早期康复护理对脑卒中患者生活质量的影响

目的 观察早期康复护理措施对脑卒中患者生活质量的影响。方法 将100例脑卒中患者随机分为常规治疗组和康复护理组，每组50例。康复护理组在常规药物治疗的基础上予早期康复护理；常规治疗组给予常规药物治疗。评定护理前后2组患者神经功能缺损程度、日常生活能力和躯体运动能力得分。运用t检验进行统计学分析。结果 经治疗及护理后，康复护理组神经功能缺损程度评分低于常规治疗组，日常生活能力和躯体运动能力评分均高于常规治疗组。结论 早期康复护理干预有利于脑卒中患者神经功能的改善和日常生活能力及躯体运动能力的恢复。     

影响缺血性脑卒中患者ADL预后的多因素分析

目的:探讨影响缺血性脑卒中患者ADL能力恢复的相关因素,为临床针对性治疗提供依据。方法:对327例确诊的首发缺血性脑卒中患者建立CRF表并记录其各项基本情况。患者出院后随访记录其6个月末时ADL恢复情况。以修订的Barthel指数(MBI)为因变量,以各项可能因素为自变量,进行单因素分析和多元逐步回归分析,最终得出多元回归方程。结果:327例患者在6个月末时失访7例,复发10例,死亡7例,最终进入回归方程的变量为Fugl-Meyer运动功能评分、是否采取早期康复治疗、年龄及神经功能缺损程度评分等。结论:分析了解影响脑卒中患者ADL能力的因素,在发病早期即给予全速的康复干预,可更好改善其预后。     

Internally and Externally Paced Finger Movements Differ in Reorganization After Acute Ischemic Stroke

Askim T, Indredavik B, Håberg A. Internally and externally paced finger movements differ in reorganization after acute ischemic stroke.

Objective

To identify adaptive changes within the motor network for internally and externally paced finger movements in the acute and chronic phase after ischemic stroke.

Design

A functional magnetic resonance imaging study of internally and externally paced thumb-index-finger opposition 4 to 7 days and 3 months after stroke and in healthy controls. Images were compared within and between groups, with the actual number of movements as regressors.

Setting

Stroke Unit, University Hospital.

Participants

Twelve patients with mild to moderate acute ischemic stroke and 15 controls (N=27).

Intervention

Stroke unit treatment focused on very early rehabilitation, followed by early supported discharge service.

Main Outcome Measure

Differences in brain activation between patients and controls and between the tasks.

Results

Patients showed significant improvement in hand function at follow-up. Brain activity related to internally paced finger movements normalized with time. For the externally paced, accurate timing task, brain activity in the chronic phase differed from that seen in the controls despite successful recovery of hand function. In comparing the externally and internally paced tasks, a trend toward recruiting a premotor-parietal-striatal network was found in patients in the chronic phase, whereas controls had increased activation of a sensorimotor network consisting of primary motor cortex, supplementary motor cortex, superior parietal lobe, thalamus, and cerebellum.

Conclusions

After ischemic stroke, brain activity subserving an internally paced motor task normalized with time, whereas motor activity in response to an externally paced task became dependent on a premotor network. These findings underscore the importance of task-specific training in the rehabilitation of stroke patients. In the future, physiotherapists should evaluate the possibility of enhancing the recovery of a more efficient network for externally paced tasks.     

Influence of rehabilitation site on hip fracture recovery in community-dwelling subjects at 6-month follow-up

OBJECTIVE: To evaluate whether postacute rehabilitation after hip fracture influences recovery of prefracture function as detected by the FIM instrument motor scale. DESIGN: Inception cohort. SETTING: University-affiliated tertiary care hospital; inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs). PARTICIPANTS: People with acute proximal femur fracture treated between March 1, 2002, and June 30, 2003. INTERVENTION: Post-hip fracture rehabilitation delivered at an IRF or SNF. MAIN OUTCOME MEASURE: FIM motor score estimated prefracture and obtained at 2 weeks and 24 weeks after hospital discharge. RESULTS: Fifty-eight patients were treated at an IRF, whereas 39 were treated at an SNF. Controlling for baseline covariates, a mixed model showed a significant group by time interaction (F(3,57.1)=14.27, P < .001). Contrasts indicated that IRF subjects had greater initial improvement. Multiple logistic regression examining factors associated with recovery of FIM motor score to 95% or more of prefracture FIM motor score by 24 weeks found that IRF setting only was associated with recovery of baseline function with odds ratio of 5.44 (95% confidence interval, 2.02-14.65). CONCLUSIONS: Even when controlling for important baseline covariates, community-dwelling hip fracture subjects treated in an IRF are more likely to attain 95% or more of prefracture functional status by 24 weeks postdischarge than subjects treated in an SNF.     

对急性缺血性脑卒中患者基于多学科协作诊疗干预的效果观察

目的 探讨多学科协作诊疗干预在急性缺血性脑卒中患者中的应用效果。方法 选取2019 年1 月1 日—2020 年6月 30 日某三级甲等医院介入手术室治疗的68 例急性缺血性脑卒中患者,在多学科协作诊疗干预前后时间段分别取样分组,对照组33例和观察组35 例;对照组实施常规措施,观察组在此基础上实施多学科协作诊疗干预;观察比较2组患者入院-溶栓时间、入院-股动脉穿刺时间、转诊时间和待手术时间;术后2组患者的致死率、致残率、神经功能损伤评分及患者就诊满意度。结果 观察组患者的入院-溶栓时间、入院-股动脉穿刺时间、转诊时间和待手术时间均短于对照组（P<0.001）;观察组患者的致残率和神经功能缺损评分均低于对照组（P<0.05）,2组患者致死率差异无统计学意义（P>0.05）;除医疗环境外,观察组对医护服务态度、团队业务能力、护理应急能力及主动性、沟通交流、健康教育和患者需求方面的评分均高于对照组（P<0.001）。结论 对急诊介入手术脑卒中患者实施基于多学科协作诊疗干预,可提高抢救患者的工作效率,改善患者临床救治结局,提高患者就诊满意度。     

Joint Replacement Rehabilitation Outcomes on Discharge From Skilled Nursing Facilities and Inpatient Rehabilitation Facilities

DeJong G, Horn SD, Smout RJ, Tian W, Putman K, Gassaway J. Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities.

Objective

To compare functional outcomes at discharge across postacute settings.

Design

Prospective observational cohort study.

Setting

Eleven inpatient rehabilitation facilities (IRFs), 8 freestanding skilled nursing facilities (SNFs), and 1 hospital-based SNF from across the United States.

Participants

Consecutively enrolled patients (N=2152): patients with knee replacement (n=1401) and patients with hip replacement (n=751).

Interventions

None; examination of existing practice patterns.

Main Outcome Measure

FIM discharge motor score.

Results

Freestanding SNF patients entered with higher motor FIM scores and left with higher scores than did IRF patients. IRF patients, however, achieved larger motor FIM gains and achieved them in a shorter time. In multivariate models controlling for patient differences and onset days, IRFs were associated with better discharge motor outcomes, but the overall setting effect was not large. The largest motor FIM differences were between medium-volume IRFs and low-volume freestanding SNFs: 4.6 motor FIM points for patients with knee replacement and 7.3 motor FIM points for patients with hip replacement. Other differences between settings were much smaller. Multivariate models explained between a third and a half of the variance in outcome.

Conclusions

As a group, IRFs had better motor FIM outcomes than did SNFs, but the size of the IRF advantage was not large. Other important facility and practice characteristics also were associated with discharge outcomes after joint replacement rehabilitation. Earlier and more intensive rehabilitation was associated with better outcomes. The volume of joint replacement patients seen by a facility also plays a part: medium-volume facilities among both SNFs and IRFs had better outcomes.     

Use of Rehabilitation and Other Health Care Services by Patients With Joint Replacement After Discharge From Skilled Nursing and Inpatient Rehabilitation Facilities

DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Smith P, Gassaway J, DaVanzo JE. Use of rehabilitation and other health care services by patients with joint replacement after discharge from skilled nursing and inpatient rehabilitation facilities.

Objective

To compare use of rehabilitation and other health services among patients with knee and hip replacement after discharge from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).

Design

Follow-up interview study at 7.5 months after discharge.

Setting

Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs from across the United States.

Participants

Patients (N=856): patients with knee replacement (n=561) and patients with hip replacement (n=295).

Interventions

No interventions.

Main Outcome Measures

Number of home and outpatient therapy visits, physician visits, emergency room visits, rehospitalizations, and medical complications.

Results

After discharge from postacute care, the vast majority of patients received home rehabilitation, outpatient rehabilitation, or both. Patients with knee replacement received an average of 19 home and/or outpatient rehabilitation visits; patients with hip replacement received almost 15 visits. There were no statistically significant differences in rates of emergency room use and rehospitalization except that patients with hip replacement discharged from IRFs had higher rates of rehospitalization than those discharged from freestanding SNFs (15.8% vs 3.1%). Multivariate analyses did not find any SNF/IRF effects.

Conclusions

Patients with joint replacement from both SNFs and IRFs receive considerable amounts of follow-up rehabilitation care. Study uncovered no setting effects related to rehospitalization or medical complications. Looking only at care rendered in the initial postacute setting provides an incomplete picture of all care received and how it may affect follow-up outcomes.     

Hemispatial Neglect and Rehabilitation in Acute Stroke

Cumming TB, Plummer-D'Amato P, Linden T, Bernhardt J. Hemispatial neglect and rehabilitation in acute stroke.

Objectives

To compare 2 methods for determining neglect in patients within 2 days of stroke, and to investigate whether early neglect was related to rehabilitation practice, and whether this relationship was affected by an early, intensive mobilization intervention.

Design

Data were collected from patients participating in a phase II randomized controlled trial of early rehabilitation after stroke.

Setting

Acute hospital stroke unit.

Participants

Stroke patients (N=71).

Intervention

The 2 arms of the trial were very early mobilization (VEM) and standard care (SC).

Main Outcome Measures

Neglect was assessed using the Star Cancellation Test and the National Institutes of Health Stroke Scale (NIHSS) inattention item within 48 hours of stroke onset, and therapy details were recorded during the hospital stay.

Results

Assessing neglect so acutely after stroke was difficult: 29 of the 71 patients were unable to complete the Star Cancellation Test, and agreement between this test and the NIHSS measure was only .42. Presence of neglect did not preclude early mobilization. SC group patients with neglect had longer hospital stays (median, 11d) than those without neglect (median, 4d); there was no difference in length of stay between patients with and without neglect in the VEM group (median, 6d in both).

Conclusion

Early mobilization of patients with neglect was feasible and may contribute to a shorter acute hospital stay.     

健康教育在脑卒中患者康复中的作用

目的探讨健康教育对急性脑卒中患者预后的影响。方法将患者分为宣教组（n=126）和对照组（n=117），对宣教组的急性脑卒中患者及家属进行健康教育，并与未进行健康教育的对照组患者预后进行对比。结果宣教组患者的生活方式较对照组有明显改善（P〈0．05），并发症较对照组显著减少（P〈0．05）。2组之间差别有统计学意义。结论必须加强对脑卒中患者的健康教育，它可显著改善患者的预后。并产生较大的社会和经济效益。     

中风病人康复治疗临床疗效分析

目的分析比较对中风病人早期和晚期进行康复治疗的临床效果。方法对95例脑中风病人,分别于发病早期和晚期给予促进技术为主的综合康复治疗方法,采用Barthel指数和Fugl-Meyer运动功能量表分析两组的临床疗效。结果两组病人治疗后的Barthel指数评分和Fugl-Meyer运动功能评分均较治疗前显著增加(P<0.001),治疗后早期治疗组的Barthel指数评分和Fugl-Meyer运动功能评分均显著高于晚期治疗组(P<0.05)。结论对中风病人进行康复治疗可使病人的躯体运动功能和生活自理能力得到显著改善,且早期治疗效果显著好于晚期治疗。     

Factors Predicting Inpatient Rehabilitation Length of Stay of Acute Stroke Patients in Singapore

Tan WS, Heng BH, Chua KS, Chan KF. Factors predicting inpatient rehabilitation length of stay of acute stroke patients in Singapore.

Objective

To determine the predictors of hospital length of stay (LOS) of stroke patients at the point of admission.

Design

A retrospective cohort study.

Setting

An acute hospital rehabilitation center in Singapore.

Participants

Stroke patients (N=491) admitted between March 2005 and December 2006.

Interventions

None.

Main Outcome Measures

Rehabilitation LOS was calculated as the total number of rehabilitation days before discharge. We measured the functional status of patients by using the Functional Independence Measure (FIM).

Results

The median LOS was 29 days (mean = 30.8d). Independent clinical and sociodemographic characteristics found to significantly predict rehabilitation LOS were FIM motor score at admission, the presence of more than 3 comorbid conditions at admission, living with nonimmediate relatives before admission, and the hospital subsidy status of the patient. In particular, the admission FIM motor score explained 43% of the variation in LOS and decreased the LOS by approximately 1.1 days for each 1-point increase in score.

Conclusion

Patients' socioeconomic status and family structure was found to influence LOS and should be considered in allocating resources and determining treatment need. The extent of motor function of patients at admission is an important factor influencing rehabilitation LOS and is a useful tool for facilitating rehabilitation resource planning for stroke patients.     

睡眠护理干预对脑卒中患者睡眠颠倒及康复的影响研究

目的:研究睡眠护理干预对脑卒中患者康复及睡眠颠倒的影响.方法:选取2018年2月至2020年1月吉林省人民医院收治的脑卒中病患者74例作为研究对象,按照数字抽签原理均分为观察组与对照组,每组37例.观察组进行睡眠护理干预,对照组进行常规护理.比较2组干预前后的睡眠状态[爱泼沃斯嗜睡量表(ESS)]及功能状态[Fugl-...     

脑梗死并发消化道出血的危险因素分析

目的:探讨脑梗死患者并发消化道出血(GIH)的危险因素。方法:收集急性脑梗死患者654例,对发生GIH患者可能的危险因素进行分析。结果:654例患者中,发生消化道出血44例(6.73%)。并发GIH患者的平均年龄、大面积梗死比例、既往卒中史比例、抗凝药物使用比例高于无GIH患者,差异均有统计学意义(P0.05),氯吡格雷与阿司匹林联合使用比例差异无统计学意义。结论:GIH在脑梗死中是常见且影响预后的严重并发症之一,对其预防及治疗需合理选择药物。     

急性缺血性脑卒中溶栓患者延续性护理方案的建立及其应用效果

目的建立急性缺血性脑卒中患者延续护理的方案,并探讨其临床应用效果。方法便利抽样法选取2015年1-12月在上海市某三级甲等医院急诊科治疗的急性缺血性脑卒中溶栓住院患者89名研究对象。按随机数字表法将其分为观察组(n=48)和对照组(n=41)。对照组患者予以常规护理,而观察组患者在此基础上实施延续性护理方案。评价两组患者出院12周内的治疗依从性、生活质量和护理满意度。结果出院前2 d,两组患者生活质量评分、对护理的满意度评分差异均无统计学意义(均P0.05);出院12周时,观察组和对照组患者的治疗依从性总分分别为(9.51±1.597)和(7.45士1.631)分,差异有统计学意义(￡=3.017,P0.01),两组患者生活质量评分、对护理的满意度评分差异均有统计学意义(P0.05或P0.01)。结论延续性护理方案能有效提高出院患者的治疗依从性、生活质量及满意度,值得推广应用。