Operative Unit of Recovery and Functional Re-education, Salvatore Maugeri Foundation, Lumezzane, Brescia, Italy -
Eur J Phys Rehabil Med. 2013 Oct;49(5):629-37. Epub 2013 May 8.
Very few studies have investigated the influence of single activities of daily living (ADL) at admission as possible predictors of functional outcome after rehabilitation.
The aim of the current study was to investigate admission functional status and performance of basic ADLs as assessed by Functional Independence Measure (FIM) scale as possible predictors of motor and functional outcome after stroke during inpatient rehabilitation.
This is a prospective and observational study.
Inpatients of our Department of Physical Medicine and Rehabilitation.
Two hundred sixty consecutive patients with primary diagnosis of stroke were enrolled and 241 patients were used in the final analyses.
Two backward stepwise regression analyses were applied to predict outcome. The first backward stepwise regression had age, gender, stroke type, stroke-lesion size, aphasia, neglect, onset to admission interval, Cumulative Illness Rating Scale, National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Scale, Trunk Control Test, and FIM (total, motor and cognitive scores) as independent variables. The second analyses included the above variables plus FIM items as an independent variable. The dependent variables were the discharge scores and effectiveness in total and motor-FIM, and discharge destination.
The first multivariate analysis showed that admission Fugl-Meyer, neglect, total, motor and cognitive FIM scores were the most important predictors of FIM outcomes, while admission NIHSS score was the only predictor of discharge destination. Conversely, when admission single FIM items were included in the statistical model, admission Fugl-Meyer, neglect, grooming, dressing upper body, and social interaction scores were the most important predictors of FIM outcomes, while admission memory and bowel control scores were the only predictors of discharge destination.
Our study indicates that performances of basic ADLs are important stroke outcome predictors and among which social interaction, grooming, upper body dressing, and bowel control are the most important.
The results of this study suggests that, when designing other studies on stroke outcome predictions, researchers should also include tests which assess performances of basic ADLs as independent variables, because this may allow identification of new prognostic indicators that can be helpful for the physician for managing stroke patients at the end of the rehabilitation period.
很少有研究调查入院时日常生活活动（ADL）的单一活动作为康复后功能结果的预测因素。
本研究旨在调查入院时的功能状态和基本 ADL 表现，使用功能独立性测量（FIM）量表评估，作为中风患者住院康复后运动和功能结果的预测因素。
这是一项前瞻性和观察性研究。
我们的物理医学和康复科的住院患者。
260 名原发性中风患者被纳入研究，241 名患者纳入最终分析。
应用 2 个向后逐步回归分析预测结果。第一个向后逐步回归分析中，自变量包括年龄、性别、中风类型、中风损伤大小、失语、忽视、发病至入院间隔、累积疾病评分、美国国立卫生研究院中风量表（NIHSS）、Fugl-Meyer 量表、躯干控制测试和 FIM（总分、运动和认知评分）。第二个分析中，自变量除了上述变量，还包括 FIM 项目。因变量是出院评分和总 FIM、运动 FIM 的有效性，以及出院去向。
多元分析表明，入院 Fugl-Meyer、忽视、总、运动和认知 FIM 评分是 FIM 结果的最重要预测因素，而入院 NIHSS 评分是出院去向的唯一预测因素。相反，当入院单项 FIM 项目纳入统计模型时，入院 Fugl-Meyer、忽视、修饰、上衣穿着、社会交往评分是 FIM 结果的最重要预测因素，而入院记忆和肠控评分是出院去向的唯一预测因素。
本研究表明，基本 ADL 的表现是中风预后的重要预测因素，其中社会交往、修饰、上衣穿着和肠控是最重要的。
本研究结果表明，当设计中风预后预测的其他研究时，研究人员还应将评估基本 ADL 表现的测试作为自变量，因为这可能有助于识别新的预后指标，为医生在康复期结束时管理中风患者提供帮助。
