Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center (VUmc), Amsterdam, The Netherlands.
Int J Stroke. 2013 Jan;8(1):25-32. doi: 10.1111/j.1747-4949.2012.00967.x.
Knowledge about factors that determine the final outcome after stroke is important for early stroke management, rehabilitation goals, and discharge planning. This narrative review provides an overview of current knowledge about the prediction of activities after stroke. We reviewed the pattern of stroke recovery for functions and activities, the impact of spontaneous recovery on activities, and the measurement of improvement in general. We explored the activities profiles during the chronic phase and predictors for activities of daily living independence after stroke, and finally, we discussed where to from here? Mathematical regularities explain the nonlinear patterns of recovery, making the outcome of activities of daily living highly predictable. Initial severity of disability and extent of improvement observed within the first weeks poststroke are important indicators of the outcome at six-months. The sequence of progress in activities is almost fixed in time. Studies showed that most motor recovery is almost completed within 10 weeks poststroke. On average, stroke recovery plateaus three- to six-months after onset. Strong evidence was found that age and scores on scales assessing severity of neurological deficits in the early poststroke phase are strongly associated with the final basic activities of daily living outcome after three-months poststroke. The validated prediction models using simple algorithms, such as National Institutes of Health Stroke Scale or Barthel Index, need to be implemented in rehabilitation services and used for stratifying stroke patients in trials. Future studies should investigate the accuracy of dynamic models that includes time poststroke to optimize the application of prediction rules in individuals with stroke.
关于决定中风后最终结果的因素的知识对于早期中风管理、康复目标和出院计划非常重要。这篇叙述性综述概述了目前关于中风后活动预测的知识。我们回顾了功能和活动的中风恢复模式、自发性恢复对活动的影响以及总体改善的测量。我们探讨了慢性期的活动特征以及中风后日常生活活动独立的预测因素，最后，我们讨论了从哪里开始？数学规律解释了恢复的非线性模式，使日常生活活动的结果具有高度可预测性。残疾初始严重程度和中风后最初几周内观察到的改善程度是六个月时结局的重要指标。活动进展的顺序几乎是固定的。研究表明，大多数运动恢复几乎在中风后 10 周内完成。平均而言，中风后的恢复在发病后三到六个月达到平台期。有强有力的证据表明，年龄和早期中风阶段评估神经功能缺损严重程度的量表评分与三个月后日常生活基本活动的最终结局密切相关。使用简单算法（如美国国立卫生研究院中风量表或巴氏指数）的验证预测模型需要在康复服务中实施，并用于对中风患者进行分层。未来的研究应调查包括中风后时间在内的动态模型的准确性，以优化在中风患者中应用预测规则。
