患者的中风严重程度和发病前残疾程度越高，在急性住院期间接受治疗师咨询和干预的可能性就越低。
Patients With Greater Stroke Severity and Premorbid Disability Are Less Likely to Receive Therapist Consultations and Intervention During Acute Care Hospitalization.
机构信息
Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave S, SHPB 360X, Birmingham, AL 35294 (USA).
Department of Psychology, Stetson University, DeLand, Florida.
出版信息
Phys Ther. 2019 Nov 25;99(11):1431-1442. doi: 10.1093/ptj/pzz116.
BACKGROUND
A substantial number of patients with stroke never receive acute care therapy services, despite the fact that therapy after stroke reduces the odds of death and disability and improves patients' functioning.
OBJECTIVE
The aim of this study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke.
DESIGN
This was a single-center longitudinal observational study.
METHODS
Adults with a diagnosis of ischemic or hemorrhagic stroke (N = 1366) were enrolled during their hospitalization in an acute stroke center in a large metropolitan area. The main outcomes were receipt of therapist consultations, interventions, or both.
RESULTS
Participants with acute hemorrhagic stroke (intracerebral: odds ratio [OR] = 0.34 [95% CI = 0.19-0.60]; subarachnoid: OR = 0.52 [95% CI = 0.28-0.99]) and with greater stroke severity by National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score of > 15: OR = 0.34 [95% CI = 0.23-0.51]) were less likely to receive therapist consultations. Participants with moderate stroke severity (NIHSS score of 6-15: OR = 1.43 [95% CI = 1.01-2.33]) were more likely to receive therapy interventions. Those who were able to ambulate before admission were more than 5 times as likely to receive therapy interventions (OR = 5.08 [95% CI = 1.91-13.52]). Also, participants with longer lengths of stay (ie, more intensive care unit and non-intensive care unit days) were more likely to receive therapist consultations and interventions. Tests or procedures were the most common reasons for unsuccessful attempts to complete therapist consultations.
LIMITATIONS
Lack of operational and qualitative data prohibited detailed explorations of barriers to delivery of therapist consultations and interventions.
CONCLUSIONS
Approximately 1 in 4 participants with acute stroke received neither a consultation nor an intervention. Efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
背景
尽管中风后接受治疗可降低死亡和残疾的几率，并改善患者的功能，但仍有大量中风患者未接受急性护理治疗服务。
目的
本研究旨在评估缺血性和出血性中风后急性住院期间接受治疗师咨询和干预的比例和相关因素。
设计
这是一项单中心纵向观察性研究。
方法
在一个大城市的急性中风中心住院的诊断为缺血性或出血性中风的成年人（N=1366）参与了本研究。主要结局为接受治疗师咨询、干预或两者的情况。
结果
急性出血性中风患者（脑出血：比值比[OR] = 0.34[95%CI=0.19-0.60]；蛛网膜下腔出血：OR = 0.52[95%CI=0.28-0.99]）和 NIHSS 评分较高（NIHSS 评分>15：OR = 0.34[95%CI=0.23-0.51]）的患者更不可能接受治疗师咨询。中度中风严重程度（NIHSS 评分 6-15：OR = 1.43[95%CI=1.01-2.33]）的患者更有可能接受治疗干预。入院前能够行走的患者接受治疗干预的可能性是前者的 5 倍以上（OR = 5.08[95%CI=1.91-13.52]）。此外，住院时间较长（即，重症监护病房和非重症监护病房天数较多）的患者更有可能接受治疗师咨询和干预。测试或程序是未能完成治疗师咨询的最常见原因。
局限性
缺乏操作和定性数据，限制了对治疗师咨询和干预提供障碍的详细探讨。
结论
大约有 1/4 的急性中风患者既未接受咨询也未接受干预。需要努力改善急性护理治疗服务的提供，以优化这些患者的护理。
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