中风后5年的功能和运动结局与2个月时的结局相当：欧洲中风康复协作评估随访研究

Functional and motor outcome 5 years after stroke is equivalent to outcome at 2 months: follow-up of the collaborative evaluation of rehabilitation in stroke across Europe.

作者信息

Meyer Sarah, Verheyden Geert, Brinkmann Nadine, Dejaeger Eddy, De Weerdt Willy, Feys Hilde, Gantenbein Andreas R, Jenni Walter, Laenen Annouschka, Lincoln Nadina, Putman Koen, Schuback Birgit, Schupp Wilfried, Thijs Vincent, De Wit Liesbet

机构信息

From the Department of Rehabilitation Sciences (S.M., G.V.,W.D.W., H.F.), Interuniversity Centre for Biostatistics and Statistical Bioinformatics (A.L.), Department of Neurosciences (V.T.), and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND) (V.T.), KU Leuven, Leuven, Belgium; Fachklinik Herzogenaurach, Herzogenaurach, Germany (N.B., W.S.); University Hospital Pellenberg, Pellenberg, Belgium (E.D.); RehaClinic, Zurzach, Switzerland (A.R.G., W.J., B.S.); University of Nottingham, School of Medicine, Nottingham, United Kingdom (N.L.); Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium (K.P., L.D.W.); University of Central Lancashire, School of Health, Preston, United Kingdom (K.P.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium (V.T.); and Department of Neurology, University Hospital Leuven, Leuven, Belgium (V.T.).

出版信息

Stroke. 2015 Jun;46(6):1613-9. doi: 10.1161/STROKEAHA.115.009421. Epub 2015 May 7.

DOI:10.1161/STROKEAHA.115.009421

PMID:25953370

Abstract

BACKGROUND AND PURPOSE

Recovery of patients within the first 6 months after stroke is well documented, but there has been little research on long-term recovery. The aim of this study was to analyze functional and motor recovery between admission to rehabilitation centres and 5 years after stroke.

METHODS

This follow-up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe study, included patients from 4 European rehabilitation centres. Patients were assessed on admission, at 2 and 6 months, and 5 years after stroke, using the Barthel Index, Rivermead Motor Assessment Gross Function, Leg and Trunk function, and Arm function. Linear mixed models were used, corrected for baseline characteristics. To account for the drop-out during follow-up, the analysis is likelihood-based (assumption of missingness at random).

RESULTS

A total of 532 patients were included in this study, of which 238 were followed up at 5 years post stroke. Mean age at stroke onset was 69 (±10 SD) years, 53% were men, 84% had ischemic strokes, and 53% had left-sided motor impairment. Linear mixed model analysis revealed a significant deterioration for all 4 outcomes between 6 months and 5 years (P<0.0001). Scores at 2 months were not statistically significant different from scores at 5 years after stroke. Higher age (P<0.0001) and increasing stroke severity on admission (P<0.0001) negatively affected long-term functional and motor recovery.

CONCLUSIONS

Five-year follow-up revealed deterioration in functional and motor outcome, with a return to the level measured at 2 months. Increasing age and increasing stroke severity negatively affected recovery up to 5 years after stroke.

摘要

背景与目的

卒中后前6个月患者的恢复情况已有充分记录，但关于长期恢复的研究较少。本研究旨在分析康复中心入院时与卒中后5年之间的功能和运动恢复情况。

方法

这项对欧洲卒中康复协作评估研究的随访纳入了来自4个欧洲康复中心的患者。在入院时、卒中后2个月和6个月以及5年时，使用巴氏指数、里弗米德运动评估总体功能、腿部和躯干功能以及手臂功能对患者进行评估。采用线性混合模型，并对基线特征进行校正。为了考虑随访期间的失访情况，分析基于似然法（假设缺失数据为随机缺失）。

结果

本研究共纳入532例患者，其中238例在卒中后5年进行了随访。卒中发病时的平均年龄为69（±10标准差）岁，53%为男性，84%为缺血性卒中，53%有左侧运动障碍。线性混合模型分析显示，在6个月至5年之间，所有4项指标均有显著恶化（P<0.0001）。卒中后2个月时的评分与5年时的评分在统计学上无显著差异。年龄较大（P<0.0001）和入院时卒中严重程度增加（P<0.0001）对长期功能和运动恢复有负面影响。