Welche Faktoren beeinflussen die motorischen Funktionsveränderungen bei Schlaganfall-Patienten während einer neurologischen Rehabilitationsbehandlung?

Zusammenfassung

Ziel der Studie Identifikation von Faktoren, die bei Schlaganfall-Patienten Einfluss auf das Ausmaß von motorischen Funktionsverbesserungen während einer stationären neurologischen Rehabilitation nehmen.

Methodik Retrospektive Analyse von 398 Schlaganfall-Patienten, die sich in stationärer Phase C- Rehabilitation (Barthel-Index zwischen 30 und 70 Punkten) befanden. Veränderungen in 3 physiotherapeutischen (Sitz/Stand; Transfer Bett/Stuhl; Treppen steigen) und 3 ergotherapeutischen (Essen/Trinken; Oberkörper Ankleiden; Objekt Manipulieren) Assessments wurden mit den Faktoren Alter, Geschlecht, initialer Barthel-Index, Zeit seit Schlaganfall, Aufenthaltsdauer; Therapie-Anzahl und –Umfang, Ischämie versus Blutung korreliert und einer schrittweisen Regressionsanalyse unterzogen.

Ergebnisse In allen Assessments zeigten sich signifikante Verbesserungen. Die Aufenthaltsdauer und Therapie-Anzahl und –Umfang korrelierten mit Verbesserungen von Sitz/Stand, Bett/Stuhl, Treppe und Oberkörper ankleiden, zudem korrelierten Therapie-Anzahl und –Umfang mit Essen/Trinken. Der initiale Barthel-Index korrelierte negativ mit Sitz/Stand, Bett/Stuhl und Oberkörper ankleiden. Alter und Geschlecht hatten keinen Einfluss auf das Ausmaß der Verbesserungen. Der Vergleich Ischämie versus Blutung ergab keine Unterschiede im Ausmaß der Verbesserungen. Patienten<3 Monate nach Schlaganfall verbesserten sich stärker in Sitz/Stand, Bett/Stuhl, Treppe, Oberkörper ankleiden und Objekt manipulieren als Patienten>6 Monate nach Schlaganfall, waren aber auch durchschnittlich 10 Tage (52 versus 42 Tage) länger in stationärer Rehabilitation. Eine schrittweise Regressionsanalyse identifizierte die Faktoren Physio-Termin-Anzahl und initialer Barthel-Index als wichtigste für Veränderungen in Sitz/Stand und Bett/Stuhl, Physio-Therapie-Menge und Zeit seit Schlaganfall für Treppen steigen, Ergo-Termin-Anzahl für Essen/Trinken, Ergo-Termin-Anzahl und Zeit seit Schlaganfall für Oberkörper ankleiden und Ergo-Termin-Anzahl und Dauer des Aufenthaltes für Objekt manipulieren.

Schlussfolgerung Bei Schlaganfall-Patienten ist eine größere Therapiemenge mit stärkeren motorischen Funktionsverbesserungen assoziiert. Alter, Geschlecht und Ätiologie des Schlaganfalls haben keinen relevanten Einfluss auf motorische Verbesserungen im Rahmen einer stationären Rehabilitation.

Abstract

Purpose To identify factors that have an impact on the degree of functional improvements in stroke patients during inpatient neurological rehabilitation.

Methods Retrospective analysis of 398 stroke patients who participated in an inpatient Phase C rehabilitation (Barthel index between 30 and 70 points). We correlated changes in 3 physiotherapeutic assessments (transfer from sitting to standing; transfer from bed to (wheel)chair; climbing stairs) and 3 occupational therapeutic assessments (eating/drinking; dressing of the upper part of the body; object manipulation) with the factors age, gender, Barthel-Index at admission, time since stroke, length of stay in inpatient rehab, number and extent of therapies and ischemic versus hemorrhagic stroke. In addition, a stepwise regression analysis was performed.

Results The patient group showed significant improvements in all assessments. Length of stay in inpatient rehab and number/extent of therapies correlated with improvements of transfer from sitting to standing, transfer from bed to (wheel)chair, climbing stairs, and dressing of the upper part of the body. Number/extent of therapies also correlated with eating/drinking. Barthel-Index at admission was negatively correlated with transfer from sitting to standing, transfer from bed to (wheel)chair, and dressing of the upper part of the body. No correlation between changes of motor functions and age or gender or type of stroke (ischemic versus hemorrhagic) was found. Patients<3 months after stroke showed stronger improvements of transfer from sitting to standing, transfer from bed to (wheel)chair, climbing stairs, dressing of the upper part of the body, and object manipulation than patients>6 months after stroke. However, patients<3 months after stroke also stayed 10 days longer in inpatient rehab. The stepwise regression analysis identified the number of physiotherapies and Barthel-Index at admission as the most important factors for changes in transfer from sitting to standing and transfer from bed to (wheel)chair, number of physiotherapies and time since stroke for climbing stairs, number of occupational therapies for eating/drinking, number of occupational therapies and time since stroke for dressing the upper part of the body and number of occupational therapies and length of inpatient rehab for object manipulation.

Conclusion In stroke patients, a higher number of therapies is associated with greater improvements of motor functions. Age, gender and type of stroke have no relevant impact on changes of motor functions during inpatient rehabilitation.

Schlüsselwörter

Schlaganfall - Rehabilitation - Prognosefaktoren - Assessments

Key words

stroke - rehabilitation - prognostic factors - assessments

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