社区康复干预对脑卒中患者日常生活活动能力的影响

An analysis of the effects of community-based rehabilitation therapy on activity of daily living performance of the Chinese stroke patients： a single blind, randomized, controlled, muiticenter trial

目的探索规范的社区康复治疗对于脑卒中患者日常生活活动能力的影响。方法在一项单盲、随机、对照、多中心试验研究中，737例脑卒中患者在脑梗死和脑出血二个层次上按社区随机化分成康复组和对照组，康复组给予规范的社区康复治疗，对照组不给予规范的社区康复治疗，随访5个月，分别于入选时，入选后2个月月末和5个月月末采用改良巴氏指数评分标准进行评测。结果规范的社区康复治疗5个月后，康复组患者的日常生活活动能力明显优于对照组（P〈0．05）。虽然康复组、对照组的日常生活活动能力积分在随访中均有不同程度的改善，但康复组患者各阶段日常生活活动能力评分积分的差值均明显高于对照组（P〈0．01）。5个月随访治疗后，脑梗死康复组、脑出血康复组和康复组总体患者的日常生活活动能力分别改善了26．28分、32．89分和27．72分，而对照组分别改善了7．65分、21．70分和10．85分。即和对照组相比，脑梗死康复组则多改善18．63分，脑出血康复组多改善11．19分，康复组总体上多改善16．87分。结论规范社区康复治疗对于脑卒中患者日常生活活动能力的提高具有较明显的促进作用。

Objective To evaluate the effects of community-based rehabilitation therapy on activity of daily living performance of the Chinese stroke patients, Methods In a single blinded, randomized, controlled multicenter trial, 737 consecutive stroke patients were stratified by two groups of cerebral infarction and hemorrhage. All the patients were randomly divided into a rehabilitation group and a control group, The patients in the rehabilitation group received standardized community-based rehabilitation therapy, while those in the control group did not, All the patients were followed up for 5 months for evaluation of their performance with activity of daily living by using Modified Barthel Index before intervention, after follow-up 2 and 5 months, respectively, Results Patients in the rehabilitation group performed better in ADL as reflected by the Modified Barthel Index score than those in the control group after 5 months of intervention （ P 〈 0. 05 ）, Although both the rehabilitation group and control group improved over time, the rehabilitation group showed a greater improvement with the Modified Barthel Index scores when compared with the control group （P 〈0.01 ）, After 5 months follow-up, the total gain of Modified Barthel Index scores was 26, 28 and 32, 89 for those with cerebral infarction and hemorrhage, respectively, in the rehabilitation group, In comparison, the gain of Modified Barthel Index scores was 7.65 and 21.70 for those with cerebral infarction and those with hemorrhage, respectively in the control group, This implies a difference in improvement of 18.63 in cerebral infarction group and 11.19 in hemorrhage group, in favor of the rehabilitation group. Conclusion Standardized community-based rehabilitation therapy may help stroke patients to improve their performance in activity of daily living significantly.