Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
Arch Phys Med Rehabil. 2024 Mar;105(3):487-497. doi: 10.1016/j.apmr.2023.09.016. Epub 2023 Oct 4.
To identify meaningful changes in patients in 3 functional domains (basic mobility [BM], daily activity [DA], and applied cognition [AC]) after discharge from inpatient stroke rehabilitation and to identify the predictors of 1-year functional improvement.
A longitudinal, multicenter, prospective cohort study.
The acute care wards of 3 hospitals in the Greater Taipei area of Taiwan.
Five hundred patients with stroke in acute care wards (mean age=60±12.2 years, 62% men, N=500).
Not applicable.
MAIN OUTCOME MEASURE(S): The Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) short forms were assessed at discharge and 3-, 6-, and 12-month follow-up. The minimal detectable change (MDC) was used to categorize changes in the scores as improved and unimproved at the 4 time points.
The mean scores of the AM-PAC BM and DA subscales substantially increased over the first 3 months after discharge (86% of participants exhibited improvement) and slightly increased during the subsequent 9 months (5∼26% of participants exhibited improvement). However, the mean score of the AC subscale decreased within the first 3 months and increased over the subsequent 9 months (22-23% of participants exhibited improvement). The BM, AC scores at discharge were the dominant predictors of subsequent functional improvement (P<.05). Patients with a higher functional stage at discharge were more likely to experience significant improvement.
This study established the capacity of the AM-PAC to predict functional improvement in 3 domains during the early, middle, and late stages of recovery. The findings can assist clinicians in identifying patients at risk of unfavorable long-term functional recovery and providing such patients with tailored interventions during the early stage of rehabilitation.
确定住院脑卒中康复后 3 个功能领域（基本移动能力[BM]、日常活动[DA]和应用认知[AC]）中患者的有意义变化，并确定 1 年功能改善的预测因素。
一项纵向、多中心、前瞻性队列研究。
台湾大台北地区 3 家医院的急性护理病房。
急性护理病房的 500 名脑卒中患者（平均年龄 60±12.2 岁，62%为男性，N=500）。
无。
在出院时和 3、6 和 12 个月随访时使用简体中文版活动后护理评估量表（AM-PAC）短表进行评估。使用最小可检测变化（MDC）将 4 个时间点的评分变化分类为改善和未改善。
出院后前 3 个月，AM-PAC BM 和 DA 子量表的平均得分显著增加（86%的参与者表现出改善），随后的 9 个月内略有增加（5∼26%的参与者表现出改善）。然而，AC 子量表的平均得分在头 3 个月内下降，随后的 9 个月内增加（22-23%的参与者表现出改善）。出院时的 BM 和 AC 评分是随后功能改善的主要预测因素（P<.05）。出院时功能阶段较高的患者更有可能经历显著改善。
本研究确立了 AM-PAC 在康复早期、中期和晚期预测 3 个领域功能改善的能力。这些发现可以帮助临床医生识别出功能恢复不良的高风险患者，并在康复早期为这些患者提供有针对性的干预措施。
