Predictors of Complete Oral Intake in Patients With Stroke After Tracheostomy.

BACKGROUND: Tracheostomy procedures inhibit swallowing, although details of subsequent recovery of oral intake remain unknown. This retrospective cohort study aimed to investigate factors influencing dysphagia improvement in patients with subacute stroke after tracheostomy. METHODS AND RESULTS: The study included 117 patients who underwent tracheostomy after subacute stroke, cerebral hemorrhage, or endogenous subarachnoid hemorrhage and received care at 2 convalescent rehabilitation wards in urban and suburban Japan between 2015 and 2022. The primary outcome measure was the achievement of complete oral intake. Patient demographics, Functional Independence Measure scores, body mass index, food intake level scale scores, and the presence of severe white matter hyperintensities on imaging were retrospectively collected from medical records. Statistical analysis involved univariate logistic regression to identify potential predictors and multivariate logistic regression to refine the model while accounting for multicollinearity. In total, 47% of patients achieved complete oral intake on discharge. Sex, days from onset to admission, Functional Independence Measure motor and cognitive scores, body mass index, food intake level scale scores, and severe white matter hyperintensities were identified as potential predictors in the univariate analysis. However, multivariate logistic regression identified only food intake level scale scores (odds ratio [OR], 3.687 [95% CI, 1.519-8.949]; P=0.004) and severe white matter hyperintensities (OR, 0.302 [95% CI, 0.096-0.956]; P=0.042) as significant predictors of complete oral intake. CONCLUSIONS: In patients with subacute stroke undergoing tracheostomy, the level of oral intake on admission and severe white matter hyperintensities on imaging may be better predictors of complete oral intake. However, prospective studies with larger sample sizes and more comprehensive data are warranted to confirm these findings.

Effects of Different Orthoses Used for Gait Training on Gait Function among Patients with Subacute Stroke.

OBJECTIVES: To facilitate selection of the appropriate orthosis, this study assessed functional ambulation outcomes of subacute stroke patients using either an ankle-foot orthosis (AFO) or a knee-ankle-foot orthosis (KAFO). METHODS: The subjects were newly diagnosed hemiplegic stroke patients admitted to Hatsudai Rehabilitation Hospital between January and June 2016. Differences between the AFO group and the KAFO group were examined using unpaired t-tests. Multiple regression analysis with stepwise regression was used to identify predictive factors for the functional ambulation category (FAC) score at discharge. RESULTS: A total of 164 patients (99 men and 65 women; mean age, 69.2 ± 15.3 years; mean days from onset to admission, 31.9 ± 12.3 days) were included in the study. The AFO, KAFO, and non-orthosis groups contained 38, 79, and 47 patients, respectively. In the AFO group, the median Stroke Impairment Assessment Set (SIAS) motor scores were 2.5-3, and the median sensory scores were 2. In the KAFO group, the median SIAS motor scores were 0-1, and the median sensory scores were 1. At discharge, 32 (84.2%) patients in the AFO group and 20 (25.3%) patients in the KAFO group had an FAC score ≥3. Multiple regression analysis found that age and the Functional Independence Measure cognitive score could be used to predict the FAC score at discharge in the AFO group. The Berg Balance Scale score was an additional predictive factor in the KAFO group. CONCLUSIONS: This study showed that the AFO group had good outcomes for independent ambulation. Furthermore, balance control is an important factor contributing to walking ability in patients with severe hemiparesis.

Clinical management provided by board-certificated physiatrists in early rehabilitation is a significant determinant of functional improvement in acute stroke patients: a retrospective analysis of Japan rehabilitation database.

BACKGROUND: Early rehabilitation for acute stroke patients is widely recommended. We tested the hypothesis that clinical outcome of stroke patients who receive early rehabilitation managed by board-certificated physiatrists (BCP) is generally better than that provided by other medical specialties. METHODS: Data of stroke patients who underwent early rehabilitation in 19 acute hospitals between January 2005 and December 2013 were collected from the Japan Rehabilitation Database and analyzed retrospectively. Multivariate linear regression analysis using generalized estimating equations method was performed to assess the association between Functional Independence Measure (FIM) effectiveness and management provided by BCP in early rehabilitation. In addition, multivariate logistic regression analysis was also performed to assess the impact of management provided by BCP in acute phase on discharge destination. RESULTS: After setting the inclusion criteria, data of 3838 stroke patients were eligible for analysis. BCP provided early rehabilitation in 814 patients (21.2%). Both the duration of daily exercise time and the frequency of regular conferencing were significantly higher for patients managed by BCP than by other specialties. Although the mortality rate was not different, multivariate regression analysis showed that FIM effectiveness correlated significantly and positively with the management provided by BCP (coefficient, .35; 95% confidence interval [CI], .012-.059; P < .005). In addition, multivariate logistic analysis identified clinical management by BCP as a significant determinant of home discharge (odds ratio, 1.24; 95% CI, 1.08-1.44; P < .005). CONCLUSIONS: Our retrospective cohort study demonstrated that clinical management provided by BCP in early rehabilitation can lead to functional recovery of acute stroke.

Revised version of the ability for basic movement scale (ABMS II) as an early predictor of functioning related to activities of daily living in patients after stroke.

BACKGROUND: The objective of this study was to test the predictive validity of a new scale, the Revised Version of the Ability for Basic Movement Scale (ABMS II). METHODS: A total of 71 patients after stroke participated in this prospective study. In addition to the ABMS II score, age, limb paresis as measured by the Brunnström stage, and functional ability as measured by the Barthel Index were also selected as predictor variables. RESULTS: Pearson's correlation coefficient analysis showed that the state of functional ability according to the 4-week Barthel Index had significant positive correlations with total scores of ABMS II and Brunnström stage at all data collection time-points. The results of linear stepwise regression analysis indicated that the 'turn over from supine position' at the start of rehabilitation and 'remain sitting' items of ABMS II at 2 weeks after onset of the stroke, in addition to the 2-week Barthel Index and 2-week Brunnström stage, were significant predictors (88.9%) of functional ability at 4 weeks after onset of stroke. CONCLUSION: This study provides evidence for the predictive value of the ABMS II with regard to functional ability in patients after stroke.