BACKGROUND: Acute stroke unit (stroke care unit) is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-...BACKGROUND: Acute stroke unit (stroke care unit) is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-sized comprehensive community hospital (secondary hospital), where medical facility is relatively insufficient, is a new pathway to satisfy stroke patients. OBJECTIVE: To observe the comprehensive effect of developing stroke rehabilitation unit based on the facility of secondary hospital and its feasibility.DESIGN: Non-randomized concurrent controlled observation.SETTING: Department of Neurology, Beijing Longfu Hospital.PARTICIPANTS: Totally 264 stroke reconvalescents who suffered stroke for 7 days and received treatment in the Department of Neurology, Beijing Longfu Hospital during June 2003 to June 2005 were involved in the study. All the involved patients were confirmed by CT or MRI. The patients were scored by using Modified Edinbergh-Scandinavia stroke scale (SSS) > 16 points. Written informed consents were obtained from all the patients. The patients were assigned into 2 groups according to the willing of patients and their relatives: ①treatment group, in which, there were 134 patients, 76 males and 58 females, aged 43 to 74 years; cerebral infarction was found in 116 cases and cerebral hemorrhage in 18 cases;② control group, in which, there were 130 patients, 66 males and 64 females, aged 45 to 77 years, cerebral infarction was found in 115 cases and cerebral hemorrhage in 15 cases. There were significant differences in baseline data of the patients between two groups. METHODS: A same basic treatment was conducted in the patients of the two groups. ① Patients in the treatment group admitted to stroke rehabilitation unit and received comprehensive rehabilitation treatment. The rehabilitation flow-sheet: randomization-letting the patients of treatment group go into the unit-making comprehensive assessment in the initial stage-making therapy plan-talking with patients and their other family members-general rehabilitation-making metaphase assessment-adjusting therapy plan-making final assessment-letting the patients discharge and doing follow-up visits. ② The patients in the control group admitted to common wards, and they were encouraged to do activities by themselves in the early stage, but did not receive rehabilitation training under the instructions from professional physicians.MAIN OUTCOME MEASURES: The following assessments were conducted on admission and 7 and 28 days after admission: ① Severity of stroke and motor function: scored as 0 to 45 points by SSS, the higher points, the severer damage. ②Activities of daily living: Evaluated by Barthel index, 110 points in total, 110 points meant normal, 0 point meant extremely poor. ③Mental status: evaluated by Hopkin’s symptom scale with a 5-point scoring. The symptom was scored with low to high points. ④Cognitive function: Quantification measurement was conducted with LOTCA method. The higher points, the better therapeutic effects. RESULTS: ① Three cases dropped out and one died in the treatment group, 11 cases dropped out and 4 died in the control group. ②The neurologic impairment points on 7 and 28 days after therapy in the treatment group were lower than those in the control group separately [7 days:(9.73±6.43) points vs. (12.63±7.87) points, t =2.28, P < 0.05;28 days:(7.88±4.81) points vs. (9.84±7.03)points, t =2.04, P < 0.05]. ③ Barthel index on 7 and 28 days after therapy in the treatment group were higher than those in the control group separately [7 days:(54.28±8.38) points vs. (39.76±7.31) points, t =2.206, P < 0.05; 28 days:(89.72±7.94) points vs. (67.34±8.63) points,t =2.812, P < 0.01]. ④ Patients were allocated into different age groups based on age and evaluated with LOTCA. Results showed that there were no significant differences among different age groups (P > 0.05). ⑤ Totally 160 patients in the two groups accomplished the Hopkin’s test, among them, 94 (58.7%) had different mental disorders; Among the patients with mental disorder, depression, obsessive-compulsive and anxiety were found mostly, being 53.8%, 52.5% and 46.2%, respectively. CONCLUSION: ① Developing stroke rehabilitation unit therapy in the secondary hospital can obviously improve the motor function and activities of daily living of stroke reconvalescents. ② More than half of the stroke reconvalescents accompany the symptoms of depression, obsessive-compulsive, anxiety and other mental disorders. ③ The cognitive function of stroke reconvalescents is not related to age.展开更多
文摘BACKGROUND: Acute stroke unit (stroke care unit) is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-sized comprehensive community hospital (secondary hospital), where medical facility is relatively insufficient, is a new pathway to satisfy stroke patients. OBJECTIVE: To observe the comprehensive effect of developing stroke rehabilitation unit based on the facility of secondary hospital and its feasibility.DESIGN: Non-randomized concurrent controlled observation.SETTING: Department of Neurology, Beijing Longfu Hospital.PARTICIPANTS: Totally 264 stroke reconvalescents who suffered stroke for 7 days and received treatment in the Department of Neurology, Beijing Longfu Hospital during June 2003 to June 2005 were involved in the study. All the involved patients were confirmed by CT or MRI. The patients were scored by using Modified Edinbergh-Scandinavia stroke scale (SSS) > 16 points. Written informed consents were obtained from all the patients. The patients were assigned into 2 groups according to the willing of patients and their relatives: ①treatment group, in which, there were 134 patients, 76 males and 58 females, aged 43 to 74 years; cerebral infarction was found in 116 cases and cerebral hemorrhage in 18 cases;② control group, in which, there were 130 patients, 66 males and 64 females, aged 45 to 77 years, cerebral infarction was found in 115 cases and cerebral hemorrhage in 15 cases. There were significant differences in baseline data of the patients between two groups. METHODS: A same basic treatment was conducted in the patients of the two groups. ① Patients in the treatment group admitted to stroke rehabilitation unit and received comprehensive rehabilitation treatment. The rehabilitation flow-sheet: randomization-letting the patients of treatment group go into the unit-making comprehensive assessment in the initial stage-making therapy plan-talking with patients and their other family members-general rehabilitation-making metaphase assessment-adjusting therapy plan-making final assessment-letting the patients discharge and doing follow-up visits. ② The patients in the control group admitted to common wards, and they were encouraged to do activities by themselves in the early stage, but did not receive rehabilitation training under the instructions from professional physicians.MAIN OUTCOME MEASURES: The following assessments were conducted on admission and 7 and 28 days after admission: ① Severity of stroke and motor function: scored as 0 to 45 points by SSS, the higher points, the severer damage. ②Activities of daily living: Evaluated by Barthel index, 110 points in total, 110 points meant normal, 0 point meant extremely poor. ③Mental status: evaluated by Hopkin’s symptom scale with a 5-point scoring. The symptom was scored with low to high points. ④Cognitive function: Quantification measurement was conducted with LOTCA method. The higher points, the better therapeutic effects. RESULTS: ① Three cases dropped out and one died in the treatment group, 11 cases dropped out and 4 died in the control group. ②The neurologic impairment points on 7 and 28 days after therapy in the treatment group were lower than those in the control group separately [7 days:(9.73±6.43) points vs. (12.63±7.87) points, t =2.28, P < 0.05;28 days:(7.88±4.81) points vs. (9.84±7.03)points, t =2.04, P < 0.05]. ③ Barthel index on 7 and 28 days after therapy in the treatment group were higher than those in the control group separately [7 days:(54.28±8.38) points vs. (39.76±7.31) points, t =2.206, P < 0.05; 28 days:(89.72±7.94) points vs. (67.34±8.63) points,t =2.812, P < 0.01]. ④ Patients were allocated into different age groups based on age and evaluated with LOTCA. Results showed that there were no significant differences among different age groups (P > 0.05). ⑤ Totally 160 patients in the two groups accomplished the Hopkin’s test, among them, 94 (58.7%) had different mental disorders; Among the patients with mental disorder, depression, obsessive-compulsive and anxiety were found mostly, being 53.8%, 52.5% and 46.2%, respectively. CONCLUSION: ① Developing stroke rehabilitation unit therapy in the secondary hospital can obviously improve the motor function and activities of daily living of stroke reconvalescents. ② More than half of the stroke reconvalescents accompany the symptoms of depression, obsessive-compulsive, anxiety and other mental disorders. ③ The cognitive function of stroke reconvalescents is not related to age.
