Key neurological impairments influence function-related group outcomes after stroke
Key neurological impairments influence function-related group outcomes after stroke
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DOI：
10.1161/01.str.0000019792.59599.cc
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发表时间：
2002-07-01
期刊：
影响因子：
8.3
通讯作者：
Reding, M
中科院分区：
文献类型：
--
作者：
Han, L;Law-Gibson, D;Reding, M
背景和目的--功能相关组(FRG)的分类基于功能评估，并被认为涵盖了不同类型和严重程度的神经损害的影响。这一假设可能并不正确。它被提议作为一种手段来比较不同机构的康复结果。如果神经损伤显著影响FRG结果，那么较高的FRG结果分数可能反映出选择偏见，有利于神经损伤较少的患者，而不是更好的康复护理质量。本研究的目的是评估运动、躯体感觉和偏盲视觉障碍对卒中后FRG预后的影响。方法：1999年从一家急性康复医院出院的288名中风患者，根据他们的功能独立性测量(FIM)活动亚分和年龄，被分配到5个FRG中的1个。根据是否存在关键的神经损害，每个FRG也被分成1/4组：单纯运动障碍(M)，运动+躯体感觉或偏盲视觉障碍(MS/MV)，运动+躯体感觉+偏盲视觉障碍(MSV)，以及其他损害的组合。所有患者从入院到出院每10天进行一次FIM评分。通过重复测量方差分析评估损害组对结果的影响在每个FRG类别内，以评估4个损害组之间的系列FIM评分的差异。结果：从最低的FRG-11到最高的FRG-15，每个FRG组的患者数量分别为78(27%)、47(16%)、75(26%)、55(19%)和33(11%)。FRG-11的MSV=63+/-16，MS/MV=68+/-19，M=81+/-13(P=0.04)；FRG-12的MSV=47+/-14，MS/MV=61+/-12，M=75+/-11(P=0.01)；FRG-13的MSV=79+/-20，MS/MV=85+/-19，M=96+/-10(P=0.01)。
Background and Purpose-The function-related group (FRG) classification is based on functional assessment and has been assumed to encompass the effects of different patterns and severity of neurological impairments. This assumption may not be correct. It has been proposed as a means of comparing rehabilitation outcome across institutions. If neurological impairments significantly affect FRG outcome, then higher FRG outcome scores may reflect selection bias favoring patients with fewer neurological impairments rather than better quality of rehabilitation care. The goal of this study was to assess the influence of motor, somatosensory, and hemianopic visual impairments on FRG outcomes after stroke.Methods-All 288 consecutive stroke patients discharged in 1999 from an acute rehabilitation hospital were assigned to 1 of 5 FRGs on the basis of their Functional Independence Measure (FIM) mobility subscore and age. Each FRG was also stratified into 1of 4 cohorts on the basis of the presence or absence of key neurological impairments: motor impairment only (M), motor Plus either somatosensory or hemianopic visual impairment (MS/MV), motor plus somatosensory plus hemianopic visual impairment (MSV), and other combinations of impairments. FIM scores were available every 10 days for all patients from admission to discharge. The effect of impairment group on outcome was assessed within each FRG category through repeated-measures analysis of variance to assess differences in serial FIM scores across the 4 impairment groups. The distribution of each of the 4 impairment groups across the 5 FRGs was assessed with chi(2) analysis.Results-The numbers of patients in each of the 5 FRGs from the lowest level, FRG-11, to the highest, FRG-15, were as follows: 78 (27%), 47 (16%), 75 (26%), 55 (19%), and 33 (11%). Different neurological impairments were associated with significantly different mean +/- SD discharge FIM scores as follows: for FRG-11, MSV = 63 +/- 16, MS/MV = 68 +/- 19, and M=81 +/- 13 (P=0.04); for FRG-12, MSV=47 +/- 14, MS/MV=61 +/- 12, and M=75 +/- 11 (P=0.01); and for FRG-13, MSV=79 +/- 20, MS/MV=85 +/- 19, and M=96 +/- 10 (P