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上肢和下肢痉挛性弛缓的复合主动活动范围(CX)与主动功能的关系。

Composite active range of motion (CX) and relationship with active function in upper and lower limb spastic paresis.

机构信息

EA 7377 BIOTN, Service de Rééducation Neurolocomotrice, Université Paris-Est Créteil, Hospital Albert Chenevier-Henri Mondor, Créteil, France.

Biometry, Ipsen Pharma, Boulogne-Billancourt, France.

出版信息

Clin Rehabil. 2020 Jun;34(6):803-811. doi: 10.1177/0269215520911970. Epub 2020 Apr 26.

Abstract

OBJECTIVE

The aim of this study is to evaluate a novel composite measure of active range of motion (X) and determine whether this measure correlates with active function.

DESIGN

Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA.

SETTING

Tertiary rehabilitation centers in Australia, Europe, and the United States.

SUBJECTS

Adults with upper ( = 254) or lower ( = 345) limb spastic paresis following stroke or brain trauma.

INTERVENTIONS

AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb.

MAIN MEASURES

X was used to calculate a novel composite measure (CX), defined as the sum of X against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CX and active function at Weeks 4 and 12 of open-label cycles were explored.

RESULTS

CX and active function were moderately correlated in the upper limb ( < 0.0001-0.0004,  = 0.476-0.636) and weakly correlated in the lower limb ( < 0.0001-0.0284,  = 0.186-0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CX and active function were weakly correlated only in the upper limb (Cycle 2 Week 12,  = 0.0160,  = 0.213; Cycle 3 Week 4,  = 0.0031,  = 0.296). Across cycles, CX improvements peaked at Week 4, while functional improvements peaked at Week 12.

CONCLUSION

CX is a valid measure for functional impairments in spastic paresis. CX improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.

摘要

目的

本研究旨在评估一种新的主动活动范围(X)综合测量方法,并确定该方法是否与主动功能相关。

设计

对两项探索 abobotulinumtoxinA 对主动功能变化的随机、安慰剂对照、双盲研究进行事后分析,并进行开放性标签扩展。

设置

澳大利亚、欧洲和美国的三级康复中心。

受试者

上肢( = 254)或下肢( = 345)卒中或脑外伤后痉挛性瘫痪的成人。

干预措施

上肢或下肢接受 abobotulinumtoxinA( ⩽5 个治疗周期)。

主要测量

X 用于计算一种新的综合测量方法(CX),定义为肘部、腕部和外在手指屈肌(上肢)或比目鱼肌和腓肠肌(下肢)对抗 X 的总和。主动功能分别采用改良 Frenchay 量表和 10 m 舒适赤脚步行速度进行评估。探索 CX 与开放性周期第 4 周和第 12 周的主动功能之间的相关性。

结果

在每个开放性周期的第 4 周和第 12 周,CX 与上肢的主动功能呈中度相关( < 0.0001-0.0004, = 0.476-0.636),与下肢的主动功能呈弱相关( < 0.0001-0.0284, = 0.186-0.285)。只有在上肢,CX 和主动功能的变化呈弱相关(第 2 周期第 12 周, = 0.0160, = 0.213;第 3 周期第 4 周, = 0.0031, = 0.296)。跨周期,CX 的改善在第 4 周达到峰值,而功能的改善在第 12 周达到峰值。

结论

CX 是痉挛性瘫痪患者功能障碍的有效测量方法。abobotulinumtoxinA 注射后 CX 的改善与主动功能的改善相关,并先于主动功能的改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9ae/7263039/51fda3c6106e/10.1177_0269215520911970-fig1.jpg

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