De Haan R, Horn J, Limburg M, Van Der Meulen J, Bossuyt P
Department of Neurology, University of Amsterdam, The Netherlands.
Stroke. 1993 Aug;24(8):1178-81. doi: 10.1161/01.str.24.8.1178.
Recently much debate has arisen on the appropriateness of assessing stroke outcomes with stroke impairment scales. Our purpose was to study the relationship between long-term impairments and functional outcomes in terms of disability, handicap, and quality of life.
We studied 87 patients who had a stroke 6 months earlier. Impairments were scored on five stroke scales: the Orgogozo Scale, the National Institutes of Health scale, the Canadian Neurological Scale, the Mathew scale, and the Scandinavian Stroke Scale. Disability was assessed with the Barthel Index, handicap with the Rankin scale, and quality of life with the Sickness Impact Profile. The linear relationship between stroke scales and functional scales was assessed with correlation coefficients. We used regression analyses to explain functional health.
The stroke scales were highly related to one another (range, r = -.85 to .92). The correlation between stroke scales and functional scales was < .70 and decreased from Barthel (mean r2 = 47.5%) to Rankin (mean r2 = 36.5%) to Sickness Impact Profile (mean r2 = 33%). Stroke scales were rather poorly correlated with patients' psychosocial conditions (mean r2 = 11.5%). Functional health status was mainly related to leg power and orientation. The standardized stroke scale weights of the explanatory items were lower than their standardized regression weights.
Stroke scales only partly explain functional health. The impact of impairments on functional outcomes seems to be underestimated by the stroke scale weights. The correlation patterns give empirical support to the hierarchical structure of the International Classification of Impairments, Disabilities and Handicaps.
近期，关于使用卒中损伤量表评估卒中预后的适宜性引发了诸多争论。我们的目的是从残疾、残障和生活质量方面研究长期损伤与功能预后之间的关系。
我们研究了87例6个月前发生卒中的患者。采用五种卒中量表对损伤进行评分：奥戈戈佐量表、美国国立卫生研究院量表、加拿大神经量表、马修量表和斯堪的纳维亚卒中量表。使用巴氏指数评估残疾情况，用兰金量表评估残障情况，用疾病影响量表评估生活质量。通过相关系数评估卒中量表与功能量表之间的线性关系。我们使用回归分析来解释功能健康状况。
卒中量表之间高度相关（范围：r = -0.85至0.92）。卒中量表与功能量表之间的相关性<0.70，从巴氏指数（平均r² = 47.5%）到兰金量表（平均r² = 36.5%）再到疾病影响量表（平均r² = 33%）逐渐降低。卒中量表与患者心理社会状况的相关性较差（平均r² = 11.5%）。功能健康状况主要与腿部力量和定向有关。解释项目的标准化卒中量表权重低于其标准化回归权重。
卒中量表仅部分解释功能健康状况。损伤对功能预后的影响似乎被卒中量表权重低估了。相关模式为国际损伤、残疾和残障分类的层次结构提供了实证支持。
