Predicting Recovery Potential for Individual Stroke Patients Increases Rehabilitation Efficiency
Predicting Recovery Potential for Individual Stroke Patients Increases Rehabilitation Efficiency
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DOI：
10.1161/strokeaha.116.015790
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发表时间：
2017-04-01
期刊：
影响因子：
8.3
通讯作者：
Smith, Marie-Claire
中科院分区：
文献类型：
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作者：
Stinear, Cathy M.;Byblow, Winston D.;Smith, Marie-Claire
背景和目的：一些临床指标和生物标志物与脑卒中后的运动恢复有关，但没有一个用于指导个体患者的康复。本研究的目的是通过使用预测恢复潜力（PREP）算法结合临床测量和生物标志物，评估上肢预测在中风康复中的实施情况。方法：对实施组（n=110）患者进行预测，对对照组（n=82）患者不进行预测。预测指导康复治疗重点的患者在实施组。评估预测信息对临床实践（住院时间、治疗师信心、治疗内容和剂量）的影响。临床结果（上肢功能、损伤和使用、独立性和生活质量）在中风后3个月和6个月进行测量。主要临床实践结果是住院时间。主要临床结果是卒中后3个月的行动研究臂测试得分。结果：在控制上肢损伤、年龄、性别和合共病的情况下，实施组住院时间（11天，95%可信区间为9-13天）比对照组（17天，95%可信区间为14-21天，P=0.001）短1周。治疗师更有信心（P=0.004），并根据实施组的预测修改治疗内容（P=0.004）
Background and Purpose-Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm.Methods-Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82). Predictions guided rehabilitation therapy focus for patients in the implementation group. The effects of predictive information on clinical practice (length of stay, therapist confidence, therapy content, and dose) were evaluated. Clinical outcomes (upper limb function, impairment and use, independence, and quality of life) were measured 3 and 6 months poststroke. The primary clinical practice outcome was inpatient length of stay. The primary clinical outcome was Action Research Arm Test score 3 months poststroke.Results-Length of stay was 1 week shorter for the implementation group (11 days; 95% confidence interval, 9-13 days) than the comparison group (17 days; 95% confidence interval, 14-21 days; P=0.001), controlling for upper limb impairment, age, sex, and comorbidities. Therapists were more confident (P=0.004) and modified therapy content according to predictions for the implementation group (P