Faculty of Medicine, University of Coimbra, Coimbra, Portugal -
Department of Physical and Rehabilitation Medicine, University Hospital Center of Coimbra, Coimbra, Portugal -
Eur J Phys Rehabil Med. 2019 Feb;55(1):1-7. doi: 10.23736/S1973-9087.18.05161-4. Epub 2018 May 14.
Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established.
This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery.
Prospective observational study.
Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period.
A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old.
Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS).
Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS.
Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program.
This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.
中风是导致短期功能障碍的主要原因，但恢复时间尚未明确。
本研究旨在评估急性缺血性中风后 24 周内的功能恢复进展，确定运动、认知和整体恢复的时间框架。
前瞻性观察研究。
三级护理中心；12 周住院期，随后进行 12 周门诊期。
一组年龄在 18-85 岁之间的大脑中动脉区域急性中风患者，共 131 例。
患者根据常规临床实践接受治疗，并进行为期 24 周的密切控制康复计划。在急性中风后 48 小时、3 周、12 周和 24 周进行功能评估，包括改良 Rankin 量表（mRS）、功能独立性测量（FIM）和中风上肢能力量表（SULCS）。
在整个研究期间，所有量表均显示患者功能显著改善（P<0.001）。所有量表的评估得分从 48 小时到 3 周显著提高；同样发生在 3 周到 12 周，除了 C-FIM。从 12 周到 24 周，任何量表都没有统计学上的功能改善。就比较而言，认知障碍在急性期比运动障碍更轻。48 小时时的 C-FIM 评分明显高于 M-FIM 和 mRS 评分。SULCS 测量的上肢功能与 C-FIM、M-FIM 和 mRS 相比，显示出中度残疾程度。
功能恢复至少持续到急性中风后 24 周，但大部分功能增益往往在最初 12 周内实现。认知功能的改善早于运动功能，最大改善发生在前三周内。从 12 周到 24 周，患者功能有明显的数值增益，突出了维持适当康复计划的必要性。
本研究深入了解了中风患者的恢复时间框架，有助于制定更有效的康复计划。
