早期康复干预对持续卒中后肩痛预后的影响

Observation of early rehabilitation intervention on prognosis of persistent poststroke shoulder pain

目的探讨早期康复干预对持续卒中后肩痛预后的影响。方法将符合纳入标准的104例病例按康复干预时间分为早康组(发病后2周内进行康复干预,n=51)、对照组(发病后3周以上进行康复干预,n=53),2组均进行康复训练。2组治疗前、发病1个月(t0)、3个月(t1)、6个月(t2)后进行康复评估,包括一般情况(年龄、性别、病灶位置、利手、发病前独立生活能力、卒中类型、卒中前合并疾病)、运动功能(MI、MAS)、感觉功能(触、冷、痛、本体觉)、认知和情感功能(MMSE、SDS)、肩痛评定(时间、评分、性质、位置等)。结果早康组2例t0、8例t1出现肩痛,2例t2出现持续卒中后肩痛;对照组治疗前发生肩痛3例,t0 6例,t1 16例,t2 6例发生持续卒中后肩痛;早康组运动功能改善优于对照组;2组感觉功能、认知功能、肩痛情况(疼痛性质、持续时间、疼痛位置)差异无统计学意义(P>0.05)。结论早期康复干预可以减少持续卒中后肩痛的发生,改善卒中患者运动功能,提高日常生活能力。

Objective To explore the impact of early rehabilitation intervention on the prognosis of persistent post stroke shoulder pain. Methods The patients who met the inclusion criteria were divided into rehabilitation intervention early group （within 2 weeks after onset, n =51） and the control group （more than 3 weeks after the onset, n =53） according to the time of rehabilitation intervention.Both groups were given rehabilitation training,and were assessed before treatment,and at the onset of 1 month （t0）,3 months （t1）,6 months （t2）.The assessment content including general situation （age,gender,lesion side,pre stroke residence,type of strock,pre stroke comorbidities）,motor function （the level of voluntary motor control was assessed using the MI,ROM,MAS）,sensory function （touch,cold,pain,proprioception）;cognitive and emotional function （MMSE,SDS） and shoulder pain assessment （pain time,score,pain character,location,etc.）. Results Rehabilitation intervention early group had 2 cases at t0,and 8 cases at t1 developed shoulder pain,2 cases had persistent shoulder pain at t2.In control group,3 cases before treatment,6 cases at t0,and 16 cases at t2 developed with shoulder pain.Patients in rehabilitation intervention early group had better motor function than that of the control group.Two groups had similar sensory function,cognitive and emotional function,and shoulder pain assessment. Conclusion Rehabilitation intervention early can reduce the incidence of persistent post stroke shoulder pain,improve movement function and improve activities of daily living.