School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
School of Physical Therapy, Western University, London, Ontario, Canada.
Arch Phys Med Rehabil. 2018 Jul;99(7):1325-1332. doi: 10.1016/j.apmr.2017.12.034. Epub 2018 Apr 3.
To explore the effectiveness of a 2-week client-centered rehabilitation intervention (tune-up) delivered 6 months after inpatient discharge on community reintegration at 1 year in people with stroke.
A multicenter randomized controlled trial with 2 groups: an intervention ("tune-up") group and a control group having the same exposure to assessment.
Three research laboratories.
Participants (N=103) with hemiparetic stroke recruited from inpatient rehabilitation units at the time of discharge.
Participants randomized to the tune-up group received 1-hour therapy sessions in their home 3times/wk for 2 weeks at 6 months postdischarge focusing on identified mobility-related goals. A second tune-up was provided at 12 months.
Community reintegration measured by the Subjective Index of Physical and Social Outcome at 12 months and secondary outcomes included the Berg Balance Scale and measures of mobility and health-related quality of life up to 15 months.
At 12 months, both groups showed significant improvement in community reintegration (P<.05), a trend evident at all time points, with no difference between groups (mean difference, -0.5; 95% confidence interval, -1.8 to 2.7; P=.68). Similarly, a main effect of time reflected improvement in mobility-related and quality of life outcomes for both groups (P≤.0.5), but no group differences (P≥.30).
All participants in the tune-up group met or exceeded at least 1 mobility-related goal; however, the intervention did not differentially improve community reintegration. The improvements in mobility and quality of life over the 15-month postdischarge period may be secondary to high activity levels in both study groups and exposure to regular assessment.
探讨在出院后 6 个月进行为期 2 周的以患者为中心的康复干预（调整）对 1 年内脑卒中患者社区重返的影响。
一项多中心随机对照试验，分为 2 组：干预组（“调整”组）和对照组，两组接受相同的评估。
三个研究实验室。
从出院时的住院康复病房招募的偏瘫脑卒中参与者。
随机分配到调整组的参与者在出院后 6 个月时接受每周 3 次、每次 1 小时的家庭治疗，重点是确定与移动相关的目标。在 12 个月时提供第二次调整。
12 个月时的社区重返情况，采用主观身体和社会结果指数进行测量，次要结果包括 Berg 平衡量表以及移动和健康相关生活质量的测量，直至 15 个月。
在 12 个月时，两组在社区重返方面都有显著改善（P<.05），所有时间点都有这种趋势，两组之间没有差异（平均差异，-0.5；95%置信区间，-1.8 至 2.7；P=.68）。同样，时间的主要效应反映了两组与移动相关的和生活质量结果的改善（P≤.05），但组间无差异（P≥.30）。
调整组的所有参与者都达到或超过了至少 1 个与移动相关的目标；然而，干预并没有对社区重返产生不同的改善。在出院后 15 个月的期间内，移动和生活质量的改善可能是由于两组的活动水平较高以及接受定期评估。
