比较脑卒中患者上肢能力改善的自我报告与观察性临床测量结果。
Comparison of self-reported vs observational clinical measures of improvement in upper limb capacity in patients after stroke.
机构信息
Imaging, University Medical Center Utrecht and Utrecht University, , Utrecht, The Netherlands.
出版信息
J Rehabil Med. 2020 Apr 22;52(4):jrm00051. doi: 10.2340/16501977-2661.
OBJECTIVE
Recovery of the paretic arm post-stroke can be assessed using observational and self-reported measures. The aim of this study was to determine whether the correspondence (match) or non-correspondence (mismatch) between observational and self-reported improvements in upper limb capacity are significantly different at 0-3 months compared with 3-6 months post-stroke.
METHODS
A total of 159 patients with ischaemic stroke with upper limb paresis were included in the study. Recovery of arm capacity was measured with observational (Action Research Arm Test; ARAT) and self-reported measures (Motor Activity Log Quality of Movement; MAL-QOM and Stroke Impact Scale Hand; SIS-Hand) at 0-3 and 3-6 months post-stroke. The proportion of matches was defined (contingency tables and Fisher's exact test) and compared across the different time-windows using McNemar's test.
RESULTS
The proportion of matches was not significantly different at 0-3 months compared with 3-6 months post-stroke for the ARAT vs MAL-QOM and SIS-Hand (all p > 0.05). In case of mismatches, patients' self-reports were more often pessimistic (86%) in the first 3 months post-stroke compared with the subsequent 3 months (39%).
CONCLUSION
The match between observational and self-reported measures of upper limb capacity is not dependent on the timing of assessment post-stroke. Assessment of both observational and self-reported measures may help to recognize possible over- or under-estimation of improvement in upper limb capacity post-stroke.
目的
可以使用观察性和自我报告的测量方法来评估中风后瘫痪手臂的恢复情况。本研究旨在确定上肢能力的观察性和自我报告性改善在中风后 0-3 个月与 3-6 个月之间是否存在显著差异。
方法
本研究共纳入 159 例缺血性脑卒中伴上肢瘫痪患者。采用观察性(动作研究上肢测试;ARAT)和自我报告性测量(运动活动日志运动质量;MAL-QOM 和中风影响量表手;SIS-Hand)在中风后 0-3 个月和 3-6 个月时测量手臂能力的恢复情况。定义了匹配的比例(列联表和 Fisher 精确检验),并使用 McNemar 检验在不同的时间窗口进行比较。
结果
ARAT 与 MAL-QOM 和 SIS-Hand 相比,在中风后 0-3 个月与 3-6 个月之间,匹配的比例没有显著差异(均 P>0.05)。在不匹配的情况下,中风后 3 个月内患者的自我报告(86%)比随后的 3 个月(39%)更为悲观。
结论
上肢能力的观察性和自我报告性测量之间的匹配并不取决于中风后评估的时间。评估观察性和自我报告性测量两者都可以帮助识别上肢能力改善的过度或低估的可能性。