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.

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.

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.

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.