Stineman M G, Fiedler R C, Granger C V, Maislin G
Department of Rehabilitation Medicine, the Leonard Davis Institute for Health Economics, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.
Arch Phys Med Rehabil. 1998 May;79(5):497-504. doi: 10.1016/s0003-9993(98)90062-4.
To determine typical outcome "benchmarks" for 18 functional tasks in patients undergoing stroke rehabilitation. The benchmarks are intended to serve as points of reference to which the outcomes of patients with similar impairments and degrees of disability can be compared.
Records from 26,339 stroke patients discharged from 252 inpatient facilities across the United States that submitted 1992 data to the Uniform Data System for Medical Rehabilitation.
Stroke impairment was detailed as the presence or absence of hemiparesis resulting from stroke and the side(s) of involvement. Within each of five stroke impairment categories, patients were further classified by the Functional Independence Measure-Function-Related Groups (FIM-FRGs) into nine syndromes by degree of disability (admission motor and cognitive FIM scores) and by age. Outcomes were determined for each stroke syndrome at patients' discharge from medical rehabilitation.
Patients' median performance levels on each of the 18 items making up the FIM, length of stay, and community discharge rates.
The majority of patients whose admission motor FIM scores were above 37 were able to eat, groom, dress the upper body, and manage bladder and bowel functions independently by discharge. In addition to these tasks, most of those whose motor FIM scores were above 55 were able to dress the lower body, bathe, and transfer onto a chair/bed or toilet. The majority of patients whose initial motor FIM scores were above 62 points and whose cognitive FIM scores were above 30 gained independence in most tasks, including stair climbing and tub transfers. Community discharge rates ranged from 51.6% for the group of patients with the most severe disabilities to 99.2% for the group with the least severe disabilities.
The clinician can apply these benchmarks to guideline development and quality improvement, and in establishing patient goals.
确定中风康复患者18项功能任务的典型结果“基准”。这些基准旨在作为参考点，可用于比较具有相似损伤和残疾程度患者的结果。
来自美国252家住院机构的26339名中风患者的记录，这些机构向统一医学康复数据系统提交了1992年的数据。
中风损伤详细描述为中风导致的偏瘫是否存在以及受累侧。在五个中风损伤类别中的每一类中，患者根据功能独立性测量-功能相关组（FIM-FRG），按残疾程度（入院时运动和认知FIM评分）和年龄进一步分为九种综合征。在患者从医学康复出院时确定每种中风综合征的结果。
患者在构成FIM的18项中的每项的中位表现水平、住院时间和社区出院率。
入院时运动FIM评分高于37分的大多数患者在出院时能够独立进食、梳洗、穿上半身衣服以及管理膀胱和肠道功能。除了这些任务外，运动FIM评分高于55分的大多数患者能够穿上下半身衣服、洗澡并转移到椅子/床或马桶上。初始运动FIM评分高于62分且认知FIM评分高于30分的大多数患者在大多数任务中获得了独立性，包括爬楼梯和从浴缸转移。社区出院率从残疾最严重组的51.6%到残疾最不严重组的99.2%不等。
临床医生可将这些基准应用于指南制定和质量改进以及设定患者目标。
