Prognosis of locomotion function at discharge in acute phase after stroke
Yukio Kurokawa, Atsuhiko Matsunaga, Tadashi Kanda, Fumihiko Sakai
(Kitasato University, Kanagawa, Japan)
PURPOSE: The purpose of this study was to assess whether age, sex, clinical or neurological parameters could aid the prognosis of locomotion function at discharge, at one month, following admission.
METHODS: Demographic, anamnestic, and clinical data were collected on 2555 consecutive stroke patients admitted to Department of Neurology, Kitasato University Hospital. Functional prognosis was assessed at one month following admission. We classified the patients into intracerebral hemorrhage, cardiogenic cerebral embolism, and thrombotic cerebral infarction, and compared them for mortality and functional state. Data were analyzed statistically by using Chi square test, correlation coefficients (for age) and two-way analysis of variance.
RESULTS: The mean age of the patients with bedridden state (74.3 years in case of cardiogenic cerebral embolism) were significantly higher than in patients' group with wheelchair, walk with aids, and walk alone, and also normal walk (P<.001).
CONCLUSION: Univariate analysis showed that the following variables were of prognostic significance for locomotion function prognosis during acute stage: age at onset, consciousness at onset, size of lesion. However the side of brain lesion were not.
THE NEWLY DEVELOPED MOTIVATION SCORE FOR USE IN STROKE OUTCOME RESEARCH
Tetsuya Tsuli, Meigen Liu, Shigeru Sonoda, Kazuhisa Domen, Kazuto Tsujiuchi, Naoichi Chino
Saitama Prefecture General Rehabilitation Center and Keio University, Saitama & Tokyo, Japan
[Objectives] To study the reliability and validity of our newly developed motivation score (MS) for use in stroke outcome research.
[Methods] The MS consists of 6 items that assess the motivation of a patient in ADL and exercise. Each item is rated from 1 to 3. We assessed 190 stroke in patients, mean age 61.0 years and 95 having right-side brain lesion, with the MS. The mean days from onset and length of stay were 47.3 and 90.9. Interrater reliability was tested by having two examiners evaluate 10 patients independently, and calculating the intraclass correlation coefficient (ICC) for total scores and weighted kappas for subscores. To test validity, we studied the correlations between the MS and the admission FIM cognitive scores, Mini-Mental State Examination scores (MMSE), and deviation in tape bisection task (DEV). We also studied how the MS contributed to the prediction of discharge FIM with stepwisse multiple regression analysis. In another group of 100 patients, we cross-validated our results.
[Results] The ICC and weighted kappas were satisfactorily high. MS correlated significantly with cognitive FIM, MMSE, and DEV. We could explain 70.8% of the variance of discharge FIM from the MS, age, days from onset to admission, admission FIM, DEV, abdominal strength, and sound side grip strength. We could cross-validate our results.
[Conclusion] The MS is reliable and valid for use in stroke outcome research.