School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia.
Arch Phys Med Rehabil. 2011 Dec;92(12):2057-70. doi: 10.1016/j.apmr.2011.07.189.
To identify patient-related factors that have been found to correlate with functional outcomes post acute stroke to guide clinical decision making with regard to rehabilitation admission after acute stroke.
We systematically searched the scientific literature between 1966 and January 2010. The primary source of studies was the electronic databases Medline, CINAHL, and Embase. The search was supplemented with citation tracking.
Two reviewers independently applied the inclusion criteria to identify relevant articles from the citations obtained through the literature search. Eligible studies included systematic reviews of prognostic indicators, studies of prognostic indicators of acute discharge disposition, and studies of rehabilitation admission criteria after acute stroke. Of the 8895 studies identified, 83 articles, representing 79 studies, were included in the review.
One reviewer extracted the data relating to the participants, prognostic indicators, and outcomes. A second reviewer independently checked data extracted with disagreement resolved by a third reviewer. Quality of included studies was assessed for internal and external validity.
Of the 79 studies, 26 were systematic reviews of prognostic indicators of functional level and/or discharge disposition, 48 were studies of prognostic indicators of acute discharge disposition, and 6 were studies of rehabilitation selection criteria. The methodologic quality of the included studies was generally poor. Age, cognition, functional level after stroke, and, to a lesser extent, continence were found to have a consistent association with outcome across all 3 research areas. In addition, stroke severity was also associated with acute discharge disposition, final discharge disposition, and functional level. Sex and side of stroke appeared to have no association across all 3 of the research areas.
This review highlights a number of important prognostic indicators and rehabilitation selection criteria that may assist clinicians in improving selection procedures and standardizing access to inpatient rehabilitation after stroke, although the quality of many studies is low. Further high quality studies and reviews of prognostic indicators and clinician decision making with regards to rehabilitation acceptance are required.
确定与急性脑卒中后功能结果相关的患者相关因素，以指导急性脑卒中后康复入院的临床决策。
我们系统地检索了 1966 年至 2010 年 1 月的科学文献。研究的主要来源是电子数据库 Medline、CINAHL 和 Embase。搜索还补充了引文跟踪。
两名审查员独立应用纳入标准，从文献检索中获得的引文识别相关文章。合格的研究包括预后指标的系统评价、急性出院处置预后指标的研究以及急性脑卒中后康复入院标准的研究。在确定的 8895 项研究中，有 83 篇文章，代表 79 项研究，被纳入综述。
一名审查员提取与参与者、预后指标和结果相关的数据。第二位审查员独立检查提取的数据，如有分歧则由第三位审查员解决。评估纳入研究的内部和外部有效性。
在 79 项研究中，26 项是功能水平和/或出院处置预后指标的系统评价，48 项是急性出院处置预后指标的研究，6 项是康复选择标准的研究。纳入研究的方法学质量普遍较差。年龄、认知、脑卒中后功能水平，以及在较小程度上的节制，在所有 3 个研究领域都与结果有一致的关联。此外，脑卒中严重程度也与急性出院处置、最终出院处置和功能水平相关。性别和脑卒中侧别在所有 3 个研究领域似乎都没有关联。
本综述强调了一些重要的预后指标和康复选择标准，这些标准可能有助于临床医生改进选择程序，并使脑卒中后获得住院康复治疗标准化，尽管许多研究的质量较低。需要进一步进行高质量的研究和预后指标以及临床医生关于康复接受的决策的综述。
