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Comparison of Three Instruments for Activity Disability in Acute Ischemic Stroke Survivors

Published online by Cambridge University Press:  14 July 2020

Qian Wu
Affiliation:
Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China College of Medicine, Tongji University, Shanghai, People’s Republic of China
Aijie Tang
Affiliation:
College of Medicine, Tongji University, Shanghai, People’s Republic of China
Shuzhen Niu
Affiliation:
College of Medicine, Tongji University, Shanghai, People’s Republic of China
Aiping Jin
Affiliation:
Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China
Xiaoqing Liu
Affiliation:
Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China
Li Zeng
Affiliation:
Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China College of Medicine, Tongji University, Shanghai, People’s Republic of China
Jinxia Jiang
Affiliation:
Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China College of Medicine, Tongji University, Shanghai, People’s Republic of China
Jennifer Kue
Affiliation:
College of Nursing, The Ohio State University, Columbus, OH, USA
Yan Shi
Affiliation:
Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China College of Medicine, Tongji University, Shanghai, People’s Republic of China
Xiaoping Zhu
Affiliation:
Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China
Corresponding
E-mail address:

Abstract:

Background:

Disabilities in physical activity and functional independence affect the early rehabilitation of stroke survivors. Moreover, a good instrument for assessing activity disability allows accurate assessment of physical disability and assists in prognosis determination.

Objective:

To compare three assessment tools for physical activity in acute-phase stroke survivors.

Methods:

We conducted this prospective observational study at an affiliated hospital of a Medical University in Shanghai, China, from June 2018 to November 2019. We administered three instruments to all patients during post-stroke days 5–7, including the Modified Barthel Index (MBI), Instrumental Activities of Daily Living (IADL), and modified Rankin scale (mRs). We analyzed correlations among the aforementioned scales and the National Institutes of Health Stroke Scale (NIHSS) using Spearman’s rank-order correlations test. Univariate analyses were performed using the Mann–Whitney U test. We used a binary logistic regression model to assess the association between the NIHSS (30 days) and patient-related variables. Finally, we used receiver operating characteristic (ROC) curves to assess the predictive value of the multivariate regression models.

Results:

There was a high correlation among the three instruments; furthermore, the MBI had a higher correlation with the NIHSS (days 5–7). The NIHSS (day 30) was correlated with thrombolysis. ROC analysis revealed that the mRs-measured disability level had the highest predictive value of short-term stroke severity (30 days).

Conclusion:

The MBI was the best scale for measuring disability in physical activity, whereas the mRs showed better accuracy in short-term prediction of stroke severity.

Résumé :

RÉSUMÉ :

Comparaison entre trois outils d’évaluation de l’invalidité dans le cas de patients ayant survécu à un AVC ischémique aigu.

Contexte :

Des limitations fonctionnelles en matière d’activité physique et d’autonomie vont affecter les premières étapes de la réadaptation des survivants à un AVC. Par ailleurs, on sait qu’un bon outil d’évaluation de ces limitations permettra de les évaluer adéquatement et d’établir un pronostic.

Objectif :

Comparer trois outils d’évaluation des limitations fonctionnelles liées à l’activité physique dans le cas de survivants à un AVC.

Méthodes:

De juin 2018 à novembre 2019, nous avons effectué une étude prospective d’observation au sein d’un établissement hospitalier affilié à une école de médecine de Shanghai. Entre les cinquièmes et septièmes jours consécutifs à un AVC, tous nos patients ont été évalués au moyen des trois outils suivants : l’indice modifié de Barthel (IMB), l’échelle de Lawton ciblant les activités instrumentales de la vie quotidienne et la Modified Rankin Scale (MRS). Au moyen du test de Spearman, nous avons ensuite analysé les corrélations se dessinant entre ces trois outils et les résultats obtenus avec un autre outil, la National Institutes of Health Stroke Scale (NIHSS). Nos analyses univariées ont été par ailleurs effectuées à l’aide du test de Wilcoxon-Mann-Whitney. Nous avons également recouru à un modèle de régression logistique binaire afin d’évaluer l’association existant entre le NIHSS (30 jours) et des variables liées aux patients. Finalement, nous avons fait appel à la fonction d’efficacité du récepteur (ou courbe ROC) pour évaluer la valeur prédictive de nos modèles de régression multivariés.

Résultats :

Une forte corrélation entre nos trois outils a émergé. De plus, il est apparu que c’est le IMB qui a montré la plus forte corrélation avec la NIHSS (jours 5, 6 et 7). La NIHSS (jour 30) a été également corrélée avec un traitement thrombolytique. Nos analyses au moyen de la fonction d’efficacité du récepteur ont révélé que le niveau de limitations fonctionnelles mesuré par la MRS avait la valeur prédictive la plus élevée pour le degré de sévérité des AVC à court terme (jour 30).

Conclusion :

L’IMB est donc apparu comme le meilleur outil pour évaluer les limitations fonctionnelles en matière d’activité physique tandis que la MRS a montré la meilleure précision quand il s’agit de prédire à court terme le niveau de sévérité des AVC.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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