Warschausky S, Kay J B, Kewman D G
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
Arch Phys Med Rehabil. 2001 Mar;82(3):329-34. doi: 10.1053/apmr.2001.21510.
To examine the recovery of aspects of functional independence as a continuous process using growth curve analysis.
Retrospective database review of functional outcome assessment data from inception cohort.
Inpatient rehabilitation unit; community.
A total of 142 subjects (79.6% men; age range, 18-77yr; mean age +/- standard deviation, 36.2 +/- 15.5yr) who were admitted to a rehabilitation unit between March 1986 and November 1994 with a minimum of 4 postinjury FIM assessments. Neurologic subgroups included 63 individuals with paraplegia, 36 with low tetraplegia, 24 with high tetraplegia, and 19 with incomplete injury.
FIM instrument.
Growth curve analyses with hierarchical linear modeling using a decelerating recovery function yielded a reliable model in which longer rehabilitation length of stay was associated with a more rapid rate of recovery but lower plateau. Neurologic injury category had expected effects on rate and degree of recovery. Level of impairment-specific results included an age effect in which older age was associated with lower level of plateau. In specific neurologic groups there was a significant gender effect, in which men made more rapid recovery than women, and a significant effect of level of education, in which higher education was associated with more rapid rate of recovery. Rate of FIM recovery was reliably modeled in the sample with incomplete injuries, but none of the demographic predictors was significant.
Functional recovery can be modeled as a decelerating rather than simple linear function. The study of predictors of recovery characteristics, including rate of recovery and plateau, offers a valuable way of understanding rehabilitative needs and outcomes. Gender and education effects on the recovery process are intriguing and warrant further investigation.
采用生长曲线分析，将功能独立性各方面的恢复作为一个连续过程进行研究。
对起始队列的功能结局评估数据进行回顾性数据库分析。
住院康复单元；社区。
1986年3月至1994年11月期间入住康复单元的142名受试者（男性占79.6%；年龄范围18 - 77岁；平均年龄±标准差为36.2±15.5岁），他们至少接受了4次伤后FIM评估。神经亚组包括63例截瘫患者、36例低位四肢瘫患者、24例高位四肢瘫患者和19例不完全损伤患者。
FIM工具。
使用减速恢复函数的分层线性模型进行生长曲线分析，得出了一个可靠的模型，即康复住院时间越长，恢复速度越快，但恢复平台期越低。神经损伤类别对恢复速度和程度有预期影响。特定损伤水平的结果包括年龄效应，即年龄较大与恢复平台期较低相关。在特定神经亚组中，存在显著的性别效应，男性恢复速度比女性快，以及显著的教育程度效应，即高等教育与更快的恢复速度相关。在不完全损伤的样本中，FIM恢复率能够可靠地建模，但人口统计学预测因素均无显著意义。
功能恢复可建模为减速函数而非简单线性函数。对恢复特征预测因素的研究，包括恢复速度和平台期，为理解康复需求和结局提供了一种有价值的方法。性别和教育程度对恢复过程的影响很有趣，值得进一步研究。
