Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physiotherapy, Faculty of Health Education and Social Work, Sør-Trøndelag University Collage, Trondheim, Norway.
Stroke Division, Florey Institutes of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Faculty of Health Sciences, La Trobe University, Melbourne, Australia.
J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):e305-12. doi: 10.1016/j.jstrokecerebrovasdis.2013.12.011. Epub 2014 Feb 12.
Early rehabilitation that includes early mobilization and increased amount of motor activity is hypothesized to be one of the most important factors contributing to the beneficial effect of comprehensive stroke unit treatment, whereas too much bed rest is hypothesized to be harmful. The purpose of the present study was to assess the association between early activity/bed rest and functional outcome 3 months later.
This was a prospective cohort study including patients with the diagnosis of stroke admitted to Trondheim University Hospital, Norway. Patients were eligible if they were less than 14 days poststroke and did not receive palliative care. Motor activity/bed rest was recorded in the acute phase using a standard method of observation, and the outcome was assessed by the modified Rankin Scale (mRS) score 3 months later. A proportional odds model was used to analyze the association between motor activity/bed rest and outcome. All analyses were adjusted for age, gender, stroke severity, time from stroke to observation, and prestroke function.
A total of 106 patients (mean age 79.0 years, 56.6% men) were included. The odds ratio for a higher mRS score (poor outcome) was 1.04 (95% confidence interval [CI] 1.02-1.07, P = .001) as time in bed increased and .97 (95% CI .93-1.02, P = .283) as time in motor activity increased.
This study confirms that time in bed in the early phase is associated with poor functional outcome 3 months later, indicating that too much bed rest should be avoided in the early phase after stroke.
早期康复包括早期活动和增加运动量，这被认为是综合卒中单元治疗有益效果的最重要因素之一，而过多的卧床休息则被认为是有害的。本研究的目的是评估早期活动/卧床休息与 3 个月后功能结局之间的关系。
这是一项前瞻性队列研究，纳入了挪威特隆赫姆大学医院收治的诊断为卒中的患者。如果患者发病后少于 14 天且未接受姑息治疗，则符合入组条件。使用标准观察方法在急性期记录运动活动/卧床休息情况，并用改良 Rankin 量表（mRS）评分评估 3 个月后的结局。使用比例优势模型分析运动活动/卧床休息与结局之间的关系。所有分析均调整了年龄、性别、卒中严重程度、发病至观察时间和发病前的功能。
共纳入 106 例患者（平均年龄 79.0 岁，56.6%为男性）。随着卧床时间的增加，mRS 评分较高（不良结局）的优势比为 1.04（95%置信区间 [CI] 1.02-1.07，P =.001），而随着运动时间的增加，优势比为 0.97（95% CI 0.93-1.02，P =.283）。
本研究证实，发病早期卧床时间与 3 个月后功能结局不良有关，这表明卒中后早期应避免过多卧床休息。
