Bogner J A, Corrigan J D, Fugate L, Mysiw W J, Clinchot D
Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, USA.
Am J Phys Med Rehabil. 2001 Sep;80(9):636-44. doi: 10.1097/00002060-200109000-00002.
To determine the role of agitation in the prediction of traumatic brain injury rehabilitation outcomes.
A longitudinal study of 340 consecutive patients admitted to an acute traumatic brain injury rehabilitation unit was conducted. Outcomes under study included rehabilitation length of stay, discharge destination, functional independence at discharge (FIM instrument), productivity at 1-yr follow-up, and life satisfaction at 1-yr follow-up (Satisfaction with Life Scale).
Univariate analyses suggested that the presence of agitation in rehabilitation is predictive of a longer length of stay and decreased functional independence in the cognitive realm at discharge. In addition, individuals who exhibit agitation at any time during rehabilitation are less likely to be discharged to a private residence. However, multivariate analyses indicated that cognitive functioning at admission to rehabilitation (FIM cognitive) mediates the relationship between the presence of agitation and length of rehabilitation, as well as between agitation and FIM cognitive at discharge. Similar results were found when discharge residence was the dependent variable; however, agitation also contributed some unique variance to the prediction. Lower cognitive functioning at admission to rehabilitation was associated with the occurrence of agitation during rehabilitation, longer length of stay, lower cognitive functioning at discharge, and a decreased likelihood that an individual would be discharged to a private residence.
The results of the multivariate analyses support the contention that agitation and cognition are intimately related, with the long-term effects of the former being at least partially driven by the latter. These findings support the importance of systematically monitoring both agitation and cognition when applying interventions to reduce agitation.
确定激越在预测创伤性脑损伤康复结局中的作用。
对340例连续入住急性创伤性脑损伤康复单元的患者进行了一项纵向研究。所研究的结局包括康复住院时间、出院去向、出院时的功能独立性（FIM量表）、1年随访时的生产力以及1年随访时的生活满意度（生活满意度量表）。
单因素分析表明，康复过程中出现激越预示着住院时间更长，且出院时认知领域的功能独立性降低。此外，在康复过程中任何时候出现激越的个体出院回家的可能性较小。然而，多因素分析表明，康复入院时的认知功能（FIM认知）介导了激越的存在与康复时间之间的关系，以及激越与出院时FIM认知之间的关系。当出院去向作为因变量时也发现了类似结果；然而，激越在预测中也有一些独特的方差贡献。康复入院时较低的认知功能与康复过程中激越的发生、更长的住院时间、出院时较低的认知功能以及个体出院回家可能性降低有关。
多因素分析结果支持激越与认知密切相关的观点，前者的长期影响至少部分由后者驱动。这些发现支持了在应用干预措施减少激越时系统监测激越和认知的重要性。
