一项队列研究，旨在探究一种简单的早期评估方法以预测中风后的上肢功能——SALGOT研究的一部分。
A cohort study investigating a simple, early assessment to predict upper extremity function after stroke - a part of the SALGOT study.
作者信息
Persson Hanna C, Alt Murphy Margit, Danielsson Anna, Lundgren-Nilsson Åsa, Sunnerhagen Katharina S
机构信息
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Unit of Physiotherapy, Division of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
BMC Neurol. 2015 Jun 18;15:92. doi: 10.1186/s12883-015-0349-6.
BACKGROUND
For early prediction of upper extremity function, there is a need for short clinical measurements suitable for acute settings. Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity. The purpose of this study was to investigate whether a sub-set of items from the Action Research Arm Test (ARAT) at 3 days and 1 month post-stroke could predict the level of upper extremity motor function required for a drinking task at three later stages during the first year post-stroke.
METHODS
The level of motor function required for a drinking task was identified with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A structured process was used to select ARAT items not requiring special equipment and to find a cut-off level of the items' sum score. The early prognostic values of the selected items, aimed to determine the level of motor function required for a drinking task at 10 days and 1 and 12 months, were investigated in a cohort of 112 patients. The patients had a first time stroke and impaired upper extremity function at day 3 after stroke onset, were ≥18 years and received care in a stroke unit.
RESULTS
Two items, "Pour water from glass to glass" and "Place hand on top of head", called ARAT-2, met the requirements to predict upper extremity motor function. ARAT-2 is a sum score (0-6) with a cut-off at 2 points, where >2 is considered an improvement. At the different time points, the sensitivity varied between 98% and 100%, specificity between 73% and 94%. Correctly classified patients varied between 81% and 96%.
CONCLUSIONS
Using ARAT-2, 3 days post-stroke could predict the level of motor function (assessed with FMA-UE) required for a drinking task during the first year after a stroke. ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.
TRAIL REGISTRATION
ClinicalTrials.gov: NCT01115348.
背景
为了早期预测上肢功能，需要适用于急性情况的简短临床测量方法。先前的研究证明了对功能的正确预测，但要么包含复杂的评估程序，要么其结果与日常活动中有用的运动功能不自动对应。本研究的目的是调查中风后3天和1个月时动作研究臂试验（ARAT）中的一组项目是否能够预测中风后第一年中三个后期阶段饮水任务所需的上肢运动功能水平。
方法
使用上肢Fugl-Meyer评估（FMA-UE）确定饮水任务所需的运动功能水平。采用结构化流程选择不需要特殊设备的ARAT项目，并找到项目总分的临界值。在112例患者队列中研究了所选项目的早期预后价值，旨在确定10天、1个月和12个月时饮水任务所需的运动功能水平。这些患者首次中风，中风发作后第3天上肢功能受损，年龄≥18岁，在中风单元接受治疗。
结果
两个项目，即“将水从一个杯子倒入另一个杯子”和“将手放在头顶”，称为ARAT-2，符合预测上肢运动功能的要求。ARAT-2是一个总分（0-6分），临界值为2分，>2分被认为是改善。在不同时间点，敏感性在98%至100%之间，特异性在73%至94%之间。正确分类的患者在81%至96%之间。
结论
使用ARAT-2，中风后3天可以预测中风后第一年饮水任务所需的运动功能水平（用FMA-UE评估）。ARAT-2显示出高预测价值，易于实施，具有临床可行性。
试验注册
ClinicalTrials.gov：NCT01115348。
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