Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.
Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.
Neuropsychol Rehabil. 2020 Sep;30(8):1430-1448. doi: 10.1080/09602011.2019.1586734. Epub 2019 Mar 15.
This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age = 70.30 = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months' post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning ( = -4.21, < .001) and instrumental activity limitation ( = -4.00, < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning ( = -4.03, < .001). Follow-up ( = 39) showed that, compared to survivors' predictions, clinicians' predictions were more closely aligned with actual stroke survivor functioning at three months' post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.
本研究旨在考察在各种残疾领域以及当前和预测的功能表现方面，中风幸存者及其临床医生在报告中风后功能方面的差异。50 名亚急性中风幸存者（年龄 70.30 ± 15.80 岁，56%为女性）及其职业治疗师分别独立完成了三项评估活动受限（认知、身体、工具性）和参与受限的评估。在出院后三个月评估当前功能和预测功能。与身体功能相比，认知功能、工具性活动受限和参与受限的评估差异更为明显。与预测认知功能（ = -4.21， < .001）和工具性活动受限（ = -4.00， < .001）相比，当前功能的差异更为明显。随访（ = 39）表明，与幸存者的预测相比，临床医生的预测与出院后三个月实际中风幸存者的功能（由亲近的他人评估）更为一致。这些发现表明，评估差异在残疾领域和时间参考点上有所不同，认知和复杂的功能活动在中风幸存者和临床医生之间差异尤为明显。此外，临床医生可能对短期功能恢复有更现实的期望。
