Recovery From Poststroke Visual Impairment: Evidence From a Clinical Trials Resource
Recovery From Poststroke Visual Impairment: Evidence From a Clinical Trials Resource
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DOI：
10.1177/1545968312454683
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发表时间：
2013-02-01
影响因子：
4.2
通讯作者：
Brady, Marian
中科院分区：
文献类型：
--
作者：
Ali, Myzoon;Hazelton, Christine;Brady, Marian
介绍。有限的证据表明，视力障碍可能影响中风后的预后。从这些损伤中恢复的程度是不明确的。目标。描述恢复情况并确定视力损害是否影响功能结局和生活质量。方法。我们从虚拟国际卒中试验档案（VISTA）中提取了人口统计学和结局数据。我们使用美国国立卫生研究院卒中量表（NIHSS）的最佳凝视和视觉域检查了水平眼动障碍和偏视，并描述了30天和90天的恢复情况。使用比例赔率模型来检查基线时的损伤、修改的Rankin量表（mRS）和90天的欧洲生活质量评分（EQ-5D）之间的关系。结果。在基线时，11,900例患者中有7,204例（60.5%）报告有视力障碍。1398 / 3285例（42.6%）和3243 / 7204例（45.0%）患者在30天和90天内完全康复。幸存者持续视力损害的负担在30天为1,135/4,028(28.2%)，在90天为1,915/9,338（20.5%）。基线时部分凝视性麻痹（P < 0.0001; OR = 0.81; 95% CI = 0.74-0.87）、强迫偏差（P < 0.0001; OR = 0.48; 95% CI = 0.43-0.53）和完全同源性偏盲（P < 0.0001; OR = 0.67; 95% CI = 0.62-0.73）与90天的不良mRS相关。结论。在中风后的第一个月，康复率更高，这表明干预的潜在时间框架。视力障碍和不良mRS之间的联系表明，这些障碍应该在多学科评估和干预中加以考虑。
Introduction. Limited evidence suggests that visual impairments may influence outcome after stroke. The degree of recovery from these impairments is poorly characterized. Objectives. To describe recovery and to determine whether visual impairments influence functional outcome and quality of life. Methods. We extracted demographic and outcome data from the Virtual International Stroke Trials Archive (VISTA). We examined horizontal eye movement disorders and hemianopia using the Best Gaze and Visual domains of the National Institutes of Health Stroke Scale (NIHSS) and described recovery at 30 and 90 days. Proportional odds modelling was used to examine the association between impairments at baseline, modified Rankin Scale (mRS), and European Quality of Life Score (EQ-5D) at 90 days. Results. Visual impairments were reported in 7,204/11,900 (60.5%) patients at baseline. Complete recovery occurred in 1,398/3,285 (42.6%) and 3,243/7,204 (45.0%) patients by 30 and 90 days respectively. The burden of persistent visual impairment in survivors was 1,135/4,028 (28.2%) at 30 days and 1,915/9,338 (20.5%) at 90 days. Partial gaze palsy (P < .0001; OR = 0.81; 95% CI = 0.74-0.87), forced deviation (P < .0001; OR = 0.48; 95% CI = 0.43-0.53), and complete homonymous hemianopia (P < .0001; OR = 0.67; 95% CI = 0.62-0.73) at baseline were associated with poor mRS at 90 days. Conclusions. The rate of recovery was greater in the first month after stroke, suggesting a potential time frame for interventions. The associations between visual impairments and poor mRS suggest that these impairments should be considered in multidisciplinary assessments and interventions.