Recovery of balance and gait after stroke is deteriorated by confluent white matter hyperintensities: Cohort study.
Balance
Gait
Recovery
Single limb stance
White matter hyperintensities
Journal
Annals of physical and rehabilitation medicine
ISSN: 1877-0665
Titre abrégé: Ann Phys Rehabil Med
Pays: Netherlands
ID NLM: 101502773
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
04
09
2020
revised:
23
12
2020
accepted:
27
12
2020
pubmed:
16
1
2021
medline:
16
2
2022
entrez:
15
1
2021
Statut:
ppublish
Résumé
White matter hyperintensities (WMHs) are well known to affect post-stroke disability, mainly by cognitive impairment. Their impact on post-stroke balance and gait disorders is unclear. We aimed to test the hypothesis that WMHs would independently deteriorate post-stroke balance and gait recovery. This study was performed in 210 individuals of the cohort Determinants of Balance Recovery After Stroke (DOBRAS), consecutively enrolled after a first-ever hemisphere stroke. Clinical data were systematically collected on day 30±3 (D30) post-stroke and at discharge from the rehabilitation ward. WMHs were searched on MRI, graded with the Fazekas scale, and dichotomized as no/mild (absence/sparse) or moderate/severe (confluent). The primary endpoint was the recovery of the single limb stance, assessed with the Postural Assessment Scale for Stroke (PASS). The secondary endpoint was the recovery of independent gait, assessed with the modified Fugl-Meyer Gait Assessment (mFMA). The adjusted hazard ratios (aHRs) of achievements of these endpoints by level of WMHs were estimated by using Cox models, accounting for other relevant clinical and imaging factors. Individuals with moderate/severe WMHs (n=86, 41%) had greater balance and gait disorders and were more often fallers than others (n=124, 59%). Overall, they had worse and slower recovery of single limb stance and independent gait (P<0.001). Moderate/severe WMHs was the most detrimental factor for recovery of balance (aHR 0.46, 95% confidence interval [CI] 0.32-0.68, P<0.001) and gait (0.51, 0.35-0.74, P<0.001), along with age, stroke severity, lesion volume and disrupted corticospinal tract. With cerebral infarct, endovascular treatments had an independent positive effect, both on the recovery of balance (aHR 1.65, 95% CI 1.13-2.4, P=0.009) and gait (1.78, 1.24-2.55, P=0.002). WMHs magnify balance and gait disorders after stroke and worsen their recovery. They should be better accounted for in post-stroke rehabilitation, especially to help establish a prognosis of mobility. CLINICALTRIALS. NCT03203109.
Sections du résumé
BACKGROUND
BACKGROUND
White matter hyperintensities (WMHs) are well known to affect post-stroke disability, mainly by cognitive impairment. Their impact on post-stroke balance and gait disorders is unclear.
OBJECTIVES
OBJECTIVE
We aimed to test the hypothesis that WMHs would independently deteriorate post-stroke balance and gait recovery.
METHODS
METHODS
This study was performed in 210 individuals of the cohort Determinants of Balance Recovery After Stroke (DOBRAS), consecutively enrolled after a first-ever hemisphere stroke. Clinical data were systematically collected on day 30±3 (D30) post-stroke and at discharge from the rehabilitation ward. WMHs were searched on MRI, graded with the Fazekas scale, and dichotomized as no/mild (absence/sparse) or moderate/severe (confluent). The primary endpoint was the recovery of the single limb stance, assessed with the Postural Assessment Scale for Stroke (PASS). The secondary endpoint was the recovery of independent gait, assessed with the modified Fugl-Meyer Gait Assessment (mFMA). The adjusted hazard ratios (aHRs) of achievements of these endpoints by level of WMHs were estimated by using Cox models, accounting for other relevant clinical and imaging factors.
RESULTS
RESULTS
Individuals with moderate/severe WMHs (n=86, 41%) had greater balance and gait disorders and were more often fallers than others (n=124, 59%). Overall, they had worse and slower recovery of single limb stance and independent gait (P<0.001). Moderate/severe WMHs was the most detrimental factor for recovery of balance (aHR 0.46, 95% confidence interval [CI] 0.32-0.68, P<0.001) and gait (0.51, 0.35-0.74, P<0.001), along with age, stroke severity, lesion volume and disrupted corticospinal tract. With cerebral infarct, endovascular treatments had an independent positive effect, both on the recovery of balance (aHR 1.65, 95% CI 1.13-2.4, P=0.009) and gait (1.78, 1.24-2.55, P=0.002).
CONCLUSIONS
CONCLUSIONS
WMHs magnify balance and gait disorders after stroke and worsen their recovery. They should be better accounted for in post-stroke rehabilitation, especially to help establish a prognosis of mobility. CLINICALTRIALS.
GOV REGISTRATION
UNASSIGNED
NCT03203109.
Identifiants
pubmed: 33450367
pii: S1877-0657(21)00006-3
doi: 10.1016/j.rehab.2021.101488
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03203109']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101488Informations de copyright
Copyright © 2021. Published by Elsevier Masson SAS.