Lincoln N B, Parry R H, Vass C D
School of Psychology, University of Nottingham, Division of Stroke Medicine, Nottingham City Hospital, Nottingham, UK.
Stroke. 1999 Mar;30(3):573-9. doi: 10.1161/01.str.30.3.573.
Many patients have impaired arm function after stroke, for which they receive physiotherapy. The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained, supervised assistant. The physiotherapy followed a typical British approach, which is Bobath derived. Ten hours of additional therapy were given over a 5-week period.
The study design was a single-blind, randomized, controlled trial. Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke. They were randomly allocated to routine physiotherapy, additional treatment by a qualified physiotherapist, or additional treatment by a physiotherapy assistant. Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living.
There were 282 patients recruited to the study. The median initial Barthel score was 6.5, and the median age of the patients was 73 years. The median initial Rivermead Motor Assessment Arm score was 1. There were no significant differences between the groups at randomization or on any of the outcome measures. Only half of the patients allocated to the 2 additional-therapy groups completed the program.
This increase in the amount of physiotherapy for arm impairment with a typical British approach given early after stroke did not significantly improve the recovery of arm function in the patients studied. A number of other studies of interventions aimed at rehabilitation of arm function have reported positive results. Such findings may have been due to the content of these interventions, to the greater intensity of the interventions, or to the selection of patients to whom the treatments were applied.
许多中风患者存在上肢功能障碍，为此他们接受物理治疗。本研究的目的是确定中风后早期增加物理治疗的量是否能改善上肢功能的恢复，并比较由合格治疗师或经过培训、有监督的助手实施这种治疗的效果。物理治疗采用典型的源自Bobath法的英国治疗方法，在5周内额外给予10小时治疗。
本研究设计为单盲、随机、对照试验。中风患者从中风后5周内入院的患者中招募。他们被随机分配到常规物理治疗组、由合格物理治疗师进行额外治疗组或由物理治疗助手进行额外治疗组。在治疗5周后以及中风后3个月和6个月时，通过上肢功能及日常生活活动独立性的测量指标对结果进行评估。
共有282名患者纳入本研究。初始Barthel评分中位数为6.5，患者年龄中位数为73岁。初始Rivermead运动评估上肢评分中位数为1。随机分组时及任何一项结果测量指标上，各组之间均无显著差异。分配到两个额外治疗组的患者中只有一半完成了该项目。
中风后早期采用典型英国方法增加上肢功能障碍的物理治疗量，在所研究的患者中并未显著改善上肢功能的恢复。其他一些针对上肢功能康复干预措施的研究报告了阳性结果。这些结果可能归因于这些干预措施的内容、干预措施的强度更大或所治疗患者的选择。
