随机对照试验研究缺血性脑卒中患者家庭康复治疗对残疾和老年抑郁的影响。

Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression.

机构信息

Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.

出版信息

Psychogeriatrics. 2012 Sep;12(3):193-9. doi: 10.1111/j.1479-8301.2012.00412.x.

DOI:10.1111/j.1479-8301.2012.00412.x

PMID:22994618

Abstract

BACKGROUND

Patients with major stroke are often left with disability and may have depression and dementia during the recovery phase. Rehabilitation programmes have been shown to improve short-term physical outcome, but their long-term effectiveness and impact on dementia and depression are uncertain.

METHODS

We performed a 6-month randomized controlled trial of a home rehabilitation programme and compared it with the standard care patients with recent ischemic stroke receive. The intervention group received home-based physical therapy once a month for 6 months, along with educational support, counselling and audiovisual materials. The control group received rehabilitation as prescribed by a physician and educational materials upon discharge from hospital. The primary measurement was a change in Barthel Index. Secondary measurements were the Hospital Anxiety and Depression Scale (HADS) and Thai Mini-Mental State Examination.

RESULTS

Of the 68 screened patients, 60 patients were enrolled. At baseline, there was no significant difference in patient characteristics between the two groups. Over 2 years, the mean Barthel Index and Hospital Anxiety and Depression Scale were significantly improved in the intervention group compared to the control group (Barthel Index mean: from 31.7 ± 5.9 to 97.2 ± 2.8 vs from 33.2 ± 4.8 to 76.4 ± 9.4, P < 0.001; Hospital Anxiety and Depression Scale mean: from 16.1 ± 7.6 to 9.1 ± 0.3 vs 16.4 ± 4.9 to 9.1 ± 0.3, P= 0.003). Depression was strongly associated with being dependent on others. However, the Thai Mini-Mental State Examination in both groups did not significantly differ (Thai Mini-Mental State Examination mean: from 24.4 ± 2.0 to 24.6 vs 23.8 ± 1.9 to 24.1 ± 0.3, P= 0.068). There was no significant interaction between baseline characteristics and treatment outcome.

CONCLUSIONS

At 2 years follow-up, it was evident that a 6-month home rehabilitation programme after ischemic stroke improved functional outcome and reduced incidence of depression, but not dementia.

摘要

背景

患有大面积中风的患者在恢复期通常会留下残疾，并可能患有抑郁和痴呆。康复计划已被证明可以改善短期身体预后，但它们的长期效果及其对痴呆和抑郁的影响尚不确定。

方法

我们进行了一项为期 6 个月的家庭康复计划的随机对照试验，并将其与近期缺血性中风患者接受的标准护理进行了比较。干预组在 6 个月内每月接受一次家庭物理治疗，同时提供教育支持、咨询和视听材料。对照组按照医生的建议接受康复治疗，并在出院时提供教育材料。主要测量指标是巴氏指数的变化。次要测量指标为医院焦虑和抑郁量表（HADS）和泰国简易精神状态检查。

结果

在 68 名筛查患者中，有 60 名患者入组。在基线时，两组患者的特征无显著差异。在 2 年的时间里，干预组的巴氏指数和医院焦虑抑郁量表明显优于对照组（巴氏指数平均值：从 31.7 ± 5.9 提高到 97.2 ± 2.8，从 33.2 ± 4.8 提高到 76.4 ± 9.4，P < 0.001；医院焦虑和抑郁量表平均值：从 16.1 ± 7.6 降低到 9.1 ± 0.3，从 16.4 ± 4.9 降低到 9.1 ± 0.3，P = 0.003）。抑郁与依赖他人密切相关。然而，两组的泰国简易精神状态检查评分均无显著差异（泰国简易精神状态检查平均值：从 24.4 ± 2.0 提高到 24.6，从 23.8 ± 1.9 提高到 24.1 ± 0.3，P = 0.068）。基线特征与治疗结果之间没有显著的相互作用。