Pérez Laura Mónica, Inzitari Marco, Roqué Marta, Duarte Esther, Vallés Elisabeth, Rodó Montserrat, Gallofré Miquel
Convalescence and Rehabilitation Unit, Intermediate Care Hospital "Parc Sanitari Pere Virgili", Esteve Terradas 30, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Neurol Sci. 2015 Oct;36(10):1875-80. doi: 10.1007/s10072-015-2273-3. Epub 2015 Jun 7.
Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.
中风后的恢复取决于多种神经、功能和心理社会因素。关于这些因素的证据并不充分，尤其是康复期间认知变化的影响。我们旨在调查包括认知表现及其随时间的变化在内的选择性特征是否会调节入住急性后康复单元的中风幸存者出院回家时的功能恢复情况。我们进行了一项多中心队列研究，纳入了2008年期间从加泰罗尼亚-西班牙的急性病房出院并入住任何老年康复单元的所有患者。使用《社会卫生资源最小数据集联合基础数据集》（CMBD-RSS）对患者的人口统计学、临床和功能变量进行评估，该数据集改编自美国疗养院使用的最小数据集工具。使用认知表现量表（CPS，范围为0-6，认知从最佳到最差）对重复评估的认知从基线到出院的变化进行计算。分析了这些因素与结果相关的多变量效应。纳入了879名中风后患者（平均年龄77.48±10.18岁，52.6%为女性）。初始CPS较差[比值比（95%置信区间）=0.851（0.774-0.935）]和存在大便失禁[比值比（95%置信区间）=0.560（0.454-0.691）]会降低功能改善后回家的可能性；而CPS从基线到出院的改善[比值比（95%置信区间）=1.348（1.144-1.588）]、前两周内更多的康复天数[比值比（95%置信区间）=1.011（1.006-1.015）]和更长的住院时间[比值比（95%置信区间）=1.011（1.006-1.015）]与结果相关。在我们的样本中，不同的临床特征，包括认知功能及其随时间的改善，与接受康复治疗的中风患者的功能改善相关。我们的结果可能为进一步研究旨在探索康复期间认知变化的影响提供信息。
