title: Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study.
abstract: Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.
authors.affiliation: Department of Rehabilitation, Faculty of Health Sciences, Tohoku Fukushi University, Sendai, Miyagi, Japan.|Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Rehabilitation, Faculty of Health and Welfare, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nagayama
authors.affiliation: Department of Physical Therapy, Yachiyo Rehabilitation College, Yachiyo, Chiba, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Rehabilitation, Northern Fukushima Medical Center, Date, Fukushima, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Rehabilitation, Northern Fukushima Medical Center, Date, Fukushima, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamane
authors.affiliation: Department of Rehabilitation, Northern Fukushima Medical Center, Date, Fukushima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Otsuki
authors.affiliation: Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.|Department of Rehabilitation, Japan Community Healthcare Organization Gunma Chuo Hospital, Maebashi, Gunma, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsuchiya
authors.affiliation: Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
authors.forename: Fusae
authors.initials: F
authors.lastname: Tozato
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D053580:Muscle Strength; D011597:Psychomotor Performance; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation