康复时间与强度对脑卒中患者功能恢复的影响

Impact of timing and dose of rehabilitation delivery on functional recovery of stroke patients

目的研究康复时间与强度对卒中患者功能恢复的影响。方法分析76例在该院医院接受治疗的首次中风患者。患者接受了多学科康复计划,其中包括住院部的物理治疗(PT)及作业治疗(OT),并在门诊接受至少3个月的康复治疗。收集的数据包括患者年龄、性别、中风种类(出血/梗死)、中风发作、康复干预时间(从中风发作开始)、住院时间、失语状况是否存在、开颅手术(是/否)以及康复总单元数。主要观察指标是中风时及中风后1、3、6个月、1年后的BI得分情况。结果中风后3个月及6个月时患者BI得分及BI改善情况与年龄呈负相关。中风后1个月及1年时,患者康复干预时间与BI改善程度呈负相关,在中风后1个月、3个月、6个月及1年时,患者康复干预时间与BI得分呈负相关。患者中风后1个月、3个月及6个月时,其PT和/或OT总单元数与BI的改善情况呈正相关。患者中风后3个月及6个月时PT和/或OT总单元数与BI的改善情况呈正相关。患者中风后1个月、3个月及6个月时的BI与起始BI得分成正相关。OT总单元数可以明显预测患者中风后3、6个月时的BI改善情况,而起始BI得分可以显著预测患者中风后1、3、6个月时的BI得分。结论康复治疗对中风患者(中风发生6个月内)功能改善有强度依赖性作用,并且早期康复治疗对中风患者功能恢复有长达1年的持续效果。

[Objective] To investigate the impact of timing and dose of rehabilitation delivery on the functional recovery of stroke patients. [Methods] From chart review, we included 76 patients who were ad- mitted to a regional hospital for first-ever stroke, and who had received multidisciplinary rehabilitation programs including physical therapy （PT） and occupational therapy （OT） at the inpatient department, and continuous rehabilitation therapy at the outpatient department for at least 3 months. The collected data included age, sex, type of stroke （hemorrhage/infarction）, onset of stroke, time to rehabilitation intervention （from onset of stroke）, length of stay, existence of aphasia, craniotomy （yes/no）, and total units of rehabilitation. Main out-come measures were serial Barthel Index （BI） at initial assessment, 1 month, 3 months, 6 months, and 1 year post-stroke. [Results] Age was inversely correlated with BI and BI improvement at 3 months and 6 months post-stroke. Rehabilitation intervention time from onset was negatively correlated with BI improvement at 1 month and 1 year, and with BI at 1 month, 3 months, 6 months, and 1 year post-stroke. The total units of inpatient PT and/or OT were positively correlated with BI improvement at 1 month, 3 months, and 6 months post-stroke. The total units of PT and/or OT were positively correlated with BI improvement at 3 months and 6 months post-stroke. And the initial BI was positively correlated with BI at 1 month, 3 months, and 6 months post-stroke. The total units of OT can significantly predict BI improvement at 3 months and 6 months post-stroke, while the initial BI capacity can significantly predict BI status at 1 month, 3 months, and 6 months post-stroke. [ Conclusion] There is a dose-dependent effect of rehabilitation on functional improvement of stroke patients for the first 6 months post-stroke, and earlier delivery of rehabilitation has lasting effects on the functional recovery of stroke patients up to 1 year.