Amaç: İnme sonrası depresif semptom şiddeti ile hastaların fonksiyonel aktivite düzeyi, ambulasyon durumu ve klinik özellikleri ile ilişkisini ortaya koymak amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, İstanbul Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi’nde yatarak rehabilitasyon gören 98 inme hastası dâhil edildi. Hastaların depresif semptom şiddeti Hamilton Depresyon Değerlendirme Ölçeği ile, fonksiyonel durumu Barthel İndeksi (Bİ) ile, ambulasyon durumu Fonksiyonel Ambulasyon Sınıflaması (FAS) ile değerlendirildi. Depresif semptom şiddetlerine göre hastalar depresyon olmayan, hafif derece depresyon ve orta derecede depresyon olarak 3 gruba ayrıldı. Hastaların fonksiyonel aktivite düzeyi, ambulasyon durumu ve klinik özellikleri bu gruplar arasında karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 65,4±8,7 yıl idi. Bİ ortalamasının depresyon olmayan grupta, hafif ve orta derece depresyon olan gruba göre istatistiksel anlamlı olarak daha yüksekti (sırasıyla 64,5±27,8; 45,0±30,3 ve 38,3±29,6). Brunnstrom alt ekstremite ve FAS ortalamaları depresyon olmayan grupta orta derece depresyon olan gruba göre daha yüksekti [sırasıyla Brunnstrom alt ekstremite için medyan (çeyrekler arası aralık) 3,50 (3,00-5,00) ve 2,50 (2,00-4,00), p=0,007; FAS için medyan (çeyrekler arası aralık) 3,00 (2,00-5,00) ve 1,00 (0,00-4,00), p=0,004]. Sonuç: İnme sonrası depresif semptom şiddeti, hastaların fonksiyonel durumu ve ambulasyon seviyesi ile ilişkili olabilir. Bu nedenle inme sonrası depressif semptomun erken tanınması ve etkili yönetimi hastaların uzun vadeli prognozunu iyileştirebilir.

Objective: To investigate the relationship between the severity of post-stroke depressive symptoms and patients’ functional activity level, ambulation status, and clinical characteristics. Material and Methods: Ninety-eight stroke patients undergoing inpatient rehabilitation at İstanbul Physical Therapy and Rehabilitation Training and Research Hospital were included in this study. The severity of depressive symptoms was assessed using the Hamilton Depression Rating Scale, functional status was assessed using the Barthel Index (BI), and ambulation status was assessed using the Functional Ambulation Classification (FAC). Patients were categorized into 3 groups based on the severity of their depressive symptoms: no depressive symptoms, mild depressive symptoms, and moderate depressive symptoms. The levels of functional activity, ambulation status, and clinical characteristics were then compared across these groups. Results: The patients had a mean age of 65.4±8.7 years. The mean BI score was significantly higher in the group with no depressive symptoms than in the group with mild or moderate depressive symptoms (64.5±27.8, 45.0±30.3 and 38.3±29.6 respectively). The median scores for the Brunnstrom lower extremity and FAC were significantly higher in the group with no depressive symptoms compared to those with moderate depressive symptoms [Brunnstrom lower extremity median (interquartile range) 3.50 (3.00- 5.00) vs. 2.50 (2.00-4.00), p=0.007; FAC median (interquartile range) 3.00 (2.00-5.00) vs. 1.00 (0.00-4.00), p=0.004]. Conclusion: The severity of post-stroke depressive symptoms may be correlated with the patients’ functional status and level of ambulation. Therefore, early recognition and effective management of these symptoms could improve patients’ long-term prognosis.

1. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693-702. [Crossref]  [PubMed] 
2. Paolucci S. Epidemiology and treatment of post-stroke depression. Neuropsychiatr Dis Treat. 2008;4:145-54. [Crossref]  [PubMed]  [PMC] 
3. Hackett ML, Yapa C, Parag V, et al. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36:1330-40. [Crossref]  [PubMed] 
4. Karataş GK. İnme Rehabilitasyonu. Beyazova M, Kutsal YG, editörler. Fiziksel Tıp ve Rehabilitasyon. 3rd ed. Ankara: Güneş Tıp Kitabevi; 2016. p. 2267-89.
5. HAMILTON M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62. [Crossref]  [PubMed]  [PMC] 
6. Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1988;45:742-7. [Crossref]  [PubMed] 
7. Akdemir A, Örsel DS, Dağ İ, ve ark. Hamilton Depresyon Derecelendirme Ölçeği (HDDÖ)'nin geçerliliği-güvenilirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi. 1996;4:251-9.
8. Küçükdeveci AA, Yavuzer G, Tennant A, et al. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000;32:87-92. [Crossref]  [PubMed] 
9. Beyazova M, Kutsal YG. Tıbbi rehabilitasyon alanında kullanılan ölçekler. Fiziksel Tıp ve Rehabilitasyon. 3rd ed. Ankara: Güneş Tıp Kitabevi; 2016. p. 275-83.
10. Holden MK, Gill KM, Magliozzi MR, et al. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984;64:35-40. [Crossref]  [PubMed] 
11. Mehrholz J, Wagner K, Rutte K, et al. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007;88:1314-9. [Crossref]  [PubMed] 
12. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966;46:357-75. [Crossref]  [PubMed] 
13. Çevikol A, Çakcı A. İnme Rehabilitasyonu. Oğuz H, Çakırbay H, Yanık B, editörler. Tıbbi Rehabilitasyon. 3rd ed. İstanbul: Nobel Tıp Kitapevi; 2015. p. 419-48.
14. GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:459-80. [PubMed]  [PMC] 
15. Rajsic S, Gothe H, Borba HH, et al. Economic burden of stroke: a systematic review on post-stroke care. Eur J Health Econ. 2019;20:107-34. [Crossref]  [PubMed] 
16. Stokman-Meiland DCM, Groeneveld IF, Arwert HJ, et al. The course of depressive symptoms in the first 12 months post-stroke and its association with unmet needs. Disabil Rehabil. 2022;44:428-35. [Crossref]  [PubMed] 
17. Yan H, Fang M, Liu XY. Role of microRNAs in stroke and poststroke depression. ScientificWorldJournal. 2013;2013:459692. [Crossref]  [PubMed]  [PMC] 
18. Robinson RG, Starkstein SE. Current research in affective disorders following stroke. J Neuropsychiatry Clin Neurosci. 1990;2:1-14. [Crossref]  [PubMed] 
19. Sharma GS, Gupta A, Khanna M, et al. Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation. J Neurosci Rural Pract. 2021;12:543-9. [Crossref]  [PubMed]  [PMC] 
20. Srivastava A, Taly AB, Gupta A, et al. Post-stroke depression: prevalence and relationship with disability in chronic stroke survivors. Ann Indian Acad Neurol. 2010;13:123-7. [Crossref]  [PubMed]  [PMC] 
21. Karaahmet OZ, Gurcay E, Avluk OC, et al. Poststroke depression: risk factors and potential effects on functional recovery. Int J Rehabil Res. 2017;40:71-5. [Crossref]  [PubMed] 
22. Gainotti G, Antonucci G, Marra C, et al. Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry. 2001;71:258-61. [Crossref]  [PubMed]  [PMC] 
23. Herrmann N, Black SE, Lawrence J, et al. The Sunnybrook stroke study: a prospective study of depressive symptoms and functional outcome. Stroke. 1998;29:618-24. [Crossref]  [PubMed] 
24. Raju RS, Sarma PS, Pandian JD. Psychosocial problems, quality of life, and functional independence among Indian stroke survivors. Stroke. 2010;41:2932-7. [Crossref]  [PubMed]