德国卒中康复模式在中国老年卒中患者中的应用

The application of the German stroke rehabilitation model in Chinese elderly stroke patients

目的验证德国康复模式用于中国卒中康复人群的有效性。方法本研究为回顾性、非干预性单臂研究,纳入了2019年3月—2022年8月期间在上海国际医学中心康复医学科接受德国康复模式治疗的卒中后患者。使用三级康复评估体系评估患者的各项功能,并根据早期Barthel指数(early barthel index,EBI)对患者进行分级,以对患者进行分类康复评估并制定康复方案。利用多种量表对患者治疗前后日常生活能力、疾病恢复情况、运动功能、语言功能、吞咽功能等进行评估。对纳入患者的人口学特征、卒中疾病情况、入院时的功能状况进行了描述性分析,连续性变量的描述性统计包括平均值、中位值、标准差、最大最小值等,分类变量的描述性统计包括计数、百分比等。患者的功能评估数据是纵向数据,包含患者在入院时、入院后每月或每周以及出院时的评估数据。对患者入院后每次的功能评估较基线(入院时)的功能评估变化进行了分析,包括每次功能评估的绝对值及标准差、自基线变化均值及标准差、以及出院时自基线变化的统计学检验(t-test)和95%置信区间。同时对患者每次评估数据的完整性进行了分析。结果81例患者纳入分析,年龄60~90岁,平均(70.7±7.1)岁。(1)日常生活能力:康复治疗后患者的EBI由治疗前的平均15.5上升至平均42.3,升高了172.3%(P<0.0001);Barthel指数(barthel index,BI)、功能独立性量表(functional independence measure,FIM)评分分别较治疗前上升了49.7%(P<0.0001)、33.0%(P<0.0001);(2)疾病恢复情况:改良Ranking量表(modified ranking scale,mRS)评分在治疗后改善了21.1%(P<0.0001),美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)则改善了32.1%(P<0.0001);(3)运动功能:患者的Berg平衡量表评分在治疗后提升了99.4%(P<0.0001),上肢和下肢Fugl-Meyer评分分别提升了44.7%(P<0.0001)和32.9%(P<0.0001);(4)言语功能:Token测验和西方失语症成套测验(The western aphasia battery,WAB)评分在治疗后分别提升了14.2%(P=0.0163)、32.4%(P=0.0997);(5)吞咽功能:反复唾液吞咽测试(repetitive saliva swallowing test,RSST)由治疗前的平均0.8次/30 s提升至2.1次/30 s。结论德国康复模式用于中国卒中人群能够有效提升患者的日常生活能力、改善卒中后恢复情况、提高平衡功能及上下肢运动能力、改善语言障碍。

Objective To verify the effectiveness of the German rehabilitation model for stroke rehabilitation in Chinese stroke patients.Method This was a retrospective,non-interventional single-arm study.The post-stroke patients who received German rehabilitation model treatment in Department of Rehabilitation Medicine of Shanghai International Medical Center from March 2019 to August 2022 were included.A three-level rehabilitation assessment system was used to evaluate the various functions of patients.According to the Early Barthel Index(EBI),the patients were graded.They were classified for rehabilitation assessment,and the rehabilitation program was developed.The daily living ability,disease recovery,motor function,language function and swallowing function of the patients before and after treatment were evaluated by various scales.Descriptive analysis was conducted on the demographic characteristics,stroke condition,and functional status at admission of the included patients.Descriptive statistics for continuous variables included mean,median,standard deviation,maximum and minimum values,etc.,while descriptive statistics for categorical variables included counts,percentages,etc.The functional assessment data of patients was longitudinal data,including the assessment data of patients at admission,monthly or weekly after admission,and at discharge.An analysis was performed on the changes in functional assessment from baseline(at admission)at each assessment after admission,including absolute values and standard deviations,mean and standard deviation of changes from baseline,as well as statistical testing(t-test)and 95%confidence intervals for changes from baseline at discharge.At the same time,the completeness of each assessment data of the patient was analyzed.Result 81 patients were included,aged 60-90 years,with an average age of(70.7±7.1)years.(1)Daily living ability:After rehabilitation treatment,the EBI of patients increased from an average of 15.5 before treatment to an average of 42.3,with an increase of 172.3%(P<0.001);Barthel Index(BI)and Functional Independence Measurement(FIM)scores increased by 49.7%(P<0.0001)and 33.0%(P<0.0001),respectively.(2)Disease recovery:Modified Ranking Scale(mRS)score improved by 21.1%after treatment(P<0.0001),and National Institute of Health Stroke Scale(NIHSS)score improved by 32.1%(P<0.0001).(3)Motor function:The Berg Balance Scale score of the patient increased by 99.4%(P<0.0001)after treatment,and the Fugl-Meyer scores of the upper and lower limbs increased by 44.7%(P<0.0001)and 32.9%(P<0.0001),respectively.(4)Language function:The scores of Token Test and Western Aphasia Battery(WAB)improved by 14.2%(P=0.0163)and 32.4%(P=0.0997)after treatment,respectively.(5)Swallowing function:Repetitive Saliva Swallowing Test(RSST)increased from an average of 0.8 times per 30 seconds before treatment to 2.1 times per 30 seconds.Conclusion The German rehabilitation model applied to Chinese stroke patients can effectively improve patients daily living ability,post-stroke recovery,balance function and upper and lower limb motor ability,and language disorders.