Stroke is one of the most important causes of death and disability worldwide. The recovery of stroke survivors represents a real challenge for healthcare services. The aim of the present pilot study was to evaluate and compare the efficiency of two different approaches of physical rehabilitation in patients in the acute and early sub-acute stages following a stroke. Two groups of patients consisting of 48 and 20 patients, respectively, underwent continuous and intermittent physical recovery, and were assessed through electromyography and clinical evaluation. After 12 weeks of rehabilitation, no significant differences were identified between the outcomes obtained from the two groups. Due to the added value of intermittent physical recovery, this method of rehabilitation could be considered an approach that needs to be further studied for the treatment of patients in the acute and early sub-acute stages following a stroke.
According to the World Health Organization data, stroke is the second leading cause of death worldwide, and the third leading cause of death and disability combined. In recent decades, the incidence and prevalence of stroke has increased by >70% (
It is widely known that there are two major categories of stroke: Ischaemic and haemorrhagic. Ischaemic strokes are generated by interruption of the blood supply to a certain cerebral region, which leads to a sudden loss of function. Haemorrhagic strokes, also called intracerebral haemorrhages, have their origin in a burst blood vessel and the subsequent bleeding into and around the brain (
Starting with symptoms that include trouble speaking, confusion, paralysis or paresis of the face and upper or lower limbs, visual impairment, headache, vomiting, dizziness, loss of coordination or altered state of consciousness, stroke can lead, in the majority of cases, to long-term effects (
One of the most important sequelae of stroke is chronic motor deficits in the upper or lower limbs, which can lead to a severe impairment of the activities of daily living (ADL) and thus a decrease in the quality of life. Therefore, this disability represents an important target in the post-stroke rehabilitation process (
The assessment of motor status for stroke survivors is performed in both the acute and chronic phases through electromyography (EMG), which is the most often used and accurate study of muscle electrical activity. EMG is employed to localize the lesion and appreciate its degree of severity, to determine the nerve pathophysiology, and to evaluate the evolutionary timeline and rate of recovery (
The recovery process after a stroke is strongly related to the evolutionary timeline, and currently, the most common categories of stroke stages are those proposed by the Stroke Roundtable Consortium: The first 24 h, hyperacute phase; the first 7 days, acute phase; the first 3 months, early sub-acute phase; months 4-6, late sub-acute phase; and from 6 months on, chronic phase (
Post-stroke rehabilitation involves a multidisciplinary approach, which needs to start in stable patients at least 48 h after the initial symptoms. The outcomes of the rehabilitation can lead to significant advantages for the patients, their families or caregivers and even for the community in which they live, in terms of reducing social and economic burden. As aforementioned, multidisciplinary effort is needed in order to solve the sequalae of strokes, and must include physicians (neurologists, neurosurgeons, rehabilitation medicine specialists) and physical, occupational and speech therapists, as well as psychological services, social support and medical equipment providers (
One of the main goals of the neurobiological rehabilitation strategies is represented by the restitution of neuronal activity, which can be achieved through pharmacological approaches and physical techniques. The physical techniques used include kinesiotherapy, cryotherapy, thermotherapy, electrotherapy and massage; all of these methods are currently used during the post-stroke rehabilitation process (
For the aim of the present study, which was carried out over a period of 2 years (January 1, 2019-December 31, 2021), 68 hemiparetic stroke survivors were recruited, who were admitted to the Rehabilitation Clinic, Emergency County Hospital of Craiova (Craiova, Romania), with which the University of Medicine and Pharmacy Craiova has a clinical agreement for medical services. All subjects had their diagnosis confirmed by a neurologist following a specialized examination, where the haemorrhagic aetiology of the brain injury was ruled out by a skull CT scan. At the time of recruitment, all subjects were clinically stable and within 48-72 h after the onset of a stroke.
The inclusion criteria were as follows: i) Post-stroke duration between 48 and 72 h after the onset of symptoms; ii) unilateral movement impairment of the upper limbs; iii) clinically stable; iv) without recent injury; v) without being under medication that can impact neuromuscular function; vi) without a positive history for recurrent vascular episodes. The exclusion criteria were as follows: i) Patients with aphasia, as they were not able to provide informed consent; ii) patients with cardiac implantable electronic devices where the electrotherapy could interfere with their functionality; iii) patients who did not agree to participate.
All patients were clinically evaluated by the medical recovery specialist at the beginning of the rehabilitation process by measuring the force of the brachial biceps and triceps muscles, as well as grading the spasticity of the upper limbs using the Modified Ashworth Scale (
The motor function of the upper limbs was assessed using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) subscale, which consists of 33 items (domains: A, upper extremity; B, wrist; C, hand; D, coordination/speed), each item being scored on a 3-point ordinal scale (0, 1 or 2), with 0 generally corresponding to no function, 1 to partial function and 2 to perfect function. The general score was represented by the sum of the scores, with a maximum score (no impairment) of 66 points (
All subjects were included in the present study on a voluntary basis and provided written informed consent. The present study was approved by the Ethics Committee of the University of Medicine and Pharmacy of Craiova (approval no. 167/12.06.2017; Craiova, Romania) and was in line with The Declaration of Helsinki.
All patients underwent complex physical therapy, consisting of kinesiotherapy, cryotherapy, thermotherapy, electrostimulation and massage, for 12 weeks. The patients were divided into two study groups that received an identical program of recovery therapies in terms of the procedures; however, the frequency of the rehabilitation sessions was different between the two groups: A total of 48 patients received continuous physical therapy, weekly for the whole study period, whereas the remaining 20 patients received intermittent rounds of physical therapy every 2 weeks (weeks 2, 4, 6, 8, 10 and 12). The two study groups were created based on the therapeutic approach decided on by the specialists from the Rehabilitation Clinic, Emergency County Hospital of Craiova.
Every patient underwent the same type of rehabilitation program as follows (
For EMG recording, Participants were seated in an upright position with their arm comfortably supported. The forearm was immobilized by the examiner during the examination and was placed in full supination at 90˚ with the arm. Subjects were instructed to voluntarily produce hand-to-forearm or forearm-to-arm flexion. EMG recordings were done over the biceps brachii or flexor carpi ulnaris using Neuropack M1 MEB-9100 EMG/EP/IOM System (Nihon Kohden Corporation). In order to ensure appropriate electric contact and low baseline noise, the surface of the electrodes was placed over the skin only after it was cleaned with alcohol. The signal sampled every other 100 µsec was amplified and filtered with a bandwidth of 10 Hz to 10 kHz. Each subject was asked to perform the same protocol at the time of admission (week 1) and every 2 weeks until the end of the recovery program (weeks 2, 4, 6, 8, 10 and 12). When the setup was completed, patients were asked to perform maximal contraction of the recorded muscles. Discharge firing rate (DFR) was considered the main objective data that could provide an indication of how the rehabilitation sessions should be targeted.
All clinical and non-clinical items, and the results of the working instruments were recorded in a Microsoft Excel file (Microsoft Excel 2016; Microsoft Corporation). The descriptive analysis of the samples was realized using absolute and relative frequencies (%) or median and interquartile range (IQR). After testing, some of the data were found not to be parametrical. More complex analysis of the possible associations between recorded variables was performed using Prism 9.3.0 (GraphPad Software; Dotmatics) and SPSS version 20 (IBM Corp.). The following statistical tests were performed: Shapiro-Wilk's test for data normality analysis; Wilcoxon's rank-sum or Wilcoxon signed-rank tests followed by Bonferroni's corrections, or Friedman followed by Nemenyi's test, and mixed ANOVA followed by Sidak's test. Where the statistical tests could not be carried out due to the small number of subjects, this was noted in the tables of results as not applicable. P<0.05 was considered to indicate a statistically significant difference.
The socio-demographic data of the study samples revealed that the two samples had a comparable average age of the subjects, whereas in the continuous therapy group, the sex ratio was 2:1 male-to-female, while the intermittent group had a 1:1 ratio. Regarding where the patients lived, the distribution was also similar between the two groups (approximately two-thirds of the patients lived in a rural area) (
According to the study methodology, clinical and laboratory data considered to have an influence on the onset and evolution of stroke were collected. It was revealed that almost two-thirds of both groups consisted of smokers and >75% of patients had one or multiple associated medical conditions (diabetes mellitus and/or high blood pressure). Laboratory data revealed that both total cholesterol and triglyceride levels were high, which is characteristic for dyslipidaemia (
The number of brain lesions was revealed by a CT scan. In the continuous therapy group, 33 patients (68.75%) presented with a left hemisphere injury resulting in an impairment of the right hemibody, and the remaining 15 patients (31.25%) had a lesion localized in the right hemisphere resulting in an impairment of the left hemisphere. In the intermittent therapy group, the lesion was situated on the left side for 14 subjects (70.00%), whereas it was situated on the right side for the remaining 6 subjects (30.00%).
According to the obtained results, the intermittent recovery appeared to be similar in effectiveness compared with continuous recovery for acute and sub-acute stroke. Clinical monitoring of the patients based on the scoring scales developed for patients with stroke revealed no differences between the patients enrolled in a continuous form of recovery program compared with those enrolled in an intermittent regimen (
Manual muscle testing (MMT) by EMG recordings detected no significant difference between the study groups. When MMT was measured for the biceps brachii (P=0.2718;
Clinical monitoring of the patients based on the scoring scales developed for patients with stroke revealed no differences between the patients enrolled in the continues recovery program compared with those enrolled in the intermittent regimen (
As an objective measuring tool, the DFR was compared between the two groups, using the most basic clinical EMG tests. No differences were observed among the two groups. The DFR was similar between the groups measured at week 12: Biceps brachii, 10.934±1.08 Hz in the continuous group vs. 10.62±1.89 Hz in the intermittent group; flexor carpi ulnaris, 9.81±1.54 Hz in the continuous group compared with 9.06±1.58 Hz (
Analysing the relationship between FMA-UE scores on all four domains and socio-demographic data, it was revealed that for both study samples the evolution of recovery in terms of improvement during the 12 weeks of therapeutic process was statistically significant independent of sex and residence (P<0.01;
The present study examined the influence of demographics (sex and environment) on the evolution of recovery from week 1 to 12 in both groups. The improvement in the level of functional ability for ADL, iADL and Barthel, as expressed by the average scores of the working tools, was significant (P<0.05) in the intermittent and highly significant (P<0.001) in the continuous group, associated with both sex and residency (
The association between risk behaviours (smoking) and medical conditions (diabetes, hypertension and dyslipidaemia) with recovery outcomes, as measured by mean FMA-EU scores, were also statistically analysed. Notably, no differences were identified in the recovery period for both groups. Thus, during the 12 weeks of the study period, all subjects showed a significant improvement (P<0.005) in their health status where comorbidities were recorded, even if the recovery procedures were applied continuously or intermittently, according to the study methodology (
The association between risk behaviours (smoking) and comorbidities (as identified through clinical assessment) with positive outcomes of the rehabilitation program was also statistically significant (P<0.05). Thus, the efficiency of the recovery process was not impacted by these clinical aspects for the subjects who followed the continuous rehabilitation program, as well as for those who received intermittent procedures (
The present study investigated the benefits of the rehabilitation programs for stroke survivors in its continuous and intermittent variants. The clinical characteristics of the study subjects from both groups were similar to those mentioned by the specialized literature in terms of the presence of behavioural and clinical risk factors, including modifiable (hypertension, diabetes mellitus, high blood cholesterol, dyslipidaemia, smoking) (
For the patients in the acute and sub-acute phases of stroke involved in the present study, the degree of functional improvement after the initial recovery program was significant, and could be considered a short-term recovery in functional status, as mentioned in previous studies (
Even if the medical conditions identified (hypertension, diabetes and dyslipidaemia) in the present subjects were not significantly involved in the deterioration of the evolution and prognosis during the post-stroke period, the presence of cardiac and metabolic comorbidities are associated with reduced survival after stroke, and this is another aspect that necessitating a mandatory long-term monitoring and recovery program (
Assessment in the acute phase using EMG has been recognized as the most accurate, accessible and useful tool for diagnosis, and has also shown its value as a long-term monitoring tool. The EMG assessment provides data on both the temporal course and rate of recovery of the lesion (
Previous studies have highlighted the importance of complex rehabilitation programs for patients following stroke in both the acute and chronic phases, based on the individualized evaluation of each patient, rather than that provided by guidelines (
In conclusion, the rehabilitation process of stroke survivors represents one of the most important elements for their future quality of life. Intermittent physical recovery could be considered a valid approach for sub-acute and acute stroke survivors following an individualized clinical evaluation. Future studies are required to confirm the findings for the chronic stages of this disease.
The authors gratefully acknowledge Dr Mihail Cristian Pirlog (Department of Medical Sociology, University of Medicine and Pharmacy Craiova, Craiova, Romania) for critical discussion and valuable support during the realization of the study, and Dr Bogdan Catalin (Department of Physiology, University of Medicine and Pharmacy Craiova, Craiova, Romania) for technical assistance with electromyography recording.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request and after the approval of the Ethics Committee of the University of Medicine and Pharmacy of Craiova, Craiova, Romania.
AMP, ATB, SCB and OCR conceptualized the present study. AMP, GC, ATB, SCB and OCR were major contributors to writing the manuscript and collected the clinical data and analyzed the data. The methodology used was established by AMP, ATB, GC and OCR. Software input was performed by AMP and GC. Data curation was performed by GC. The original draft was prepared by AMP and GC. The editing and rewriting of the manuscript was performed by ATB and OCR. ATB and OCR supervised the project. AMP and GC confirm the authenticity of all the raw data. All have authors read and approved the final manuscript.
The present study was approved by the Ethics Committee of the University of Medicine and Pharmacy of Craiova (approval no. 167/12.06.2017; Craiova, Romania) and was in line with The Declaration of Helsinki. Written informed consent was obtained from all subjects involved in the study.
Not applicable.
The authors declare that they have no competing interests.
Comparison between FMA-UE scores during the study period. Improvement in all domains of the FMA-UE, (A) upper extremity, (B) wrist, (C) hand and (D) coordination/speed, was detected after 12 weeks. (E) Total motor score of the two tested groups was similar (P>0.05) after 12 weeks of functional recovery. The data are presented as the mean ± SD. ****P<0.001. FMA-UE, Fugl-Meyer Assessment Upper Extremity.
MMT and Modified Ashworth Scale of the subjects from the study groups. After 12 weeks of the physical rehabilitation program, the MMT estimations for (A) biceps brachialis (P=0.2718) and (B) triceps brachialis (P=0.3692) muscles between the two groups showed similar results. (C) Within the same interval, the two groups have shown a similar trend when measuring the degree of spasticity using the Modified Ashworth Scale, but this was not statistically significant (P>0.05). The data are presented as the mean ± SD. Blue bars represent the results for the ‘Continuous’ group, while the red bars indicate the results for the ‘Intermittent’ group. MMT, manual muscle testing; a.u., arbitrary units.
Comparison between the functional ability of subjects. No differences were observed between the two recovery groups regarding (A) Barthel Index, (B) iADL scale and (C) ADL scale. The data are presented as the mean ± SD. ***P<0.001 and ****P<0.001. ADL, activities of daily living; iADL Instrumental ADL.
DFR extracted from electromyography recordings. (A) Example of improvement of DFR in the biceps brachialis and flexor carpi ulnaris after 12 weeks. (B) Biceps brachialis and (C) flexor carpi ulnaris DFR was improved in both groups after 12 weeks of rehabilitation therapies. The data are presented as the mean ± SD. ***P<0.01 and ****P<0.001. DFR, discharge-firing rate.
Recovery therapies applied in the present study.
Procedure | Monday | Tuesday | Wednesday | Thursday | Friday |
---|---|---|---|---|---|
Kinesiotherapy | 30 min | 30 min | 30 min | 30 min | 30 min |
Cryotherapy | 20 min | 20 min | 20 min | 20 min | 20 min |
Thermotherapy | 20 min | 20 min | 20 min | 20 min | 20 min |
Electrotherapy | 45 min | 45 min | 45 min | 45 min | 45 min |
Massage | Not applicable | 10 min | Not applicable | 10 min | Not applicable |
Sociodemographic data of the two study groups.
Characteristic | Continuous therapy group, n=48 (%) | Intermittent therapy group, n=20 (%) |
---|---|---|
Mean age, years | 57.83±1.73 | 58.05±1.64 |
Sex | ||
Male | 32 (66.67) | 10 (50.00) |
Female | 16 (33.33) | 10 (50,00) |
Environment | ||
Urban | 20 (41.67) | 8 (40.00) |
Rural | 28 (58.33) | 12 (60.00) |
Clinical data of the two study-samples.
Characteristic | Continuous therapy group, n=48 (%) | Intermittent therapy group, n=20 (%) |
---|---|---|
Smokers | 31 (64.58) | 14 (70.00) |
Comorbidities | ||
Diabetes mellitus | 4 (8.33) | 1 (5.00) |
High blood pressure | 25 (52.08) | 11 (55.00) |
Diabetes mellitus + Hypertension | 10 (20.83) | 3 (15.00) |
Laboratory data | ||
Total cholesterol, mg/dl | 229.66±46.55 | 252.00±52.47 |
Triglycerides, mg/dl | 208.60±57.94 | 222.40±54.50 |
Association between FMA-UE scores and demographic data during the recovery process.
Continuous therapy group, n=48 | Intermittent therapy group, n=20 | |||||
---|---|---|---|---|---|---|
FMA-UE scores | FMA-UE scores | |||||
Patients | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value |
Male patients | ||||||
A-upper extremity | 17.00 (13.00-20.00) | 30.00 (28.00-31.00) | <0.001 | 16.00 (13.50-18.75) | 29.00 (22,00-30.75) | <0.010 |
B-wrist | 4.00 (3.00-5.00) | 7.00 (7.00-8.00) | <0.001 | 4.00 (3.25-5.00) | 8.00 (6.25-8.00) | <0.010 |
C-hand | 6.00 (4.75-6.00) | 10.00 (9.00-11.00) | <0.001 | 6.00 (5.00-6.00) | 10.00 (7.25-10.75) | <0.010 |
D-coordination/speed | 0.50 (0.00-1.25) | 3.00 (2.00-4.00) | <0.001 | 0.00 (0.00-0.75) | 3.00 (2.25-4.00) | <0.010 |
Female patients | ||||||
A-upper extremity | 17.50 (15.00-20.25) | 28.50 (27.75-32.25) | <0.001 | 18.50 (14.50-22.00) | 30.50 (27.25-32.75) | <0.010 |
B-wrist | 4.00 (3.00-5.00) | 6.50 (5.75-8.00) | <0.001 | 5.50 (4.00-6.00) | 7.50 (7.00-9.00) | <0.010 |
C-hand | 6.00 (5.00-6.25) | 9.50 (8.00-11.00) | <0.001 | 5.50 (5.00-7.00) | 10.00 (9.00-11.00) | <0.010 |
D-coordination/speed | 0.50 (0.00-1.25) | 3.00 (2.00-3.25) | <0.001 | 0.50 (0.00-1.75) | 3.00 (2.25-4.00) | <0.010 |
Living in urban areas | ||||||
A-upper extremity | 15.50 (13.00-18.25) | 28.00 (24.50-31.00) | <0.001 | 16.50 (14.75-20.25) | 29.00 (27.75-31.25) | <0.010 |
B-wrist | 3.50 (3.00-4.00) | 7.00 (6.00-8.00) | <0.001 | 4.50 (4.00-6.00) | 8.00 (7.00-8.00) | <0.010 |
C-hand | 5,00 (4.00-6.00) | 9.50 (8.00-10.00) | <0.001 | 6.00 (5.00-6.00) | 10.00 (8.75-11.00) | <0.010 |
D-coordination/speed | 0.00 (0.00-1.00) | 3.00 (2.00-3.00) | <0.001 | 0.00 (0.00-1.00) | 3.00 (2.75-4.00) | <0.010 |
Living in rural areas | ||||||
A-upper extremity | 18.50 (16.75-21.25) | 30.00 (28.75-32.25) | <0.001 | 17.50 (12.50-22.00) | 30.00 (24.00-33.00) | <0.010 |
B-wrist | 5.00 (4.00-5.00) | 7.50 (7.00-8.00) | <0.001 | 4.50 (2.75-6.25) | 7.50 (5.50-9.00) | <0.010 |
C-hand | 6.00 (5.00-7.00) | 10.00 (9.75-11.00) | <0.001 | 5.50 (4.50-7.00) | 9.50 (8.25-11.00) | <0.010 |
D-coordination/speed | 1.00 (0.00-2.00) | 4.00 (3.00-4.00) | <0.001 | 0.00 (0.00-2.00) | 3.50 (2.00-4.00) | <0.010 |
Wilcoxon signed-rank test, week 1 vs. week 12. FMA-UE, Fugl-Meyer Assessment Upper Extremity.
Association between demographic data and evolution of the recovery process.
A, Continuous therapy group, n=48 | |||||||||
---|---|---|---|---|---|---|---|---|---|
Barthel | iADL | ADL | |||||||
Patients | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value |
Male | 50.00 (27.50-60.00) | 60.00 (48.75-70.00) | <0.0010 | 3.00 (2.00-3.25) | 4.00 (3.00-5.00) | <0.0010 | 5.00 (2.75-6.00) | 7.00 (5.00-8.00) | <0.0010 |
Female | 45.00 (35.00-55.00) | 57.50 (48.75-70.00) | <0.0010 | 3.00 (2.00-4.00) | 4.00 (3.75-5.00) | <0.0010 | 4.50 (2.75-6.00) | 6.50 (5.00-8.00) | <0.0010 |
Urban | 42.50 (20.00-51.25) | 55.00 (43.75-70.00) | <0.0010 | 3.00 (1.75-3.25) | 4.00 (2.75-4.25) | <0.0010 | 4.00 (2.00-6.00) | 6.00 (4.75-8.00) | <0.0010 |
Rural | 55.00 (48.75-60.00) | 65.00 (57.50-70.00) | <0.0010 | 3.00 (3.00-4.00) | 4.50 (4.00-5.00) | <0.0010 | 5.00 (3.75-6.25) | 8.00 (6.50-8.00) | <0.0010 |
B, Intermittent therapy group, n=20 | |||||||||
Barthel | iADL | ADL | |||||||
Patients | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value |
Male | 47.50 (32.50-50.00) | 55.00 (37.50-60.00) | <0.0500 | 3.00 (2.25-3.00) | 4.00 (3.00-4.00) | 0.0110 | 4.50 (2.50-5.75) | 6.00 (3.75-7.00) | <0.0100 |
Female | 52.50 (45.00-65.00) | 57.50 (50.00-70.00) | <0.0100 | 3.00 (2.00-3.00) | 4.00 (3.25-4.75) | 0.0015 | 5.50 (3.25-7.75) | 6.50 (6.00-8.00) | <0.0500 |
Urban | 47.50 (43.75-51.25) | 55.00 (48.75-61.25) | <0.0100 | 3.00 (2.75-3.00) | 4.00 (3.00-4.00) | 0.0015 | 5.00 (3.75-6.00) | 6.00 (6.00-7.00) | <0.0100 |
Rural | 52.50 (33.75-66.25) | 60.00 (45.00-70.00) | <0.0500 | 2.50 (1.75-3.25) | 4.00 (2.75-5.00) | 0.0133 | 5.50 (2.75-7.25) | 6.50 (3.50-8.25) | <0.0500 |
Wilcoxon signed-rank test, week 1 vs. week 12. ADL, activities of daily living; iADL, Instrumental ADL.
Association between clinical data and the FMA-UE scores during the recovery process.
Continuous therapy group, n=48 | Intermittent therapy group, n=20 | |||||
---|---|---|---|---|---|---|
FMA-UE scores | FMA-UE scores | |||||
Risk behaviour/comorbidities | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value |
Smokers | ||||||
A-upper extremity | 18.00 (15.00-20.00) | 30.00 (28.00-31.00) | <0.001 | 16.00 (14.00-20.50) | 28.50 (26.25-31.00) | <0.001 |
B-wrist | 4.00 (3.00-5.00) | 7.00 (6.50-8.00) | <0.001 | 4.50 (3.25-5.75) | 7.50 (6.25-8.00) | <0.001 |
C-hand | 6.00 (5.00-6.00) | 10.00 (9.00-10.50) | <0.001 | 5.50 (5.00-6.00) | 10.00 (9.00-11.00) | <0.001 |
D-coordination/speed | 1.00 (0.00-1.00) | 3.00 (3.00-4.00) | <0.001 | 0.00 (0.00-0.75) | 3.00 (2.00-3.75) | <0.001 |
Diabetes | ||||||
A-upper extremity | 14.00 (11.00-18.00) | 28.00 (25.75-29.00) | <0.001 | 15.00 (13.25-18.00) | 25.00 (20.25-30.00) | n.a. |
B-wrist | 3.00 (3.00-4.00) | 7.00 (6.00-8.00) | <0.001 | 3.00 (2.75-4.00) | 6.00 (4.75-7.50) | n.a. |
C-hand | 5.00 (4.00-6.00) | 9.00 (8.25-10.00) | <0.001 | 4.50 (3.75-5.75) | 8.50 (6.75-10.50) | n.a. |
D-coordination/speed | 0.00 (0.00-1.00) | 3.00 (2.00-3.00) | <0.001 | 0.00 (0.00-0.5) | 2.50 (1.50-3.25) | n.a. |
Hypertension | ||||||
A-upper extremity | 17.00 (14.00-20.00) | 29.00 (28.00-31.50) | <0.001 | 17.50 (15.00-21.00) | 30.00 (27.25-32.00) | <0.001 |
B-wrist | 4.00 (3.00-5.00) | 7.00 (6.50-8.00) | <0.001 | 5.00 (3.25-6.00) | 8.00 (7.00-9.00) | <0.001 |
C-hand | 6.00 (5.00-6.50) | 10.00 (9.00-11.00) | <0.001 | 6.00 (5.00-6.75) | 10.00 (8.25-11.00) | <0.001 |
D-coordination/speed | 0.00 (0.00-1.00) | 3.00 (2.00-4.00) | <0.001 | 0.00 (0.00-1.00) | 4.00 (2.25-4.00) | <0.001 |
Diabetes + hypertension | ||||||
A-upper extremity | 14.00 (10.25-17.25) | 28.00 (25.75-29.75) | <0.010 | 16.00 (13.50-20.00) | 29.00 (23.50-31.00) | n.a. |
B-wrist | 3.00 (3.00-4.00) | 7.00 (6.25-8.00) | <0.010 | 3.00 (2.50-5.00) | 7.00 (5.50-8.00) | n.a. |
C-hand | 5.00 (4.00-5.75) | 9.00 (8.25-10.00) | <0.010 | 5.00 (4.00-6.50) | 10.00 (8.00-11.00) | n.a. |
D-coordination/speed | 0.00 (0.00-0.75) | 2.50 (2.00-3.00) | <0.010 | 0.00 (0.00-1.00) | 3.00 (1.50-3.50) | n.a. |
Dyslipidaemia | ||||||
A-upper extremity | 17.00 (12.00-19.00) | 29.00 (27.5-31) | <0.001 | 16.00 (14.00-21.00) | 29.00 (26.50-32.00) | <0.001 |
B-wrist | 4.00 (3.00-5.00) | 7.00 (7.00-8.00) | <0.001 | 5.00 (3.50-6.00) | 8.00 (6.50-8.50) | <0.001 |
C-hand | 6.00 (5.00-6.00) | 10.00 (9.00-10.5) | <0.001 | 6.00 (5.00-6.50) | 10.00 (8.50-11.00) | <0.001 |
D-coordination/speed | 0.00 (0.00-1.00) | 3.00 (2.00-4.00) | <0.001 | 0.00 (0.00-1.00) | 3.00 (2.00-4.00) | <0.001 |
Wilcoxon signed-rank test, week 1 vs. week 12. FMA-UE, Fugl-Meyer Assessment Upper Extremity; n.a., not applicable.
Association between clinical data and evolution of the recovery process.
A, Continuous therapy group, n=48 | |||||||||
---|---|---|---|---|---|---|---|---|---|
Barthel | iADL | ADL | |||||||
Risk behaviour/Comorbidities | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value |
Smokers | 50.00 (40.00-57.50) | 60.00 (50.00-70.00) | <0.001 | 3.00 (2.50-4.00) | 4.00 (3.00-5.00) | <0.001 | 5.00 (3.50-6.00) | 7.00 (5.00-8.00) | <0.001 |
Diabetes | 40.00 (22.50-45.00) | 47.50 (45.00-55.00) | n.a. | 2.50 (1.25-3.00) | 3.00 (3.00-4.00) | n.a. | 3.50 (2.00-4.75) | 5.00 (5.00-6.75) | n.a. |
Hypertension | 50.00 (32.50-57.50) | 60.00 (45.00-70.00) | <0.001 | 3.00 (2.00-3.50) | 4.00 (3.00-4.50) | <0.001 | 5.00 (2.50-6.00) | 7.00 (5.00-8.00) | <0.001 |
Diabetes + hypertension | 35.00 (22.50-48.75) | 45.00 (37.50-65.00) | <0.010 | 2.50 (1.00-3.00) | 3.00 (2.25-4.00) | <0.050 | 3.50 (2.00-5.50) | 5.00 (4.25-6.75) | <0.010 |
Dyslipidaemia | 50.00 (30.00-55.00) | 60.00 (45.00-67.50) | <0.001 | 3.00 (2.00-3.50) | 4.00 (3.00-5.00) | <0.001 | 4.00 (2.00-6.00) | 7.00 (5.00-8.00) | <0.001 |
B, Intermittent therapy group, n=20 | |||||||||
Barthel | iADL | ADL | |||||||
Patients | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value | Week 1 | Week 12 | P-value |
Smokers | 45.00 (37.50-57.50) | 52.50 (50.00-63.75) | <0.010 | 3.00 (2.00-3.00) | 4.00 (3.00-4.00) | <0.010 | 4.50 (3.00-5.75) | 6.00 (5.25-7.00) | <0.001 |
Diabetes | 40.00 (33.75-52.50) | 50.00 (45.00-57.50) | n.a. | 2.00 (1.75-2.50) | 3.50 (2.50-4.25) | n.a. | 3.00 (2.75-4.25) | 5.50 (4.25-6.75) | n.a. |
Hypertension | 50.00 (37.50-60.00) | 57.50 (50.00-68.75) | <0.001 | 3.00 (2.25-3.00) | 4.00 (4.00-4.00) | <0.001 | 5.00 (3.25-7.00) | 6.00 (5.25-8.00) | <0.001 |
Diabetes + hypertension | 35.00 (32.50-55.00) | 50.00 (40.00-65.00) | n.a. | 2.00 (1.50-3.00) | 4.00 (2.50-4.50) | n.a. | 3.00 (2.50-5.50) | 5.00 (3.50-7.00) | n.a. |
Dyslipidaemia | 45.00 (40.00-57.50) | 55.00 (50.00-65.00) | <0.001 | 3.00 (2.00-3.00) | 4.00 (3.00-4.00) | <0.001 | 5.00 (3.00-6.50) | 6.00 (5.50-7.50) | <0.010 |
Wilcoxon signed-rank test, week 1 vs. week 12. ADL, activities of daily living; iADL, Instrumental ADL; n.a., not applicable.