Stabel Henriette Holm, Pedersen Asger Roer, Johnsen Søren Paaske, Nielsen Jørgen Feldbæk
a Hammel Neurorehabilitation Centre and University Research Clinic , Aarhus University , Hammel , Denmark.
b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark.
Top Stroke Rehabil. 2017 Dec;24(8):585-591. doi: 10.1080/10749357.2017.1373973. Epub 2017 Sep 18.
Patients with non-traumatic rupture of an aneurysm located at the anterior communicating artery (ACoA) often experience cognitive disabilities. It is unknown whether location of aneurysm also affects the possibility for improvement in functional independence compared to patients with an aneurysmal subarachnoid hemorrhage (a-SAH) located elsewhere. The aim was to explore the association between location of aneurysm (ACoA versus other) and level of functional independence, measured by Functional Independence Measure (FIM), at discharge from rehabilitation. Additionally, age and FIM at admission were explored.
Historical cohort study among 107 patients with a-SAH based on data from a clinical database and a population-based register. Data were analyzed using multivariable logistic regression.
Patients with ACoA were admitted with poorer cognitive FIM (median 6 (IQR 5-14) compared to patients with aneurysms located elsewhere (median 12 (IQR 6-23) (p = 0.0129); no difference at discharge. No association between aneurysm location and functional independence was observed. Higher age was associated with poorer outcome in bowel management OR 0.54 (95% CI 0.31-0.92), bladder management OR 0.59 (95% CI 0.35-0.98), comprehension OR 0.53 (95% CI 0.30-0.94), and memory OR 0.48 (95% CI 0.25-0.93). Overall, FIM at admission was associated with functional independence at discharge with the exception of stair walking and bladder management which did not reach statistical significance.
ACoA was not associated with poorer level of functional independence compared to patients with a-SAH located elsewhere. Higher age was associated with poorer outcome in continence, comprehension, and memory, whereas higher FIM was associated with better functional independence across items at discharge.
前交通动脉（ACoA）动脉瘤非创伤性破裂的患者常出现认知障碍。与其他部位动脉瘤性蛛网膜下腔出血（a-SAH）患者相比，动脉瘤位置是否也会影响功能独立性改善的可能性尚不清楚。本研究旨在探讨动脉瘤位置（ACoA与其他部位）与康复出院时功能独立性水平之间的关联，功能独立性水平通过功能独立性测量量表（FIM）进行评估。此外，还探讨了年龄和入院时的FIM。
基于临床数据库和人群登记数据，对107例a-SAH患者进行历史性队列研究。采用多变量逻辑回归分析数据。
ACoA动脉瘤患者入院时认知FIM较差（中位数为6（四分位间距5 - 14）），而其他部位动脉瘤患者为中位数12（四分位间距6 - 23）（p = 0.0129）；出院时无差异。未观察到动脉瘤位置与功能独立性之间的关联。年龄较大与肠道管理（比值比0.54，95%置信区间0.31 - 0.92）、膀胱管理（比值比0.59，95%置信区间0.35 - 0.98）、理解能力（比值比0.53，95%置信区间0.30 - 0.94）和记忆力（比值比0.48，95%置信区间0.25 - 0.93）较差的结局相关。总体而言，入院时的FIM与出院时的功能独立性相关，但上下楼梯和膀胱管理未达到统计学意义。
与其他部位a-SAH患者相比，ACoA动脉瘤与功能独立性较差无关。年龄较大与大小便失禁、理解能力和记忆力较差的结局相关，而较高的FIM与出院时各项功能独立性较好相关。
