急性脑卒中早期康复的功能变化与费用的随机对照研究

Cost-effectiveness analysis and functional change of the early rehabilitation in acute stroke patients: a Prospective randomized controlled trial

目的:探讨早期康复对急性脑卒中患者功能变化的影响及相关费用的分析和评价。方法:80例急性脑卒中患者随机分成康复组(40例)和对照组(40例),除进行常规的神经内科治疗外,康复组患者在急性期(病后1个月内,病情稳定48h)至病后6个月进行规范的康复治疗,包括运动疗法、作业疗法和言语治疗等,并对每组患者在入组时、病后3个月和6个月时的功能状况采用改良Barthel和综合功能评定(FCA)进行评测。比较两组在病后3个月和6个月的相关费用,包括直接医疗费用、直接非医疗费用、间接费用等,并进行了成本—效果分析。结果:病后3个月和6个月两组患者的功能状况均有不同程度的改善,其中康复组患者功能改善程度较大,差异有显著性意义(P<0.05)。病后3个月康复组38例的费用总和为$889104.2(23397.5±14176.4),对照组38例的费用总和为$737686.1(19412.8±20897.6),差异有显著性意义(P<0.05);病后6个月康复组38例的费用总和为$1087417.5(28616.2±22009.1),对照组为$901915.2(23734.6±22687.0),差异无显著性意义(P>0.05)。MBI或FCA积分每增加1分在康复组所需的总费用和直接医疗费用相对较低。结论:早期规范的康复治疗可以改善急性脑卒中的功能状况。

Objective:To study the cost-effectiveness and functional change of the early rehabilitation in acute stroke patients.Method:80 acute stroke patients were randomly divided into two groups: rehabilitation group(40 cases) and controlled group(40 cases). They were given general internal medicine. Patients in rehabilitation group were given standard physiotherapy, occupational therapy and speech therapy and so on. All patients were assessed respectively with the Functional Comprehensive Assessment(FCA) and Modified Barthel Index(MBI) at the admission, the end of 3rd month and 6th month after stroke. The direct medical costs, direct non-medical costs, indirect costs and the total cost were investigated. The cost-effectiveness in the two groups was analyzed at the end of 3rd month and 6th month after stroke.Result:The functional status of patients in two groups had been improved at the end of 3rd month and 6th month(P<0.05). The functional status of patients in the rehabilitation group was better than it in the controlled group (P<0.05). The total cost in rehabilitation group was $889104.2(23397.5±14176.4), and $737686.1(19412.8±20897.6) in the controlled group at the end of 3rd month. (P<0.05). The total cost in the rehabilitation group was $1087417.5(28616.2±22009.1), and $901915.2(23734.6±22687.0) in the controlled group at the end of 6th month (P>0.05).But the total cost and the direct medical cost in rehabilitation group for the improvement of function in MBI and FCA at the end of 3rd month and 6th month were lower than those in the controlled group(P<0.05).Conclusion: The early and standard rehabilitation may improve the functional status in acute stroke patients. It is an effective and economical medical method for treating acute stroke.