Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium.
Department of Allied Health and Department of Research, Rehabilitation Hospital RevArte, Antwerp, Belgium.
BMC Neurol. 2021 Dec 15;21(1):488. doi: 10.1186/s12883-021-02493-1.
A previously shown 'mismatch' group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months.
Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months.
We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months.
We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.
先前的研究表明，在脑卒中后 6 个月，有一组患者上肢（UL）运动功能良好，但上肢活动感知度较低，他们在日常生活中使用患侧上肢的频率低于基于临床测试的预期，这种不匹配在 12 个月时也可能存在。本研究旨在另一个队列中确认这一人群，并探讨从 6 个月到 12 个月这一人群的演变情况，以及确定入院时和 6 个月时的哪些因素可以在 12 个月时区分不匹配和匹配组。
脑卒中患者在康复入院时入组，然后在 6 个月和 12 个月时进行评估。上肢功能的观察结果通过 Fugl-Meyer 上肢评定量表（FMA-UE）的上肢亚量表进行测量，上肢活动的感知度通过卒中影响量表 3.0（SIS-Hand）的手亚量表进行测量。我们将观察到的上肢功能良好（FMA-UE＞50/66）但感知到的活动度较低（SIS-Hand≤75/100）定义为不匹配。在 12 个月时，对匹配组和不匹配组在入院时和 6 个月时的潜在鉴别因素（人口统计学特征、卒中特征、上肢躯体感觉功能、认知缺陷、精神功能和活动度）进行统计学比较。
我们纳入了 60 名参与者（女性占 42%），平均年龄为 65（12）岁。我们在 6 个月时确认了 11 名（18%）患者的不匹配组，在 12 个月时增加到了 14 名（23%）患者。在不匹配组中，与 12 个月时的匹配组相比，患者在入院时和 6 个月时的卒中严重程度更高，躯体感觉障碍更严重。
我们在脑卒中后 6 个月和 12 个月时均确认了一组上肢运动功能良好但上肢活动感知度较低的患者。入院时对卒中严重程度和躯体感觉障碍的评估可以确定 12 个月时的不匹配情况，可能需要进行干预。然而，不匹配组患者之间的临床结局差异较大，这表明需要根据个体需求定制训练。
