Lower extremity physical function and quality of life in patients with stroke: a longitudinal cohort study.

PURPOSE: Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact on an individual's Quality of Life (QoL). The aim of this study is to characterise the relationship between LEPF and QoL. METHODS: The MOBITEC-Stroke Study is a longitudinal cohort-study including patients with their first occurrence of ischaemic stroke. Using a linear mixed-effects model, the relationship between LEPF (timed up-and-go performance (TUG); predictor) and QoL (Stroke Specific Quality of Life scale (SS-QoL); outcome) at 3 and 12 months post stroke was investigated and adjusted for sex, age, Instrumental Activities of Daily Living (IADL), fear of falling (Falls Efficacy Scale-International Version, FES-I), and stroke severity (National Institute of Stroke Severity scale, NIHSS), accounting for the repeated measurements. RESULTS: Data of 51 patients (65 % males, 35% females) were analysed. The mean age was 71.1 (SD 10.4) years, median NIHSS score was 2.0. SS-QoL was 201.5 (SD 20.5) at 3 months and 204.2 (SD 17.4) at 12 months; the mean change was 2.7 (95% CI -2.4 to 7.7), p= 0.293. A positive association was found between baseline TUG performance (estimate log score -13.923; 95% CI -27.495 to -0.351; p=0.048) and change in SS-QoL score in multivariate regression analysis. CONCLUSION: Higher LEPF (i.e better TUG performance) at baseline, was associated with an improvement in QoL from 3- to 12-months post stroke. These results highlight the critical role of physical function, particularly baseline LEPF, in influencing the QoL of stroke survivors.

Timed up-and-go performance is associated with objectively measured life space in patients 3 months after ischemic stroke: a cross-sectional observational study.

BACKGROUND: Stroke is a common cause of mobility limitation, including a reduction in life space. Life space is defined as the spatial extent in which a person moves within a specified period of time. We aimed to analyze patients' objective and self-reported life space and clinical stroke characteristics. METHODS: MOBITEC-Stroke is a prospective observational cohort study addressing poststroke mobility. This cross-sectional analysis refers to 3-month data. Life space was assessed by a portable tracking device (7 consecutive days) and by self-report (Life-Space Assessment; LSA). We analysed the timed up-and-go (TUG) test, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and the level of functional outcome (modified Rankin Scale; mRS) in relation to participants' objective (distance- and area-related life-space parameters) and self-reported (LSA) life space by multivariable linear regression analyses, adjusted for age, sex, and residential area. RESULTS: We included 41 patients, mean age 70.7 (SD11.0) years, 29.3% female, NIHSS score 1.76 (SD1.68). We found a positive relationship between TUG performance and maximum distance from home (p = 0.006), convex hull area (i.e. area enclosing all Global Navigation Satellite System [GNSS] fixes, represented as a polygon linking the outermost points; p = 0.009), perimeter of the convex hull area (i.e. total length of the boundary of the convex hull area; p = 0.008), as well as the standard ellipse area (i.e. the two-dimensional ellipse containing approximately 63% of GNSS points; p = 0.023), in multivariable regression analyses. CONCLUSION: The TUG, an easily applicable bedside test, seems to be a useful indicator for patients' life space 3 months poststroke and may be a clinically useful measure to document the motor rehabilitative process.

Prognostic Role of High Sensitivity Troponin T (hsTnT) After Recanalization of Chronic Total Occlusions (CTO).

BACKGROUND: The prognostic role of periprocedural hsTnT after percutaneous coronary intervention (PCI) of CTOs is unknown. We evaluated the incidence and impact of hsTnT elevations on clinical and angiographic outcomes after CTO-PCI. METHODS: In a retrospective database analysis we identified 309 successfully treated CTO-PCI patients that had a re-angiography 6 months after the initial procedure. Both catheterizations were used for quantitative coronary angiography (QCA). HsTnT was measured before and 18-24 h after CTO-PCI. According to periinterventional hsTnT release patients were divided into 4 quartiles (QI: 0-99 ng/l; QII: 100-199 ng/l; QIII: 200-299 ng/l; QIV: ≥300 ng/l) and correlated with QCA and clinical data. RESULTS: Mean age of the patient population was 67 ± 10.6 years. The antegrade approach was used in 91% of the procedures. After treatment, in-CTO-segment minimal lumen diameter (MLD) was 2.97 ± 0.42 mm. On 6 months follow up In-CTO-segment MLD decreased to 2.74 ± 0.71 mm which corresponded to an In-CTO-segment late lumen loss (LLL) of 0.23 ± 0.45 mm. Target lesion revascularization rate (TLR) occurred in 21 of 309 patients (6.8%). Higher periinterventional hsTnT release (QIII-IV) was associated with more frequent TLR compared to lower hsTnT release (QI-II) (28.6% vs. 4%; p < 0.0001). In a multivariable model hsTnT release emerged as an independent predictor of TLR (OR 7.3; 95%CI 2.12-26.9). CONCLUSIONS: Our findings suggest that hsTnT release is associated with increased TLR. Therefore, peri-interventional hsTnT measurement might be useful in the risk stratification of CTO procedures.