Department of Social Work & Social Administration, University of Hong Kong, Hong Kong, China.
Sau Po Center on Ageing, The University of Hong Kong, Hong Kong, China.
J Clin Nurs. 2019 Jan;28(1-2):47-55. doi: 10.1111/jocn.14617. Epub 2018 Jul 27.
To determine whether and how cognitive impairment interacts with therapy intensity to affect functional improvements in older stroke patients over an 8-week postdischarge intervention delivered in a community setting.
Cognitive status is an important predictor of success of community-based rehabilitation, but little has been known as to how cognitive impairment may affect outcomes through its interaction with the rehabilitation process.
A prospective follow-up evaluation was conducted in Hong Kong of older stroke patients (n = 384) who were admitted to an 8-week home-based rehabilitation intervention after discharge in Hong Kong between 2012-2014.
Cognitive screening was conducted among patients at the time of discharge from hospital. The intervention process was monitored, and individuals' therapy intensity was assessed and recorded by physical or occupational therapists independently in each therapy session. Outcomes were measured using the 10-item Barthel ADL index at discharge and after the intervention.
Therapy intensity significantly moderated the relationship between cognitive impairment and functional recovery. Cognitively impaired stroke patients with moderate-intensity rehabilitation reported significantly higher increase in functional performance than that of patients with low- and high-intensity rehabilitation. In patients with no cognitive impairment, those who received high-intensity treatment showed significantly more functional gains than that of patients being treated with less intensive rehabilitation.
Cognitive impairment affected functional outcomes through its interaction with different levels of therapy intensity among poststroke older patients.
Increasing therapy intensity from moderate to high benefitted cognitively intact but not cognitively impaired patients. These results should inform decisions about community-based rehabilitation and be used to identify the most cost-effective service delivery model.
确定认知障碍是否以及如何通过与治疗强度相互作用，影响在社区环境中进行的 8 周出院后干预中老年卒中患者的功能改善。
认知状态是社区康复成功的重要预测因素，但对于认知障碍如何通过与康复过程的相互作用影响结果，人们知之甚少。
2012-2014 年期间，在香港对出院后接受 8 周家庭康复干预的老年卒中患者（n=384）进行了前瞻性随访评估。
在患者出院时进行认知筛查。监测干预过程，物理治疗师或职业治疗师在每次治疗时独立评估并记录个体的治疗强度。使用 Barthel 日常生活活动指数（10 项）在出院时和干预后测量结果。
治疗强度显著调节了认知障碍与功能恢复之间的关系。中强度康复的认知障碍卒中患者的功能表现显著提高，高于低强度和高强度康复的患者。在无认知障碍的患者中，接受高强度治疗的患者的功能改善明显大于接受低强度康复治疗的患者。
认知障碍通过与老年卒中后患者不同水平的治疗强度相互作用影响功能结果。
将治疗强度从中度增加到高度，对认知正常但认知障碍患者有益。这些结果应告知社区康复决策，并用于确定最具成本效益的服务提供模式。
