Luk James K H, Cheung Raymond T F, Ho S L, Li Leonard
Acute Geriatrics Unit, Grantham Hospital, Hong Kong, SAR, China.
Cerebrovasc Dis. 2006;21(4):229-34. doi: 10.1159/000091219. Epub 2006 Jan 27.
The predicting value of age on stroke rehabilitation has been controversial. There is a lack of large-scale studies in the Chinese population to examine the effect of age on stroke rehabilitation outcomes. This study examines the predictors of a good outcome after rehabilitation in Chinese stroke patients with special attention to age as a factor.
This retrospective cohort study includes stroke patients receiving a standard inpatient multidisciplinary rehabilitation program in a neuro-rehabilitation ward of a convalescence hospital in Hong Kong from January 2000 to December 2003. Functional independence measure (FIM) >or=90 was used to define a good outcome. Multivariate regression analysis was used to assess the independent predictors of a good outcome.
There were important differences in clinical characteristics and complications of stroke among patients of three age groups: <65, >or=65 and <80, and >or=80 years. The total FIM scores both upon admission and at discharge were lower in the older age groups. No significant difference was observed in the changes in FIM scores across these age groups. Age was not an independent predictor for a good outcome. FIM upon admission was an independent predictor for a good outcome (discharge FIM >or=90) in all patients and in individual age groups. Having employment before stroke was a predictor for good outcome in all patients. Living at home prior to stroke was a predictor for the total population and the >or=65 and <80 years group. The length of stay predicted a good outcome in the group >or=80 years.
Admission functional status, employment and living at home before stroke but not age per se are predictors of a good outcome following stroke rehabilitation. As older patients show comparable improvement during rehabilitation, intensive rehabilitation should not be withheld in stroke patients simply because of advanced age.
年龄对中风康复的预测价值一直存在争议。在中国人群中，缺乏大规模研究来探讨年龄对中风康复结局的影响。本研究特别关注年龄这一因素，对中国中风患者康复后良好结局的预测因素进行了研究。
这项回顾性队列研究纳入了2000年1月至2003年12月在香港一家康复医院神经康复病房接受标准住院多学科康复计划的中风患者。功能独立性测量（FIM）≥90被用来定义良好结局。采用多变量回归分析来评估良好结局的独立预测因素。
三个年龄组（<65岁、≥65岁且<80岁、≥80岁）的中风患者在临床特征和并发症方面存在重要差异。年龄较大的组入院时和出院时的FIM总分较低。在这些年龄组中，FIM评分的变化未观察到显著差异。年龄不是良好结局的独立预测因素。入院时的FIM是所有患者以及各个年龄组良好结局（出院时FIM≥90）的独立预测因素。中风前有工作是所有患者良好结局的预测因素。中风前居家生活是总体人群以及≥65岁且<80岁组良好结局的预测因素。住院时间是≥80岁组良好结局的预测因素。
中风康复后良好结局的预测因素是入院时的功能状态、工作情况和中风前居家生活情况，而非年龄本身。由于老年患者在康复过程中显示出相当的改善，不应仅仅因为年龄较大而不给中风患者进行强化康复治疗。
