Adamit Tal, Maeir Adina, Ben Assayag Einor, Bornstein Natan M, Korczyn Amos D, Katz Noomi
School of Occupational Therapy, Hebrew University , Jerusalem , Israel .
Disabil Rehabil. 2015;37(8):667-73. doi: 10.3109/09638288.2014.923523. Epub 2014 Jun 3.
This study focused on the relationships between cognition, participation and quality of life (QoL) among first-ever mild ischemic stroke patients 3 months post-event. We hypothesized that significant correlations exist between cognition, executive functions (EF), QoL and participation; and that EF and QoL will significantly contribute to participation beyond demographics and stroke severity at 3 and from 3 to 6 months post-stroke.
A prospective cohort study, recruiting consecutive first-ever stroke patients from a large tertiary hospital. The inclusion criteria were first event, mild stroke (NIHSS ≤ 5), and no previous significant neurological or cognitive impairment. In addition to assessment every 6 month at the hospital, an assessment battery was administered at home 3 months post-stroke.
Participants showed mild to moderate difficulties in cognition and participation (n = 249). Low to moderate correlations were found between cognition and EF with participation (-0.380, p < 0.05; r = 0.460, p < 0.001, respectively); and cognition with QoL (r = 0.421, p < 0.001). EF and QoL contributed significantly to participation at 3 months (R(2) = 0.961) and in addition education at 6 months (R(2) = 0.701).
Participants after mild ischemic stroke experienced cognitive and EF difficulties that affect their participation and QoL. Further studies are needed of mild stroke survivors to enhance our understanding of the variables that affect participation.
The findings of the current study have significant implications for the participation of people after mild stroke in the community. Health care systems in general and rehabilitation programs, in particular, do not consider that these clients need rehabilitation as most of them perform basic daily functions independently. Thus, although cognitive and EF deficits are found in people following even mild stroke, but are not externally apparent, these impairments are mostly neglected by the health care system. Mild stroke has long-term effects in most cases and effect family members as well. The implications of the study's results, as well as those of other studies, emphasize the necessity of follow-up and rehabilitation efforts at home and in the community. These efforts should focus on re-enabling the individual to participate in previous activities as much as possible and on providing support for family members. The strength of this study lies in the large number of participants who were evaluated at home in their natural environments. Studies of this kind are rarely performed in the participants' real-life settings, thus the current study provides an important perspective on the participation of this population in the community.
本研究聚焦首次发生轻度缺血性卒中患者发病3个月后认知、参与度和生活质量（QoL）之间的关系。我们假设认知、执行功能（EF）、生活质量和参与度之间存在显著相关性；并且在卒中后3个月以及3至6个月时，执行功能和生活质量将在人口统计学因素和卒中严重程度之外，对参与度产生显著影响。
一项前瞻性队列研究，从一家大型三级医院连续招募首次发生卒中的患者。纳入标准为首次发病、轻度卒中（美国国立卫生研究院卒中量表[NIHSS]≤5）且既往无明显神经或认知障碍。除了在医院每6个月进行一次评估外，在卒中后3个月时还在家中进行了一组评估。
参与者在认知和参与度方面表现出轻度至中度困难（n = 249）。认知与执行功能和参与度之间存在低至中度相关性（分别为r = -0.380，p < 0.05；r = 0.460，p < 0.001）；认知与生活质量之间存在相关性（r = 0.421，p < 0.001）。执行功能和生活质量在3个月时对参与度有显著贡献（R² = 0.961），此外在6个月时教育程度也有贡献（R² = 0.701）。
轻度缺血性卒中后的参与者经历了影响其参与度和生活质量的认知和执行功能困难。需要对轻度卒中幸存者进行进一步研究，以加深我们对影响参与度的变量的理解。
本研究结果对轻度卒中后人群在社区中的参与度具有重要意义。一般的医疗保健系统，特别是康复项目，并不认为这些患者需要康复，因为他们中的大多数人能够独立完成基本日常功能。因此，尽管即使是轻度卒中后的人群也存在认知和执行功能缺陷，但这些缺陷并不外在明显，医疗保健系统大多忽视了这些损害。大多数情况下，轻度卒中具有长期影响，也会影响家庭成员。本研究结果以及其他研究结果的启示强调了在家中和社区进行随访和康复努力的必要性。这些努力应专注于尽可能使个体重新参与以前的活动，并为家庭成员提供支持。本研究的优势在于大量参与者是在其自然环境中的家中接受评估。这类研究很少在参与者的现实生活环境中进行，因此本研究为该人群在社区中的参与度提供了重要视角。
