Kwakkel G, Kollen B J, Wagenaar R C
University Hospital Vrije Universiteit, Department of Physical Therapy and Research Institute for Fundamental and Clinical Human Movement Sciences, Amsterdam, The Netherlands.
J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):473-9. doi: 10.1136/jnnp.72.4.473.
To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases.
A three group randomised controlled trial with repeated measures was used.
One hundred and one patients with a primary middle cerebral artery stroke were randomly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on (1) upper limb function, (2) lower limb function or (3) immobilisation with an inflatable pressure splint (control group). Follow up assessments within and between groups were compared at 6, 9, and 12 months after stroke.
No statistically significant effects were found for treatment assignment from 6 months onwards. At a group level, the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained. However, no significant differences in functional recovery between groups were found for Barthel index (BI), functional ambulation categories (FAC),action research arm test (ARAT), comfortable and maximal walking speed, Nottingham health profile part 1(NHP-part 1), sickness impact profile-68 (SIP-68), and Frenchay activities index (FAI) from 6 months onwards. At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function (n=8 and 5, respectively) and lower limb function (n=19 and 9, respectively). Activities of daily living (ADL) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards. In particular, patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards.
On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme. However, a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity, walking ability, and ADL beyond the error threshold.
评估在急性和亚急性康复阶段参与上肢和下肢强化训练计划的患者在中风后1年的长期影响。
采用三组随机对照试验并进行重复测量。
101例原发性大脑中动脉中风患者被随机分配到三组之一，接受为期20周的康复计划，重点分别为：（1）上肢功能，（2）下肢功能，或（3）使用充气压力夹板固定（对照组）。在中风后6、9和12个月对组内和组间的随访评估进行比较。
从6个月起，治疗分组未发现有统计学意义的效果。在组间水平上，中风后20周时显示出的有利于下肢的疗效显著差异仍然存在。然而，从6个月起，在Barthel指数（BI）、功能性步行分类（FAC）、动作研究臂测试（ARAT）、舒适和最大步行速度、诺丁汉健康概况第1部分（NHP - part 1）、疾病影响概况 - 68（SIP - 68）以及Frenchay活动指数（FAI）方面，各组间功能恢复无显著差异。在个体受试者水平上，大量患者的上肢功能（分别为n = 8和5）和下肢功能（分别为n = 19和9）出现改善或恶化。日常生活活动（ADL）评分显示，从6个月起，5例患者恶化，4例改善超过误差阈值。特别是，在6个月时功能恢复不完全但有一定恢复的患者，从6个月起可能会继续改善或退步。
平均而言，患者在接受为期20周的上肢或下肢功能训练计划后，中风后长达1年可维持其功能改善。然而，相当数量恢复不完全的患者在灵活性、步行能力和ADL方面出现超过误差阈值的改善或恶化。
