Abstract TP343: Palpatory Musculoskeletal Dysfunction Following Acute Cerebral Ischemia and Relationship with Neurological Deficit and Quality-of-Life

Background / Objective: Stroke causes severe musculoskeletal disabilities, many of which osteopathic manipulative treatment aims to mitigate by correcting somatic dysfunction (SD), identified by osteopathic palpatory exam. We demonstrated the reliability of a novel osteopathic diagnostic construct [Functional Pathology of the Musculoskeletal System (FPMSS)] to quantify SD among asymptomatic volunteers and patients with acute cerebral ischemia (under review). No prior study has addressed the natural history of SD following acute ischemic stroke nor its’ relationship with neurologic disability and survivor quality-of-life (QoL). We aimed to quantify SD severity following acute stroke and to determine its relationship with motor paralysis and health related QoL at 3 months. Methods: This prospective cohort study quantified SD applying FPMSS criteria: disproportionate motion restriction at a joint(s) identified by passive assessment. Seven consensus trained providers performed blinded paired assessments of 80 motion tests in asymptomatic volunteers and in patients with TIA or acute ischemic stroke (inter-rater agreement: ICC > 0.5). The NIHSS motor components (mNIHSS) quantified paralysis severity during hospitalization for stroke. Neuro-QoL captured patient reported outcomes 3-months post stroke. Linear mixed model analysis (applying Tukey-Kramer correction) was used to determine group differences in SD severity and the evolution of dysfunction in those with stroke. Relationships between QoL, stroke deficit severity, and SD grades were analyzed by univariate linear regression. Results: 120 participants were examined (healthy=20; TIA=20; stroke=80; mean ages were 40, 64, and 67 years, respectively). Forty-eight percent were female, 63% of stroke patients had hemiparesis [admission NIHSS mean=6.9 (SD=6.2)], 50 participants had notable paralysis [e.g., mNIHSS≥2 ; mean=4 (SD=2.4)], and 33% had discharge mRS > 2. Thirteen percent (13/100) of patients died during the study. Compared to asymptomatic controls, patients with recent cerebral ischemia exhibited statistically significant greater SD severity (table). Neuromotor deficit severity was associated with reduction in multiple QoL health domains. No significant correlation was seen between SD and 90 day QoL. Conclusion: SD is more severe among patients with recent cerebral ischemia, trending worse among those with profound paralysis. Ninety day QoL was associated with level of paralysis but not SD severity.