摘要
脑卒中具有高发病率、高致残率、高死亡率的特点,脑卒中后运动功能障碍常导致患者日常生活活动(ADL)能力降低,影响患者生活质量。在临床和科研工作中选择具有良好反应性的量表,敏感地反映患者ADL能力变化情况具有重要意义。本研究总结国内外常用脑卒中患者ADL评定量表[Barthel指数(BI)、功能独立性量表(FIM)和改良Rankin量表(mRS)]的评估条目、量表特点和目标人群,并分析这3个量表在不同疾病阶段的脑卒中患者中的反应性。对于脑卒中急性期患者,BI和mRS量表的反应性均低于FIM量表;对于脑卒中亚急性期患者,BI、FIM、mRS量表反应性均较好,但BI量表由于评价内容较简单而存在“天花板”效应,其反应性低于mRS量表;对于脑卒中恢复期患者,患者的身体功能恢复已基本达到平台期,其ADL能力恢复主要集中在家庭和社会生活方面,但BI、FIM、mRS量表均缺乏关于家庭和社会生活的评价条目,反应性较差。复杂活动测评工具(FAI)和龙氏日常生活能力评定量表(LS)在常用ADL量表基础上增加了IADL的评价内容,但FAI、LS量表临床应用普及程度还不高,还缺少其反应性的相关研究。下一步研究中,将加强FAI和LS量表在脑卒中后不同疾病阶段患者中的应用,并开展其反应性的研究,以期为脑卒中患者康复训练计划制定和训练效果评估提供更强有力的依据。
Stroke is characterized with high morbidity,high disability rate and high mortality rate.Motor dysfunction after stroke often leads to decreased activities of daily living(ADL)and affects the quality of life of patients.It is of great significance to select a scale with good responsiveness in clinical and scientific work to reflect the changes of ADL abilities of patients sensitively.In this paper,we summarized the assessment items,characteristics and target population of the Barthel index(BI),functional independence measure(FIM)and modified Rankin scale(mRS),which were commonly used at home and abroad for ADL evaluation of stroke patients,and analyzed the responsiveness of these three scales in stroke patients at different stages of disease.For acute stroke patients,the responsiveness of BI and mRS scale was lower than that of FIM scale.For subacute stroke patients,BI,FIM and mRS Scales all showed good responsiveness,but due to the simple evaluation content,BI scale had a"ceiling"effect and its responsiveness was lower than mRS scale.For patients in chronic stage of stroke,their physical function recovery has almost reached a plateau,and their ADL ability recovery mainly focuses on family and social life,but BI,FIM and mRS scale lack evaluation items about family and social life,resulting in poor responsiveness.Frenchay activities index(FAI)and Longshi Scale(LS)have added IADL evaluation content to the commonly used ADL scales.However,the FAI and LS scales are not widely used,and there is still a lack of relevant studies on their responsiveness.In the future studies,the application of FAI and LS scales in patients with different stages after stroke will be strengthened,and the study on their responsiveness will be carried out,in order to provide a stronger basis for the development of rehabilitation training plan and evaluation of training effect for patients with stroke.
作者
薛凯文
刘翔翔
张泽宇
王玉龙
XUE Kaiwen;LIU Xiangxiang;ZHANG Zeyu;WANG Yulong(School of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan,Shandong 250355,China;The First Affiliated Hospital of Shenzhen University,Shenzhen,Guangdong 518035,China;Shenzhen Second People's Hospital,Shenzhen,Guangdong 518035,China)
出处
《康复学报》
CSCD
2022年第4期374-380,共7页
Rehabilitation Medicine
基金
国家重点研发计划“主动健康和老龄化科技应对”重点专项(2020YFC2008700)
深圳市医疗卫生“三名工程”项目(SZSM202111010)
