Effect of vitamin D supplementation on lower extremity motor function and ambulation in stroke patients

Background/aim: The aim of this study was to investigate the effect of vitamin D supplementation on ambulation and mobility in hospitalized patients undergoing stroke rehabilitation. Materials and methods: This study was conducted retrospectively between September 2020 and October 2020 at Gazi University Faculty of Medicine Physical Medicine and Rehabilitation Department. Seventy-six patients who received inpatient stroke rehabilitation treatment between May 2018 and February 2020 were included in the study. The patients were divided into two groups as those who did and did not take vitamin D supplements. Lower extremity motor function and ambulation status were compared using Brunnstrom recovery stage (lower extremity) and functional ambulation classification (FAC) scores before and after rehabilitation. Results: Thirty-nine patients received vitamin D treatment during the rehabilitation process and 37 patients did not. The two groups were similar in terms of age, sex, time since stroke, stroke type, comorbid diseases, nutritional status, rehabilitation duration, and FAC and Brunnstrom scores before rehabilitation (p > 0.05). At the end of rehabilitation, the changes in FAC and Brunnstrom scores were higher in patients receiving vitamin D supplementation (p = 0.005 and p = 0.018). The change in FAC and Brunnstrom scores in patients who were undergoing rehabilitation for the first time and/or in the first 3 months after stroke was higher in the group receiving vitamin D supplementation compared with the group not receiving vitamin D (p < 0.05). In patients who were not within the first 3 months after stroke, vitamin D treatment did not affect FAC and Brunnstrom scores. Conclusion: Vitamin D supplementation may increase the success of rehabilitation therapy in patients during the first 3 months poststroke.Key words: Stroke rehabilitation, vitamin D, brunnstrom recovery stage, functional ambulation

PDF

___

1. Murray CJ, Lopez AD. Measuring the global burden of disease. New England Journal of Medicine 2013; 369 (5): 448-457. doi: 10.1056/NEJMra1201534
2. GBD 2016 Lifetime Risk of Stroke Collaborators. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. New England Journal of Medicine 2018; 379 (25): 2429- 2437. doi: 10.1056/NEJMoa1804492
3. Belagaje SR. Stroke rehabilitation. CONTINUUM: Lifelong Learning in Neurology 2017; 23 (1): 238-253. doi: 10.1212/ CON.0000000000000423
4. Çidem M, Karacan I, Beytemur O, Kara S. Prevalence and risk factors for vitamin D deficiency in patients with widespread musculoskeletal pain. Turkish Journal of Medical Sciences 2017; 47 (3): 728-731. doi: 10.3906/sag-1508-30
5. Uluduz D, Adil MM, Rahim B, Gilani WI, Rahman HA et al. Vitamin D deficiency and osteoporosis in stroke survivors: an analysis of National Health and Nutritional Examination Survey (NHANES). Journal of Vascular and Interventional Neurology 2014; 7 (1): 23-28.
6. Kim K, Cho KH, Im SH, Choi J, Yu J et al. Decrement of serum vitamin D level after stroke. Annals of Rehabilitation Medicine 2017; 41 (6): 944-950. doi: 10.5535/arm.2017.41.6.944
7. Wrzosek M, Łukaszkiewicz J, Wrzosek M, Jakubczyk A, Matsumoto H et al. Vitamin D and the central nervous system. Pharmacological Reports 2013; 65 (2): 271-278. doi: 10.1016/ s1734-1140(13)71003-x
8. Sommer I, Griebler U, Kien C, Auer S, Klerings I et al. Vitamin D deficiency as a risk factor for dementia: a systematic review and meta-analysis. BMC Geriatrics 2017; 17 (1):1-3. doi: 10.1186/s12877-016-0405-0
9. Anjum I, Jaffery SS, Fayyaz M, Samoo Z, Anjum S. The role of vitamin D in brain health: a mini literature review. Cureus 2018; 10 (7): e2960. doi: 10.7759/cureus.2960
10. Garcion E, Sindji L, Montero‐Menei C, Andre C, Brachet P et al. Expression of inducible nitric oxide synthase during rat brain inflammation: regulation by 1, 25‐dihydroxyvitamin D3. Glia 1998; 22 (3): 282-294.
11. Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state. European Journal of Applied Physiology 2019; 119 (4): 825-839. doi: 10.1007/s00421-019-04104-x
12. Momosaki R, Abo M, Urashima M. Vitamin D supplementation and post-stroke rehabilitation: a randomized, double-blind, placebo-controlled trial. Nutrients 2019; 11 (6): 1295-1304. doi: 10.3390/nu11061295
13. Gupta A, Prabhakar S, Modi M, Bhadada SK, Kalaivani M et al. Effect of Vitamin D and calcium supplementation on ischaemic stroke outcome: a randomised controlled open‐label trial. International Journal of Clinical Practice 2016; 70 (9): 764-770. doi: 10.1111/ijcp.12866
14. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Physical Therapy 1966; 46 (4): 357-375. doi: 10.1093/ptj/46.4.357
15. Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients: standards for outcome assessment. Physical Therapy 1986; 66 (10): 1530-1539. doi: 10.1093/ptj/66.10.1530
16. Bauman WA, Emmons RR, Cirnigliaro CM, Kirshblum SC, Spungen AM. An effective oral vitamin D replacement therapy in persons with spinal cord injury. The Journal of Spinal Cord Medicine 2011; 34 (5): 455-460. doi: 10.1179/2045772311Y.0000000032
17. de Carvalho JF, da Rocha Araújo FAG, da Mota LMA, Aires RB, de Araujo RP. Vitamin D supplementation seems to improve fibromyalgia symptoms: Preliminary results. The Israel Medical Association Journal 2018; 20 (6): 379-381.
18. Liu H, Wang J, Xu Z. Prognostic utility of serum 25-hydroxyvitamin D in patients with stroke: A metaanalysis. Journal of Neurology 2019; 1-10. doi: 10.1007/ s00415-019-09599-0
19. Xu T, Zhong C, Peng Y, Chen CS, Wang J et al. Serum 25‐ hydroxyvitamin D deficiency predicts poor outcome amongst acute ischaemic stroke patients with low high density lipoprotein cholesterol. European Journal of Neurology 2016; 23 (12): 1763-1768. doi: 10.1111/ene.13121
20. Daubail B, Jacquin A, Guilland JC, Khoumri C, Aboa-Eboulé C et al. Association between serum concentration of vitamin D and 1-year mortality in stroke patients. Cerebrovascular Diseases 2014; 37 (5): 364-367. doi: 10.1159/000362534
21. Park KY, Chung PW, Kim YB, Moon HS, Suh BC et al. Serum vitamin D status as a predictor of prognosis in patients with acute ischemic stroke. Cerebrovascular Diseases 2015; 40 (1- 2): 73-80. doi: 10.1159/000434691
22. Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. In Mayo Clinic Proceedings 2010; 85 (8): 752-758. doi: 10.4065/mcp.2010.0138
23. Narasimhan S, Balasubramanian P. Role of vitamin D in the outcome of ischemic stroke-a randomized controlled trial. Journal of Clinical and Diagnostic Research 2017; 11 (2): CC06- CC10. doi: 10.7860/JCDR/2017/24299.9346
24. Sari A, Durmus B, Karaman CA, Ogut E, Aktas I. A randomized, double-blind study to assess if vitamin D treatment affects the outcomes of rehabilitation and balance in hemiplegic patients. Journal of Physical Therapy Science 2018; 30 (6): 874- 878. doi: 10.1589/jpts.30.874
25. Cassidy JM, Cramer SC. Spontaneous and therapeutic-induced mechanisms of functional recovery after stroke. Translational Stroke Research 2017; 8 (1): 33-46. doi: 10.1007/s12975-016- 0467-5