慢性中风幸存者的自下而上或自上而下设计的康复课程:试点随机对照试验
Mahnaz Hejazi-Shirmard1, Ghorban Taghizadeh2,3, Mehdi Rassafiani4,5
1Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Disability and rehabilitation
|July 30, 2024
概括
在慢性中风幸存者中,自上而下的和自下而上的康复方法显示出相似的有效性. 虽然两者都改善了障碍和参与,但只有自上而下的方法显著超过了参与的临床重要差异最小值.
科学领域:
- 康复科学 康复科学 康复科学
- 神经科学是一个神经科学.
- 临床医学 临床医学
背景情况:
- 卒中幸存者经常经历运动功能,活动和参与方面的损害.
- 康复策略旨在改善中风后的功能结果.
- 功能,残疾和健康国际分类 (ICF) 框架为评估健康和残疾提供了一个标准化的模型.
研究的目的:
- 为了比较"自上而下的"和"自下而上的"康复方法的有效性.
- 评估这些干预措施对ICF框架内的损伤,活动和参与水平的影响.
- 确定干预措施是否超过关键结果措施的临床重要差异最小值 (MCID).
主要方法:
- 一个单盲随机临床试验,涉及39名慢性中风幸存者.
- 参与者被分配到自上而下的,自下而上的干预措施或对照组,持续6周.
- 评估包括运动分析,Trail Making Tests (TMT),Fugl-Meyer评估 (FMA),盒子和块测试,运动活动日志 (MAL) 和加拿大职业绩效测量 (COPM).
主要成果:
- 所有组在损伤 (FMA) 和参与 (COPM) 中都显示出显著的改善.
- 顶下组独特地超越了参与的MCID (COPM).
- 上向和下向两组都超过了损伤 (FMA) 的MCID,上肢活动 (MAL) 在上向组中有所改善,但没有显著改善.
结论:
- 在慢性中风幸存者中,自上而下的,自下而上的和传统的干预措施表现出相似的有效性.
- 虽然这两种方法都改善了功能,但自上而下的方法可能为参与提供了更大的好处.
- 进一步的研究可以探索特定的患者特征,这些特征可以预测对这些干预措施的不同反应.
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