De Wit Liesbet, Putman Koen, Schuback Birgit, Komárek Arnost, Angst Felix, Baert Ilse, Berman Peter, Bogaerts Kris, Brinkmann Nadine, Connell Louise, Dejaeger Eddy, Feys Hilde, Jenni Walter, Kaske Christiane, Lesaffre Emmanuel, Leys Mark, Lincoln Nadina, Louckx Fred, Schupp Wilfried, Smith Bozena, De Weerdt Willy
Katholieke Universiteit Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101, Heverlee, Belgium.
Stroke. 2007 Jul;38(7):2101-7. doi: 10.1161/STROKEAHA.107.482869. Epub 2007 May 31.
Outcome after first stroke varies significantly across Europe. This study was designed to compare motor and functional recovery after stroke between four European rehabilitation centers.
Consecutive stroke patients (532 patients) were recruited. They were assessed on admission and at 2, 4, and 6 months after stroke with the Barthel Index, Rivermead Motor Assessment of Gross Function, Rivermead Motor Assessment of Leg/Trunk, Rivermead Motor Assessment of Arm, and Nottingham Extended Activities of Daily Living (except on admission). Data were analyzed using random effects ordinal logistic models adjusting for case-mix and multiple testing.
Patients in the UK center were more likely to stay in lower Rivermead Motor Assessment of Gross Function classes compared with patients in the German center (DeltaOR, 2.4; 95% CI, 1.3 to 4.3). In the Swiss center, patients were less likely to stay in lower Nottingham Extended Activities of Daily Living classes compared with patients in the UK center (DeltaOR, 0.7; 95% CI, 0.5 to 0.9). The latter were less likely to stay in lower Barthel Index classes compared with the patients in the German center (DeltaOR, 0.6; 95%CI, 0.4 to 0.8). Recovery patterns of Rivermead Motor Assessment of Leg/Trunk and Rivermead Motor Assessment of Arm were not significantly different between centers.
Gross motor and functional recovery were better in the German and Swiss centers compared with the UK center, respectively. Personal self-care recovery was better in the UK compared with the German center. Previous studies in the same centers indicated that German and Swiss patients received more therapy per day. This was not the result of more staff but of a more efficient use of human resources. This study indicates potential for improving rehabilitation outcomes in the UK and Belgian centers.
首次中风后的结局在欧洲各地差异显著。本研究旨在比较四个欧洲康复中心中风后的运动和功能恢复情况。
招募连续的中风患者（532例）。在入院时以及中风后2个月、4个月和6个月，使用巴氏指数、里弗米德粗大功能运动评估、里弗米德腿部/躯干运动评估、里弗米德手臂运动评估和诺丁汉扩展日常生活活动量表进行评估（入院时除外）。使用随机效应有序逻辑模型对数据进行分析，以调整病例组合和多重检验。
与德国中心的患者相比，英国中心的患者更有可能处于较低的里弗米德粗大功能运动评估等级（DeltaOR，2.4；95%CI，1.3至4.3）。与英国中心的患者相比，瑞士中心的患者处于较低的诺丁汉扩展日常生活活动等级的可能性较小（DeltaOR，0.7；95%CI，0.5至0.9）。与德国中心的患者相比，英国中心的患者处于较低巴氏指数等级的可能性较小（DeltaOR，0.6；95%CI，0.4至0.8）。各中心之间里弗米德腿部/躯干运动评估和里弗米德手臂运动评估的恢复模式没有显著差异。
与英国中心相比，德国和瑞士中心的粗大运动和功能恢复分别更好。与德国中心相比，英国的个人自我护理恢复更好。之前在同一中心进行的研究表明，德国和瑞士的患者每天接受的治疗更多。这不是因为工作人员更多，而是因为人力资源的利用更高效。本研究表明英国和比利时中心在改善康复结局方面具有潜力。
