入院リハビリテーション後の脳卒中生存者における上肢機能回復と機能的転帰

Upper extremity (UE) impairment is common after stroke. In a cohort of stroke survivors, we sought to evaluate UE impairment before and after rehabilitation, correlate UE impairment with performance of UE-dependent activities of daily living (ADL) and establish the clinical factors associated with UE impairment.

This is a retrospective review of the data of stroke survivors admitted to a rehabilitation centre in Singapore over a 1-year period. Outcome measures included Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Functional Independence Measure-ADL (FIM-ADL). Based on the FMA-UE score, upper limb function was classified into 'no to poor', 'limited', 'notable' or 'full' arm-hand capacity.

A total of 259 stroke survivors with a mean age of 62.9 ± 12.3 years were studied. Significant improvements were noted in FMA-UE and FIM-ADL scores after rehabilitation (P < 0.01). Of the 135 (52.1%) stroke survivors with no to poor arm-hand capacity, only 32 (23.7%) had good UE outcome, defined as improvement to notable or full arm-hand capacity. Of the stroke survivors with limited arm-hand capacity, 72.2% achieved good UE outcome. Better cognition, less severe stroke and better truncal balance were associated with higher admission FMA-UE scores.

Significant improvements in UE impairment and related UE-dependent ADL were noted after inpatient rehabilitation. The findings of this study can serve as a guide in educating stroke survivors and caregivers on expected UE outcomes and caregiving needs upon discharge from rehabilitation.