K Řasová, P Martinková, M Vařejková, B Miznerova, J Hlinovská, D Hlinovský, D Iskendri, L Lebdušková, R Vojíková, J Zakouřilová, J Běhounek, V Musil, T Philipp
Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia.
Department of Rheumatology and Physiotherapy, Third Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic.
Front Neurol. 2024 Oct 23;15:1442120. doi: 10.3389/fneur.2024.1442120. eCollection 2024.
Stroke often impairs upper extremity motor function, with recovery in the sub-acute phase being crucial for regaining independence. This study examines changes in isometric muscle strength, dexterity, and self-care independence during this period, and evaluates the effects of a comprehensive intensive rehabilitation (COMIRESTROKE).
Individuals in sub-acute stroke recovery and age- and sex-matched controls were assessed for pre- and post-rehabilitation differences in primary outcomes (grip/pinch strength, Nine Hole Peg Test [NHPT], Action Research Arm Test [ARAT]). COMIRESTROKE's effects on primary and secondary outcomes (National Institute of Health Stroke Scale [NIHSS], Modified Rankin Scale [MRS], Functional Independence Measure [FIM]) were evaluated. Outcomes were analyzed for dominant and non-dominant limbs, both regardless of impairment and with a focus on impaired limbs.
Fifty-two individuals with stroke (NIHSS 7.51 ± 5.71, age 70.25 ± 12.66 years, 21.36 ± 12.06 days post-stroke) and forty-six controls participated. At baseline, individuals with stroke showed significantly lower strength (dominant grip, key pinch, tip-tip pinch, < 0.05), higher NHPT scores ( < 0.05), and lower ARAT scores ( < 0.001). COMIRESTROKE led to improvements in dominant key pinch, non-dominant tip-tip pinch, NHPT, and both dominant and non-dominant ARAT ( < 0.05). Notably, non-dominant key pinch improved significantly when considering only impaired hands. Pre- and post-test differences between groups were significant only for ARAT (both limbs), even after adjustment ( < 0.05). All secondary outcomes (NIHSS, MRS, FIM) showed significant improvement post-COMIRESTROKE ( < 0.001).
Individuals with stroke exhibit reduced muscle strength and dexterity, impairing independence. However, comprehensive intensive rehabilitation significantly improves these functions. Data are available from the corresponding author upon request and are part of a sub-study of NCT05323916.
中风常损害上肢运动功能，亚急性期的恢复对于重新获得独立至关重要。本研究考察了这一时期等长肌力、灵巧性和自我护理独立性的变化，并评估了综合强化康复（COMIRESTROKE）的效果。
对亚急性中风恢复期患者以及年龄和性别匹配的对照组进行评估，以确定康复前后主要结局指标（握力/捏力、九孔插钉试验[NHPT]、动作研究臂试验[ARAT]）的差异。评估了COMIRESTROKE对主要和次要结局指标（美国国立卫生研究院卒中量表[NIHSS]、改良Rankin量表[MRS]、功能独立性测量[FIM]）的影响。对优势侧和非优势侧肢体的结局进行了分析，既包括不考虑损伤情况的分析，也包括重点关注受损肢体的分析。
52例中风患者（NIHSS 7.51±5.71，年龄70.25±12.66岁，中风后21.36±12.06天）和46例对照组参与了研究。在基线时，中风患者的力量显著较低（优势侧握力、关键捏力、指尖捏力，P<0.05），NHPT得分较高（P<0.05），ARAT得分较低（P<0.001）。COMIRESTROKE导致优势侧关键捏力、非优势侧指尖捏力、NHPT以及优势侧和非优势侧ARAT均得到改善（P<0.05）。值得注意的是，仅考虑受损手时，非优势侧关键捏力有显著改善。即使在调整后，两组之间的前后测试差异仅在ARAT（双侧肢体）方面具有统计学意义（P<0.05）。所有次要结局指标（NIHSS、MRS、FIM）在COMIRESTROKE后均显示出显著改善（P<0.001）。
中风患者表现出肌肉力量和灵巧性下降，损害了独立性。然而，综合强化康复显著改善了这些功能。如有需要，可向通讯作者获取数据，这些数据是NCT05323916子研究的一部分。
