Department of Physical Therapy, University of Delaware, Newark, DE, USA.
Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
Top Stroke Rehabil. 2024 Jan;31(1):97-103. doi: 10.1080/10749357.2023.2202018. Epub 2023 Apr 14.
Each year, 795,000 Americans experience a stroke. As stroke mortality declines, more individuals are in the chronic phase of recovery (>6 months post-stroke). Over 80% of stroke survivors have multiple, chronic health conditions (MCC). While the relationship between MCC and mortality and function during acute recovery has been explored, less is known about how MCC burden affects participation in chronic stroke survivors.
This study investigated whether MCC burden is related to participation in those with chronic stroke.
Two hundred and sixty-six participants with chronic (≥6 months) stroke were included in this cross-sectional and retrospective analysis. Participants had a mean age of 62.2 ± 12.8 years, and time since stroke (TSS) of 36.0 ± 44.6 months (114F/152 M). Participants completed the 6-minute Walk Test (6MWT), Activities-Specific Balance Confidence Scale (ABC), Modified Cumulative Illness Rating Scale (MCIR) to quantify the presence and severity of chronic illness across 14 body systems, and the Stroke Impact Scale - Participation subscale (SIS-P). Participation (SIS-P) was the dependent variable. Independent variables were entered into a sequential regression model in three blocks: demographic variables, physical capacity (6MWT distance) and balance self-efficacy (ABC), and MCC burden (MCIR).
After adjusting for age, sex, and time since stroke, physical capacity and balance self-efficacy explained 31.4% ( < 0.001), and the MCC burden explained 2.0% ( = 0.004). Higher participation was related to lower MCC burden.
MCC burden is a significant contributor to variance in participation in chronic stroke survivors, above and beyond demographics, physical capacity, and self-efficacy, and therefore should be considered when creating rehabilitation programs to improve participation.
每年有 79.5 万名美国人经历中风。随着中风死亡率的下降，更多的人处于中风后的慢性恢复期（>6 个月）。超过 80%的中风幸存者患有多种慢性健康状况（MCC）。虽然已经探讨了 MCC 负担与急性恢复期的死亡率和功能之间的关系，但对于 MCC 负担如何影响慢性中风幸存者的参与知之甚少。
本研究调查了 MCC 负担与慢性中风患者的参与程度是否相关。
本横断面和回顾性分析纳入了 266 名慢性（>6 个月）中风患者。参与者的平均年龄为 62.2 ± 12.8 岁，中风后时间（TSS）为 36.0 ± 44.6 个月（114 名女性/152 名男性）。参与者完成了 6 分钟步行测试（6MWT）、活动特异性平衡信心量表（ABC）、改良累积疾病评分量表（MCIR），以量化 14 个体系统中慢性疾病的存在和严重程度，以及中风影响量表-参与子量表（SIS-P）。参与（SIS-P）是因变量。将独立变量按以下三个块输入顺序回归模型：人口统计学变量、身体能力（6MWT 距离）和平衡自我效能（ABC）以及 MCC 负担（MCIR）。
在调整年龄、性别和中风后时间后，身体能力和平衡自我效能解释了 31.4%（<0.001），而 MCC 负担解释了 2.0%（=0.004）。更高的参与度与更低的 MCC 负担相关。
MCC 负担是慢性中风幸存者参与度差异的重要贡献因素，超过了人口统计学、身体能力和自我效能，因此在制定康复计划以提高参与度时应考虑 MCC 负担。
