Washington DC Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
George Washington University, Washington, DC.
J Am Med Dir Assoc. 2021 Feb;22(2):453-458.e3. doi: 10.1016/j.jamda.2020.06.031. Epub 2020 Dec 9.
Cognitive impairment is highly prevalent after stroke, with 77% of people having impairment in at least 2 cognitive domains. The purpose of this study is to describe the association between therapy minutes per length of stay (LOS) day and cognitive recovery in patients receiving rehabilitation services in inpatient post-acute care facilities following a stroke.
Secondary analyses of data collected in inpatient rehabilitation and skilled nursing facilities from 2005 to 2010 for an observational cohort study.
Participants were adults aged ≥65 years with Medicare insurance and primary diagnosis of stroke (N = 100). Participants who met criteria for dementia (n = 5) were excluded from analyses. We calculated therapy minutes per LOS day for occupational therapy, physical therapy, speech-language pathology, and all therapies combined; therapy times were dichotomized into high or low minutes per LOS day (MLD). We used an ordinary least squares regression model for cognitive outcome at discharge to control for cognitive status at admission, therapy intensity by discipline, and LOS.
At baseline, participants were classified as having severe (n = 11), moderate (n = 39), or mild (n = 45) cognitive impairment. Impairment groups were not significantly different on any demographic variables. The adjusted regression model showed that high occupational therapy MLD (>50 minutes per LOS day) (P = .028) was significantly associated with cognitive measure at discharge compared with low occupational therapy MLD when controlling for cognitive impairment group at baseline (P < .001). Neither high physical therapy MLD nor speech-language pathology MLD was significantly associated with cognitive outcome relative to their respective low TMLD groups.
Our results show that higher-intensity occupational therapy services were associated with better cognitive outcome at discharge from inpatient rehabilitation after stroke. Findings also suggest that volume of therapy alone does not necessarily produce optimal outcomes. Both amount and type of therapy should be tailored to meet the needs of individual patients.
认知障碍在中风后非常普遍，77%的人至少有 2 个认知领域受损。本研究的目的是描述在中风后接受住院康复服务的患者中，每天治疗时间与住院康复期间认知恢复之间的关系。
对 2005 年至 2010 年在住院康复和熟练护理机构收集的数据进行二次分析，用于观察性队列研究。
参与者为年龄≥65 岁、有医疗保险且主要诊断为中风的成年人（N=100）。满足痴呆标准的患者（n=5）被排除在分析之外。我们计算了职业治疗、物理治疗、言语治疗和所有治疗方法的每日治疗时间与住院时间的比值（TMLD）；将治疗时间分为高或低 TMLD。我们使用普通最小二乘法回归模型来控制入院时的认知状态、按学科划分的治疗强度和住院时间，对出院时的认知结果进行分析。
在基线时，参与者被分为严重（n=11）、中度（n=39）或轻度（n=45）认知障碍。在任何人口统计学变量上，损伤组之间均无显著差异。调整后的回归模型显示，在控制基线时的认知障碍组（P<0.001）的情况下，与低职业治疗 TMLD 相比，高职业治疗 TMLD（>50 分钟/住院日）（P=0.028）与出院时的认知测量显著相关。高物理治疗 TMLD 或言语治疗 TMLD 与各自的低 TMLD 组相比，与认知结果无显著相关性。
我们的研究结果表明，中风后住院康复期间，高强度职业治疗服务与出院时的认知结果更好相关。研究结果还表明，治疗量本身并不一定会产生最佳结果。治疗的数量和类型都应根据患者的需求进行调整。
