The sequelae after stroke often have resulted in limits in functions and social integration of the patients. Objectives: (1) to estimate sequela prevalence and (2) to describe the re-integration status of the hemiplegic patients. Method: Medical records of 120 patients presented at Bach Mai Hospital between 1996 to 1999 had been reviewed retrospectively; 64 patients had returned to followed up examination and 25 had been examnined at their home. Among them, 62.5% suffered from shoulder pain, 43.6% having the elbow contracture and 58.1% with wrist spastic flexion. 44.6% to 50% of the patients have difficulties in bathing and cloth changing. 51.8% were independent in ambulation. 35.42% of the patients at working age have income-generating activities. About 75% of the subjects have been socially integrated. Conclusion: These relative good results depended of active involvement of the patients and their family members in rehabilitation in-and after hospitalization.
Stroke, Outcome Assessment (Health Care)

OBJECTIVE: To evaluate the effect of prolonged inpatient rehabilitation therapy in subacute stroke patients. METHOD: We enrolled 52 subacute stroke patients who had received 3 months of inpatient rehabilitation therapy. Thirty stroke patients received additional inpatient rehabilitation therapy for 3 months and 22 control patients received only home-based care. The evaluation was measured at 3 and at 6 months after stroke occurrence. Functional improvement was measured using the modified motor assessment scale (MMAS), the timed up and go test (TUG), the 10-meter walking time (10 mWT), the Berg balance scale (BBS) and the Korean-modified Barthel index (K-MBI). The health-related quality of life was evaluated using the medical outcome study, 36-item short form survey (SF-36). RESULTS: In the experimental group, significant improvements were observed for all parameters at 6 months (p<0.05). However, significant improvements were observed only in MMAS, BBS, and K-MBI at 6 months in the Control group (p<0.05). In comparing the 2 groups, significant difference were observed in all parameters (p<0.05) except 10 meter walking time (p=0.73). The improvement in SF-36 was meaningfully higher in experimental group compared to control group. CONCLUSION: This study demonstrates that subacute stroke patients can achieve functional improvements and an enhanced quality of life through prolonged inpatient rehabilitation therapy.
Humans ; Inpatients ; Outcome Assessment (Health Care) ; Quality of Life ; Stroke ; Walking

The stroke rehabilitation evaluation system has been designed and developed in view of the present practice status of clinical rehabilitation medicine. The system not only implements patient information collection and rehabilitation evaluation, but also outputs individual rehabilitation program automatically according to evaluation outcome.
Humans ; Outcome Assessment (Health Care) ; methods ; Software Design ; Stroke Rehabilitation

PURPOSE: The aim of this study was to investigate if the 7–item Berg balance scale (BBS) 3–point, which is a short form of the BBS (SFBBS), has compatible psychometric properties in comparison with the original BBS, and also to study the concurrent validity using a 10-meter walk test (10mWT) and a timed up and go test (TUG), which are widely used with SFBBS in clinical settings. METHODS: A total of 255 patients who had experienced stroke participated in this cross-sectional study. We used results obtained from 188 patients who completed both 10mWT and TUG. The three levels in the center of the BBS were collapsed to a single level (i.e.,0-2-4) to form the SFBBS. The concurrent validity was assessed by computing the Spearman coefficients for correlation among outcome measures and in between each outcome measure and the SFBBS. As there were four outcomes, the corrected p-value for significant correlation was 0.013 (0.05/4). RESULTS: Spearman coefficients for correlations and evaluation instruments for concurrent validity revealed significantly high validity for both of SFBBS and BBS (r=0.944). 10mWT and TUG were −0.749 and −0.770 respectively, which are in the high margin and are statistically significant (p>0.000). CONCLUSION: SFBBS has sound psychometric properties for evaluating patients with stroke. Thus, we recommend the use of SFBBS in both clinical and research settings.
Cross-Sectional Studies ; Humans ; Outcome Assessment (Health Care) ; Psychometrics ; Stroke*

Stroke is a prototype disorder that disables as well as kills people. The disability-adjusted life years (DALY) metric developed by the World Health Organization to measure the global burden of disease integrates healthy life years lost due to both premature mortality and living with disability. Accordingly, it is well suited to stroke research. The DALY has previously been applied only to large but relatively crude population-level data analyses, but now it is possible to calculate the DALY lost in individual stroke patients. Measuring each patient's stroke outcome with DALY lost has expanded its application to the analysis of treatment effect in acute stroke trials, delineating the poststroke complication impact, the differential weighting of discrete vascular events, and estimating a more refined stroke burden in a specific population. The DALY metric has several advantages over conventional stroke outcome measures: 1) Since the DALY measures the burden of diverse health conditions with a common metric of life years lost, stroke burden and benefits of stroke interventions can be directly compared to other health conditions and their treatments. 2) Quantifying stroke burden or interventional benefits as the life years lost or gained makes the DALY metric more intuitively accessible for public and health system planners. 3) As a continuous, equal-interval scale, the DALY analysis might be statistically more powerful than either binary or ordinal rank outcome analyses in detecting the treatment effects of clinical trials. 4) While currently employed stroke outcome measures take one-time snapshots of disability or mortality and implicitly indicate long-term health impact, the DALY explicitly indicates the burdens of living with disability for an individual's remaining life.
Humans ; Mortality, Premature ; Outcome Assessment (Health Care) ; Statistics as Topic ; Stroke ; World Health Organization

OBJECTIVE: To investigate the effects of mirror therapy using a tablet PC for post-stroke central facial paresis. METHODS: A prospective, randomized controlled study was performed. Twenty-one post-stroke patients were enrolled. All patients performed 15 minutes of orofacial exercise twice daily for 14 days. The mirror group (n=10) underwent mirror therapy using a tablet PC while exercising, whereas the control group (n=11) did not. All patients were evaluated using the Regional House–Brackmann Grading Scale (R-HBGS), and the length between the corner of the mouth and the ipsilateral earlobe during rest and smiling before and after therapy were measured bilaterally. We calculated facial movement by subtracting the smile length from resting length. Differences and ratios between bilateral sides of facial movement were evaluated as the final outcome measure. RESULTS: Baseline characteristics were similar for the two groups. There were no differences in the scores for the basal Modified Barthel Index, the Korean version of Mini-Mental State Examination, National Institutes of Health Stroke Scale, R-HBGS, and bilateral differences and ratios of facial movements. The R-HBGS as well as the bilateral differences and ratios of facial movement showed significant improvement after therapy in both groups. The degree of improvement of facial movement was significantly larger in the mirror group than in the control group. CONCLUSION: Mirror therapy using a tablet PC might be an effective tool for treating central facial paresis after stroke.
Facial Paralysis* ; Humans ; Mouth ; National Institutes of Health (U.S.) ; Outcome Assessment (Health Care) ; Prospective Studies ; Smiling ; Stroke*

OBJECTIVE: To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke. METHODS: We recruited 75 patients with subacute hemiplegic stroke. Patients were divided into two groups according to the location of the lesion and the side of the dominant hand. Group 1 consisted of patients whose strokes affected the dominant hand (i.e., right hemiplegia and right dominant hand or left hemiplegia and left dominant hand). Group 2 consisted of patients whose strokes affected the non-dominant hand (i.e., left hemiplegia and right dominant hand or right hemiplegia and left dominant hand). The primary outcome measure was the Short-Form 36-Item Health Survey (SF-36), which was used to evaluate health-related QOL. Secondary outcomes were scores on the Modified Barthel Index (MBI) and Beck Depression Inventory (BDI). RESULTS: We did not find any statistically significant differences between the groups in any SF-36 domain including the summaries of physical and mental component. Similarly, the MBI and BDI scores were not significantly different between the groups. CONCLUSION: The effect of paralysis on the dominant hand and QOL in patients with subacute stroke was not significantly different from the effect of paralysis on the non-dominant hand.
Depression ; Hand* ; Health Surveys ; Hemiplegia ; Humans ; Outcome Assessment (Health Care) ; Paralysis* ; Quality of Life* ; Stroke*

BACKGROUND AND PURPOSE: Recombinant tissue plasminogen activator (rtPA) is one of the proven therapies that improve the outcome of patients with acute ischemic stroke (AIS). In 2009, the Ministry of Health and Welfare, Executive Yuan, Republic of China, launched the project “Hospital Emergent Capability Accreditation by Level-Stroke (HECAL-Stroke)” to improve AIS treatment in Taiwan. The current study was performed to determine whether the project launched by the government was effective in promoting rtPA therapy among AIS patients. METHODS: All participating hospitals were verified and designated as “heavy duty (HD),”“moderate duty (MoD),” or “medium duty (MeD)” according to the stroke center criteria. Four annual indices (rates of treatment, protocol adherence, in-time treatment, and complications) were recorded from 2009 to 2014 as outcome measures. The data were analyzed using the χ² test for significance. RESULTS: The number of certified hospitals progressively increased from 74 to 112 during the 6-year period and finally consisted of 33 HD, 9 MoD and 70 MeD hospitals in 2014. The annual intravenous rtPA treatment rate increased significantly from 3.0% in 2009 to 4.5% in 2014. The protocol adherence rates were 95.7% in the HD group, 92.4% in the MoD group and 72.8% in the MeD group. The annual in-time treatment rate significantly improved from 26.0% in 2009 to 60.1% in 2014. The overall symptomatic intracranial hemorrhagic rate after rtPA treatment was 8.6%. CONCLUSIONS: Initiation of the HECAL-Stroke project by the government significantly improved rtPA treatment in Taiwan.
Accreditation* ; Humans ; Outcome Assessment (Health Care) ; Stroke* ; Taiwan* ; Tissue Plasminogen Activator

OBJECTIVE: To investigate the effects of robot-assisted arm training on motor and functional recovery of upper limb in patients with subacute stroke. METHOD: Thirty one subacute stroke patients were randomly divided into 2 groups. Robot-assisted arm training group received robot-assisted therapy using Armeo(R)Spring (Hocoma Inc., Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional arm training with same duration and frequency as robotic group. Outcome measures were used manual muscle test (MMT) for motor strength, Fugl-Meyer assessment (FMA), Manual function test (MFT) for arm function, Korean-modified Barthel index (K-MBI) for activities of daily living, Korean-mini mental state examination (K-MMSE) and Computerized Neuro-Cognitive Function test software-40 (CNT-40) for cognitive function. All recruited patients underwent these evaluations before and after four weeks robot-assisted arm training. RESULTS: Robot-assisted training on upper limb after subacute stroke showed improvement on motor strength, arm function, and activities of daily living. But change values in terms of MMT, FMA, MFT, K-MBI exhibited a no statistically significant difference compared with conventional group (p>0.05). CONCLUSION: In patients with upper limb deficits after subacute stroke, Robot-assisted arm training was considered to facilitate motor and functional recovery of upper limb. But robot-assisted arm training did not significantly improve motor and arm function at 4 weeks compared with conventional arm training group. Further research is required about the comparison of conventional rehabilitation therapy group and the questions about the duration, severity of stroke.
Activities of Daily Living ; Arm* ; Humans ; Outcome Assessment (Health Care) ; Rehabilitation ; Stroke* ; Upper Extremity

In clinical trials, treatment response should be assessed with appropriate outcome measure and analytic methods. Selection of outcome measure is dependent on the characteristics of subjects and given therapy. For stroke prevention trials, the usual outcome measure is the composite of clinical events such as non-fatal stroke, non-fatal myocardial infarction, or vascular death. On the other hand, for acute stroke trials, stroke severity and functional outcome are essential outcome measures. Neuroimaging is an emerging tool of outcome measure as well as a means of optimizing patient selection in stroke trials. For the analysis of therapeutic efficacy, measured outcomes were usually dichotomized to "good" or "bad" according to arbitrary criteria. Although this approach makes the result of clinical trials easy to interpret, it may have the great chance of missing the clinically important, but modest therapeutic efficacy. To overcome this disadvantage, new analytic strategies such as sliding dichotomy and shift analysis have been proposed. Understanding of outcome measures and analytic methods is important to interpret or design the stroke clinical trials.
Hand ; Myocardial Infarction ; Neuroimaging ; Outcome Assessment (Health Care)* ; Patient Selection ; Stroke*