Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke
Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke
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DOI：
10.1682/jrrd.2005.04.0075
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发表时间：
2006-05-01
影响因子：
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通讯作者：
Edwards, Dorothy F.
中科院分区：
文献类型：
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作者：
Dromerick, Alexander W.;Lang, Catherine E.;Edwards, Dorothy F.
本研究探讨了参加急性康复治疗试验的相对单纯运动性偏瘫的中风患者的上肢（UL）功能限制与自我报告残疾之间的关系。所有参与者都参加了 VECTORS（中风康复的早期约束治疗）研究。 VECTORS 是一项早期应用约束诱导运动疗法（CIMT）的单中心试点临床试验。完成 90 天 VECTORS 的所有 39 名受试者均纳入本次分析。所有评估均由对治疗类型不知情的训练有素的研究人员进行。本文中的数据检查了中风后 90 天进行的评估之间的关系。功能限制测量包括行动研究安（ARA）测试和沃尔夫运动功能测试（WMFT），自我报告的残疾测量包括功能独立测量（FIM）和运动活动日志（MAL）（通过电话）。从卒中发作到随机分组的平均正负标准差时间为 9.4 正负 4.3 天，中位随访时间为 99 天（范围 68-178）。在 ARA 测试或 WMFT 中获得满分或接近满分的受试者在 FIM 和 MAL 上报告了残余残疾。 WMFT（功能能力得分）的运动质量与自我报告的频率没有很强的相关性，WMFT（计时得分）的运动速度与自我报告的频率（MAL 使用量）没有很强的相关性。在这项早期的 UL 干预试验中，我们发现感知残疾测量捕获了功能限制和损伤量表未评估的信息。我们的结果表明，通过功能限制和损伤量表衡量的出色运动恢复并不等于日常高效 UL 使用的恢复，并且任务完成的速度并不转化为实际使用。我们的结果证实需要一种对变化敏感的测量策略，评估广泛的性能范围，并在早期康复干预试验中检测有意义的临床改善。
This study explored relationships between upper-limb (UL) functional limitations and self-reported disability in stroke patients with relatively pure motor hemiparesis who were enrolled in an acute rehabilitation treatment trial. All participants were enrolled in the VECTORS (Very Early Constraint Treatment for Recovery from Stroke) study. VECTORS is a single-center pilot clinical trial of early application of constraint-induced movement therapy (CIMT). All 39 subjects who completed 90 days of VECTORS were included in this analysis. Trained study personnel who were blinded to the treatment type performed all evaluations. Data in this article examine relationships between assessments performed 90 days after stroke. Functional limitation measures included the Action Research Ann (ARA) test and Wolf Motor Function Test (WMFT), and self-reported disability measures included the Functional Independence Measure (FIM) and Motor Activity Log (MAL) (by telephone). Mean plus or minus standard deviation time from stroke onset to randomization was 9.4 plus or minus 4.3 days, and median time to follow-up was 99 days (range 68-178). Subjects with perfect or near-perfect scores on the ARA test or WMFT reported residual disability on the FIM and MAL. Quality of movement on the WMFT (functional ability score) was not strongly associated with self-reported frequency, and speed of movement on the WMFT (timed score) was not associated with self-reported frequency (MAL amount of use). In this early UL intervention trial, we found that perceived disability measures captured information that was not assessed by functional limitation and impairment scales. Our results indicate that excellent motor recovery as measured by functional limitation and impairment scales did not equal restoration of everyday productive UL use and speed of task completion did not translate to actual use. Our results confirm the need for a measurement strategy that is sensitive to change, assesses a broad performance range, and detects meaningful clinical improvements in early rehabilitation intervention trials.