Rao N, Jellinek H M, Harberg J K, Fryback D G
Marianjoy Rehabilitation Center, Wheaton, IL 60189.
Arch Phys Med Rehabil. 1988 Mar;69(3 Pt 1):179-82.
This study was designed to explore new ways of predicting the functional outcomes of stroke and brain injury patients. Upon admission and initial assessment of functional performance, we used an on-line computer program to indicate the most important and subjective judgment items to set rehabilitation goals for patients. The functional performance and discharge outcomes of patients from an inpatient program were measured by using five nonmedical functional items from the patient evaluation conference system (PECS). For stroke patients we most frequently selected motor loss, perceptual/cognitive deficit, spasticity, sensory deficit (PECS medical items), and comprehension (subjective cue). For traumatic brain injury patients, however, we selected motor loss, perceptual/cognitive deficit, spasticity (PECS medical items), communication, and comprehension (subjective cues). Data were statistically analyzed using the Fisher Exact Test. Of the medical function items, a level of independence in the sensory deficit function in stroke patients at admission was associated with a patient achieving independence in ambulation at discharge. Demonstrating a moderate or maximum level of attention, concentration, and realism was positively related to a patient achieving a level of independence in ambulation at discharge. Independence in the function items of behavior and interaction was associated with moderate or maximum levels of comprehension at admission. In traumatic brain injury patients, none of the subjective cues were associated with achieving independence at discharge in any of the functional levels. This paper demonstrates the value of developing a way to assess subjective measures that are based on their ability to predict outcomes. Using such a method, new predictive measures can be developed.
本研究旨在探索预测中风和脑损伤患者功能预后的新方法。在患者入院并对其功能表现进行初始评估时，我们使用一个在线计算机程序来指出最重要的主观判断项目，以便为患者设定康复目标。通过使用患者评估会议系统（PECS）中的五项非医学功能项目，对住院项目患者的功能表现和出院结果进行了测量。对于中风患者，我们最常选择运动功能丧失、感知/认知缺陷、痉挛、感觉缺陷（PECS医学项目）以及理解能力（主观线索）。然而，对于创伤性脑损伤患者，我们选择运动功能丧失、感知/认知缺陷、痉挛（PECS医学项目）、沟通能力以及理解能力（主观线索）。使用Fisher精确检验对数据进行统计学分析。在医学功能项目中，中风患者入院时感觉缺陷功能的独立水平与患者出院时行走独立相关。表现出中度或最大程度的注意力、专注力和现实感与患者出院时行走达到独立水平呈正相关。行为和互动功能项目的独立性与入院时中度或最大程度的理解能力相关。在创伤性脑损伤患者中，任何主观线索与任何功能水平出院时实现独立均无关联。本文证明了开发一种基于预测结果能力来评估主观指标方法的价值。使用这种方法，可以开发新的预测指标。
