Stroke rehabilitation patients, practice, and outcomes: Is earlier and more aggressive therapy better?
Stroke rehabilitation patients, practice, and outcomes: Is earlier and more aggressive therapy better?
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DOI：
10.1016/j.apmr.2005.09.016
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发表时间：
2005-12-01
影响因子：
4.3
通讯作者：
Conroy, B
中科院分区：
文献类型：
--
作者：
Horn, SD;DeJong, G;Conroy, B
目的：研究卒中康复住院患者的患者特征、康复治疗、神经营养药物、营养支持和康复开始时间与功能结局和出院目的地的关系。设计：前瞻性观察性队列研究。设置：5家美国住院康复机构。参与者：卒中后康复患者（N=830;年龄，> 18岁）患有中度或重度中风，来自中风后康复结局项目数据库。干预措施：不适用。主要结局指标：出院总，电机，和cog神经功能缺损评分和出院destination.Results：控制患者的差异，各种活动和干预措施与更好的结果，包括早期开始康复，每天花更多的时间在更高层次的康复活动，如步态，上肢控制，解决问题，使用新的精神药物，肠内喂养。几个研究结果部分与传统的做法，如开始步态训练，在第一个3小时的物理治疗，即使是低水平的患者，与更好的outcomes.Conclusions：具体的治疗活动和干预措施与更好的结果。早期康复入院、康复过程早期的高水平活动、管饲和更新的药物治疗与更好的卒中康复结局相关。
Objective: To examine associations of patient characteristies, rehabilitation therapies, neurotropic medications, nutritional support, and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients.Design: Prospective observational cohort study.Setting: Five U.S. inpatient rehabilitation facilities.Participants: Poststroke rehabilitation patients (N=830; age, > 18y) with moderate or severe strokes, from the PostStroke Rehabilitation Outcomes Project database.Interventions: Not applicable. Main Outcome Measures: Discharge total, motor, and cog nitive FIM scores and discharge destination.Results: Controlling for patient differences, various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation, more time spent per day in higher-level rehabilitation activities such as gait, upper-extremity control, and problem solving, use of newer psychiatric medications, and enteral feeding. Several findings part with conventional practice, such as starting gait training in the first 3 hours of physical therapy, even for low-level patients, was associated with better outcomes.Conclusions: Specific therapy activities and interventions are associated with better outcomes. Earlier rehabilitation admission, higher-level activities early in the rehabilitation process, tube feeding, and newer medications are associated with better stroke rehabilitation outcomes.