Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy -
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Eur J Phys Rehabil Med. 2018 Dec;54(6):811-818. doi: 10.23736/S1973-9087.18.04809-8. Epub 2018 Aug 27.
After discharge, most patients who have suffered a stroke remain with some limitations in their stair climbing ability. This is a critical factor in order to be independent in real-life mobility. Although there are several studies on prognostic factors for gait recovery, few of them have focused on the recovery of stair climbing.
The aim of this study was to identify prognostic risk factors for the recovery of stair climbing ability in a large sample of subjects with subacute stroke.
Observational study.
Neurorehabilitation Inpatient Unit.
Subjects within the first month after stroke that had been admitted to an inpatient rehabilitation unit and discharged after an intensive inpatient rehabilitation.
Demographical and clinical data were collected. Barthel Index (BI), Trunk Control Test and Motricity Index (MI) scores were recorded at admission and at discharge. Patients received two daily 40-minute sessions of motor rehabilitation, six days per week, during approximately two months. Forward Binary Logistic regressions were used to identify the role of risk factors, using as dependent variables the recovery of stair climbing ability and walking ability at discharge. As independent variables we used age, gender, onset-to-admission interval, side of hemiparesis, trunk control, Motricity Index (MI), presence of obesity, presence of neglect, presence of depression, classification of cerebral infarction (total anterior circulation, partial anterior circulation, posterior circulation or lacunar infarcts), degree of independence in activities of daily living, and cognitive state, all assessed at admission.
A total of 257 subjects were enrolled. BI-Score, MI-Score and presence of unilateral spatial neglect at admission were able to explain 83% of variance for the recovery of stair climbing ability. Subjects with a BI >40 at admission were about 17 times more likely to be able to climb stairs again than other patients, and those with MI ≥25 were about 9 times more likely than the rest. The presence of unilateral spatial neglect reduced this possibility of recovering stair climbing ability by about 5.5 times. Of these factors, only MI ≥25, together with a score at Trunk Control Test >12, significantly predicted also walking recovery.
This study highlights the different prognostic factors for recovering stair climbing and walking abilities, with a major role of unilateral spatial neglect in the former.
There is a need for specific rehabilitation of stair climbing, also for improving the independence in activities of daily living, especially in patients who the clinical staff already knows should manage stairs in their community after being discharged.
许多脑卒中患者出院后仍存在上下楼梯能力的障碍，这是影响其日常生活独立活动能力的关键因素。虽然有多项研究针对步态恢复的预后因素，但很少有研究关注上下楼梯的恢复情况。
本研究旨在确定亚急性脑卒中患者中与上下楼梯能力恢复相关的预后危险因素。
观察性研究。
神经康复住院病房。
入组对象为脑卒中发病后 1 个月内，入组我院神经康复病房，经过强化住院康复治疗后出院的患者。
收集患者的人口统计学和临床资料，在入院和出院时分别记录 Barthel 指数（BI）、躯干控制测试和运动指数（MI）评分。患者在大约两个月的时间内，每天接受两次、每次 40 分钟的运动康复治疗，每周六天。采用向前二项逻辑回归，使用依赖变量为出院时上下楼梯能力和行走能力的恢复情况，确定危险因素的作用。独立变量包括年龄、性别、发病至入院时间间隔、偏瘫侧、躯干控制、MI、肥胖、忽视、抑郁、脑梗死分类（全前循环、部分前循环、后循环或腔隙性梗死）、日常生活活动的独立性程度以及认知状态，所有这些都在入院时进行评估。
共纳入 257 名患者。入院时的 BI 评分、MI 评分和单侧空间忽略的存在，能够解释上下楼梯能力恢复的 83%的差异。入院时 BI>40 的患者再次上下楼梯的可能性是其他患者的约 17 倍，而 MI≥25 的患者再次上下楼梯的可能性是其他患者的约 9 倍。单侧空间忽略使恢复上下楼梯能力的可能性降低了约 5.5 倍。在这些因素中，只有 MI≥25，加上躯干控制测试>12 的评分，还显著预测了行走能力的恢复。
本研究强调了恢复上下楼梯和行走能力的不同预后因素，其中单侧空间忽略在前者中起主要作用。
需要对上下楼梯能力进行专门的康复治疗，这也有助于提高日常生活活动的独立性，尤其是对那些临床工作人员已知在出院后应在社区中管理楼梯的患者。
