Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit
Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit
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DOI：
10.1016/j.jfma.2021.07.009
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发表时间：
2022-02-24
影响因子：
3.2
通讯作者：
Wang, Tyng-Guey
中科院分区：
文献类型：
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作者：
Chen, Wei-Chieh;Hsiao, Ming-Yen;Wang, Tyng-Guey
背景/目的：这项回顾性研究旨在确定哪些因素，如认知，运动恢复，吞咽功能，膀胱和肠道功能，显着预测出院时的日常生活活动（ADL）的独立性在国内人口的急性脑卒中后接受住院康复。研究方法：我们回顾了从国立台湾大学医院综合医学数据库（NTUH-iMD）检索的3000例中风患者的病历，这些患者于2014年至2017年入住NTUH。主要的结局指标是出院时基础ADL（改良Barthel指数[mBI]）的独立性。回归分析用于确定基础ADL（mBI）的预后因素。结果：2538例合格患者在住院期间的总mBI从40.7 +/- 33.0改善至63.1 +/- 34.1。基线日常活动功能（R2变化= 0.042）是与出院时独立性相关的最重要的预后因素，其次是依赖性坐起（R2变化= 0.014），坐姿平衡受损（R2变化= 0.010），偏瘫下肢Brunnstrom分期（R2变化= 0.006），以及在康复入院时由医生评估的膀胱失禁的存在（R2变化= 0.006）（R2 = 0.53，p < 0.05）。坐立困难、坐位平衡受损和尿失禁是影响出院时ADL独立性的负性预后因素（p < 0.05）。而偏瘫下肢Brunnstrom分期和康复入院时基线mBI评分是出院时ADL独立性的积极预后因素（p < 0.05）。结论：基线ADL功能是急性脑卒中后功能独立性的最重要预后因素。此外，偏瘫患者的活动受限和下肢运动功能障碍也是功能独立的重要原因。
Background/Purpose: This retrospective study aimed to determine which factors, such as cognition, motor recovery, swallowing function, and bladder and bowel functions, significantly predicted independence in the activities of daily living (ADL) at hospital discharge in a domestic population of patients experiencing post-acute stroke who received in-hospital rehabilitation. Methods: We reviewed medical records that were retrieved from the Integrated Medical Database, National Taiwan University Hospital (NTUH-iMD) of 3000 patients who suffered from stroke and were admitted to NTUH from 2014 to 2017. The main outcome measure was independence in the basic ADL (modified Barthel index [mBI]) at discharge. Regression analyses were used to identify prognostic factors for the basic ADL (mBI). Results: The total mBI improved from 40.7 +/- 33.0 to 63.1 +/- 34.1 in eligible 2538 patients during their hospital stay. The baseline daily activity function (R2 change = 0.042) was the most important prognostic factor associated with independence at discharge, followed by dependence in sitting up (R2 change = 0.014), impaired sitting balance (R2 change = 0.010), the Brunnstrom stage of hemiplegic lower limb (R2 change = 0.006), and the presence of bladder incontinence (R2 change = 0.006) assessed by physician upon rehabilitation admission (R2 = 0.53, p < 0.05). Dependency in sitting up, impaired sitting balance, and the presence of urinary incontinence were negative prognostic factors of ADL independence at discharge (p < 0.05). By contrast, the Brunnstrom stage of hemiplegic lower limb and baseline mBI scores at rehabilitation admission were positive prognostic factors of ADL independence at discharge (p < 0.05). Conclusion: Baseline ADL function was the most important prognostic factor of functional independence in post-acute stroke. Moreover, the activity limitation of dependency on sitting up and motor function impairment of hemiplegic lower limb prognosticated functional independence.