Department of Rehabilitation IRCCS San Raffaele, Pisana, Rome, Italy.
Eur J Phys Rehabil Med. 2010 Sep;46(3):389-99. Epub 2010 Apr 13.
The aim of this study was to evaluate which neurological impairments on discharge from rehabilitation services are associated with a worse outcome in terms of health related-quality of life (HRQoL) one year after stroke.
We enrolled 528 first-time stroke patients in a multicenter observational study involving 18 Italian inpatients rehabilitation centers. Neurological impairment-related factors, socio-demographic and general clinical variables and process indicators were considered independent variables at discharge. Outcome was represented by the following dependent variables of HRQoL: EuroQoL-5D questionnaire (5D-EQoL) and its derived index (Eq-Index) and a Visual Analogue Score (QoL-VAS).
The strongest predictors of lower HRQoL were an incomplete limbs motor recovery. An incomplete lower limb motor recovery was associated with a lower HRQoL only in the "mobility" domains, whereas a incomplete upper limb motor recovery could predict a lower HRQoL in all domains except "mobility". Regarding cognitive impairments, the presence of neglect at discharge was associated with a lower HRQoL in "self-care", "pain-discomfort" and "anxiety-depression". Female gender, presence of urinary catheter seemed to exert a much lesser role in predicting HRQoL.
The results of this study suggest that upper limb motor impairments may have a detrimental impact on the patient's perceived HRQoL one year after stroke.
本研究旨在评估在康复服务出院时的哪些神经功能损伤与中风后一年的健康相关生活质量（HRQoL）结局较差相关。
我们纳入了 528 名首次中风的患者，他们参与了一项涉及 18 个意大利住院康复中心的多中心观察性研究。出院时，将神经功能损伤相关因素、社会人口学和一般临床变量以及过程指标作为自变量。将以下 HRQoL 的因变量作为结局：欧洲五维健康量表（EQ-5D）问卷及其衍生指数（EQ-Index）和视觉模拟评分（QoL-VAS）。
HRQoL 较低的最强预测因素是四肢运动不完全恢复。不完全的下肢运动恢复仅与“移动性”领域的 HRQoL 较低相关，而不完全的上肢运动恢复可能预测除“移动性”之外所有领域的 HRQoL 较低。关于认知损伤，出院时存在忽视与“自我护理”、“疼痛不适”和“焦虑抑郁”领域的 HRQoL 较低相关。女性性别和存在导尿管似乎在预测 HRQoL 方面作用较小。
本研究结果表明，上肢运动损伤可能对中风后一年患者的感知 HRQoL 产生不利影响。
