Kawakami Kenji, Tanabe Shigeo, Kinoshita Daiki, Kitabatake Ryo, Koshisaki Hiroo, Fujimura Kenta, Kanada Yoshikiyo, Sakurai Hiroaki
Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake-shi, Aichi, Japan; Graduate School of Health Sciences, Fujita Health University, Aichi, Japan; Department of Rehabilitation, Kyoto Rehabilitation Hospital, Kyoto-shi, Kyoto, Japan.
Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake-shi, Aichi, Japan; Graduate School of Health Sciences, Fujita Health University, Aichi, Japan.
J Rehabil Med. 2025 Jan 3;57:jrm41993. doi: 10.2340/jrm.v57.41993.
To identify factors associated with earlier independence in "real-life walking" during hospitalization in subacute stroke patients.
Retrospective cohort study.
SUBJECTS/PATIENTS: Two hundred and six hemiplegic patients.
Functional Independence Measure (FIM) walking items were measured biweekly from admission to discharge. Patients were grouped by achieving independent "real-life walking" (FIM-walking score ≥6). Time to independence, stratified by age, FIM motor score (FIM-M), FIM cognitive score (FIM-C), and Functional Ambulation Categories (FAC) scores were compared using Kaplan- Meier plots and log-rank tests. Hazard ratios were calculated via multivariable Cox proportional hazard models.
The median time to independence was 4 weeks, with significant differences (p < 0.05) by age, FIM-M, FIM-C, and FAC stratification. Age ≤64 years (hazard ratio 1.92, 95% confidence interval 1.21-3.06), FIM-C ≥25 (hazard ratio 2.42, 95% confidence interval 1.52-3.86), and FAC ≥3 (hazard ratio 1.98, 95% confidence interval 1.22-3.21) significantly affected earlier walking independence (all p < 0.01). Impeding factors were FIM-M ≤38 (hazard ratio 0.23, 95% confidence interval 0.13-0.40; p < 0.01) and FAC = 0 (hazard ratio 0.184, 95% confidence interval 0.06-0.62; p < 0.01).
Early improvement in "real-life walking" was associated with younger age, greater cognitive function, and greater "test-setting walking" ability on admission. Low activities of daily living independence and "test-setting walking" ability hindered early progress.
确定亚急性卒中患者住院期间与“现实生活中行走”更早实现独立相关的因素。
回顾性队列研究。
受试者/患者：206例偏瘫患者。
从入院到出院，每两周测量一次功能独立性评定量表（FIM）中的行走项目。患者按实现独立“现实生活中行走”（FIM行走评分≥6分）进行分组。采用Kaplan-Meier曲线和对数秩检验比较按年龄、FIM运动评分（FIM-M）、FIM认知评分（FIM-C）以及功能性步行分类（FAC）评分分层后的独立时间。通过多变量Cox比例风险模型计算风险比。
独立的中位时间为4周，按年龄、FIM-M、FIM-C和FAC分层存在显著差异（p<0.05）。年龄≤64岁（风险比1.92，95%置信区间1.21-3.06）、FIM-C≥25（风险比2.42，95%置信区间1.52-3.86）以及FAC≥3（风险比1.98，95%置信区间1.22-3.21）显著影响更早的行走独立性（均p<0.01）。阻碍因素为FIM-M≤38（风险比0.23，9%置信区间0.1-0.40；p<0.01）和FAC = 0（风险比0.184，95%置信区间0.06-0.62；p<0.01）。
“现实生活中行走”的早期改善与年龄较小、认知功能较好以及入院时“测试环境下行走”能力较强有关。日常生活活动独立性低和“测试环境下行走”能力阻碍了早期进展。
