The effects of depression and abnormal illness behaviour on outcome following rehabilitation from stroke
The effects of depression and abnormal illness behaviour on outcome following rehabilitation from stroke
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DOI：
10.1191/026921598669567216
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发表时间：
1998-02-01
影响因子：
3
通讯作者：
Smith, DS
中科院分区：
文献类型：
--
作者：
Clark, MS;Smith, DS
目的：探讨抑郁症和异常疾病行为（AIB）对脑卒中患者长期康复预后的相对影响。设计：纵向设计，评估康复入院和出院情况，以及出院后6个月和12个月。环境：本研究在南澳大利亚阿德莱德遣返总医院的康复科进行。研究对象：94名接受住院康复治疗的12个月中风幸存者。主要结果测量：用疾病行为问卷评估AIB，用Zung抑郁自评量表评估抑郁。一般健康问卷和视觉模拟情绪量表也被使用。功能结果用澳大利亚ADL指数的能力和表现评估来评估，生活方式活动用法国活动指数来评估。结果：多变量分析控制了年龄和中风严重程度。在康复出院时以及6个月和12个月后，AIB比年龄或中风严重程度更能预测功能能力和表现。抑郁症在任何评估中都与功能能力和表现无关，但在6个月和12个月时都强烈预测了不活跃的生活方式。相比之下，生活方式活动与AIB无关。结论：抑郁症和AIB似乎对预后有截然不同的影响。AIB是长期功能性残疾的关键决定因素，而抑郁症与较差的社会功能有关。早期识别和治疗AIB和抑郁症对脑卒中康复患者的最终社会和功能结果至关重要。
Objective: To examine the relative effects of depression and abnormal illness behaviour (AIB) on long-term rehabilitation outcome following stroke.Design: A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge.Setting: The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia.Subjects: Ninety-four twelve-month stroke survivors who had undergone an inpatient rehabilitation programme.Main outcome measures: AIB was assessed using the Illness Behaviour Questionnaire, and depression with the Zung Self-Rating Depression Scale. The General Health Questionnaire and a visual analogue mood scale were also used. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities index.Results: Multivariate analysis of outcome controlled for age and stroke severity. AIB was a better predictor of functional competence and performance than either age or stroke severity, at rehabilitation discharge and both six and twelve months later. Depression was not related to functional competence and performance at any assessment, but was strongly predictive of an inactive lifestyle at both six and twelve months. By contrast, lifestyle activities were not related to AIB.Conclusions: Depression and AIB appear to have guile distinct effects on outcome. AIB emerged as a key determinant of long-term functional disability, while depression was associated with poorer social functioning. The early recognition and treatment of AIB and depression is important for the ultimate social and functional outcomes of stroke rehabilitation patients.