脑卒中晚期多模式康复后的长期改善：一项随机对照试验。

Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke: A Randomized Controlled Trial.

作者信息

Bunketorp-Käll Lina, Lundgren-Nilsson Åsa, Samuelsson Hans, Pekny Tulen, Blomvé Karin, Pekna Marcela, Pekny Milos, Blomstrand Christian, Nilsson Michael

机构信息

From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.).

出版信息

Stroke. 2017 Jul;48(7):1916-1924. doi: 10.1161/STROKEAHA.116.016433. Epub 2017 Jun 15.

DOI:10.1161/STROKEAHA.116.016433

PMID:28619985

Abstract

BACKGROUND AND PURPOSE

Treatments that improve function in late phase after stroke are urgently needed. We assessed whether multimodal interventions based on rhythm-and-music therapy or horse-riding therapy could lead to increased perceived recovery and functional improvement in a mixed population of individuals in late phase after stroke.

METHODS

Participants were assigned to rhythm-and-music therapy, horse-riding therapy, or control using concealed randomization, stratified with respect to sex and stroke laterality. Therapy was given twice a week for 12 weeks. The primary outcome was change in participants' perception of stroke recovery as assessed by the Stroke Impact Scale with an intention-to-treat analysis. Secondary objective outcome measures were changes in balance, gait, grip strength, and cognition. Blinded assessments were performed at baseline, postintervention, and at 3- and 6-month follow-up.

RESULTS

One hundred twenty-three participants were assigned to rhythm-and-music therapy (n=41), horse-riding therapy (n=41), or control (n=41). Post-intervention, the perception of stroke recovery (mean change from baseline on a scale ranging from 1 to 100) was higher among rhythm-and-music therapy (5.2 [95% confidence interval, 0.79-9.61]) and horse-riding therapy participants (9.8 [95% confidence interval, 6.00-13.66]), compared with controls (-0.5 [-3.20 to 2.28]); =0.001 (1-way ANOVA). The improvements were sustained in both intervention groups 6 months later, and corresponding gains were observed for the secondary outcomes.

CONCLUSIONS

Multimodal interventions can improve long-term perception of recovery, as well as balance, gait, grip strength, and working memory in a mixed population of individuals in late phase after stroke.

CLINICAL TRIAL REGISTRATION

URL: http//www.ClinicalTrials.gov. Unique identifier: NCT01372059.

摘要

背景与目的

迫切需要能改善中风后期功能的治疗方法。我们评估了基于节奏与音乐疗法或骑马疗法的多模式干预措施是否能使中风后期混合人群的自我感知恢复情况得到改善以及功能得到提升。

方法

采用隐藏随机分组法，根据性别和中风部位将参与者分为节奏与音乐治疗组、骑马治疗组或对照组。治疗每周进行两次，共12周。主要结局指标是通过卒中影响量表评估的参与者对中风恢复的感知变化，并进行意向性分析。次要客观结局指标是平衡、步态、握力和认知方面的变化。在基线、干预后以及3个月和6个月随访时进行盲法评估。

结果

123名参与者被分配到节奏与音乐治疗组（n = 41）、骑马治疗组（n = 41）或对照组（n = 41）。干预后，节奏与音乐治疗组（5.2 [95%置信区间，0.79 - 9.61]）和骑马治疗组参与者（9.8 [95%置信区间，6.00 - 13.66]）对中风恢复的感知（从基线开始在1至100分的量表上的平均变化）高于对照组（-0.5 [-3.20至2.28]）；P = 0.001（单因素方差分析）。6个月后，两个干预组的改善情况均持续存在，次要结局指标也出现了相应的改善。