Ota Tomohiro, Hashidate Hiroyuki, Shimizu Natsuki, Saito Akihiko
Major in Health Science, Graduate School of Kyorin University: 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan.
Hatsudai Rehabilitation Hospital, Japan.
J Phys Ther Sci. 2018 Aug;30(8):1003-1008. doi: 10.1589/jpts.30.1003. Epub 2018 Jul 24.
[Purpose] To verify differences in independent mobility improvements between people with subacute stroke with knee-ankle-foot orthoses (KAFOs) and those with ankle-foot orthoses (AFOs) from admission to discharge, and to identify the relationship between mobility improvements and their characteristics. [Participants and Methods] This study included 381 hospitalized patients with subacute stroke who required complete mobility assistance at admission and for whom KAFOs (KAFO group) or AFOs (AFO group) were prescribed after admission. The functional independence measure (FIM) score at admission and discharge, FIM gain, age, Brunnstrom stage (BS) of the paretic lower limb at admission, and the period from admission to prescription for lower limb orthoses were investigated. [Results] Repeated-measures two-way analysis of variance revealed a significant group × time interaction in the walk/wheelchair and stair-climbing items of the FIM. Improvements in the scores in the KAFO group were significantly lower than those in the AFO group. Age, BS, FIM at admission, and period from admission to lower limb orthosis prescription significantly correlated with FIM gain in the walk/wheelchair and stair-climbing items. [Conclusion] A more effective intervention using lower limb orthoses with consideration of the influence of age, motor paralysis, and activities of daily living at admission is required to promote the improvements of people with subacute stroke prescribed KAFOs or AFOs.
[目的] 验证亚急性卒中患者使用膝踝足矫形器(KAFO)和踝足矫形器(AFO)从入院到出院在独立移动能力改善方面的差异,并确定移动能力改善与其特征之间的关系。[参与者与方法] 本研究纳入了381例住院的亚急性卒中患者,这些患者入院时需要完全的移动辅助,入院后被开具了KAFO(KAFO组)或AFO(AFO组)。调查了入院和出院时的功能独立性测量(FIM)评分、FIM增益、年龄、入院时患侧下肢的Brunnstrom分期(BS)以及从入院到开具下肢矫形器的时间。[结果] 重复测量双向方差分析显示,在FIM的步行/轮椅和爬楼梯项目中存在显著的组×时间交互作用。KAFO组的评分改善显著低于AFO组。年龄、BS、入院时的FIM以及从入院到开具下肢矫形器的时间与步行/轮椅和爬楼梯项目中的FIM增益显著相关。[结论] 为促进开具KAFO或AFO的亚急性卒中患者的改善,需要在考虑年龄、运动麻痹和入院时日常生活活动影响的情况下,采用更有效的下肢矫形器干预措施。