Rand Debbie, Eng Janice J
Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Physical Therapy, University of British Columbia & Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.
J Stroke Cerebrovasc Dis. 2015 Feb;24(2):274-83. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.039. Epub 2014 Dec 18.
The ultimate goal of upper extremity (UE) stroke rehabilitation is for the individual with stroke to return using their arms and hands during daily activities in their own environment. No studies have monitored arm use as individuals with stroke transition from rehabilitation to the home setting. This longitudinal study compared the functional ability and daily use of the affected UE of individuals with stroke between discharge to home and 12 months after stroke and predicted the UE daily use 12 months after stroke.
Participants were assessed on discharge to home from rehabilitation and at 12 months after stroke. UE daily use was measured by wrist accelerometers and self-report by the Motor Activity Log (MAL). Multivariate logistic regression models were used to predict UE daily use 12 months after stroke.
The UE functional ability improved significantly from discharge to 12 months after stroke. The amount of self-report UE daily use significantly improved (z = -2.9, P = .004), but accelerometer activity counts did not (z = -0.15, P = .88), and the daily use of the nonaffected UE was 3 times more than the affected UE. After controlling for age and accelerometer daily use on discharge, UE variables of movement, function, dexterity, and strength accounted for an additional 10.9%-13.6% of the variance for accelerometer readings. After controlling for gender and MAL daily use on discharge, UE variables accounted for an additional 7%-12% of the variance for the MAL.
UE daily use 12 months after stroke is very limited despite the motor and functional improvement. Enhanced motor and functional ability at discharge predicts more UE daily use at 12 months after stroke. Interventions that monitor and encourage these individuals to use their UE are required to ensure that functional gains translate to daily use.
上肢（UE）中风康复的最终目标是使中风患者能够在自身环境中的日常活动中恢复使用手臂和双手。尚无研究监测中风患者从康复环境过渡到家庭环境时的手臂使用情况。这项纵向研究比较了中风患者出院回家时与中风后12个月时患侧UE的功能能力和日常使用情况，并预测了中风后12个月时UE的日常使用情况。
在患者从康复机构出院时以及中风后12个月时对参与者进行评估。通过腕部加速度计测量UE的日常使用情况，并通过运动活动日志（MAL）进行自我报告。使用多变量逻辑回归模型预测中风后12个月时UE的日常使用情况。
从中风出院到中风后12个月，UE功能能力有显著改善。自我报告的UE日常使用量有显著改善（z = -2.9，P = .004），但加速度计活动计数没有改善（z = -0.15，P = .88），且未受影响的UE的日常使用量是受影响UE的3倍。在控制了出院时的年龄和加速度计日常使用情况后，UE的运动、功能、灵活性和力量变量在加速度计读数的方差中又占了10.9%-13.6%。在控制了出院时的性别和MAL日常使用情况后，UE变量在MAL的方差中又占了7%-12%。
尽管运动和功能有所改善，但中风后12个月时UE的日常使用仍然非常有限。出院时增强的运动和功能能力可预测中风后12个月时更多的UE日常使用情况。需要采取干预措施来监测并鼓励这些个体使用其UE，以确保功能改善转化为日常使用。
