Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-02-19 Cooperative journals: 《中国全科医学》
Abstract： Background Somatosensory and motor dysfunction are common dysfunctions after stroke，both lead to limitations in activities of daily living and social participation，there is still a lack of research evidence to analyze the relationship between the two from multiple perspectives. Objective To investigate the relationship between somatosensory and motor function among overall，upper and lower extremities in different-age-group patients within one year after stroke. Methods This prospective study enrolled the poststroke patients within one year from several hospitals in Fujian Province. The sensory subscale of the Fugl-Meyer assessment（FMA-S）and the sensory subitem of National Institute of Health stroke scale（NIHSS）were used to evaluate the patient's somatosensory function. The motor subscale of the Fugl-Meyer assessment（FMA-M），Brunnstrom assessment，Berg Balance Scale（BBS）and the motor subitem of NIHSS were used to evaluate the patient's motor function. Modified Barthel index（MBI）was used to evaluate the patient's activities of daily living（ADL）. Hospital Anxiety and Depression Scale（HADS）was used to evaluate the patient's psychosomatic function. They were divided into two groups（the elderly group/the young and middle-aged group）according to their age，we compared the differences in general information and rehabilitation assessments between the two groups. And we analyzed the correlation between somatosensory function and motor function/ADL/psycho-psychological function. Results A total of 254 patients were included，with an average age of （61.0±12.3）years and an average disease course of 30.0（17.0，65.5）days. There were 112 cases（44.1%）in the elderly group and 142 cases（55.9%）in the young and middle-aged group. FMA-S and FMA-M scores were positively correlated in both groups（rs values were 0.313 and 0.171，both P<0.05），NIHSS sensory items were all negatively correlated with FMA-M scores（rs values were -0.199 and -0.177，both P<0.05）. In the elderly group，FMA-S-UE related scores were positively correlated with FMA-M-UE，Brunnstrom-UE，and Brunnstrom-HAND scores； they were negatively correlated with NIHSS-UE score（all P<0.05）. In the young and middle-aged group，FMA-S-UE total and light-touch scores were positively correlated with FMA-M-UE and Brunnstrom-HAND scores； FMA-S-UE proprioception score was positively correlated with FMA-M-UE，Brunnstrom-UE scores（all P<0.05）. In the older group，FMA-S-LE related scores were positively correlated with FMA-M-LE，Brunnstrom-LE，and BBS scores； FMA-S-LE total and light touch scores were negatively correlated with NIHSS#2;LE scores（all P<0.01）. In the young and middle-aged group，FMA-S-LE total and proprioception scores were positively correlated with FMA-M-LE，Brunnstrom-LE，and BBS scores； FMA-S-LE light touch score was positively correlated with Brunnstrom-LE and BBS scores； FMA-S-LE total and proprioception scores were each negatively correlated with NIHSS-LE score（all P<0.05）. In the elderly group，FMA-S was positively correlated with MBI（rs=0.270，P<0.05），FMA-S score was negatively correlated with HADS-A and HADS-D scores（rs are respectively -0.300 and -0.374，P<0.01），NIHSS sensory item was positively correlated with HADS-D score（rs=0.235，P<0.01）. Conclusion There is a positive correlation between somatosensory and motor function in different age group patients within one year after stroke，and age may affect the correlation between somatosensory function and motor function/ADL/psychosocial function.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-01-11 Cooperative journals: 《中国全科医学》
Abstract： Background Post-stroke cognitive impairment（PSCI）can significantly limit the recovery of stroke patients at all stages and lead to a decline in activity participation and quality of life. Objective Based on the concept of full cycle rehabilitation in stroke，to conduct a cross-sectional study to analyze the differences in PSCI at different ages and disease periods and its correlation with potential influencing factors. Methods Stroke patients were hospitalized in the rehabilitation departments of 27 hospitals in different regions of China from October 2022 to July 2023 using simple random sampling method for cross-sectional analysis. A total of 402 patients were finally included according to the study criteria，and categorized into the young and middle-aged group（18-64 years old）and the elderly group（ ≥ 65 years old）according to the criteria of the National Bureau of Statistics of China，and the patients were also categorized into the acute-phase group（1-7 d），subacute#2;phase group（8-180 d），and the chronic-phase group（>180 d）according to the International Stroke Rehabilitation Alliance. Baseline information on patients was collected through interviews，assessments，and an electronic case system. Cognitive function was assessed using the Montreal Cognitive Assessment（MoCA），and subscores and total scores were calculated for each cognitive domain. Using the National Institute of Health stroke scale（NIHSS），Fugl-Meyer Assessment-Upper Extremity （FMA-UE），Fugl-Meyer Assessment-Lower Extremity（FMA-LE），Berg Balance Scale（BBS），Modified Barthel Index（MBI），Hospital Anxiety Scale（HADS-A），and the Hospital Depression Scale（HADS-D）were used to assess the disease conditions and physical functioning of the patients. Spearman's rank correlation analysis was used to investigate the correlation between cognitive function levels and other clinical indicators at different ages and different stages of disease. Results The prevalence of PSCI in stroke patients was 76.4%（307/402），including 81.0%（136/168）in elderly patients and 73.1%（171/234）in young and middle-aged patients；the prevalence of PSCI in stroke patients was 56%（14/25）in the acute phase，78.4%（265/338）in the subacute phase，and 71.8%（28/39）in the chronic phase. The results of grouping by age and disease period showed that the elderly group had lower visuospatial and executive function，attention，numeracy，delayed recall scores and total MoCA scores than those in the young and middle-aged group（P<0.05）. Patients in the subacute phase group had lower visuospatial and executive function，language，delayed recall scores and total MoCA scores than those in the acute phase group（P<0.05）. Correlation analysis showed that the total MoCA score was positively correlated（P<0.001）with educational level（rs=0.314），stroke type（rs=0.114），FMA-UE（rs=0.245），FMA-LE（rs=0.242），BBS（rs=0.265），MBI（rs=0.293），and was negatively correlated（P<0.05）with gender（rs=-0.107），age（rs=-0.103），history of hypertension（rs=-0.112），hemiplegic side（rs=-0.139），disease duration（rs=-0.135），NIHSS（rs=-0.107），HADS-A（rs=-0.239），HADS-D（rs=-0.280）. Further stratified analyses showed that the middle-aged and elderly groups were correlated with the total MoCA score in terms of the educational level，NIHSS and physical function indicators such as FMA-UE，FMA-LE，BBS，MBI，HADS-A，and HADS-D（P<0.05）. In the acute-phase group，disease duration，FMA-UE，and HADS-A were related to total MoCA score（P<0.05）. In the subacute-phase group，age，education level，hypertension，history of alcohol consumption，type of stroke，hemiplegic side，disease duration，NIHSS，and physical function indicators such as FMA-UE，FMA-LE，BBS，MBI，HADS-A，HADS-D were correlated with the total MoCA score（P<0.05），and only educational level，hypertension，and HADS-D were correlated with the total MoCA score in the chronic-phase group（P<0.05）. Conclusion PSCI is closely related to age，disease development period，education level，physical function，balance，activities of daily living，anxiety and depression levels in stroke patients，and individualised preventive strategies and interventions should be developed for patients based on different stratified cognitive potential influencing factors，as well as increased screening and attention to cognition in the early stages of the disease to the later stages of rehabilitation.
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