Preditores das habilidades manual e de locomoção em indivíduos após acidente vascular cerebral: um estudo longitudinal

Abstract

Stroke is one of the main causes the disability in adult life, and the impact on functioning is a significant consequence for the individuals. There are many factors that influence recovery of the subject's functioning, in addition to their health condition. The analysis of factors that can predict manual and mobility ability, even in the hospital phase, allows for the prior identification of individuals at higher risk for the development of disabilities. The provision of prognostic information can support professionals in the clinical reasoning process, in the definition of goals and guide the selection of the most appropriate interventions, as well as assist in the elaboration of care plan, which includes the planning of hospital discharge and the referral to rehabilitation services in the health care system. This study aimed at identifying whether variables measured during the early phases of hospitalization (age, global level of neurological function, motor function, cognitive function, residual deficit - muscle strength and functional capacity) could predict limitations in manual and locomotion skills three months after the stroke. A prospective cohort study was carried out in the Stroke Unit (SU) of the Risoleta Tolentino Neves Hospital (HRTN), after approval by the Research Ethics Committee of the Federal University of Minas Gerais (UFMG) and of the HRTN (CAAE: 84263818.8.0000.5149). The sample consisted of all individuals admitted to the SU/HRTN from 23/09/2019 to 23/09/2020 and who met the following inclusion criteria: clinical diagnosis of primary stroke, with diagnostic confirmation by neuroimaging and age ≥20 years. Individuals which had previous disability, other musculoskeletal or neurological conditions prior to the stroke and/or previous dependence to perform activities of daily living were excluded. The dependent variables, manual and mobility ability, were measured by applying the ABILHAND-Brazil and ABILOCO-Brazil, through interviews three months after the event. Predictive variables, measured during early phase of hospital, included age (years), global level of neurological function (National Institutes of Health Stroke Scale - NIHSS), cognitive function (Mini Mental State Examination - MMSE), lower and upper limb motor function (Fugl-Meyer Assessment - FMA), residual deficit – muscle strength (dynamometer), and functional capacity (Modified Rankin Scale - mRS). Two models were created, through multiple linear regression analyses, Forward method was used to identify amongst the group of predictor variables those that significantly could explain the outcome variables (manual and locomotion abilities three months after the stroke), as well as the explanatory strength of the predictive model. The sample consisted of 154 individuals, with a mean age of 60±16 years, and 77 (50%) were men. For the manual ability model, motor function (FMA-Upper Limb) explained 30% (F=54.8; p<0.0001) of the variance of the ABILHAND-Brazil scores. When age was included in the model, the explained variance increased to 32% (F=31.9; p<0.0001). For the locomotion ability model, motor function (FMA-Lower Limb) explained 35% (F=65.2; p<0.0001) of the variance of the ABILOCO-Brazil scores. When cognitive function (MMSE) was included in the model, the explained variance increased to 37% (F=4.6; p=0.035). No other independent variable added significant exploratory capacity. The results showed that motor function had greater predictive power for both models, and its assessment should be considered within a hospital context, when the objective is to predict manual and locomotion abilities of post-stroke individuals. Additionally, age and cognitive function should not be neglected, when assessing the prediction of manual and locomotion abilities, respectively.