Rabadi Meheroz H, Xu Chao
Veterans Affairs Medical Center, Oklahoma City, OK, USA -
Veterans Affairs Medical Center, Oklahoma City, OK, USA.
Eur J Phys Rehabil Med. 2025 Feb;61(1):19-27. doi: 10.23736/S1973-9087.24.08563-0. Epub 2024 Dec 16.
The role of motivation per se in the presence or absence of depression in stroke-related cognitive and functional motor recovery has not been studied.
This study aimed to determine the role of motivation on cognition and functional motor recovery in patients after an acute and subacute ischemic stroke.
Prospective, observational, single-center study.
Enrollment was undertaken in an inpatient neurorehabilitation facility.
A total of 125 veterans with stroke were admitted to an inpatient neurorehabilitation facility.
Recovery locus of control (RLOC) measured the degree of motivation. The primary outcome measures were changes from baseline in the Action Research Arm Test (ARAT), total and sub-scores of Functional Independence Measures (TFIM), and the 2-minute walk test (2-MWT) on discharge from the IRF.
The mean age of the study sample was 65±9.3 years, they were mainly non-Hispanic white (N.=92, 74%) men (N.=119, 95%) admitted 9±11 days after acute stroke. When the sample was divided into less motivated (score 0-25, N.=32) and motivated (score ≥ 26, N.=93) as measured by the total RLOC for a statistical median of 26, the two groups had similar baseline characteristics including admission depression, TFIM, ARAT, and 2-MWT scores. The change in the primary outcome measure scores from baseline was similar between the two groups. Motivated group veterans had a lower all-cause mortality rate at 12 months than less motivated veterans (P=0.001).
A higher level of motivation irrespective of the degree of depression did not improve cognitive or functional motor recovery scores. However, motivated veterans had a lower all-cause mortality at 12 months.
The result of this study has important implications in clinical practice highlighting that motivated patients are more likely to be discharged home and have a lower all-cause mortality.
动机本身在中风相关认知和功能运动恢复中是否存在抑郁的情况下所起的作用尚未得到研究。
本研究旨在确定动机对急性和亚急性缺血性中风患者认知和功能运动恢复的作用。
前瞻性、观察性、单中心研究。
在一家住院神经康复机构进行入组。
共有125名中风退伍军人入住一家住院神经康复机构。
恢复控制点（RLOC）测量动机程度。主要结局指标是从基线到出院时在行动研究臂测试（ARAT）、功能独立性测量（TFIM）总分及子分数以及2分钟步行测试（2-MWT）的变化。
研究样本的平均年龄为65±9.3岁，他们主要是非西班牙裔白人（n = 92，74%）男性（n = 119，95%），在急性中风后9±11天入院。当根据RLOC总分的统计中位数26将样本分为动机较低组（得分0 - 25，n = 32）和动机较高组（得分≥26，n = 93）时，两组具有相似的基线特征，包括入院时的抑郁情况以及TFIM、ARAT和2-MWT得分。两组主要结局指标得分从基线的变化相似。动机较高组退伍军人在12个月时的全因死亡率低于动机较低组退伍军人（P = 0.001）。
无论抑郁程度如何，较高水平的动机并未改善认知或功能运动恢复得分。然而，动机较高的退伍军人在12个月时的全因死亡率较低。
本研究结果在临床实践中具有重要意义，突出表明有动机的患者更有可能出院回家且全因死亡率较低。
