1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.
2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
Neurorehabil Neural Repair. 2017 Oct-Nov;31(10-11):864-876. doi: 10.1177/1545968317732680.
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
在脑卒中康复中，最困难的临床问题是“患者的康复潜力有多大？”和“鉴于患者的临床特征，这个人的最佳康复策略是什么？”如果没有这些问题的答案，临床医生在决定治疗的内容和重点方面就会感到困难，研究人员设计的研究也会无意中将很可能有反应的参与者与没有反应的参与者混合在一起。开发和实施能够区分患者亚组的生物标志物将有助于解决这些问题，并揭示对康复过程重要的因素。本文的目的是提供一份关于脑卒中康复生物标志物现有证据的共识声明。考虑了脑卒中后恢复时间线上运动、感觉、认知和语言领域的生物标志物；重点是脑结构和功能，不包括血液标志物和遗传学。我们提供了一些被认为可以准备纳入临床试验的生物标志物的证据，以及其他一些有前途但尚未准备好的生物标志物，因此代表了一个发展重点。我们以一个例子结束，该例子说明了生物标志物在康复和康复研究中的实用性，展示了在纳入生物标志物后如何增强未来临床试验的效果。通过这种方式，我们提出了一个前进的方向，即在何时何地可以纳入生物标志物来提高脑卒中后康复和恢复实践和研究的效果。
