Association of Rehabilitation Care Duration and Functional Status of People with Chronic Stroke
Abstract
Introduction: There is limited information on the status of international classification of functioning, disability, and health (ICF) framework in subjects with chronic stroke with varying duration of rehabilitation care. Accordingly, this study investigates whether the duration of rehabilitation care affects the status of ICF in subjects with chronic stroke.
Materials and Methods: This was an observational cross-section study on 58 individuals with chronic stroke. The number of subjects who received rehabilitation care for less than 3 months and more than 3 months were 22 (group A) and 36 (group B), respectively. The ICF components of impairment of body functions and structure were assessed using the clock drawing test, the Beck depression inventory, and the Fugl-Meyer assessment of motor recovery after stroke. The activity limitation and participation using timed up and go test, the community integration questionnaire, and environmental factors were assessed by the Craig Hospital inventory of environmental factors.
Results: The Fugl-Meyer assessment and the policy components of the Craig hospital inventory of environmental factors showed a significant difference between the groups. Longer duration of rehabilitation care only showed a positive effect on the Fugl-Meyer assessment scores. No other components of ICF showed any difference between the groups.
Conclusion: The duration of rehabilitation impacts the impairments of body functions and body structures of ICF components. The study findings are limited and further studies are required before generalizing the results.
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2. Miller EL, Murray L, Richards L, Zorowitz, RD, Bakas T, Clark P, Billinger SA. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010; 41(10): 2402-48. [DOI: 10.1161/STR.0b013e3181e7512b.]
3. Cieza A, Stucki G. Understanding functioning, disability, and health in rheumatoid arthritis: the basis for rehabilitation care. Current Opinion in Rheumatology. 2005; 17(2): 183-89. [DOI: 10.1097/01.bor.0000151405.56769.e4.]
4. Stucki G. Kostanjsek N, Ustün B, Cieza, A. ICF-based classification and measurement of functioning. European Journal of Physical and Rehabilitation Medicine. 2008; 44(3): 315-28.[DOI:
5. World Health Organization. International Classification of Functioning, Disability and Health: ICF. World Health Organization. 2001. Accessed from: https://www.who.int/classifications/icf/en/
6. Steiner W A, Ryser L, Huber E, Uebelhart D, Aeschlimann A, Stucki G.Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Physical Therapy.2002; 829 (11): 1098-107.
7. Geyh, S, Cieza A, Schouten J, Dickson H, Frommelt P, Omar Z, Kostanjsek N, Ring H, Stucki G. ICF Core Sets for stroke. Journal of Rehabilitation Medicine 2004; 44(suppl): 135-41. [DOI: 10.1080/16501960410016776.]
8. Silva SM, Corrêa FI, de Morais Faria CD, Buchalla CM, da Costa Silva PF, Corrêa JC. Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools. Journal of Physical Therapy Science. 2015;27(6):1665-70.[DOI: 10.1589/jpts.27.1665.]
9. Goljar N, Burger H, Vidmar G, Leonardi M, Marinček Č. Measuring patterns of disability using the International Classification of Functioning, Disability and Health in the post-acute stroke rehabilitation setting. Journal of Rehabilitation Medicine. 2011;43(7):590-601. [DOI: 10.2340/16501977-0832.]
10. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, Miller K, Lincoln N, Partridge C, Wellwood I, Langhorne P. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke. 2004; 35(11):2529-39. [DOI: 10.1161/01.STR.0000143153.76460.7d.]
11. Chen CC, Heinemann AW, Granger CV, Linn RT. Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities. Archives of Physical Medicine and Rehabilitation.2002 83(11):1514–23. [DOI:10.1053/apmr.2002.35107.]
12. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-169. [DOI: 10.1161/STR.0000000000000098.]
13. Adunsky A, Fleissig Y, Levenkrohn S, Arad M, Noy S. Clock drawing task, mini-mental state examination and cognitive-functional independence measure: relation to functional outcome of stroke patients. Archives of Gerontology and Geriatrics. 2002;35(2): 153-60. [DOI: 10.1016/s0167-4943(02)00018-3.]
14. Sunderland T, Hill JL, Mello AM, Lowlor BA, Grundersheimer J, Newhouse PA, Grafman, JH. Clock drawing in Alzheimer’s disease: a novel measure of dementia severity. Journal of American Geriatric Society. 1989; 37 (8): 725-729.[DOI: 10.1111/j.1532-5415.1989.tb02233.x.]
15. Shulman KI, Shedletsky R, Silver IL.The challenge of time: clock‐drawing and cognitive function in the elderly. International Journal of Geriatric Psychiatry.1986; 1(2): 135-40.[DOI: 10.1002/gps.930010209]
16. Byrne BM, Stewart S M, Lee PW. Validating the beck depression inventory-II for Hong Kong community adolescents. International Journal of Testing.2004; 49 (3):199-216. [DOI: 10.1207/s15327574ijt0403_1]
17. Berg A, Lönnqvist J, Palomäki H, Kaste M. Assessment of depression after stroke: a comparison of different screening instruments. Stroke. 2009;40(2):523-29. [DOI: 10.1161/STROKEAHA.108.527705.]
18. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry. 1961; 4(6):561-571. [DOI: 10.1001/archpsyc.1961.01710120031004.]
19. Park S, Park JY. Grip strength in post-stroke hemiplegia. Journal of Physical Therapy Science. 2016; 28(2): 677-79.[DOI: 10.1589/jpts.28.677.]
20. Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian journal of rehabilitation medicine.1975; 7(1): 13-31.
21. Crow JL, Harmeling-van der Wel BC. Hierarchical properties of the motor function sections of the Fugl-Meyer assessment scale for people after stroke: a retrospective study. Physical Therapy. 2008; 88(12): 1554-67[DOI: 10.2522/ptj.20070186.]
22. Podsiadlo D, Richardson, S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of American Geriatric Society.1991; 39(2): 142-48. [DOI: 10.1111/j.1532-5415.1991.tb01616.x.]
23. Flansbjer UB, Holmbäck A M, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine. 2005;37(2):75-82. [DOI: 10.1080/16501970410017215.]
24. Willer B, Ottenbacher KJ, Coad ML. The community integration questionnaire. A comparative examination. American Journal of Physical Medicine & Rehabilitation. 1994;73(2):103-11.[DOI: 10.1097/00002060-199404000-00006.]
25. Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia. Archives of Physical Medicine and Rehabilitation. 2010; 91(3):395-99. [DOI: 10.1016/j.apmr.2009.10.021.]
26. Whiteneck GG, Harrison-Felix CL, Mellick DC, Brooks CA, Charlifue SB, Gerhart KA. Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers. Archives of Physical Medicine and Rehabilitation. 2004;85(8):1324-35.[DOI: 10.1016/j.apmr.2003.09.027.]
27. Han CW, Yajima Y, Lee EJ, Nakajima K, Meguro M, Kohzuki M. Validity and utility of the Craig Hospital Inventory of Environmental Factors for Korean community-dwelling elderly with or without stroke. The Tohoku Journal of Experimental Medicine. 2002; 206(1): 41-9.[DOI: 10.1620/tjem.206.41.]
28. Hatem SM, Saussez G, della Faille M, Prist V, Zhang X, Dispa D, BleyenheuftY. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Frontiers in Human Neuroscience, 2016; 10:442 [DOI: 10.3389/fnhum.2016.00442]
29. Huang HC, Chung KC, Lai DC, Sung SF. The impact of timing and dose of rehabilitation delivery on functional recovery of stroke patients. Journal of the Chinese Medical Association.2009; 72(5); 257-64. [DOI: 10.1016/S1726-4901(09)70066-8.]
30. Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P.Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database of Systematic Reviews. 2014 22(4). [DOI: 10.1002/14651858.CD001920.pub3]
31. Kuptniratsaikul V, Kovindha A, Piravej K, Dajpratham P. First-year outcomes after stroke rehabilitation: a multicenter study in Thailand. ISRN Rehabilitation. 2013; Article ID 595318. [DOI: 10.1155/2013/595318]
32. Hsu NW, Tsao HM, Chen HC, Chou P. Anxiety and depression mediate the health-related quality of life differently in patients with cardiovascular disease and stroke–preliminary report of the Yilan Study: a population-based community health survey. PloS one. 2014; 9(9). [DOI: 10.1371/journal.pone.0107609]
33. Li IG, Han HY, Lee HS. Emotional disorder of stroke patients. Journal of Korean Academy of Rehabilitation Medicine. 1995;12:33-8.
34. Jeong YJ, Kim WC, Kim YS, Choi KW, Son SY, Jeong YG.The relationship between rehabilitation and changes in depression in stroke patients. Journal of Physical Therapy Science.2014; 26(8): 1263-66.[DOI: 10.1589/jpts.26.1263.]
35. Sunderland A, Tinson, D J, Bradley EL, Fletcher D, Hewer RL, Wade DT. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. Journal of Neurology Neurosurgery & Psychiatry.1992; 55(7):530-35[DOI: 10.1136/jnnp.55.7.530.]
36. Kwakkel G, Kollen BJ, van der Grond J, Prevo J. Probability of regaining dexterity in the flaccid upper limb. Stroke. 2003; 34 (9): 2181-86. [DOI:10.1161/01.STR.0000087172.16305.CD.]
37. Duncan P, Studenski S, Richards L., Gollub, S., Lai, S. M., Reker, D., Perera S, Yates J, Koch V, Rigler S, Johnson, D. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke. 2003; 34(9): 2173-80. [DOI:10.1161/01.STR.0000083699.95351.F2.]
38. Boissy P, Bourbonnais D, Carlotti MM, Gravel D, Arsenault BA. Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function. Clinical Rehabilitation. 1999; 13(4); 354-62. [DOI: 10.1191/026921599676433080.]
39. Duret C ,Hutin E. Effects of Prolonged Robot-Assisted Training on Upper Limb Motor Recovery in Subacute Stroke. Neurorehabilitation.2013; 33(1) :41-8. [DOI: 10.3233/NRE-130926.]
40. Buccino G, Solodkin A, Small SL. Functions of the mirror neuron system: implications for neurorehabilitation. Cognitive and Behavioral Neurology. 2006; 19(1): 55-63. [DOI:10.1097/00146965-200603000-00007.]
41. Whitall J, Waller S M, Silver H, Macko RF. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke.2000; 31(10): 2390-95. [DOI: 10.1161/01.str.31.10.2390.]
42. Cawood J, Visagie S. Environmental factors influencing participation of stroke survivors in a Western Cape setting: original research. African Journal of Disability. 2015; 4(1): 1-9. [DOI: 10.4102/ajod.v4i1.198.]
43. Jafari M, Makarem A, Dalvandi A, Azimian M, Hosseini MA. Determination of facilitators and barriers in post stroke life, in Kerman city. 2011; 5(2):1-10.
2. Miller EL, Murray L, Richards L, Zorowitz, RD, Bakas T, Clark P, Billinger SA. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010; 41(10): 2402-48. [DOI: 10.1161/STR.0b013e3181e7512b.]
3. Cieza A, Stucki G. Understanding functioning, disability, and health in rheumatoid arthritis: the basis for rehabilitation care. Current Opinion in Rheumatology. 2005; 17(2): 183-89. [DOI: 10.1097/01.bor.0000151405.56769.e4.]
4. Stucki G. Kostanjsek N, Ustün B, Cieza, A. ICF-based classification and measurement of functioning. European Journal of Physical and Rehabilitation Medicine. 2008; 44(3): 315-28.[DOI:
5. World Health Organization. International Classification of Functioning, Disability and Health: ICF. World Health Organization. 2001. Accessed from: https://www.who.int/classifications/icf/en/
6. Steiner W A, Ryser L, Huber E, Uebelhart D, Aeschlimann A, Stucki G.Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Physical Therapy.2002; 829 (11): 1098-107.
7. Geyh, S, Cieza A, Schouten J, Dickson H, Frommelt P, Omar Z, Kostanjsek N, Ring H, Stucki G. ICF Core Sets for stroke. Journal of Rehabilitation Medicine 2004; 44(suppl): 135-41. [DOI: 10.1080/16501960410016776.]
8. Silva SM, Corrêa FI, de Morais Faria CD, Buchalla CM, da Costa Silva PF, Corrêa JC. Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools. Journal of Physical Therapy Science. 2015;27(6):1665-70.[DOI: 10.1589/jpts.27.1665.]
9. Goljar N, Burger H, Vidmar G, Leonardi M, Marinček Č. Measuring patterns of disability using the International Classification of Functioning, Disability and Health in the post-acute stroke rehabilitation setting. Journal of Rehabilitation Medicine. 2011;43(7):590-601. [DOI: 10.2340/16501977-0832.]
10. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, Miller K, Lincoln N, Partridge C, Wellwood I, Langhorne P. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke. 2004; 35(11):2529-39. [DOI: 10.1161/01.STR.0000143153.76460.7d.]
11. Chen CC, Heinemann AW, Granger CV, Linn RT. Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities. Archives of Physical Medicine and Rehabilitation.2002 83(11):1514–23. [DOI:10.1053/apmr.2002.35107.]
12. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-169. [DOI: 10.1161/STR.0000000000000098.]
13. Adunsky A, Fleissig Y, Levenkrohn S, Arad M, Noy S. Clock drawing task, mini-mental state examination and cognitive-functional independence measure: relation to functional outcome of stroke patients. Archives of Gerontology and Geriatrics. 2002;35(2): 153-60. [DOI: 10.1016/s0167-4943(02)00018-3.]
14. Sunderland T, Hill JL, Mello AM, Lowlor BA, Grundersheimer J, Newhouse PA, Grafman, JH. Clock drawing in Alzheimer’s disease: a novel measure of dementia severity. Journal of American Geriatric Society. 1989; 37 (8): 725-729.[DOI: 10.1111/j.1532-5415.1989.tb02233.x.]
15. Shulman KI, Shedletsky R, Silver IL.The challenge of time: clock‐drawing and cognitive function in the elderly. International Journal of Geriatric Psychiatry.1986; 1(2): 135-40.[DOI: 10.1002/gps.930010209]
16. Byrne BM, Stewart S M, Lee PW. Validating the beck depression inventory-II for Hong Kong community adolescents. International Journal of Testing.2004; 49 (3):199-216. [DOI: 10.1207/s15327574ijt0403_1]
17. Berg A, Lönnqvist J, Palomäki H, Kaste M. Assessment of depression after stroke: a comparison of different screening instruments. Stroke. 2009;40(2):523-29. [DOI: 10.1161/STROKEAHA.108.527705.]
18. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry. 1961; 4(6):561-571. [DOI: 10.1001/archpsyc.1961.01710120031004.]
19. Park S, Park JY. Grip strength in post-stroke hemiplegia. Journal of Physical Therapy Science. 2016; 28(2): 677-79.[DOI: 10.1589/jpts.28.677.]
20. Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian journal of rehabilitation medicine.1975; 7(1): 13-31.
21. Crow JL, Harmeling-van der Wel BC. Hierarchical properties of the motor function sections of the Fugl-Meyer assessment scale for people after stroke: a retrospective study. Physical Therapy. 2008; 88(12): 1554-67[DOI: 10.2522/ptj.20070186.]
22. Podsiadlo D, Richardson, S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of American Geriatric Society.1991; 39(2): 142-48. [DOI: 10.1111/j.1532-5415.1991.tb01616.x.]
23. Flansbjer UB, Holmbäck A M, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine. 2005;37(2):75-82. [DOI: 10.1080/16501970410017215.]
24. Willer B, Ottenbacher KJ, Coad ML. The community integration questionnaire. A comparative examination. American Journal of Physical Medicine & Rehabilitation. 1994;73(2):103-11.[DOI: 10.1097/00002060-199404000-00006.]
25. Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia. Archives of Physical Medicine and Rehabilitation. 2010; 91(3):395-99. [DOI: 10.1016/j.apmr.2009.10.021.]
26. Whiteneck GG, Harrison-Felix CL, Mellick DC, Brooks CA, Charlifue SB, Gerhart KA. Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers. Archives of Physical Medicine and Rehabilitation. 2004;85(8):1324-35.[DOI: 10.1016/j.apmr.2003.09.027.]
27. Han CW, Yajima Y, Lee EJ, Nakajima K, Meguro M, Kohzuki M. Validity and utility of the Craig Hospital Inventory of Environmental Factors for Korean community-dwelling elderly with or without stroke. The Tohoku Journal of Experimental Medicine. 2002; 206(1): 41-9.[DOI: 10.1620/tjem.206.41.]
28. Hatem SM, Saussez G, della Faille M, Prist V, Zhang X, Dispa D, BleyenheuftY. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Frontiers in Human Neuroscience, 2016; 10:442 [DOI: 10.3389/fnhum.2016.00442]
29. Huang HC, Chung KC, Lai DC, Sung SF. The impact of timing and dose of rehabilitation delivery on functional recovery of stroke patients. Journal of the Chinese Medical Association.2009; 72(5); 257-64. [DOI: 10.1016/S1726-4901(09)70066-8.]
30. Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P.Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database of Systematic Reviews. 2014 22(4). [DOI: 10.1002/14651858.CD001920.pub3]
31. Kuptniratsaikul V, Kovindha A, Piravej K, Dajpratham P. First-year outcomes after stroke rehabilitation: a multicenter study in Thailand. ISRN Rehabilitation. 2013; Article ID 595318. [DOI: 10.1155/2013/595318]
32. Hsu NW, Tsao HM, Chen HC, Chou P. Anxiety and depression mediate the health-related quality of life differently in patients with cardiovascular disease and stroke–preliminary report of the Yilan Study: a population-based community health survey. PloS one. 2014; 9(9). [DOI: 10.1371/journal.pone.0107609]
33. Li IG, Han HY, Lee HS. Emotional disorder of stroke patients. Journal of Korean Academy of Rehabilitation Medicine. 1995;12:33-8.
34. Jeong YJ, Kim WC, Kim YS, Choi KW, Son SY, Jeong YG.The relationship between rehabilitation and changes in depression in stroke patients. Journal of Physical Therapy Science.2014; 26(8): 1263-66.[DOI: 10.1589/jpts.26.1263.]
35. Sunderland A, Tinson, D J, Bradley EL, Fletcher D, Hewer RL, Wade DT. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. Journal of Neurology Neurosurgery & Psychiatry.1992; 55(7):530-35[DOI: 10.1136/jnnp.55.7.530.]
36. Kwakkel G, Kollen BJ, van der Grond J, Prevo J. Probability of regaining dexterity in the flaccid upper limb. Stroke. 2003; 34 (9): 2181-86. [DOI:10.1161/01.STR.0000087172.16305.CD.]
37. Duncan P, Studenski S, Richards L., Gollub, S., Lai, S. M., Reker, D., Perera S, Yates J, Koch V, Rigler S, Johnson, D. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke. 2003; 34(9): 2173-80. [DOI:10.1161/01.STR.0000083699.95351.F2.]
38. Boissy P, Bourbonnais D, Carlotti MM, Gravel D, Arsenault BA. Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function. Clinical Rehabilitation. 1999; 13(4); 354-62. [DOI: 10.1191/026921599676433080.]
39. Duret C ,Hutin E. Effects of Prolonged Robot-Assisted Training on Upper Limb Motor Recovery in Subacute Stroke. Neurorehabilitation.2013; 33(1) :41-8. [DOI: 10.3233/NRE-130926.]
40. Buccino G, Solodkin A, Small SL. Functions of the mirror neuron system: implications for neurorehabilitation. Cognitive and Behavioral Neurology. 2006; 19(1): 55-63. [DOI:10.1097/00146965-200603000-00007.]
41. Whitall J, Waller S M, Silver H, Macko RF. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke.2000; 31(10): 2390-95. [DOI: 10.1161/01.str.31.10.2390.]
42. Cawood J, Visagie S. Environmental factors influencing participation of stroke survivors in a Western Cape setting: original research. African Journal of Disability. 2015; 4(1): 1-9. [DOI: 10.4102/ajod.v4i1.198.]
43. Jafari M, Makarem A, Dalvandi A, Azimian M, Hosseini MA. Determination of facilitators and barriers in post stroke life, in Kerman city. 2011; 5(2):1-10.
| Files | ||
| Issue | Vol 17 No 4 (2023) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v17i4.13892 | |
| Keywords | ||
| International classification of functioning Disability Health Stroke Rehabilitation | ||
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How to Cite
1.
Gupta R, Azharuddin M, Khan F, Noohu M. Association of Rehabilitation Care Duration and Functional Status of People with Chronic Stroke. jmr. 2023;17(4):428-437.
