脑卒中幸存者的活动能力与功能结局和生活质量相关：一项观察性队列研究。

Ambulatory activity in stroke survivors associated with functional outcome and quality of life: An observational cohort study.

机构信息

The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245, Burgundy Street, Heidelberg, 3084 Victoria, Australia.

出版信息

Ann Phys Rehabil Med. 2022 Mar;65(2):101540. doi: 10.1016/j.rehab.2021.101540. Epub 2021 Nov 13.

DOI:10.1016/j.rehab.2021.101540

PMID:33984539

Abstract

BACKGROUND

Physical activity is beneficial in stroke prevention and recovery. Understanding activity dynamics and its effect on outcome after stroke is important to improve recommendations and develop interventions.

OBJECTIVES

We examined serial changes in daily ambulatory activity (AA) averaged over 1 week in people with subacute to chronic stroke and its association with functional outcome (modified Rankin scale [mRS]) and quality of life (EQ-5D-3L).

METHODS

This observational study examined AA in stroke survivors with no to moderate disability (US National Institute of Stroke Scale [NIHSS] score) who were mostly community dwelling and had cryptogenic stroke based on data from the Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke study. The participants underwent long-term AA monitoring by accelerometric activity data obtained from an insertable cardiac monitor without receiving any specific encouragement regarding physical activity. We analysed AA changes and assessed the association between baseline AA and mRS/EQ-5D-3L scores. A small group of participants had follow-up data for 2 years, which allowed for analysing long-term serial changes.

RESULTS

We included 186 participants (mean [SD] age 61.3 [11.2] years, 67% male, mean 39 [28] days after stroke). AA increased during the subacute phase in individuals with mild (NIHSS score 1-4, P<0.001) and moderate (NIHSS score 5-10, P=0.013) disability but not in the non-impaired group. Baseline AA was inversely associated with NIHSS score (P<0.001) and was associated with mRS score (P=0.001) and weakly correlated with EQ-5D-3L score at 6 months (P=0.032, r=0.22). For the 45 participants with follow-up data (mean age 64.5 [9.7] years, 80% male, mean 34 [21] days after stroke), AA remained stable.

CONCLUSION

AA increased in stroke survivors with impairments but remained stable in those whose symptoms had resolved. AA during the early subacute period was associated with mRS and EQ-5D-3L scores at 6 months. Insertable cardiac monitoring offers a feasible method for monitoring activity over prolonged periods in people after stroke. Its increased use may offer an opportunity to overcome the limited reliability and validity of many existing measures.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT00924638).

摘要

背景

身体活动有益于预防和恢复中风。了解活动动态及其对中风后结果的影响对于改善建议和开发干预措施非常重要。

目的

我们检查了亚急性至慢性中风患者一周内日常活动（AA）的连续变化，及其与功能结局（改良 Rankin 量表[mRS]）和生活质量（EQ-5D-3L）的关系。

方法

本观察性研究检查了基于连续心脏监测评估隐匿性中风后心房颤动研究数据的无至中度残疾（美国国立卫生研究院中风量表[NIHSS]评分）的中风幸存者的 AA，这些患者主要居住在社区，且隐匿性中风。参与者通过植入式心脏监测器获得的加速度计活动数据进行长期 AA 监测，而无需接受任何关于体力活动的具体鼓励。我们分析了 AA 的变化，并评估了基线 AA 与 mRS/EQ-5D-3L 评分之间的关系。一小部分参与者有 2 年的随访数据，这允许分析长期的连续变化。

结果

我们纳入了 186 名参与者（平均[标准差]年龄 61.3[11.2]岁，67%为男性，平均发病后 39[28]天）。在轻度（NIHSS 评分 1-4，P<0.001）和中度（NIHSS 评分 5-10，P=0.013）残疾的个体中，AA 在亚急性期增加，但在无残疾组中没有增加。基线 AA 与 NIHSS 评分呈负相关（P<0.001），与 mRS 评分相关（P=0.001），与 6 个月时的 EQ-5D-3L 评分弱相关（P=0.032，r=0.22）。对于 45 名有随访数据的参与者（平均年龄 64.5[9.7]岁，80%为男性，平均发病后 34[21]天），AA 保持稳定。