Ng Yee Sien, Tan Kristin Hui Xian, Chen Cynthia, Senolos Gilmore Cura, Koh Gerald Choon Huat
From the Department of Rehabilitation Medicine, Singapore General Hospital (YSN, GCS); Duke-NUS Graduate Medical School (YSN); and Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (KHXT, CC, GCHK), Singapore, Singapore.
Am J Phys Med Rehabil. 2016 Oct;95(10):709-17. doi: 10.1097/PHM.0000000000000502.
To describe clinical characteristics and functional outcomes in recurrent stroke, identify factors associated with improved outcomes, and to compare these outcomes with first-ever stroke patients.
Five-year prospective cohort study of 1277 consecutive stroke patients admitted to inpatient rehabilitation, with 16.6% recurrent stroke. Primary functional outcome measure was the Functional Independence Measure. FIM gain quantified the difference between admission and discharge FIM scores. FIM effectiveness measured the percentage recovery.
In recurrent stroke patients, mean AdmissionFIM and DischargeFIM scores were 62.5 and 74.2, respectively, with a mean FIM gain of 11.7 and FIM effectiveness of 20.4%. Comparing to first-ever stroke, recurrent stroke patients were older, had higher unemployment rates, higher proportion of ischemic stroke types, and higher prevalence of hypertension, diabetes, ischemic heart disease, and depression. In multivariate analysis of the entire cohort, recurrent stroke predicted lower FIM gains and effectiveness. When the recurrent stroke group was further sub-analyzed, better FIM gain was associated with higher cognitive AdmissionFIM scores and presence of a caregiver, whereas better FIM effectiveness was correlated with higher motor AdmissionFIM scores.
Recurrent stroke patients made less functional gains compared to first-ever stroke patients. However, improvements were still significant and these patients should be offered comprehensive inpatient rehabilitation to optimize outcomes.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the learner will be able to: (1) Describe unique demographics, and characteristics of recurrent stroke patients admitted for inpatient rehabilitation; (2) Differentiate functional outcomes between first-ever and recurrent stroke patients; and (3) Utilize factors associated with functional improvements in recurrent strokes in treatment planning.
Advanced
: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
描述复发性卒中的临床特征和功能转归，确定与改善转归相关的因素，并将这些转归与首次卒中患者进行比较。
对1277例连续入住住院康复机构的卒中患者进行为期五年的前瞻性队列研究，其中16.6%为复发性卒中。主要功能转归指标为功能独立性测量（FIM）。FIM增益量化了入院时和出院时FIM评分的差异。FIM有效性衡量了恢复的百分比。
在复发性卒中患者中，入院时FIM平均评分和出院时FIM平均评分分别为62.5和74.2，FIM平均增益为11.7，FIM有效性为20.4%。与首次卒中相比，复发性卒中患者年龄更大，失业率更高，缺血性卒中类型的比例更高，高血压、糖尿病、缺血性心脏病和抑郁症的患病率更高。在对整个队列的多变量分析中，复发性卒中预示着FIM增益和有效性较低。当对复发性卒中组进行进一步亚分析时，更好的FIM增益与更高的认知入院时FIM评分和有照料者相关，而更好的FIM有效性与更高的运动入院时FIM评分相关。
与首次卒中患者相比，复发性卒中患者的功能改善较少。然而，改善仍然显著，应该为这些患者提供全面的住院康复以优化转归。
高级
学术物理医学与康复学会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理医学与康复学会将此活动指定为最多1.5个AMA PRA第1类学分™。医生应仅根据其参与活动的程度索取学分。
