Evaluation of stroke patients with the extended activities of daily living scale in Taiwan

Purpose : This study examined the construct validity of the Nottingham Extended Activities of Daily Living scale (EADL) in stroke patients in Taiwan. Methods : The EADL and the Barthel Index were administered via telephone interview. Minor revisions were made for the EADL to reflect cultural differences and the recommendations of two previous studies on the use of EADL. One hundred and fifty three stroke patients from the community participated in the study. Results : Two items, 'make hot snack' and 'write letters', were deleted from the EADL because they appeared to be of little discriminative value. The results suggest that a changed hierarchical order was present among the domestic and leisure subscales. All of the subscales, then, fulfilled the Guttman scaling criteria (coefficient of reproducibility < 0.9, coefficient of scalability < 0.6). The scores of the revised EADL were significantly related to age and the Barthel Index scores (Spearman correlation coefficients 0.41 and 0.69, respectively, p < 0.001). There was no significant difference between the overall scores of men and women (median = 10, 10, respectively, Mann-Whitney U test, p < 0.67). Conclusion : These data support the validity of the EADL with minor modifications in the evaluation of the functional performance in stroke patients in Taiwan and confirm it to be a useful outcome measure in stroke research.     

影响脑卒中偏瘫患者日常生活能力恢复的因素分析

目的:分析脑卒中偏瘫患者治疗前后影响日常生活活动能力(activitiesofdailyliving,ADL)的相关因素。方法:对53例脑卒中偏瘫患者治疗前后进行上下肢功能、ADL等相关因素评定。结果:影响入院前ADL(ADL0)的正性因素包括肌张力、治疗前下肢运动能力,负性因素为年龄、尿便失禁、入院前居住地及发病次数。治疗后ADL(ADL1)的正性因素有ADL0和病变性质,而患肢腱反射的亢进或减弱和发病后住院时间则是ADL1预后的负性因素。家庭人数与ADL1恢复程度呈负相关(r=-0.527,n=53)。结论:肌张力和患肢腱反射是影响患者ADL恢复的有利因素;家庭人数多是ADL恢复的阻碍因素,提示对家属进行康复意识的教育非常必要。     

延伸护理对脑卒中患者日常生活能力和生活质量的影响

目的 探讨延伸护理对脑卒中患者日常生活能力(ADL)和生活质量的影响。 方法 选取脑卒中患者128例,按随机数字表法分为对照组和研究组各64例。对照组给予常规出院宣教及出院后电话随访,研究组进行延伸护理服务。采用改良Barthel指数评定量表(MBI)及生活质量综合评定问卷评定患者的ADL以及生活质量。 结果 ①出院后2、4、6个月时2组患者MBI均呈现上升趋势,且研究组MBI变化更明显,时间因素和分组因素对MBI的影响均有统计学意义(F_时间=446.781,P<0.01;F_分组=49.384,P<0.01)。出院6个月时研究组日常生活活动能力优于对照组(Z=-2.139,P<0.05)。②出院6个月时2组生活质量各维度评分与出院时比较均有明显增高,且研究组的躯体功能指数、生理功能指数和社会功能指数明显高于对照组(t=11.893,P<0.01; t=12.034,P<0.01; t=8.230,P<0.01)。 结论 延伸护理服务可以改善脑卒中患者的ADL和生活质量。     

影响脑卒中患者日常生活活动能力预后的相关因素分析

目的：探讨脑卒中偏瘫患者治疗前后影响日常生活活动（ADL）能力的相关因素。方法：选择可能对脑卒中患者临床预后有影响的因素，以入院康复治疗1个月后改良Barthel指数为标准，进行回顾性和多因素分析。入选病例为17例脑卒中偏瘫患者。结果：康复治疗1个月后患者的ADL能力主要与治疗前的ADL能力呈正相关。与年龄、发病天数、肺部感染、尿路感染、关节挛缩等呈负相关。结论：并发症的发生是脑卒中患者ADL能力恢复的主要影响因素。提示要积极预防并发症，并对患者的家属和护理人员进行康复护理教育。同时强调早期康复治疗对于促进脑卒中患者ADL能力的恢复是十分重要的。     

Correlation of perceptual performance and activities of daily living in stroke patients

Twenty-five male stroke patients were assessed with the use of a battery of perceptual tests (Gross Visual Skills [Baum, 1981]. Adult Visual-Perceptual Assessment [Baylor University Medical Center, Occupational Therapy Department, 1980], Manikin and Feature Profile subtests of the Arthur Point Scale of Performance Tests [Arthur, 1943; Buros, 1974, 1978], Judgment of Line Orientation [Benton, Varney, & DeS. Hamsber, 1978], Bender Visual Motor Gestalt Test [Bender, 1946], Haptic Visual Discrimination Test [McCarron & Dial, 1976, 1979a, 1979b], Block Design and Object Assembly subtests of the Wechsler Adult Intelligence Scale-Revised [Wechsler, 1981], and Test of Three-Dimensional Constructional Praxis [Benton, 1973a; Benton & Fogel, 1962]). Also administered was the Klein-Bell ADL Scale (Klein & Bell, 1982) to measure performance of activities of daily living. The research questions were as follows: (a) To what extent did this sample of stroke patients differ from the nomative samples on perceptual performance? (b) To what extent did any tests of perceptual performance correlate with performance of activities of daily living? and (c) What, if any, instruments were more useful in discriminating the perceptual performance of stroke patients from that of normative samples? The results indicated that stroke patients showed significant deficits in perceptual performance, some of which correlated with activities of daily living performance. Patients with right hemispheric lesions performed similarly to those with left hemispheric lesions except on the Haptic Visual Discrimination Test.     

Validation of the advanced activities of daily living scale

The objective was to evaluate the metric properties of the List of Advanced Activities of the Daily Living. A study quantitative was conducted. The sample comprised 200 older adults from the city of Pouso Alegre, Brazil. The following instruments were employed: 1- Questionnaire sociodemographic and health; 2- Vitor Quality of Life Scale for the Elderly (VITOR QLSE); and 3 - List of Advanced Activities in Daily Life – AAVDs. It was verified through the exploratory factorial analysis that the list possesses three denominated domains of Activities of Leisure, Social Activities and Productive Activities. The three-factor solution explained 58.18% of total variance: 30% by the first factor, 18.03% by the second, and 10.14% by the third. The coefficient alpha for the overall scale was 0.80. The list of AADLs presented reliable and valid metric properties to be applied in the elderly.     

The Lawton instrumental activities of daily living scale

By detecting early functional decline, the scale can help nurses with discharge planning. OVERVIEW: Acute illness or a worsening chronic condition can hasten functional decline in older adults. During hospitalization, reduced mobility and other factors may rapidly decrease an older patient's ability to perform activities crucial for independent living, and the effects might be permanent. The Lawton Instrumental Activities of Daily Living (IADL) Scale assesses a person's ability to perform tasks such as using a telephone, doing laundry, and handling finances. Measuring eight domains, it can be administered in 10 to 15 minutes. The scale may provide an early warning of functional decline or signal the need for further assessment. For a free online video demonstrating use of this assessment, go to http://links.lww.com/A246.     

日常生活活动能力量表在脑卒中康复临床使用情况的调查

目的:了解日常生活活动能力量表在我国脑卒中康复临床的应用情况现状.方法:采用分层非随机抽样的方法,于2013年3月-4月问卷调查国内几大省会城市设有康复科的三甲医院从事脑卒中康复临床工作的66位康复医生和162位康复治疗师.结果:在脑卒中康复临床中日常生活活动(ADL)量表使用率分别是:改良Barthel指数＞FIM＞ Lawton IADL＞FAI.其中不同岗位调查对象的量表使用率分别为:PT治疗师＞康复医师＞ST治疗师＞OT治疗师.基础性日常生活活动(BADL)量表无论使用率还是总体认可度上都优于工具性日常生活活动(IADL)量表(P＜0.05).量表临床使用与康复医师和治疗师对量表的认可度有关,其中量表自身各方面的优缺点是影响其在脑卒中康复临床推广应用的内在影响因素之一.结论:工具性日常生活能力量表尚未在脑卒中康复临床得到普遍应用,提示目前脑卒中临床更偏重于基础性日常生活能力康复,而疏于患者工具性生活能力康复.     

早期康复介入对重症脑卒中患者日常生活活动能力的影响

目的观察早期康复护理干预在重症脑卒中患者护理服务中的效果。方法将2009年9月--2011年4月收治的30例脑卒中患者作为对照组,2011年5月--2012年12月进行早期康复护理的31例脑卒中患者作为观察组,比较2组患者日常生活能力恢复情况及患者、家属对护理服务的满意度。结果观察组患者ADL评分显著高于对照组（P〈0．01）,观察组患者及家属对护理工作的满意度与对照组比较有统计学差异（P〈O．01）。结论开展早期康复护理干预能明显改善患者ADL的能力,同时能提高患者及家属对护理工作的满意度。     

A comparison of the responsiveness of the Nottingham extended activities of daily living scale,London handicap scale and SF-36

Purpose : Clinical trials require scales which are sensitive to the effects of intervention. This study examined the sensitivity to change of three generic health status measurement scales commonly used in evaluations of interventions in chronic, disabling disease. Methods : Questionnaires comprising the SF-36, London Handicap Scale and Nottingham Extended Activities of Daily Living scale were administered to 81 patients before and after hip replacement. Changes were quantified as 'effect sizes'. Results : Eighty nine per cent of patients reported improvements three months after surgery. The largest changes were seen on the SF-36 pain scale (effect size 1.2 at three months, 1.5 at 6-12 months), physical function (1.1, 1.3) and role limitation - physical (0.8, 1.2) scales. The London Handicap Scale also measured large changes (effect sizes 0.6, 0.9), but the Extended Activities of Daily Living scale was insensitive to change (effect sizes 0.1, 0.2). Conclusions : Some of the SF-36 dimensions were very sensitive to change. The London Handicap Scale was also reasonably responsive, and has the advantage of being a single, utility-based, score. The simpler Extended ADL score was poorly responsive.     

护理日常生活活动能力量表的效度分析

目的 检测护理日常生活活动能力（ＡＤＬ）量表的效度。方法 回顾分析了２５例住院康复患,中风１８例,脑外伤７例,记录入院、出院时护理ＡＤＬ量表左、右侧ＡＤＬ分（ＬＡＤＬ、ＲＡＤＬ）,偏瘫侧ＡＤＬ分（ＨＥＭＩＡＤＬ）、非偏瘫侧ＡＤＬ分（ＮＨＥＭＩＡＤＬ）,并记录其功能独立测量（ＦＩＭ）、巴塞尔指数（ＢＩ）、Ｆｕｇｌ－Ｍｅｙｅｒ脑卒中运动功能评分９ＦＵＧＬ）、简易精神状态检查分（ＭＭＳＥ）、住院时间（     

A comparison of the responsiveness of the Nottingham extended activities of daily living scale, London handicap scale and SF-36

Purpose: Clinical trials require scales which are sensitive to the effects of intervention. This study examined the sensitivity to change of three generic health status measurement scales commonly used in evaluations of interventions in chronic, disabling disease. Methods: Questionnaires comprising the SF-36, London Handicap Scale and Nottingham Extended Activities of Daily Living scale were administered to 81 patients before and after hip replacement. Changes were quantified as 'effect sizes'. Results: Eighty nine per cent of patients reported improvements three months after surgery. The largest changes were seen on the SF-36 pain scale (effect size 1.2 at three months, 1.5 at 6-12 months), physical function (1.1, 1.3) and role limitation - physical (0.8, 1.2) scales. The London Handicap Scale also measured large changes (effect sizes 0.6, 0.9), but the Extended Activities of Daily Living scale was insensitive to change (effect sizes 0.1, 0.2). Conclusions: Some of the SF-36 dimensions were very sensitive to change. The London Handicap Scale was also reasonably responsive, and has the advantage of being a single, utility-based, score. The simpler Extended ADL score was poorly responsive.     

Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke

Lu W-S, Chen CC, Huang S-L, Hsieh C-L. Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke.ObjectiveTo estimate the smallest real difference (SRD) values of 2 instrumental activities of daily living measures (the Nottingham Extended Activities of Daily Living [NEADL] and the Frenchay Activities Index [FAI]) in patients with chronic stroke.DesignTest-retest reliability study.SettingPhysical rehabilitation units of 5 hospitals.ParticipantsChronic stroke patients (N=52; 37 men, 15 women) who were discharged from the hospital for more than 6 months.InterventionsNot applicable.Main Outcome MeasuresBoth measures were administered twice about 2 weeks apart to participants. The SRD was calculated on the basis of standard error of measurement: SRD = 1.96 × √2 × Standard error of measurement. SRD% (the value of SRD divided by total score of a measure) was used to compare measurement errors across both measures. Reproducibility between successive measurements of the measures was investigated with intraclass correlation coefficients (ICCs).ResultsThe SRD (SRD%) values of the NEADL and the FAI were 12.0 (21.1%) and 6.7 (14.9%), respectively. Test-retest reproducibility of both measures was high (ICC: NEADL=.89, FAI=.89).ConclusionsBecause of substantial SRD values of the NEADL and the FAI, prospective users should be cautious in using both measures to detect real change for a single subject.     

Well-being and instrumental activities of daily living after stroke

OBJECTIVE: To explore the relationship between subjective well-being and competence in instrumental activities of daily living after stroke. DESIGN: Cross-sectional with evaluation at six months post stroke. SUBJECTS: Eighty-two patients admitted to an acute stroke unit, of whom 64 were seen at six months. The mean age was 77.5 years, 55% were females and 55% were living alone. MAIN OUTCOME MEASURES: The General Health Questionnaire (GHQ-20 version), a well-being scale, was factor analysed and yielded three dimensions, named 'coping', 'anxiety' and 'satisfaction' that served as main outcomes. RESULTS: Explanatory variables were the four subscales of the Nottingham IADL scale, the Ullevaal Aphasia Screening test, urinary continence and demographics. Structural equation modelling showed that the GHQ dimension 'satisfaction' related significantly to the Nottingham subscale 'leisure activities' (beta = -0.38, p = 0.01), whereas 'coping' was indirectly associated with 'leisure activities' by its correlation with 'satisfaction' (R = 0.26, p = 0.01). None of the outcomes were statistically associated with aphasia, continence or the background variables. CONCLUSION: 'Leisure activities' demonstrated the strongest association to subjective well-being as expressed by the 'satisfaction' dimension. In stroke rehabilitation leisure activities should be addressed when assessing function and planning intervention.     

The relationship of cognitive skills performance to activities of daily living in stroke patients

This article reports on two studies that examine the relationship between measurements of activities of daily living (ADL) and cognitive skills performance. Study 1 is a post hoc analysis of ADL improvement scores collected on acute stroke patients who were either given or not given cognitive skills remediation. An examination of individual ADL scores showed significantly higher personal hygiene, bathing, and toilet activity improvement scores for patients receiving cognitive skills remediation. In Study 2, cognitive skills and ADL pre- and posttest scores for stroke patients were measured by occupational therapists, who also implemented an ADL as well as a cognitive skills remediation program as part of the patient's therapy. Some significant positive correlations between initial cognitive skills measurements and ADL outcome were found. The best correlate of patients' ADL performance at discharge was performance on an auditory attention task. Verbal comprehension correlated with overall ADL improvement, and overall cognitive skills improvement correlated with overall ADL improvement. Implications of these two studies are discussed.     

基于家庭的延伸康复护理对脑卒中患者日常活动能力及神经功能的影响

目的探究脑卒中患者开展基于家庭的延伸康复护理对其日常活动能力及神经功能的影响,并为这类群体提供优质医疗服务积累实战经验。方法选取本院神经外科2013年6月-2014年5月收治的48例临床痊愈出院的脑卒中患者,设为对照组,本组患者仅给予每月1次的电话追踪随访,了解患者康复状况并解答家属护理过程中的疑惑;另选取本院神经外科2014年5月-2015年5月收治的临床痊愈出院的50例脑卒中患者,设为观察组,开展家庭康复护理,每周1次,持续6个月。8周后分别对两组患者进行脑卒中残损量表(SIAS)及日常活动能力(ADL)测评,并进行对比。结果干预前两组患者的各项脑卒中残损量表评分及日常活动能力评分差异无统计学意义(P0.05),干预后观察组患者的运动功能恢复情况、肌张力恢复情况及总分都明显高于对照组,差异有统计学意义(P0.05);干预后观察组患者日常活动能力得分明显优于对照组,差异有统计学意义(P0.05)。结论基于家庭的延伸康复护理能提高脑卒中患者的活动能力,强化患者自我护理的的信心,最大限度恢复神经功能。     

神经促通技术联合针刺对脑卒中偏瘫患者日常生活活动能力的影响

目的：探讨神经促通技术配合针刺对脑卒中偏瘫患者日常生活活动能力（ADL）的影响。方法：将96例脑卒中患者随机分为3组,A组（针刺+神经促通组）32例,B组（单纯针刺组）32例, C组（单纯神经促通组）32例,采用改良Barthel指数分别于治疗前、治疗后30d、60d进行评分。结果：治疗30d后,各组指标均有所提高,治疗后60d后,各组得分继续增高,A组得分增加最多,且A组明显优于B组和C组(P<0.01),B、C组之间比较差异无显著性(P>0.05)。结论：神经促通技术配合针刺能提高脑卒中患者日常生活活动能力,其疗效优于单纯神经促通技术或单纯针刺。     

早期康复护理干预对脑卒中偏瘫患者日常生活活动能力的影响

目的:探讨早期康复护理干预对脑卒中偏瘫患者日常生活活动能力(ADL)的影响。方法:将118例脑卒中偏瘫患者随机分为康复组和对照组各59例,对照组按神经内科护理常规进行护理,康复组由责任护士按护理程序实施系统化早期康复护理干预,包括基础护理、心理护理、早期患肢康复锻炼、语言功能锻炼、吞咽功能锻炼、日常生活能力训练。采用Barthel指数对两组患者干预前后ADL进行评定比较。结果:两组干预后Barthel指数均较干预前明显升高(P<0.01),康复组干预后Barthel指数明显高于对照组(P<0.01)。结论:早期康复护理干预能提高脑卒中偏瘫患者ADL,降低致残率,改善生活质量。     

社区康复对脑卒中患者运动功能和日常生活活动能力的影响

目的：探讨影响社区脑卒中患者运动功能和日常生活活动能力康复效果的相关因素。方法：282例脑卒中患者随机分为社区康复组172例和对照组110例，社区康复组进行康复治疗和随访，对照组只进行随访。于入组和治疗5个月后，应用Barthel指数（BI）、临床神经功能缺损评分量表（NIM）对两组患者进行评定。结果：治疗5个月后，社区康复组和对照组的NIM和ADL评分比较，康复组效果优于对照组（P〈0．05）。新病例康复组和既往病例康复组NIM和ADL评分比较，新病例组优于既往病例组（P〈0．05）。结论：社区康复治疗对提高患者运动功能和ADL的恢复作用显著：社区康复治疗介入时间越早对患者运动功能和ADL恢复的作用越明显。