Okuda Yoshinobu, Aoike Futoshi
Tane Neuro-Rehabilitation Hospital, Minami-ichioka, Minato-ku, Osaka, Japan.
Int J Rehabil Res. 2021 Sep 1;44(3):222-225. doi: 10.1097/MRR.0000000000000476.
To investigate potential differences in functional recovery after rehabilitation between intracerebral haemorrhage and cerebral infarction, we retrospectively compared the outcomes of patients with intracerebral haemorrhage (N = 208) and cerebral infarction (N = 480) who were consecutively discharged from our convalescent rehabilitation hospital between January 2013 and December 2018. Functional improvement was estimated by functional independence effectiveness measurements (proportion of potential for improvement achieved) upon discharge. Univariate analysis showed no significant differences in functional improvement between the two groups possibly because of the demographic variations upon admission. Multiple regression analysis demonstrated that the impact and type of factors related to functional improvement (functional independence measure upon admission, age, length of hospital stay, and time to admission after onset) were similar in both groups. Nevertheless, stratified analysis revealed, compared with patients with cerebral infarction, better improvement in patients with intracerebral haemorrhage that were admitted early after onset (<20 days), which exhibited high or moderate severity upon admission (functional independence measure: 36-89), or had a long hospital stay (>129 days). The present study showed differences as well as similarities in functional recovery between two stroke subtypes and suggests that better functional improvement might be expected in patients with intracerebral haemorrhage compared with those with cerebral infarction through an earlier start of intensive rehabilitation or longer rehabilitation in the hospital even if they exhibited relatively severe impairment upon admission. The type of stroke should be taken into consideration when predicting functional recovery and planning rehabilitation management in stroke patients.
为了研究脑出血和脑梗死患者康复后功能恢复的潜在差异，我们回顾性比较了2013年1月至2018年12月期间从我们的康复疗养医院连续出院的脑出血患者（N = 208）和脑梗死患者（N = 480）的结局。出院时通过功能独立有效性测量（实现改善潜力的比例）评估功能改善情况。单因素分析显示两组之间在功能改善方面无显著差异，这可能是由于入院时的人口统计学差异所致。多元回归分析表明，两组中与功能改善相关的因素（入院时的功能独立测量、年龄、住院时间和发病后入院时间）的影响和类型相似。然而，分层分析显示，与脑梗死患者相比，脑出血患者如果在发病后早期（<20天）入院、入院时表现为高或中度严重程度（功能独立测量：36 - 89）或住院时间长（>129天），则功能改善更好。本研究显示了两种中风亚型在功能恢复方面的差异和相似之处，并表明与脑梗死患者相比，脑出血患者通过更早开始强化康复或在医院进行更长时间的康复，即使入院时表现出相对严重的损伤，也可能预期有更好的功能改善。在预测中风患者的功能恢复和规划康复管理时，应考虑中风类型。
