The influence of age on length of stay,functional independence and discharge destination of rehabilitation inpatients in Italy

Advanced age in itself does not predict a poor functional outcome or a longer length of stay in rehabilitation units. Seven hundred and sixty-four adult cases were analysed, from 14 post-acute rehabilitation facilities throughout Italy. Data came from the national database run by the agency distributing the Italian version of an internationally validated scale of disability, the FIM©^sm (Functional Independence Measure). The FIM is an 18-item scale rating independence in the domains of selfcare, sphincter control, mobility, locomotion, communication and social cognition. The total FIM score may range from 18 to 126 (higher score = greater independence). Patients were classified with respect to the cut-off age of 75 years (76+ and 75?, mean age 82 and 57 years, n = 203 and 561, 27% and 73% of the cases, respectively). The median interval between onset of disability and admission to the facility (onset-to- admission delay, OAD) was 36 and 45 days in the 76+ and the 75? group, respectively (p < 0.001). Mean admission FIM score was 70 (±28) in the 76+ and 71 (±27) in the 75? group. Discharge FIM scores were 84±29 and 93±26, respectively (p < 0001). Median length of stay (LOS) was 34 days in the 76+ and 41 days in the 75? group, respectively (p < 0.005). The 76+ and 75? groups were discharged home in 86% and 90% of the cases, respectively (p = 0.053). The results suggest that inpatient rehabilitation is substantially effective and efficient for older as well as for younger patients.     

Stroke impairment predictors of discharge function, length of stay, and discharge destination in stroke rehabilitation

OBJECTIVES: This article presents analytic results from a prospective study of 313 stroke rehabilitation patients, looking at the relative contributions of different stroke impairments toward prediction of discharge function, rehabilitation length of stay, and discharge destination after inpatient rehabilitation. The relationship between number of stroke risk factors and recurrence of strokes during rehabilitation was also evaluated. METHODS: A total of 313 subjects were enrolled consecutively. Information on type of stroke and individual stroke-related impairment was collected prospectively. Recurrent stroke, rehabilitation length of stay, discharge destination, discharge function, and available family support at discharge were documented. RESULTS: Rates of impairment occurrence and coexistence are presented. Analysis using linear (length of stay, discharge function) and logistic (discharge destination) regression revealed significant contributory predictive effects of admission balance, aphasia, number of impairments, and family support on length of stay; admission balance and number of impairments on discharge function; and admission balance, body neglect, and presence of family support on discharge destination. CONCLUSION: In addition to admission function and balance, other factors to consider in predicting length of stay for patients should include the number of stroke-related impairments and family support. For discharge destination prediction, the presence of body neglect should be considered in addition to balance and family support. Evaluation of patients for right-sided neglect and left-sided neglect is important.     

心理干预对脑卒中后抑郁神经功能康复的影响

目的：探讨心理干预对脑卒中后抑郁状态及神经功能康复的影响。方法：将80例脑卒中后抑郁患者随机分成观察组和对照组,观察组采取心理干预加常规护理,对照组单用常规护理方法。采用汉密顿抑郁量表（HAMD）、神经功能缺损评分（NFA）、日常生活活动能力（ADL）测定,分别对两组患者进行疗效评价。结果：3个月的干预后,观察组患者HAMD及NFA均明显低于对照组;ADL评分则明显高于对照组（均P〈0.05）。结论：心理干预不仅有助于改善脑卒中后抑郁患者的抑郁状态,而且对神经功能的康复有促进作用。     

职业治疗对住院慢性精神分裂症患者康复效果的影响

目的：探讨职业治疗对长期住院慢性精神分裂症患者社会功能与康复效果的影响。方法将80例长期住院的慢性精神分裂症患者随机分为两组,两组均接受常规药物治疗及常规康复训练,在此基础上职业治疗组转入康复科接受职业治疗,观察6个月。采用阳性与阴性症状量表、住院精神病人社会功能评定量表、Morningside康复状态量表评定临床效果。结果治疗后职业治疗组阳性与阴性症状量表阴性症状分、Morningside康复状态量表总分显著低于对照组（P＜0．05或0．01）,住院精神病人社会功能评定量表评分显著高于对照组（P＜0．01）。结论职业治疗融合传统农艺治疗能有效改善慢性精神分裂症患者的阴性症状,提高社会功能及康复效果。     

A narrative review of the impact of medical comorbidities on stroke rehabilitation outcomes

Purpose: Medical comorbidities in stroke patients influence acute mortality, but may also affect participation of survivors in rehabilitation. There is limited research investigating the impact of comorbidities on stroke rehabilitation outcomes. The review will explore the literature on the impact of comorbidities on stroke rehabilitation outcome.

Materials and methods: The literature was searched systematically, including MEDLINE database, EMBASE and PsychINFO, combining variations of the terms stroke, rehabilitation and comorbidities. Results were limited to English language publications. Included studies had a functional outcome.

Results: Twenty relevant articles were identified. Fifteen small prospective or large retrospective studies using global comorbidity scales produced conflicting relationships between comorbidities and rehabilitation outcomes. Five publications addressed specific comorbidities, with three studies finding negative correlation between diabetes and rehabilitation outcomes, although effects diminished with age. In general, there were discrepancies in how comorbidities were identified. Few studies specifically focused on comorbidities and/or rehabilitation outcomes.

Conclusions: There is conflicting evidence regarding the impact of comorbidities on stroke rehabilitation outcomes. However, the presence of more severe diabetes may be associated with worse outcomes. The role of comorbidities in stroke rehabilitation would be best clarified with a large cohort study, with precise comorbidity identification measured against rehabilitation specific outcomes.

• Implications for rehabilitation

• Benefit of rehabilitation after stroke in improving functional outcome is well-established.

• Many stroke patients have comorbid conditions which can impact rehabilitation participation, leading to less benefit obtained from rehabilitation.

• The burden of comorbid conditions may slow rehabilitation progress, which may warrant a longer duration of rehabilitation to obtain required functional gain to be discharged into the community.

     

微信在缺血性脑卒中患者院外康复护理中的应用及效果

目的探讨微信在缺血性脑卒中患者院外康复护理中的应用方法及效果。方法87例缺血性脑卒中出院患者完成此研究,其中,能接受微信平台干预的为试验组(45例),其余为对照组(42例)。出院后,对照组通过电话随访接受院外康复护理,试验组在电话随访的基础上通过微信平台接受院外康复护理。在干预前、干预3个月和干预6个月时,用慢性病管理自我效能量表、改良巴氏指数量表对患者进行调查,并统计试验组应用微信平台的数据。结果干预3个月和干预6个月时,试验组慢性病管理自我效能和日常生活能力得分均高于同期对照组(P<0.05)。微信康复指导内容阅读次数中排名前三位为疾病相关知识、恢复期和软瘫期康复训练指导。微信咨询内容中排名前三位为康复训练指导、疾病预防知识及危险因素和疾病紧急处理方案。结论基于微信平台的院外康复护理能更好地提高缺血性脑卒中患者慢性病管理自我效能和日常生活能力。     

强化康复训练对脑卒中后偏瘫痉挛状态的影响

目的：研究强化康复训练对脑卒中后偏瘫痉挛状态的治疗效果。方法：将44例脑卒中后肢体痉挛患者随机分为两组。一组为常规康复训练组，一组为强化康复训练组，两组患者均给予常规剂量巴氯芬121服。采用Ashworth分级法（ASS）、Fugl—Meyer评定法（FMA）和改良Barthel指数评分法（MBI）对2组患者治疗前、后肌张力，肢体运动功能及生活自理能力进行评定。结果：治疗后2组患者肌张力较治疗前均有明显降低（P〈0．01），肢体运动功能和ADL能力较治疗前有明显提高（P〈0．01），强化康复训练组疗效明显优于常规康复训练组（P〈0．05）。结论：强化康复训练对脑卒中所致偏瘫肌痉挛有更加显著的改善作用。     

Influence of medical comorbidities and complications on FIM change and length of stay during inpatient rehabilitation

OBJECTIVE: This study was performed to evaluate the influence of medical problems on functional outcome measures of patients admitted for comprehensive inpatient rehabilitation. DESIGN: In this retrospective database review of patients, demographic information, length of stay, FIM scores at admission and discharge, and FIM efficiency were collected and analyzed. Preexisting comorbidities and acute medical complications of all patients were identified, tabulated, and analyzed. RESULTS: A total of 175 patients were categorized into three major groups. In the postorthopedic surgery group, the presence of preexisting medical comorbidities did not significantly affect admission or discharge FIM scores. In contrast, traumatic brain injury patients with preexisting medical comorbidities had a tendency to be admitted and discharged with lower FIM scores. However, traumatic brain injury patients with acute medical complications still made reasonable functional improvement during their extended stay, so that their FIM efficiency was adequately maintained. In the cerebrovascular accident group, almost all patients had preexisting medical issues. CONCLUSIONS: The rehabilitation population is diverse, and functional outcome measures for distinct disease entities may be differentially affected by factors such as preexisting medical comorbidities and acute medical complications. Except for life-threatening medical emergencies, rehabilitation patients may benefit by staying on the acute rehabilitation unit, where both medical management and a comprehensive rehabilitation program are provided with continuity.     

早期康复治疗对急性脑卒中运动功能恢复的影响

探讨早期康复治疗对急性脑卒中偏瘫患者发病1个月时运动功能恢复的影响。方法:将57例脑卒中患者随机分为康复组和对照组。于发病后7—23天,对康复组30例脑卒中患者,用以Bobath为主的运动疗法进行康复训练,至病后1个月时结束,对照组27例脑卒中患者不接受康复训练。两组药物治疗基本相同。用Fugl-Meyer运动功能评定法(FMA)评定患者的运动功能;用脑卒中患者临床神经功能缺损程度评分标准(ND)评定患者的病情严重程度。结果:康复治疗前后康复组与对照组比较肌张力差异均无显著性(P>0.05);康复治疗前、后ND的差值康复组与对照组比较差异有显著性(P=0.01),康复治疗后,康复组神经功能缺损程度明显减轻;康复治疗前、后FMA评分的差值,康复组与对照组比较,上肢差异有显著性(P<0.05),下肢差异无显著性(P>0.05)。结论:脑卒中发病1个月内,早期短期的康复治疗,可降低临床神经功能缺损积分,提高患者的上肢运动功能。     

早期康复治疗对急性脑卒中患者运动功能的影响

目的 :探讨早期康复治疗对脑卒中偏瘫患者一个月后运动功能的影响。方法 :12 9例脑卒中偏瘫患者随机分成治疗组 (74例 )和对照组 (5 5例 )进行了临床对照性研究 ,两组均常规进行神经内科的药物治疗 ,治疗组加以运动疗法和电疗等康复治疗方法 ,并对每例患者在进入课题时和一个月后测试两次Fugl-Meyer运动功能 (FMA)。 结果 :治疗组两次评价分别为 4 .94± 4 .5 4、10 .6 0± 5 .2 0 ,对照组为 7.5 6± 6 .36、10 .2 7± 6 .5 7;两组前后比较均有高度显著性差异 ;两组的变化均数比较治疗组一个月后运动功能能力恢复优于对照组 (P <0 .0 0 1)。结论 :早期综合康复治疗对患者一个月后的运动功能能力具促进的作用 ,可明显降低患者的功能障碍 ,提高其生存质量     

早期康复护理干预用于中风患者的效果及对其运动功能恢复的影响

目的探讨早期康复护理干预用于中风患者的效果及对其运动功能恢复的影响。方法选取84例中风患者并按数字表法分为对照组和观察组,各42例,对照组患者采用一般护理方法,观察组患者采用早期康复护理干预。比较2组患者的干预后效果,干预前后ADL评分及Fuel-Meyer评分的变化。结果观察组护理后的总有效率(90.48%)高于对照组护理后的总有效率(66.67%),差异具有统计学意义(P0.05);观察组干预后的ADL评分(69.54±11.25)分和Fuel-Meyer评分(67.15±8.69)分高于对照组ADL评分(43.84±9.55)分和Fuel-Meyer评分(41.59±6.58)分,差异具有统计学意义(P0.05)。结论中风患者采用早期康复护理干预的效果显著,可以有效提高患者的日常生活能力和肢体的活动力,加快患者康复,提高生活质量。     

Skilled nursing facility rehabilitation and discharge to home after stroke

OBJECTIVE: To determine the relation between rehabilitation therapy (RT) intensity and time to discharge home for stroke patients in skilled nursing facilities (SNFs). DESIGN: Retrospective cohort study. We used regression analyses, stratified by expected outcome, and propensity score adjustment. Setting All SNFs in Ohio, Michigan, and Ontario, Canada. PARTICIPANTS: A cohort of residents, aged 65 and over, admitted from hospitals to SNFs with a diagnosis of stroke (N=23,824). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Time to discharge home from an SNF. RESULTS: RT was given to more than 95% of residents for whom discharge was expected within 90 days and to more than 60% of residents for whom discharge was uncertain or not expected. RT increased the likelihood of discharge to the community for all groups except those expected to be discharged within 30 days. The dose-response relation was strongest for residents with either an uncertain discharge prognosis or no discharge expected. CONCLUSIONS: Postacute residents with an uncertain prognosis are an important target population for intensive RT.     

脑卒中患者肺功能康复的研究进展

近年来,脑卒中的发病率逐年升高,医院内脑卒中患者人数也持续上涨。急性脑卒中患者的心肺活动能力受限,长期卧床导致排痰功能下降,易引起肺水肿和肺部感染等并发症,对脑卒中患者的转归与康复产生极大阻碍。本文从发病机制对脑卒中相关性肺功能障碍进行了细致全貌分析,系统阐述了其康复治疗的难点,在此基础上优化了脑卒中患者肺功能康复的治疗方法,并对卒中后肺康复治疗的发展指明了方向。     

Prognostic factors of activity limitation and discharge destination after stroke rehabilitation

OBJECTIVE: The aim of this study was to identify predictive variables related to activity limitation and home destination of a large sample of first-time stroke patients at discharge from a rehabilitation hospital. DESIGN: A multicenter observational study was conducted among 1023 first-time stroke patients who were admitted to 18 different Italian inpatient rehabilitation centers between February 1999 and November 2000. Only 997 patients were considered eligible. At admission, sociodemographic and clinical data were considered as independent variables. The outcome measures evaluated the ability to become functionally independent (independence gain [Barthel Index score > or =18]) at discharge and home return. RESULTS: The study data suggest that independence gain is associated with an earlier rehabilitation intervention, being male, and low or absent cognitive deficit. Home return is associated with no indwelling bladder catheterization, no dysphagia, and living with a companion (roommate or family member) before the stroke. CONCLUSIONS: In postacute stroke rehabilitation, level of cognitive impairment, bladder dysfunction and dysphagia, early diagnosis and treatment, early rehabilitation intervention, and living status (whether the person was residing with a companion before the stroke) are important criteria for outcome measurement at the time of admission. These previous characteristics will most certainly provide clinicians with useful information during the acute phase.     

家庭康复指导对脑卒中患者日常生活能力的影响

目的探讨脑卒中家庭康复指导对脑卒中患者日常生活能力的影响。方法选取经神经内科治疗病情处于恢复期的脑卒中出院患者40例,随机分成实验组与对照组,实验组进行家庭康复指导,对照组进行常规出院指导,两组分别在出院时和4周后进行巴氏评分。结果干预前实验组巴氏评分（48．0±22．734）分,4周后实验组巴氏评分明显提高为（73．0±21．909）分,其中个人卫生、上厕所、穿脱衣服、上下床或椅子4项与对照组比较差异有统计学意义。结论患者病情稳定出院后,仍有康复潜能,持续、科学、易懂的家庭生活指导可以提高患者的日常生活能力。     

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。