Predicting outcome after stroke: the role of basic activities of daily living predicting outcome after stroke.
Predicting outcome after stroke: the role of basic activities of daily living predicting outcome after stroke.
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发表时间：
2013-05
影响因子：
4.5
通讯作者：
B. Gialanella;R. Santoro;C. Ferlucci
中科院分区：
文献类型：
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作者：
B. Gialanella;R. Santoro;C. Ferlucci
背景：很少有研究将入院时的日常生活能力(ADL)作为康复后功能结果的可能预测指标进行研究。目的探讨住院康复期卒中患者入院时的功能状态和功能独立性量表(FIM)评定的基本ADL的表现，作为预测卒中后运动和功能结局的可能指标。设计：这是一项前瞻性和观察性研究。单位：本院物理医学与康复科住院患者。纳入260例初诊为卒中的患者，241例患者进入最终分析。方法采用两个向后逐步回归分析进行预后预测。以年龄、性别、卒中类型、卒中病变大小、失语、忽视、发病至入院间隔、累积疾病评定量表、美国国立卫生研究院卒中评定量表(NIHSS)、Fugl-Meyer量表、躯干控制测验和FIM(总分、运动和认知评分)为自变量。第二个分析包括上述变量加上FIM项目作为自变量。因变量为出院评分、总有效率、运动功能评价和出院目的地。结果多因素分析显示，入院Fugl-Meyer、忽视、总分、运动和认知FIM评分是FIM预后最重要的预测因子，而入院NIHSS评分是出院目的地的唯一预测因子。相反，当入院时单项FIM包括在统计模型中时，入院Fugl-Meyer、忽视、打扮、上身着装和社交得分是FIM结果最重要的预测因素，而入院记忆和肠道控制分数是唯一预测出院目的地的因素。结论基础ADL是预测卒中预后的重要指标，其中社交、打扮、上身着装、大便控制是最重要的影响因素。临床康复的影响这项研究的结果表明，当设计其他关于中风预后预测的研究时，研究人员还应该将评估基本ADL表现的测试作为独立变量，因为这可能允许识别新的预后指标，这些指标可以帮助医生在康复期结束时管理中风患者。
BACKGROUND Very few studies have investigated the influence of single activities of daily living (ADL) at admission as possible predictors of functional outcome after rehabilitation. AIM The aim of the current study was to investigate admission functional status and performance of basic ADLs as assessed by Functional Independence Measure (FIM) scale as possible predictors of motor and functional outcome after stroke during inpatient rehabilitation. DESIGN This is a prospective and observational study. SETTING Inpatients of our Department of Physical Medicine and Rehabilitation. POPULATION Two hundred sixty consecutive patients with primary diagnosis of stroke were enrolled and 241 patients were used in the final analyses. METHODS Two backward stepwise regression analyses were applied to predict outcome. The first backward stepwise regression had age, gender, stroke type, stroke-lesion size, aphasia, neglect, onset to admission interval, Cumulative Illness Rating Scale, National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Scale, Trunk Control Test, and FIM (total, motor and cognitive scores) as independent variables. The second analyses included the above variables plus FIM items as an independent variable. The dependent variables were the discharge scores and effectiveness in total and motor-FIM, and discharge destination. RESULTS The first multivariate analysis showed that admission Fugl-Meyer, neglect, total, motor and cognitive FIM scores were the most important predictors of FIM outcomes, while admission NIHSS score was the only predictor of discharge destination. Conversely, when admission single FIM items were included in the statistical model, admission Fugl-Meyer, neglect, grooming, dressing upper body, and social interaction scores were the most important predictors of FIM outcomes, while admission memory and bowel control scores were the only predictors of discharge destination. CONCLUSION Our study indicates that performances of basic ADLs are important stroke outcome predictors and among which social interaction, grooming, upper body dressing, and bowel control are the most important. CLINICAL REHABILITATION IMPACT The results of this study suggests that, when designing other studies on stroke outcome predictions, researchers should also include tests which assess performances of basic ADLs as independent variables, because this may allow identification of new prognostic indicators that can be helpful for the physician for managing stroke patients at the end of the rehabilitation period.