Feng Hui, Li Xueping
Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Jiangsu, China.
Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China.
J Clin Neurol. 2025 Sep;21(5):439-448. doi: 10.3988/jcn.2024.0530.
Existing rehabilitation programs for neurological critical patients are based on early mobilization or exercise. However, whether there is an optimal rehabilitation program in terms of its rehabilitation efficacy needs further exploration.
An optimal rehabilitation program for neurological critical patients was developed in July 2020 and evaluated in December 2020. Retrospective data on the duration of the rehabilitation intervention, mortality rate, treatment adverse events (AE), and functional status were collected in the hospital electronic database from January to June 2020. The Manchester Mobility Score (MMS), UK Medical Research Council (MRC) muscle strength score, and Barthel Index for the ability to perform the activities of daily living were used to evaluate body function.
The incidence of nonfatal serious AEs was significantly lower in patients treated with the optimized rehabilitation program (1.71% vs. 3.41%), while the rehabilitation time was significantly shorter (23.17±6.99 days vs. 26.34±6.25 days, mean±standard deviation) and there were significant improvements in activity ability (MMS: 10.88±3.31 vs. 7.89±3.31), muscle strength (MRC muscle strength score: 9.56±3.84 vs. 7.84±3.36), and activities of daily living (Barthel Index: 27.36±9.34 vs. 19.47±6.25). Importantly, the nutritional status of the patients was also significantly improved by the optimal program.
The optimized rehabilitation program was superior to the nonoptimized program in decreasing AEs and improving the activity ability, muscle strength, and ability to perform the activities of daily living.
现有的神经重症患者康复计划基于早期活动或锻炼。然而,就康复效果而言,是否存在最佳康复计划尚需进一步探索。
2020年7月制定了针对神经重症患者的最佳康复计划,并于2020年12月进行评估。从医院电子数据库中收集了2020年1月至6月期间康复干预持续时间、死亡率、治疗不良事件(AE)和功能状态的回顾性数据。采用曼彻斯特运动评分(MMS)、英国医学研究委员会(MRC)肌力评分以及日常生活活动能力的巴氏指数来评估身体功能。
接受优化康复计划治疗的患者非致命严重AE的发生率显著更低(1.71%对3.41%),而康复时间显著更短(23.17±6.99天对26.34±6.25天,均值±标准差),活动能力(MMS:10.88±3.31对7.89±3.31)、肌力(MRC肌力评分:9.56±3.84对7.84±3.36)和日常生活活动(巴氏指数:27.36±9.34对19.47±6.25)均有显著改善。重要的是,最佳计划还显著改善了患者的营养状况。
优化后的康复计划在降低AE以及改善活动能力、肌力和日常生活活动能力方面优于未优化的计划。