Department of Language and Communication Science, City University London, London, UK.
Disabil Rehabil. 2011;33(3):211-8. doi: 10.3109/09638288.2010.508829. Epub 2010 Aug 16.
Stroke rehabilitation programmes aim to improve functional outcomes and quality of life. This study explored long-term outcomes in a cohort of people admitted to two acute stroke units with stroke. Comparisons were drawn between people with aphasia (PWA) and people without aphasia.
People admitted to hospital with a first stroke were assessed at 2-weeks, 3-months and 6-months post-stroke. Measures included: the Barthel Index for Activities of Daily Living (ADL), the Frenchay Aphasia Screening Test, the General Health Questionnaire-12 for emotional well-being and the Stroke and Aphasia Quality of Life Scale-39g. Extended ADL and social support were also measured at 3 and 6 months, with the Frenchay Activities Index and the Social Support Survey, respectively.
Of 126 eligible participants, 96(76%) took part and 87(69%) were able to self-report. Self-report data are reported here. Although outcomes improved significantly across time, at 6 months people continued to experience substantial functional limitations (16% aphasic; 32% dependent on basic ADL); participation limitations (79% ≤30 on the FAI); high psychological distress (45%) and compromised quality of life (54% ≤4 on the SAQOL-39g). Levels of social support remained relatively stable. Though at 3-months post-stroke PWA were significantly more likely to experience high psychological distress (93% versus 50% for those without), across time, there were no significant differences between PWA and those without on psychological distress and also ADL and social support. There were, however, significant differences on extended ADL (F(1,68) = 7.80, p < 0.01) and quality of life (F(1,69) = 6.30, p < 0.05).
PWA participated in fewer activities and reported worse quality of life after stroke than people without aphasia, even when their physical abilities, well-being and social support were comparable. Implications for clinical practice and future research are discussed.
脑卒中康复计划旨在改善功能预后和生活质量。本研究探讨了一组因脑卒中入住两家急性脑卒中病房的患者的长期预后。比较了伴有失语症（PWA）和不伴有失语症的患者。
首次脑卒中入院患者在脑卒中后 2 周、3 个月和 6 个月进行评估。评估内容包括：日常生活活动能力（ADL）的巴氏指数（Barthel Index）、Frenchay 失语症筛查测试（Frenchay Aphasia Screening Test）、用于情绪健康的一般健康问卷-12（General Health Questionnaire-12）和脑卒中及失语症生活质量量表-39g（Stroke and Aphasia Quality of Life Scale-39g）。3 个月和 6 个月时还评估了扩展 ADL 和社会支持，分别使用 Frenchay 活动指数（Frenchay Activities Index）和社会支持调查（Social Support Survey）。
126 名符合条件的参与者中，96 名（76%）参与了研究，87 名（69%）能够自我报告。此处报告的是自我报告的数据。尽管各项结果随时间显著改善，但在 6 个月时，患者仍持续存在严重的功能受限（16%有失语症；32%基本 ADL 依赖）；活动受限（79%FAI 评分≤30）；存在较高的心理困扰（45%）和生活质量受损（SAQOL-39g 评分≤4 的占 54%）。社会支持水平相对稳定。尽管在脑卒中后 3 个月时，PWA 经历较高心理困扰的可能性显著更高（93%比无失语症者的 50%高），但随时间推移，PWA 和无失语症者在心理困扰和 ADL 及社会支持方面均无显著差异。然而，在扩展 ADL（F(1,68) = 7.80，p < 0.01）和生活质量（F(1,69) = 6.30，p < 0.05）方面存在显著差异。
即使 PWA 的身体能力、幸福感和社会支持与无失语症者相当，他们在脑卒中后参与的活动更少，生活质量更差。讨论了对临床实践和未来研究的影响。
