Ancheta J, Husband M, Law D, Reding M
Weill Medical College of Cornell University at Burke Rehabilitation Hospital, 785 Mamaroneck Ave., White Plains, NY 10605, USA.
Neurorehabil Neural Repair. 2000;14(2):127-34. doi: 10.1177/154596830001400205.
This study tests the hypothesis that the rehabilitation hospital admission functional Independence Measure (FIM) score and interval post stroke can be used to define clinically relevant functional recovery goals, estimate length of stay, and compare quality of care.
The effects of time from stroke to rehabilitation unit admission on admission and discharge FIM scores, length of rehabilitation stay, and change in FIM score/day have not yet been reported.
Analysis was based on prospectively collected data from patients admitted to an inpatient stroke rehabilitation unit with FIM scores < or = 90 and an initial, unilateral, hemispheric, thrombotic, or embolic stroke who were fully independent without the use of an assistive device before their stroke. Patients with severe (admission FIM < 54) and moderate (admission FIM 54-90) stroke deficits were divided into cohorts based on interval from stroke to rehabilitation hospital admission: 0-2, 2-4, and 4-6 weeks.
Over a 17-month interval, 87 patients met selection criteria. Significant improvements were seen in total FIM scores for all. For those with moderate stroke, all three time cohorts reached a FIM score of 102 +/- 2 SEM after 35 +/- 2 days on the rehabilitation unit. Patients admitted within 2 weeks of a severe stroke reached a plateau FIM score of 72 +/- 6 after 43 +/- 3 days on the rehabilitation unit compared with the 2-4 week group (FIM = 57 +/- 5 after 53 +/- 4 days) and the 4-6 week group (FIM = 54 +/- 10 after 40 +/- 6 days). Complications increased with severity of stroke and delay in rehabilitation hospital transfer.
Admission FIM score and interval from stroke to rehabilitation hospital admission can be used to set FIM outcome goals, predict length of rehabilitation hospitalization needed to meet those goals, and compare quality of care across institutions with different referral patterns. Our results provide a benchmark against which to compare less intense or shorter duration inpatient treatment options.
本研究检验以下假设，即康复医院入院时的功能独立性测量（FIM）评分及卒中后间隔时间可用于定义临床相关的功能恢复目标、估计住院时间并比较护理质量。
卒中至康复单元入院的时间对入院及出院时的FIM评分、康复住院时间以及FIM评分每日变化的影响尚未见报道。
分析基于前瞻性收集的入住住院卒中康复单元患者的数据，这些患者FIM评分≤90分，首次发生单侧半球血栓形成或栓塞性卒中，且卒中前无需使用辅助装置即可完全独立。重度（入院FIM<54分）和中度（入院FIM 54 - 90分）卒中缺陷患者根据卒中至康复医院入院的间隔时间分为三组：0 - 2周、2 - 4周和4 - 6周。
在17个月的时间里，87例患者符合入选标准。所有人的总FIM评分均有显著改善。对于中度卒中患者，所有三个时间组在康复单元治疗35±2天后FIM评分均达到102±2标准误。重度卒中发病后2周内入院的患者在康复单元治疗43±3天后FIM评分达到平台期，为72±6，而2 - 4周组（53±4天后FIM = 57±5）和4 - 6周组（40±6天后FIM = 54±10）则较低。并发症随卒中严重程度及康复医院转诊延迟而增加。
入院FIM评分及卒中至康复医院入院的间隔时间可用于设定FIM结局目标、预测实现这些目标所需的康复住院时间，并比较不同转诊模式机构之间的护理质量。我们的结果提供了一个基准，可据此比较强度较低或住院时间较短的住院治疗方案。
