| 소속 |
Korea University Anam Hospital, Department of Rehabilitation Medicine1, Korea University, Brain Convergence Research Center2, Korea university, Department of Biomedical Sciences3, Korea university, Department of Biostatistics4 |
| 저자 |
Yoonhye Na2,3, Minjae Cho2,3, Yu Mi Hwang2,3, Hyonggin An4†, Eun Young Lee1,2*, Sung-Bom Pyun1,2† |
Background
Balance is a complex skill requiring integrative motor and sensory functions. Balance function recovery is important for the achievement of independent ambulation after stroke. The aim of this study was to make accurate predictions of a stroke patients’ balance recovery at 6 months after the onset of stroke using the clinical and neurophysiological variables measured early after stroke.
Methods
We prospectively collected the data of stroke patients from the STroke Outcome Prediction (STOP) project. Among the total of 166 patients, 63 stroke patients with hemiplegia were finally included for the study (Fig. 1). Balance function was measured using the Berg balance scale (BBS) at early after stroke (BBS-baseline) and 6 months after onset (BBS-6). We divided patients into two groups with a BBS-6 cutoff score of 34 points: good recovery (≥ 34, n = 50) and poor recovery groups (< 34, n = 14) of balance function for logistic regression analysis. We collected amplitude rate (%) of somatosensory evoked potential (SEP) of the tibial nerves for proprioceptive sensory function. Also, demographical, neurological and clinical data including the age, sex, MMSE, stroke type and side, Fugl-Meyer assessment of lower extremity (FMA-LE), lower extremity motor strength of affected limb were collected. And we selected significant variables for multivariate regression analysis (p<0.05) after performing univariate regression analysis (p<0.1).
Results.
The BBS-6 score significantly improved as compared to BBS-baseline (Fig. 2). Among the variables, stroke patients with younger age, male, higher BBS-baseline score, FMA-LE and affected lower extremity motor strength showed good recovery (Table 1). In univariate regression analysis, age (OR=0.956. p=0.086), MMSE (OR=1.050, p=0.093), FMA-LE (OR=1.121, p=0.003), motor strength of hemiparetic limb (hip flexion, OR=2.610; hip extension, OR=2.658; knee flexion, OR=2.050; knee extension, OR=2.043; ankle dorsiflexion; OR=1.895, ankle plantar flexor; OR=2.159, all p-values < 0.01), BBS-baseline (OR=1.139, p=0.051), SEP amplitude rate (OR=1.019, p=0.023) were selected for multivariate regression analysis. And multivariate regression analysis results revealed that hip extensor strength of affected limb was the only significant predictor of balance function recovery at 6 months after stroke (OR: 2.783, p<0.001, confidence interval: 1.593-4.859, adjusted R2 = 0.476). But BBS-baseline and SEP amplitude rate were not significant factors for balance recovery.
Conclusion.
In our results, early hip extensor strength was the only strongest predictor of balance function recovery at month after stroke onset. Early measurement of hip extensor can be used as a good biomarker for balance recovery and planning balance rehabilitation.
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