Rehabilitation Therapy Doses Are Low After Stroke and Predicted by Clinical Factors.
Rehabilitation Therapy Doses Are Low After Stroke and Predicted by Clinical Factors.
复制标题
中风后康复治疗剂量较低，并且由临床因素预测。
DOI：
10.1161/strokeaha.122.041098
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发表时间：
2023
期刊：
影响因子：
8.3
通讯作者：
STRONGStudyInvestigators
中科院分区：
文献类型：
--
作者：
Young,BrittanyM;Holman,EAlison;Cramer,StevenC;STRONGStudyInvestigators
背景中风是长期残疾的主要原因。众所周知，中风后加强康复治疗可以改善功能结果。这项研究检查了中风恢复第一年的治疗剂量，并确定了预测康复治疗剂量的因素。方法在美国 28 家急症护理医院中风发病后 2 至 10 天，招募了经放射学确诊的新发中风成人。在急性住院期间进行初步评估后，在中风后 3、6 和 12 个月就诊时确定物理治疗、职业治疗和言语治疗疗程的次数。负二项回归检查临床和人口因素是否与治疗计数相关。错误发现率用于纠正多重比较。结果在急性卒中入院期间纳入的 763 名患者中，有 510 名可进行随访。总体治疗计数较低，大多数治疗在前 3 个月内实施； 35.0%的患者未接受物理治疗； 48.8%，没有职业治疗，61.7%，没有言语治疗。出院目的地与累积治疗显着相关；出院到住院康复机构的患者比例因地点而异，从 0% 到 71% 不等。尽管西班牙裔患者接受的物理治疗和职业治疗的累积量较低，但大多数人口统计因素并不能预测治疗剂量。临床因素的严重程度（握力和美国国立卫生研究院卒中量表评分，以及美国国立卫生研究院卒中量表失语和忽视的子评分）的严重程度预示着后续治疗剂量会更高。中风后 3 个月评估的损伤和功能测量（Fugl-Meyer、改良 Rankin 量表和中风影响量表日常生活活动）也可预测随后的累积治疗剂量。 结论 在美国，中风后第一年的康复治疗剂量较低。这是第一项全美范围内的研究，证明行为缺陷可以预测治疗剂量，缺陷更严重的患者接受更高的剂量。研究结果为识别有可能接受过低康复剂量的人群提供了指导。
BackgroundStroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose.MethodsAdults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons.ResultsOf 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses.ConclusionsRehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.