From the Department of Neurology (S.C.C., J.L.S.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Neurology (S.C.C., V.L., L.D., J. See, R.A., A.M., R.J.Z., N.L.C., J.M.C.), Department of Psychological Science (J.H.), Institute for Software Research (W.S.), and Department of Statistics (M.T.S.), University of California, Irvine; Department of Physical Therapy (A.M.), Chapman University, Irvine, CA; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill; Department of Stroke Rehabilitation Research (A.M.B.), Kessler Foundation; Department of Stroke Rehabilitation (A.M.B.), Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation (J.K.), MetroHealth System, Case Western Reserve University, Cleveland, OH; Brain Stimulation and Robotics Laboratory (D.E.), Burke Neurological Institute; Department of Telemedicine and Virtual Rehabilitation (D.P.), Burke Medical Research Institute, White Plains, NY; Abilities Research Center (D.P.), Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Clinical Neurosciences (K.A.), University of California, San Diego, La Jolla; Brooks Rehabilitation Clinical Research Center (K.N.), Brooks Rehabilitation, Jacksonville, FL; Department of Physical Medicine and Rehabilitation (E.J.R.), Northwestern University, Chicago, IL; Department of Neurology (D.L.T.), University of Washington, Seattle; Departments of Health Science and Research (M.L.W.) and Public Health Sciences (W.Z.), Medical University of South Carolina, Charleston; Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Department of Neurology (J. Spilker, J.P.B.), University of Cincinnati, OH; Department of Rehabilitation Medicine (S.L.W.), Division of Physical Therapy Education, Emory University, Atlanta, GA; Atlanta VA Health Care System (S.L.W.), Center for Visual and Neurocognitive Rehabilitation, Decatur, GA; and NINDS (S.J.), NIH, Bethesda, MD.
Neurology. 2021 Apr 6;96(14):e1812-e1822. doi: 10.1212/WNL.0000000000011667. Epub 2021 Feb 15.
To evaluate the effect of intensive rehabilitation on the modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains.
Patients were enrolled >90 days poststroke. Each was evaluated before and 30 days after a 6-week course of daily rehabilitation targeting the arm. Activity gains, measured using the mRS, were examined and compared to body structure/function gains, measured using the Fugl-Meyer (FM) motor scale. Additional analyses examined whether activity gains were more strongly related to specific body structure/function gains.
At baseline (160 ± 48 days poststroke), patients (n = 77) had median mRS score of 3 (interquartile range, 2-3), decreasing to 2 [2-3] 30 days posttherapy ( < 0.0001). Similarly, the proportion of patients with mRS score ≤2 increased from 46.8% at baseline to 66.2% at 30 days posttherapy ( = 0.015). These findings were accounted for by the mRS score decreasing in 24 (31.2%) patients. Patients with a treatment-related mRS score improvement, compared to those without, had similar overall motor gains (change in total FM score, = 0.63). In exploratory analysis, improvement in several specific motor impairments, such as finger flexion and wrist circumduction, was significantly associated with higher likelihood of mRS decrease.
Intensive arm motor therapy is associated with improved mRS in a substantial fraction (31.2%) of patients. Exploratory analysis suggests specific motor impairments that might underlie this finding and may be optimal targets for rehabilitation therapies that aim to reduce activities limitations.
Clinicaltrials.gov identifier: NCT02360488.
This study provides Class III evidence that for patients >90 days poststroke with persistent arm motor deficits, intensive arm motor therapy improved mRS in a substantial fraction (31.2%) of patients.
评估强化康复对改良 Rankin 量表（mRS）的影响，mRS 是急性脑卒中研究中常用的衡量活动受限的指标，并确定与 mRS 改善最相关的身体结构/功能（运动障碍）的具体变化。
患者在脑卒中后>90 天入组。每位患者在 6 周每日康复治疗手臂后 30 天进行评估。使用 mRS 评估活动增益，并与 Fugl-Meyer（FM）运动量表评估的身体结构/功能增益进行比较。进一步的分析检查了活动增益是否与特定的身体结构/功能增益有更强的相关性。
在基线时（脑卒中后 160±48 天），患者（n=77）的中位 mRS 评分为 3（四分位间距，2-3），治疗后 30 天降至 2[2-3]（<0.0001）。同样，mRS 评分≤2 的患者比例从基线时的 46.8%增加到治疗后 30 天的 66.2%（=0.015）。这些发现归因于 24 名患者（31.2%）mRS 评分降低。与没有改善的患者相比，治疗相关 mRS 评分改善的患者的总体运动增益相似（总 FM 评分变化，=0.63）。在探索性分析中，手指屈曲和腕关节环转等特定运动障碍的改善与 mRS 降低的可能性显著相关。
强化手臂运动疗法与相当一部分（31.2%）患者的 mRS 改善相关。探索性分析表明，特定的运动障碍可能是导致这一发现的基础，可能是旨在减少活动受限的康复治疗的最佳靶点。
Clinicaltrials.gov 标识符：NCT02360488。
本研究提供了 III 级证据，表明对于脑卒中后>90 天且手臂运动功能持续存在缺陷的患者，强化手臂运动疗法可改善相当一部分（31.2%）患者的 mRS。
