Department of Rehabilitation, Tokyo Shinjuku Medical Center, Japan Community Health Care Organization, Tokyo, Japan.
Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan.
PM R. 2022 Oct;14(10):1167-1176. doi: 10.1002/pmrj.12689. Epub 2021 Sep 14.
The extent of rehabilitation is a key element in promoting functional recovery in patients with stroke. However, the type of rehabilitation therapy that should be provided to improve functional outcomes remains unclear.
To compare the effects of three different rehabilitation provision systems, namely conventional rehabilitation therapy, conventional rehabilitation therapy plus physical therapy (PT) on weekends, and conventional rehabilitation therapy plus PT and occupational therapy (OT) on weekends, on functional recovery in patients with subacute stroke.
Retrospective observational cohort study.
Convalescence rehabilitation hospital.
Three hundred one patients with subacute stroke (mean age, 69.7 ± 12.8 years).
Patients were classified into three groups according to rehabilitation therapy they received: a conventional group (only weekdays PT and OT; n = 70), an additional PT group (additional PT on weekends; n = 119), and an additional PT + OT group (additional PT and OT on weekends; n = 112).
Functional Independence Measure (FIM) effectiveness was calculated as (discharge FIM - admission FIM/maximum FIM - admission FIM) × 100. A multivariate general linear model was used to assess the difference in FIM effectiveness among the groups.
The mean FIM effectiveness in the conventional, additional PT, and additional PT + OT groups were 39.3 ± 30.1, 43.4 ± 33.2, and 54.3 ± 29.1, respectively. The multivariate analysis revealed a significant difference in FIM effectiveness among the three groups (p = .036), and the η was 0.02, indicating a small effect. The additional PT + OT group showed significantly greater improvements in FIM effectiveness than the conventional group (mean difference = 8.78, SE = 3.58, 95% confidence interval: 0.17-17.39).
This study showed that the additional PT + OT group had better functional recovery than did the conventional group. This indicates that increasing the amount of both PT and OT can promote poststroke functional recovery.
康复程度是促进脑卒中患者功能恢复的关键因素。然而，提供何种康复治疗以改善功能结局尚不清楚。
比较三种不同康复提供系统，即常规康复治疗、常规康复治疗加周末物理治疗（PT）以及常规康复治疗加周末 PT 和作业治疗（OT），对亚急性脑卒中患者功能恢复的影响。
回顾性观察队列研究。
康复疗养医院。
301 例亚急性脑卒中患者（平均年龄，69.7±12.8 岁）。
根据接受的康复治疗将患者分为三组：常规组（仅工作日 PT 和 OT；n=70）、额外 PT 组（周末额外 PT；n=119）和额外 PT+OT 组（周末额外 PT 和 OT；n=112）。
采用功能独立性测量（FIM）评估疗效，计算公式为（出院 FIM-入院 FIM/最大 FIM-入院 FIM）×100。采用多变量一般线性模型评估各组 FIM 疗效的差异。
常规组、额外 PT 组和额外 PT+OT 组的平均 FIM 疗效分别为 39.3±30.1、43.4±33.2 和 54.3±29.1。多变量分析显示三组间 FIM 疗效差异有统计学意义（p=0.036），η 2=0.02，提示效应较小。额外 PT+OT 组的 FIM 疗效改善明显优于常规组（平均差值=8.78，SE=3.58，95%置信区间：0.17-17.39）。
本研究表明，额外 PT+OT 组的功能恢复优于常规组。这表明增加 PT 和 OT 的量可以促进脑卒中后的功能恢复。
