Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan.
Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan.
PLoS One. 2021 Dec 9;16(12):e0260743. doi: 10.1371/journal.pone.0260743. eCollection 2021.
Outpatient rehabilitation was temporarily suspended because of coronavirus disease (COVID-19), and there was a risk that patients' activities of daily living (ADLs) would decrease and physical functions unmaintained. Therefore, we investigated the ADLs and motor functions of chronic stroke patients whose outpatient rehabilitation was temporarily interrupted.
In this observational study, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and Barthel Index (BI) scores of 49 stroke hemiplegic patients at 6 and 3 months before rehabilitation interruptions were retrospectively determined and were prospectively investigated on resumption of outpatient rehabilitation. Presence or absence of symptoms and difficulties caused by the interruption period (IP) was investigated using a binomial method. Deltas were analyzed using a generalized linear model (GLM) according to the survey period. Age, sex, severity of FMA-UE immediately post-resumption and post-onset period were used as covariates. For survey items showing significant model fit, the 95% confidence interval of minimum detectable change (MDC95) was calculated, and the amount of change was compared. Questionnaire responses were tested via proportion ratio. Statistical significance was set at 5%.
The FMA-UE part A and total scores were significantly model fit depending on periods. The estimated FMA-UE total score decreased by 1.64 (z = -2.38, p = 0.02) during the 3-month IP. No fits were observed by GLM in other parts of the FMA-UE, ARAT, or BI. The calculated MDC95 was 3.58 for FMA-UE part A and 4.50 for FMA-UE overall. Answers to questions regarding sleep disturbance and physical pain were significantly biased toward "no" in the psychosomatic function items (p<0.05). There was no bias in the distribution of answers to questions regarding joint stiffness, muscle weakness, muscle stiffness, and difficulty in moving arms and hands. All 16 questions regarding activities and participation items were significantly biased toward answers "no" (p<0.05).
The FMA-UE part A and total scores were affected. Patients complained of subjective symptoms related to upper limb paralysis after the IP. Since ADLs of patients were maintained, the therapist can recommend that patients not receiving outpatient treatments be evaluated in relation to the shoulder, elbow, and forearm and instructed on self-training to maintain motor function.
由于冠状病毒病（COVID-19），门诊康复暂时停止，患者的日常生活活动（ADL）可能会下降，身体功能无法维持。因此，我们调查了门诊康复暂时中断的慢性中风患者的 ADL 和运动功能。
在这项观察性研究中，回顾性确定了 49 例偏瘫中风患者在康复中断前 6 个月和 3 个月的上肢 Fugl-Meyer 评估（FMA-UE）、动作研究上肢测试（ARAT）和巴氏指数（BI）评分，并前瞻性调查了恢复门诊康复后的情况。使用二项式方法调查中断期（IP）期间是否存在症状和困难。使用广义线性模型（GLM）根据调查期分析差值。年龄、性别、恢复后即刻和发病后 FMA-UE 的严重程度作为协变量。对于显示出显著模型拟合的调查项目，计算最小可检测变化（MDC95）的 95%置信区间，并比较变化量。通过比例比测试问卷回复。统计学意义设定为 5%。
FMA-UE 部分 A 和总分在不同时期的模型拟合程度显著。在 3 个月的 IP 期间，FMA-UE 总分估计下降了 1.64（z = -2.38，p = 0.02）。GLM 未观察到 FMA-UE 的其他部分、ARAT 或 BI 的拟合。FMA-UE 部分 A 的 MDC95 为 3.58，FMA-UE 总分为 4.50。在身心功能项目中，关于睡眠障碍和身体疼痛的问题的回答在统计学上明显偏向“否”（p<0.05）。在关于关节僵硬、肌肉无力、肌肉僵硬以及手臂和手部运动困难的问题的回答分布中没有偏差。关于活动和参与项目的所有 16 个问题的回答在统计学上明显偏向“否”（p<0.05）。
FMA-UE 部分 A 和总分受到影响。患者在 IP 后抱怨与上肢瘫痪相关的主观症状。由于患者的日常生活活动得到维持，治疗师可以建议未接受门诊治疗的患者评估肩部、肘部和前臂，并指导自我训练以维持运动功能。
