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急性脊髓损伤后特异性康复的结局:一项德国单中心研究。

Outcome after post-acute spinal cord specific rehabilitation: a German single center study.

作者信息

Ponfick Matthias

机构信息

HELIOS Klinik Kipfenberg GmbH, Kipfenberg, Germany.

出版信息

Spinal Cord Ser Cases. 2017 Sep 7;3:17055. doi: 10.1038/scsandc.2017.55. eCollection 2017.

Abstract

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

The objective of this study was to analyze single center outcome measures of spinal cord injury (SCI)-specific rehabilitation (SCISR) in Germany.

SETTING

The study was conducted at an SCI specialized rehabilitation center.

METHODS

Nonparametric tests for outcome description such as SCIM and length of stay. Logistic regression for outcome prediction was used.

RESULTS

One hundred and sixty patients (113 men, 47 women) with a mean age of 64.4 years were included. Non-traumatic etiologies, such as vascular diseases, tumors, infections or degenerative diseases accounted for 55.6% of SCI (89/160). Men experienced significantly more cervical lesions (=0.02) and presented with lower SCIMstart values (=0.04). Patients with AIS D (incomplete SCI) had significantly higher SCIMstart and SCIMend (<0.01, each). Age correlated negatively with SCIMstart and SCIMend (=-0.21; <0.05; =-0.21; <0.05; respectively). The chance to reach an SCIMend ⩾50 points (milestone for starting post-primary rehabilitation) increased with every SCIM point at the beginning of rehabilitation by 12.2% (95% CI 7.3-17.3%) and for every day in rehabilitation by 1.4% (95% CI 0.5-2.3%). Every additional day in acute medical care, however, decreased the chance for this by 2.2% (95% CI -3.6 to -0.8%).

CONCLUSIONS

This is the first study giving outcomes for post-acute SCISR in Germany. The obtained data support that even in an older cohort, early admission to SCISR after SCI and longer LOSreha increases the chance for higher independence at the end of the rehabilitation period.

摘要

研究设计

回顾性队列研究。

目的

本研究的目的是分析德国脊髓损伤(SCI)特异性康复(SCISR)的单中心结局指标。

背景

该研究在一家SCI专科康复中心进行。

方法

采用非参数检验描述结局指标,如脊髓损伤独立性测量量表(SCIM)和住院时间。使用逻辑回归进行结局预测。

结果

纳入160例患者(男性113例,女性47例),平均年龄64.4岁。非创伤性病因,如血管疾病、肿瘤、感染或退行性疾病占SCI的55.6%(89/160)。男性颈椎损伤明显更多(=0.02),且SCIM起始值更低(=0.04)。美国脊髓损伤协会(AIS)D级(不完全性SCI)患者的SCIM起始值和结束值显著更高(均<0.01)。年龄与SCIM起始值和结束值呈负相关(分别为=-0.21;<0.05;=-0.21;<0.05)。康复开始时,每增加1个SCIM评分,达到SCIM结束值⩾50分(开始二级康复的里程碑)的机会增加12.2%(95%置信区间7.3 - 17.3%),康复每增加1天,机会增加1.4%(95%置信区间0.5 - 2.3%)。然而,急性医疗护理每增加1天,达到该目标的机会降低2.2%(95%置信区间 - 3.6至 - 0.8%)。

结论

这是第一项给出德国急性后期SCISR结局的研究。所得数据支持,即使在老年队列中,SCI后早期进入SCISR并延长康复住院时间可增加康复末期更高独立性的机会。

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