Kwakkel G, van Dijk G M, Wagenaar R C
Department of Physical Therapy, University Hospital Vrije Universiteit and Research Institute for Fundamental and Clinical Human Movement Sciences, Amsterdam, The Netherlands.
Clin Rehabil. 2000 Feb;14(1):28-41. doi: 10.1191/026921500675130139.
The ability of physical therapists (PTs) and occupational therapists (OTs) to predict level of outcome accurately was investigated prospectively in 91 severely disabled stroke patients with a first-ever middle cerebral artery (MCA) stroke.
Within the second and fifth week after stroke onset, 364 predictions were made by 59 PTs and 47 OTs about walking ability, dexterity, activities of daily living (ADL), need for additional care in ADL, time required to achieve independent walking ability and maximal level of ADL, and destination of discharge at six months after stroke. The functional recovery patterns of stroke patients were assessed by an independent observer. The accuracy of the therapists' predictions was compared with that of derived prediction models. In addition, the influence of characteristics of patients and therapists on the accuracy of the predictions was investigated.
Compared to observed outcomes at six months after stroke, therapists' lowest accuracies of prediction were found for the moment at which maximal ADL score was achieved (rs = 0.07; p = NS), and highest accuracy was for level of dexterity of the hemiplegic arm (rs = 0.78; p <0.01). Therapists' predictions of functional outcome at six months tended to be too pessimistic. No significant differences were observed for dexterity and walking ability when the predictions by PTs and OTs were compared with those of regression models, whereas significant differences were found for the accuracies of OTs' and PTs' first prediction of destination of discharge and second predictions of outcome in ADL and need for additional care in ADL. No significant differences were found between the accuracy of PTs' and OTs' predictions, and their ability to predict functional outcome was not significantly influenced by the characteristics of patient and therapists.
At two and five weeks after stroke, OTs and PTs can accurately predict level of walking ability and dexterity at six months. The prediction of time required for achieving maximal level of recovery, destination of discharge, outcome of ADL as well as need for additional care in ADL leaves room for improvement.
前瞻性研究了91例首次发生大脑中动脉（MCA）卒中的严重残疾卒中患者的物理治疗师（PT）和职业治疗师（OT）准确预测预后水平的能力。
在卒中发作后的第二周和第五周内，59名PT和47名OT对步行能力、灵活性、日常生活活动（ADL）、ADL中额外护理需求、实现独立步行能力和ADL最高水平所需时间以及卒中后六个月的出院目的地进行了364次预测。由一名独立观察者评估卒中患者的功能恢复模式。将治疗师预测的准确性与推导的预测模型的准确性进行比较。此外，还研究了患者和治疗师的特征对预测准确性的影响。
与卒中后六个月观察到的结果相比，治疗师预测达到ADL最高评分的时间准确性最低（rs = 0.07；p = 无显著性差异），而偏瘫手臂灵活性水平的预测准确性最高（rs = 0.78；p <0.01）。治疗师对六个月时功能预后的预测往往过于悲观。当将PT和OT的预测与回归模型的预测进行比较时，在灵活性和步行能力方面未观察到显著差异，而在OT和PT对出院目的地的首次预测以及ADL中结局和ADL中额外护理需求的第二次预测准确性方面发现了显著差异。PT和OT预测的准确性之间未发现显著差异，并且他们预测功能预后的能力未受到患者和治疗师特征的显著影响。
在卒中后两周和五周时，OT和PT可以准确预测六个月时的步行能力和灵活性水平。对达到恢复最高水平所需时间、出院目的地、ADL结局以及ADL中额外护理需求的预测仍有改进空间。
