Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke
Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke
复制标题
DOI：
10.1212/wnl.0000000000200154
复制
发表时间：
2022-05-03
期刊：
影响因子：
9.9
通讯作者：
Lin, David J.
中科院分区：
文献类型：
--
作者：
Erler, Kimberly S.;Wu, Rui;Lin, David J.
背景和目标 精确测量结果对于卒中试验和临床护理至关重要。先前的研究强调了全球结果测量（例如改良兰金量表（mRS））和特定领域测量（例如运动、感觉、语言或认知功能）之间的概念差异。本研究将运动表型与 mRS 联系起来，具体目的是确定 mRS 水平是否区分运动损伤和功能表型，并将 mRS 结果与中风后从急性恢复到亚急性恢复的损伤和功能的有意义的变化进行比较。方法对缺血性中风后上肢无力的患者在中风后第一周和 90 天内通过一系列损伤和功能测量进行评估。根据 90 天 mRS 评分检查损伤和功能结果。检查与 90 天 mRS 评分相关的运动损伤、日常生活活动和活动能力方面具有临床意义的变化。结果在这个由 73 名中风患者组成的队列中，损伤和功能结果与 90 天 mRS 评分相关，但在个体 mRS 水平内显示出很大的变异性：在 mRS 2 级内，上肢损伤范围从接近偏瘫（上肢 Fugl-Meyer 评分为 8）到无缺陷（上肢功能障碍）。肢体 Fugl-Meyer 评分 66)。总体而言，相邻 mRS 水平之间的损伤和功能结果几乎没有差异。虽然 mRS 3 级和 4 级之间的一些结果指标存在显着差异（九孔钉、腿部运动、步态速度、计时起立、NIH 中风量表和 Barthel 指数），但 mRS 1 级和 2 级之间的结果指标没有差异。任何相邻 mRS 级之间的 Fugl-Meyer 和握力没有差异。大量患者在中风后的前 90 天内经历了具有临床意义的损伤和功能变化，但没有取得良好的 mRS 结果（mRS 评分
Background and ObjectivesPrecise measurement of outcomes is essential for stroke trials and clinical care. Prior research has highlighted conceptual differences between global outcome measures such as the modified Rankin Scale (mRS) and domain-specific measures (e.g., motor, sensory, language or cognitive function). This study related motor phenotypes to the mRS, specifically aiming to determine whether mRS levels distinguish motor impairment and function phenotypes, and to compare mRS outcomes to meaningful changes in impairment and function from acute to subacute recovery after stroke.MethodsPatients with upper extremity weakness after ischemic stroke were assessed with a battery of impairment and functional measures within the first week and at 90 days after stroke. Impairment and functional outcomes were examined in relation to 90-day mRS scores. Clinically meaningful changes in motor impairment, activities of daily living, and mobility were examined in relation to 90-day mRS score.ResultsIn this cohort of 73 patients with stroke, impairment and functional outcomes were associated with 90-day mRS scores but showed substantial variability within individual mRS levels: within mRS level 2, upper extremity impairment ranged from near hemiplegia (with an upper extremity Fugl-Meyer score 8) to no deficits (upper extremity Fugl-Meyer score 66). Overall, there were few differences in impairment and functional outcomes between adjacent mRS levels. While some outcome measures were significantly different between mRS levels 3 and 4 (Nine-Hole Peg, Leg Motor, gait velocity, Timed Up and Go, NIH Stroke Scale, and Barthel Index), none of the outcome measures differed between mRS levels I and 2. Fugl-Meyer and grip strength were not different between any adjacent mRS levels. A substantial number of patients experienced clinically meaningful changes in impairment and function in the first 90 days after stroke but did not achieve good mRS outcome (mRS score