Chang Yu-Chien, Lin Hsiu-Fen, Chen Yu-Fu, Chen Hong-Yaw, Shiu Yu-Tsz, Shi Hon-Yi
Division of Neurology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung 80249, Taiwan.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan.
J Clin Med. 2023 Sep 7;12(18):5828. doi: 10.3390/jcm12185828.
This study proposed to evaluate the temporal trend, define the minimal clinically important difference (MCID) for five functional status measures, and identify risk factors for reaching deterioration in the MCID. This prospective cohort study analyzed 680 patients with ischemic stroke and 151 patients with hemorrhagic stroke at six hospitals between April 2015 and October 2021. All patients completed the functional status measures before rehabilitation (baseline), and at the 12th week and 2nd year after rehabilitation. Patients in the post-acute care (PAC) group exhibited significantly larger improvements for the functional status measures compared to those in the non-PAC group ( < 0.05). Patients with hemorrhagic stroke also displayed larger improvements in the functional status measures when compared to patients with ischemic stroke. Furthermore, the improvement in MCID ranged from 0.01 to 16.18 points when comparing baseline and the 12th week after rehabilitation, but the deterioration in MCID ranged from 0.38 to 16.12 points. Simultaneously, assessing the baseline and the second year after rehabilitation, the improvement in MCID ranged from 0.01 to 18.43 points, but the deterioration in MCID ranged from 0.68 to 17.26 points. Additionally, the PAC program, age, education level, body mass index, smoking, readmission within 30 days, baseline functional status score, use of Foley catheter and nasogastric tube, as well as a history of previous stroke are significantly associated with achieving deterioration in MCID ( < 0.05). These findings suggest that if the mean change scores of the functional status measures have reached the thresholds, the change scores can be perceived by patients as clinically important.
本研究旨在评估时间趋势，确定五项功能状态指标的最小临床重要差异（MCID），并识别达到MCID恶化的风险因素。这项前瞻性队列研究分析了2015年4月至2021年10月期间六家医院的680例缺血性脑卒中患者和151例出血性脑卒中患者。所有患者在康复前（基线）、康复后第12周和第2年完成功能状态指标评估。与非急性后期护理（PAC）组相比，PAC组患者的功能状态指标改善更为显著（<0.05）。与缺血性脑卒中患者相比，出血性脑卒中患者的功能状态指标改善也更大。此外，比较基线和康复后第12周时，MCID的改善范围为0.01至16.18分，但MCID的恶化范围为0.38至16.12分。同时，评估基线和康复后第二年时，MCID的改善范围为0.01至18.43分，但MCID的恶化范围为0.68至17.26分。此外，PAC项目、年龄、教育水平、体重指数、吸烟、30天内再次入院、基线功能状态评分、使用Foley导管和鼻胃管以及既往脑卒中病史与MCID恶化显著相关（<0.05）。这些发现表明，如果功能状态指标的平均变化分数达到阈值，患者可将这些变化分数视为具有临床重要性。
