Ingwersen Thies, Wolf Silke, Birke Gunnar, Schlemm Eckhard, Bartling Christian, Bender Gabriele, Meyer Alfons, Nolte Achim, Ottes Katharina, Pade Oliver, Peller Martin, Steinmetz Jochen, Gerloff Christian, Thomalla Götz
Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
MediClin Klinikum Soltau, Oeninger Weg 59, 29614, Soltau, Germany.
Neurol Res Pract. 2021 Dec 27;3(1):66. doi: 10.1186/s42466-021-00164-7.
Impaired motor functions after stroke are common and negatively affect patients' activities of daily living and quality of life. In particular, hand motor function is essential for daily activities, but often returns slowly and incompletely after stroke. However, few data are available on the long-term dynamics of motor recovery and self-reported health status after stroke. The Interdisciplinary Platform for Rehabilitation Research and Innovative Care of Stroke Patients (IMPROVE) project aims to address this knowledge gap by studying the clinical course of recovery after inpatient rehabilitation.
In this prospective observational longitudinal multicenter study, patients were included towards the end of inpatient rehabilitation after ischemic or hemorrhagic stroke. Follow-up examination was performed at three, six, and twelve months after enrollment. Motor function was assessed by the Upper Extremity Fugl-Meyer Assessment (FMA), grip and pinch strength, and the nine-hole peg test. In addition, Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) was included. Linear mixed effect models were fitted to analyze change over time. To study determinants of hand motor function, patients with impaired hand function at baseline were grouped into improvers and non-improvers according to hand motor function after twelve months.
A total of 176 patients were included in the analysis. Improvement in all motor function scores and PROMIS-10 was shown up to 1 year after inpatient rehabilitation. FMA scores improved by an estimate of 5.0 (3.7-6.4) points per year. In addition, patient-reported outcome measures increased by 2.5 (1.4-3.6) and 2.4 (1.4-3.4) per year in the physical and mental domain of PROMIS-10. In the subgroup analysis non-improvers showed to be more often female (15% vs. 55%, p = 0.0155) and scored lower in the Montreal Cognitive Assessment (25 [23-27] vs. 22 [20.5-24], p = 0.0252).
Continuous improvement in motor function and self-reported health status is observed up to 1 year after inpatient stroke rehabilitation. Demographic and clinical parameters associated with these improvements need further investigation. These results may contribute to the further development of the post-inpatient phase of stroke rehabilitation.
The trial is registered at ClinicalTrials.gov (NCT04119479).
中风后运动功能受损很常见，会对患者的日常生活活动和生活质量产生负面影响。特别是手部运动功能对日常活动至关重要，但中风后恢复缓慢且不完全。然而，关于中风后运动恢复的长期动态变化和自我报告的健康状况的数据很少。中风患者康复研究与创新护理跨学科平台（IMPROVE）项目旨在通过研究住院康复后的恢复临床过程来填补这一知识空白。
在这项前瞻性观察性纵向多中心研究中，患者在缺血性或出血性中风后的住院康复末期被纳入。在入组后的三个月、六个月和十二个月进行随访检查。通过上肢Fugl-Meyer评估（FMA）、握力和捏力以及九孔插钉试验评估运动功能。此外，还纳入了患者报告结局测量信息系统10项简短形式（PROMIS-10）。采用线性混合效应模型分析随时间的变化。为了研究手部运动功能的决定因素，将基线时手部功能受损的患者根据十二个月后的手部运动功能分为改善者和未改善者。
共有176名患者纳入分析。住院康复后长达1年，所有运动功能评分和PROMIS-10均有改善。FMA评分每年改善估计5.0（3.7-6.4）分。此外，在PROMIS-10的身体和心理领域，患者报告的结局测量每年分别增加2.5（1.4-3.6）和2.4（1.4-3.4）。在亚组分析中，未改善者女性比例更高（15%对55%，p = 0.0155），蒙特利尔认知评估得分更低（25 [23-27]对22 [20.5-24]，p = 0.0252）。
中风住院康复后长达1年，运动功能和自我报告的健康状况持续改善。与这些改善相关的人口统计学和临床参数需要进一步研究。这些结果可能有助于中风康复住院后期的进一步发展。
该试验已在ClinicalTrials.gov注册（NCT04119479）。
