Identifying the Factors With Later Standing Acquisition in Patients With a Right-Hemisphere Stroke: A Cross-Sectional Study Using POSTIM Data.

Abstract

Objective: To identify factors associated with later standing acquisition in subacute post-stroke patients with right-hemisphere stroke.

Methods: This cross-sectional study used baseline data from the POSTIM multicenter randomized controlled trial (ClinicalTrials.gov: NCT01677091), involving eight rehabilitation units in France. Included patients were patient aged 18-80 with a first right supratentorial stroke (within 9 months), who could stand unassisted for at least 30 seconds with eyes closed but had <40% body weight bearing on the paretic leg during posturography. Evaluations included motor weakness, spasticity (triceps surae, quadriceps, adductors), epicritic and arthrokinetic sensitivity, spatial neglect, body representation, and balance. Logistic regression identified factors associated with later standing acquisition (>3 months).

Results: Among 86 participants (mean age 59.7±10.3 years; 68.6% male), 49 (57%) acquired standing capacity within 3 months, while 37 (43%) did so later. Those with later standing acquisition showed greater spasticity in all muscle groups (p<0.02), more severe motor weakness (p=0.003), and impaired arthrokinetic sensitivity (p=0.02). Balance was significantly worse in this group (p<0.005). Multivariate analysis identified three independent factors of later standing acquisition: spatial neglect (odds ratio [OR]=3.22; 95% confidence interval [CI], 1.09-9.51; p=0.03), ischemic stroke (OR=3.27; 95% CI, 1.08-9.90; p=0.04), and quadriceps spasticity (OR=1.98; 95% CI, 1.17-3.35; p=0.01).

Conclusion: In right-hemisphere stroke, ischemic etiology, quadriceps spasticity, and spatial neglect are significantly associated with later standing acquisition. These factors may be useful for identifying patients at risk of later standing acquisition and for guiding future interventional research.