Lo Raymond S K, Cheng Joanna O Y, Wong Eric M C, Tang Wai Kwong, Wong Lawrence K S, Woo Jean, Kwok Timothy
Department of Medicine and Geriatrics, Shatin Hospital, Chinese University of Hong Kong, 33 A Kung Kok St, Ma On Shan, New Territories, Hong Kong, China.
Stroke. 2008 Jan;39(1):148-53. doi: 10.1161/STROKEAHA.107.491399. Epub 2007 Nov 29.
Stroke, a major health issue affecting the elderly, limits their participation in society. The aim of this study was to investigate changes in stroke survivors' handicap levels and to identify their determinants in the subacute phase from 3 months to 1 year.
Data were collected from a prospective cohort of 303 Chinese stroke survivors with the use of questionnaires, including the Lawton Instrumental Activities of Daily Living-Chinese Version (IADL-CV), Barthel Index, Chinese Mini-Mental State Examination, Chinese Geriatric Depression Scale, and the Chinese version of the London Handicap Scale.
A total of 297 and 268 patients were successfully followed up at 6 and 12 months, respectively. Whereas IADL remained unchanged throughout, we found an improvement in Barthel Index but a deterioration in the Chinese Geriatric Depression Scale score at 12 months. Multilevel modeling revealed improvements in the mobility and social integration handicap domains and a deterioration in the orientation domain at 12 months. Overall handicap remained unchanged. At 12 months, depression was most significantly and independently associated with poststroke handicap, and advanced old age alone (>80 years) was associated with clinically significant deterioration in handicap.
Even though IADL remained static at 1 year, mobility and social integration handicap dimensions can be improved in the early community phase after stroke. Nonphysical factors such as depression were confirmed to be significantly associated with handicap. Rehabilitation should target the high-risk group of very elderly stroke survivors who were 4 times more likely to deteriorate in handicap.
中风是影响老年人的一个主要健康问题，限制了他们参与社会的能力。本研究的目的是调查中风幸存者残疾水平的变化，并确定在3个月至1年的亚急性期其残疾水平的决定因素。
使用问卷调查从303名中国中风幸存者的前瞻性队列中收集数据，问卷包括Lawton日常生活能力量表中文版（IADL-CV）、巴氏指数、简易精神状态检查表中文版、老年抑郁量表中文版和伦敦残疾量表中文版。
分别有297名和268名患者在6个月和12个月时成功完成随访。虽然IADL在整个过程中保持不变，但我们发现巴氏指数有所改善，但老年抑郁量表中文版评分在12个月时恶化。多水平模型显示，12个月时，运动和社会融合残疾领域有所改善，而定向领域恶化。总体残疾状况保持不变。在12个月时，抑郁与中风后残疾最显著且独立相关，仅高龄（>80岁）与残疾的临床显著恶化相关。
尽管1年时IADL保持稳定，但中风后早期社区阶段的运动和社会融合残疾维度可以得到改善。抑郁等非身体因素被证实与残疾显著相关。康复应针对高龄中风幸存者这一高危群体，他们残疾恶化的可能性是其他群体的4倍。
