Prediction of Walking Independence in Older Women with Vertebral Compression Fracture Using Phase Angle: A Preliminary Study Using Propensity Score.

Objectives: This study aimed to clarify whether phase angle can be a predictor of walking independence in older women with vertebral compression fractures (VCFs) and to determine a clinically usable cutoff value. Methods: We retrospectively assessed data of older women (n=59; median age, 83.0 years) with VCFs. Propensity score-matching and logistic regression were performed to examine the association between phase angle at admission and walking independence at discharge. The cutoff value for the phase angle at admission for predicting walking independence was calculated based on the receiver operating characteristic curve. Results: Thirty-one patients (52.5%) could walk independently at discharge. Thirty patients were extracted from the independent and non-independent groups according to the propensity score. After propensity score matching, there was no significant difference between the groups for age, medical history, knee extension strength, skeletal muscle mass index, mini nutritional assessment-short form score, or revised Hasegawa's dementia scale score. However, the phase angle of the independent group was significantly higher than that of the non-independent group (P<0.05). Logistic regression revealed that phase angle at admission was significantly associated with walking independence at discharge (odds ratio, 12.2; 95% confidence interval, 2.1-72.0; P<0.01). The area under the receiver operating characteristic curve was 0.868, and the calculated phase angle cutoff value was 3.55°. Conclusions: This study revealed that the phase angle can predict walking independence in older women with VCFs. The cutoff values for women calculated in this study can be used as a simple and objective predictive index of walking independence.

Balance Function Required for Bathing Independence in Patients with Stroke and Hip Fracture.

Objectives: Little attention has been paid to the relationship between balance function and bathing independence. This research aimed to determine the degree of balance function needed by patients with stroke and patients with hip fracture (hereinafter referred to as patients with stroke and hip fracture) to bathe independently. Methods: Retrospective data analysis was performed on 59 patients with hip fracture and 201 patients with stroke. Logistic regression was performed to determine whether bathing independence was associated with the Berg Balance Scale (BBS) in patients with stroke and hip fracture. A receiver operating characteristic curve was generated to calculate cutoff values. Results: The BBS was significantly associated with bathing independence in patients with stroke and hip fracture. The calculated BBS cutoff value was 48 points for those with stroke (sensitivity, 84.7%; specificity, 79.1%) and 43 points for those with hip fracture (sensitivity, 81.3%; specificity, 77.8%). Conclusions: Balance function was independently associated with bathing independence. The level of balance function required for bathing independence may be lower for patients with hip fracture than for those with stroke. This could be a simple and useful indicator for rehabilitation professionals to interpret BBS results when conducting bathing interventions.

Age-stroke related dysfunction interaction associated with home discharge of stroke inpatients in the rehabilitation ward.

The purpose of this study was to investigate whether interactions exist among cognitive and physical functions and activities of daily living (ADL) associated with home discharge of stroke patients in the rehabilitation ward. The subjects were 231 patients with a first stroke. Age, gender, affected side, the stroke impairment assessment set, ADL and discharge destination were collected from the medical record. Using a decision tree, a combination of variables that might have an interaction effect associated with home discharge was extracted. The existence of an interaction between the extracted variables was confirmed by logistic regression analysis. A combination of total score of the stroke impairment assessment set (≤27 points) and age (>76.5 years) at admission was extracted from the decision tree. As a result of the logistic regression analysis, this interaction term was significantly associated with home discharge. The findings of the present study suggest that there is an interaction between age and stroke-related dysfunction related to home discharge. Stroke patients aged over 76.5 years with the stroke impairment assessment set score of 27 or less at admission to the rehabilitation ward may need rehabilitation program considering the difficulty of home discharge.

Cutoff Value for a Nutritional Indicator Related to Gait Independence in Elderly Fracture Patients: A Preliminary Study.

OBJECTIVE: Previous studies have reported the relationship between nutritional status and gait independence in elderly fracture patients. However, the degree to which nutritional indicators are related to gait independence is unclear. The purpose of this study is to calculate a cutoff value for a nutritional indicator related to gait independence in patients with hip and vertebral compression fractures. METHOD: This study included 69 patients (33 hip fracture, 36 vertebral compression fracture) who underwent rehabilitation at a convalescent rehabilitation ward. The relationships between nutritional indexes (Mini-Nutritional Assessment-Short Form [MNAⓇ-SF] and skeletal muscle mass index [SMI] ) at admission and gait independence at discharge were analyzed using logistic regression. In addition, receiver operating characteristic analysis was performed to calculate a cutoff value that predicts gait independence. RESULTS: Among the nutritional indicators used in this study, only MNAⓇ-SF was significantly able to predict gait independence at discharge, and this association was maintained, even after adjustment for confounders. The calculated MNAⓇ-SF cutoff values were 5.5 (sensitivity 100%, specificity 46.3%) and 7.5 points (sensitivity 67.9%, specificity 78.0%). CONCLUSION: This study suggests that MNAⓇ-SF may be an index for predicting gait independence in patients with hip or vertebral compression fractures in the convalescent rehabilitation ward. The cutoff values calculated in this study were simple and useful index for physical therapists to interpret the results of MNAⓇ-SF.

Impact of Sensory Impairment on Improvement of Upper-limb Function in Patients under 75 Years of Age with Subacute Stroke: A Preliminary Study.

OBJECTIVES: The aim of this study was to investigate whether an interaction exists between sensory impairment and age with respect to the recovery of upper-limb function in patients with subacute stroke. METHODS: This retrospective observational study included 83 patients recovering from subacute stroke in a rehabilitation hospital ward. The recovery of upper-limb function in four groups classified by age and sensory impairment were compared using analysis of covariance. Furthermore, multiple regression analysis was performed with recovery of upper-limb function as the dependent variable and with binarized sensory impairment and binarized age and their interaction term as the independent variables. RESULTS: The estimated marginal means of upper-limb recovery were significantly higher in the non-late elderly (≤74 years) without sensory impairment group than in the other three groups. No significant differences were observed among the following three groups: the non-late elderly with sensory impairment, the late elderly (≥75 years) without sensory impairment, and the late elderly with sensory impairment. In multiple regression analysis, the interaction term between sensory impairment and age was significantly associated with improvement in upper-limb function (ß=0.16, P <0.05). Age alone was significant, but sensory impairment alone was not significant. CONCLUSIONS: Sensory impairment in patients with subacute stroke affects the recovery of upper-limb function as a result of age interactions.

Interactions of Cognitive and Physical Functions Associated with Toilet Independence in Stroke Patients.

OBJECTIVES: The purpose of this study was to clarify the interaction among cognitive and physical functions associated with toilet independence in stroke patients. MATERIALS AND METHODS: We retrospectively examined 125 stroke patients. We performed decision tree analysis to detect the interaction associated with toilet independent using assessment of motor function on the affected side, muscle strength on unaffected side, trunk function, neglect, motivation, and cognitive function. The interactions detected via decision tree confirmed the existence and influence using logistic regression. RESULTS: The verticality test of the Stroke Impairment Assessment Set (3 or ≤2 points) was selected at the first level, and the Revised Hasegawa's dementia scale (≥19 or ≤18 points) and age (≥70 or ≤69 y) were selected at the second level of decision tree. Interaction terms created by these factors were significantly associated with toilet independence after adjusting for the independent influence of each factor using logistic regression. CONCLUSIONS: Our results show an interaction of trunk and cognitive functions or trunk function and age associated with toilet independence. The probability of toilet independence dramatically changes if two factors of each interaction were satisfied in stroke patients.

Abdominal muscle strength and the recovery of upper extremity function in stroke patients: a study using propensity score matching.

PURPOSE: The purpose of this study was to understand the relationship between abdominal muscle strength and recovery of upper limb function, after adjusting for various confounding factors, such as age, gender, and sensory function. METHODS: We retrospectively analyzed data of 78 sub-acute stroke patients with mild-to-moderate upper limb dysfunction. Participants were divided into two groups, strong and weak, according to the abdominal muscle strength. The improvement of scores on the Simple Test for Evaluating Hand Function was compared between the groups. We employed propensity score matching to adjust for numerous relevant variables, including age, affected side, duration from onset, upper limb function, grip strength, sensory function, visuospatial perception, motivation, and cognitive function at admission. RESULTS: The improvement of scores on the Simple Test for Evaluating Hand Function of the strong group was significantly larger than the weak one, both before and after matching. This trend was noted in the subgroup analysis of participants with moderate dysfunction on admission; however; the trend was not clearly noticeable in participants with mild dysfunction. CONCLUSIONS: Our results suggest that abdominal muscle strength is significantly associated with the recovery of upper limb function in sub-acute stroke patients, especially in those with moderate upper limb dysfunction.Implications for RehabilitationAbdominal muscle strength is associated with the recovery of upper limb function in subacute stroke patients with moderate upper limb dysfunction.Abdominal muscle strength can be used as a predictive factor for the prognosis of upper limb function in stroke patients.

Functions necessary for gait independence in patients with stroke: A study using decision tree.

BACKGROUND: Little is known about the existence and impact of interactions among multiple impairments to gait independence. The purpose of this study is to reveal the interaction of physical functions and its impact on gait independence in stroke patients. METHODS: This retrospective study included 108 subacute stroke patients. We conducted a decision tree analysis to examine the existence of interactions in relation to gait independence among the gross motor function of lower limb, knee extension strength, sensory function, and trunk function. Further, we confirmed the existence and impact of interaction detected via the decision tree after adjusting for the effects of confounding factors using logistic regression. RESULTS: The knee extension strength and proprioception on the affected side were selected in the first and second level of the decision tree. In addition, the knee extension strength was selected in the third level. The interaction of the knee extension strength and proprioception on the affected side was significantly associated with gait independence, both before and after adjusting for age, visuospatial perception, and cognitive functions. CONCLUSIONS: Our results suggest that the interaction of the knee extension strength and proprioception on the affected side is strongly associated with gait independence in stroke patients.

Effects of the Interaction among Motor Functions on Self-care in Individuals with Stroke.

BACKGROUND: No study to date has focused on what combinations of motor functions are strongly associated with self-care independence in individuals with stroke. The purpose of this study is to clarify the impact of motor function interactions on self-care independence in individuals with stroke. METHODS: This retrospective observational study included 132 individuals with first stroke. We conducted a decision tree analysis to examine the impact on daily living skills of numerous key functions - the upper and lower limbs on the affected side, bilateral grip strength and lower limb muscle strength on the unaffected side, bilateral upper limb and trunk function, and balance. Further, we confirmed the interaction effects detected via the decision tree approach using logistic regression. RESULTS: As per the decision tree analysis, the interaction between balance and upper limb function of the affected side showed an association with self-care independence. The interaction terms of balance and upper limb function we analyzed were significantly associated with the ability to achieve self-care independence, after some adjustments to eliminate the influence of confounding factors. CONCLUSIONS: These results suggest that the combination of functional status of balance and upper limb function of the affected side are strongly associated with the independence of self-care. The decision tree created in this study could serve as an effective guide when implementing a remedial approach for individuals with stroke aiming to achieve self-care independence.

Use of a multilayer perceptron to create a prediction model for dressing independence in a small sample at a single facility.

[Purpose] This study aimed to assess the accuracy of a prediction model for dressing independence created with a multilayer perceptron in a small sample at a single facility. [Participants and Methods] This retrospective observational study included 82 first-stroke patients. The prediction models for dressing independence at hospital discharge were created using a multilayer perceptron, logistic regression, and a decision tree, and compared for predictive accuracy. Age, dressing performance, trunk function, visuospatial perception, balance, and cognitive function at admission were used as variables. [Results] The area under the receiver operating characteristic curve, classification accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value for training data were highest with the multilayer perceptron model. Cochran's Q and multiple comparison tests revealed a significant difference between logistic regression and multilayer perceptron models. Testing of data in 10-fold cross-validation yielded the same results, except for sensitivity. [Conclusion] The present study suggested that higher accuracy could be expected with a multilayer perceptron than with logistic regression and a decision tree when creating a prediction model for independence of activities of daily living in a small sample of stroke patients.

A path analysis model for grooming performance in stroke patients.

Purpose: The aim of this study was to clarify the relationships between various types of functions and grooming performance and describe their hierarchical structure in survivors of stroke.Method: This was a retrospective observational study on 75 individuals with first stroke. A hypothetical path model, created based on previous studies, was examined for goodness of fit between the data and the model using path analysis. We hypothesized that in survivors of stroke, grooming performance is influenced by age, motor and sensory functions of the affected limbs, trunk function, grip and knee extensor strength, visuospatial perception, intellectual function, motivation, affected and unaffected upper limb function, and balance.Results: A revised path model was created that achieved goodness-of-fit index criteria. Balance, affected and unaffected upper limb function, and motivation were found to have a direct effect and balance and unaffected upper limb function were found to have especially stronger effect on grooming performance. The order of the standardized total effects of each function was as follows: balance, unaffected upper limb function, motivation, and affected lower limb function.Conclusions: Our results suggest that interventions targeting balance and unaffected upper limb function could be effective in rehabilitation to improve grooming performance in survivors of stroke.Implications for rehabilitationBalance and unaffected upper limb function have a strong effect on grooming independence in survivors of stroke.Balance is most influenced by affected lower limb function, and unaffected upper limb function is equally influenced by balance, visuospatial perception, and grip strength.Interventions targeting balance and unaffected upper limb function can improve grooming performance in survivors of stroke.

Quantifying lower extremity and trunk function for dressing in stroke patients: a retrospective observational study.

Background Dressing performance relates strongly with balance function, and it is mainly influenced by the motor functions of the affected and unaffected lower extremity and trunk function in stroke patients. For the remedial approach to be effective, ascertaining the degree of function needed in the affected and unaffected lower extremities and trunk to achieve balance function requisite for dressing is necessary. Objectives This study aimed to elucidate standards of lower extremity and trunk function necessary for stroke patients to gain balance requisite for dressing. Methods The study included 105 first-time stroke patients, who were classified by Berg Balance Score ≥44 or not and ≥32 or not which are previously reported standard indicators for independent and supervision level in dressing. Receiver operating characteristic curves were determined for the stroke impairment assessment item of sensory and motor function of affected lower extremity, abdominal muscle strength, and knee extension muscle strength. Results Area under the curve was ≥0.7 for all variables. In BBS 44-point analyses, the calculated cut-off values were 4 points for SIAS hip flexion, 4 points for SIAS knee extension, 2 points for SIAS foot pat on the affected side, 3 points for SIAS tactile and position sensation of the affected lower extremity, 3 points for SIAS abdominal muscle strength, and 3 points for SIAS knee extension muscle strength on the unaffected side. Conclusions These cut-off values can be used as targets for motor functions, when using the remedial approach for achieving dressing independence.

Relationship between Grooming Performance and Motor and Cognitive Functions in Stroke Patients with Receiver Operating Characteristic Analysis.

BACKGROUND: This study aimed to elucidate the relationship between grooming performance of stroke patients and various motor and cognitive functions and to examine the cognitive and physical functional standards required for grooming independence. METHODS: We retrospectively analyzed the data of 96 hospitalized patients with first stroke in a rehabilitation hospital ward. Logistic regression analysis and receiver operating characteristic curves were used to investigate the related cognitive and motor functions with grooming performance and to calculate the cutoff values for independence and supervision levels in grooming. RESULTS: For analysis between the independent and supervision-dependent groups, the only item with an area under the curve (AUC) of .9 or higher was the Berg Balance Scale, and the calculated cutoff value was 41/40 (sensitivity, 83.6%; specificity, 87.8%). For analysis between the independent-supervision and dependent groups, the items with an AUC of .9 or higher were the Simple Test for Evaluating Hand Function (STEF) on the nonaffected side, Vitality Index (VI), and FIM® cognition. The cutoff values were 68/67 for the STEF (sensitivity, 100%; specificity, 72.2%), 9/8 points for the VI (sensitivity, 92.3%; specificity, 88.9%), and 23/22 points for FIM® cognition (sensitivity, 91.0%; specificity, 88.9%). CONCLUSIONS: Our results suggest that upper-extremity functions on the nonaffected side, motivation, and cognitive functions are particularly important to achieve the supervision level and that balance is important to reach the independence level. The effective improvement of grooming performance is possible by performing therapeutic or compensatory intervention on functions that have not achieved these cutoff values.