Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 31

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Y. Kimura et al.
indicating severe paralysis. ADL ability was assessed using
the FIM. The FIM is composed of 18 items divided into 6
subcategories: self-care (6 items), sphincter control (2 items),
transfers (3 items), locomotion (2 items), communication (2
items), and social cognition (3 items). Each item is scored on
a 7-point ordinal scale from a score of 1 (total dependence) to
7 (complete independence). The high reliability of the FIM for
stroke survivors has been reported previously (25).
group 1, USN with other CIs; group 2, USN without other CIs;
and group 3, non-USN (Fig. 1).
The characteristics of the participants were compared across
the groups by 1-way analysis of variance, Kruskal–Wallis test,
χ 2 test, and Fisher’s exact test after evaluating the normality
of the variables using the Shapiro–Wilk test. To examine the
effect of the USN and other CIs on recovery of independent
gait, we used logistic regression analysis using the 3 groups
as the independent variables (reference, group 3) and the FIM
walking score (score ≥ 6 or ≤ 5) as the dependent variables. In
the logistic regression analysis, 2 models were used. In the first
model, we did not adjust for covariates (Model 1, Crude); in the
second model, in addition to Model 1, variables with p < 0.05
in univariate analysis were included as covariates (Model 2,
multivariate model).
Statistical significance was defined as a p-value less than 0.05
for all analyses. Statistical analyses were performed using the
SPSS software version 24.0 (IBM, Tokyo, Japan).
Rehabilitation treatment
In the Japanese medical insurance system, participants are refer-
red from acute hospitals approximately 30 days after onset of
stroke and receive hospital care in convalescent rehabilitation
wards for up to 180 days (29). In this study, all participants under-
went rehabilitation programmes every day during hospitalization.
The programmes were based on a comprehensive approach and
included physical, occupational, and speech therapies, as neces-
sary. Participants were provided with approximately 2 h (median
118 (interquartile range (IQR) 100–136) min) of rehabilitation
programmes per day. There was no specific protocol or proce-
dure for treating USN in this study. All participants with USN
underwent approximately equivalent amounts of conventional
therapies, such as visual scanning training, trunk rotation train-
ing, and feedback training in ADL tasks. In addition, participants
with other CIs underwent conventional cognitive training.
RESULTS
During the study period, 131 consecutive stroke survi-
vors met the inclusion criteria, and 94 were analysed
in the present study (Fig. 1).
The characteristics of the participants are shown in
Table I. The mean age of the study participants was
69.9 years ± 9.3, and 57 (62.8%) were men. A total of
44 participants (46.8%) had had an ischaemic stroke
Data analysis
The participants were assigned to 3 groups according to the
presence or absence of USN and the MMSE score on admission:
Stroke survivors who were admitted to our
convalescent rehabilitation ward during
April 2011 to March 2017
n = 372
Inclusion criteria
•
•
•
•
First stroke in the right brain hemisphere
Diagnosis of cerebral hemorrhage or cerebral infarction
Independence in performing ADL prior to stroke
Requirement of wheelchair for locomotion at admission
n =131
Excluded
•
•
•
•
Dementia prior to stroke (n = 10)
Severe musculoskeletal diseases or neuromuscular diseases (n = 10)
Worsening medical conditions during hospitalization (n = 9)
Unable to complete the assessment (n = 8)
n = 94
Presence or absence of USN
MMSE 23 or 24
Group 1
USN with other CIs
n = 30
Group 2
USN without other CIs
n = 26
Group 3
non-USN
n = 38
Fig. 1. Flow chart of the participants’ selection process. USN: unilateral spatial neglect; CIs: cognitive impairments; MMSE: Mini-Mental State
Examination.
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