三种常用平衡量表评估脑卒中偏瘫患者平衡和功能结局的一致性

背景对脑卒中患者平衡评定有助于康复目标与治疗计划的制定.目的探讨脑卒中偏瘫患者常用的3个平衡量表各参数与其他功能评价变量之间的相互关系.设计平衡量表间变量参数.单位解放军总医院耳鼻咽喉科、康复医学科.对象2002-09/2003-07在解放军总医院康复医学科进行康复治疗的57例脑卒中偏瘫患者.均为首次发病、颈内动脉系统一侧大脑半球病变的患者,其中男45例,女12例,年龄14～79岁,病程0.3～11个月.方法对57例患者于康复训练后进行Berg平衡量表、改良Fugl-Meyer平衡量表、脑卒中患者姿势控制量表、下肢运动功能、日常生活活动能力和步行功能评定.用Pearson相关分析方法来确定3种平衡量表之间的相关性;确定3种平衡量表与下肢运动功能、日常生活活动能力和步行功能之间的相关性.主要观察指标①3种平衡量表之间的相关性.②3种平衡量表与下肢运动功能、日常生活活动能力之间的相关性.结果57例脑卒中偏瘫患者均进入结果分析.①Berg平衡量表评分(46.70±5.15),Fugl-Meyer平衡量表评分(10.26±1.58),脑卒中患者姿势控制量表评分(32 56±2.06),Fugl-Meyer评价法中下肢运动功能评分(22.35±5.82),功能独立性测量中的转移和行进项目评分(24.95±5.2),10 m最大步行速度为(49.06±24.68)m/s].3种平衡量表之间呈高度相关(r=0.613～0.766,P＜0.001).②3种平衡量表与患者的下肢运动功能、日常生活活动能力和步行功能之间呈高度相关(r=0.479～0.718,P＜0.001).结论Berg平衡量表、Fugl-Meyer平衡量表和脑卒中患者姿势控制量表在评定脑卒中患者平衡功能方面具有良好的一致性和良好的效度,均可以反映脑卒中患者的平衡和功能结局,对患者下肢运动功能、日常生活活动能力及步行功能的恢复具有预测性.

Consistency of three measures commonly used in the assessment of balance and functional outcome of patients with post-stroke hemiplegia

BACKGROUND: To assess the balance function of post-stoke patients would be conducive to establish rehabilitative goal and to set up therapeutic plan.OBJECTIVE: To investigate the relationship between parameters of three commonly used measures and those of other functional evaluation for patients with post-stroke hemiplegia.DESIGN: Analysis of the relationship between parameters of balance rating scales.SETTING: At otolaryngology department and rehabilitative medicine department of the general military hospital.PARTICIPANTS: From September 2002 to July 2003, totally 57 patients with post-stroke hemiplegia, 45 males and 12 females, aged from 14 to 78years old, with the course of disease ranged from 0. 3 to 11 months, received rehabilitative treatment at rehabilitative department of the general military hospital, were selected to take part in the study. All were confirmed of internal carotid artery system lateral hemispheric disease.METHODS: Three balance measures, namely Berg balance scale, modified Balance subscale of the Fugl-Meyer test and Postural assessment scale for stroke patients were administered on 57 patients for evaluating their lower limb motor function, daily life capability and walking ability after rehabilitative treatments. The relationship between three measures was analyzed with Pearson-correlative analysis, and the relationship between three measures and lower limb motor function, daily life capability and walking ability were also investigated.MAIN OUTCOME MEASURES: ① relationship between three measures;② relationship between three measures and lower limb motor function, daily life capability and walking ability.RESULTS: The data from 57 stroke hemiplegic patients was analyzed without missing. ① Scores for Berg balance assessment, Fugl-Meyer balance rating scale and posture controlling scale for stroke patients was 46.70 ± 5. 15, 10. 26 ± 1.58 and 32.56 ± 2.06, respectively, and the scores of lower limb motor function in Fugl-Meyer assessment was 22. 35 ± 5.82,and moving and marching item in functional independence assessment 24.95 ± 5.2, 10 m maximum walking speed(49.06 ±24.68) m/s. The three measures were proved of significantly higher consistency( r = 0.613-0. 766,P ＜ 0.001 ). ② The three measures were also found to be obviously associated with the lower limb motor function, daily life capability and walking ability of patients with stroke( r = 0. 479-0. 718, P ＜ 0. 001 ).CONCLUSION: Berg balance assessment, modified Fugl-Meyer balance rating scale and posture-controlling scale have been proved of higher consistency and efficacy for assessing the balance function of post-stroke patients, thereby can be used as predictor for the balance functional outcomes,as well as the recovery of the lower limb motor function, daily life capability and walking ability of post-stroke patients.