Department of Neurorehabilitation IRCCS San Raffaele Pisana, Rome, Italy.
San Raffaele University, Rome, Italy.
PLoS One. 2018 Feb 21;13(2):e0193235. doi: 10.1371/journal.pone.0193235. eCollection 2018.
Upper limb recovery is one of the main goals of post-stroke rehabilitation due to its importance for autonomy in Activities of Daily Living (ADL). Although the efficacy of upper limb Robot-assisted Therapy (RT) is well established in literature, the impact of the initial status of the patient on the effects of RT is still understudied. This paper aims to identify whether demographic, clinical and motor characteristics of stroke patients may influence the ability to independently perform ADL after RT.
A retrospective study was conducted on sixty stroke patients who conducted planar upper limb goal-directed tasks with the InMotion 2.0 robot. The RT was administered 5 days/week for 4 weeks and each session lasted 45 minutes. The primary outcome measure was the Modified Barthel Index (BI), dichotomized into favourable (BI ≥75) and unfavourable (BI<75) outcomes. The potential predictors were the demographic and clinical records, and the following clinical assessment scores: Modified Ashworth Scale-Shoulder (MAS-S); Modified Ashworth Scale-Elbow (MAS-E); Fugl-Meyer Assessment Upper Extremity (FMA-UE); upper limb section of the Motricity Index (MIul); total passive Range Of Motion (pROM); and Box and Block Test (BBT).
Statistical analysis showed that the BBT, FMA-UE and MIul scores were significant predictors of a favourable outcome in ADL. The cut-off scores of the independent variables were calculated (FMA-UE = 32; MIul = 48; BBT = 3) with respect to the dichotomic BI outcome. Their robustness was assessed with the Fragility Index (FMA-UE = 2; MIul = 3; BBT = 7), showing that BBT is the most robust predictor of favourable BI outcome. Moreover, subjects with all predictors higher than the cut-off scores had higher probability to increase their independence in ADL at the end of the therapy. Demographic records, spasticity and pROM were not identified as predictors.
Stroke patients with greater manual dexterity and less impairment appear to have a higher probability of achieving clinically significant ADL outcomes after upper limb RT. The obtained results can help to optimise the management of RT treatment planning. Further studies on a larger number of patients with a long-term follow up are recommended in order to evaluate other potential predictors and to validate the results.
上肢恢复是中风后康复的主要目标之一，因为它对日常生活活动（ADL）的自主性很重要。尽管文献中已经证实了上肢机器人辅助治疗（RT）的疗效，但患者初始状态对 RT 效果的影响仍在研究中。本文旨在确定中风患者的人口统计学、临床和运动特征是否会影响 RT 后的 ADL 独立能力。
对 60 名接受 InMotion 2.0 机器人进行平面上肢目标导向任务的中风患者进行了回顾性研究。RT 每周 5 天，共 4 周，每次持续 45 分钟。主要结局测量指标为改良巴氏指数（BI），分为有利（BI≥75）和不利（BI<75）结局。潜在预测因子为人口统计学和临床记录，以及以下临床评估评分：改良 Ashworth 量表-肩部（MAS-S）；改良 Ashworth 量表-肘部（MAS-E）；Fugl-Meyer 上肢评估（FMA-UE）；运动指数上肢部分（MIul）；总被动活动度（pROM）；和 Box and Block 测试（BBT）。
统计分析表明，BBT、FMA-UE 和 MIul 评分是 ADL 有利结局的显著预测因子。根据 BI 二分结果计算了自变量的截断分数（FMA-UE=32；MIul=48；BBT=3）。用脆弱指数（FMA-UE=2；MIul=3；BBT=7）评估了它们的稳健性，结果表明 BBT 是预测 BI 有利结局的最稳健预测因子。此外，所有预测因子均高于截断分数的受试者在治疗结束时更有可能增加其 ADL 独立性。人口统计学记录、痉挛和 pROM 未被确定为预测因子。
上肢 RT 后，手灵活性更高、损伤程度更低的中风患者似乎更有可能获得有临床意义的 ADL 结局。研究结果有助于优化 RT 治疗计划的管理。建议对更多患者进行长期随访的进一步研究，以评估其他潜在的预测因子并验证结果。
