Andrenelli E, Ippoliti E, Coccia M, Millevolte M, Cicconi B, Latini L, Lagalla G, Provinciali L, Ceravolo M G, Capecci M
Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, "Politecnica delle Marche" University, Ancona, Italy -
Eur J Phys Rehabil Med. 2015 Oct;51(5):575-85. Epub 2015 Jan 23.
Although stroke-related disability has been extensively studied, only few studies have investigated Participation restriction in chronic stroke survivors.
To identify features and predictors of Activity limitation and Participation restriction in the chronic phase of a first-ever stroke.
Cross-sectional observational study.
Comprehensive stroke unit with outpatient rehabilitation facility.
Subjects submitted to intensive rehabilitation after first-ever stroke, from 1st January 2009 to 31st December 2010.
Participation was investigated through the Frenchay Activity Index (FAI) and the Functional Status Questionnaire (FSQ) at 2.4±0.5 years after the event. Basic activities of daily living (ADL) and mood were also assessed through the Modified Barthel Index (MBI) and the Beck Depression Inventory (BDI). A retrospective search of the medical records looked for: type/side of brain lesion, stroke clinical syndromes, comorbidities and functional condition at discharge from intensive rehabilitation (upper limb motricity index-ULMI-, Functional Ambulation Category-FAC, MBI, cognitive deficits).
Forty-five subjects (17 female, age 70.1±11.5 years) were enrolled. They showed a striking restriction in their Participation, mainly for FAI-outdoor activities (median FAI score was <50% of the theoretical maximum). A poor gait function (FAC) and an impaired mood (BDI) were the only independent predictors of FAI indoor (F=6.1; p=,005; R^2= 64%) and outdoor activities (F=4.1; P=0.01; R^2=48%), respectively. The univariate analysis showed a strong dependence of all FSQ scores from global disability (MBI), motor function impairment (ULMI and FAC) and cognitive deficits. Depression influenced "psychological function" score, whereas gait capacity was the only factor significantly associated with the "work performance" score. The gait function level, achieved after intensive rehabilitation, was extrapolated by the multivariate analysis, as the most powerful independent predictor of the chronic activity limitations, as measured by MBI (F=33.8, P<0.0001, R2=0.539).
Gait dysfunction is the main factor of Activity limitations and Participation restriction in chronic stroke. Participation is restricted by global disability, depression, older age and dementia. More than 50% variance of Participation measures cannot be explained by the quoted factors.
The study results support the need to integrate the standard rehabilitation approach with vocational rehabilitation in order to reduce Participation restriction.
尽管与中风相关的残疾问题已得到广泛研究，但仅有少数研究调查了慢性中风幸存者的参与受限情况。
确定首次中风慢性期活动受限和参与受限的特征及预测因素。
横断面观察性研究。
设有门诊康复设施的综合性中风单元。
2009年1月1日至2010年12月31日首次中风后接受强化康复治疗的患者。
在中风事件发生2.4±0.5年后，通过法国ay活动指数（FAI）和功能状态问卷（FSQ）对参与情况进行调查。还通过改良巴氏指数（MBI）和贝克抑郁量表（BDI）评估日常生活基本活动（ADL）和情绪。对病历进行回顾性检索，查找：脑损伤类型/部位、中风临床综合征、合并症以及强化康复出院时的功能状况（上肢运动指数-ULMI-、功能步行分类-FAC、MBI、认知缺陷）。
共纳入45名受试者（17名女性，年龄70.1±11.5岁）。他们在参与方面存在明显受限，主要是在FAI的户外活动方面（FAI中位数得分低于理论最大值的50%）。步态功能差（FAC）和情绪受损（BDI）分别是FAI室内活动（F=6.1；P=0.005；R²=64%）和户外活动（F=4.1；P=0.01；R²=48%）的唯一独立预测因素。单因素分析显示，所有FSQ得分强烈依赖于整体残疾程度（MBI）、运动功能损害（ULMI和FAC）和认知缺陷。抑郁影响“心理功能”得分，而步态能力是与“工作表现”得分显著相关的唯一因素。多因素分析推断，强化康复后达到的步态功能水平是慢性活动受限的最有力独立预测因素，以MBI衡量（F=33.8，P<0.0001，R²=0.539）。
步态功能障碍是慢性中风活动受限和参与受限的主要因素。参与受限受整体残疾、抑郁、老年和痴呆影响。超过50%的参与测量方差无法用上述因素解释。
研究结果支持将标准康复方法与职业康复相结合以减少参与受限的必要性。
