Factors associated with improvement in impaired consciousness during the acute phase of cerebral infarction: a prospective observational study.
Koki Matsumoto, Akiyoshi Takami, Misato Makino and 1 others
PMID 37791000WHAT IT FOUND
Younger age, no worsening, and doing standing practice were linked to consciousness improvement in acute stroke.
However, patients who started with milder impairment showed less improvement, likely because they had little room to get better. This is an association, not proof that standing practice causes recovery.
Key findings
01In the multivariate analysis, performing standing practice was associated with a higher likelihood of improvement in impaired consciousness (odds ratio 17.221), while older age, worsening of the stroke, cerebral edema, and delirium were associated with lower likelihood.
02Patients with milder impaired consciousness at the start of rehabilitation showed poorer improvement, possibly due to a ceiling effect where there was little room for the score to get better.
03Walking practice, despite being more stimulating than standing, was not identified as a significant predictor of improvement in impaired consciousness.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study is observational, so it cannot prove that standing practice caused the improvement; patients who were able to stand may have been inherently less impaired or more stable than those who could not. The analysis of standing practice may be biased by the difference in status between those who could perform it and those who could not, a limitation the authors acknowledge. The study was conducted at a single hospital in Japan, using the Japan Coma Scale, which may limit generalizability to other populations or consciousness scales. Patients with severe aphasia were excluded, meaning the findings do not apply to stroke patients with significant communication barriers. The 'ceiling effect' in patients with mild initial impairment means the study may understate the potential for improvement in this specific subgroup or misinterpret the lack of change as a failure of intervention.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not assume that standing practice caused the improvement in consciousness. This was an observational study, and patients who were well enough to stand may have had less severe overall impairments than those who remained in bed. The high odds ratio reflects an association, not a proven treatment effect.