Prediction of functional outcome in stroke patient

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Prediction of functional outcome in stroke patient


Author: Au, Kai-ming Brian
Title: Prediction of functional outcome in stroke patient
Degree: M.Sc.
Year: 2000
Subject: Cerebrovascular disease -- Patients -- Rehabilitation -- China -- HongKong
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xiv, 167 leaves : ill. ; 30 cm
Language: English
InnoPac Record:
Abstract: Stroke is one of the leading causes of disability among adults in Hong Kong and many developed countries. Recent reports show that as the population is ageing and the stroke victim is getting younger, the incidence of stroke has been increasing in recent years. However, mortality from stroke has declined and there are stroke survivors who need rehabilitation. The rapid development of standardized assessment in stroke rehabilitation locally, has paved the way for predictive studies of stroke rehabilitation outcome. This study aims to investigate the relationships among the motor, cognitive, and psychological impairments of stroke patients in the rehabilitation phase, and examine the recovery of clients in these areas within four weeks. Finally, this study also attempted to identify the possible predictors of functional outcomes in stroke rehabilitation. The type of impairments that were investigated in this study include cognitive and motor functions, unilateral neglect and depression, which were measured using an assessment package consisting of Neurobehavioral Cognitive Status Examination (NCSE), Fugl-Meyer Assessment (FMA), Albert's Test and Beck Depression Inventory (BDI). Functional outcome was measured by Functional Independence Measures (FIM). 47 stroke patients from Tai Po Hospital were recruited in this study according to the selection criteria. Clients were assessed at baseline, the second and fourth week. Results showed that motor, cognitive, and psychological impairment correlated significantly with each other. Cognitive functions correlated negatively with unilateral neglect (r= -0.243 to -0.470) and depression (r=-0.297). Motor functions have significant correlation with cognitive functions (r=0.304 to 0.362). While unilateral neglect has association with cognitive functional outcome in cognitive FIM subscale (r= -0.333), motor functions were found to associate with the motor functional outcome in motor FIM subscale (r= 0.516 to 0.890). Interestingly, cognitive functions showed significant correlation with both motor functional outcome (0.302 to 0.352) and cognitive functional outcome (r= 0.475 to 0.778). However, depression did not correlate with any outcomes. Most of the impairments, such as cognitive and motor functions and depression, improved significantly over four weeks. Similarly, improvement was also found in all FIM scales (Motor FIM subscale, cognitive FIM subscale and Total FIM score). Male was found to have better improvement in some cognitive functions. Female was more depressed than male subjects at admission. On the other hand, balance was better in subjects with right hemiplegia. However, there was no significant difference in any outcome measures between subject with different type of stroke. Balance was the main predictor for motor functional outcome (motor FIM subscale) at fourth week (R2 = 0.588; adjusted R2=0.577; F(l,39)=55.664, p<0.001) whereas judgement and attention were the key predictors for cognitive functional outcome (cognitive FIM subscale) (R2=0.737; adjusted R2=0.723; F(l,39)=84.689, p). The predictors for general functional outcome (total FIM score) at fourth week were balance and judgement (R2=0.656; adjusted R2=0.638; F(2,38)=36.311, p<0.001). The findings suggest initial assessment in both cognitive and motor assessment is essential in stroke rehabilitation program. Besides, the initial balance control and judgement ability of stroke patient are important for predicting functional outcome.

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