共查询到20条相似文献，搜索用时 31 毫秒
1.
Annick Van Gils Sarah Meyer Margaretha Van Dijk Liselot Thijs Marc Michielsen Christophe Lafosse Veronik Truyens Kristine Oostra Andre Peeters Vincent Thijs Hilde Feys Lena Krumlinde-Sundholm Daphne Kos Geert Verheyden 《Archives of physical medicine and rehabilitation》2018,99(12):2513-2522
Objective
To investigate interrater and intrarater reliability, measurement error, and convergent and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke).Design
Cross-sectional observational study.Setting
A total of 7 stroke rehabilitation centers.Participants
Stroke survivors (reliability sample: n=30; validity sample: N=118) were included (median age 67y; interquartile range [IQR], 59-76); median time poststroke 81 days (IQR 57-117).Interventions
N/A.Main Outcome Measures
Ad-AHA Stroke, Action Research Arm Test (ARAT), upper extremity Fugl-Meyer Assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults poststroke. Reliability of Ad-AHA Stroke was examined using intraclass correlation coefficients (ICCs), Bland–Altman plots, and weighted kappa statistics for reliability on item level. SEM was calculated based on Ad-AHA units. Convergent validity was assessed by calculating Spearman rank correlation coefficients between Ad-AHA Stroke and ARA test and UE-FMA. Comparison of Ad-AHA Stroke scores between subgroups of patients according to hand dominance, neglect, and age evaluated discriminative validity.Results
Intrarater and interrater agreement showed an ICC of 0.99 (95% confidence interval, 0.99-0.99), an SEM of 2.15 and 1.64 out of 100, respectively, and weighted kappa for item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was strong (ρ=0.9). Patients with neglect had significantly lower Ad-AHA scores compared to patients without neglect (P=.004).Conclusions
The Ad-AHA Stroke captures actual bimanual performance. Therefore, it provides an additional aspect of upper limb assessment with good to excellent reliability and low SEM for patients with subacute stroke. High convergent validity with the ARA test and UE-FMA and discriminative validity were supported. 相似文献2.
Pierre Nicolo Cécile Magnin Elena Pedrazzini Gijs Plomp Anaïs Mottaz Armin Schnider Adrian G. Guggisberg 《Archives of physical medicine and rehabilitation》2018,99(5):862-872.e1
Objective
To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke.Design
Double-blinded, randomized, placebo-controlled study.Setting
University hospital rehabilitation unit.Participants
Inpatients with stroke (N=41; mean age, 65y; range, 28–85y; mean weeks poststroke, 5; range, 2–10) with resultant paresis in the upper extremity (mean Fugl-Meyer score, 14; range, 3–48).Interventions
Subjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks, combined with physical therapy.Main Outcome Measures
Brain function was assessed with directed and nondirected functional connectivity based on high-density electroencephalography before and after stimulation sessions. Primary clinical end point was the change in slope of the multifaceted motor score composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score, 9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and the treatment time.Results
Neither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS induced different neural effects. Only cTBS was able to reduce transcallosal influences from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation analyses indicated that the modulation of interhemispheric driving and perilesional beta-band connectivity were not independent mediators for functional recovery across all patients. However, exploratory subgroup analyses suggest that the enhancement of perilesional beta-band connectivity through tDCS might have more robust clinical gains if started within the first 4 weeks after stroke.Conclusions
The inhibition of the contralesional M1 or the reduction of interhemispheric interactions was not clinically useful in the heterogeneous group of subjects with subacute stroke. An early modulation of perilesional oscillation coherence seems to be a more promising strategy for brain stimulation interventions. 相似文献3.
Kara K. Patterson Jennifer S. Wong Svetlana Knorr Jessica A. Grahn 《Archives of physical medicine and rehabilitation》2018,99(5):945-951
Objectives
To assess rhythm abilities, to describe their relation to clinical presentation, and to determine if rhythm production independently contributes to temporal gait asymmetry (TGA) poststroke.Design
Cross-sectional.Setting
Large urban rehabilitation hospital and university.Participants
Individuals (N=60) with subacute and chronic stroke (n=39) and data for healthy adults extracted from a preexisting database (n=21).Interventions
Not applicable.Main Outcome Measures
Stroke group: National Institutes of Health Stroke Scale (NIHSS), Chedoke-McMaster Stroke Assessment (CMSA) leg and foot scales, Montreal Cognitive Assessment (MoCA), rhythm perception and production (Beat Alignment Test [BAT]), and spatiotemporal gait parameters were assessed. TGA was quantified with the swing time symmetry ratio. Healthy group: age and beat perception scores assessed by the BAT. Rhythm perception of the stroke group and healthy adults was compared with analysis of variance. Spearman correlations quantified the relation between rhythm perception and production abilities and clinical measures. Multiple linear regression assessed the contribution of rhythm production along with motor impairment and time poststroke to TGA.Results
Rhythm perception in the stroke group was worse than healthy adults (F1,56=17.5, P=.0001) Within the stroke group, rhythm perception was significantly correlated with CMSA leg (Spearman ρ=.33, P=.04), and foot (Spearman ρ=.49, P=.002) scores but not NIHSS or MoCA scores. The model for TGA was significant (F3,35=12.8, P<.0001) with CMSA leg scores, time poststroke, and asynchrony of rhythm production explaining 52% of the variance.Conclusions
Rhythm perception is impaired after stroke, and temporal gait asymmetry relates to impairments in producing rhythmic movement. These results may have implications for the use of auditory rhythmic stimuli to cue motor responses poststroke. Future work will explore brain responses to rhythm processing poststroke. 相似文献4.
Flavia Coroian Claire Jourdan Karima Bakhti Claire Palayer Audrey Jaussent Marie-Christine Picot Denis Mottet Marc Julia Huey-Yune Bonnin Isabelle Laffont 《Archives of physical medicine and rehabilitation》2018,99(2):321-328
Objective
To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization.Design
Randomized blinded assessor controlled trial.Setting
Physical Medicine and Rehabilitation departments of 2 university hospitals.Participants
Patients (N=20) with incomplete hemiplegia (16 men; mean age, 64y; median time since stroke, 32mo).Interventions
A 6-week comprehensive rehabilitation program, 3d/wk, 3 sessions/d. In addition, a 45-minute session per day was performed using an isokinetic dynamometer, with either isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening group) or passive joint mobilization (control group).Main Outcome Measures
The primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA) score at day 45 (t1). Secondary endpoints were increases in UL-FMA scores, Box and Block Test scores, muscle strength, spasticity, and Barthel Index at t1, t2 (3mo), and t3 (6mo).Results
Recruitment was stopped early because of excessive fatigue in the isokinetic strengthening group. The increase in UL-FMA score at t1 was 3.5±4.4 in the isokinetic strengthening group versus 6.0±4.5 in the control group (P=.2). Gains in distal UL-FMA scores were larger (3.1±2.8) in the control group versus 0.6±2.5 in the isokinetic strengthening group (P=.05). No significant group difference was observed in secondary endpoints. Mixed models confirmed those results. Regarding the whole sample, gains from baseline were significant for the UL-FMA at t1 (+4.8; P<.001), t2, and t3 and for the Box and Block Test at t1 (+3; P=.013) and t2.Conclusions
In a comprehensive rehabilitation program, isokinetic strengthening did not show superiority to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit in impairments and function of late UL rehabilitation programs for patients with stroke. 相似文献5.
Yu-wei Hsieh Ku-chou Chang Jen-wen Hung Ching-yi Wu Mu-hui Fu Chih-chi Chen 《Archives of physical medicine and rehabilitation》2018,99(12):2399-2407
Objective
We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.Design
A single-blinded, 2-sequence, 2-period, crossover-designed study.Setting
Rehabilitation clinics and participant’s home environment.Participants
Individuals with disabilities poststroke.Interventions
During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.Main Outcome Measures
Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.Results
Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.Conclusions
The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels. 相似文献6.
Gong-Hong Lin Yi-Jing Huang Shih-Chieh Lee Sheau-Ling Huang Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(4):676-683
Objective
To develop a computerized adaptive testing system of the Functional Assessment of Stroke (CAT-FAS) to assess upper- and lower-extremity (UE/LE) motor function, postural control, and basic activities of daily living with optimal efficiency and without sacrificing psychometric properties in patients with stroke.Design
Simulation study.Setting
One rehabilitation unit in a medical center.Participants
Patients with subacute stroke (N=301; mean age, 67.3±10.9; intracranial infarction, 74.5%).Interventions
Not applicable.Main Outcome Measures
The UE and LE subscales of the Fugl-Meyer Assessment, Postural Assessment Scale for Stroke Patients, and Barthel Index.Results
The CAT-FAS adopting the optimal stopping rule (limited reliability increase of <.010) had good Rasch reliability across the 4 domains (.88–.93) and needed few items for the whole administration (8.5 items on average). The concurrent validity (CAT-FAS vs original tests, Pearson r=.91–.95) and responsiveness (standardized response mean, .65–.76) of the CAT-FAS were good in patients with stroke.Conclusions
We developed the CAT-FAS, and our results support that the CAT-FAS has sufficient efficiency, reliability, concurrent validity, and responsiveness in patients with stroke. The CAT-FAS can be used to simultaneously assess patients' functions of UE, LE, postural control, and basic activities of daily living using, on average, no more than 10 items; this efficiency is useful in reducing the assessment burdens for both clinicians and patients. 相似文献7.
Pawel Kiper Andrzej Szczudlik Michela Agostini Jozef Opara Roman Nowobilski Laura Ventura Paolo Tonin Andrea Turolla 《Archives of physical medicine and rehabilitation》2018,99(5):834-842.e4
Objective
To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke etiology (ie, ischemic, hemorrhagic).Design
Randomized controlled trial.Setting
Hospital facility for intensive rehabilitation.Participants
Patients (N=136) within 1 year from onset of a single stroke (ischemic: n=78, hemorrhagic: n=58).Interventions
The experimental treatment was based on the combination of RFVE with CR, whereas control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5d/wk, for 4 weeks.Main Outcome Measures
Fugl-Meyer upper extremity scale (F-M UE) (primary outcome), FIM, National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements included duration (time), mean linear velocity (speed), and number of submovements (peak) (secondary outcomes).Results
Patients were randomized in 2 groups (RFVE with CR: n=68, CR: n=68) and stratified by stroke etiology (ischemic or hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) for F-M UE (P<.001), FIM (P<.001), NIHSS (P≤.014), ESAS (P≤.022), time (P<.001), speed (P<.001), and peak (P<.001). Stroke etiology did not have significant effects on patient outcomes.Conclusions
The RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke etiology. 相似文献8.
Oyéné Kossi Jean-Louis Thonnard 《Archives of physical medicine and rehabilitation》2018,99(11):2238-2243
Objective
To investigate responsiveness of the Participation Measurement Scale (PM-Scale) for the measurement of participation of stroke survivors.Design
A 6-month observational study with 3 evaluation time points. Responsiveness of the PM-Scale was investigated over a period of 6 months.Setting
Rehabilitation centers.Participants
Stroke survivors (N =64); mean age ± SD, 56.9±12.6 years; sex, 45 men (70%).Interventions
Not applicable.Main Outcome Measures
Participants were evaluated using the PM-Scale. The modified Rankin Scale was used to categorize the overall disability level for each participant.Results
The mixed-effect model analysis showed a significant difference in the participation over time (χ2=35.04; df=2; P<.001). In addition, the model exhibited significant effects of the sex, age, and disability at enrollment on the subjects’ participation levels. Furthermore, the PM-Scale detected different levels of changes in the entire cohort over time (small change, effect size [ES]=0.33; moderate change, ES=0.67; and large change, ES=1). The PM-Scale also facilitated the classification of the participants into discriminative categories such as important improvement (t score≥1.96; 1.8≤ES≤2.13), moderate improvement (0<t score<1.96; 0.56≤ES≤0.78), no change (t score=0), moderate decrease (?1.96<t score<0; ES=0.67), and important decrease (t score≤?1.96; ES=1.47).Conclusions
The PM-Scale exhibited good responsiveness and accurately detected changes in stroke subjects’ involvement in life situations. These results validate the usefulness of the PM-Scale for clinical trials and in settings to evaluate the effects of interventions on subjects with stroke in Africa. 相似文献9.
Nam G. Lee Joshua H. You Chung H. Yi Hye S. Jeon Bong S. Choi Dong R. Lee Jae M. Park Tae H. Lee In T. Ryu Hyun S. Yoon 《Archives of physical medicine and rehabilitation》2018,99(11):2168-2174
Objectives
To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke.Design
Two-group randomized controlled trial with pretest-posttest design.Setting
Hospital rehabilitation center.Participants
Adults with chronic hemiparetic stroke (N=28).Interventions
Participants were randomly divided into either conventional core stabilization (n=14) or DNS (n=14) groups. Both groups received a total of 20 sessions of conventional core stabilization or DNS training for 30 minutes per session 5 times a week during the 4-week period.Main Outcome Measures
Electromyography was used to measure the APA time for bilateral external oblique (EO), transverse abdominis (TrA)/internal oblique (IO), and erector spinae (ES) activation during rapid shoulder flexion. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES) were used to measure trunk movement control, balance performance, and fear of falling.Results
Baseline APA times were delayed and fear of falling was moderately high in both the conventional core stabilization and DNS groups. After the interventions, the APA times for EO, TrA/IO, and ES were shorter in the DNS group than in the conventional core stabilization group (P<.008). The BBS and TIS scores (P<.008) and the FES score (P<.003) were improved compared with baseline in both groups, but FES remained stable through the 2-year follow-up period only in the DNS group (P<.003).Conclusions
This is the first clinical evidence highlighting the importance of core stabilization exercises for improving APA control, balance, and fear of falls in individuals with hemiparetic stroke. 相似文献10.
Paola Forti Fabiola Maioli Elisabetta Magni Letizia Ragazzoni Roberto Piperno Marco Zoli Maura Coveri Gaetano Procaccianti 《Archives of physical medicine and rehabilitation》2018,99(3):477-483
Objective
To investigate whether oldest-old age (≥85y) is an independent predictor of exclusion from stroke rehabilitation.Design
Retrospective cohort study.Setting
Stroke unit (SU) of a tertiary hospital.Participants
Elderly patients (N=1055; aged 65–74y, n=230; aged 75–84y, n=432; aged ≥85y, n=393) who, between 2009 and 2012, were admitted to the SU with acute stroke and evaluated by a multiprofessional team for access to rehabilitation. The study excluded patients for whom rehabilitation was unnecessary or inappropriate.Interventions
Not applicable.Main Outcome Measures
Access to an early mobilization (EM) protocol during SU stay and subsequent access to postacute rehabilitation after SU discharge. Analyses were adjusted for prestroke and stroke-related characteristics.Results
32.2% of patients were excluded from EM. Multivariable-adjusted odds ratios (ORs) of EM exclusion were 1.30 (95% confidence interval [CI], .76–2.21) for ages 75 to 84 years and 2.07 (95% CI, 1.19–3.59) for ages ≥85 years compared with ages 65 to 74 years. Of 656 patients admitted to EM and who, at SU discharge, had not yet fully recovered their prestroke functional status, 18.4% were excluded from postacute rehabilitation. For patients able to walk unassisted at SU discharge, the probability of exclusion did not change across age groups. For patients unable to walk unassisted at SU discharge, ORs of exclusion from postacute rehabilitation were 3.74 (95% CI, 1.26–11.13) for ages 75 to 84 years and 9.15 (95% CI, 3.05–27.46) for ages ≥85 years compared with ages 65 to 74 years.Conclusions
Oldest-old age is an independent predictor of exclusion from stroke rehabilitation. 相似文献11.
Yi-Jing Huang Gong-Hong Lin Shih-Chieh Lee Yi-Miau Chen Sheau-Ling Huang Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(3):529-533
Objectives
To examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P.Design
Data were retrieved from a previous study wherein 212 patients were assessed at 14 and 30 days after stroke with the BBS and PASS.Setting
Medical center.Participants
Patients (N=212) with first onset of stroke within 14 days before hospitalization.Interventions
Not applicable.Main Outcome Measures
Group-level responsiveness was examined by the standardized response mean (SRM), and individual-level responsiveness was examined by the proportion of patients whose change scores exceeded the minimal detectable change of each measure. The responsiveness was compared using the bootstrap approach.Results
The BBS-3P and PASS-3P had good group-level (SRM, .60 and SRM, .56, respectively) and individual-level (48.1% and 44.8% of the patients with significant improvement, respectively) responsiveness. Bootstrap analyses showed that the BBS-3P generally had superior responsiveness to the BBS and SFBBS, and the PASS-3P had similar responsiveness to the PASS and SFPASS. The BBS-3P and PASS-3P were equally responsive to both group and individual change.Conclusions
The responsiveness of the BBS-3P and PASS-3P was comparable or superior to those of the original and short-form measures. We recommend the BBS-3P and PASS-3P as responsive outcome measures of balance for individuals with stroke. 相似文献12.
Ren-Jing Huang Ching-Hsiang Lai Shin-Da Lee Fang-Yu Pai Shen-Wen Chang Ai-Hui Chung Yi-Fang Chang Hua Ting 《Archives of physical medicine and rehabilitation》2018,99(4):699-706
Objective
To investigate whether objective polysomnographic measures of prevalent sleep problems such as sleep-disordered-breathing (SDB) and insomnia are associated with activities of daily living levels in inpatients at rehabilitation units.Design
Retrospective and observational study.Setting
Single rehabilitation center.Participants
Inpatients with subacute stroke (N=123) (61.6±13.1 years; 23.8±3.4 kg/m2; 33% women; 90.5±36.7 days post-stroke) underwent a 1-night polysomnographic study and a 1-month inpatient rehabilitation program.Main outcome measures
Admission and discharge Barthel Index (BI) scores and its change scores.Results
One hundred three (92%) patients had moderate-to-severe SDB (46.7±25.1 events/h in the apnea-hypopnea index), and 24 (19.5%) patients had acceptable continuous positive airway pressure adherence. Diverse values were found for total sleep time (259±71 min), sleep efficiency (69.5%±19.3%), sleep latency (24.3±30.9 min), and wakefulness after sleep onset (93.1±74.2 min). Admission BI scores and the BI change scores were 33.8±23.2 and 10.1±9.2, respectively. The National Institutes of Health Stroke Scale (NIHSS, 10.2±5.6), available in 57 (46%) patients, was negatively associated with admission levels and gains in BI change scores (P<.001, =0.002, respectively) in a univariate analysis. In regression models with backward selection, excluding NIHSS score, both age (P=.025) and wakefulness after sleep onset (P<.001) were negatively associated (adjusted R2=0.260) with admission BI scores. Comorbidity of hypertension; sleep latency percentage of stage 1, non–rapid eye movement sleep; and desaturation events ≥4% (P<.001, 0.001, 0.021, and 0.043, respectively; adjusted R2=0.252) were negatively associated with BI score gains.Conclusions
Based on objective sleep measures, insomnia rather than SDB in inpatients with subacute stroke was associated negatively with admission levels of activity of daily living and its improvement after a 1-month rehabilitation course. 相似文献13.
Raziyeh Maasoumi Fatemeh Zarei Effat Merghati-Khoei Taylor Lawson Seyyed Hasan Emami-Razavi 《Archives of physical medicine and rehabilitation》2018,99(3):548-554
Objective
To develop a sexual needs rehabilitation framework in women after spinal cord injury (SCI).Design
Mixed-methods study. The study consisted of 3 steps: (1) a primary needs assessment with quantitative and qualitative methods; (2) prioritization of identified needs by expert panels; and (3) development of a framework.Setting
Multi-dimensional clinical referral center.Participants
Married women (N=31) with an SCI that occurred at least 1 year ago.Interventions
Not applicable.Main Outcome Measures
Development of sexual needs rehabilitation framework.Results
The quantitative phase in the first phase showed that the total mean ± SD score of the Sexual Quality of Life–Female questionnaire was 60.47±1.53, and the total mean ± SD score of the Female Sexual Function Index was 50.54±11.35. Moreover, women's sexual understanding post-SCI in the qualitative assessment revealed the following 3 main themes: (1) “dilemma leading to limited sexual activity”; (2) “seeking positive sexual adjustment”; and (3) “lack of client-based sexual and reproductive education/counseling in the rehabilitation process.” Results from prioritizing identified needs in the second step indicated that the most important needs related to sexual aspects of life. In the final step, the framework for Iranian woman with post-SCI sexual rehabilitative needs developed with focus on sexual behavior complication post-SCI as a main need.Conclusions
It is important to assess probable unmet needs before designing, planning, and implementing an interventional rehabilitative health care program, especially when focusing on issues of sexuality. A developed framework can be applied by the rehabilitation team during initial caregiving and can be continued as long as needed. 相似文献14.
Cheng-Yang Hsieh Hsiu-Chen Huang Darren Philbert Wu Chung-Yi Li Meng-Jun Chiu Sheng-Feng Sung 《Archives of physical medicine and rehabilitation》2018,99(6):1042-1048.e6
Objective
To determine the relation between rehabilitation intensity and poststroke mortality.Design
Retrospective cohort study.Setting
Nationwide claims data.Participants
From Taiwan's National Health Insurance claims databases, patients (N=6737; mean age, 66.9y; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled.Interventions
The intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the number of rehabilitation sessions.Main Outcome Measures
Long-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates.Results
Patients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR], .73; 95% confidence interval [CI], .63–.84) of mortality than the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR, 0.94; 95% CI, 0.84–1.06) compared with the low-intensity group. This association was not modified by stroke severity.Conclusions
Among patients with mild to moderate stroke severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk than low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of patients with stroke should be encouraged. 相似文献15.
Hsin-Yu Chiang Wen-Shian Lu Wan-Hui Yu I-Ping Hsueh Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(8):1499-1506
Objective
To examine the interrater and intrarater reliability of the Balance Computerized Adaptive Test (Balance CAT) in patients with chronic stroke having a wide range of balance functions.Design
Repeated assessments design (1wk apart).Setting
Seven teaching hospitals.Participants
A pooled sample (N=102) including 2 independent groups of outpatients (n=50 for the interrater reliability study; n=52 for the intrarater reliability study) with chronic stroke.Interventions
Not applicable.Main Outcome Measures
Balance CAT.Results
For the interrater reliability study, the values of intraclass correlation coefficient, minimal detectable change (MDC), and percentage of MDC (MDC%) for the Balance CAT were .84, 1.90, and 31.0%, respectively. For the intrarater reliability study, the values of intraclass correlation coefficient, MDC, and MDC% ranged from .89 to .91, from 1.14 to 1.26, and from 17.1% to 18.6%, respectively.Conclusions
The Balance CAT showed sufficient intrarater reliability in patients with chronic stroke having balance functions ranging from sitting with support to independent walking. Although the Balance CAT may have good interrater reliability, we found substantial random measurement error between different raters. Accordingly, if the Balance CAT is used as an outcome measure in clinical or research settings, same raters are suggested over different time points to ensure reliable assessments. 相似文献16.
MoCA Domain Score Analysis and Relation to Mobility Outcomes in Dysvascular Lower Extremity Amputees
Courtney Frengopoulos Michael W. Payne Ricardo Viana Susan W. Hunter 《Archives of physical medicine and rehabilitation》2018,99(2):314-320
Objective
To investigate the association between cognitive functioning, as measured by the Montreal Cognitive Assessment (MoCA), and functional outcomes upon discharge from prosthetic rehabilitation.Design
Retrospective chart audit.Setting
Rehabilitation hospital.Participants
Consecutive admissions (N=130; mean age, 66.21±11.19y) with lower extremity amputation of dysvascular etiology.Interventions
Not applicable.Main Outcome Measures
Cognitive status was assessed using the MoCA. The L Test of Functional Mobility (L Test) and the 2-minute walk test were used to estimate functional mobility and walking endurance.Results
In multivariable linear regression analysis, those who scored 2 on the visuospatial/executive functioning (out of 5) and language (out of 3) domains had statistically shorter distances walked on the 2-minute walk test than did those who scored the highest on these MoCA domains. These values were not clinically relevant. Time to complete the L Test for those who scored the lowest on the MoCA domains of visuospatial/executive functioning and delayed recall and 3 on the attention domain (out of 6) was significantly longer than that for those who scored the highest.Conclusions
Individuals with lower extremity amputation have an increased risk of cognitive impairment related to amputation etiology. Lower levels of functioning on MoCA domains of visuospatial/executive functioning, delayed recall, and attention were shown to negatively relate to the rehabilitation outcome of functional mobility, as measured by the L Test. 相似文献17.
Shih-Chieh Lee Yi-Jing Huang Gong-Hong Lin Yeh-Tai Chou Chia-Yeh Chou Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(2):306-313
Objective
To develop a computerized adaptive test of social functioning (Social-CAT) for patients with stroke.Design
This study contained 2 phases. First, a unidimensional item bank was formed using social-related items with sufficient item fit (ie, infit and outfit mean square [MNSQ]). The social-related items were selected from 3 commonly used patient-reported quality-of-life measures. Items with differential item functioning (DIF) of sex were deleted. Second, we performed simulations to determine the best set of stopping rules with both high reliability and efficiency. The participants' responses to the items were extracted from a previous study.Setting
Rehabilitation wards and departments of rehabilitation/neurology of 5 general hospitals.Participants
Patients (N=263) with stroke (47.1% were inpatients).Interventions
Not applicable.Main Outcome Measure
Social-CAT.Results
The unidimensionality of the 24 selected items was supported (infit and outfit MNSQs =0.8–1.2). One item had DIF of sex and was deleted. The item bank was composed of the remaining 23 items. With the best set of stopping rules (person reliability ≥.90 or limited reliability increased ≤.001), the Social-CAT used on average 10 items to achieve sufficient reliability (average person reliability =.88; 81.0% of the patients with reliability ≥.90).Conclusions
The Social-CAT appears to be a unidimensional measure with acceptable reliability and efficiency, and it could be useful for both clinicians and patients in time-pressed clinical settings. 相似文献18.
Emilio Portaccio Azzurra Morrocchesi Anna Maria Romoli Bahia Hakiki Maria Pia Taglioli Elena Lippi Martina Di Renzone Antonello Grippo Claudio Macchi 《Archives of physical medicine and rehabilitation》2018,99(5):914-919
Objectives
To evaluate the prognostic utility of serial assessment on the Coma Recovery Scale–Revised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving a severe brain injury.Design
Prospective cohort study.Setting
An intensive rehabilitation unit.Participants
Patients (N=110) consecutively admitted to the intensive rehabilitation unit. Inclusion criteria were (1) a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) caused by an acquired brain injury, and (2) aged >18 years.Interventions
All patients underwent clinical evaluations using the Italian version of the CRS-R during the first month of hospital stay.Main Outcome Measures
Behavioral classification on the CRS-R and the score on the Glasgow Outcome Scale (GOS) at final discharge. Patients transitioning from UWS to MCS or emergence from MCS (E-MCS), and from MCS to E-MCS were classified as patients with improved responsiveness (IR).Results
After a mean ± SD hospital stay of 5.3±2.7 months, 59 of 110 patients (53.6%) achieved IR. In the multivariable analysis, a higher CRS-R score change at week 4 (odds ratio =1.99; 95% confidence interval [CI], 1.49–2.66; P<.001) was the only significant predictor of IR at discharge. Fifty-three patients (48.2%) were classified as severely impaired at discharge (GOS=3). In the multivariable analysis, higher GOS scores were related to a higher CRS-R score at admission (B=.051; 95% CI, .027–.074; P<.001), a higher CRS-R score change at week 4 (B=.087; 95% CI, .064–.110; P<.001), and an absence of severe infections (B=–.477; 95% CI, –.778 to –.176; P=.002).Conclusions
An improvement on the total CRS-R score and on different subscales across the first 4 weeks of inpatient rehabilitation discriminates patients who will have a better outcome at discharge, providing information for rehabilitation planning and for communication with patients and their caregivers. 相似文献19.
Zhongqiu Hong Minghong Sui Zhiqiang Zhuang Huihua Liu Xiuyuan Zheng Chuanping Cai Dongmei Jin 《Archives of physical medicine and rehabilitation》2018,99(5):1011-1022.e1
Objective
To investigate the effectiveness of neuromuscular electrical stimulation (NMES) with or without other interventions in improving lower limb activity after chronic stroke.Data Sources
Electronic databases, including PubMed, EMBase, Cochrane Library, PEDro (Physiotherapy Evidence Database), and PsycINFO, were searched from the inception to January 2017.Study Selection
We selected the randomized controlled trials (RCTs) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with a control group of no electrical stimulation treatment.Data Extraction
The primary outcome was defined as lower limb motor function, and the secondary outcomes included gait speed, Berg Balance Scale, timed Up and Go, 6-minute walk test, Modified Ashworth Scale, and range of motion.Data Synthesis
Twenty-one RCTs involving 1481 participants were identified from 5759 retrieved articles. Pooled analysis showed that NMES had a moderate but statistically significant benefit on lower limb motor function (standard mean difference 0.42, 95% confidence interval 0.26–0.58), especially when NMES was combined with other interventions or treatment time within either 6 or 12 weeks. NMES also had significant benefits on gait speed, balance, spasticity, and range of motion but had no significant difference in walking endurance after NMES.Conclusions
NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors. These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities. 相似文献20.
Cynthia Gagnon Isabelle Lessard Bernard Brais Isabelle Côté Caroline Lavoie Matthis Synofzik Jean Mathieu 《Archives of physical medicine and rehabilitation》2018,99(9):1747-1754