Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Psychiatry, Weill Cornell Medicine, New York, New York.
Arch Phys Med Rehabil. 2021 Apr;102(4):645-655. doi: 10.1016/j.apmr.2020.11.020. Epub 2021 Jan 10.
To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect.
Retrospective, longitudinal cohort study.
Inpatient rehabilitation unit of an urban academic medical center.
Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke.
None.
Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as "improved," "unchanged," or "declined" between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS).
For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains.
Despite group gains from DC to 6M and an apparent "plateau" after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.
使用活动测量后急性护理（AM-PAC）描述住院脑卒中康复后的功能变化，这是一种对变化敏感且具有低天花板效应风险的评估方法。
回顾性、纵向队列研究。
城市学术医疗中心的住院康复病房。
在 2012-2016 年期间入院的 433 名脑卒中患者中，共有 269 名（62%）纳入数据库，其中 89 名（33.1%）从住院脑卒中康复中出院的患者有完整的数据。有和没有完整数据的患者非常相似。该组的平均年龄为 68.0±14.2 岁，国立卫生研究院脑卒中评分 8.0±8.0，康复住院时间为 14.7±7.4 天，84%为缺血性脑卒中，22.5%为复发性脑卒中。
无。
在出院后第一年（DC）内，通过多种方式测量功能变化。在住院 DC 时以及在 DC 后 6 个月（6M）和 12 个月（12M）时，计算 AM-PAC 的基本活动能力（BM）、日常活动（DA）和应用认知领域的连续平均分数，并进行比较。根据最小可检测变化、（估计的）最小临床重要差异和 AM-PAC 功能阶段（FS）的变化≥1，将个体之间的分类变化分类为“改善”、“不变”或“下降”。
对于连续分析，所有领域的 Friedman 检验均有统计学意义（P≤.002），Wilcoxon 符号秩检验在所有领域均有统计学意义（均 P<.001），但 6M 和 12M 之间 BM 和 DA 无变化（P>.60），应用认知能力下降（P=.002）。尽管从 DC 到 6M 组有改善，但在个体水平上，有 10%-20%的患者下降，50%-70%的患者无变化。尽管从 6M 到 12M 组无差异，但在 BM 和 DA 领域，有 15%-25%的患者改善，20%-30%的患者下降。
尽管从 DC 到 6M 组有改善，但在脑卒中后 6M 后出现明显的“平台期”，个体水平仍存在较大的异质性。我们的结果强调，在评估脑卒中康复的进展或结果时，需要考虑个体水平的结果。
