Saito Jun, Koyama Tetsuo, Domen Kazuhisa
Department of Rehabilitation Medicine, Goshi Hospital, Hyogo, Japan.
Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo, Japan.
Ann Rehabil Med. 2018 Oct;42(5):670-681. doi: 10.5535/arm.2018.42.5.670. Epub 2018 Oct 31.
To outline the association between the National Institutes of Health Stroke Scale (NIHSS) in the acute stage and the Functional Independence Measure (FIM) of motor items several months later.
Seventy-nine infarct cases with middle-cerebral-artery region transferred to long-term rehabilitation facilities were analyzed. Patients were allocated to either the model-development group or the confirmatory group at a 2:1 ratio. Independent variables were based on the NIHSS during the acute care and on demographic factors such as age and modified Rankin Scale (mRS) before onset. Multivariate logistic analyses were performed to predict the independence of each FIM motor item. These models were evaluated in the confirmatory group.
Multivariate logistic analyses in the model-development group (n=53) indicated that at least one NIHSS item was statistically significantly associated with the functional independence of a single FIM motor item. Of the NIHSS items, the affected lower extremity item was the most widely associated with 11 of the FIM motor items, except for eating and shower transfer. The affected upper extremity function was the second widely involved factor associated with 7 of the FIM motor items including eating, grooming, bathing, toileting, bed transfer, toilet transfer, and shower transfer. Age and mRS were also statistically significant contributing factors. The obtained predictive models were assessed in the confirmatory group (n=26); these were successful except for the stairs climb item.
In combination with age and pre-stroke status, the NIHSS items (especially the affected extremity items) may be useful for the prediction of long-term outcome in terms of activities in daily living.
概述急性期美国国立卫生研究院卒中量表（NIHSS）与数月后运动项目的功能独立性测量（FIM）之间的关联。
分析了79例大脑中动脉区域梗死且转至长期康复机构的病例。患者按2:1的比例被分配至模型开发组或验证组。自变量基于急性护理期间的NIHSS以及诸如年龄和发病前改良Rankin量表（mRS）等人口统计学因素。进行多因素逻辑分析以预测每个FIM运动项目的独立性。这些模型在验证组中进行评估。
模型开发组（n = 53）的多因素逻辑分析表明，至少有一项NIHSS项目与单个FIM运动项目的功能独立性在统计学上显著相关。在NIHSS项目中，除进食和淋浴转移外，受影响的下肢项目与11项FIM运动项目的关联最为广泛。受影响的上肢功能是第二个广泛涉及的因素，与7项FIM运动项目相关，包括进食、修饰、洗澡、如厕、从床转移、从马桶转移和淋浴转移。年龄和mRS也是具有统计学意义的影响因素。在验证组（n = 26）中评估了所获得的预测模型；除爬楼梯项目外，这些模型均成功。
结合年龄和卒中前状态，NIHSS项目（尤其是受影响肢体项目）可能有助于预测日常生活活动方面的长期预后。
