Racial disparities in outcomes of inpatient stroke rehabilitation

OBJECTIVE: To determine whether race is associated with outcomes of inpatient stroke rehabilitation. DESIGN: Retrospective cohort study. SETTING: A community-based inpatient rehabilitation facility. PARTICIPANTS: Poststroke patients (N=1002) admitted to a community-based inpatient rehabilitation facility between 1995 and 2001. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional improvement at discharge from the rehabilitation facility, discharge disposition, and functional improvement at 3 months after discharge. Inpatient and follow-up data were collected from the facility's electronic patient database. We used the FIM instrument to assess functional status at admission, discharge, and follow-up. RESULTS: In multivariable models, blacks achieved less functional improvement at discharge (-1.9 FIM points, P=.02) compared with whites and, despite worse FIM scores, were more likely to be discharged to home (adjusted odds ratio=1.7; 95% confidence interval, 1.1-2.5). Although Asian-American patients did not differ from whites in terms of functional improvement at discharge or disposition, they had less improvement at 3 months following discharge (-6.3 FIM points, P=.005). CONCLUSIONS: We identified racial disparities in poststroke outcomes in a community-based inpatient rehabilitation facility. Future research in stroke rehabilitation should explore the consistency of these findings across settings and if they are confirmed, identify explanatory mediators to better inform efforts to eliminate racial disparities.     

脑卒中患者生存质量的影响因素分析

目的 了解脑卒中患者的生存质量（QOL）及其影响因素。方法 将80例脑卒中偏瘫患者随机分成康复组（40例）及对照组（40例），2组均常规给予神经内科药物治疗，康复组同时还加用运动疗法、作业疗法及言语治疗等综合治疗措施，2组患者经6个月相应治疗后，采用世界卫生组织生存质量评定量表简表（WHOQOL—BREF）中文版对其QOL进行评定，同时对影响QOL的各种因素进行分析、比较。结果 2组患者经治疗后，其QOL均有不同程度的提高，且康复组疗效优于对照组；logestic回归分析表明，影响脑卒中患者QOL的主要因素包括年龄、患病到治疗的时间、职业、早期康复治疗以及婚姻状况等。结论 早期康复治疗有利于改善急性脑卒中患者的QOL水平。     

护理干预对提高中风患者生活质量的效果观察

目的探讨提高中风患者生活质量的护理方法。方法将50例中风患者随机分为对照组23例和实验组27例,对照组给予针灸内科常规护理,实验组在此基础上给予心理护理和康复训练。结果两组患者治疗护理后日常生活活动(ADL)能力和贝克抑郁量表(BDI)评分均有好转,但实验组疗效明显优于对照组(P<0.05)。结论实施针对性心理护理和康复训练可明显提高中风患者的治疗效果。     

综合康复医疗对脑卒中患者生活质量的影响

将符合入选标准的患者随机分为康复治疗组及对照组，同时应用自编的符合心理测量学特征的《脑卒中患者生活质量量表》对两组患者脑卒中前后进行评定，同时应用评估ＢａｒｔｈｅｌＡＤＬ指数，收集相关临床症状和体征，随后，治疗组接受综合康复医疗，对照组不接受康复医疗。治疗时间３个月，３个月后再用同样量表对两组患者进行评定。结果表明：康复医疗可以改善脑卒中患者的生活质量；多元回归分析显示：患者的生活质量与患者的年龄、躯体后遗症的有无、心理障碍的有无呈现一定关系。     

Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke

OBJECTIVE: To evaluate the effectiveness of a distributed version of constraint-induced movement therapy (CIMT). DESIGN: Within-subjects control intervention study. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Eleven persons with chronic stroke. All had active extension of at least 20 degrees at the wrist and at least 10 degrees for each finger of the more-affected hand. INTERVENTIONS: Intensive motor training of the more-affected arm for 3 hours a day for 20 days; restraint of the other arm for 9.3 hours daily to limit its use. This intervention provides the same amount of training as provided in the conventional CIMT therapy protocol (60 h) but distributes training time over twice the number of days. MAIN OUTCOME MEASURES: Real-world (Motor Activity Log) and laboratory motor activity (Wolf Motor Function Test, Frenchay Arm Test, Nine Hole Peg Test), strength (grip force) and spasticity (Ashworth Scale), and quality of life (QOL; Stroke Impact Scale) were assessed. RESULTS: Participants showed significant improvements in more-affected arm real-world motor activity, laboratory motor activity, strength and spasticity, as well as in some aspects of QOL, up to 6 months after treatment ( P .05). CONCLUSIONS: Distributed CIMT is a promising intervention for improving motor function and QOL in patients with chronic stroke.     

The effect of the introduction of a case-mix-based funding model of rehabilitation for severe stroke: an Australian experience

OBJECTIVE: To compare resource use of, and outcomes for, rehabilitation for severe stroke before and after the implementation of the Casemix and Rehabilitation Funding Tree case-mix-based funding model. DESIGN: Prospective, observational cohort study. SETTING: Eight inpatient rehabilitation centers in Australia. PARTICIPANTS: Consecutive sample of 609 patients with severe stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation length of stay (LOS), discharge destination, and FIM instrument motor score at discharge. RESULTS: The average rehabilitation LOS changed significantly between the preimplementation year and the implementation year (Mann-Whitney U, P=.001). There were no significant differences in discharge destination. FIM motor score at discharge showed significant reduction in improvement (Mann-Whitney U, P=.001) between the preimplementation year and the implementation year. There were no significant correlations between LOS in rehabilitation and gain in function for either the preimplementation year (Spearman rho, P=.07) or the implementation year (P=.15). CONCLUSIONS: The change in funding model was associated with a decrease in inpatient costs and with an associated increase in disability at discharge. Our results suggest that the rate of improvement in severe stroke is variable; also, they support the use of funding models for stroke rehabilitation that allow flexibility in resource allocation.     

设立专职康复护士对脑卒中偏瘫患者生活质量的影响

目的 探讨设立专职康复护士对脑卒中偏瘫患者生活质量的影响.方法 对 64 例脑卒中患者采用常规治疗的基础上,专职康复护士给予康复护理干预.在入院时及康复护理干预后12周,用生存质量指数量表、改良Barthel指数、汉密尔顿抑郁量表 17 项进行测评.结果 康复护理干预后12周,患者生活质量指数、改良Barthel指数显...     

多学科协作干预在脑卒中合并痛风发作患者康复护理中的应用

目的 探讨多学科协作干预模式在脑卒中合并痛风发作患者中的应用效果。 方法 选取2017年5月-2018年5月在某三级甲等综合医院康复科就诊的35例脑卒中合并痛风发作的患者为对照组,给予常规护理干预,选择2018年6月-2019年6月的35例脑卒中合并痛风发作的患者为观察组,在常规护理的基础上接受多学科协作干预,并在干预前及干预后第3、5、7d比较2组日常生活自理能力、疼痛情况,在患者出院时比较2组患者住院天数、住院费用。 结果 2组自理能力和疼痛评分在时间、组间及交互效应上比较均有统计学差异(F_时间=7.612,P=0.025;F_组间=4.521,P=0.032;F_交互=11.443,P＜0.001;F_时间=9.221,P=0.009;F_组间=5.773,P=0.011;F_交互=10.824,P＜0.001);干预后,观察组住院天数、住院费用均低于对照组(t=-7.301,P＜0.001;t=-2.419,P=0.006)。 结论 多学科协作干预模式有利于改善脑卒中合并痛风发作患者痛风症状,促进患者肢体功能的恢复,减轻疼痛,达到让患者回归家庭、回归社会的康复目标。     

Bobath神经发育疗法在脑卒中后幸存者康复训练中的应用

目的探讨在康复护理中运用Bobath神经发育疗法（NDT．Bobath）对缺血性脑卒中后患者步态障碍康复及生活能力的影响。方法将2010年7月至2012年12月收治的168例缺血性脑卒中幸存患者按入院时间分为对照组和观察组,每组各84例,对照组给予常规康复治疗及康复护理,观察组除常规康复治疗、护理外,同时运用NDT-Bobath,分别采用步行速度、步行节律、步幅长度、下肢运动功能评定简式Fugl—Meyer评分（FMA）、日常生活能力Barthel指数（BI）对患者治疗前后及NDT—Bobath前后患者运动及生活能力进行评分,并进行分析比较。结果治疗前两组患者的步行速度、步行节律、步幅长度、FMA及BI评分比较,差异均无统计学意义（P〉0．05）。治疗6周后,观察组步行速度、步行节律、步幅长度、FMA及BI评分分别为（0．716±0．398）m／s,（85．3±18．5）步／min,（1．748±O．598）m,（62．5±19．7）分,（ss．1±22．4）分,优于对照组的（O．564±0．358）m／s,（77．8±18．7）步／min,（1．514±0．545）m,（45．8±16．6）分,（36．4±18．1）分,差异有统计学意义（t分别为2．602,2．613,2．651,5．941,6．906;P〈0．01）。结论在缺血性脑卒中后患者康复治疗及护理中运用NDT．Bobath能提高患者步态障碍的恢复及Et常生活质量。     

健康干预对脑卒中患者生存质量的影响

目的：探讨健康干预对脑卒中患者的生存质量的影响。方法以112例脑卒中患者为研究对象,通过健康教育、康复训练、心理支持、社会支持等进行健康干预。在干预前与干预后3个月、6个月、12个月分别对患者的生存质量进行测量,并统计分析比较。结果两组患者总健康状况、总生存质量、心理领域、生理领域干预前与干预后3个月、6个月、12个月比较差异具有统计学意义（P＜0．001）,且总健康状况、生理及心理领域在干预后之间比较,差异也具有统计学意义（P＜0．01）。社会关系、环境领域干预前与干预后比较,差异无统计学意义（P＜0．05）。结论脑卒中患者的健康教育、康复训练、心理和社会支持影响患者的生存质量。加强对患者的健康干预,可以提高患者的存在质量。     

卒中单元综合治疗对脑卒中患者运动功能康复的影响

目的 观察卒中单元综合治疗对脑卒中患者运动功能康复的影响。方法 在卒中单元中选取290例脑卒中患者，分为早期康复组（A组，184例）和一般治疗组（B组，106例），在武汉市东西湖区医院神经内科普通病房随机选取62例脑卒中患者为普通对照组（C组）。治疗前以及治疗1个月后采用Barthel指数法和Fugl—Meyer法对3组患者的日常生活活动（ADL）能力和运动功能进行评定。结果 治疗前，3组的Barthel和Fugl—Meyer积分相近，差异均无统计学意义（P〉0．05）；治疗1个月后，A组和B组的评分均显著高于C组（P〈0．01），且A组的评分明显高于B组（P〈0．01）。结论 卒中单元综合治疗能有效提高脑卒中患者的运动功能和ADL能力。     

The effect of Tai Chi exercise on motor function and sleep quality in patients with stroke: A meta-analysis

ObjectiveThe meta-analysis is to objectively evaluate the efficacy of Tai Chi exercise for motor function and sleep quality in patients with stroke.MethodsRandomized controlled trials(RCTs) about the effects of Tai Chi versus a non-exercise or conventional rehabilitation exercise control group on motor function and sleep quality in patients with stroke were searched from multiple electronic databases(PubMed, Web of Science, the Cochrane Library, EMBASE, AMED, CBM, CNKI, Wanfang and VIP) until August 2016. Two investigators independently screened eligible studies, extracted data, and assessed the methodological quality by using the quality evaluation criteria for RCTs recommended by Cochrane Handbook. Then meta-analysis was performed by RevMan5.3 software.ResultsA total of 17 RCTs with 1209 participants were included. The meta-analysis indicated that there was a significant difference on improving the balance function(P < 0.001) and ability of daily activity (P = 0.0003) of patients with stroke between Tai Chi group and control group. However, no significant effect was found on Tai Chi for walking function and sleep quality(P > 0.05).ConclusionTai Chi exercise can significantly improve the balance function and ability of daily activities of patients with stroke, and there are no significant differences in walking function and sleep quality. Therefore, lots of multicenter, large-sample, higher quality randomized controlled trials are needed to verify the effects of Tai Chi exercise in improving walking function and sleep quality for patients with stroke.     

康复训练联合药物抗骨质疏松治疗改善脑卒中后偏瘫患者生活质量疗效观察

目的：探讨康复训练联合醋酸钙＋维生素D2＋骨化三醇抗骨质疏松治疗对脑卒中后偏瘫患者生活质量的影响。方法脑卒中后偏瘫患者80例,分为试验组和对照组各40例,两组均进行正规康复训练,试验组并联合使用醋酸钙＋维生素D2＋骨化三醇抗骨质疏松治疗,分别于治疗前及治疗后1月采用健康调查简表（the MOS item short from health survey,SF-36）对两组患者生活质量进行评定。结果治疗1个月后,两组的生活质量均有提高,试验组生理机能、生理职能、躯体疼痛、精力、活力、精神健康方面均高于对照组,差异有统计学意义（ P＜0.05）。结论康复训练可提高偏瘫患者生活质量,在常规康复训练的基础上结合基础抗骨质疏松药物治疗,对于改善脑卒中偏瘫患者患侧肢体的运动功能、躯体疼痛、精神健康方面更为有效,从而提高患者生活质量。     

A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life

OBJECTIVE: To examine the benefits of modified constraint-induced movement therapy (mCIMT) on motor function, daily function, and health-related quality of life (HRQOL) in elderly stroke survivors. DESIGN: Two-group randomized controlled trial, with pretreatment and posttreatment measures. SETTING: Rehabilitation clinics. PARTICIPANTS: Twenty-six elderly stroke patients (mean age, 72 y) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident. INTERVENTIONS: Twenty-six patients received either mCIMT (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for a period of 3 weeks. MAIN OUTCOME MEASURES: Outcome measures included the Fugl-Meyer Assessment (FMA), FIM instrument, Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The FMA evaluated the severity of motor impairment; the FIM instrument and MAL reported daily function; and the SIS detected HRQOL. RESULTS: The mCIMT group exhibited significantly greater improvements in motor function, daily function, and the physical domain of HRQOL than the traditional rehabilitation group. Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group. CONCLUSIONS: These findings suggest mCIMT is a promising intervention for improving motor function, daily function, and physical aspects of HRQOL in elderly patients with stroke. The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program.     

Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke

OBJECTIVE: To examine the relation between left unilateral spatial neglect (USN) and rehabilitation outcomes in patients with right hemisphere stroke. DESIGN: A retrospective analysis of a database of right hemisphere stroke patients. SETTING: Acute inpatient rehabilitation hospital. PARTICIPANTS: Patients (N=175) with a diagnosis of right hemisphere stroke who had undergone a neuropsychologic screening including assessment of USN and depressive symptoms at time of admission to an inpatient rehabilitation program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional status was evaluated with the FIM instrument at admission and discharge. The relationship between USN, depressive symptoms, cognitive functioning, length of stay (LOS), and rate of progress in rehabilitation was examined via univariate (correlational) and multivariate (Cox regression) analyses. RESULTS: Patients with USN had longer LOS and progressed more slowly compared with those without USN. When matched against patients with equally poor functional status at admission, USN patients still had longer admissions and progressed more slowly. CONCLUSIONS: USN is a unique predictor of rehabilitation outcomes in patients with right hemisphere stroke. Identification of those specific functional skill areas most affected by USN may make possible the development of targeted interventions aimed at these key areas.     

Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia

OBJECTIVE: To assess the feasibility of a new stroke rehabilitation therapy for the hemiparetic hand. DESIGN: Case series. Pre- and postintervention assessment with 1- and 3-month follow-ups. SETTING: Clinical research laboratory of a large public hospital. PARTICIPANTS: Three subjects with chronic (>6mo postcerebrovascular accident) upper-extremity hemiplegia. INTERVENTION: Subjects used an electric stimulator to cause the paretic hand extensor muscles to contract and thereby open the hand. Subjects controlled the intensity of the stimulation, and thus the degree of hand opening, by volitionally opening the unimpaired contralateral hand, which was detected by an instrumented glove. For 6 weeks, subjects used the stimulator to perform active repetitive hand-opening exercises 2 hours daily at home and functional tasks 1.5 hours twice a week in the laboratory. MAIN OUTCOME MEASURES: Maximum voluntary finger extension, maximum voluntary isometric finger-extension moment, finger-movement control, and box and block test (BBT) score at pre- and posttreatment and at 1 month and 3 months posttreatment. RESULTS: Maximum voluntary finger extension increased from baseline to end of treatment and from the end of treatment to 1-month follow-up in 2 subjects. Maximum voluntary isometric finger-extension moment, finger-movement control, and BBT score increased from baseline to the end of treatment and from the end of treatment to 1-month follow-up in all 3 subjects. The improvements generally declined at 3 months. CONCLUSIONS: The results suggest a positive effect on motor impairment, meriting further investigation of the intervention.     

Benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke

OBJECTIVE: To analyze the benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation hospital in Japan. PARTICIPANTS: A total of 1056 patients with stroke were divided into 3 groups based on the interval between stroke onset and admission to the rehabilitation hospital: group I, within 90 days (n=507, 48%); group II, 91 to 180 days (n=377, 36%); and group III, more than 180 days (n=172, 16%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcome (A to D; independent to totally dependent) in walking, affected upper extremity, and activities of daily living (ADLs) and discharge disposition. RESULTS: Walking status improved in 70.9% of nonambulatory patients in group I, in 54.8% in group II, and in 43.9% in group III. Similarly, ADLs improved in 66.7% of the totally dependent patients in group I and in approximately 50% in groups II and III. Functional gain in those with a totally nonfunctional upper extremity at admission was poor (29.7%). Initial functional categories affected each outcome (P<.0001). On discharge, 73.8% in group I and approximately 60% in groups II and III went home. CONCLUSION: Approximately half of all patients regained their abilities in walking and ADLs after inpatient multidisciplinary rehabilitation up to 1 year after stroke. However, there was considerable limitation in functional recovery of the affected upper extremity.     

Recovery of standing balance and health-related quality of life after mild or moderately severe stroke

OBJECTIVE: To examine the physiologic and functional recovery of standing balance and health-related quality of life (HRQOL) in people after mild and moderate stroke. DESIGN: Inception cohort study with evaluations at 1 month and 3 months poststroke. SETTING: Laboratory. PARTICIPANTS: Twenty-nine volunteers who had sustained a stroke. Subjects were categorized into mild and moderate groups. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional balance was assessed (Clinical Outcome Variables Scale [COVS]) and physiologic measures (electromyography, postural sway) were taken when subjects stood quietly on a force platform and when they performed a rapid unilateral arm-raise perturbation. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to evaluate HRQOL. RESULTS: Subjects in the mild group were approaching maximal scores on the COVS (87.7+/-4.1/91) at 3 months poststroke, yet had significant impairment in paretic muscle activation patterns when compared with healthy subjects. Subjects in the moderate group had increased paretic muscle activation over the 2 months, accompanied by significant increases of 10.7+/-5.9 points on the COVS. For both groups, there was significantly less postural sway on the paretic than the nonparetic leg and significant improvements in the SF-36 (physical component) over time. CONCLUSIONS: Subjects recovering from a stroke showed a significant improvement in physical HRQOL and functional and physiologic balance, yet the physiologic balance recovery was not complete even in the mild group.