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入院时的中风损伤、平衡和认知状态可预测中风后90天内的步行独立性,但它们的作用会随时间变化。

Stroke impairment, balance, and cognitive status on admission predict walking independence up to 90 days post-stroke but their contributions change over time.

作者信息

Hiratsuka Kenta, Tamiya Takamichi, Matsuoka Shinji, Kimura Kazushi

机构信息

Department of Physical Therapy, Hakodate Medical Association Nursing and Rehabilitation Academy.

Biomedical Science and Engineering Research Center, Hakodate Medical Association Nursing and Rehabilitation Academy, Hakodate.

出版信息

Int J Rehabil Res. 2023 Mar 1;46(1):61-69. doi: 10.1097/MRR.0000000000000561. Epub 2022 Dec 26.

Abstract

This study aimed to identify predictors of gait independence in three successive patient cohorts that received inpatient rehabilitation for at least 30 days, 60 days, or 90 days post-stroke. A total of 26 independent variables were collected within 3 days of stroke onset, including basic information (age, sex, stroke type), sensorimotor function (Stroke Impairment Assessment Set), gait function, balance function, and cognitive function. The dependent variable was walking independence (without assistance from another person) at 30, 60, or 90 days post-stroke. A decision tree was developed for predicting gait independence at each assessment time point. The predictors of walking independence differed among the cohorts that received inpatient rehabilitation for at least 30, 60, and 90 days post-stroke. Specifically, the Short Form Berg Balance Scale score was in the higher layer and was a strong predictor of gait at all time points. The cognitive Functional Independence Measure progressed to the higher layer at later time points. The lower extremity motor function was an additional predictor in the 30-day cohort. For later cohorts, the predictive value of balance and cognitive function declined whereas the contribution of the paralyzed grip strength and trunk function increased. These results suggest that sensorimotor and cognitive function within 3 days of stroke can predict walking independence between 1 and 3 months post-stroke; however, the prognostic value of predictors varies among the patients who receive inpatient rehabilitation for shorter versus longer time.

摘要

本研究旨在确定三组连续的患者队列中步态独立性的预测因素,这些患者在中风后接受了至少30天、60天或90天的住院康复治疗。在中风发作后3天内共收集了26个独立变量,包括基本信息(年龄、性别、中风类型)、感觉运动功能(中风损伤评估量表)、步态功能、平衡功能和认知功能。因变量是中风后30天、60天或90天的行走独立性(无需他人协助)。开发了一个决策树来预测每个评估时间点的步态独立性。在中风后接受至少30天、60天和90天住院康复治疗的队列中,行走独立性的预测因素有所不同。具体而言,简短伯格平衡量表评分处于较高层次,是所有时间点步态的有力预测因素。认知功能独立性测量在后期时间点进入较高层次。下肢运动功能是30天队列中的另一个预测因素。对于后期队列,平衡和认知功能的预测价值下降,而瘫痪握力和躯干功能的贡献增加。这些结果表明,中风后3天内的感觉运动和认知功能可以预测中风后1至3个月的行走独立性;然而,预测因素的预后价值在接受较短或较长时间住院康复治疗的患者中有所不同。

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