Roth E J, Heinemann A W, Lovell L L, Harvey R L, McGuire J R, Diaz S
Department of Physical Medicine and Rehabilitation, Northwestern University Medical School, Rehabilitation Institute of Chicago, IL 60611-3015, USA.
Arch Phys Med Rehabil. 1998 Mar;79(3):329-35. doi: 10.1016/s0003-9993(98)90015-6.
To describe the association between impairment and disability during stroke rehabilitation and to examine the effects of rehabilitation by studying the degree of disability reduction experienced by stroke patients who did not have significant reductions in impairment levels.
Statistical analysis of items from a database of prospectively collected information on stroke patients admitted for rehabilitation.
Large urban academic freestanding rehabilitation facility.
Four hundred two patients consecutively admitted for comprehensive acute stroke inpatient rehabilitation.
The National Institutes of Health Stroke Scale (NIHSS) was used to measure impairment and the Functional Independence Measure (FIM) was used to measure disability. Motor and cognitive subscales of the FIM instrument were evaluated. Raw NIHSS and FIM scores were converted to linear measures using Rasch analysis.
Relationships were studied between converted NIHSS and the two FIM subscales for admission, discharge, and change scores using linear regression analysis. In a second analysis, two groups of patients were identified; the 342 patients who experienced no substantial reduction of impairment comprised the "no impairment reduction (NIR) group," and the 60 patients who had a significant reduction of impairment level comprised the "impairment reduction (IR) group." Multivariate analysis of variance was used to determine and compare the amount of change in motor and cognitive FIM measures over time for each of the two groups.
NIHSS correlated significantly with motor and cognitive FIM subscores for admission, discharge, and change measures; R2 values ranged between .02 and .36. Both the NIR group and the IR group experienced significant decreases in disability during rehabilitation. The differences in discharge FIM measures between the two groups were relatively small.
Although stroke-related impairment and disability are significantly correlated with each other, reduced impairment level alone does not fully explain the reduced disability that occurs during rehabilitation. Even patients without substantial impairment reduction demonstrate disability reduction during rehabilitation, suggesting that rehabilitation has an independent role in improving function beyond that explained by neurologic recovery alone.
描述中风康复期间损伤与残疾之间的关联，并通过研究损伤水平未显著降低的中风患者的残疾程度降低情况来检验康复效果。
对前瞻性收集的中风康复住院患者信息数据库中的项目进行统计分析。
大型城市独立学术康复机构。
402例连续入院接受综合性急性中风住院康复治疗的患者。
采用美国国立卫生研究院卒中量表（NIHSS）测量损伤，采用功能独立性测量（FIM）评估残疾。对FIM工具的运动和认知子量表进行评估。使用Rasch分析将原始NIHSS和FIM分数转换为线性测量值。
采用线性回归分析研究转换后的NIHSS与入院、出院及变化分数的两个FIM子量表之间的关系。在第二项分析中，确定了两组患者；342例损伤未大幅降低的患者组成“无损伤降低（NIR）组”，60例损伤水平显著降低的患者组成“损伤降低（IR）组”。采用多变量方差分析确定并比较两组患者运动和认知FIM测量随时间的变化量。
NIHSS与入院、出院及变化测量的运动和认知FIM子分数显著相关；R2值在0.02至0.36之间。NIR组和IR组在康复期间残疾均显著降低。两组出院时FIM测量的差异相对较小。
虽然中风相关的损伤与残疾显著相关，但仅损伤水平的降低并不能完全解释康复期间残疾的降低。即使是损伤未大幅降低的患者在康复期间也表现出残疾降低，这表明康复在改善功能方面具有独立作用，不仅仅是由神经恢复所解释的。
