缺血性脑卒中后上肢运动功能的恢复：关注具有临床显著差异的轨迹群组。
Arm Motor Recovery After Ischemic Stroke: A Focus on Clinically Distinct Trajectory Groups.
机构信息
Department of Physical Therapy (D.K.K., M.P.-F., T.J.K.) and Center for Interprofessional Studies and Innovation (A.B.F.), MGH Institute of Health Professions, Boston, Massachusetts; Center for Neurotechnology and Neurorecovery, Department of Neurology (D.J.L., A.C., K.S., L.R.H.), Divisions of Neurocritical Care and Stroke, Department of Neurology (D.J.L., L.R.H.), Department of Physical Therapy (K.P.), and Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurotechnology and Neurorecovery, Providence, Rhode Island (L.R.H.); and School of Engineering, Brown University, Providence, Rhode Island (L.R.H.).
出版信息
J Neurol Phys Ther. 2021 Apr 1;45(2):70-78. doi: 10.1097/NPT.0000000000000350.
BACKGROUND AND PURPOSE
Recovery of arm function poststroke is highly variable with some people experiencing rapid recovery but many experiencing slower or limited functional improvement. Current stroke prediction models provide some guidance for clinicians regarding expected motor outcomes poststroke but do not address recovery rates, complicating discharge planning. This study developed a novel approach to defining recovery groups based on arm motor recovery trajectories poststroke. In addition, between-group differences in baseline characteristics and therapy hours were explored.
METHODS
A retrospective cohort analysis was conducted where 40 participants with arm weakness were assessed 1 week, 6 weeks, 3 months, and 6 months after an ischemic stroke. Arm recovery trajectory groups were defined on the basis of timing of changes in the Fugl-Meyer Assessment Upper Extremity (FMA-UE), at least the minimal clinically important difference (MCID), 1 week to 6 weeks or 6 weeks to 6 months. Three recovery trajectory groups were defined: Fast (n = 19), Extended (n = 12), and Limited (n = 9). Between-group differences in baseline characteristics and therapy hours were assessed. Associations between baseline characteristics and group membership were also determined.
RESULTS
Three baseline characteristics were associated with trajectory group membership: FMA-UE, NIH Stroke Scale, and Barthel Index. The Fast Recovery group received the least therapy hours 6 weeks to 6 months. No differences in therapy hours were observed between Extended and Limited Recovery groups at any time points.
DISCUSSION AND CONCLUSIONS
Three clinically relevant recovery trajectory groups were defined using the FMA-UE MCID. Baseline impairment, overall stroke severity, and dependence in activities of daily living were associated with group membership and therapy hours differed between groups. Stratifying individuals by recovery trajectory early poststroke could offer additional guidance to clinicians in discharge planning.
UNLABELLED
(See Supplemental Digital Content 1 for Video Abstract, available at: http://links.lww.com/JNPT/A337.).
背景与目的
脑卒中后手臂功能的恢复差异很大，有些人恢复迅速，但许多人恢复较慢或功能改善有限。目前的脑卒中预测模型为临床医生提供了一些关于脑卒中后预期运动结果的指导，但没有涉及恢复速度，这使得出院计划变得复杂。本研究开发了一种新方法，根据脑卒中后手臂运动恢复轨迹来定义恢复组。此外，还探讨了组间基线特征和治疗时间的差异。
方法
回顾性队列分析纳入 40 名手臂无力的患者，分别在脑卒中后 1 周、6 周、3 个月和 6 个月进行评估。根据 Fugl-Meyer 上肢评估（FMA-UE）至少达到最小临床重要差异（MCID）的变化时间，将手臂恢复轨迹组定义为 1 周到 6 周或 6 周到 6 个月。定义了 3 个恢复轨迹组：快速（n=19）、扩展（n=12）和有限（n=9）。评估组间基线特征和治疗时间的差异。还确定了基线特征与组内成员关系的相关性。
结果
有 3 个基线特征与轨迹组内成员相关：FMA-UE、NIH 脑卒中量表和巴氏指数。快速恢复组在 6 周到 6 个月之间接受的治疗时间最少。在任何时间点，扩展和有限恢复组之间的治疗时间都没有差异。
讨论和结论
使用 FMA-UE MCID 定义了 3 个具有临床意义的恢复轨迹组。基线损伤、整体脑卒中严重程度和日常生活活动依赖与组内成员相关，组间的治疗时间存在差异。在脑卒中后早期根据恢复轨迹对个体进行分层，可以为临床医生提供额外的出院计划指导。
未加标签
（请查看补充数字内容 1 以获取视频摘要，网址：http://links.lww.com/JNPT/A337.）。
Zotero 插件