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DOI: 10.1055/s-0042-1755267
Predictors of functional communication in people with aphasia after stroke
Preditores de comunicação funcional em pessoas com afasia após acidente vascular cerebral
Abstract
Background Aphasia, the most common language disorder secondary to stroke, has been associated with increased mortality, longer hospitalization and rehabilitation times, worse performance in daily activities, increased financial burden, and short- and long-term complications. Aphasia can negatively impact functional communication skills, including social networks, social activities, relationships with other people and social support.
Objective To evaluate patients with poststroke aphasia in their respective residences to investigate potential predictors of functional communication.
Methods The prospective cohort included patients with poststroke aphasia aged 18 years or older who resided in the city of Salvador, Northeastern Brazil. Following discharge from the Stroke Unit (SU), the individuals themselves, or their guardians, were contacted by telephone to schedule a home visit no less than three months after discharge. At baseline, sociodemographic and clinical data were collected, in addition to the scores on the National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (mBI). The American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) was applied at the patients' homes. Multivariate linear regression was employed using the total score on the ASHA FACS as the outcome of interest.
Results A multivariate analysis of the associated factors identified using the linear regression revealed that only functional capacity (as assessed by the mBI) upon discharge from the SU remained as an independent predictor of functional communication performance (β = 0.042; 95% confidence interval [95%CI] = 0.013–0.071; p = 0.002).
Conclusion The functional capacity to perform daily activities, evaluated upon discharge from a stroke unit, was identified as a potential predictor of functional communication performance, regardless of the time elapsed after the stroke.
Resumo
Antecedentes A afasia, distúrbio de linguagem mais comum secundário ao acidente vascular cerebral (AVC), está associada ao aumento da mortalidade, a um maior tempo de internação e reabilitação, ao pior desempenho nas atividades diárias, ao aumento da carga financeira, e às complicações de curto e longo prazos. Pode impactar negativamente as habilidades de comunicação funcional, incluindo atividades sociais, relacionamento com outras pessoas, e o apoio social.
Objetivo Avaliar pacientes com afasia pós-AVC em suas respectivas residências para investigar potenciais preditores de comunicação funcional.
Métodos A coorte prospectiva incluiu pacientes com afasia pós-AVC com 18 anos de idade ou mais, residentes em Salvador, Brasil. Após a alta da Unidade de AVC (UAVC), os próprios indivíduos, ou seus responsáveis, foram contatados por telefone para agendamento de visita domiciliar no mínimo três meses após a alta. Inicialmente, foram coletados dados sociodemográficos e clínicos, além das pontuações na National Institutes of Health Stroke Scale (NIHSS) e no Índice de Barthel modificado (IBM). O American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) foi aplicado no domicílio dos pacientes. A regressão linear multivariada foi empregada usando a pontuação total no ASHA FACS como o desfecho de interesse.
Resultados A análise multivariada por meio de regressão linear revelou que apenas a capacidade funcional avaliada na alta da UAVC permaneceu como preditor independente do desempenho da comunicação funcional (β = 0,042; intervalo de confiança de 95% [IC95%] = 0,013–0,071; p = 0,002).
Conclusão A capacidade funcional para realizar as atividades diárias, avaliada na alta hospitalar, foi identificada como potencial preditor do desempenho da comunicação funcional, independente do tempo desde o AVC.
Authors' Contributions
EBP: concept, design, definition of the intellectual content, literature search, clinical studies, data acquisition, data analysis, and manuscript preparation, editing, and review; HFM: concept, design, definition of intellectual content, clinical studies, and manuscript preparation, editing, and review; AF: concept, design, definition of the intellectual content, clinical studies, data acquisition, data analysis, and manuscript preparation, editing, and review; IM: concept, design, definition of the intellectual content, clinical studies, data analysis, and manuscript review. IGM: concept, data acquisition, literature search, and manuscript review; JOF: clinical studies, data acquisition, data analysis, and manuscript editing and review; PAJ: clinical studies, data acquisition, and manuscript review; AS, MM, and LG: data acquisition, literature search, and manuscript review.
Publication History
Received: 12 May 2021
Accepted: 24 September 2021
Article published online:
29 September 2022
© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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