Pai Hsiang-Chu, Lai Mei-Yu, Chen An-Chih, Lin Pei-Shan
Hsiang-Chu Pai, PhD, RN, is Associate Professor, Mei-Yu Lai, MSN, RN, is Head Nurse, An-Chih Chen, MSD, DR, is the Chief of Stroke Center, and Pei-Shan Lin, BSN, RN, is Case Manager of Stroke Center, Chung-Shan Medical University Hospital, Taichung City, Taiwan, R.O.C.
Nurs Res. 2018 Jul/Aug;67(4):286-293. doi: 10.1097/NNR.0000000000000280.
Early prediction of future functional capability is crucial for stroke survivors' care management.
The purposes of this study were to test the trajectory of change across time in activities of daily living (ADLs) and to determine whether the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours poststroke, gender, and age predict ADLs at 1, 3, 6, and 12 months poststroke.
A prospective cohort design was used. Baseline characteristics and neurological deficits were measured in 1,021 stroke survivors. The 13-item NIHSS was used to examine neurological status within 24 hours poststroke. ADLs were measured with the Barthel index at 1, 3, 6, and 12 months poststroke. A latent growth curve model was used to analyze how the dynamic changes in ADLs were related to NIHSS score, gender, and age.
The latent growth curve model analyses revealed that, as the time following a stroke increases, survivors tend to gradually improve with regard to ADLs. In addition, lower levels of initial ADLs were associated with higher growth in ADLs over time. However, after 6 months poststroke, further gains in ADLs slowed. Based on further analysis, the findings indicate that a lower NIHSS score, being male, and a young age at time of stroke were associated with higher initial levels of ADLs. Having a higher NIHSS score, being female, and a young age at time of stroke predicted an increase in ADLs over time.
To promote ADLs of stroke patients, NIHSS score at admission, gender, and age should be included as important predictors of stroke care management. The results highlight that the rehabilitation of stroke patients should be focused more on ADLs at 1-6 months poststroke.
对未来功能能力的早期预测对于中风幸存者的护理管理至关重要。
本研究的目的是测试日常生活活动（ADL）随时间的变化轨迹，并确定中风后24小时内的美国国立卫生研究院卒中量表（NIHSS）评分、性别和年龄是否能预测中风后1、3、6和12个月时的ADL。
采用前瞻性队列设计。对1021名中风幸存者测量了基线特征和神经功能缺损。使用13项NIHSS检查中风后24小时内的神经状态。在中风后1、3、6和12个月时用巴氏指数测量ADL。使用潜在增长曲线模型分析ADL的动态变化如何与NIHSS评分、性别和年龄相关。
潜在增长曲线模型分析显示，随着中风后时间的增加，幸存者在ADL方面往往会逐渐改善。此外，初始ADL水平较低与ADL随时间的更高增长相关。然而，中风后6个月后，ADL的进一步改善减缓。基于进一步分析，结果表明较低的NIHSS评分、男性以及中风时年龄较小与较高的初始ADL水平相关。较高的NIHSS评分、女性以及中风时年龄较小预测ADL会随时间增加。
为促进中风患者的ADL，入院时的NIHSS评分、性别和年龄应作为中风护理管理的重要预测指标。结果强调中风患者的康复应更侧重于中风后1至6个月的ADL。
