BACKGROUND： At present, there are many studies on the rehabilitation therapy of stroke patients with hemiplegia, but there is deficiency of corresponding standardized rehabilitation program. OBJECTIVE： To explore th...BACKGROUND： At present, there are many studies on the rehabilitation therapy of stroke patients with hemiplegia, but there is deficiency of corresponding standardized rehabilitation program. OBJECTIVE： To explore the effects of standardized tertiary rehabilitation on the activities of daily living in stroke patients with hemiplegia within 6 months after attack. DESIGN： A clinical observation. SETTING： Department of Rehabilitation Medicine, Huashan Hospital of Fudan University. PARTICIPANTS： Eighty-two outpatients and inpatients with acute stroke were selected from the Department of Neurology, Shanghai Huashan Hosptial from January 1999 to June 2003, including 49 males and 33 females, 40 - 80 years of age, with a mean age of （65 ±11） years old. Inclusive criteria： According to the diagnostic standards for cerebrovascular diseases set by Fourth National Academic Meeting for Cerebrovascular Disease in 1995, the patients were diagnosed as new attack of cerebral infarction or cerebral hemorrhage, and confirmed by CT or MRI to be initial patients; They should be accorded with the following conditions, including within 1 week after stabilization of life signs, Glasgow coma score 〉 8 points, 40 - 80 years of age, with disturbance of limb function. Informed consents were obtained from all the patients or their relatives. Exclusive criteria： Patients were excluded due to active liver disease, liver and kidney malfunction, congestive heart failure, malignant tumor, history of dementia, failure in respiratory function, tetraplegia; cerebral infarction or cerebral hemorrhage for more than 3 weeks; unable to be followed up due to in other cities and provinces; psychiatric history; deafness and muteness. According to the will of the patients or their relatives, the patients who accepted the standardized rehabilitation program were enrolled as the treatment group （n =42）, and the others as the control group （n =40）. Approval was obtained from the ethical committee of the hospital. METHODS： All the patients were given routine therapies of internal medicine after admission. According to the conditions of Brunnstom recovery 6-phase evaluation, the patients in the treatment group were trained with the pre-designed comprehensive standardized rehabilitation program for corresponding period. At early period （within about 1 month after attack）, the patients received rehabilitative interventions in the Department of Emergency or Department of Neurology, once a day, 45 minutes for each time, 5 times a week; At middle period （about 1 - 3 months after attack）, the patients received rehabilitative interventions in the rehabilitation ward or center, once to twice a day, 30 - 45 minutes for each time, 4 - 5 days a week; At late period （about 3 - 6 months after attack）, the patients received rehabilitative intervention mainly assisted by rehabilitation physician in the community, relatives and volunteers, 3 - 4 times a week, and they were followed in the house or outpatient department once every two weeks. MAIN OUTCOME MEASURES： The patients were evaluated blindly by the same rehabilitation physician using scale of modified Barthel index at admission and 1, 3 and 6 months after attack respectively. RESULTS： Totally 82 patients with acute stroke were enrolled, and 3 cases in the treatment group missed, including 2 cases died at 1 month after admission, and 1 case refused the follow up l0 days later, all the others were involved in the analysis of results. The scores of modified Barthel index at corresponding time points after admission in the treatment group were all obviously higher than those in the control group （P 〈 0,01）, and the score differences were also obviously higher than those in the control group （P 〈 0,01）. The activities of daily living at admission and 1, 3 and 6 months after admission in the treatment group were 22,50%, 46.43%, 75,95% and 89,52% of that of normal people respectively, and those in the control group were 17.09%, 25,77%, 43,38% and 55,00% respectively, The activities of daily Diving at admission and 1, 3 and 6 months in the treatment group were 131.66%, 180.17%, 175.08% and 162.76% of those in the controlgroup. As compared with at admission, the percentage of the score difference to the total score at the ends of the 1^st, 3^rd and 6^th months were 23.93%, 53.45% and 67.02% in the treatment group, while 8.67%, 25.36% and 36.98% in the control group. CONCLUSION： Standardized tertiary rehabilitation can obviously promote the activities of daily living in stroke patients with hemiplegia.展开更多
康复护理是康复医学不可分割的重要组成部分,包括一般护理和专科护理,其最终目的是最大限度地恢复患者的生活自理能力,重建患者身心平衡,健康地重返社会。Barthel指数评分量表主要评估患者的日常生活能力( Activities of daily living,A...康复护理是康复医学不可分割的重要组成部分,包括一般护理和专科护理,其最终目的是最大限度地恢复患者的生活自理能力,重建患者身心平衡,健康地重返社会。Barthel指数评分量表主要评估患者的日常生活能力( Activities of daily living,A D L ),是目前评估A D L 能力的最为公认、最常用的量表[1],该量表信度与效度已被国内外的研究充分验证[23]。它不仅可以用来评定患者治疗前后的功能状况,还可以预测治疗结果及预后效果,在康复医学中被广泛使用。本文就近年来Barthel指数评定表在康复护理中的应用现状综述如下。展开更多
目的运用Rasch分析检验Barthel指数在内科老年住院患者日常生活活动能力评估中的适用性。方法采用便利抽样法,选择在广州市某三级甲等医院住院治疗的老年患者190例进行Barthel指数评估,从信度、区分度、单维性、匹配度、条目难度、响应...目的运用Rasch分析检验Barthel指数在内科老年住院患者日常生活活动能力评估中的适用性。方法采用便利抽样法,选择在广州市某三级甲等医院住院治疗的老年患者190例进行Barthel指数评估,从信度、区分度、单维性、匹配度、条目难度、响应阈值有序性、条目功能差异等方面对评估结果进行Rasch分析。结果Barthel指数的受试者信度和条目信度分别为0.90和1.00,受试者区分度和条目区分度分别为3.08和16.19。残差主成分分析中第一维度解释了78.3%的变异,第二维度解释了5.1%的变异;除条目“平地行走”和“床椅转移”的加权拟合均方(Infit Mean square)>1.5外,其余条目均与Rasch模型拟合较好;“控制大便”和“控制小便”之间的残差相关系数>0.7。受试者能力(0.01±0.75Logit)与条目难度匹配可接受,仍有14.2%的受试者未被条目覆盖。条目难度排序为:洗澡>修饰>上下楼梯>如厕>穿衣>进食>控制小便>控制大便>平地行走>床椅转移。条目响应水平的阈值有序,但条目“上下楼梯”、“平地行走”和“床椅转移”中存在难度间距过小的响应水平(<1.4 Logit)。未检测到功能偏倚的条目。结论Barthel指数是一个信度和区分能力良好的单维性工具,但在评估老年住院患者日常生活活动能力时仍存在一定的局限性,活动相关条目与模型拟合欠佳,评估界限有待明晰;大、小便控制条目相互依赖性高,因此需谨慎解读内科老年住院患者的Barthel指数总分。展开更多
OBJECTIVE： To evaluate the effectiveness and safety of the Xingnao Kaiqiao needling method for treating acute ischemic stroke.DATA SOURCES： We retrieved relevant randomized controlled trials involving Xingnao Kaiqia...OBJECTIVE： To evaluate the effectiveness and safety of the Xingnao Kaiqiao needling method for treating acute ischemic stroke.DATA SOURCES： We retrieved relevant randomized controlled trials involving Xingnao Kaiqiao acupuncture for treatment of acute ischemic stroke. The China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and Pub Med were searched from June 2006 to March 2016.DATA SELECTION： We analyzed randomized and semi-randomized clinical controlled trials that compared Xingnao Kaiqiao acupuncture with various control treatments, such as conventional drugs or other acupuncture therapies, for treatment of acute ischemic stroke. The quality of articles was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions（Version 5.1）, and the study was carried out using Cochrane system assessment methods. Rev Man 5.2 was used for the meta-analysis of the included studies.OUTCOME MEASURES： The mortality rate, disability rate, activities of daily living（Barthel Index）, and clinical efficacy were observed.RESULTS： Twelve studies met the inclusion criteria for this review. The meta-analysis showed that between Xingnao Kaiqiao acupuncture and the control treatment, Xingnao Kaiqiao acupuncture reduced the disability rate [risk ratio（RR） = 0.51, 95% confidence interval（CI） = 0.27-0.98, z = 2.03, P 〈 0.05], elevated the activities of daily living（weighted mean difference = 12.23, 95% CI： 3.66-20.08, z = 2.80, P 〈 0.005）, and had greater clinical efficacy（RR = 1.61, 95% CI： 1.23-2.09, z = 3.53, P 〈 0.0004）. However, there was no significant difference in mortality rate（RR = 0.61, 95% CI： 0.15-2.45, z = 0.70, P 〉 0.05）. CONCLUSION： The Xingnao Kaiqiao needling method is effective and safe for acute ischemic stroke. However, there was selective bias in this study, and the likelihood of measurement bias is high. Thus, more high-quality randomized controlled trials are needed to provide reliable evidence of the efficacy and safety of Xingnao Kaiqiao acupuncture in the treatment of acute ischemic stroke.展开更多
基金a grant from the State Science and Technology Department of "the Tenth Five-Year Plan" Tackle Key Problem,No.2001BA703B21
文摘BACKGROUND： At present, there are many studies on the rehabilitation therapy of stroke patients with hemiplegia, but there is deficiency of corresponding standardized rehabilitation program. OBJECTIVE： To explore the effects of standardized tertiary rehabilitation on the activities of daily living in stroke patients with hemiplegia within 6 months after attack. DESIGN： A clinical observation. SETTING： Department of Rehabilitation Medicine, Huashan Hospital of Fudan University. PARTICIPANTS： Eighty-two outpatients and inpatients with acute stroke were selected from the Department of Neurology, Shanghai Huashan Hosptial from January 1999 to June 2003, including 49 males and 33 females, 40 - 80 years of age, with a mean age of （65 ±11） years old. Inclusive criteria： According to the diagnostic standards for cerebrovascular diseases set by Fourth National Academic Meeting for Cerebrovascular Disease in 1995, the patients were diagnosed as new attack of cerebral infarction or cerebral hemorrhage, and confirmed by CT or MRI to be initial patients; They should be accorded with the following conditions, including within 1 week after stabilization of life signs, Glasgow coma score 〉 8 points, 40 - 80 years of age, with disturbance of limb function. Informed consents were obtained from all the patients or their relatives. Exclusive criteria： Patients were excluded due to active liver disease, liver and kidney malfunction, congestive heart failure, malignant tumor, history of dementia, failure in respiratory function, tetraplegia; cerebral infarction or cerebral hemorrhage for more than 3 weeks; unable to be followed up due to in other cities and provinces; psychiatric history; deafness and muteness. According to the will of the patients or their relatives, the patients who accepted the standardized rehabilitation program were enrolled as the treatment group （n =42）, and the others as the control group （n =40）. Approval was obtained from the ethical committee of the hospital. METHODS： All the patients were given routine therapies of internal medicine after admission. According to the conditions of Brunnstom recovery 6-phase evaluation, the patients in the treatment group were trained with the pre-designed comprehensive standardized rehabilitation program for corresponding period. At early period （within about 1 month after attack）, the patients received rehabilitative interventions in the Department of Emergency or Department of Neurology, once a day, 45 minutes for each time, 5 times a week; At middle period （about 1 - 3 months after attack）, the patients received rehabilitative interventions in the rehabilitation ward or center, once to twice a day, 30 - 45 minutes for each time, 4 - 5 days a week; At late period （about 3 - 6 months after attack）, the patients received rehabilitative intervention mainly assisted by rehabilitation physician in the community, relatives and volunteers, 3 - 4 times a week, and they were followed in the house or outpatient department once every two weeks. MAIN OUTCOME MEASURES： The patients were evaluated blindly by the same rehabilitation physician using scale of modified Barthel index at admission and 1, 3 and 6 months after attack respectively. RESULTS： Totally 82 patients with acute stroke were enrolled, and 3 cases in the treatment group missed, including 2 cases died at 1 month after admission, and 1 case refused the follow up l0 days later, all the others were involved in the analysis of results. The scores of modified Barthel index at corresponding time points after admission in the treatment group were all obviously higher than those in the control group （P 〈 0,01）, and the score differences were also obviously higher than those in the control group （P 〈 0,01）. The activities of daily living at admission and 1, 3 and 6 months after admission in the treatment group were 22,50%, 46.43%, 75,95% and 89,52% of that of normal people respectively, and those in the control group were 17.09%, 25,77%, 43,38% and 55,00% respectively, The activities of daily Diving at admission and 1, 3 and 6 months in the treatment group were 131.66%, 180.17%, 175.08% and 162.76% of those in the controlgroup. As compared with at admission, the percentage of the score difference to the total score at the ends of the 1^st, 3^rd and 6^th months were 23.93%, 53.45% and 67.02% in the treatment group, while 8.67%, 25.36% and 36.98% in the control group. CONCLUSION： Standardized tertiary rehabilitation can obviously promote the activities of daily living in stroke patients with hemiplegia.
文摘康复护理是康复医学不可分割的重要组成部分,包括一般护理和专科护理,其最终目的是最大限度地恢复患者的生活自理能力,重建患者身心平衡,健康地重返社会。Barthel指数评分量表主要评估患者的日常生活能力( Activities of daily living,A D L ),是目前评估A D L 能力的最为公认、最常用的量表[1],该量表信度与效度已被国内外的研究充分验证[23]。它不仅可以用来评定患者治疗前后的功能状况,还可以预测治疗结果及预后效果,在康复医学中被广泛使用。本文就近年来Barthel指数评定表在康复护理中的应用现状综述如下。
文摘目的运用Rasch分析检验Barthel指数在内科老年住院患者日常生活活动能力评估中的适用性。方法采用便利抽样法,选择在广州市某三级甲等医院住院治疗的老年患者190例进行Barthel指数评估,从信度、区分度、单维性、匹配度、条目难度、响应阈值有序性、条目功能差异等方面对评估结果进行Rasch分析。结果Barthel指数的受试者信度和条目信度分别为0.90和1.00,受试者区分度和条目区分度分别为3.08和16.19。残差主成分分析中第一维度解释了78.3%的变异,第二维度解释了5.1%的变异;除条目“平地行走”和“床椅转移”的加权拟合均方(Infit Mean square)>1.5外,其余条目均与Rasch模型拟合较好;“控制大便”和“控制小便”之间的残差相关系数>0.7。受试者能力(0.01±0.75Logit)与条目难度匹配可接受,仍有14.2%的受试者未被条目覆盖。条目难度排序为:洗澡>修饰>上下楼梯>如厕>穿衣>进食>控制小便>控制大便>平地行走>床椅转移。条目响应水平的阈值有序,但条目“上下楼梯”、“平地行走”和“床椅转移”中存在难度间距过小的响应水平(<1.4 Logit)。未检测到功能偏倚的条目。结论Barthel指数是一个信度和区分能力良好的单维性工具,但在评估老年住院患者日常生活活动能力时仍存在一定的局限性,活动相关条目与模型拟合欠佳,评估界限有待明晰;大、小便控制条目相互依赖性高,因此需谨慎解读内科老年住院患者的Barthel指数总分。
基金supported by the Support Program(Ⅱ)of Hundreds of Universities Outstanding Innovative Talents in Hebei Province of China,No.BR2-104
文摘OBJECTIVE： To evaluate the effectiveness and safety of the Xingnao Kaiqiao needling method for treating acute ischemic stroke.DATA SOURCES： We retrieved relevant randomized controlled trials involving Xingnao Kaiqiao acupuncture for treatment of acute ischemic stroke. The China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and Pub Med were searched from June 2006 to March 2016.DATA SELECTION： We analyzed randomized and semi-randomized clinical controlled trials that compared Xingnao Kaiqiao acupuncture with various control treatments, such as conventional drugs or other acupuncture therapies, for treatment of acute ischemic stroke. The quality of articles was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions（Version 5.1）, and the study was carried out using Cochrane system assessment methods. Rev Man 5.2 was used for the meta-analysis of the included studies.OUTCOME MEASURES： The mortality rate, disability rate, activities of daily living（Barthel Index）, and clinical efficacy were observed.RESULTS： Twelve studies met the inclusion criteria for this review. The meta-analysis showed that between Xingnao Kaiqiao acupuncture and the control treatment, Xingnao Kaiqiao acupuncture reduced the disability rate [risk ratio（RR） = 0.51, 95% confidence interval（CI） = 0.27-0.98, z = 2.03, P 〈 0.05], elevated the activities of daily living（weighted mean difference = 12.23, 95% CI： 3.66-20.08, z = 2.80, P 〈 0.005）, and had greater clinical efficacy（RR = 1.61, 95% CI： 1.23-2.09, z = 3.53, P 〈 0.0004）. However, there was no significant difference in mortality rate（RR = 0.61, 95% CI： 0.15-2.45, z = 0.70, P 〉 0.05）. CONCLUSION： The Xingnao Kaiqiao needling method is effective and safe for acute ischemic stroke. However, there was selective bias in this study, and the likelihood of measurement bias is high. Thus, more high-quality randomized controlled trials are needed to provide reliable evidence of the efficacy and safety of Xingnao Kaiqiao acupuncture in the treatment of acute ischemic stroke.
