O'Neill Brian F, Evans Jonathan J
West of Scotland Mobility and Rehabilitation Centre, Southern General Hospital, Glasgow, Scotland, UK.
Disabil Rehabil. 2009;31(13):1083-91. doi: 10.1080/09638280802509579.
Post-amputation rehabilitation is physically and cognitively demanding. Understanding which specific cognitive domains mediate outcome is critical to the development of interventions.
A cohort undergoing post-amputation rehabilitation was assessed before limb fitting and followed up at 6 months (n = 34). The average age was 60.69 years (SD = 13.98). 82.4% of the sample was male. 79.4% had amputations because of peripheral arterial disease. Memory, visuospatial function, executive function, praxis, emotion and language were assessed at Time 1 (first prosthetic clinic attendance). Time 1 data were also gathered on aetiology, level of amputation, comorbidities, pain and demographics. Six month outcomes were the locomotor capability index (LCI), the special interest group in amputee medicine (SIGAM) mobility grades and self reported hours of use.
The LCI at 6 months was significantly predicted in regression analyses by a measure of visual memory (figure recall) (adjusted R2 = 24.8%, df = 32, zbeta = 0.52, p = 0.002. Hours of use were predicted by the verbal fluency test total (adjusted R2 = 17.1%, df= 26, zbeta = 0.45, p = 0.017). SIGAM mobility grades were predicted by a combination of immediate verbal memory (story recall), age, level of amputation and presence of pain (adjusted R2 = 58.2, df = 30, zbeta = 0.52, p = 0.000).
Neuropsychological and clinical variables predict a large amount of 6 month outcome variance. Cognitive difficulties may be considered mediators of poor outcome.
截肢后康复对身体和认知能力要求较高。了解哪些特定认知领域介导康复结果对于干预措施的制定至关重要。
对一组接受截肢后康复的患者在安装假肢前进行评估，并在6个月时进行随访（n = 34）。平均年龄为60.69岁（标准差 = 13.98）。样本中82.4%为男性。79.4%的患者因外周动脉疾病而截肢。在第1次（首次假肢门诊就诊）时评估记忆、视觉空间功能、执行功能、实践能力、情绪和语言。还收集了第1次时的病因、截肢水平、合并症、疼痛和人口统计学数据。6个月时的结果指标为运动能力指数（LCI）、截肢医学特殊兴趣小组（SIGAM）活动分级以及自我报告的使用时长。
在回归分析中，视觉记忆测量指标（图形回忆）显著预测了6个月时的LCI（调整后R² = 24.8%，自由度 = 32，z系数 = 0.52，p = 0.002）。言语流畅性测试总分预测了使用时长（调整后R² = 17.1%，自由度 = 26，z系数 = 0.45，p = 0.017）。SIGAM活动分级由即时言语记忆（故事回忆）、年龄、截肢水平和疼痛情况共同预测（调整后R² = 58.2，自由度 = 30，z系数 = 0.52，p = 0.000）。
神经心理学和临床变量可预测6个月康复结果的大量变异。认知困难可能被视为康复效果不佳的介导因素。
