Upright activity within the first week after stroke is associated with better functional outcome and health-related quality of life: A Norwegian multi-site study
Anne Hokstad, Bent Indredavik, Julie Bernhardt, Birgitta Langhammer, Mari Gunnes, Christine Lundemo, Martina Reiten Bovim, Torunn Askim
Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
Objective: To assess the amount of early upright activity of patients managed in Norwegian stroke units and its association with functional outcome and health-related quality of life 3 months later.
Design: A prospective observational multi-centre study.
Subjects: A total of 390 acute stroke patients, mean age 76.8 years, 48.1% men, less than14 days post-stroke, recruited from 11 Norwegian stroke units.
Methods: Time spent in different activity categories (in bed, sitting out of bed, upright) was observed with a standard method. Outcome was assessed by modified Rankin Scale (mRS), and health-related quality of life by EuroQol-5 Dimension 5 level (EQ-5D-5L) 3 months later. Ordinal logistic and linear regression analyses were used to examine the association between activity categories and mRS and EQ-5D-5L, respectively. Age, National Institute of Health Stroke Scale (NIHSS) score, premorbid mRS, sex, and hospital-site were added as covariates.
Results: The odds ratio (OR) (95% confidence interval (CI)) for poorer functional outcome (higher mRS) decreased as time spent in upright activities increased (OR 0.97 (95% CI 0.94–1.00)). There was also a significant positive association between time in upright activity and higher EQ-5D-5L, Beta 0.184 (95% CI 0.001– 0.008) 3 months later.
Conclusion: This study confirms the beneficial effect of upright activity applied during hospital stay in Norwegian stroke units.
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