Weng Shuo-Chun, Hsu Chiann-Yi, Shen Chiung-Chyi, Huang Jin-An, Chen Po-Lin, Lin Shih-Yi
Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
Front Aging Neurosci. 2022 Jun 17;14:834273. doi: 10.3389/fnagi.2022.834273. eCollection 2022.
In 2014, Taiwan's National Health Insurance administration launched a post-acute care (PAC) program for patients to improve their functions after acute stroke. The present study was aimed to determine PAC assessment parameters, either alone or in combination, for predicting clinical outcomes.
We retrospectively enrolled stroke adult patients through one PAC network in central Taiwan between January 2014 and December 2020. We collected data on post-stroke patients' functional ability at baseline and after PAC stay. The comprehensive assessment included the following: Modified Rankin Scale (MRS), Functional Oral Intake Scale (FOIS), Mini-Nutritional Assessment (MNA), Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA), Mini-Mental State Examination (MMSE), aphasia test, and quality of life. The above items were assessed first at baseline and again at discharge from PAC. Logistic regression was used to determine factors that were associated with PAC length of stay (LOS), 14-day hospital readmission, and 1-year mortality.
A total of 267 adults (mean age 67.2 ± 14.7 years) with completed data were analyzed. MRS, activities of daily living (ADLs), instrumental activities of daily living (IADLs), BBS, and MMSE all had improved between disease onset and PAC discharge. Higher baseline and greater improvement of physical and cognitive functions between initial and final PAC assessments were significantly associated with less readmission, and lower mortality. Furthermore, the improved ADLs, FOIS, MNA, FMA-motor, and MMSE scores were related to LOS during PAC. Using logistic regression, we found that functional improvements ≥5 items [adjusted odds ratio (aOR) = 0.16; 95% confidence interval (CI) = 0.05-0.45] and improved MMSE (aOR = 0.19; 95% CI = 0.05-0.68) were significantly associated with reduced post-PAC mortality or readmission. Whereas, functional improvements ≥7 items, improved FOIS, and MNA significantly prolonged LOS during PAC.
Physical performance parameters of patients with acute stroke improved after PAC. PAC assessment with multiple parameters better predicted clinical outcomes. These parameters could provide information on rehabilitation therapy for acute stroke patients receiving PAC.
2014年，台湾地区的国民健康保险管理部门为急性中风患者启动了一项急性后期照护（PAC）计划，以改善他们的功能。本研究旨在确定单独或联合使用的PAC评估参数，用于预测临床结局。
我们回顾性纳入了2014年1月至2020年12月期间在台湾中部一个PAC网络中的成年中风患者。我们收集了中风患者在基线时和PAC住院后的功能能力数据。综合评估包括以下内容：改良Rankin量表（MRS）、功能性口服摄入量量表（FOIS）、微型营养评定量表（MNA）、伯格平衡量表（BBS）、Fugl-Meyer评估量表（FMA）、简易精神状态检查表（MMSE）、失语症测试和生活质量。上述项目首先在基线时进行评估，然后在PAC出院时再次评估。采用逻辑回归分析确定与PAC住院时间（LOS）、14天内再入院和1年死亡率相关的因素。
共分析了267例数据完整的成年人（平均年龄67.2±14.7岁）。从疾病发作到PAC出院，MRS、日常生活活动能力（ADL）、工具性日常生活活动能力（IADL）、BBS和MMSE均有改善。初始和最终PAC评估之间较高的基线水平以及身体和认知功能的更大改善与再入院率降低和死亡率降低显著相关。此外，改善后的ADL、FOIS、MNA、FMA运动评分和MMSE评分与PAC住院期间的LOS相关。通过逻辑回归分析，我们发现功能改善≥5项[调整后的比值比（aOR）=0.16；95%置信区间（CI）=0.05-0.45]和MMSE改善（aOR =0.19；95%CI =0.05-0.68）与PAC后死亡率或再入院率降低显著相关。而功能改善≥7项、FOIS改善和MNA显著延长了PAC住院期间的LOS。
急性中风患者的身体性能参数在PAC后有所改善。多参数PAC评估能更好地预测临床结局。这些参数可为接受PAC的急性中风患者的康复治疗提供信息。
