Impairment and disability: Their relation during stroke rehabilitation
Impairment and disability: Their relation during stroke rehabilitation
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DOI：
10.1016/s0003-9993(98)90015-6
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发表时间：
1998-03-01
影响因子：
4.3
通讯作者：
Diaz, S
中科院分区：
文献类型：
--
作者：
Roth, EJ;Heinemann, AW;Diaz, S
目的：描述中风康复过程中损伤和残疾之间的关系，并通过研究损伤水平没有显著降低的中风患者所经历的残疾减轻程度来检查康复的效果。设计：对前瞻性收集的中风患者康复信息数据库中的项目进行统计分析，设置：大型城市学术独立康复机构。参与者：402名连续入院接受综合性急性卒中住院康复治疗的患者。主要结果测量：采用美国国立卫生研究院卒中量表（NIHSS）测量损伤，采用功能独立性测量（FIMSM）测量残疾。采用Rasch分析法将原始NIHSS和FIMSM评分转换为线性测量值。方法：采用线性回归分析法研究NIHSS转换值与FIMSM两个分量表入院、出院和变化评分的关系。342名患者的损伤没有明显减轻，组成了“无损伤减轻（NIR）组”，60名患者的损伤水平显著降低，组成了“损伤减轻（IR）组”。采用多变量方差分析确定并比较两组中运动和认知FIMSM指标随时间的变化量。结果：NIHSS与入院、出院和变化指标的运动和认知FIMSM分项评分显著相关; R-2值范围在0.02和0.36之间。NIR组和IR组经历了显着减少残疾在康复过程中，在放电FIMSM措施两组之间的差异相对较小。结论：虽然中风相关的损害和残疾是显着相关的彼此，降低损伤水平并不能完全解释减少残疾，发生在康复过程中。即使没有实质性的损害减少的患者在康复过程中表现出残疾减少，这表明康复在改善功能方面具有独立的作用，而不仅仅是神经恢复。(C)1998年由美国康复医学大会和美国物理医学和康复学会。
Objectives: To describe the association between impairment and disability during stroke rehabilitation and to examine the effects of rehabilitation by studying the degree of disability reduction experienced by stroke patients who did not have significant reductions in impairment levels.Design: Statistical analysis of items from a database of prospectively collected information on stroke patients admitted for rehabilitation,Setting: Large urban academic freestanding rehabilitation facility.Participants: Four hundred two patients consecutively admitted for comprehensive acute stroke inpatient rehabilitation.Main Outcome Measures: The National Institutes of Health Stroke Scale (NIHSS) was used to measure impairment and the Functional Independence Measure (FIMSM) was used to measure disability. Motor and cognitive subscales of the FIMSM instrument were evaluated, Raw NIHSS and FIMSM scores were converted to linear measures using Rasch analysis,Methods: Relationships were studied between converted NIHSS and the two FIMSM subscales for admission, discharge, and change scores using linear regression analysis, In a second analysis, two groups of patients were identified; the 342 patients who experienced no substantial reduction of impairment comprised the "no impairment reduction (NIR) group," and the 60 patients who had a significant reduction of impairment level comprised the "impairment reduction (IR) group." Multivariate analysis of variance was used to determine and compare the amount of change in motor and cognitive FIMSM measures over time for each of the two groups,Results: NIHSS correlated significantly with motor and cognitive FIMSM subscores for admission, discharge, and change measures; R-2 values ranged between .02 and .36. Both the NIR group and the IR group experienced significant decreases in disability during rehabilitation, The differences in discharge FIMSM measures between the two groups were relatively small.Conclusions: Although stroke-related impairment and disability are significantly correlated with each other, reduced impairment level alone does not fully explain the reduced disability that occurs during rehabilitation. Even patients without substantial impairment reduction demonstrate disability reduction during rehabilitation, suggesting that rehabilitation has an independent role in improving function beyond that explained by neurologic recovery alone. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.