The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting

OBJECTIVE: To examine the utility of the Berg Balance Scale (BBS) in predicting length of stay and discharge destination for patients admitted to a stroke rehabilitation unit. DESIGN: Retrospective study. SETTING: Regional tertiary inpatient stroke rehabilitation unit. PATIENTS: One hundred twenty-eight of 141 patients admitted consecutively between January 1, 1995, and March 31, 1996. MAIN OUTCOME MEASURES: Length of stay and discharge destination. RESULTS: Admission BBS scores and Functional Independence Measure scores correlated with length of stay (r = -0.6 and -0.5, respectively, controlling for age). Logistic regression revealed that the following were independent predictors of being discharged home rather than to an institution (adjusted odds ratio, 95% confidence interval): admission BBS (1.09, 1.04-1.13), age (.89, .83-.95), and presence of family support (11.7, 3.1-44.3). CONCLUSIONS: Measuring the BBS scores of patients upon admission to an acute stroke rehabilitation unit may assist in approximating length of stay and predicting eventual discharge destination.     

中文版躯干损伤量表评定脑卒中患者躯干功能的信度及效度研究

目的:探讨中文版躯干损伤量表(TIS)评定脑卒中患者躯干功能的信度及效度,为该量表的临床应用提供客观依据。方法:病例组和对照组各50例参加了本研究,病例组进行TIS、Fugl-Meyer中的平衡部分(FM-B)和Berg平衡量表(BBS)评定,并在2天内完成TIS第二次评定;对照组进行1次的TIS和FM-B评定。将两次TIS的结果做相关性分析测试其信度;将TIS结果与FM-B、BBS作相关性分析检验其效度。结果:TIS两次测试结果高度相关,重测信度组内相关系数(ICC)为0.899-0.971,测量者间ICC为0.843-0.973;TIS与FM-B、BBS总分高度相关(r=0.891,r=0.858);病例组和对照组的TIS总分分别为21.7±1.3分和13.5±4.3分,两者间差异具有显著性(P<0.01)。结论:中文版TIS具有良好的效度、信度和区分度,可用于脑卒中患者躯干功能的评价。     

Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study

OBJECTIVE: To assess and to compare the reliability of the Modified Tardieu Scale with the Modified Ashworth Scale in patients with severe brain injury and impaired consciousness. DESIGN: Cross-sectional observational comparison study. SETTING: An early rehabilitation centre for adults with neurological disorders. SUBJECTS: Thirty patients with impaired consciousness due to severe cerebral damage of various aetiologies. MEASUREMENT PROTOCOL: Four experienced physical therapists rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, hip, knee and ankle spasticity were assessed by the use of Modified Tardieu Scale and Modified Ashworth Scale data collection procedures. MAIN OUTCOME MEASURES: Test-retest and inter-rater reliability (kappa = kappa value) of the Modified Tardieu Scale and the Modified Ashworth Scale. RESULTS: The test-retest reliability of the Modified Ashworth Scale was moderate to good (kappa = 0.47-0.62) and of the Modified Tardieu Scale moderate to very good (kappa = 0.52-0.87). Test-retest reliability was significantly higher within the Modified Tardieu Scale in comparison with the Modified Ashworth Scale (Z > 1.96; p < 0.05) except for shoulder extensor and internal rotator muscles (Z < 1.96; p > 0.05). Although inter-rater reliability of both scales was poor to moderate (Modified Ashworth Scale: kappa = 0.16-0.42; Modified Tardieu Scale: kappa = 0.29-0.53), significantly higher K-values were revealed with the Modified Tardieu Scale for all tested muscle groups (Z > 1.96; p < 0.05) except for wrist extensors (Z < 1.96; p > 0.05). CONCLUSION: In patients with severe brain injury and impaired consciousness the Modified Tardieu Scale provides higher test retest and inter-rater reliability compared with the Modified Ashworth Scale and may therefore be a more valid spasticity scale in adults.     

The Falls-Efficacy Scale,Swedish version: does it reflect clinically meaningful changes after stroke?

Purpose : The overall aim of this prospective investigation was to evaluate the ability of the Falls Efficacy Scale (Swedish version) (FES(S)) to reflect clinically meaningful changes over time. Method : Changes on the FES(S) scale were compared with changes in two different standardized measures of observer-assessed balance, the Berg Balance Scale (BBS), the Fugl-Meyer balance subscale (FMB), and of motor function and ambulation in 62 stroke patients. Assessments took place on admission for rehabilitation, at discharge and 10 months after the stroke. Indices of effect size were used to evaluate responsiveness of the instruments. Three time periods were studied: admission to discharge (early response), discharge to 10 month follow-up (late response) and admission to follow-up (overall response). Results : The main findings are that the FES(S) is as responsive as BBS and FMB in detecting changes during the early and overall response periods. Changes in FES(S) scores between admission and discharge correlated significantly with changes in observer-assessed balance, motor function and ambulation scores. Conclusions : The present results suggest that measurement of perceived confidence in task performance using the FES(S) scale is responsive to improvement in patients with hemiparesis at an early stage after stroke.     

The Falls-Efficacy Scale,Swedish version: does it reflect clinically meaningful changes after stroke?

Purpose : The overall aim of this prospective investigation was to evaluate the ability of the Falls Efficacy Scale (Swedish version) (FES(S)) to reflect clinically meaningful changes over time.

Method : Changes on the FES(S) scale were compared with changes in two different standardized measures of observer-assessed balance, the Berg Balance Scale (BBS), the Fugl-Meyer balance subscale (FMB), and of motor function and ambulation in 62 stroke patients. Assessments took place on admission for rehabilitation, at discharge and 10 months after the stroke. Indices of effect size were used to evaluate responsiveness of the instruments. Three time periods were studied: admission to discharge (early response), discharge to 10 month follow-up (late response) and admission to follow-up (overall response).

Results : The main findings are that the FES(S) is as responsive as BBS and FMB in detecting changes during the early and overall response periods. Changes in FES(S) scores between admission and discharge correlated significantly with changes in observer-assessed balance, motor function and ambulation scores.

Conclusions : The present results suggest that measurement of perceived confidence in task performance using the FES(S) scale is responsive to improvement in patients with hemiparesis at an early stage after stroke.     

Relationship between usual physical, cognitive and social activities and functional recovery at hospital discharge after acute stroke.

OBJECTIVE: To assess the relationship between lifestyle prior to the event and functional recovery at hospital discharge after acute stroke. DESIGN: Cohort study. PATIENTS: A sample of 191 patients with first stroke episode (87.4% ischaemic). METHODS: Severity of the event at admission was measured by the Modified National Institutes of Health Stroke Scale. The Frenchay Activity Index was used to evaluate the patients' previous lifestyles. Functional recovery was assessed using the Modified Rankin scale on discharge from hospital. A Rankin score < or = 2 was the main outcome. RESULTS: At discharge, 37.2% of the patients were functionally independent. A receiver operating characteristic curve analysis established a value of > or = 18 on the Frenchay Activity Index scale as the best cut-off point to predict favourable outcome (specificity 62%; 95% confidence interval (CI) 54-69% and a sensibility of 60%; 95% CI 49-69%) with an area under the curve of 0.65 (95% CI 0.57-0.71). There was a positive association between Frenchay Activity Index > or = 18 and a Rankin score < or = 2, after controlling for potential confounders (odds ratio 2.62; 95% CI 1.21-5.66; p = 0.001). CONCLUSION: This result emphasizes the protective effect of mental, physical and social activity for the prevention of functional damage after an acute cerebrovascular event.     

Outcomes during and after inpatient rehabilitation: comparison between adults and older adults.

OBJECTIVE: To compare changes on biopsychosocial variables between adults (< 65 years) and older adults (> or = 65 years) during and after an inpatient rehabilitation program. DESIGN: Comparative study. PARTICIPANTS: A total of 165 people 18 years and over admitted to an inpatient rehabilitation unit. METHODS: The participants were evaluated 3 times: at admission and discharge and 3 months later. Outcome measures were: Functional Autonomy Measurement System (SMAF), Modified Mini-Mental State Examination, Trail Making Test, Motor-Free Visual Perceptual Test, Visual Analogue Scale (VAS), Berg Balance Scale (BBS), Timed Up and Go (TUG), Jamar dynamometer, and General Well-being Schedule (GWBS). RESULTS: Both groups improved significantly between admission and discharge on the SMAF, BBS, TUG, VAS, Jamar dynamometer and GWBS. Although scores on many of the outcome measures differed at admission, the 2 groups improved similarly during rehabilitation. After 3 months, stability or a slight improvement was observed for both groups; however, younger participants improved more on mobility, balance, walking and grip strength. CONCLUSION: Although older participants had more disabilities at admission, they benefited as much as younger people from an intensive rehabilitation program with a comparable length of stay. However, younger participants continued to improve 3 months later.     

Specificity of functional mobility measures in older adults after hip fracture: a pilot study

OBJECTIVE: To determine the relationships between measures of functional mobility (Timed Up and Go [TUG], Self-Paced Walking [SPW], Berg Balance Scale [BBS]) and global functional status (FIM trade mark instrument), the motor component of the FIM instrument (motor FIM), and the mobility/locomotor-specific FIM component (ML-FIM) in older patients admitted to an inpatient rehabilitation program after hip fracture. DESIGN: The TUG, SPW, BBS, and FIM instrument were administered within 24 hr after admission and before discharge to 20 patients undergoing inpatient rehabilitation after a hip fracture. RESULTS: Significant correlations at admission were found between FIM and TUG scores (r = -0.47; p < 0.05), TUG and motor FIM (r = -0.45; p < 0.05), TUG and ML-FIM (r = -0.58; p < 0.01), FIM and BBS (r = 0.60; p < 0.01), motor FIM and BBS (r = 0.50; p < 0.05), and ML-FIM and BBS (r = 0.45; p < 0.05). At discharge, a significant correlation was found between the motor FIM and SPW (r = -0.49; p < 0.05). Change scores between both the motor FIM and ML-FIM and TUG scores were significantly correlated (r = -0.47, p < 0.05, r = -0.50, p < 0.05, respectively). CONCLUSIONS: The FIM instrument, motor FIM, and ML-FIM may not be specific measures of functional mobility in patients with hip fracture.     

Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation

OBJECTIVE: To assess the criterion-related validity of the Berg Balance Scale (BBS) in subjects with Parkinson's disease (PD). DESIGN: Prospective, correlational analysis between the BBS and accepted measures of PD motor and functional impairment. SETTING: The federally funded PD research center, an interdisciplinary center of excellence for people with PD within a Veterans Affairs medical center. PARTICIPANTS: Thirty-eight men (average +/- standard deviation, 71.1+/-10.5 y) with confirmed PD. Their initial diagnosis had been made on average 5.8+/-3.6 years earlier. All could stand or walk unassisted and had mild to moderate disability. Patients who could not ambulate without assistive devices were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Correlational analyses between the BBS and the Unified Parkinson's Disease Rating Scale (UPDRS) motor scale, Modified Hoehn and Yahr Staging (Hoehn and Yahr) Scale, and the Modified Schwab and England Capacity for Daily Living Scale (S&E ADL Scale). RESULTS: BBS score showed significant correlations with indicators of motor functioning, stage of disease, and daily living capacity. BBS score was inversely associated with the UPDRS motor score (-.58, P <.005), Hoehn and Yahr Scale staging (-.45, P <.005), and S&E ADL Scale rating (.55, P <.005). In all 3 correlations, lower scores on the BBS (indicating greater balance deficits) correlated with higher UPDRS scores (indicating greater motoric or functional impairment). CONCLUSIONS: Results support the criterion-related validity of the BBS. Its utility in other balance conditions of older adults has been established. Rehabilitation interventions have been shown to improve the balance deficits associated with PD. Early referral and periodic reassessment is vital to achieving and maintaining improvements. Our research results agree with other published research in suggesting that the BBS may be used as a screening tool and ongoing assessment tool for patients with PD.     

The modified Rivermead Mobility Index: validity and reliability

Purpose : This paper presents the evaluation of the following psychometric properties of the Modified Rivermead Mobility Index (MRMI): face/content validity, responsiveness, testretest reliability, inter-rater reliability and internal consistency. This mobility scale represents a further development of the Rivermead Mobility Index (RMI). In its new form the scoring was adapted from a two-point to a six-point scale. The number of test items was reduced from fifteen to eight items in order to measure mobility-related items that physiotherapists consider being essential for demonstrating treatment effects in patients following a stroke. Method : A consensus exercise with forty-two physiotherapists attending a stroke care conference established face/content validity. Inter-rater and test-retest reliability were examined by assessing thirty patients by two independent raters selected from a pool of eight physiotherapists in two different settings, an elderly care unit and a stroke rehabilitation unit. All patients were hospitalised and had experienced a stroke within the past six weeks. Responsiveness was examined by calculating the effect size statistic on the admission and discharge score of sixteen acute patients following stroke. Results : The results showed that the modified RMI was: responsive to change (effect size = 1.15), stable when tested on two occasions (paired t-test = 0.732; p 0.47), highly reliable between raters (ICC = 0.98; p<0.001) with high internal consistency (Cronbach's alpha = 0.93). Conclusions : These results suggest that when using the Modified RMI to assess patients in the early stages following stroke, similar results can be obtained by different raters, regardless of experience. However there needs to be a difference of more than 4.5 points (degree of measurement error at 95% confidence level) in the overall score to detect true changes in the patient's level of mobility.     

The modified rivermead mobility index: validity and reliability

PURPOSE: This paper presents the evaluation of the following psychometric properties of the Modified Rivermead Mobility Index (MRMI): face/content validity, responsiveness, test-retest reliability, inter-rater reliability and internal consistency. This mobility scale represents a further development of the Rivermead Mobility Index (RMI). In its new form the scoring was adapted from a two-point to a six-point scale. The number of test items was reduced from fifteen to eight items in order to measure mobility-related items that physiotherapists consider being essential for demonstrating treatment effects in patients following a stroke. METHOD: A consensus exercise with forty-two physiotherapists attending a stroke care conference established face/content validity. Inter-rater and test-retest reliability were examined by assessing thirty patients by two independent raters selected from a pool of eight physiotherapists in two different settings, an elderly care unit and a stroke rehabilitation unit. All patients were hospitalised and had experienced a stroke within the past six weeks. Responsiveness was examined by calculating the effect size statistic on the admission and discharge score of sixteen acute patients following stroke. RESULTS: The results showed that the modified RMI was: responsive to change (effect size = 1.15), stable when tested on two occasions (paired t-test = 0.732; p = 0.47), highly reliable between raters (ICC = 0.98; p < 0.001) with high internal consistency (Cronbach's alpha = 0.93). CONCLUSIONS: These results suggest that when using the Modified RMI to assess patients in the early stages following stroke, similar results can be obtained by different raters, regardless of experience. However there needs to be a difference of more than 4.5 points (degree of measurement error at 95% confidence level) in the overall score to detect true changes in the patient's level of mobility.     

Virtual TeleStroke Support for the Emergency Department Evaluation of Acute Stroke

OBJECTIVES: Telemedicine-enabled acute stroke consultation (TeleStroke) may be useful to determine eligibility for treatment with tissue plasminogen activator (tPA) and provide support to emergency departments without on-site stroke expertise. METHODS: Emergency physicians consulted with stroke neurologists via two-way videoconferencing in the evaluation of patients with possible acute stroke. History, neurologic examination, and computed tomography of the head were reviewed to determine eligibility for treatment with tPA. Interpretations of computed tomography were compared for inter-rater reliability between the neurologist and the neuroradiologist using a conventional workstation. Videotape and written records were analyzed to determine time intervals, patient management, and user satisfaction. RESULTS: The authors reviewed data from 24 patients evaluated over 27 months at an island-based hospital. The mean National Institutes of Health Stroke Scale score was 5.7 (range, 0-22). Fifteen patients arrived at the emergency department less than three hours after symptom onset; 12 were presented for TeleStroke consultation within three hours after symptom onset. Eight of these 12 (75%) had acute ischemic stroke, and six of these eight potentially eligible patients (75%) received intravenous tPA. There was very good agreement among all remote readers for detecting the one case of imaging exclusion (subdural hemorrhage). There were no protocol violations, and a mean (+/- SD) consult-to-needle time of 36 (+/- 15) minutes and door-to-needle time of 106 (+/- 22) minutes was achieved. Transfer was avoided in 11 patients. Physicians believed that TeleStroke consultation improved care in >95% of the cases. CONCLUSIONS: TeleStroke videoconferencing can support emergency department-based evaluation of acute stroke and may facilitate tPA delivery in neurologically underserved facilities. A prospective, randomized trial is needed to determine if these systems are superior to traditional telephone consultation.     

Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke

OBJECTIVE: To assess the relative responsiveness of 2 commonly used upper-extremity motor scales, the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA), in evaluating recovery of upper-extremity function after an acute stroke in patients undergoing inpatient rehabilitation. DESIGN: Prospective. SETTING: An acute stroke rehabilitation unit. PARTICIPANTS: One hundred four consecutive admissions (43 men, 61 women; mean age +/- standard deviation, 72+/-13y) to a rehabilitation unit 16+/-9 days after acute stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The following assessments were completed within 72 hours of admission and 24 hours before discharge: ARAT, upper-extremity motor domain of the FMA, National Institutes of Health Stroke Scale, FIM instrument total score, and FIM activities of daily living (FIM-ADL) subscore. RESULTS: The Spearman rank correlation statistic indicated that the 2 upper-limb motor scales (ARAT, FMA) correlated highly with one another, both on admission (rho = .77, P < .001) and on discharge (rho = .87, P < .001). The mean change in score from admission to discharge was 10+/-15 for the ARAT and 10+/-13 for the FMA motor score. The responsiveness to change as measured by the standard response mean was .68 for the ARAT and .74 for the FMA motor score. The Spearman rank correlation of each upper-limb motor scale with the FIM-ADL at the time of admission was as follows: ARAT, rho equal to .32 (P < .001) and FMA motor score, rho equal to .54 (P < .001). CONCLUSIONS: Both the FMA motor score and the ARAT were equally sensitive to change during inpatient acute rehabilitation and could be routinely used to measure recovery of upper-extremity motor function.     

Assessing reliability and validity of the Chinese version of the stroke scale: scale development

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is a systematic, 15-point evaluation tool, designed to assess neurological deficit in acute stroke patients and written in English. It is used to support important medical and nursing decisions. OBJECTIVES: To translate the NIHSS into Chinese and establish its psychometric properties using Chinese evaluators. DESIGN: Methodological research design. SETTING: One medical centre. Participants: Using convenience sampling, 48 subjects admitted with acute ischemic stroke were selected. METHODS: In this study, six clinicians from the Department of Neurology (3 nurses, 3 doctors) assessed the 48 patients using the C-NIHSS, the Glasgow Coma Scale and the Barthel index. RESULTS: The C-NIHSS content validity index reached 1.00, and the Cronbach's alpha coefficient for internal consistency was 0.92. Of the 15 scale items, two (facial palsy and limb ataxia) had low inter-rater values (k values below 0.39). Kappa (kappa) values were substantial (over 0.60) for all other items. The C-NIHSS has a significantly negative correlation with both Glasgow Coma Scale (r = -0.824, p < 0.01), and Barthel index (r = -0.683, p < 0.01) scores. CONCLUSIONS: The C-NIHSS is a reliable and valid scale for the clinical assessment of neurological deficit in acute stroke patients.     

坐立试验评价脑卒中患者平衡功能的研究

目的：以5次坐立试验（five—times—sit—to—stand test，FTSST）评定脑卒中患者平衡功能，并与其他平衡量表比较，探讨其临床应用的稳定性和相关因素。方法：按条件选择脑卒中患者66例（实验组）和正常人63例（对照组）。采用5次坐立试验、BBS评定、FM—B评定、Barthel指数和步行速度进行测试，对脑卒中患者和正常人两组资料进行比较分析。结果：实验组与对照组之间5次坐立试验时间的差异均有非常显著性意义（P〈0．01）。实验组患者中5次坐立试验时间与BBS评定、FM—B评定、Barthel指数及步行速度之间的相关系数分别为-0．873（P〈0．01）、-0．826（P〈0．011、-0．740（P〈0．01）、-0．876（P〈0．01）。结论：FTSST临床评测脑卒中患者平衡功能的稳定性好，方法简便实用，干扰因素少，可用于临床评定脑卒中患者的平衡功能。     

Inter-rater reliability of the Barthel Index, the Activity Index, and the Nottingham Extended Activities of Daily Living: The use of ADL instruments in stroke rehabilitation by medical and non medical personnel

This investigation addressed the question whether non-medical personnel could produce similar ratings to physicians when applying ADL scales. A sports scientist was trained in the assessment of stroke patients with the Barthel Index, the Activity Index and the Nottingham Extended Activities of Daily Living Scale. He and a rehabilitation physician assessed 20 stroke patients in first in-patient rehabilitation with these instruments. Measurements of inter-rater reliability were calculated for scores, subscales and single items, and for the latter also rater correspondence. Inter-rater reliability was good to excellent for all scores and subscales (ICC: 0.82-0.99). Reliability and correspondence was good to excellent for the items of the Barthel Scale, satisfactory to excellent for those of the Activity Index. Some 25 % of the items of the Nottingham Extended Activities of Daily Living revealed unsatisfactory reliability but still high inter-rater correspondence. Results indicate that physicians and non-medical personnel are able to apply these scales reliably to stroke patients.     

Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital

[Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment received, ictus onset, hospitalization time, discharge date, and date of first evaluation at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was utilized to measure functional incapacity with the individuals divided into two groups, before and after acute stroke unit implementation (2010). Functional incapacity was compared between before and after acute stroke unit implementation by the Mann-Whitney test, χ² test and Fisher’s exact test. [Results] The medical records of 170 patients were evaluated. In the group evaluated after 2010, the patients were significantly older and presented a shorter time between hospitalization and discharge, shorter time until the first evaluation in rehabilitation, and increased percentage of mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit implementation, the patients treated in the rehabilitation section presented a shorter hospitalization time and rehabilitation delay and less functional incapacity.Key words: Stroke, Acute stroke unit, Rehabilitation outcome     

The Orpington Prognostic Scale for patients with stroke: reliability and pilot predictive data for discharge destination and therapeutic services

PURPOSE: To determine the inter-rater and test-retest reliability of the Orpington Prognostic Scale (OPS) in patients with stroke. Pilot data were gathered to evaluate its predictive validity for discharge destination and therapeutic services required on discharge.METHOD: Ninety-four consecutive patients, admitted to hospital due to stroke participated. Pairs of physiotherapists (PT) and occupational therapists (OT) assessed patients using the OPS on days 7 and 14 post stroke. For inter-rater reliability, one rater performed the OPS while the other observed, each scoring the scale independently. For test-retest reliability, two different raters tested the subjects separately within the same day. Data were gathered on the discharge destination and the number of follow-up services prescribed.RESULTS: The inter-rater reliability as measured by the intraclass correlation coefficient (ICC) was 0.99 (95% CI 0.97 - 0.99). For test-retest reliability, the ICC was 0.95 (95% CI 0.90 - 0.98). The accuracy for predicting discharge to home using OPS 5.0 was 65% (95% CI 0.52 - 0.76). OPS scores were not related to number of follow-up services prescribed.CONCLUSIONS: Despite high inter-rater and test-retest reliability, the OPS has limited predictive accuracy for discharge destination and is a poor predictor of follow-up services.     

Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients

OBJECTIVE: To analyze survival, mortality, and long-term functional disability outcome and to determine predictors of unfavorable outcome in critically ill patients admitted to a neurologic intensive care unit (neuro-ICU). DESIGN: Retrospective cohort study with post-neuro-ICU health-related evaluation of functional long-term outcome. SETTING: Ten-bed neuro-ICU in a tertiary care university hospital. PATIENTS: A consecutive cohort of 1,155 patients admitted to a neuro-ICU during a 36-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 1,155 consecutive patients, of whom 41% were women, were enrolled in the study. The predominant reasons for neuro-ICU care were cerebrovascular diseases, such as intracerebral hemorrhage (20%), subarachnoid hemorrhage (16%), and complicated, malignant ischemic stroke (15%). A total of 213 patients (18%) died in the neuro-ICU. The Glasgow Outcome Scale and modified Rankin scale were dichotomized into two groups determining unfavorable vs. favorable outcome (Glasgow Outcome Scale scores 1-3 vs. 4-5 and modified Rankin scale scores 2-6 vs. 0-1). Factors associated with unfavorable outcome in the unselected cohort according to logistic regression analysis were admission diagnosis, age (p < .01), and a higher score in the simplified Therapeutic Intervention Scoring System (TISS-28) at time of admission (p < .01). Functional long-term outcome was evaluated by telephone interview for 662 patients after a median follow-up of approximately 2.5 yrs by evaluating modified Rankin scale and Glasgow Outcome Scale scores. Factors associated with unfavorable functional long-term outcome were admission diagnosis, sex, age of >70 yrs (odds ratio, 8.45; 95% confidence interval, 4.52-15.83; p < .01), TISS-28 of >40 points at admission (odds ratio, 4.05; 95% confidence interval, 2.54-6.44; p < .01), TISS-28 of >40 points at discharge from the neuro-ICU (odds ratio, 3.50; 95% confidence interval, 1.51-8.09; p < .01), and length of stay (odds ratio, 1.01; 95% confidence interval, 1.00-1.03; p = .02). CONCLUSION: We found admission diagnosis, age, length of stay, and TISS-28 scores at admission and discharge to be independent predictors of unfavorable long-term outcome in an unselected neurocritical care population.     

FES辅助踏车与MOTOmed智能训练系统对早期脑卒中患者下肢功能的对比研究

目的:探讨功能性电刺激(FES)辅助踏车对脑卒中偏瘫患者早期下肢运动功能以及日常生活活动能力的影响。方法:将早期脑卒中偏瘫患者40例随机分为观察组和对照组各20例。2组均采用常规个体化康复治疗,观察组加用FES踏车进行治疗,对照组给予MOTOmed下肢踏车治疗。治疗前后分别采用功能性步行分级量表(FAC)、Tinetti量表、Berg平衡量表、Fugl-Meyer评分法(FMA)及改良Barthel指数(MBI)进行评估。结果:治疗6周后,2组FAC等级较治疗前均有显著提高(P0.01),2组间比较差异无统计学意义。治疗后,2组Tinetti量表、FMA下肢评分、MBI及BBS评分均较治疗前明显提高(P0.01),且观察组高于对照组(P0.05,0.01)。结论:FES辅助踏车系统和MOTOmed智能训练系统均有助于脑卒中早期下肢功能的恢复,而FES辅助踏车系统对下肢功能的改善效果优于MOTOmed智能训练系统。