Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation
Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation
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DOI：
10.1016/j.apmr.2020.11.020
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发表时间：
2021-03-31
影响因子：
4.3
通讯作者：
Toglia, Joan
中科院分区：
文献类型：
--
作者：
O'Dell, Michael W.;Jaywant, Abhishek;Toglia, Joan
目的：使用急性后护理活动测量（AM-PAC）描述住院卒中康复后的功能变化，这是一种对变化敏感且天花板效应风险较低的评估措施。设计：回顾性纵向队列研究。地点：城市学术医疗中心的住院康复单位。参与者：在 2012 年至 2016 年收治的 433 名卒中患者中，共有 269 名（62%）被纳入我们的数据库，其中 89 名被纳入数据库。住院脑卒中康复出院患者269例（33.1%）数据完整。有和没有完整数据的患者非常相似。该组的平均年龄为 68.0 +/- 14.2 岁，美国国立卫生研究院中风评分为 8.0 +/- 8.0，康复住院时间为 14.7 +/- 7.4 天，其中 84% 患有缺血性中风，22.5% 患有复发性中风。 干预措施：无。 主要结果指标：在各种不同的疾病中测量出院后第一年的功能变化 (DC)。方式。在住院患者 DC 和 DC 后 6 (6M) 和 12 个月 (12M) 时计算并比较 AM-PAC 的基本活动能力 (BM)、日常活动 (DA) 和应用认知领域的连续平均分。根据最小可检测变化、（估计）最小临床重要差异以及变化 >= 1 AM-PAC 功能阶段 (FS)，将 3 个时间点之间的个体类别变化分为“改善”、“不变”或“下降”。结果：对于连续分析，弗里德曼检验对所有领域均显着（P
Objective: To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect.Design: Retrospective, longitudinal cohort study.Setting: Inpatient rehabilitation unit of an urban academic medical center.Participants: Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0 +/- 14.2 years, National Institutes of Health Stroke Score of 8.0 +/- 8.0, and rehabilitation length of stay of 14.7 +/- 7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke.Intervention: None.Main Outcome Measures: Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as "improved," "unchanged," or "declined" between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change >= 1 AM-PAC functional stage (FS).Results: For the continuous analyses, the Friedman test was significant for all domains (P