professionals by individuals with stroke at one, three, and six months after hospital discharge in Brazil and compare referral and access rates after discharge. Longitudinal and prospective study, with individuals with primary stroke, without previous disabilities. At hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. The possible determinants of access, according to Andersen's model, were: a) predisposing factors: age, sex, education levels, and belief that they could improve with treatment; b) need factors: stroke severity, levels of disability; c) enabling factors: socioeconomic status, disposable income for health care, and quality of care provided by rehabilitation professionals. One, three, and six months after hospital discharge, individuals were contacted to identify which rehabilitation professionals were accessed. Multiple linear regression model and Wilcoxon tests were used (α=5%). 201 individuals were included. Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01) of access at one, three, and six months after hospital discharge, respectively. In all periods, there was less access than that recommended at the time of hospital discharge (p<0.01). Need factors (disability levels and stroke severity) were determinants of access in all assessed periods. In addition, in all periods, the comprehensiveness of care for individuals with stroke was compromised. [ABSTRACT FROM AUTHOR]

Purpose: To identify acute predictors of both generic and specific health-related quality of life (HRQoL) 3 months after stroke in individuals from a middle-income country. Materials and methods: A 3-month prospective study with individuals who had suffered their first stroke, without previous disability, discharged from a stroke unit. The dependent outcomes, assessed 3 months after stroke, were generic and specific HRQoL (SF-36 and SSQOL total scores, respectively). The predictors assessed in the stroke unit were age, sex, education level, duration of hospital stay, current living arrangement, stroke severity (National Institutes of Health Stroke Scale-NIHSS), functional independence (Modified Barthel Index-MBI), motor impairment (Fugl-Meyer Assessment), and lower- and upperlimb residual muscle strength deficits. Linear multiple regression analyses were employed to identify predictors of both generic (model-1) and specific (model-2) HRQoL (α=5%). Results: One hundred twenty-six individuals were assessed at 3-month post-stroke (61.3 ± 13.6 years). Regression analysis showed that functional independence was the best predictor of both generic (R²=21%; F=34.82; p<0.001) and specific (R²=29%; F=51.71; p<0.001) HRQoL at 3-month poststroke. Conclusion: Both generic and specific HRQoL at 3-month post-stroke can be predicted by functional independence assessed in the acute phase with the MBI. [ABSTRACT FROM AUTHOR]

The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test–retest reliability. Test–retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96–0.99) and 80% of the individual items had almost perfect agreement (k= 0.81–1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke. [ABSTRACT FROM AUTHOR]

Introduction: Individuals after stroke present several motor impairments, which reduced the functional capacity. The understanding of modifiable factors which are related to functional capacity in individuals with chronic stroke could better direct clinical practice. However, the mechanisms that could influence functional capacity in individuals with chronic stroke are not fully understood. Objective: This study aimed to determine which modifiable variables would best predict self‐reported functional capacity after stroke. Design: Cross‐sectional. Setting: Research laboratory setting. Participants: Ninety two individuals with chronic stroke, who had a mean age of 60 (SD 13) years and a time since the onset of the stroke of 52 (67) months. Main Outcome Measures: Regression analysis of cross‐sectional data was used to investigate whether body mass index, habitual walking speed, physical activity levels, fatigue, motor recovery, walking distance, and residual strength deficits of the lower limb muscles would predict self‐reported functional capacity. Results: Habitual walking speed alone explained 48% of the variance in functional capacity. When fatigue was included in the model, the explained variance increased to 55%. Conclusions: Habitual walking speed and fatigue were significant predictors of self‐reported functional capacity in individuals with chronic stroke. These individuals may increase their functional capacity with interventions aimed at increasing walking speed and reducing fatigue. [ABSTRACT FROM AUTHOR]

Oxygen uptake efficiency slope during submaximal tests has been proposed as a more appropriate measure of aerobic capacity after suffering a stroke, since some individuals cannot tolerate maximal exercise testing. However, it has not yet been investigated whether the oxygen uptake efficiency slope is able to differentiate between healthy individuals and those who have suffered a stroke. To compare the oxygen uptake efficiency slope during walking and stair climbing between stroke survivors and age- and sex-matched healthy controls. This is a cross-sectional study in which 18 individuals who had suffered a stroke (stroke survivors) and 18 healthy controls matched for sex and age were included. Oxygen consumption and minute ventilation were collected breath-by-breath during walking (6-min Walk Test) and stair climbing. The oxygen uptake efficiency slope was estimated by the slope of the line obtained through linear regression. The stroke survivors had a lower oxygen uptake efficiency slope during the 6-min Walk Test than the healthy controls (MD 498, 95% CI 122 to 873, p =.01). The between-group difference for the Stair Test was smaller and not statistically significant (MD 349, 95%CI −73 to 772, p =.10). Stroke survivors had lower oxygen uptake efficiency slope during the performance of the 6-min Walk Test when compared to sex- and age-matched healthy controls. This suggests that stroke survivors have worse cardiopulmonary capacity. [ABSTRACT FROM AUTHOR]

Objective: To compare the sociodemographic and clinico-functional characteristics of patients admitted to a stroke unit immediately before and during two different COVID-19 pandemic phases. Methods: This exploratory study was conducted in the stroke unit of a public hospital in Brazil. Patients consecutively admitted to a stroke unit for 18 months with primary stroke aged =20 years were included and divided into three groups: G1: Pre-pandemic; G2: Early pandemic; and G3: Late pandemic. The sociodemographic and clinico-functional characteristics of the groups were compared (a=0.05). Results: The study included 383 individuals (G1=124; G2=151; G3=108). The number of risk factors (higher in G2; p=0.001), smoking (more common in G2; p=0.01), type of stroke (ischemic more common in G3; p=0.002), stroke severity (more severe in G2; p=0.02), and level of disability (more severe in G2: p=0.01) were significantly different among the groups. Conclusion: A greater number of serious events and risk factors including smoking and higher level of disability was observed in patients in the beginning of the pandemic than in the late phases. Only the occurrence of ischemic stroke increased in the late phase. Therefore, these individuals may have an increased need for rehabilitation services monitoring and care during their lifespan. Additionally, these results indicate that health promotion and prevention services should be strengthened for future health emergencies. [ABSTRACT FROM AUTHOR]

To investigate the test–retest reliability and measurement error of the Brazilian version of the modified Gait Efficacy scale (mGES-Brazil) in individuals who have had stroke. The mGES-Brazil was applied on two occasions, five to seven days apart, in a research laboratory setting. Test–retest reliability and measurement error, which included the standard error of measurement (SEM), smallest detectable change (SDC), and analysis of the limits of agreement by the Bland–Altman plots, were examined. Fifty individuals who have had stroke (18 men), with a mean age of 64 ± 11 years, were evaluated. All individual items showed good reliability (Intra-class Correlation Coefficient – ICC2,1 > 0.90). The ICC was 0.98 (95% CI 0.97 to 0.99) and the Bland and Altman plots revealed no systematic changes in the mean test–retest scores. The SEM (SEM%) was 3 (5%), within the recommended values, while the SDC was 8 points. The mGES-Brazil demonstrated to be reliable to be applied within clinical and research contexts for the assessment of changes in walking confidence of individuals who have had stroke. Changes in mGES scores ≥8 points reflect real changes. [ABSTRACT FROM AUTHOR]

Currently, the best strategy to deal with disabilities after stroke is rehabilitation. National and international clinical guidelines recommend that all post-stroke individuals have access to rehabilitation professionals within 72 hours after hospital discharge. In addition, access should be continued until the individual's functional goals are achieved. However, the determinants of access to rehabilitation professionals by post-stroke individuals in middle-income countries, where the burden of this disease is high, are little known. To identify the determinants of access to rehabilitation professionals by post-stroke individuals one, three and six months after hospital discharge in Brazil and to compare the access obtained in each period with that referred by the multidisciplinary team at the time of hospital discharge. A longitudinal, prospective, and exploratory study, carried out in Belo Horizonte, Minas Gerais, Brazil. Individuals after primary stroke, without previous disabilities were included. During hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. One, three and six months after hospital discharge, individuals were contacted by telephone to identify the rehabilitation professionals accessed. Possible determinants of access were classified according to Andersen's behavioral model for using health services and included: a) predisposing factors: age, sex, education, and belief that it could improve with treatment; b) need factors: stroke severity and level of disability; c) facilitating factors: socioeconomic status, disposable income for health care and quality of care provided by rehabilitation professionals. Multiple linear regression model and Wilcoxon test were used (α=5%). 201 individuals were included. Higher level of disability and stroke severity explained 31%, 34% and 39% of access to rehabilitation professionals one, three and six months after hospital discharge (p<0.01) respectively. Three months after discharge, having less education added 4% of explanation to the variation in access (p<0.01). In all evaluated periods, the number of professionals accessed was significantly lower than recommended at discharge (p<0.01). In general, individuals with a more severe stroke and a higher level of disability were those who had greater access to rehabilitation professionals one, three and six months after hospital discharge. In addition, the comprehensiveness care for post-stroke individuals were compromised was compromised in all periods evaluated, indicating that current legislation in Brazil on post-stroke individuals care was partially complied. Access to rehabilitation professionals has been directed equitably and in insufficient quantity to post-stroke individuals. Therefore, health management services must direct human and financial resources to expand immediate and comprehensive access to rehabilitation professionals for all post-stroke individuals after hospital discharge. These resources can improve the resolution of the transfer from hospital care to community care, as recommended. [ABSTRACT FROM AUTHOR]

To determine the Duke Activity Status Index (DASI) cut-off scores and verify if they would be able to discriminate between chronic stroke individuals, who had poor, from those who had good functional capacity (FC). Cross-sectional study, where 92 individuals with chronic stroke had their FC measured by DASI scores and were classified into community and non-community walkers. Both the receiver operating characteristic and the area under the curve were used to determine the best DASI cut-off values that could discriminate between individuals, who had poor, from those who had good FC. Binary logistic regression analysis is used to investigate the ability of DASI scores in predicting community walkers. DASI cut-off value of 31.95 showed to be sensitive and specific to differentiate between individuals, who had poor from good FC. The regression analysis revealed that the chance of individuals, who had better FC (≥ 31.95) be community walkers was 10.69 (95%CI:4–32.75) times higher than that of those who had poor FC (< 31.95). The model demonstrated good predictive ability. The DASI cut-off value of 31.95 showed to be sensitive and specific to distinguish between chronic stroke individuals, who had poor, from those who had good FC. The identification of individuals, who have good and poor functional capacity, is important for clinical reasoning and decision-making in stroke rehabilitation. The Duke Activity Status Index (DASI) is a clinically useful tool for the assessment of functional capacity, based upon the performance of common daily living activities. The DASI cut-off of 31.95 points was able to discriminate between individuals with stroke, who had poor, from those who had good functional capacity. The chance of individuals, who had good functional capacity (DASI ≥ 31.95) be community walkers was 10.69 times higher than that of those who had poor functional capacity (DASI < 31.95). The findings support the use of the DASI as a simple tool for the assessment of functional capacity, especially in low-resource settings. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Design: Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Results: Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 < r < 0.52, p < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p < 0.001) of the variance in walking speed, 32% (F = 19.1; p < 0.001) of stair ascent, and 31% (F = 16.8; p < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p < 0.001) of the variance. Conclusion: Measures of strength and motor coordination of the paretic lower limb were significantly correlated with all activity measures. However, despite the fact that knee flexor strength explained some variance in walking speed and stair ascent/descent cadences, motor coordination was the only measure that explained the variances in all three selected activity measures. These findings are innovative for neurological rehabilitation, since this is the first study to demonstrate that deficits in motor coordination of the paretic lower limb best explained limitations in performing different lower-limb activities. [ABSTRACT FROM AUTHOR]

Background: Post Covid‐19 syndrome can cause cognitive impairment and may be associated with a higher risk of developing dementia in older people. Method: This is a cohort study that is evaluating over 12 months the functional status and cognition of elderly people after hospital discharge. One group is composed of elderly people admitted to the hospital for Covid‐19 and the other group is composed of elderly people hospitalized for other clinical reasons. The groups are evaluated with The Mattis (DRS), AD8, ADCS‐ADL, PCL‐C, GDS‐15, FIM, COPM, CFS, FSS, mMRC and SARC‐calf. We will describe the preliminary results of the first 31 patients included in the COVID‐19 group on functional status, cognition, mood and quality of life. Result: Thirty‐one patients with COVID‐19 were evaluated three months after hospital discharge. One was excluded due to previous mental disorder and another due to a request to be excluded from the study. We found a mean age of 69.55 ± 7.72 years, schooling 7.14 ± 4.48 years, 51.7% female, Charlson Comorbidity Index 2.21 ± 1.84, 48.3% with smoking history and 62.9% had incomplete vaccine protection for COVID‐19. Considering cognition, 13.9% of the sample had no impairment, 55.1% had mild cognitive impairment (MCI) (17.2% amnestic MCI and 37.9% non‐amnesic MCI) and 31% had dementia. 24.1% declared their health status and quality of life as fair or poor. Mean CFS was 4.45 ± 1.18, GDS‐15 4.28 ± 3.38, FSS 30.76 ± 19.24, PCL‐c 29.34 ± 10.41, SARC‐calf 4.03 ± 4.61. All had mMRC dyspnea classified between 1 and 4. Conclusion: There was a high prevalence of mild cognitive impairment and dementia among patients after three months of discharge, with a predominance of mild frailty due to CFS and the presence of fatigue. It is noteworthy that a quarter of the sample reported low quality of life. [ABSTRACT FROM AUTHOR]