Center for Stroke Rehabilitation Research, 158368Kessler Foundation, West Orange, NJ, USA.
Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
Neurorehabil Neural Repair. 2022 Aug;36(8):500-513. doi: 10.1177/15459683221107891. Epub 2022 Jun 8.
We examined whether number of prism adaptation treatment (PAT) sessions in regular clinical practice would predict spatial neglect (SN) improvement and rehabilitation outcomes. We reviewed clinical records from 16 U.S. rehabilitation hospitals where neurological patients were assessed for SN using the Catherine Bergego Scale (CBS) and if SN was detected, and may have received PAT. Multiple linear regression was used to predict CBS Change (indicating SN improvement) in 520 patients who received PAT while considering age, sex, diagnosis, time post diagnosis, CBS at baseline, neglected side of space, and length of stay. Another set of regression models including the same variables and adding Function Independent Measure (FIM®) at admission was used to predict FIM Gains (indicating rehabilitation outcomes) in 1720 patients receiving PAT or not. We found that greater number of PAT sessions predicted greater CBS Change, especially in patients with moderate-to-severe neglect. Number of PAT sessions also positively correlated with Total FIM, Motor FIM, and Cognitive FIM Gains regardless of SN severity classification at baseline. Furthermore, number of PAT sessions predicted CBS Change and FIM Gains among patients completing ≤8 PAT sessions but not among patients with ≥8 sessions, who however, showed greater CBS Change with increased PAT frequency (i.e., fewer days between two consecutive sessions). Receiving more once-daily PAT sessions predicted greater improvement in SN and rehabilitation outcomes. Receiving PAT at a higher frequency for 8 or more sessions predicted better SN improvement. Thus, dosage matters. The study provides practice-based evidence that PAT is appropriate for inpatient rehabilitation.
我们研究了在常规临床实践中进行的棱镜适应治疗 (PAT) 次数是否可预测空间忽略 (SN) 改善和康复结果。我们回顾了来自 16 家美国康复医院的临床记录,这些患者使用 Catherine Bergego 量表 (CBS) 评估 SN,如果发现 SN,则可能接受 PAT。我们使用多元线性回归来预测接受 PAT 的 520 名患者的 CBS 变化(表示 SN 改善),同时考虑年龄、性别、诊断、诊断后时间、基线 CBS、忽略的空间侧以及住院时间。另一组回归模型包括相同的变量,并在入院时添加功能独立性测量 (FIM®),以预测接受或未接受 PAT 的 1720 名患者的 FIM 收益(表示康复结果)。我们发现,进行更多的 PAT 次数可预测更大的 CBS 变化,尤其是在中度至重度忽略的患者中。PAT 次数与 Total FIM、Motor FIM 和 Cognitive FIM 收益呈正相关,无论基线 SN 严重程度分类如何。此外,在完成 ≤8 次 PAT 的患者中,PAT 次数预测 CBS 变化和 FIM 收益,但在完成 ≥8 次 PAT 的患者中则不预测,而这些患者随着 PAT 频率的增加(即两次连续治疗之间的天数减少),CBS 变化更大。接受更多的每日一次 PAT 治疗可预测 SN 和康复结果的更大改善。接受 8 次或更多次的高频 PAT 治疗可预测更好的 SN 改善。因此,剂量很重要。该研究提供了基于实践的证据,表明 PAT 适合住院康复。
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