Jerome D, Dehail P, Daviet J-C, Lamothe G, De Sèze M-P, Orgogozo J-M, Mazaux J-M
EA 4136 Handicap and Nervous System, Rehabilitation Medicine Unit, Department of Clinical Neurosciences, Pellegrin Hospital, Academic Hospital of Bordeaux, University Victor-Segalen - Bordeaux , 33076 Bordeaux cedex, France.
Ann Phys Rehabil Med. 2009 Sep-Oct;52(7-8):525-37. doi: 10.1016/j.rehab.2009.06.007. Epub 2009 Aug 19.
Most studies of functional outcomes in hemiplegic stroke patients use standard disability rating scales (such as the Barthel Index). However, planning the allocation of assistance and resources requires additional information about these patients' expectations and needs.
To assess functional independence in daily living and house holding, changes in home settings, type of technical aid and human helps, and expectations in hemiplegic patients 1 to 2 years after the stroke.
Sixty-one out of 94 patients admitted to the neurovascular unit of French university hospital for a first-ever documented stroke were consecutively enrolled. The study was restricted to patients under 75, since patients over 75 do not follow the same care network. Patients were examined at their homes or interviewed by phone 17 months (on average) after the stroke. Standard functional assessment tools (such as the Barthel Index and the instrumental activities of daily living [IADL] score) were recorded, along with descriptions of home settings and instrumental and human help. Lastly, patients and caregivers were asked to state their expectations and needs.
Although only one person was living in a nursing home after the stroke, 23 (34%) of the other interviewees had needed to make home adjustments or move home. Seven patients (11%) were dependent in terms of the activities of daily living (a Barthel Index below 60) and 11 (18%) had difficulty in maintaining domestic activities and community living (an IADL score over 10). Although the remaining patients had made a good functional recovery, 23 were using technical aids and 28 needed family or caregiver assistance, including 23 patients with full functional independence scores. Twenty-five patients (42%) were suffering from depression as defined by the diagnosis and statistical manual of mental disorders (4th edition, text revision, DSM IV-R). The patients' prime concerns were related to recovery of independence, leisure activities and financial resources. Family members' expectations related to the complexity of administrative matters, lack of information and the delay in service delivery.
In under-75 hemiplegic stroke patients, high scores on standard disability rating scales do not always mean that no help is required.
大多数关于偏瘫中风患者功能结局的研究使用标准残疾评定量表（如巴氏指数）。然而，规划援助和资源分配需要有关这些患者期望和需求的更多信息。
评估中风后1至2年偏瘫患者在日常生活和家务方面的功能独立性、家庭环境变化、技术辅助和人力帮助的类型以及期望。
法国大学医院神经血管科收治的94例首次发生中风的患者中，连续纳入了61例。该研究仅限于75岁以下的患者，因为75岁以上的患者遵循不同的护理网络。患者在中风后17个月（平均）在家中接受检查或通过电话接受访谈。记录了标准功能评估工具（如巴氏指数和日常生活活动能力[IADL]评分），以及家庭环境、工具性和人力帮助的描述。最后，询问患者和护理人员他们的期望和需求。
尽管中风后只有一人住在养老院，但其他受访者中有23人（34%）需要对家庭进行调整或搬家。7例患者（11%）在日常生活活动方面存在依赖（巴氏指数低于60），11例患者（18%）在维持家务活动和社区生活方面存在困难（IADL评分超过10）。尽管其余患者功能恢复良好，但23人使用了技术辅助设备，28人需要家人或护理人员的帮助，其中包括23例功能独立性评分完全正常的患者。25例患者（42%）符合《精神障碍诊断与统计手册》（第4版，文本修订版，DSM-IV-R）定义的抑郁症。患者最关心的问题与恢复独立性、休闲活动和财务资源有关。家庭成员的期望与行政事务的复杂性、信息不足和服务提供延迟有关。
在75岁以下的偏瘫中风患者中，标准残疾评定量表上的高分并不总是意味着不需要帮助。
