Physiotherapy العلاج الطبيعي

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Browsing Physiotherapy العلاج الطبيعي by Author "Malak Ayed Abdel-Mughni Abdel-Hafez Wazwaz"

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    Predictors of Stroke Rehabilitation Outcome
    (Al-Quds University, 2025-08-16) Malak Ayed Abdel-Mughni Abdel-Hafez Wazwaz; ملاك عايد عبد المغني عبد الحافظ وزوز
    Stroke is the second leading cause of mortality and mortality and Disability-Adjusted Life Year (DALY) loss globally, with over 30% struggling with instrumental ADLs. Rehabilitation improves functional outcomes and quality of life for stroke patients. Factors influencing recovery include clinical severity, comorbidities, demographic characteristics, socioeconomic status, and access to care. In Palestine, stroke rehabilitation faces structural limitations, with non-governmental organizations providing primary post-stroke therapy services. Methods: A prospective cohort study was conducted in Hebron, Palestine, involving 36 first-ever stroke patients recruited from hospitals, 32 participants completed both baseline and 3 month follow-up assessments. The mean age was 64.22 years, with equal gender distribution. Rehabilitation outcomes were assessed using standardized ICF-based tools: Fugl-Meyer Assessment and NIHSS (impairment level), ARAT and Barthel Index (Functional activity level), and Adapted Participation Questionnaire (participation level). Data on demographics, comorbidities, socioeconomic status, and rehabilitation service utilization across care settings were also collected. Results: A statistically significant improvement in impairment level was observed between baseline and three-month follow-up, as measured by the Fugl-Meyer Upper Extremity (FMUE) scores (Z = -2.657, p = 0.008). Key predictors of FMUE improvement included age, body mass index (BMI), stroke type and severity (NIHSS), presence of diabetes mellitus (DM), and the total amount of physical therapy received across home, hospital, and inpatient settings. Similarly, significant improvement was noted in the Fugl-Meyer Lower Extremity (FMLE) scores (Z = -2.621, p = 0.009), with improvement predicted by gender, smoking status, osteoarthritis (OA), coronary artery disease (CAD), and inpatient physical therapy. At the functional activity level, the Barthel Index showed a significant increase (Z = 4.787, p < 0.001), with improvement predicted by the number of children, financial status, I stroke type, referral to rehabilitation, and receipt of physical, occupational, and psychological therapy in inpatient settings, as well as physical therapy at home. The Action Research Arm Test (ARAT) also demonstrated significant improvement (Z = -3.521, p < 0.001), with predictive factors including DM, HT, OA, financial status, stroke severity (NIHSS), employment status, physical therapy at home, and outpatient occupational therapy. Finally, at the participation level, no statistically significant improvement was observed, as measured by the Adapted Participation Questionnaire (Z = -1.387, p = 0.07). Conclusion: At three months post-stroke, rehabilitation was associated with statistically significant improvements in impairment and functional activity levels. However, no significant change was observed in the participation level. Keywords: Stroke, Predictors, The International Classification of Functioning, Disability and Health, Impairment level, functional activity level, participation level, use of care settings.