Neuropathic pain and pain catastrophizing are common after stroke and may be associated with poorer rehabilitation outcomes. However, their independent associations with functional recovery remain insufficiently explored. This study aimed to determine the frequency of neuropathic pain and pain catastrophizing in patients with stroke and to examine their associations with post-treatment rehabilitation outcomes. In this prospective observational study, patients with post-stroke hemiplegia undergoing inpatient rehabilitation were evaluated at baseline and after a 4-week rehabilitation program. Functional status was assessed using the Barthel Index, Brunnstrom Staging, Modified Ashworth Scale, and Functional Ambulation Classification. Quality of life was assessed using the SF-12. Neuropathic pain and pain catastrophizing were assessed using the painDETECT questionnaire and Pain Catastrophizing Scale. Baseline-adjusted linear regression models examined whether baseline painDETECT and Pain Catastrophizing Scale scores were independently associated with post-treatment outcomes. Eighty patients were included. At baseline, 10 patients (12.5%) had possible neuropathic pain, 17 (21.3%) had definite neuropathic pain, and 15 (18.8%) had clinically significant pain catastrophizing. After rehabilitation, possible and definite neuropathic pain were observed in 5 (6.3%) and 8 patients (10.0%), respectively, and clinically significant pain catastrophizing in 9 patients (11.3%). Functional and pain-related outcomes improved after rehabilitation. In adjusted models, higher baseline Pain Catastrophizing Scale scores were independently associated with lower post-treatment Barthel Index and Functional Ambulation Classification scores. Baseline painDETECT scores were not independently associated with post-treatment outcomes. Pain catastrophizing, but not painDETECT score, was independently associated with poorer post-treatment functional independence and ambulation.
Disorders of consciousness and impaired neurological recovery are common during acute hospitalization for stroke, yet evidence-based pharmacologic strategies to enhance neurorecovery remain limited. Amantadine is frequently used off-label in this setting based on data from traumatic brain injury; however, evidence supporting its use in stroke is unclear. To systematically review the available literature evaluating the use of amantadine during acute hospitalization in adult patients with stroke. This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251273897). PubMed/MEDLINE, Embase, and Cochrane CENTRAL were searched for studies that included adults with stroke who received amantadine during acute hospitalization compared to standard care without amantadine, placebo, or within-cohort comparisons among amantadine-treated patients. Outcomes of interest included recovery of consciousness, neurological and functional outcomes, in-hospital mortality, and adverse events. Due to heterogeneity in study design, patient populations, and outcome measures, a quantitative meta-analysis was not performed. Seven studies involving a total of 929 patients were included, the majority with stroke, although one mixed non-traumatic brain injury cohort also included patients with status epilepticus (n = 29) and bacterial meningitis (n = 11). Amantadine was initiated during acute hospitalization, mostly in the intensive care unit, at doses of 100-200 mg twice daily. Across observational cohorts, 50-65% of patients responded to amantadine, defined as improvement in arousal or recovery of consciousness, with higher response rates observed in smaller cohorts. Amantadine exposure was also associated with earlier improvement in consciousness compared with no treatment. However, no consistent long-term functional effect or reduction in mortality was reported. Amantadine was generally well tolerated; reported adverse events included seizures (5-13%), agitation (6-14%), QTc prolongation (up to 8%), and sleep disruption (16%). No consistent safety signal attributable to amantadine was identified, although comparative safety data were limited. Risk of bias ranged from low to moderate across the included studies. The evidence supporting amantadine use during acute hospitalization for stroke is limited and heterogeneous. While amantadine is commonly used to promote arousal in patients with impaired consciousness after stroke, available data do not allow firm conclusions regarding efficacy for functional recovery or mortality, and safety conclusions remain limited by inconsistent adverse-event reporting. Prospective, stroke-specific studies conducted in the acute hospital setting are needed to clarify the efficacy, optimal timing, and safety of amantadine in this population.
To compare the effects of different exercise modalities on lower-limb balance and functional motor performance after stroke and to examine their nonlinear dose-response relationships to identify potentially optimal exercise doses using a Bayesian network meta-analysis. A systematic search of PubMed, Embase, Web of Science, the Cochrane Library, and SPORTDiscus identified 54 randomized controlled trials (RCTs). A Bayesian random-effects dose-response network meta-analysis examined associations between total exercise dose, exercise modalities, and lower-limb balance and functional mobility after stroke. Both lower-limb balance and functional movement outcomes showed clear nonlinear improvements with increasing total exercise doses, peaking at approximately 1,800-2,200 MET×min/week. Beyond this range, marginal benefits plateaued or declined, with greater inter-individual variability. For lower-limb balance, gains stabilized or slightly decreased past 2,200 MET×min/week. Functional movement improvements formed an early plateau at around 1,800 MET×min/week, sustained up to 2,200, then gradually diminished. Exercise modalities displayed distinct dose sensitivities: integrated aerobic training (IAT) rapidly achieved peak benefits at moderate loads, supporting early rehabilitation; motor control training (MCT) maintained stable effects over a broader range, facilitating long-term neuromuscular reinforcement; virtual reality training (VRT) showed localized peaks at low to moderate doses but exhibited increased uncertainty at higher levels. This study suggests that moderate weekly exercise doses may improve lower-limb balance and functional mobility after stroke, with dose-response patterns differing across exercise modalities. These findings support dose regulation and individualized exercise prescription, although further high-quality trials are needed to confirm the observed dose ranges and modality-specific effects. This study is the first to apply a Bayesian non-linear network meta-analysis to model the joint effects of exercise dose and training modality in stroke rehabilitation, addressing the critical gap in prior research that lacked integrated, quantitative guidance for optimizing intervention strategies.It identifies an optimal total exercise dose of approximately 1800–2200 MET×min/week for improving lower-limb balance and functional motor performance in stroke patients. Beyond this threshold, benefits plateau or slightly decline, accompanied by increased interindividual variability.It demonstrates distinct dose-response profiles across modalities: integrated aerobic training (IAT) peaks at moderate doses, motor control training (MCT) sustains effects over a broader range, and virtual reality training (VRT) shows localized benefits at low-to-moderate doses with greater variability in outcomes.
To evaluate the synergistic mechanisms and clinical efficacy of integrating acupuncture with modern rehabilitation (including functional swallowing training and neuromuscular electrical stimulation) for post-stroke dysphagia (PSD). This is a narrative review with a systematic literature approach.This review synthesizes evidence from recent randomized controlled trials, meta-analyses, and mechanistic studies on combined acupuncture and rehabilitation interventions for PSD. Key outcomes assessed include swallowing function (VFSS, FOIS), aspiration pneumonia rates, and quality-of-life measures. Current evidence demonstrates that combining acupuncture with conventional rehabilitation yields superior improvements in swallowing function, oral intake, and aspiration reduction compared to rehabilitation alone. Acupuncture enhances neuroplasticity, modulates central and peripheral swallowing circuits, and reduces inflammation, while rehabilitation strengthens neuromuscular coordination. Synergistic effects arise as acupuncture primes neural substrates, facilitating more efficient gains from rehabilitative exercises. However, challenges include heterogeneity in acupuncture protocols, limited mechanistic clarity, and practitioner variability. Integrative therapy combining acupuncture and modern rehabilitation represents a potentially promising strategy that requires further validation through ri-gorously designed studies for managing PSD. With further standardization, mechanistic research, and international collaboration, this approach could become a widely accepted, effective treatment to improve swallowing recovery and quality of life among stroke survivors. This narrative review employed a systematic literature search strategy. Databases searched included PubMed, Web of Science, CNKI (China National Knowledge Infrastructure), and Wanfang Data, covering the period from inception to October 2024. Search terms combined keywords including “post-stroke dysphagia,” “acupuncture,” “electroacupuncture,” “rehabilitation,” “swallowing training,” “neuromuscular electrical stimulation,” “randomized controlled trial,” and “meta-analysis.” Inclusion criteria were: (1) randomized controlled trials, prospective cohort studies, retrospective studies, systematic reviews, and meta-analyses; (2) studies evaluating acupuncture (manual or electroacupuncture) combined with rehabilitation interventions for post-stroke dysphagia; (3) studies reporting swallowing function outcomes (Videofluoroscopic Swallowing Study, Functional Oral Intake Scale, Standardized Swallowing Assessment, Water Swallow Test, etc.), quality of life, or complication rates. Two independent reviewers screened titles and abstracts, with disagreements resolved by discussion or a third reviewer.
Stroke survivors often depend on caregivers for assistance with activities of daily living (ADL), yet it remains unclear which individuals receive more assistance long-term. We examined predictors of the quantity of informal caregiving in the first year following their stroke. Data from the National Health and Aging Trends Study (2011-2020, n = 578) was used in this retrospective cohort study of older adults. Individuals with at least 1 formal or informal caregiver who reported an incident stroke were included. Multivariate negative binomial regression analyses identified informal caregiver and stroke survivor characteristics associated with the quantity of informal caregiving received. Regression coefficients were converted to average marginal effect (AME) to describe the predicted number of informal caregiving hours. Community-dwelling stroke survivors received a median of 15.2 (IQR, 4.1-47.0) hours/week of informal caregiving from an average of 2.3 (SD 1.4) informal caregivers within one-year of an incident stroke. Stroke survivors who were males, married, had more physical and cognitive impairments received more informal caregiving. Relative to individuals with 0-1 ADL limitations receiving 10 informal care hours/week, on average, those with 5-7 ADL limitations received 2.7 more hours/week (AME: 2.65, 95% CI: 1.47-3.83); p < 0.001). Subgroups of non-White stroke survivors and those with primary caregivers tend to receive more informal care than White stroke survivors and those with shared caregivers, respectively. Within this nationally representative dataset, specific stroke survivor demographic and clinical variables were associated with high amounts of informal caregiving which may help inform policy and future interventions to effectively allocate resources and target high-need families. Community-dwelling stroke survivors who were males, married, or had more physical and cognitive impairments received more informal caregiving within one year after a strokeNon-White stroke survivors and those with primary caregivers tend to receive more informal care than White stroke survivors and those with shared caregivers, respectively.Why does this paper matter?We identified clinical and demographic factors associated with high amounts of informal caregiving in the subsequent year after a stroke. The results of this study may help guide policy development and resource allocation, enabling targeted interventions to effectively support families with high caregiving needs.
Chronic ischemic stroke survivors experience cognitive, emotional, and participation-related limitations that affect reintegration into the community and life satisfaction. Mindfulness-Based Stress Reduction (MBSR) and Cognitive Rehabilitation Therapy (CRT) may aid in the recovery process of stroke survivors. These rehabilitation programs may act through different mechanisms. However, little is known about the domain-specific responsiveness of stroke survivors to these rehabilitation programs. The objectives of this study were to investigate the domain-specific functional responsiveness of stroke survivors with chronic ischemic stroke to both mindfulness-based and cognitive rehabilitation programs, especially in terms of participation, communication, and cognitive outcomes. This controlled longitudinal study consisted of 36 stroke survivors with chronic ischemic stroke who were randomly assigned to one of the three groups: MBSR, cognitive rehabilitation based on Powell's protocol, or a control group. Participants underwent the Stroke Impact Scale (SIS) assessment. Changes in SIS domain scores from baseline to post-intervention and two-month follow-up were evaluated using repeated measures analysis of variance. The results revealed that the patterns of domain-specific responsiveness varied between the interventions. It was noted that the mindfulness-based intervention showed better recovery in cognitive-affective domains, especially memory, thinking, and participation/role function. Conversely, cognitive rehabilitation showed better recovery in communication-related outcomes. No significant recovery was noted in the control group for any of the domains. The study suggests that both mindfulness-based and cognitive rehabilitation interventions facilitate recovery through unique pathways in chronic ischemic stroke survivors. Domain-specific responsiveness may be a valuable tool for providing clinically relevant information for tailoring rehabilitation approaches according to individual patient characteristics.
Assessing hallux (big toe) pulling force after stroke is important for rehabilitation. The Enhanced Paper Grip Test (EPGT) is a simple method to measure this force. This cross-sectional observational study aimed to determine the reliability and validity of the EPGT in individuals post-stroke. Forty-four patients with ischemic stroke, aged 18 to 65 years (mean time since stroke 11.94 ± 6.31 months), participated in this study. The EPGT was applied in two sessions one week apart by two physiotherapists. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients [ICC (3,1)]. Convergent validity was assessed by correlating EPGT scores with the modified mini-BESTest and ankle muscle strength measurements. The EPGT demonstrated excellent intra-rater reliability (ICC = 0.927-0.990) and inter-rater reliability (ICC = 0.953-0.992). EPGT scores were strongly correlated with the modified mini-BESTest scores, with higher correlations on the affected side (ρ = 0.927, p < 0.001) than the non-affected side (ρ = 0.639, p < 0.001). Significant positive correlations were also observed between EPGT scores and ankle muscle strength, particularly on the affected side (ankle plantar flexors: ρ = ;0.826, p < 0.001; ankle dorsiflexors: ρ = 0.846, p < 0.001), while moderate-to-weak correlations were found on the non-affected side (APF: ρ = 0.435, p = 0.01; ADF: ρ = 0.353, p = 0.04). The EPGT is a valid and reliable tool for assessing hallux (big toe) pulling force post-stroke and can be quickly applied in clinical settings. ClinicalTrials.gov (NCT07181005). The Enhanced Paper Grip Test (EPGT) is a reliable and valid tool for assessing side-specific ankle muscle strength in patients post-stroke, enabling clinicians to quickly quantify hemiparetic lower limb weakness in routine practice.EPGT scores show significant correlations with balance performance (modified mini-BESTest) and ankle muscle strength, particularly on the affected side, providing clinicians with a practical, objective measure to guide individualized rehabilitation and fall-risk management.The test is simple, low-cost, and requires minimal training, allowing for safe, rapid assessments in clinical settings, supporting both initial evaluation and ongoing monitoring of recovery in post-stroke rehabilitation.
Stroke rehabilitation requires a multidisciplinary approach, in which nurses contribute to the continuity and coordination of care. While their role is integral within the rehabilitation team, the experiential and contextual dimensions of nursing practice in stroke rehabilitation remain insufficiently explored. This study aimed to explore the lived experiences of nurses in stroke rehabilitation and to identify factors influencing their roles and working conditions. A qualitative study with a phenomenological orientation was conducted in two rehabilitation hospitals. Data were collected through face-to-face semi-structured interviews with 14 nurses. Data collection continued until sufficient depth and richness of the data were achieved. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis supported by MAXQDA Analytics Pro 2024. Three main themes were identified: (1) the integrative role, (2) everyday challenges, and (3) working conditions. Nursing practice was experienced as requiring continuous vigilance, emotional regulation, and ongoing negotiation between patient needs, safety, and organizational constraints. This study reconceptualizes nursing roles in stroke rehabilitation as integrative practices rather than task-based functions. The findings highlight the need for organizational strategies that better support nurses in managing complex clinical and emotional demands, which may enhance nurses' well-being and improve the quality of rehabilitation care.
Stroke is a leading cause of long-term disability globally, substantially impairing quality of life (QoL) in survivors. While maladaptive metacognitive beliefs is regarded as a potentially influential factor, the underlying mechanism through which it influences QoL remains unclear. To investigate QoL among stroke survivors, identify its influencing factors, and explore the mediating role of rehabilitation motivation between maladaptive metacognitive beliefs and QoL as well as the moderating role of education level. In this cross-sectional study, 772 convalescent stroke survivors were recruited from four Grade A tertiary hospitals in Henan Province, China, between October 2024 and August 2025. Data were collected using general characteristics questionnaire, the Metacognition Questionnaire, the Stroke Rehabilitation Motivation Scale, the Short-Version Stroke-Specific Quality of Life Scale, and the Barthel Index. Model 7 in process version 4.1 was used to test the moderated mediation model. QoL was significantly correlated with occupation, residential status, stroke family history, stroke type, activities of daily living (ADL), metacognition, and rehabilitation motivation. The moderated mediation model involving rehabilitation motivation and education level for explaining how metacognition was associated with QoL was validated. Specifically, the mediating pathway through rehabilitation motivation was stronger among stroke survivors with higher education compared with those with lower education. Among stroke survivors, the association of metacognition with QoL is mediated by rehabilitation motivation, with this association being amplified by education level. For stroke survivors with varying education levels, interventions such as metacognitive therapy may improve metacognitive abilities, enhance rehabilitation motivation, and thereby promote QoL.
Occupational therapy (OT) is an important component of stroke rehabilitation, but the global research landscape, collaboration patterns, research hotspots, and emerging trends in OT for stroke have not been systematically mapped. This bibliometric study aimed to analyze publications on OT for stroke from 2006 to 2025 and provide evidence for future clinical practice and research planning. English-language articles related to OT for stroke were retrieved from the Web of Science Core Collection from January 1, 2006, to October 31, 2025. After applying predefined inclusion and exclusion criteria, bibliometric and visualization analyses were performed using VOSviewer and CiteSpace 6.4.R1. Publication trends, countries, institutions, authors, journals, keyword co-occurrence, keyword clustering, timeline evolution, and burst terms were analyzed. A total of 770 publications were included. The annual number of publications showed a fluctuating but overall upward trend, with the highest output observed in 2021 and 2022, each with 60 publications. The United States, Australia, the United Kingdom, and China were the leading contributing countries, while Jikei University and La Trobe University were the most productive institutions. The most prolific authors were Masahiro Abo and Louise Gustafsson. The British Journal of Occupational Therapy and Topics in Stroke Rehabilitation were the leading journals in terms of publication output. Keyword analyses showed that early research mainly focused on upper-limb function, functional recovery, and basic rehabilitation interventions, whereas recent hotspots have expanded to neurorehabilitation, knowledge translation, virtual reality, clinical trials, mental health, and home-based rehabilitation. Research on OT for stroke has increased overall over the past 2 decades, with evolving hotspots from impairment-oriented rehabilitation toward broader, occupation-centered, participation-oriented, technology-assisted, and home-based rehabilitation approaches. However, collaboration among countries, institutions, and authors remains relatively fragmented. Future studies should strengthen international and interdisciplinary cooperation and generate high-quality clinical evidence to support OT practice in stroke rehabilitation.
To develop and content-validate a protective factor - based nursing intervention aimed at enhancing rehabilitation resilience in stroke survivors. This study was guided by the Medical Research Council Framework for Developing and Evaluating Complex Interventions (the MRC framework). Focusing on the development phase (Phase I), we systematically integrated existing evidence, theoretical models, and clinical guidelines to construct a structured intervention protocol targeting rehabilitation resilience. A two-round Delphi process was conducted to evaluate content validity, with the Content Validity Index (CVI), coefficient of variation (CV), and Kendall's coefficient of concordance (W) used to assess expert consensus and reliability. Sixteen experts participated in the Delphi process, demonstrating high engagement and authority (authority coefficient = 0.875). Consensus improved across rounds, with CV values decreasing (0-0.29 to 0-0.20) and Kendall's W increasing (0.276 to 0.519). All intervention items achieved excellent content validity (I-CVI = 1.00; S-CVI = 1.00). The finalized intervention protocol is structured across four rehabilitation phases: early rehabilitation, mid-stage rehabilitation, late rehabilitation, and discharge planning, with each phase targeting key protective factors to enhance resilience.Conclusion: A theoretically grounded and evidence-informed rehabilitation resilience nursing intervention was successfully developed and validated. The protocol demonstrates strong content validity, clinical relevance, and feasibility, providing a robust foundation for subsequent feasibility testing and randomized controlled trials. This work addresses a critical gap in the literature by offering a transparent and systematic description of intervention development for resilience-based stroke rehabilitation.
Falls during walking remain a major cause of disability after stroke. Perturbation-based balance training (PBBT) improves reactive stability, but its effects on gait-related neuromuscular coordination and the added value of functional electrical stimulation (FES) are not well established. To determine whether PBBT, performed with or without task-synchronized FES, improves clinical performance, intermuscular coordination during gait, and reactive balance stability in individuals with chronic stroke. In this randomized controlled trial, 35 ambulatory individuals ≥ 6 months post-stroke were allocated to PBBT alone (n = 18) or PBBT combined with FES (n = 17). Participants completed eight sessions over four weeks. Outcomes were assessed at baseline, post-intervention, and 3-month follow-up. Clinical measures included the Mini-BESTest, Timed Up and Go (TUG), Fugl-Meyer Assessment-Lower Extremity, and 10-Meter Walk Test. Neuromuscular coordination was quantified using the Peak Activation Interval (PAI) between vastus lateralis and medial gastrocnemius during gait. Reactive balance stability was assessed using center-of-mass (CoM) stability after balance perturbation. Linear mixed-effects models were used for analysis. Significant main effects of Time were observed across clinical outcomes (p < 0.05), with improvements maintained at follow-up. PAI increased from baseline to post-intervention (β = 7.29, p = 0.003), indicating improved intermuscular timing. CoM stability improved from baseline to post-intervention (β = 0.171, p < 0.001) and remained higher at follow-up (p = 0.009). No significant Group × Time interactions were detected (all p > 0.05). PBBT improved mobility, gait neuromuscularcoordination, and reactive balance stability in persons with stroke. Theaddition of FES did not provide additional group-level benefit. NCT06237972.
Transcutaneous spinal cord stimulation (tSCS) is an emerging noninvasive neuromodulation approach for rehabilitation in individuals with stroke. Studies have suggested benefits, but evidence remains fragmented and methodologically heterogeneous. This scoping review maps and synthesizes current evidence on tSCS for stroke rehabilitation, focusing on study design, stimulation parameters, outcome measures, and reported effects. Following PRISMA-ScR guidelines, we systematically searched five databases (PubMed, Embase, Web of Science, CINAHL, and Google Scholar) from inception to December 2025. Two independent reviewers screened titles and abstracts, with a third resolving discrepancies. We extracted data on participant characteristics, stimulation parameters, outcome measures, and findings. Thirteen studies met inclusion criteria, comprising five randomized and eight non-randomized designs, with sample sizes ranging from 2 to 21 participants. Most studies enrolled predominantly male individuals with chronic stroke. Four studies used multi-session protocols while nine single session protocols. Stimulation parameters varied widely amplitude (5-250 mA), frequency (15-100 Hz), carrier frequency (0-10 kHz), and pulse width (0.5-2 ms). Ten studies targeted lower-extremity function, two upper extremity functions, and one autonomic function. Multi-session trials pairing tSCS with task-specific training reported improvements in selected outcomes, though small sample sizes limit generalization. tSCS remains an exploratory adjunctive intervention in stroke rehabilitation. Future research should prioritize adequately powered controlled trials with standardized stimulation protocols, stratification by stroke severity and chronicity, and long-term follow-up to establish clinical efficacy and optimal implementation in stroke rehabilitation.
Recent emerging evidence suggests that vagus nerve stimulation combined with exercise training (VNS+training) is effective in improving upper limb recovery in people with stroke. The current study aimed (1) to conduct a meta-analysis of the effectiveness VNS+training on upper limb recovery and (2) to identify potential factors that may affect the effect size (ES)of VNS+training in people with stroke. The electronic databases CINAHL, Medline, Cochrane Library, EMBASE, PubMed, Scopus, Web of Science, CINAHL, CNKI, and WANFANG, were systematically searched from inception to July 2025. Studies investigating the effectiveness of VNS+training on upper limb recovery in people with stroke were included. A total of 13 articles were included in the systematic review, and data from 10 discrete studies with 424 participants were included in the meta-analysis. The ES of VNS+training was large in motor impairment (g = 1.264, 95% CI = 0.727-1.800) and in motor function (g = 0.728, 95% CI = 0.354-1.102) and was moderate in activities of daily living (ADL) (g = 0.508, 95% CI = 0.190-0.826). Subgroup analyses revealed larger effects for participants who received VNS prior to exercise training (with transcutaneous auricular VNS and at acute/subacute phase of stroke). The effectiveness of VNS+training in improving upper limb impairment, function, and ADL in people with stroke were found to be significantly higher than that of control group. The larger ES suggests that prior taVNS may have a more beneficial effect than concurrent taVNS. Further well-designed, adequately powered studies are needed to confirm these findings and directly compare prior versus concurrent taVNS.
The performance fatigue index provides objective measures for assessing the impact of fatigue on performance and it may be utilized for monitoring functional outcomes in individuals with stroke; however, its psychometric properties have been minimally studied in this population. To examine the test-retest reliability and agreement; known-group validity of the performance fatigue index; and its correlations with self-perceived fatigue, depressive symptoms, sleep quality, and reintegration to normal living in people with stroke. Participants with and without stroke completed a 6-minute walk test for calculating the performance fatigue index. Participants with stroke also completed the Fatigue Assessment Scale, the Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, and the Reintegration to Normal Living Index. The intra-class correlation coefficient, standard error of measurement, minimal detectable change, and known group validity of the performance fatigue index were determined. Spearman's correlation was used to examine the relationships between the index and other variables. The intra-class correlation coefficient of the performance fatigue index was 0.99, the standard error of measurement was 0.53 and the minimal detectable change was 1.46. The performance fatigue index could be used to differentiate individuals with stroke from those without stroke. It significantly correlated with self-perceived physical fatigue subscore (rs = 0.29, p = .034) and reintegration to normal living (rs = -0.34, p = .012) but not correlated with self-perceived mental fatigue subscore, depressive symptoms, or sleep quality. The performance fatigue index is reliable and valid in assessing and monitoring post-stroke physical fatigue in clinical and research settings.
Weakness in respiratory muscles following a stroke may hinder the regulation of intra-abdominal pressure, potentially escalating the risk and severity of urinary incontinence (UI). A thorough understanding of how respiratory muscle strength and diaphragm function relate to UI in stroke patients is essential for comprehensive clinical assessment. This study aimed to explore the connection between maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), diaphragm function, and symptoms of urinary incontinence in stroke patients. Fifty stroke patients (mean age 60.16 ± 9.56 years; 74% male) participated in the study. Respiratory muscle strength was assessed through standardized measurements of MIP and MEP. Endurance was evaluated with the Inspiratory Threshold Load (ITL) test. The effect of UI on quality of life was assessed using the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Diaphragm function was measured with specific tests based on the Dynamic Neuromuscular Stabilization (DNS) method. Differences between symptomatic and asymptomatic groups were analyzed using Pearson correlation, independent t-tests, Mann-Whitney U tests, and chi-square tests. Significant negative correlations were found between MIP and ITL scores and the severity of urinary incontinence (p < 0.001), while MEP exhibited weaker but still significant correlations (p < 0.05). Patients with urinary incontinence demonstrated significantly reduced diaphragm function compared to their asymptomatic counterparts (p < 0.01). In individuals with stroke, diminished respiratory muscle strength, particularly diaphragm dysfunction, is linked to increased severity of UI. These findings highlight the necessity of evaluating respiratory muscle function in this population. NCT07048210.
Spasticity is a common condition among stroke survivors, and previous studies have explored the effects of whole-body vibration therapy for its benefits. However, the findings regarding lower limb spasticity remain inconsistent. Thus, the aim of this study was to determine the effect of eight-week whole-body vibration exercise on lower limb spasticity for stroke survivors. This is a single-blind randomized controlled trial. The 40 participants were eligible to participate the study and were allocated randomly to either an intervention group or control group. The intervention group implemented as 40 min of conventional therapy sessions and whole-body vibration training daily, five times a week for eight weeks; the control group implemented the same movements on a vibration platform without vibration with daily habitual living styles. The measurements were assessed at baseline, week four, and week eight. Primary outcomes were measured using the Modified Ashworth Scale and surface electromyography to measure spasticity. The Fugl-Meyer assessment was measured as a secondary outcome. In the intervention group, spasticity of the triceps surae decreased by a mean of 0.45 points on the Modified Ashworth Scale from baseline to mid-intervention, and the same mean reduction was maintained at post-intervention. However, the statistical between-group differences were not observed at either mid-intervention or post-intervention. No significant between-group or within-group differences were observed in surface electromyography outcomes or Fugl-Meyer Assessment scores in either the intervention or control group. Whole-body vibration therapy may contribute to improvements in lower-limb spasticity in stroke survivors and demonstrates some moderate effect sizes. These findings suggest that whole-body vibration may have potential benefits as a long-term adjunct therapy in stroke rehabilitation.Trial registrationThe registration number is ChiCTR1900026439. Whole-body vibration therapy reduces lower-limb spasticity in stroke survivorsThe intervention shows moderate effect sizes with a meaningful clinical impactRMS and Fugl–Meyer scores showed no significant between-group differences.
Predicting activities of daily living (ADL) in stroke patients optimizes discharge planning, which relies on accurate functional assessment. Recent studies have shown that functional connectivity (FC) of brain networks induced by upper extremity rehabilitation robotic training (UE-RAT) effectively reflects functional status, but its prognostic value for ADL remains unclear. Utilize functional near-infrared spectroscopy (fNIRS) to measure FC during UE-RAT and develop machine learning models to evaluate the predictive value of task-FC for ADL. This study recruited 86 patients with subacute stroke. Activation and FC features of key brain regions, such as the superior frontal cortex (SFC) and primary motor cortex (M1), were measured in the resting state and during UE-RAT using fNIRS. Concurrently, 38 clinical features were collected. With modified Barthel Index (mBI) ≥75 at discharge as the prediction target, machine learning algorithms such as artificial neural network (ANN) were used to construct resting-state fNIRS model, task-state fNIRS model, clinical model, and combined model, and analyze the importance of the predictor variables based on the Shapley additive interpretation (SHAP). The combined model constructed by combining clinical and task-state fNIRS features had the best predictive performance (AUC_mean: 0.955, 95% CI: 0.948-0.962). Higher connectivity between the ipsilateral premotor cortex (iPMC) and primary motor cortex (iM1) during the task state, along with higher mBI scores and lower mRS scores, predict significant improvement in functional independence for patients. UE-RAT induced FC can be a valid biomarker for mBI prediction and can improve the accuracy of rehabilitation prediction.
Gait alterations after stroke may lead to knee pain, limiting rehabilitation and reducing quality of life. To estimate the prevalence of knee pain and identify associated factors in ambulatory chronic stroke survivors. We conducted a cross-sectional study in 12 outpatient rehabilitation units in Vietnam, enrolling 212 patients with stroke. We recorded demographics, morbidities, knee pain, clinical examination findings and gait parameters. Weight-bearing asymmetry was measured using a two-scale method. Minimal knee flexion during the stance phase was derived from markerless gait analysis. Factors associated with knee pain were assessed using modified Poisson regression with robust standard errors to estimate adjusted prevalence ratios (aPRs). Multinomial logistic regression was performed to identify factors associated with pain laterality. The prevalence of knee pain was 19.8%. The following factors were independently associated with knee pain: age (aPR: 1.03; 95% CI: 1.01-1.06), stroke type (aPR: 2.51; 95% CI: 1.55-4.09), time since stroke onset (aPR: 1.08; 95% CI: 1.04-1.12), prior knee osteoarthritis (aPR: 2.27; 95% CI: 1.31-3.91), obesity (aPR: 1.84; 95% CI: 1.14-2.96), and quality of life (aPR: 0.02; 95% CI: 0.01-0.06). Smaller minimal knee flexion was associated with a higher risk of ipsilateral knee pain (p = 0.009). The prevalence of knee pain among ambulatory chronic stroke survivors was approximately 20%. Older age, hemorrhagic stroke, longer poststroke time, obesity, prior knee osteoarthritis, and poorer quality of life were independently associated with knee pain. Greater hyperextension during stance was associated with a higher risk of knee pain in the affected limb.
Stroke incidence among working-age adults is increasing, making return to work (RTW) a key milestone in recovery and quality of life. However, post-stroke professional reintegration remains challenging, often requiring survivors to manage physical and cognitive impairments, fatigue, and insufficient workplace adaptations, in the absence of specific policies or guidelines and qualitative evidence. This brief report explores Portuguese stroke survivors' RTW experiences, focusing on perceived consequences, barriers, and enablers. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A total of 1,175 stroke survivors completed a questionnaire 18-24 months after stroke, and a heterogeneous subsample participated in semi-structured interviews (n = 22). Qualitative data from stroke survivors who were employed before the event were analyzed using thematic analysis. Five major themes emerged. RTW was facilitated by employer and coworker support, workplace adaptations, and lower levels of post-stroke impairment. Survivors who returned to work reported positive emotional and social outcomes, such as restored normalcy and reduced social isolation, alongside negative experiences, including insecurity, stress, and fear of reduced performance. Barriers to RTW included persistent impairments, changes in workplace dynamics, and the lack of formal reintegration support. Participants highlighted the need for flexible working conditions, personalized and long-term monitoring, legal protection, and financial support. Conclusions: These findings emphasize the need for tailored, evidence-based professional reintegration strategies to support stroke survivors' sustainable RTW and overall well-being.