Journal List > Brain Neurorehabil > v.11(2) > 1102586

Jeong, Han, Jang, and Lee: Factors Affecting Activities of Daily Living in Severely Disabled Stroke Patients

Abstract

To investigate factors which affect the activities of daily living (ADL) in severely disabled stroke patients. Medical records of 64 post-stroke patients were reviewed retrospectively. All patients had had rehabilitation for 3 months, and their ADL was assessed using the Korean version of Modified Barthel Index at the time of admission and after 3 months. We also investigated age, onset duration of stroke and the Korean version of Mini-Mental State Examination (K-MMSE) at the time of admission. The ability to roll over, sit, sit to stand, transfer, ambulation, climbing stairs, sitting balance and standing balance were evaluated at the time of admission and after 3 months, either. The factors affecting ADL were K-MMSE and functional ability, such as the ability to roll over, come to sit, sit to stand, sitting and standing balance. The most important factors were the level of K-MMSE and the ability to come to sit. The ability to sit up and the K-MMSE score are the independent factors that can predict the ADL after rehabilitation in severely disabled stroke patient.

Highlights

  • • The stroke patient, especially those who Korean version of Mini-Mental State Examination (K-MMSE) score over 10, should have an active training of activities of daily living (ADL) in conjunction with the conventional rehabilitation.

  • • The ability to sit up and K-MMSE are the independent factors which can predict ADL after rehabilitation.

INTRODUCTION

As more survivors exist who have suffered brain injuries, such as a stroke and traumatic brain injury, the rehabilitation of these survivors has become an important issue. Of the fifty million stroke survivors in the world 25% to 74% are dependent on caregivers for their activities of daily living (ADL) after a stroke [123].
In patients after a stroke, the recovery of ability to conduct ADL affects the quality of life [45]. Ability to perform their own ADL, including eating, grooming, and bathing, is very important for both the patient and the caregiver.
There are several studies about factors that can affect the prognosis of rehabilitation in patients with brain lesions. These includes the extent of brain damage, the initial extent of disability, the extent of the cognitive function damage, the age of onset as well as psycho-environmental factors. Among these, it has been debated which factors would affect the prognosis of rehabilitation, especially predicting ability for the ADL. In addition, identifying subgroups of patients who may benefit most from a particular rehabilitation and stratifying patients into prognostically comparable groups can also be important [67].
In this study, we aimed to discover those factors that may affect ADL after rehabilitation, especially in severely disabled stroke patients. This information would help caregivers and researchers plan and provide effective rehabilitation for post-stroke patients.

MATERIALS AND METHODS

Participants

We did a retrospective analysis of patients admitted to rehabilitation hospitals. The inclusion criteria were: 1) patients who had had a stroke during the preceding 2 years, 2) disabled patients who needed continuous rehabilitation, 3) patients who had received rehabilitation for at least three months, 4) patients who had stable medical conditions, and 5) were participating in an active rehabilitation program.
Any patients with severe aphasia were excluded because the scores on the Korean version of the Mini-Mental State Examination (K-MMSE) scores might not precisely represent their current cognition status. Patients with other severe musculoskeletal disorders were also excluded. This study was approved by the Institutional Review Board (IRB) of Ewha Womans University Medical Center (IRB No.2017-10-059).

Methods

All information was acquired from medical records of patients, retrospectively. The ADL was evaluated with the Korean version of Modified Barthel Index (K-MBI) at the time of admission and after 3 months. During the study period, all patients were evaluated with the K-MMSE at the time of admission.
The functional ability (FA), which consists of 8 sub-items, including ability to roll over, sit, stand up, transfer, gait, climbing stairs, sitting balance, and standing balance, was evaluated at the time of admission and at three months after the admission. This assessment used a slight modification of the Postural Assessment Scale for Stroke Patient (PASS) [8], a post-stroke balance assessment tool. The 6 sub-items (ability to roll over, sit, stand up, transfer, gait and climbing stairs) were graded with a range from 1 to 6 (total assist, 1; maximal assist, 2; moderate assist, 3; minimal assist, 4; supervision, 5; independent, 6) (Appendix 1), and the 2 sub-items (sitting balance and standing balance) were scored with a range from 1 to 4 (Zero, 1; Poor, 2; Fair, 3; or Good, 4) (Appendix 2).
To evaluate the effect of age, patients were divided into 2 groups: group A1 and group A2, with the cutoff age of 70; their K-MBI scores were compared. Concerning the duration of disability, the patients were divided into 3 groups: group D1 had a stroke in the past 6 months; group D2 had a stroke within the last 6 and 12 months; and group D3 had a stroke within the past 1 to 2 years. To evaluate the effects of the initial cognitive function, patients were divided into 4 groups based on their K-MMSE score: group M1 had a score between 0 and 9; group M2 had a score between 10 and 19; group M3 had score between 20 and 24; and group M4 had a score between 25 and 30.

Statistics

The SPSS ver. 17.0 (SPSS, Inc., Chicago, IL, USA) was used for the statistical analysis. A p value of less than 0.05 was considered statistically significant. A univariate analysis with a t-test and 1-way analysis of variance was used to compare demographic and baseline information between the groups. A paired t-test was used to compare their ADL before and after treatment. A univariate correlation was done to find those significant factors that could affect the participants' K-MBI scores. A multivariate linear regression with stepwise elimination was done to find the independent factors which can affect K-MBI score.

RESULTS

Sixty-four post stroke patients were included in this study. Their average age was 73.62 ± 10.64 years, and the number of females was 33 (51.6%). The mean duration of stroke was 11.53 ± 5.93 months; 34 (53.1%) patients had a left hemiplegia, 23 (35.9%) patients had a right hemiplegia, and 7 (10.9%) patients had quadriplegia. The causes of stroke were ischemic stroke (n = 51, 79.7%), intracranial hemorrhage (n = 9, 14.1%), and subarachnoid hemorrhage (n = 4, 6.3%) (Table 1).
Table 1

Demographic characteristics of patients at admission to rehabilitation

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Characteristics Values
Age (yr) 73.62 ± 10.64 (45–93)
≤ 70 23 (35.9)
> 70 41 (64.1)
Gender
Male 31 (48.4)
Female 33 (51.6)
Duration of stroke onset (mon) 11.53 ± 5.93 (3–24)
≤ 6 17 (26.6)
> 6 and ≤ 12 24 (37.5)
> 12 and ≤ 24 23 (35.9)
Hemiplegic side
Right 23 (35.9)
Left 34 (53.1)
Bilateral 7 (10.9)
Cause of brain lesion
Ischemic stroke 51 (79.7)
Intracranial hemorrhage 9 (14.1)
Subarachnoid hemorrhage 4 (6.3)
Values are presented as number of cases (%) or mean ± standard deviation (range).
The mean K-MBI score before the treatment was 30.14 ± 21.12. After 3 months of rehabilitation, the K-MBI score had increased significantly (39.67 ± 23.45). In the K-MBI, the 10 sub-items were significantly improved after 3 months of rehabilitation except for the ambulation item (p = 0.095). The ‘Stair climbing’ sub-item showed less improvement than did other items (p = 0.049) (Table 2).
Table 2

FA and K-MBI assessed at admission and after 3 months

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Variables Before rehabilitation After rehabilitation p
FA
Ability to roll over 4.11 ± 1.70 4.56 ± 1.41 0.000*
Ability to sit up 3.30 ± 1.60 4.03 ± 1.54 0.000*
Ability to sit to stand 2.63 ± 1.40 3.41 ± 1.50 0.000*
Ability to gait 1.89 ± 1.22 2.71 ± 1.60 0.000*
Ability to stair up & down 1.43 ± 0.96 1.71 ± 1.25 0.002*
Sitting balance 2.89 ± 0.89 3.33 ± 0.76 0.000*
Standing balance 1.86 ± 0.83 2.28 ± 0.90 0.000*
K-MBI total 30.14 ± 21.12 39.67 ± 23.45 0.000*
Personal hygiene 2.05 ± 1.53 2.63 ± 1.37 0.000*
Feeding 5.13 ± 3.22 6.02 ± 3.08 0.000*
Dressing 2.58 ± 2.38 3.77 ± 2.83 0.000*
Toileting 2.34 ± 2.77 3.20 ± 3.09 0.001*
Bathing self 0.69 ± 1.10 0.95 ± 1.13 0.018*
Bladder control 5.33 ± 4.41 6.44 ± 4.29 0.001*
Bowel control 5.33 ± 4.35 6.44 ± 4.24 0.001*
Ambulation 6.38 ± 4.84 7.63 ± 5.61 0.095
Wheelchair 0.71 ± 1.02 1.23 ± 1.35 0.001*
Chair/bed transfer 4.94 ± 4.16 7.23 ± 4.39 0.000*
Stair climbing 0.30 ± 1.11 0.45 ± 1.38 0.049*
Values are presented as mean ± standard deviation.
FA, functional ability; K-MBI, Korean version of Modified Barthel Index.
*p < 0.05 analyzed by analysis of variance.
The significant improvement was shown also in all assessments of FA. At the time of admission, the mean score of ability to sit up was 3.30 ± 1.60. After 3 months of rehabilitation, the mean score of ability to sit up was increased to 4.03 ± 1.54, which meant that the patients required only minimal help rather than moderate help for sitting up (Table 2).
When patients were divided into groups based on their age, both groups showed significant improvement in their K-MBI score after rehabilitation (p < 0.01). Group A1 had significantly more improvement in the K-MBI score than did group A2 (p = 0.144). When patients were divided into groups based on the duration of stroke, all groups showed significant improvement in their K-MBI scores. There was no significant difference between the groups. When patients were divided into groups based on their K-MMSE score, all groups except for group M1 showed significant improvement in their K-MBI scores after treatment. When the improvement of the K-MBI score was compared between groups, it was significantly different between groups (p < 0.005) (Table 3).
Table 3

Score of K-MBI according to the age group, duration of stroke and K-MMSE level at admission and after 3 months rehabilitation

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Group Number of patients K-MBI score p value Increment of K-MBI score
Before rehabilitation After rehabilitation
Age (yr)
≤ 70 23 36.39 ± 21.88 48.26 ± 22.52* 0.000 11.87 ± 10.84
> 70 41 26.63 ± 20.10 34.85 ± 22.83* 0.000 8.22 ± 9.26
Duration of stroke onset (mon)
≤ 6 17 25.06 ± 21.57 34.29 ± 25.13 0.004 9.24 ± 11.14
> 6 and ≤ 12 24 36.79 ± 21.42 47.08 ± 22.25 0.000 10.29 ± 9.90
> 12 and ≤ 24 23 26.96 ± 19.50 35.91 ± 22.38 0.000 8.96 ± 9.40
Level of K-MMSE
0–9 9 6.33 ± 6.87 10.56 ± 14.28 0.231 4.22 ± 9.78
10–19 22 22.18 ± 14.79 29.27 ± 15.28 0.000 7.09 ± 6.92
20–24 12 40.25 ± 20.26 57.92 ± 19.95 0.001 17.67 ± 13.20
25–30 21 42.90 ± 19.32 52.62 ± 17.62 0.000 9.72 ± 8.19
Values are presented as mean ± standard deviation.
K-MBI, Korean version of Modified Barthel Index; K-MMSE, Korean version of Mini Mental State Examination.
*Statistically significant (p < 0.01) in comparison of K-MBI before and after rehabilitation in each group by paired t-test; Statistically significant (p < 0.005) in comparison of K-MBI before and after rehabilitation in each group by paired t-test; Statistically significant (p = 0.005) between groups by 1-way analysis of variance.
In the univariate analysis, age, K-MMSE group, ability to roll over, sit up, stand up, ambulation, stair climbing, sitting balance and standing balance were significant factors which was associated with the final K-MBI score after 3 months of rehabilitation (Table 4).
Table 4

Pearson correlation coefficients (p value) of K-MBI score after rehabilitation with variables

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Variables r p value
Age −0.332 0.004*
Gender 0.019 0.441
Duration of stroke onset −0.032 0.403
K-MMSE level 0.628 0.000*
Ability to roll over 0.661 0.000*
Ability to sit up 0.753 0.000*
Ability to sit to stand 0.719 0.000*
Ability to gait 0.664 0.000*
Ability to stair up 0.610 0.000*
Sitting balance 0.631 0.000*
Standing balance 0.612 0.000*
Univariate analysis was performed.
K-MBI, Korean version of Modified Barthel Index; K-MMSE, Korean version of the Mini-Mental State Examination.
*p < 0.05.
The multivariate analysis with stepwise elimination showed that the ability to sit up (β = 0.589) and initial K-MMSE (β = 0.360) were significant independent factors affecting the K-MBI score after 3 months of rehabilitation. The final multivariate analysis model was as below (Table 5).
Table 5

Multiple stepwise regression analysis affecting K-MBI score after rehabilitation

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Factors K-MBI Score after Rehabilitation
β p value
Ability to sit up 0.589 0.000
K-MMSE level 0.360 0.000
R2 0.669
Adjusted R2 0.658 0.000
Multivariate analysis model was shown;
Y (K-MBI after rehabilitation) = −18.035 + 9.054X1 (ability to sit up) + 7.821X2 (K-MMSE level)
K-MBI, Korean version of Modified Barthel Index; K-MMSE, Korean version of Mini Mental State Examination.
K-MBI score after 3 months of rehabilitation:
−18.035 + (9.054 × ability to sit up) + (7.821 × initial K-MMSE score) (adjusted R2 = 65.8%)

DISCUSSION

In this study, improvement of ADL in post-stroke patients who were severely disabled and needed inpatient rehabilitation was achieved after 3 months of rehabilitation, even in those older than 70 or in chronic patient at a year after from onset. In terms of cognitive function, significant improvement in ADL was observed in all patients except for patients with very low cognitive function, such as below 10 in the K-MMSE. In addition, in this study the ability to sit up and the initial K-MMSE scores were independent predictors of ADL outcome after 3 months rehabilitation, with statistical significance.
The predictive value of many clinical determinants for the outcomes of ADL after a stroke has remained unclear. Some studies showed strong evidence for a baseline neurological status, upper-limb paresis, and age as predictors for outcomes of ADL. In addition, gender and risk factors of a stroke such as atrial fibrillation were not associated with functional outcome [9]. However, those studies focused on the early post-stroke phase for the final ADL. They included studies conducted 2 weeks or less after the stroke onset and evaluated the final outcome of ADL 3 months post-stroke, thus limiting their application to subacute and chronic periods. So, we studied the recovery of ADL for the period of 24 months post-stroke.
In this study, the ability of daily living activities was improved after rehabilitation in all age groups, even in those over 70 years, though the improvement of ADL was significantly greater in the group under 70 years. Some previous studies have shown that older people who are stroke patients have poor functional outcomes after rehabilitation [10111213]. Nevertheless, other previous studies explained that functional improvement can be achieved in the elderly [14151617]. O'Brien and Xue [18] also showed functional benefits in elderly patients over 85 years of age who were admitted to an inpatient rehabilitation facility for post care of a stroke. Considering the results of the previous studies, our study implies that elderly patients in an aging society should be actively rehabilitated to improve their daily activities. On the other hand, our age-classification criteria of the group was 70 years old; the cutoff is usually 65 or 75 years old in concurrent studies. In future study, consideration of the patients' age range or use a continuous-variable analysis would be needed.
It is well known that improvements in disability and impairment measurements occur during the first month, and there is still considerable room for improvement in the following 3 months. It also has been reported that most people get the maximum improvements on the score for the basic ADL in the first year after the onset of a stroke [19]. However, our study showed that ADL and functional status kept improving when the patient continued rehabilitation even after a year or two past the stroke onset. Such a result implies that chronic patients who had had a stroke more than a year should continue rehabilitation to further improve their independent daily activities.
One factor affecting ADL after rehabilitation is the initial K-MMSE score in this study. The previous study shows that cognitive impairment was significant and an independent factor associated with functional outcome in post-stroke patients. [14202122] Oneş et al. [12] reported that there was a significant positive association between Mini-Mental State Examination (MMSE) at admission and the functional discharge measure. They compared patients with a MMSE score of 24 or below to patients with a score above 24 for their total functional improvement; there were significant differences between the 2 groups. Also, Massucci et al. [20] reported that an MMSE score ≥ 24 was significantly associated with independent gain (Barthel Index score ≥ 18). Han et al. [22] compared the initial MMSE score with the Modified Barthel Index (MBI) score at the beginning of rehabilitation and at discharge. They concluded that the initial MMSE scores correlated well with the functional outcome of stroke patients, especially on the memory and language sub-items. They divided participants into 3 groups according to their initial MMSE score, low (19 or less), middle (20 to 25), and high (26 or more). In our study, we subdivided the lower K-MMSE group into 2 groups, less than 10 and 10 to 19, to assess patients with severe cognitive decline. Jakavonytė-Akstinienė et al. [23] also reported that the degree of cognitive impairment according to the MMSE scale (age and education are not considered) is as follows: 21–24 points, mild cognitive dysfunction; 11–20 points, moderate cognitive dysfunction; 0–10 points, severe cognitive dysfunction [2425]. Our study results show that the patients with a K-MMSE score of 10 or greater showed improvements in ADL after 3 months of rehabilitation, whereas those with very severely impaired cognition, having a K-MMSE score of less than 10, did not do as well.
In the univariate analysis, age, K-MMSE, ability to roll over, sit up, stand up, ambulation, stair climbing, sitting balance and standing balance were significant factors which was associated with K-MBI score after 3 months of rehabilitation. The multivariate analysis of this study showed that the initial cognitive function, which was assessed by K-MMSE and the ability to sit up were both significant independent factors affecting the ADL outcomes after 3 months of rehabilitation. In previous study, it was revealed that standing up from a seated position was one of the most frequently performed functional tasks, and it was an essential pre-requisite to walking. Also, it was thought that the ability to stand up without assistance is important for independent living [2627]. In the current study, however, to conduct ADL ability, sitting up was more important than standing up, perhaps because the subjects included in this study were relatively severely disabled patients who required rehabilitation for more than 3 months and who could not walk independently. This is related to changes in the components of the K-MBI after three months of rehabilitation, and is why other components showed significant improvements, but the ‘walking’ category did not. Among the components, the improvement of ‘stair up’ was also statistically significant. However, the pre- and post-rehabilitation scores showed 0 on the point scale, so there seemed to be almost no functional differences. Therefore, in a relatively severe disability group requiring in-patient rehabilitation, ‘sit up’ is more important than ‘stand up’ as a factor that affects the daily living activities.
The significance of sitting and standing up in functional outcome may be consistent with previous studies, that the training of core stability and trunk balance leads to a significant improvement in mobility and the ADL in subacute post-stroke patients [28]. This is because the anticipatory postural adjustments of trunk muscles play a major role in maintaining antigravity postures like sitting and standing when a reaching task is executed [29]. In addition, recent evidence supports the idea that the trunk control test and the Trunk Impairment Scale were important predictors for functional outcome at discharge after a stroke [27303132].
This study has several limitations that should be noted. First, we used only one tool, the K-MBI, to measure the improvement in daily activities. If we could have used 2 or more measurements, a better outcome would have been found. In addition, the more variables predicting functional outcomes such as severity of stroke at admission, neglect, nutritional status or depressive mood could be included in future studies. A patient with aphasia, as a factor affecting ADL, had been excluded from the current study for exact evaluation of cognitive function, but it should be considered in following studies. Also, the measurement of FA was not a validated tool, although it was similar to PASS. In future studies, a validated tool should be used to properly assess FA. Finally, it is common to set a cutoff value of 70 for age, so future studies should use a standard category for age or could consider statistical analysis of age as a continuous variable. This study showed that regardless of age or duration of stroke, the ADL outcomes were improved after 3 months of rehabilitation in post-stroke patient, especially in patient with an initial K-MMSE score of more than 10. Therefore, active rehabilitation could also be needed in patients older than 70, chronic patients after a year from onset, and patients with impaired cognitive function. Furthermore, the ability to sit up should be evaluated thoroughly, since it is an independent factor along with the K-MMSE score, which can predict the ADL after rehabilitation in severely disabled post-stroke patient. These results imply the importance of sitting-up exercises in ADL rehabilitation. Any patients with an K-MMSE score of more than 10 needs more attentive ADL training.

Notes

Conflict of Interest The authors have no potential conflicts of interest to disclose.

Appendices

Appendix 1

Assessment of functional ability

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Appendix 2

Assessment of sitting and standing balance

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References

1. Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA. American Heart Association Council on Cardiovascular Nursing and the Stroke Council. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010; 41:2402–2448.
2. Centers for Disease Control and Prevention (US). Traumatic brain injury in the united states: a report to congress. Atlanta, GA: Centers for Disease Control and Prevention;1999.
3. Testa JA, Malec JF, Moessner AM, Brown AW. Outcome after traumatic brain injury: effects of aging on recovery. Arch Phys Med Rehabil. 2005; 86:1815–1823.
crossref
4. Huang ME, Cifu DX, Keyser-Marcus L. Functional outcome after brain tumor and acute stroke: a comparative analysis. Arch Phys Med Rehabil. 1998; 79:1386–1390.
crossref
5. van Mierlo ML, van Heugten CM, Post MW, Hajós TR, Kappelle LJ, Visser-Meily JM. Quality of life during the first two years post stroke: the Restore4Stroke cohort study. Cerebrovasc Dis. 2016; 41:19–26.
crossref
6. Moons KG, Royston P, Vergouwe Y, Grobbee DE, Altman DG. Prognosis and prognostic research: what, why, and how? BMJ. 2009; 338:b375.
crossref
7. Young FB, Weir CJ, Lees KR. GAIN International Trial Steering Committee and Investigators. Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials. Stroke. 2005; 36:2187–2192.
crossref
8. Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke. 1999; 30:1862–1868.
9. Veerbeek JM, Kwakkel G, van Wegen EE, Ket JC, Heymans MW. Early prediction of outcome of activities of daily living after stroke: a systematic review. Stroke. 2011; 42:1482–1488.
10. Mutai H, Furukawa T, Araki K, Misawa K, Hanihara T. Factors associated with functional recovery and home discharge in stroke patients admitted to a convalescent rehabilitation ward. Geriatr Gerontol Int. 2012; 12:215–222.
crossref
11. Ng YS, Stein J, Salles SS, Black-Schaffer RM. Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke. Arch Phys Med Rehabil. 2005; 86:2138–2143.
crossref
12. Oneş K, Yalçinkaya EY, Toklu BÇ, Cağlar N. Effects of age, gender, and cognitive, functional and motor status on functional outcomes of stroke rehabilitation. NeuroRehabilitation. 2009; 25:241–249.
13. Ostwald SK, Swank PR, Khan MM. Predictors of functional independence and stress level of stroke survivors at discharge from inpatient rehabilitation. J Cardiovasc Nurs. 2008; 23:371–377.
crossref
14. Abdul-sattar AB, Godab T. Predictors of functional outcome in Saudi Arabian patients with stroke after inpatient rehabilitation. NeuroRehabilitation. 2013; 33:209–216.
crossref
15. Bagg S, Pombo AP, Hopman W. Effect of age on functional outcomes after stroke rehabilitation. Stroke. 2002; 33:179–185.
crossref
16. Black-Schaffer RM, Winston C. Age and functional outcome after stroke. Top Stroke Rehabil. 2004; 11:23–32.
crossref
17. Denti L, Agosti M, Franceschini M. Outcome predictors of rehabilitation for first stroke in the elderly. Eur J Phys Rehabil Med. 2008; 44:3–11.
18. O'Brien SR, Xue Y. Inpatient rehabilitation outcomes in patients with stroke aged 85 years or older. Phys Ther. 2016; 96:1381–1388.
19. Mayo NE, Wood-Dauphinee S, Ahmed S, Gordon C, Higgins J, McEwen S, Salbach N. Disablement following stroke. Disabil Rehabil. 1999; 21:258–268.
20. Massucci M, Perdon L, Agosti M, Celani MG, Righetti E, Recupero E, Todeschini E, Franceschini M. Italian Cooperative Research (ICR2). Prognostic factors of activity limitation and discharge destination after stroke rehabilitation. Am J Phys Med Rehabil. 2006; 85:963–970.
crossref
21. Wagle J, Farner L, Flekkøy K, Bruun Wyller T, Sandvik L, Fure B, Stensrød B, Engedal K. Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months. Dement Geriatr Cogn Disord. 2011; 31:379–387.
crossref
22. Han TR, Kim JH, Seong DH, Chun MH. The correlation of the mini-mental state examination (MMSE) and functional outcome in the stroke patients. J Korean Acad Rehabil Med. 1992; 16:118–122.
23. Jakavonytė-Akstinienė A, Dikčius V, Macijauskienė J. Prognosis of treatment outcomes by cognitive and physical scales. Open Med (Wars). 2018; 13:74–82.
24. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189–198.
25. Bunevičius R. Protinės būklės mini tyrimas. Biol Psychiatry Psychopharmacol. 2000; 2:13.
26. Verheyden G, Nieuwboer A, De Wit L, Feys H, Schuback B, Baert I, Jenni W, Schupp W, Thijs V, De Weerdt W. Trunk performance after stroke: an eye catching predictor of functional outcome. J Neurol Neurosurg Psychiatry. 2007; 78:694–698.
crossref
27. Alexander NB, Galecki AT, Nyquist LV, Hofmeyer MR, Grunawalt JC, Grenier ML, Medell JL. Chair and bed rise performance in ADL-impaired congregate housing residents. J Am Geriatr Soc. 2000; 48:526–533.
crossref
28. Cabanas-Valdés R, Bagur-Calafat C, Girabent-Farrés M, Caballero-Gómez FM, Hernández-Valiño M, Urrútia Cuchí G. The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial. Clin Rehabil. 2016; 30:1024–1033.
crossref
29. Moore S, Brunt D. Effects of trunk support and target distance on postural adjustments prior to a rapid reaching task by seated subjects. Arch Phys Med Rehabil. 1991; 72:638–641.
30. Duarte E, Marco E, Muniesa JM, Belmonte R, Diaz P, Tejero M, Escalada F. Trunk control test as a functional predictor in stroke patients. J Rehabil Med. 2002; 34:267–272.
crossref
31. Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke. 2002; 33:2626–2630.
crossref
32. Franchignoni FP, Tesio L, Ricupero C, Martino MT. Trunk control test as an early predictor of stroke rehabilitation outcome. Stroke. 1997; 28:1382–1385.
crossref
TOOLS
ORCID iDs

Hyewon Jeong
https://orcid.org/0000-0001-9186-0943

Soo Jeong Han
https://orcid.org/0000-0002-5685-0384

Soon Ja Jang
https://orcid.org/0000-0002-0886-5602

Jeong Eun Lee
https://orcid.org/0000-0001-5018-335X

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