Shiraishi Nariaki, Suzuki Yusuke, Matsumoto Daisuke, Jeong Seungwon, Sugiyama Motoya, Kondo Katsunori
Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Handa-city, Aichi, Japan.
Department of Comprehensive Community Care Systems, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Arch Phys Med Rehabil. 2017 Mar;98(3):434-441. doi: 10.1016/j.apmr.2016.08.467. Epub 2016 Sep 12.
To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge.
Retrospective, observational, propensity score (PS)-matched case-control study.
General hospitals.
Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no-self-exercise program groups.
Self-exercise program participation.
At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value - admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no-high efficiency), and mRS score.
Patients were classified into a self-exercise program (n=780) or a no-self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no-high efficiency) of 2.2 (95% confidence ratio, 1.75-2.70).
SEPs may contribute to improving ADL.
探讨中风后患者的自我锻炼计划是否有助于出院时提高日常生活活动能力（ADL）。
回顾性、观察性、倾向评分（PS）匹配的病例对照研究。
综合医院。
参与者包括2006年1月3日至2012年12月26日期间住院的中风后患者（N = 1560），符合以下标准：（1）有年龄、性别、中风至入院时间、住院时间、FIM评分、改良Rankin量表（mRS）评分、格拉斯哥昏迷量表评分、日本中风量表评分以及自我锻炼计划参与情况的数据；（2）中风发作后7天内入院，住院时间在7至60天之间，中风前mRS评分≤2，且未因FIM或mRS恶化而出院。自我锻炼计划组和无自我锻炼计划组各选取780对PS匹配的对子。
参与自我锻炼计划。
出院时的FIM运动评分、FIM认知评分、FIM运动评分增益（出院值 - 入院值）、FIM运动评分增益率（增益/住院时间）、一个除以FIM运动评分增益率中位数的二元变量（高效率或非高效率）以及mRS评分。
患者分为自我锻炼计划组（n = 780）和无自我锻炼计划组（n = 780）。匹配后，除运动系统变量外，组间无显著差异。PS的受试者工作特征曲线下面积值为0.71，95%置信区间为0.68至0.73，该模型被认为拟合度相对良好。对PS匹配对子的逻辑回归分析表明，自我锻炼计划是有效的，ADL（高效率或非高效率）的总体优势比为2.2（95%置信比，1.75 - 2.70）。
自我锻炼计划可能有助于改善ADL。
