Rehabilitation Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.B., L.R., K.S.S.), University of Gothenburg, Sweden.
Sahlgrenska University Hospital, Gothenburg, Sweden (L.R., K.S.S.).
Stroke. 2020 Jul;51(7):2179-2187. doi: 10.1161/STROKEAHA.120.029913. Epub 2020 Jun 17.
A majority of people with stroke remain impaired in their functional mobility. The aim of the study was to determine longitudinal changes in functional mobility after stroke.
The study was of a longitudinal and prospective design. The functional mobility was assessed using the Timed Up-and-Go test on 5 different occasions: 5 days after onset, within 24 hours after discharge, 1 month after discharge, 3 months, and 1 year poststroke. Stroke severity was stratified based on impairments and activity limitations using a baseline cluster analysis. A multilevel model was developed to predict longitudinal progression in functional mobility based on stroke severity.
One-hundred-thirty-five patients were included at baseline. Two distinct subgroups (moderate stroke [52%] and mild stroke [48%]) were identified based on impairments and activity limitations using clustering. Ninety-one patients were included in the longitudinal analysis. After controlling for age and cognition, significant improvements in functional mobility were found in the moderate stroke group between baseline and 1 year poststroke (mean difference in Timed Up-and-Go test time, -6.4 s, adjusted <0.001). Patients with moderate stroke had a maximum rate of improvement in functional mobility during the first 3 months poststroke and then declined significantly at 1 year (12% increase in Timed Up-and-Go test time, adjusted =0.025). Younger patients had better functional mobility. Although there was also a slight improvement in the mild stroke group, it was not statistically significant.
The recovery of functional mobility differs between mild and moderate stroke. Patients with moderate stroke improved their functional mobility during the first 3 months, after which it decreased significantly. These findings suggest that long-term rehabilitation is desirable to maintain and perhaps increase the gained functional mobility. Older patients and those with moderate impairments and activity limitations have particular needs. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01622205.
大多数脑卒中患者的功能性移动能力仍存在障碍。本研究旨在确定脑卒中后功能性移动能力的纵向变化。
本研究为纵向前瞻性设计。使用计时起立行走测试（Timed Up-and-Go test）在 5 个不同时间点评估功能性移动能力：发病后 5 天、出院后 24 小时内、出院后 1 个月、3 个月和 1 年。基于基线聚类分析，根据损伤和活动受限情况对脑卒中严重程度进行分层。建立多水平模型，根据脑卒中严重程度预测功能性移动能力的纵向进展。
基线时共纳入 135 例患者。基于损伤和活动受限情况，使用聚类分析确定了 2 个不同亚组（中度脑卒中[52%]和轻度脑卒中[48%]）。对 91 例患者进行了纵向分析。在控制年龄和认知后，中度脑卒中组在基线至 1 年时功能性移动能力显著改善（计时起立行走测试时间平均差值为-6.4 秒，调整后 P<0.001）。中度脑卒中患者在脑卒中后 3 个月内功能性移动能力的改善速度最快，然后在 1 年时显著下降（计时起立行走测试时间增加 12%，调整后 P=0.025）。年轻患者的功能性移动能力更好。虽然轻度脑卒中组也有轻微改善，但无统计学意义。
轻度和中度脑卒中患者的功能性移动能力恢复情况不同。中度脑卒中患者在脑卒中后 3 个月内改善了功能性移动能力，此后显著下降。这些发现表明，需要长期康复来维持并可能增加获得的功能性移动能力。老年患者和中度损伤及活动受限患者有特殊需求。注册：网址：https://www.clinicaltrials.gov。唯一标识符：NCT01622205。
