Perry J, Garrett M, Gronley J K, Mulroy S J
Pathokinesiology Rancho Los Amigos Medical Center, Downey, Calif, USA.
Stroke. 1995 Jun;26(6):982-9. doi: 10.1161/01.str.26.6.982.
The limited walking ability that follows a stroke restricts the patient's independent mobility about the home and community, a significant social handicap. To improve the in-hospital prediction of functional outcome, the relationships between impairment, disability, and handicap were assessed with clinical measures in 147 stroke patients.
The patients' level of functional walking ability at home and in the community was assigned by expert clinicians to one of the six categories of a modified Hoffer Functional Ambulation scale at least 3 months after discharge. A 19-item questionnaire was further used to assess current customary mobility of the subjects. Functional muscle strength and proprioception were tested, and walking velocity was measured.
The significant indicators of impairment, upright motor control knee flexion and extension strength, differentiated household from community ambulators. The addition of velocity improved the functional prediction. Proprioception was clinically normal in all walkers. The validity of the criteria for the six levels of walking handicap was confirmed statistically. Stepwise discriminant analysis reduced the ambulation activities on the questionnaire from 19 to 7. Redefinition of the criteria for patient classification using the coefficients and constants of the seven critical functions improved the prediction of patient walking ability to 84%.
The results of this study offer a quantitative method of relating the social disadvantage of stroke patients to the impairment and disability sustained. The measurement of therapeutic outcome in relation to the social advantage for the patient would allow more efficient standardization of treatment and services.
中风后步行能力受限限制了患者在家庭和社区中的独立活动能力，这是一个严重的社会障碍。为了改善对功能结局的院内预测，我们采用临床测量方法评估了147例中风患者的损伤、残疾和障碍之间的关系。
出院至少3个月后，由专业临床医生根据改良的霍弗功能步行量表的六个类别之一，确定患者在家庭和社区中的功能步行能力水平。进一步使用一份包含19个条目的问卷来评估受试者当前的日常活动能力。测试了功能性肌肉力量和本体感觉，并测量了步行速度。
损伤的显著指标，即直立运动控制时膝关节屈伸力量，区分了家庭步行者和社区步行者。增加速度提高了功能预测能力。所有步行者的本体感觉在临床上均正常。从统计学上证实了六个步行障碍水平标准的有效性。逐步判别分析将问卷中的步行活动从19项减少到7项。使用七个关键功能的系数和常数重新定义患者分类标准，将患者步行能力的预测提高到了84%。
本研究结果提供了一种将中风患者的社会不利因素与所遭受的损伤和残疾联系起来的定量方法。衡量与患者社会优势相关的治疗结果将有助于更有效地规范治疗和服务。
