Pavan Arianna (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
Fasano Alessio (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
Cortellini Laura (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
Lattanzi Stefania (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
Papadopoulou Dionysia (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
Insalaco Sabina (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
Germanotta Marco (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
Aprile Irene (IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy)
According to published research, the incidence of clinical recovery in stroke victims increases during the initial weeks following the acute event and then decreases significantly in the months that follow (1). Previous research has demonstrated that, in the three to six months following a stroke, there is little to no improvement, particularly in terms of walking and motor function (2). Since then, this concept of functional recovery limited in the subacute phase has been abandoned. Current robotic rehabilitation approaches have shown efficacy even when applied beyond the first three months after the acute event; in particular, intensive robotic gait training has shown significant improvements in chronic stroke patients(3). The aim of this study is to retrospectively analyze the functional recovery profile of stroke patients in response to continuous rehabilitation treatment for more than six months after the acute event.
In this retrospective study, data were collected from 44 patients with stroke outcomes (20 females and 24 males, mean age 65±12) who were admitted to the Rome centre of the Don Carlo Gnocchi Foundation between May 2022 and May 2023. The latency range of the subjects taken into analysis varied from 1 to 48 months from the acute event. In particular, we recruired subjects who received consecutive rehabilitation cycles with a total duration of more than six months, in the different rehabilitation settings (inpatient 46%, partial inpatient 18% and outpatient 36%). The rehabilitation project included daily sessions of conventional and robotic neuromotor physiotherapy, speech therapy, occupational therapy and neuropsychological sessions. From the medical records, data were obtained from the following scales, relating to the beginning and end of each patient’s rehabilitation project: modified Barthel Index (mBI) for autonomy in activities of daily living, Numerical Rating Scale (NRS) for pain and Functional Ambulation Classification (FAC) to assess walking ability. In this study, only the mBI was considered. In particular, a statistical approach based on a linear mixed model was used to examine the relationship between the time elapsed since the acute event and the mBI index. In detail, the mBI was considered as a dependent variable, the months since the event as a fixed effect, and the subjects as a random effect. This analysis was conducted separately for data from four time intervals: within 6 months, between 6 months and 1 year, between 1 and 2 years, and between 2 and 3 years after the acute event.
Only data from the first three years after the acute event for each patient were considered for the statistical analysis. The results showed a positive association between mBI and latency from the event in all four time intervals examined (Figure 1). Specifically, the fixed effect estimates were 5.9 (SE: 0.6) within 6 months (p<0.001), 2.9 (SE: 0.4) between 6 months and one year (p<0.001), 1.0 (SE: 0.3) between the first and second year (p<0.001) and 0.6 (SE: 0.2) between the second and third year (p<0.01).
This study demonstrates the value of early intense therapy in the functional recovery of stroke patients. Furthermore, long-term rehabilitation cycles that extend more than a year after the acute event are successful at preserving function and improving functional impairment recovery. These findings emphasize the need of giving therapy to chronic and late-stage patients.
