Indredavik B, Bakke F, Slørdahl S A, Rokseth R, Håheim L L
Department of Medicine, University Hospital of Trondheim, Norway.
Stroke. 1998 May;29(5):895-9. doi: 10.1161/01.str.29.5.895.
We have previously shown that treatment of acute stroke patients in the combined acute and rehabilitation stroke unit in our hospital improves survival and functional outcome compared with treatment in general wards. The primary aim of the present trial was to examine whether the treatment in our stroke unit had an effect on different aspects of quality of life (QoL) for stroke patients 5 years after the onset of stroke.
In a randomized controlled trial, 110 patients with symptoms and signs of an acute stroke were allocated to the stroke unit and 110 to general wards. No significant differences existed in baseline characteristics between the two groups. The patients alive after 5 years were assessed by the Nottingham Health Profile (NHP) and the Frenchay Activities Index (FAI), which were the scales used as primary outcome measures for QoL. As secondary outcome measures we used a global score for the NHP and a simple visual analogue scale (VAS).
After 5 years, 45 of the patients treated in the stroke unit and 32 of those treated in general wards were alive. All surviving patients were assessed by the FAI. Thirty-seven (82.2%) of the stroke unit patients and 25 (78.1%) of the general wards patients were assessed by the NHP; 38 (84.4%) and 28 (87.5%), respectively, were assessed by the VAS. Patients treated in the stroke unit had a higher score on the FAI (P=0.0142). Assessment with the NHP showed better results in the stroke unit group for the dimensions of energy (P=0.0323), physical mobility (P=0.0415), emotional reactions (P=0.0290), social isolation (P=0.0089), and sleep (P=0.0436), although there was no difference in pain (P=0.3186). The global NHP score and VAS score also showed significantly better results in the stroke unit group (NHP, P<0.01; VAS, P<0.001). Patients who were independent in activities of daily living had significantly better QoL assessed by these scales than patients who were dependent.
Our study shows for the first time that stroke unit care improves different aspects of long-term QoL for stroke patients.
我们之前已经表明，与在普通病房治疗相比，在我院的急性与康复联合卒中单元对急性卒中患者进行治疗可提高生存率和功能转归。本试验的主要目的是研究在我们的卒中单元进行治疗对卒中发病5年后患者生活质量（QoL）的不同方面是否有影响。
在一项随机对照试验中，110例有急性卒中症状和体征的患者被分配至卒中单元，110例被分配至普通病房。两组的基线特征无显著差异。5年后存活的患者通过诺丁汉健康量表（NHP）和法国ay活动指数（FAI）进行评估，这两个量表用作QoL的主要结局指标。作为次要结局指标，我们使用了NHP的综合评分和一个简单的视觉模拟量表（VAS）。
5年后，卒中单元治疗的患者中有45例存活，普通病房治疗的患者中有32例存活。所有存活患者均通过FAI进行评估。37例（82.2%）卒中单元患者和25例（78.1%）普通病房患者通过NHP进行评估；分别有38例（84.4%）和28例（87.5%）通过VAS进行评估。在卒中单元接受治疗的患者在FAI上得分更高（P=0.0142）。使用NHP评估显示，在精力（P=0.0323）、身体活动能力（P=0.0415）、情绪反应（P=0.0290）、社会隔离（P=0.0089）和睡眠（P=0.0436）维度上，卒中单元组的结果更好，尽管在疼痛方面无差异（P=~0.3186）。NHP综合评分和VAS评分在卒中单元组也显示出显著更好的结果（NHP，P<0.01；VAS，P<0.001）。在日常生活活动中独立的患者通过这些量表评估的QoL明显优于依赖的患者。
我们的研究首次表明，卒中单元护理可改善卒中患者长期QoL的不同方面。
