Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program

Chan-Lin Chu; Yueh-Peng Chen; Carl C P Chen; Chih-Kuang Chen; Hsiang-Ning Chang; Chien-Hung Chang; Yu-Cheng Pei

doi:10.2147/NDT.S253700

Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program

Neuropsychiatr Dis Treat. 2020 Aug 13:16:1975-1985. doi: 10.2147/NDT.S253700. eCollection 2020.

Authors

Chan-Lin Chu^{1

2}, Yueh-Peng Chen³, Carl C P Chen^{3

4}, Chih-Kuang Chen^{3

4}, Hsiang-Ning Chang⁴, Chien-Hung Chang^#^{1

2

5}, Yu-Cheng Pei^#^{3

4

6

7}

Affiliations

¹ Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
² School of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁴ Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁵ Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.
⁶ Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
⁷ Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.

^# Contributed equally.

Abstract

Background: Tailored rehabilitation programs for stroke patients cannot be made without knowledge of their recovery potential. The aim of this study is to characterize the functional recovery patterns of ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients under post-acute care stroke rehabilitation.

Methods: This retrospective study analyzed the data of patients enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) rehabilitation program, which provides an individualized 1- to 3-hour intensive physical, occupational, and speech and language therapy for post-acute stroke patients in Taoyuan Chang Gung Memorial hospital in Taiwan. Our primary endpoint measure was Barthel Index (BI), and secondary endpoint measures included other 12 functional measures.

Results: A total of 489 patients were included for analysis. Patients with stroke history had less BI improvement than those who suffered their first-ever stroke. In first-ever stroke patients who had completed 6 to 12 weeks of PAC-CVD program, subcortical ICH patients had greater BI, quality of life, sensation, and balance improvements, and had greater late-phase recovery than their IS counterparts. In IS patients, those with age >75 had less BI improvement; those with National Institute of Health Stroke Scale (NIHSS) score 1-5 had greater Motor Activity Log quality of use (MAL-quality) improvement than those with NIHSS score >5; those with Mini-Mental State Examination (MMSE) score ≥24 had greater BI and instrumental activities of daily living (IADL) improvement. Using the general linear model, previous stroke (ß: -6.148, p=0.01) and subcortical ICH (ß: 5.04, p=0.03) were factors associated with BI improvement.

Conclusion: Subcortical ICH patients have greater functional improvement and greater late-phase recovery than their IS counterparts following PAC rehabilitation. More studies are needed to validate our findings and unravel the underlying mechanisms of stroke recovery to optimize the treatment strategy following a stroke.

Keywords: activities of daily living; functional recovery; hemorrhagic stroke; ischemic stroke; post-acute care; rehabilitation.

Grants and funding

This project was supported by Chang Gung Medical Foundation Grants, CMRPG3B0111-3,CMRPG3G0901, CMRPG5H0051-3, and CMRPG3K0231-2.