Duncan P, Richards L, Wallace D, Stoker-Yates J, Pohl P, Luchies C, Ogle A, Studenski S
Center on Aging, University of Kansas Medical Center, Kansas City, Kansas 66160-7117, USA
Stroke. 1998 Oct;29(10):2055-60. doi: 10.1161/01.str.29.10.2055.
Many stroke survivors have minimal to moderate neurological deficits but are physically deconditioned and have a high prevalence of cardiovascular problems; all of these are potentially modifiable with exercise. The purposes of this randomized, controlled pilot study were (1) to develop a home-based balance, strength, and endurance program; (2) to evaluate the ability to recruit and retain stroke subjects; and (3) to assess the effects of the interventions used.
Twenty minimally and moderately impaired stroke patients who had completed inpatient rehabilitation and who were 30 to 90 days after stroke onset were randomized to a control group or to an experimental group that received a therapist-supervised, 8-week, 3-times-per-week, home-based exercise program. The control group received usual care as prescribed by the patients' physicians. Baseline and postintervention assessments included the Fugl-Meyer Motor Assessment, the Barthel Index of Activities of Daily Living (ADL), the Lawton Scale of Instrumental ADL, and the Medical Outcomes Study-36 Health Status Measurement. Functional assessments of balance and gait included a 10-m walk, 6-Minute Walk, and the Berg Balance Scale. Upper extremity function was evaluated by the Jebsen Test of Hand Function.
Of 22 patients who met study criteria, 20 completed the study and 2 refused to participate. The experimental group tended to improve more than the control group in motor function (Fugl-Meyer Upper Extremity: mean change in score, 8. 4 versus 2.2; Fugl-Meyer Lower Extremity: 4.7 versus -0.9; gait velocity: median change, 0.25 versus .09 m/s; 6-Minute Walk: 195 versus 114 ft; Berg Balance Score: 7.8 versus 5; and Medical Outcomes Study-36 Health Status Measurement of Physical Function: 15. 5 versus 9). There were no trends in differences in change scores by the Jebsen Test of Hand Function, Barthel Index, and Lawton Instrumental ADL Scale.
This study demonstrated that a randomized, controlled clinical trial of a poststroke exercise program is feasible. Measures of neurological impairments and lower extremity function showed the most benefit. Effects of the intervention on upper extremity dexterity and functional health status were equivocal. The lasting effects of the intervention were not assessed.
许多中风幸存者存在轻度至中度神经功能缺损，但身体机能衰退，心血管问题患病率高；所有这些情况通过运动都有可能得到改善。这项随机对照试验性研究的目的是：（1）制定一项基于家庭的平衡、力量和耐力训练计划；（2）评估招募和留住中风患者的能力；（3）评估所采用干预措施的效果。
20例轻度和中度受损的中风患者，他们已完成住院康复治疗，且中风发作后30至90天，被随机分为对照组或试验组。试验组接受由治疗师监督的、为期8周、每周3次的家庭运动计划。对照组接受患者医生规定的常规护理。基线和干预后评估包括Fugl-Meyer运动评估、巴氏日常生活活动指数（ADL）、Lawton工具性ADL量表以及医学结局研究-36健康状况测量。平衡和步态的功能评估包括10米步行、6分钟步行以及Berg平衡量表。上肢功能通过Jebsen手功能测试进行评估。
符合研究标准的22例患者中，20例完成了研究，2例拒绝参与。试验组在运动功能方面的改善倾向大于对照组（Fugl-Meyer上肢：得分平均变化，8.4对2.2；Fugl-Meyer下肢：4.7对-0.9；步速：中位数变化，0.25对0.09米/秒；6分钟步行：195对114英尺；Berg平衡评分：7.8对5；医学结局研究-36身体功能健康状况测量：15.5对9）。Jebsen手功能测试、巴氏指数和Lawton工具性ADL量表的变化得分差异无趋势。
本研究表明，中风后运动计划的随机对照临床试验是可行的。神经功能缺损和下肢功能测量显示受益最大。干预对上肢灵活性和功能健康状况的影响不明确。未评估干预的长期效果。
