Effectiveness of behavior change and self-management theoretically-informed telehealth interventions for stroke secondary prevention: An overview of systematic reviews.

INTRODUCTION: Despite the increased use of telehealth interventions, low-level evidence supports their use for behavior change and self-management in stroke secondary prevention. Therefore, this overview of systematic reviews (SRs) critically appraises and consolidates the evidence about theoretically-informed telehealth interventions in stroke secondary prevention. METHODS: Two phases were conducted independently by two reviewers. Phase-1 included SRs contemplating randomized controlled trials (RCTs) implementing telehealth interventions with individuals post-stroke, targeting cardiovascular events, risk-reducing health behaviors or physiological risk factors. Phase-2 interrogated RCTs from these SRs that implemented theoretically-informed interventions. Best-evidence synthesis of published meta-analyses and new meta-analyses of theoretically-informed interventions were conducted. GRADE evidence was applied. RESULTS: In Phase-1 (15 SRs), best-evidence synthesis identified telehealth interventions as effective in reducing recurrent angina and recurrent stroke rates (both with very low GRADE), improving medication adherence (low GRADE), physical activity participation (very low GRADE), and blood pressure targets (very low GRADE), reducing systolic blood pressure (SBP) (moderate GRADE) and low-density lipoprotein levels (very low GRADE). In Phase-2 (14 RCTs), new meta-analyses identified theoretically-informed telehealth interventions as effective in improving medication adherence (SMD: 0.38; 95%CI: 0.13-0.64; I²: 72%, low GRADE) and healthy eating (SMD: 0.38; 95%CI: 0.15-0.60; I²: 38%, low GRADE), and decreasing SBP (MD: -9.19; 95%CI: -5.49 to -12.89; I²: 0%, moderate GRADE). DISCUSSION: Telehealth demonstrates utility in stroke secondary prevention, notably in SBP reduction. High-quality RCTs are required given the lack of current evidence supporting theoretically-informed telehealth interventions addressing primary outcomes of secondary prevention, and the low certainty evidence identified for health behavior change.

Predictors of health-related quality of life one year after stroke: a systematic review with meta-analysis.

The objective was to investigate, through a systematic review, which independent variables predict health-related quality of life (HRQoL) one year after stroke. Searches were conducted in LILACS, MEDLINE, Scielo, Web of Science, and PEDro. The inclusion criteria were observational longitudinal studies, which included at least one independent variable measured at baseline, as a potential predictor of HRQoL measured 12 months after stroke. The predictors of interest were variables across all domains of the International Classification of Function, Disability and Health. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A total of 17 papers were included, involving 8338 participants, and 10 possible predictors of the HRQoL one year after stroke. The meta-analysis was performed for six of them (cognition, depression, neurological deficit, stroke severity, motor impairment, and limitation in activities of daily living), and significant results were found only for limitation in activities of daily living (odds ratio, 1.30 [95% confidence interval, 1.09-1.57]; I2  = 72%; P  < 0.01). The descriptive analysis of the remaining four predictors suggested a significant predictive value of balance and functional independence, whereas the results for trunk control were not significant and for social participation were unclear. In conclusion, individuals within the first 11.5 weeks after stroke with lower limitation in activities of daily living, higher functional independence, and better balance, are more likely to have a higher HRQoL one year after stroke. Thus, these predictors, all modifiable factors, need to be targeted during acute rehabilitation.

Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke.

PURPOSE: To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. MATERIALS AND METHODS: 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. RESULTS: Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). CONCLUSIONS: Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.

Stroke survivors experience dependence in basic activities of daily living (ADL) which is reduced over six months after the stroke and showed different individual variability in patterns of recovery.Patients with moderate/severe stroke-related neurological deficits had higher chances of becoming dependent in activities related to feeding, bathing, dressing, transfers, stair climbing, and ambulation.Rehabilitation professionals should consider assessing stroke-related neurologic deficits within the first hours after stroke, with particular attention to individuals with moderate/severe impairments.

Cycling using functional electrical stimulation therapy to improve motor function and activity in post-stroke individuals in early subacute phase: a systematic review with meta-analysis.

BACKGROUND: Stroke necessitates interventions to rehabilitate individuals with disabilities, and the application of functional electrical stimulation therapy (FEST) has demonstrated potential in this regard. This study aimed to analyze the efficacy and effectiveness of cycling using FEST to improve motor function and lower limb activity in post-stroke individuals. METHODS: We performed a systematic review according to the recommendations of the PRISMA checklist, searching MEDLINE, Cochrane, EMBASE, LILACS, and PEDro databases by July 2022, without any date or language limitations. Studies were selected using the following terms: stroke, electrical stimulation therapy, cycling, and clinical trials. Randomized or quasi-randomized clinical trials that investigated the effectiveness of cycling using FEST combined with exercise programs and cycling using FEST alone for motor function and activity in subacute post-stroke individuals were included. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from eligible studies and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Five randomized clinical trials involving 187 participants were included. Moderate-quality evidence indicates that cycling using FEST combined with exercise programs promotes relevant benefits in trunk control (MD 9 points, 95% CI 0.36-17.64) and walking distance (MD 94.84 m, 95% CI 39.63-150.05, I = 0%), the other outcomes had similar benefits. Cycling using FEST alone compared to exercise programs promotes similar benefits in strength, balance, walking speed, walking distance, and activities of daily living. CONCLUSION: This systematic review provides low- to moderate-quality evidence that cycling using FEST may be an effective strategy to consider in improving motor function and activity outcomes for post-stroke individuals in the early subacute phase. REVIEW REGISTRATION: PROSPERO (CRD42022345282).

Predicting self-perceived manual ability at three and six months after stroke: A prospective longitudinal study.

BACKGROUND: Recovery of manual ability is a critical issue in rehabilitation. Currently, little is known regarding the baseline predictors of self-perceived manual ability, which could capture information on individual's perceived functional ability, especially in carrying-out routine tasks outside clinical settings. OBJECTIVE: To identify baseline predictors, which can be easily obtained within clinical settings, of self-perceived manual ability at three and six months after discharge from a stroke unit. METHODS: A 6-month longitudinal study was carried-out. Participants were recruited from a stroke unit of a public hospital. The dependent outcome was self-perceived manual ability, and the following predictors were investigated: age, stroke severity, upper-limb motor impairments, cognitive function, muscle strength, and functional capacity. Linear regression analyses were employed to identify multivariate predictors of manual ability at three and six months after discharge (α=5%). RESULTS: Participated 131 individuals, 69 women (mean age of 60 years). Regression analyses revealed that stroke severity and age accounted for 31% and 47% of the variance in manual ability at three and six months after stroke, respectively. Stroke severity was the best predictor of manual ability at three (R2=29%; F=44.7; p<0.0001) and six months (R2=45%; F=88.2; p<0.0001) after stroke, respectively. CONCLUSION: Stroke severity showed to be the best predictor of manual ability at both three and six months after stroke. Although significant, age added little to the explained variance.

Balance deficit is the domain of the Fugl-Meyer scale that best explain limitations in functional independence during hospitalization after a stroke.

PURPOSE: To investigate which of the residual sensorimotor impairments, assessed by the Fugl-Meyer scale, would best explain functional independence during hospitalization after a stroke. METHODS: This cross-sectional study retrieved data from medical records between January 2014 to December 2021. Explanatory independent variables were the following domains of the Fugl-Meyer scale: joint pain, joint range of motion, balance, sensory function, and motor function of the upper and lower limbs. Functional independence was measured by the Functional Independence Measure (FIM). Step-wise multiple linear regression analysis was used to identify which measures would explain functional independence (α=5%). RESULTS: Data from 1,344 individuals, who had a mean age of 64 years, were retrieved. All included explanatory variables were significantly correlated with the FIM scores (0.24 ≤ r ≤ 0.87). Balance alone explained 76 % (F=4.24; p<0.001) of the variance in the FIM scores. When sensory function and upper-limb motor function scores were included in the model, the explained variance increased to 82 % (F = 1.935; p < 0.001). CONCLUSIONS: Balance, which is important for carrying-out self-care activities, is the domain of the Fugl-Meyer scale that best explained functional independence during hospitalization after a stroke. Although sensory function and motor function of the upper limb added little to the explained variance, they should not be underlooked. Future research is needed to determine whether progressive balance training interventions would enhance functional independence after a stroke.

Trunk biomechanical changes between the sit-to-stand and stand-to-sit performed at self-selected and fast speeds in stroke survivors.

PURPOSE: To compare the trunk biomechanical characteristics between the sit-to-stand and stand-to-sit performed at self-selected and fast speeds in stroke survivors and healthy-matched controls. METHODS: Thirty individuals (15 stroke survivors and 15 healthy-matched controls) were included. The following biomechanical characteristics were determined: peak of trunk forward flexion and time until the peak of trunk forward flexion, total duration, phase I (sit-to-stand: time spent from the beginning to seat-off; stand-to-sit: time spent from the beginning to seat-on) and II durations (sit-to-stand: time spent from seat-off to the end of the task; stand-to-sit: time spent from the seat-on to the end of the task). Two-way repeated measures ANOVA was used (α = 5%). RESULTS: The maximum angle of trunk forward flexion and time spent until the maximum angle of trunk forward flexion in both tasks were significantly higher in stroke survivors. For both groups and speeds, phase I duration and peak of trunk forward flexion of the stand-to-sit were significantly higher than that of the sit-to-stand (11.41≤F ≤ 33.60; 0.001 ≤ p ≤ 0.002) and, phase II duration was significantly higher during the sit-to-stand than that of the stand-to-sit (21.27 ≤ F ≤ 65.10; p ≤ 0.001). CONCLUSIONS: These results confirm specific trunk biomechanical characteristics between sit-to-stand and stand-to-sit in stroke survivors and healthy-matched controls.

Implications for RehabilitationSpecific biomechanical characteristics between the sit-to-stand and stand-to-sit were confirmed in stroke survivors and healthy-matched controls at both speeds.Fast speeds showed differences that were not observed at self-selected speeds.Trunk biomechanical characteristics must be carefully evaluated and should be considered in rehabilitation programs that aim to improve sit-to-stand and stand-to-sit performance.

Effects of high-intensity respiratory muscle training on respiratory muscle strength in individuals with Parkinson's disease: Protocol of a randomized clinical trial.

OBJECTIVE: To investigate the efficacy of high-intensity respiratory muscle training (combined inspiratory and expiratory muscle training) in improving inspiratory and expiratory muscle strength, inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life in this population. METHODS: A randomized controlled trial, concealed allocation, blinded assessments, and intention-to-treat analysis will be carried out. Altogether, 34 individuals with PD (age ≥ 50 years old, with maximum inspiratory pressure (MIP) <80cmH2O or maximum expiratory pressure (MEP) <90cmH2O) will be recruited. Patients will be randomly assigned to either (1) high-intensity respiratory muscle training (experimental group, 60% of MIP and MEP) or (2) sham training (control group, 0cmH2O). Individuals will perform a home-based intervention, with indirect home supervision, consisting of two daily 20-min sessions (morning and afternoon), seven times a week, during eight weeks. Primary outcomes are MIP and MEP. Secondary outcomes are inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life. The effects of the training will be analyzed from the collected data using intention-to-treat. Between-group differences will be measured using a two-way ANOVA with repeated measures (2*3), considering baseline, post-intervention, and 12-week follow-up. IMPACT: The results of this trial will provide valuable new information on the efficacy of high-intensity respiratory muscle training in improving muscle strength, functional outcomes, and quality of life in individuals with PD. Performing combined inspiratory and expiratory muscle training using a single equipment is cheaper and feasible, takes less time and is easy to use. In addition, this intervention will be carried out in the home environment that increases accessibility, reduces time, and costs of transport, which increases the feasibility to reproduce their findings in clinical practice. TRIAL REGISTRATION: NCT05608941. Registered on November 8, 2022.

Are age-predicted equations valid in predicting maximum heart rate in individuals after stroke?

PURPOSE: To investigate the validity of six age-predicted maximum heart rate (HRmax) equations after stroke. MATERIAL AND METHODS: Sixty individuals (54 (12) years; 64 (69) months after stroke) were included. A Cardiopulmonary Exercise Test (CPET) performed on a treadmill obtained the HRmax. The most used age-predicted equations were investigated: (1) 220-age, proposed by Fox; (2) 206.9- (0.67 × age), proposed by Gellish; (3) 208- (0.7 × age), proposed by Tanaka; (4) 216.6- (0.84 × age), proposed by Astrand; (5) 164- (0.72 × age) and (6) 200- (0.92 × age) proposed by Brawner. RESULTS: No statistically significant agreement was found between the HRmax obtained by the CPET and the one predicted by the equations 1-5 (-0.18 ≤ 95% confidence interval ≤0.79). A significant and moderate agreement was found between the HRmax obtained by the CPET and the one predicted by equation (6) (95% CI= 0.05-0.75; Intraclass Correlation Coefficient= 0.51). Bland-Altman plots showed that equations (1-4) and (6) overestimated the HRmax. Equation (6) presented the lower mean difference. CONCLUSIONS: The equations developed for non-disabled individuals (1-4) are not adequate to be used in individuals after a stroke. Equation (6) (Brawner) showed the best results to be used in individuals after stroke; however, it should be used cautiously.

Prediction equations for maximum heart rate (HR_max) are commonly used to prescribe aerobic exercise for individuals following a stroke.The equations developed for non-disabled individuals are not valid for use with individuals after stroke, leading to an overestimation of the HR_max.An age-predicted HR_max equation developed for individuals with coronary heart disease may provide outcomes that are more accurate for stroke survivors, but care should still be taken when using it.

Relative contributions of positive, negative, and adaptive features to limitations in upper-limb function three months after stroke.

PURPOSE: To investigate the contributions of motor impairments to limitations in upper-limb function three months after stroke. DESIGN: Cross-sectional, exploratory study. METHODS: Dependent variable was upper-limb function, measured by the Motor Assessment Scale (MAS), which scores range from 0 to 18. Independent variables included measures of strength, dexterity, spasticity, and contracture of the paretic upper limb. Multiple linear regression analysis was employed to identify which of the independent variables could explain the MAS scores (p<0.05). Analysis was performed with the whole sample and with a sub-group of participants, who had high function (MAS≥12). RESULTS: Sixty-nine individuals participated. Out of them, 63 had high upper-limb function. Regression analysis with the whole sample revealed that strength and dexterity were retained in the models. Together they explained 64% of the variance of the MAS scores (p<0.001), being strength the greater relative contributor. When the regression analysis included only participants with high upper-limb function, dexterity had a greater relative contribution, than strength. Together they explained 52 % of the variance (p< 0.001). CONCLUSIONS: Strength was the main contributor to upper-limb function in individuals three months after stroke. However, in individuals, who already had higher upper-limb function, dexterity showed to be the major contributor.

Changes in the clinico-functional characteristics of stroke patients in the acute phase during the COVID-19 pandemic.

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 (α=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.

Predictors of access to healthcare services within 1 month after stroke in a developing country: A longitudinal prospective study.

BACKGROUND: Globally, people with disabilities face difficulties accessing care, resulting in worse health outcomes and higher healthcare costs. However, information regarding access to healthcare services for stroke survivors in developing countries is scarce. OBJECTIVE: To identify predictors of access to healthcare services within 1 month of hospital discharge in a developing country (Brazil). METHODS: For six months, individuals from a stroke unit, aged ≥20 years, after their first stroke and without previous disability, were included and evaluated at hospital discharge for socio-demographic (sex, age, education, and socio-economic level) and clinical-functional (severity of stroke and level of disability) characteristics. The number and type of referrals to healthcare services provided by hospital staff were also recorded. One month after hospital discharge, data regarding access to healthcare services obtained by the subjects were collected. The Wilcoxon test was used to compare the number of referrals and access to healthcare services obtained by the subjects. To identify the predictors of access, a binary logistic regression was used (α = 5%). RESULTS: A total of 78 individuals were evaluated one month after hospital discharge, all with at least one referral. The total access to healthcare services within 1 month of stroke was significantly lower than the total number of referrals (p < 0.001). Sex (odds ratios (OR) = 18.92; p = 0.01) and educational level (OR = 1.48; p = 0.04) were significant predictors of access. CONCLUSIONS: Being female and having low education levels were predictors of access to healthcare services within 1 month of stroke in a developing country. In addition, the access was below expectations, compromising the integrality of care and national and international recommendations, which is a concern given the need for early care to obtain better results in health and functional outcomes.

Individuals with stroke three months after hospital discharge reported worse quality of life during the COVID-19 pandemic.

PURPOSE: To compare quality of life (QOL) of individuals with stroke three months after hospital discharge, using generic and specific QOL measures, before and during the COVID-19 pandemic. METHODS: Individuals, who were admitted to a public hospital, were recruited and evaluated before (G1) and during (G2) the COVID-19 pandemic. The groups were matched for age, sex, socio-economic status, and levels of stroke severity (National Institutes of Health Stroke Scale) and functional dependence (Modified Barthel Index). After three months of hospital discharge, they were evaluated and compared using generic (Short-form Health Survey 36: SF-36) and specific (Stroke Specific Quality of Life: SSQOL) QOL measures. RESULTS: Seventy individuals were included (35 in each group). Statistically significant between-group differences were found for both total SF-36 (p=0.008) and SSQOL (p=0.001) scores, indicating that individuals reported worse QOL during the COVID-19 pandemic. Furthermore, G2 also reported worse generic QOL related to the SF-36 domains of physical functioning, bodily pain, general health perception, and emotional role limitations (p < 0.01) and worse specific QOL related to following SSQOL domains: Family roles, mobility, mood, personality, and social roles (p < 0.05). Finally, G2 reported better QOL related to energy and thinking (p < 0.05) SSQOL domains. CONCLUSION: In general, individuals with stroke, who were evaluated during the COVID-19 pandemic three months after hospital discharge, reported worse perceptions of QOL in several domains of both generic and specific QOL measures.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist.

OBJECTIVE: To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. DESIGN: Systematic review. SUBJECTS: Individuals with neurological conditions. INTERVENTION: Not applicable. MAIN MEASURES: The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. RESULTS: From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as "sufficient" in a study with appropriate methodological quality ("very good" or "adequate"). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. CONCLUSION: The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. REGISTRATION NUMBER: CRD42021257662.

Functional independence measured in the acute phase of stroke predicts both generic and specific health-related quality of life: a 3-month prospective study in a middle-income country.

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 upper-limb 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 post-stroke. 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.

Health-related quality of life (HRQoL), a patient-centered outcome, is essential for healthcare, mainly in stroke, a chronic disease with a broad spectrum of disabilities.Functional independence is a key outcome and should always be a part of characterizing patients before the rehabilitation process.Functional independence assessed with the Modified Barthel Index in the acute phase of stroke predicts both generic and specific HRQoL at 3-month post-stroke.Patients post-stroke with lower functional independence at hospital discharge may be at risk of having lower HRQoL at 3-month post-stroke.

An Equation With Clinical Applicability and Adequate Validity to Predict the Maximum Oxygen Consumption of Individuals Post-stroke.

OBJECTIVE: To develop an equation with clinical applicability and adequate validity to predict the maximum oxygen consumption (V̇o2max) of individuals post-stroke. DESIGN: A cross-sectional study. SETTING: A university laboratory. PARTICIPANTS: Individuals post-stroke in the chronic phase (at least 6 months post-stroke). Step-1 (equation development): n=50, aged 55±12 years; Step-2 (validity investigation): n=20, aged 58±8 years (N=50 [step 1], N=20 [step 2]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Step-1 (equation development): multiple linear regression analysis was performed. DEPENDENT VARIABLE: V̇o2max (mL/kg/min) in the cardiopulmonary exercise test. INDEPENDENT VARIABLES: age (years), sex (1-women, 2-men), body mass index (BMI) (kg/m2), and distance (meters) in the Six-Minute Walk Test (6MWT) (6MWT-Equation) or in the Incremental Shuttle Walk Test (ISWT) (ISWT-Equation). Step-2 (validity investigation): agreement between the V̇o2max measured and predicted was evaluated with the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and the Bland-Altman method (α=5%). RESULTS: In step-1 (equation development), the 4 independent variables for each equation were retained (6MWT-Equation: R2=0.68, P<.001; ISWT-Equation: R2=0.58, P<.001). In step-2 (validity investigation), the 6MWT-Equation showed an ICC of 0.73 (95% CI=0.30, 0.89; P=.004) and a mean bias of 0.003 mL/kg/min; and the ISWT-Equation showed an imprecise ICC of 0.55 (95% CI=-0.12, 0.82; P=.045) and a mean bias of 0.971 mL/kg/min. 6MWT-Equation (V̇o2max=22.239+0.02 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI) showed adequate validity. CONCLUSIONS: An equation with clinical applicability and adequate validity in the investigated sample was developed to predict the V̇o2max of individuals post-stroke in the chronic phase (6MWT-Equation). Future studies with larger sample should investigate its external validity.

Diagnostic accuracy of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to estimate disability after stroke.

PURPOSE: To analyze WHODAS 2.0's diagnostic capacity and accuracy in stroke survivors. METHODS: Cross-sectional methodological study, in which individuals with chronic stroke were evaluated. Disability was considered the outcome variable, being evaluated by WHODAS 2.0; the modified Rankin scale (mRS) was used as the parameter variable. Disability was categorized in two levels being: "No or mild disability" (mRS 0-2) and "Moderate to severe disability" (mRS 3-5). To identify the cutoff point, a Receiver-Operating Characteristic (ROC) curve was constructed with a confidence interval (CI) of 95% and considering sensitivity and specificity. RESULTS: The cutoff point >39.62 proved acceptable for distinguishing individuals with moderate/severe disability from individuals with no or mild disability (≤39.62 points), with 66.22% sensitivity, 72.41% specificity, positive predictive value (PPV) of 45.45%, and negative predictive value (NPV) of 84.74%. The area under the curve (AUC) was 0.747 (CI 95%: 0.65-0.83; p < 0.001). CONCLUSION: WHODAS 2.0 demonstrated acceptable diagnostic capacity and the cutoff point of 39.62 proved suitable for distinguishing individuals with moderate/severe disability from those with no or mild disability after stroke.Implications for rehabilitationWHODAS 2.0 demonstrated acceptable diagnostic capacity.The WHODAS 2.0 cut-off point of >39.62 allows stratification of post-stroke disability into two different levels (no/mild disability versus moderate/severe disability).These results facilitate clinical decision-making by rehabilitation professionals.

Changes in the clinico-functional characteristics of stroke patients in the acute phase during the COVID-19 pandemic

ABSTRACT 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 (α=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.

Relationship between lower limb motor impairment and biomechanical strategies used during mobility activities in post-stroke individuals / Relación entre el deterioro motor de las extremidades inferiores y las estrategias biomecánicas utilizadas durante las actividades de movilidad en individuos pos accidente cerebrovascular / Relação entre comprometimento motor de membro inferior e estratégias biomecânicas utilizadas durante atividades de mobilidade em indivíduos pós-acidente vascular encefálico

ABSTRACT Motor impairment and mobility limitations are frequently observed in post-stroke individuals and are associated with functional dependence and low perceived quality of life. Therefore, evaluating the association between motor impairment and the biomechanical strategies used by post-stroke individuals in performing mobility activities is necessary. This study aimed to evaluate the correlation between lower limb motor impairment assessed by the motor section of the Fugl-Meyer assessment (FMA) scale and the mobility of post-stroke individuals considering the biomechanical strategies assessed by the timed "up and go" assessment of biomechanical strategies (TUG-ABS). This exploratory cross-sectional study included 100 individuals in the chronic phase after stroke with a mean age of 55.02±12.57 years. The FMA was used to assess lower limb motor impairment and the TUG-ABS to assess mobility during the following activities performed sequentially: changing from sitting to standing position, walking, turning 180°, and changing from standing to sitting position. Spearman's correlation was used to evaluate the relationship between variables (α=5%). Lower limb motor impairment and mobility considering the biomechanical strategies adopted by post-stroke individuals in the aforementioned activities (changing from sitting to standing position, walking, turning 180°, and changing from standing to sitting position) showed a significant (p<0.001), positive correlation of moderate magnitude (rs=0.60). This indicates that motor impairment is an important outcome to be considered during the rehabilitation of post-stroke individuals with mobility limitations, as assessed by the TUG-ABS.

RESUMEN El deterioro motor y la limitación de la movilidad se observan con frecuencia en individuos pos-accidente cerebrovascular (ACV) y se asocian con una dependencia funcional y baja percepción de la calidad de vida. Por ello, es importante evaluar la relación entre el deterioro motor y las estrategias biomecánicas que utilizan los individuos pos-ACV durante las actividades de movilidad. El objetivo de este estudio fue evaluar la correlación entre el deterioro motor de las extremidades inferiores, evaluado por la sección motora de la escala de Fugl-Meyer (EFM), y la movilidad de los individuos pos-ACV, teniendo en cuenta las estrategias biomecánicas evaluadas por la prueba timed "up and go" assessment of biomechanical strategies (TUG-ABS). Se trata de un estudio transversal, exploratorio, en el cual participaron 100 individuos en la fase crónica pos-ACV, de edad media de 55,02±12,57 años. Para evaluar el deterioro motor de las extremidades inferiores se utilizó la EFM, y se aplicó la prueba TUG-ABS para evaluar la movilidad durante las actividades de sentarse a ponerse de pie, caminar, girar y ponerse de pie a sentarse, realizadas secuencialmente. La correlación de Spearman se realizó para verificar la relación entre las variables (α=5%). El deterioro motor de las extremidades inferiores y la movilidad teniendo en cuenta las estrategias biomecánicas adoptadas por los individuos pos-ACV durante las actividades propuestas mostraron una significativa correlación (p<0,001), positiva y de magnitud moderada (rs=0,60). Esto indica que el deterioro motor es importante para tener en cuenta en el proceso de rehabilitación de individuos pos-ACV con limitaciones de movilidad como las evaluadas por el TUG-ABS.

RESUMO O comprometimento motor e a limitação da mobilidade são frequentemente observadas em indivíduos após o acidente vascular encefálico (AVE) e estão associadas à dependência funcional e à baixa percepção da qualidade de vida. Portanto, é preciso investigar a relação do comprometimento motor e as estratégias biomecânicas utilizadas por indivíduos pós-AVE na realização de atividades de mobilidade. O objetivo deste estudo foi avaliar a correlação entre o comprometimento motor de membro inferior, avaliado pela seção motora da escala de Fugl-Meyer (EFM), e a mobilidade de indivíduos pós-AVE considerando as estratégias biomecânicas avaliadas pelo teste timed "up and go" assessment of biomechanical strategies (TUG-ABS). Trata-se de um estudo transversal exploratório, no qual participaram 100 indivíduos na fase crônica pós-AVE, com média de idade de 55,02±12,57 anos. Foi utilizada a EFM para avaliação do comprometimento motor de membro inferior e o teste TUG-ABS para avaliação da mobilidade durante as atividades de sentado para de pé, marcha, giro e de pé para sentado realizadas sequencialmente. Foi realizada a correlação de Spearman para verificar a relação entre as variáveis (α=5%). O comprometimento motor de membro inferior e a mobilidade considerando as estratégias biomecânicas adotadas por indivíduos pós-AVE durante as atividades propostas apresentaram correlação significativa (p<0,001), positiva e de moderada magnitude (rs=0,60). Isso indica que o comprometimento motor é um desfecho importante para se considerar no processo de reabilitação de indivíduos pós-AVE que apresentam limitações de mobilidade como as avaliadas pelo TUG-ABS.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review protocol.

Several measurement tools commonly used in face-to-face neurological rehabilitation have been used in telerehabilitation. However, it is not known whether these tools have adequate measurement properties and clinical utility. This systematic review aims to investigate the measurement properties and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological diseases. A systematic review to investigate the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions will be conducted. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. this systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 May 2021 (registration number: CRD42021257662). Electronic searches will be performed in following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic + Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Two trained independent reviewers will select the studies according to the inclusion criteria, and will also extract the data, evaluate the clinical utility and methodological quality. The relevant data such as design, participants, settings, and mode of administration, measurement properties, and clinical utility will be summarized. Disagreements between reviewers will be resolved by consensus or by the decision of a third independent reviewer. Hand searches of other relevant studies will be employed. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the clinical utility scale will be used to assess the methodological quality and clinical utility of these tools, respectively. This systematic review will provide information regarding the measurement properties and the clinical utility of the measurement tools used in neurological telerehabilitation. This information will be useful to assist health professionals in choosing adequate measurement tools and planning new research studies.