de Graaf Joris A, van Mierlo Maria L, Post Marcel W M, Achterberg Wilco P, Kappelle L Jaap, Visser-Meily Johanna M A
a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , the Netherlands.
b Center for Rehabilitation and Department of Rehabilitation Medicine , University of Groningen and University Medical Center Groningen , Groningen , the Netherlands.
Disabil Rehabil. 2018 Mar;40(6):637-645. doi: 10.1080/09638288.2016.1271466. Epub 2017 Jan 5.
This study aims to (1) assess differences in participation restrictions between stroke survivors aged under and over 70 years and (2) identify predictors associated with favorable and unfavorable long-term participation in both age groups.
Prospective cohort study in which 326 patients were assessed at stroke onset, two months and one year after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used to measure participation restrictions one year after stroke. Bivariate and multivariate logistic regression analyses were performed including demographic factors, stroke-related factors, emotional functioning and comorbidity as possible predictors.
Stroke survivors aged over 70 years perceived more participation restrictions in comparison to stroke survivors aged under 70 years one year after stroke. Independently significant predictors for unfavorable participation outcomes were advancing age, more severe stroke and anxiety symptoms in patients aged over 70 years, and female gender, more severe stroke, impaired cognition and depression symptoms in patients aged under 70 years. Lower age was the only independent predictor associated with favorable participation after one year in stroke survivors aged over 70 years.
This study emphasizes the need to pay more attention to participation restrictions in elderly stroke survivors. Implications for rehabilitation More attention in the rehabilitation process should be paid to restrictions in participation of stroke survivors aged older than 70 years, taking into account the different participation needs and predictors of older stroke survivors. Early screening on the presence of anxiety symptoms could potentially prevent long-term restrictions in participation in stroke survivors aged over 70-year old. Stroke survivors experience considerable restrictions in physical activity and mobility after one year, highlighting the need for the development of community-based exercise programs for stroke survivors.
本研究旨在（1）评估70岁以下和70岁以上中风幸存者在参与限制方面的差异，以及（2）确定与两个年龄组长期有利和不利参与相关的预测因素。
前瞻性队列研究，对326例患者在中风发作时、中风后两个月和一年进行评估。使用乌得勒支康复参与评估量表（USER-参与量表）来测量中风一年后的参与限制。进行了双变量和多变量逻辑回归分析，纳入人口统计学因素、中风相关因素、情绪功能和合并症作为可能的预测因素。
与70岁以下的中风幸存者相比，70岁以上的中风幸存者在中风一年后感觉参与限制更多。70岁以上患者参与结果不利的独立显著预测因素是年龄增长、中风更严重和焦虑症状，而70岁以下患者是女性、中风更严重、认知受损和抑郁症状。较低年龄是70岁以上中风幸存者一年后参与良好的唯一独立预测因素。
本研究强调需要更加关注老年中风幸存者的参与限制。对康复的启示 在康复过程中应更加关注70岁以上中风幸存者的参与限制，同时考虑到老年中风幸存者不同的参与需求和预测因素。对70岁以上中风幸存者焦虑症状的早期筛查可能会预防长期的参与限制。中风幸存者在一年后身体活动和行动能力方面存在相当大的限制，这突出了为中风幸存者制定社区锻炼计划的必要性。
