Rehabilitation Division, Iwate Medical University Hospital, Japan.
Department of Rehabilitation Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan.
J Stroke Cerebrovasc Dis. 2022 Oct;31(10):106698. doi: 10.1016/j.jstrokecerebrovasdis.2022.106698. Epub 2022 Aug 8.
This study aimed to investigate the effectiveness and safety of early mobilization with a physiatrist and registered therapist Operating rehabilitation (PROr) for patients with stroke and severe disturbance of consciousness (DoC).
We retrospectively screened records from patients with stroke admitted to our hospital from January 2015 to June 2021. Eligible patients with severe DoC were classified into two groups: patients who received standard rehabilitation (control group) and patients who received PROr (PROr group). We studied longitudinal change in the level of consciousness using the Japan Coma Scale (JCS) during hospital stay and compared in-hospital mortality, the incidence of respiratory complication, and modified Rankin Scale of discharge between the two groups.
Among the 2191 patients screened for inclusion, 16 patients were included in the PROr group, and 12 patients were included in the control group. Early mobilization was more promoted in the PROr group compared to the control group, but there were no significant differences in in-hospital mortality, the incidence of respiratory complication, or modified Rankin Scale at discharge between the two groups. In patients who survived during their hospital stay, JCS scores 2 weeks after the onset of stroke and JCS scores at discharge significantly improved from the start of rehabilitation in the PROr group, but not in the control group.
Early mobilization provided with the PROr program appears to be a safe treatment and may contribute to the improvement of consciousness level for patients with acute stroke and severe DoC.
本研究旨在探讨物理治疗师和注册治疗师早期操作康复（PROr）对昏迷和严重意识障碍（DoC）患者的有效性和安全性。
我们回顾性筛选了 2015 年 1 月至 2021 年 6 月期间我院收治的脑卒中患者的病历。将严重 DoC 的合格患者分为两组：接受标准康复（对照组）和接受 PROr（PROr 组）的患者。我们研究了住院期间使用日本昏迷量表（JCS）评估意识水平的纵向变化，并比较了两组患者的住院死亡率、呼吸并发症发生率和出院时改良 Rankin 量表评分。
在筛选的 2191 例患者中，16 例患者纳入 PROr 组，12 例患者纳入对照组。PROr 组的早期活动较对照组更为促进，但两组患者的住院死亡率、呼吸并发症发生率或出院时改良 Rankin 量表评分无显著差异。在住院期间存活的患者中，PROr 组在脑卒中发病后 2 周的 JCS 评分和出院时的 JCS 评分较康复开始时显著改善，但对照组则无明显改善。
PROr 方案提供的早期活动似乎是一种安全的治疗方法，可能有助于改善急性脑卒中伴严重 DoC 患者的意识水平。
