Kinoshita Tokio, Nishimura Yukihide, Nakamura Takeshi, Hashizaki Takamasa, Kojima Daisuke, Kawanishi Makoto, Uenishi Hiroyasu, Arakawa Hideki, Ogawa Takahiro, Kamijo Yoshi-Ichiro, Kawasaki Takashi, Tajima Fumihiro
Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama city, Wakayama, Japan.
Department of Rehabilitation Medicine, Iwate Medical University, Morioka city, Iwate, Japan.
PLoS One. 2017 Oct 26;12(10):e0187099. doi: 10.1371/journal.pone.0187099. eCollection 2017.
Clinical evidence suggests that early mobilization of patients with acute stroke improves activity of daily living (ADL). The purpose of this study was to compare the utility of the physiatrist and registered therapist operating acute rehabilitation (PROr) applied early or late after acute stroke.
This study was prospective cohort study, assessment design. Patients with acute stroke (n = 227) admitted between June 2014 and April 2015 were divided into three groups based on the time of start of PROr: within 24 hours (VEM, n = 47), 24-48 hours (EM, n = 77), and more than 48 hours (OM, n = 103) from stroke onset. All groups were assessed for the number of deaths during hospitalization, and changes in the Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), and Functional Independence Measure (FIM) at hospital discharge.
All patients were assessed by physiatrists, who evaluated the specific needs for rehabilitation, and then referred them to registered physical therapists and occupational therapists to provide early mobilization (longer than one hour per day per patient).
The number of deaths encountered during the PROr period was 13 (out of 227, 5.7%), including 2 (4.3%) in the VEM group. GCS improved significantly during the hospital stay in all three groups, but the improvement on discharge was significantly better in the VEM group compared with the EM and OM groups. FIM improved significantly in the three groups, and the gains in total FIM and motor subscale were significantly greater in the VEM than the other groups.
PROr seems safe and beneficial rehabilitation to improve ADL in patients with acute stroke.
临床证据表明，急性脑卒中患者早期活动可改善日常生活活动能力（ADL）。本研究旨在比较物理治疗师和注册治疗师在急性脑卒中后早期或晚期实施急性康复治疗（PROr）的效用。
本研究为前瞻性队列研究，评估设计。2014年6月至2015年4月收治的急性脑卒中患者（n = 227）根据PROr开始时间分为三组：卒中发病后24小时内（VEM组，n = 47）、24 - 48小时（EM组，n = 77）和超过48小时（OM组，n = 103）。评估所有组住院期间的死亡人数，以及出院时格拉斯哥昏迷量表（GCS）、美国国立卫生研究院卒中量表（NIHSS）和功能独立性测量（FIM）的变化。
所有患者均由物理治疗师进行评估，物理治疗师评估康复的具体需求，然后将患者转介给注册物理治疗师和职业治疗师以提供早期活动（每位患者每天超过一小时）。
PROr期间出现的死亡人数为13例（227例中的5.7%），其中VEM组2例（4.3%）。三组患者住院期间GCS均显著改善，但出院时VEM组的改善情况明显优于EM组和OM组。三组患者FIM均显著改善，VEM组总FIM和运动子量表的改善幅度显著大于其他组。
PROr似乎是一种安全且有益的康复治疗方法，可改善急性脑卒中患者的ADL。
