加速中风康复：大型康复试验的身体结构和功能、活动、参与和生活质量结果。
Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial.
机构信息
1 University of Southern California, Los Angeles, CA, USA.
2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.
出版信息
Neurorehabil Neural Repair. 2018 Feb;32(2):150-165. doi: 10.1177/1545968318760726.
BACKGROUND
Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many.
OBJECTIVE
To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes.
METHODS
On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases.
RESULTS
Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log-28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences.
CONCLUSIONS
Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov . Identifier: NCT00871715).
背景
任务导向疗法已被开发出来，以解决中风后仍然存在的严重上肢残疾问题。然而，许多患者对康复和恢复的程度和方法仍不满意。
目的
比较一种以技能为导向的干预措施与常规护理治疗对身体功能和结构、活动、参与和生活质量结果的影响。
方法
平均在中风后 46 天，361 名患者被随机分配到 3 个门诊治疗组之一：以患者为中心的加速技能获取计划（ASAP）、剂量等效的常规职业治疗（DEUCC）或常规治疗（UCC）。在随机分组后、治疗后、6 个月和 1 年时进行结果评估。纵向混合效应模型比较了各组在治疗和随访阶段中风后改善的差异。
结果
在所有组中，大多数改善发生在治疗阶段，随后在随访阶段变化较慢。与 DEUCC 和 UCC 相比，ASAP 组在治疗期间在中风影响量表手、力量、移动性、身体功能和参与评分、自我效能、感知健康、再融入、以患者为中心和生活质量结果方面的增益更大。ASAP 参与者在治疗后报告的运动活动日志 28 项运动质量比 UCC 更高，并且感知到与生活质量相关的更大改善。到研究结束时，所有组都达到了相似的水平，只有有限的组间差异。
结论
可以实施定制的任务导向训练，以加速全面的患者报告结果的改善。虽然大多数结果在 1 年后的组间差异消失，但 ASAP 参与者平均提前 8 个月达到这些结果（临床试验：多学科综合手臂康复评估 [ICARE] 中风倡议，网址：www.ClinicalTrials.gov/ClinicalTrials.gov. 标识符：NCT00871715）。
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