Predictors of Function, Activity, and Participation of Stroke Patients Undergoing Intensive Rehabilitation: A Multicenter Prospective Observational Study Protocol

Bahia Hakiki, Anita Paperini, Chiara Castagnoli, Ines Hochleitner, Sonia Verdesca, Antonello Grippo, Maenia Scarpino, Antonio Maiorelli, Irene Eleonora Mosca, Paola Gemignani, Marco Borsotti, Maria Assunta Gabrielli, Emilia Salvadori, Anna Poggesi, Giulia Lucidi, Catiuscia Falsini, Monica Gentilini, Monica Martini, Maria Luisa Eliana Luisi, Barbara Biffi, Paolo Mainardi, Teresa Barretta, Silvia Pancani, Andrea Mannini, Silvia Campagnini, Silvia Bagnoli, Assunta Ingannato, Benedetta Nacmias, Claudio Macchi, Maria Chiara Carrozza, Francesca Cecchi, Bahia Hakiki, Anita Paperini, Chiara Castagnoli, Ines Hochleitner, Sonia Verdesca, Antonello Grippo, Maenia Scarpino, Antonio Maiorelli, Irene Eleonora Mosca, Paola Gemignani, Marco Borsotti, Maria Assunta Gabrielli, Emilia Salvadori, Anna Poggesi, Giulia Lucidi, Catiuscia Falsini, Monica Gentilini, Monica Martini, Maria Luisa Eliana Luisi, Barbara Biffi, Paolo Mainardi, Teresa Barretta, Silvia Pancani, Andrea Mannini, Silvia Campagnini, Silvia Bagnoli, Assunta Ingannato, Benedetta Nacmias, Claudio Macchi, Maria Chiara Carrozza, Francesca Cecchi

Abstract

Background: The complex nature of stroke sequelae, the heterogeneity in rehabilitation pathways, and the lack of validated prediction models of rehabilitation outcomes challenge stroke rehabilitation quality assessment and clinical research. An integrated care pathway (ICP), defining a reproducible rehabilitation assessment and process, may provide a structured frame within investigated outcomes and individual predictors of response to treatment, including neurophysiological and neurogenetic biomarkers. Predictors may differ for different interventions, suggesting clues to personalize and optimize rehabilitation. To date, a large representative Italian cohort study focusing on individual variability of response to an evidence-based ICP is lacking, and predictors of individual response to rehabilitation are largely unexplored. This paper describes a multicenter study protocol to prospectively investigate outcomes and predictors of response to an evidence-based ICP in a large Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation. Methods: All patients with diagnosis of ischemic or hemorrhagic stroke confirmed both by clinical and brain imaging evaluation, admitted to four intensive rehabilitation units (adopting the same stroke rehabilitation ICP) within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled (expected sample: 270 patients). Measures will be taken at admission (T0), at discharge (T1), and at follow-up 6 months after a stroke (T2), including clinical data, nutritional, functional, neurological, and neuropsychological measures, electroencephalography and motor evoked potentials, and analysis of neurogenetic biomarkers. Statistics: In addition to classical multivariate logistic regression analysis, advanced machine learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. Discussion: By identifying data-driven prognosis prediction models in stroke rehabilitation, this study might contribute to the development of patient-oriented therapy and to optimize rehabilitation outcomes. Clinical Trial Registration: ClinicalTrials.gov, NCT03968627. https://www.clinicaltrials.gov/ct2/show/NCT03968627?term=Cecchi&cond=Stroke&draw=2&rank=2.

Keywords: biomarkers; functional recovery; neurophysiology; rehabilitation; stroke.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Hakiki, Paperini, Castagnoli, Hochleitner, Verdesca, Grippo, Scarpino, Maiorelli, Mosca, Gemignani, Borsotti, Gabrielli, Salvadori, Poggesi, Lucidi, Falsini, Gentilini, Martini, Luisi, Biffi, Mainardi, Barretta, Pancani, Mannini, Campagnini, Bagnoli, Ingannato, Nacmias, Macchi, Carrozza and Cecchi.

Figures

Figure 1
Figure 1
Study timeline.
Figure 2
Figure 2
Rehabilitation treatment.

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