Najczęściej spotykane ograniczenia w wykonywaniu czynności codziennego życia po udarze Emilia Mikolajewska*
Rehabilitation Clinic, The 10th Clinical Military Hospital with Policlinic, Bydgoszcz, Poland
*E-mail: <e.mikolajewska@wp.pl>
© The Author(s) 2012;
This article is published with open access at Licensee Open Journal Systems of Radom University in Radom, Poland
Keywords: rehabilitation; ischemic stroke; activities of daily living; quality of life.
Abstract
Aim:All dimensions of quality of life: functional, psychological and social seem be decreased as a
result of stroke. Aim of this study is to evaluate incidence of the most common problems in activities of daily living (ADLs).
Material and Methods: Sixteen patients after ischemic stroke, females and males, were assessed
using selected part of the Barthel Index in the area of transfers from bed to chair and back,
mobility on level surfaces and stairs climbing.
Results: In the area of transfers 18,75 % of patients were independent, and the same percentage of
patients was unable to transfer from bed to chair and back. In area of mobility on level surfaces 18,75 % of patients were independent, and the same percentage of patients was assessed as immobile. In the area of stairs climbing 18,75 % of patients were independent, and the same percentage of patients was assessed as unable to climb the stairs.
Discussion: Results of the research confirm high incidence of ADLs limitations within the most
basic activities, critical in everyday life: moving from wheelchair to bed and return, walking on level surface, going up and down stairs, but both very good and very poor results were rather rare.
1. Introduction
The total number of stroke cases in Poland exceeds 70 000 per year. Ischaemic stroke is the most common constituting 80-85 % of all stroke cases [1-5]. Moreover risk of the recurrence of ischemic stroke is estimated to 40 % (in 5 years). About 50 % of post-stroke survivors have limited independence and need help of other people in activities of daily living (ADLs) [6, 7]. It can severely influence their quality of life. Aim of this study was to evaluate incidence of the most common problems in activities of daily living (ADLs).
2. Material and Methods
Investigated group consisted of sixteen patients post ischemic stroke. The patients’ profiles are presented in Table 1. Inclusion criteria were as follows: age above 18 years, diagnosis: ischemic stroke and time after cerebrovascular accident (CVA) – from 4 weeks to 2 years. Inclusion of patients was each time confirmed by medical records. Size and anatomical involvement of infarct varied depend on the patient.
Table 1. Patients’ overall profile.
Number and percentage Side of paresis: Left Right 8 (50 %) 8 (50 %) Sex: Females Males 8 (50 %) 8 (50 %) Age [years]: Min Max SD Mean Median 32 81 12,64 52,87 55 Time after cerebrovascular accident (CVA):
4 weeks – 2 years 16 (100 %)
The measurement of the ADLs using selected items of Barthel Index [8] were performed in each patient on admission (before the therapy). Reliability of the Barthel Index is assessed “valid” [9, 10, 11].
My study has focused on determination of post-stroke patients’ abilities in the area of ADLs: moving from wheelchair to bed and return, walking on level surface, going up and down stairs. These elements are often impaired as a result of the stroke. Moreover achievement of the selected items of the Barthel Index constitutes good starting point to develop further, more advanced activities. There is another important remark: selected items can be measured using help of other people or assistive devices, etc.
Table 2. Barthel Index – part of the test [8]
ACTIVITY SCORE
TRANSFERS (bed to chair and back):
0 = unable, no sitting balance
5 = major help (one or two people, physical), can sit 10 = minor help (verbal or physical)
15 = independent
MOBILITY (on level surfaces):
0 = immobile or < 50 m
5 = wheelchair independent, including corners, > 50 m
10 = walks with help of one person (verbal or physical) > 50 m 15 = independent (but may use any aid, e.g. stick) > 50 m
STAIRS:
5 = needs help (verbal, physical, carrying aid) 10 = independent
TOTAL SCORE (0-40):
The ADLs Barthel Index - Guidelines:
The assessment can be used to determine a baseline level of functioning and can be used to monitor improvement in activities of daily living over time. The items are weighted according to a scheme developed by the authors. The person receives a score based on whether they have received help while doing the task. The scores for each of the items are summed to create a total score. The higher the score the more "independent" the person. Independence means that the person needs no assistance at any part of the task. If a persons does about 50% independently then the "middle" score would apply.
The results, where available, are expressed as mean, median, minimal value (min), maximal value (max) and standard deviation (SD). Statistical analysis of data was performed using the Statistica Software. A probability (p) value < 0.05 was considered as statistically significant.
3. Results
Results among 16 patients (100 %) involved in the study were as follows: Table 1. Results for whole group of patients
Activity Number of patients with score
0 5 10 15
Transfers 3 (18,75 %) 3 (18,75 %) 7 (43,75 %) 3 (18,75 %)
Mobility 3 (18,75 %) 4 (25 %) 6 (37,5 %) 3 (18,75 %)
Stairs 4 (25 %) 9 (62,5 %) 3 (18,75 %) not available
In the area of transfers (bed to chair and back) 18,75 % of patients were independent (score=15), and the same percentage of patients was unable to transfer from bed to chair and back (score = 0). Any limitations in the area of transfers were observed in 81,25 % of patients.
In area of mobility on level surfaces 18,75 % of patients were independent (score=15),
and the same percentage of patients was assessed as immobile. Any limitations in area of
mobility were observed in 81,25 % of patients.
In the area of stairs climbing 18,75 % of patients were independent (score=10), and the same percentage of patients was assessed as unable to climb the stairs. Any limitations in area
of stairs climbing were observed in 81,25 % of patients.
4. Discussion
Post-stroke patients often need for effective rehabilitation because of limitations in ADLs. Based on the previous research:
at least 22 % stroke survivors walks only with help of other people [12], at least 26 % stroke survivors is dependent on other people in ADLs [12],
the most common functional limitations affect the most basic activities: bathing, dressing, housekeeping, mobility and communication abilities [13, 14],
resulting quality of life decreases [15].
Results of my research confirm rather high incidence of ADLs limitations within the most basic activities, critical in everyday life: moving from wheelchair to bed and return, walking on level surface, going up and down stairs. Both very good and very poor results were rather rare. Moderate problems with mobility on level surfaces not exclude stair climbing with help. Differences between results depending on sex or side of paresis were statistically negligible.
Low mean and median values of age, respectively 52,87 and 55 years, indicate, that investigated group consisted of relatively young people (compared e.g. with research of Tasiemski et al. [16], where mean age = 63,76 ± 10,23) with bigger recovery potential.
My aim was to assess functional status of patients suffering stroke. All of them before my research participated in any form of rehabilitation (both early and long-term, depends on time after CVA). No doubts further long-term rehabilitation can significantly improve their functional status, but I showed general view and severity of their functional problems influencing further life and its quality.
Very important issues seem be possibilities of continuation of education and professional career [17, 18]. Significantly full adaptation of foreign research’ results can be risky. Based on Polish research [16], only 12 % of post-stroke survivors is satisfied because of his/her material situation. This way community activities and entertainment can be beyond reach. The most popular are: reading the books, listening to the music, watching TV and Internet surfing [16]. There is discussed, if there is a result of smaller possibilities (functional, financial, level of support in community, etc.) or decreased self-assessment and possible depression.
To sum up analysis of stroke survivors’ quality of life seems be underestimated issue. Influence of stroke is huge both for the patient and his/her family/carers. No doubts all dimensions of quality of life: functional, psychological and social seem be decreased as a result of stroke.
Limitation of this research is lack of control group. Based on this study I am going to continue my research, using control group and providing better evidence. Proposed direction of further research is also dividing research into two: in group of geriatric (≥ 60 years) patients and younger, to compare the results, more precisely investigating influence of age to recovery potential. What more the same research provided simultaneously in hospital rehabilitation (usually more severe cases), outpatient rehabilitation and home rehabilitation settings can assess functional levels in all these groups of post-stroke patients.
5. Conclusions
No doubts there is need to provide further studies in the area od ADLs in post-stroke patients as independent sources of knowledge. It seems ADLs limitations and resulting life quality’ decrease can influence effectivity of rehabilitation and further life of stroke survivors and their families.
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This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) Which Permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
Mikolajewska Emilia. The most common problems in wheelchair selection – own observations = Najczęściej spotykane błędy w doborze wózka dla niepełnosprawnych w świetle badań własnych. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Napierała Marek Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329876002. RSW. Radom. 2013. 88-93. ISBN 9781329876002. 220 p. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.
Original Text published © The Author (s) 2012. Mikolajewska Emilia. The most common problems in wheelchair selection – own