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)

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

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

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 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*

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 explore the amount of practice and progression during task-oriented circuit training (TOCT) in chronic stroke survivors; to test the use of pedometers and observation-based measures in detecting step activity; to verify the possible correlation between step activity and locomotor function improvements. METHODS: Six community-dwelling chronic stroke survivors underwent 10 TOCT sessions (2 hours/each) over 2 weeks in which they were trained both on a treadmill and on six task-oriented workstations (W1–W6). During the sessions, they wore a piezoelectric pedometer and step activities were recorded. Outcome measures were as follows: % of activities during which pedometers worked properly; pedometer-based measures (total step counts, treadmill steps, workstation steps—total and W2,W3,W5,W6); observation-based measures (number of repetitions in task W1 and W4); walking speed changes measured by the 10-m walking test (10MWT) and walking endurance changes (6-minute walking test) after TOCT. RESULTS: During TOCT sessions (n=57), activities were recorded through pedometer-based measures in 4 out of the 6 patients. The total amount of step activity was 5,980.05±1,968.39 steps (54.29% in task-oriented workstations, 37.67% on treadmill, and 8.03% during breaks). Exercise progression was highlighted significantly by observational measures (W1, W4). A positive correlation was observed between increased gait speed and observational stair step repetitions progression (W1) (r=0.91, p=0.01) or pedometer-based tandem exercise step progression (W3) (r=0.98, p=0.01). CONCLUSION: TOCT can be considered a high-intensity, progressive intervention to restore locomotor function in chronic stroke survivors. Pedometer-based measures might help in quantifying TOCT's volume of practice; however, further investigations are required.
Circuit-Based Exercise* ; Feasibility Studies* ; Gait ; Humans ; Outcome Assessment (Health Care) ; Rehabilitation ; Stroke* ; Survivors* ; Walking

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*

OBJECTIVE: To investigate the efficacy of balance control training using a newly developed balance control trainer (BalPro) on the balance and gait of patients with subacute hemiparetic stroke. METHODS: Forty-three subacute stroke patients were assigned to either a balance control training (BCT) group or a control group. The BCT group (n=23) was trained with BalPro for 30 minutes a day, 5 days a week for 2 weeks, and received one daily session of conventional physical therapy. The control group (n=20) received two sessions of conventional physical therapy every day for 2 weeks. The primary outcome was assessment with the Berg Balance Scale (BBS). Secondary outcomes were Functional Ambulation Category (FAC), the 6-minute walking test (6mWT), Timed Up and Go (TUG), the Korean version of Modified Barthel Index (K-MBI), and the manual muscle test (MMT) of the knee extensor. All outcome measures were evaluated before and after 2 weeks of training in both groups. RESULTS: There were statistically significant improvements in all parameters except MMT and FAC after 2 weeks of treatment in both groups. After training, the BCT group showed greater improvements in the BBS and the 6mWT than did the control group. CONCLUSION: Balance control training using BalPro could be a useful treatment for improving balance and gait in subacute hemiparetic stroke patients.
Gait ; Humans ; Knee ; Outcome Assessment (Health Care) ; Postural Balance ; Stroke* ; Walking