Department of Rehabilitation, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan.
Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
Disabil Rehabil. 2022 Dec;44(25):7872-7876. doi: 10.1080/09638288.2021.2001054. Epub 2021 Dec 11.
To identify longitudinal changes in life-space mobility and the factors influencing it among chronic, stable post-stroke patients.
This prospective study included Japanese post-stroke patients who received day-care rehabilitation services and could undergo three life-space mobility assessments (at baseline, 12, and 24 months) for over 2 years, using the Life-Space Assessment (LSA) tool. Physical function, cognitive function, and activities of daily living were assessed by self-selected comfortable gait speed, Mini-Mental State Examination (MMSE), and Functional Independence Measure Motor subscale (FIM motor) scores, respectively, in addition to age, sex, time from onset, stroke type, and comorbidities. A multivariable linear mixed-effects model was used to examine the longitudinal changes in LSA scores and associated factors.
A total of 89 participants were enrolled. At baseline, the median age was 74 years, 33% were women, and median time from onset was 75 months. The LSA scores significantly declined over the two-year period. In the multivariate linear mixed-effects model adjusted for clinical characteristics, comfortable gait speed and age were significantly associated with changes in the LSA score, independent of FIM motor scores and MMSE scores.
Life-space mobility may persistently decline, and gait function may be a determinant influencing these changes in community-dwelling chronic post-stroke patients.Implications for RehabilitationLimited life-space mobility leads to less frequent participation in social activities and an increased risk of adverse health outcomes such as hospitalization.Changes in life-space mobility should be considered in the rehabilitation care plan for chronic post-stroke patients.Life-space mobility may decline persistently in stable post-stroke patients, even if they have periodically received day-care rehabilitation services.Since gait speed is a predominant factor affecting life-space mobility, regular assessment of gait function and appropriate strategies are needed to prevent deterioration of gait speed in chronic post-stroke patients.
确定慢性稳定期卒中患者生活空间移动能力的纵向变化及其影响因素。
本前瞻性研究纳入了接受日间康复服务且可进行三次生活空间移动能力评估（基线、12 个月和 24 个月）超过 2 年的日本卒中后患者，使用生活空间评估（LSA）工具。身体功能、认知功能和日常生活活动能力分别通过自我选择的舒适步行速度、简易精神状态检查（MMSE）和功能性独立测量运动分量表（FIM 运动）评分进行评估，此外还评估了年龄、性别、发病时间、卒中类型和合并症。采用多变量线性混合效应模型来检验 LSA 评分的纵向变化及其相关因素。
共纳入 89 名参与者。基线时，患者的中位年龄为 74 岁，33%为女性，发病时间中位数为 75 个月。在两年期间，LSA 评分显著下降。在调整临床特征的多变量线性混合效应模型中，舒适步行速度和年龄与 LSA 评分的变化显著相关，独立于 FIM 运动评分和 MMSE 评分。
生活空间移动能力可能持续下降，而步态功能可能是影响社区居住的慢性卒中后患者这些变化的决定因素。
有限的生活空间移动能力会导致患者参与社会活动的频率降低，并增加住院等不良健康结果的风险。慢性卒中患者的康复护理计划中应考虑生活空间移动能力的变化。稳定的卒中后患者的生活空间移动能力可能会持续下降，即使他们定期接受日间康复服务。由于步行速度是影响生活空间移动能力的主要因素，因此需要定期评估步态功能并采取适当的策略，以防止慢性卒中患者的步行速度恶化。
