Chaiyawat Pakaratee, Kulkantrakorn Kongkiat, Sritipsukho Paskorn
Faculty of Medicine, Thammasat University, Pathumtanee, Thailand.
Neurol Int. 2009 Nov 16;1(1):e10. doi: 10.4081/ni.2009.e10.
The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke. This was a randomized controlled trial in 60 patients with recent middle cerebral artery infarction. After hospital discharge for acute stroke care, they were randomly assigned to receive either a home rehabilitation program for three months (intervention group) or usual care (control group). We collected outcome data over three months after their discharge from the hospital. The Barthel Index (BI), the Modified Rankin Scale (MRS), the health-related quality-of-life index (EQ-5D), the Hospital Anxiety and Depression score (HADs), and the Thai Mental State Examination (TMSE) were used to analyze the outcomes. In the intervention group, all outcomes were significantly better (p<0.05) than in the control group, except in the case of TMSE. A favorable outcome, which was defined as minimal or no disability as measured by BI (score 95-100), was achieved by 93.33% of patients in the intervention group, and 90% had favorable scores (0 or 1) on the MRS. This showed a benefit in reducing disability, with two being the number of patients considered as needed-to-treat (NNT) (95% CI, 1.0-1.2). All dimensions of EQ-5D in the intervention group were significantly better for quality of life and generic health status than in the control group (p=0.001). Depression was found in one patient (3.33%) in the intervention group and in two patients (6.67%) in the control group. Dementia was found in three patients (10%) in the intervention group and in four patients (13.33%) in the control group. We concluded that an early home rehabilitation program for patients with ischemic stroke in the first three-month period provides significantly better outcomes in improving function, reducing disability, increasing quality of life, and reducing depression than a program of usual care does.
本研究的目的是开发并检验针对缺血性中风患者的个体化家庭康复计划的有效性。这是一项针对60例近期大脑中动脉梗死患者的随机对照试验。在因急性中风接受医院治疗出院后，他们被随机分配接受为期三个月的家庭康复计划（干预组）或常规护理（对照组）。我们在他们出院后的三个月内收集了结果数据。使用巴氏指数（BI）、改良Rankin量表（MRS）、健康相关生活质量指数（EQ-5D）、医院焦虑抑郁量表（HADs）和泰国精神状态检查（TMSE）来分析结果。在干预组中，除TMSE外，所有结果均显著优于对照组（p<0.05）。干预组中93.33%的患者取得了良好结果，即根据BI测量为轻度残疾或无残疾（得分95 - 100），90%的患者在MRS上获得了良好评分（0或1）。这表明在减少残疾方面有益处，所需治疗人数（NNT）为2（95%CI，1.0 - 1.2）。干预组EQ-5D的所有维度在生活质量和总体健康状况方面均显著优于对照组（p = 0.001）。干预组有1例患者（3.33%）出现抑郁，对照组有2例患者（6.67%）出现抑郁。干预组有3例患者（10%）出现痴呆，对照组有4例患者（13.33%）出现痴呆。我们得出结论，在头三个月为缺血性中风患者提供早期家庭康复计划，在改善功能、减少残疾、提高生活质量和减少抑郁方面比常规护理计划有显著更好的效果。
