Skidmore Elizabeth R, Butters Meryl, Whyte Ellen, Grattan Emily, Shen Jennifer, Terhorst Lauren
Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Arch Phys Med Rehabil. 2017 Apr;98(4):673-680. doi: 10.1016/j.apmr.2016.10.004. Epub 2016 Oct 26.
To examine the effects of direct skill training and guided training for promoting independence after stroke.
Single-blind randomized pilot study.
Inpatient rehabilitation facility.
Participants in inpatient rehabilitation with acute stroke and cognitive impairments (N=43).
Participants were randomized to receive direct skill training (n=22, 10 sessions as adjunct to usual inpatient rehabilitation) or guided training (n=21, same dose).
The FIM assessed independence at baseline, rehabilitation discharge, and months 3, 6, and 12.
Linear mixed models (random intercept, other effects fixed) revealed a significant intervention by time interaction (F=5.11, P<.001), a significant main effect of time (F=49.25, P<.001), and a significant effect of stroke severity (F=34.46, P<.001). There was no main effect of intervention (F=.07, P=.79). Change in FIM scores was greater for the direct group at rehabilitation discharge (effect size of between-group differences, d=.28) and greater for the guide group at months 3 (d=.16), 6 (d=.39), and 12 (d=.53). The difference between groups in mean 12-month change scores was 10.57 points.
Guided training, provided in addition to usual care, offered a small advantage in the recovery of independence, relative to direct skill training. Future studies examining guided training in combination with other potentially potent intervention elements may further advise best practices in rehabilitation for individuals with cognitive impairments after acute stroke.
探讨直接技能训练和引导训练对促进卒中后独立性的影响。
单盲随机试点研究。
住院康复机构。
急性卒中和认知障碍的住院康复参与者（N = 43）。
参与者被随机分配接受直接技能训练（n = 22，作为常规住院康复的辅助进行10次训练）或引导训练（n = 21，相同剂量）。
FIM在基线、康复出院时以及3个月、6个月和12个月时评估独立性。
线性混合模型（随机截距，其他效应固定）显示干预与时间的交互作用显著（F = 5.11，P <.001），时间的主效应显著（F = 49.25，P <.001），卒中严重程度的效应显著（F = 34.46，P <.001）。干预没有主效应（F =.07，P =.79）。直接训练组在康复出院时FIM评分的变化更大（组间差异效应量，d =.28），引导训练组在3个月（d =.16）、6个月（d =.39）和12个月（d =.53）时变化更大。两组12个月平均变化评分的差异为10.57分。
相对于直接技能训练，在常规护理基础上提供的引导训练在独立性恢复方面具有微小优势。未来结合其他可能有效的干预要素对引导训练进行研究，可能会为急性卒中后认知障碍患者的最佳康复实践提供进一步建议。
