布勒茨手部测试量表在卒中急性期上肢及手功能障碍患者中的初步应用分析
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摘要
目的探讨布勒茨手部测试(BzH)量表在卒中急性期偏瘫患者上肢及手部功能评定中的初步应用价值。方法连续回顾性纳入2017年10月至2018年10月首都医科大学宣武医院康复医学科卒中急性期上肢及手功能障碍患者16例,对其进行4周的标准上肢及手部康复训练,康复治疗前后分别进行Fugl-Meyer上肢运动功能评价(FMA-UE)、Wolf运动功能评价(WMFT)和BzH量表测评,观察患者治疗前后3个量表得分的变化情况,分析BzH量表与FMA-UE和WMFT量表的相关性。使用组内相关系数(ICC)分析评测者对治疗前后BzH量表总分及其各项任务评分的一致性。结果 (1)治疗前,FMA-UE上臂、腕手、总分和WMFT、BzH量表评分分别为19. 0 (13. 5,27. 0)、6. 5(0. 2,10. 8)、30. 5(18. 0,48. 5)、(30±11)、14. 5(2. 0,44. 2)分;治疗后,FMA-UE上臂、腕手、总分、WMFT、BzH量表评分分别为29. 0 (24. 0,34. 0)、14. 0 (10. 0,19. 8)、50. 5 (41. 0,59. 2)、(37±13)、42. 0(17. 8,59. 2)分,治疗后评分均高于治疗前,差异均有统计学意义(均P <0. 05)。(2)治疗前和治疗4周后,BzH与FMA-UE上臂均呈中度相关(r值分别为0. 64、0. 68,均P <0. 05),与FMA-UE腕手均呈高度相关(r值分别为0. 88、0. 83,均P <0. 01),与总分分别呈高、中度相关(r值分别为0. 80、0. 75,均P <0. 01),与WMFT评分均呈高度相关(r值分别为0. 82、0. 89,均P=0. 01)。(3) 2名测评人员对BzH总分(ICC=0. 995)及其7项任务评分(均ICC> 0. 990)均高度一致(均P <0. 01)。结论 BzH量表可尝试用于卒中急性期偏瘫患者上肢及手部基础运动及日常生活活动能力的评测。
Objective To investigate the preliminary application value of Broetz hand test( BzH) in the assessment of upper limb and hand function in patients with hemiplegia in acute stage of stroke. Methods From October 2017 to October 2018,16 patients with upper limb and hand dysfunction in acute stage of stroke at the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They received four weeks of standard upper limb and hand rehabilitation training. Before and after rehabilitation treatment,they were evaluated by Fugl-Meyer motor assessment of the upper extremity( FMA-UE),Wolf motor function test( WMFT),and BzH scale,respectively. The changes of the scores of the three scales before and after treatment were observed,and the correlation between the BzH scale and the FMA-UE and WMFT scales was analyzed. Intra-class coefficient( ICC) was used to analyze the consistency of the total score of BzH scale and its each task score before and after treatment.Results( 1) Before treatment,FMA-UE upper arm,wrist hand,total score,WMFT,BzH scale scores were19. 0( 13. 5,27. 0),6. 5( 0. 2,10. 8),30. 5( 18. 0,48. 5),30 ± 11,and 14. 5( 2. 0,44. 2),respectively;after treatment,FMA-UE upper arm,wrist hand,total score,WMFT,BzH scale scores were 29. 0( 24. 0,34. 0),14. 0( 10. 0,19. 8),50. 5( 41. 0,59. 2),37 ± 13,and 42. 0( 17. 8,59. 2),respectively. The scores after treatment were higher than before treatment. The differences were statistically significant( all P <0. 05).( 2) BzH and FMA-UE upper arms were moderately correlated before treatment and after 4 weeks of treatment( r values were 0. 64 and 0. 68 respectively,all P < 0. 05),and FMA-UE wrists were highly correlated( r values were 0. 88 and 0. 83 respectively),and total score were highly and moderately correlated,respectively( r values were 0. 80 and 0. 75 respectively,all P < 0. 01),and were highly correlated with WMFT scores( r values were 0. 82 and 0. 89 respectively,all P = 0. 01).( 3) Two reviewers were highly consistent with the BzH total scores( ICC = 0. 995) and its seven-task scores( all ICC > 0. 990,all P < 0. 01).Conclusion The BzH scale can be used to assess the basic motor and activities of daily living of upper limbs and hands in patients with hemiplegia in acute stage of stroke.
Objective To investigate the preliminary application value of Broetz hand test( BzH) in the assessment of upper limb and hand function in patients with hemiplegia in acute stage of stroke. Methods From October 2017 to October 2018,16 patients with upper limb and hand dysfunction in acute stage of stroke at the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They received four weeks of standard upper limb and hand rehabilitation training. Before and after rehabilitation treatment,they were evaluated by Fugl-Meyer motor assessment of the upper extremity( FMA-UE),Wolf motor function test( WMFT),and BzH scale,respectively. The changes of the scores of the three scales before and after treatment were observed,and the correlation between the BzH scale and the FMA-UE and WMFT scales was analyzed. Intra-class coefficient( ICC) was used to analyze the consistency of the total score of BzH scale and its each task score before and after treatment.Results( 1) Before treatment,FMA-UE upper arm,wrist hand,total score,WMFT,BzH scale scores were19. 0( 13. 5,27. 0),6. 5( 0. 2,10. 8),30. 5( 18. 0,48. 5),30 ± 11,and 14. 5( 2. 0,44. 2),respectively;after treatment,FMA-UE upper arm,wrist hand,total score,WMFT,BzH scale scores were 29. 0( 24. 0,34. 0),14. 0( 10. 0,19. 8),50. 5( 41. 0,59. 2),37 ± 13,and 42. 0( 17. 8,59. 2),respectively. The scores after treatment were higher than before treatment. The differences were statistically significant( all P <0. 05).( 2) BzH and FMA-UE upper arms were moderately correlated before treatment and after 4 weeks of treatment( r values were 0. 64 and 0. 68 respectively,all P < 0. 05),and FMA-UE wrists were highly correlated( r values were 0. 88 and 0. 83 respectively),and total score were highly and moderately correlated,respectively( r values were 0. 80 and 0. 75 respectively,all P < 0. 01),and were highly correlated with WMFT scores( r values were 0. 82 and 0. 89 respectively,all P = 0. 01).( 3) Two reviewers were highly consistent with the BzH total scores( ICC = 0. 995) and its seven-task scores( all ICC > 0. 990,all P < 0. 01).Conclusion The BzH scale can be used to assess the basic motor and activities of daily living of upper limbs and hands in patients with hemiplegia in acute stage of stroke.
引文
[1]Eraifej J,Clark W,France B,et al.Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function:a syst ematic review and meta-analysis[J].Syst Rev,2017,6(1):40.
[2]陈秀玲,刘明.Barthel指数评定量表在临床康复患者中的应用[J].医药前沿,2016,6(16):100-101.
[3]Nijland R,van Wegen E,Verbunt J,et al.A comparison of two validated tests for upper limb function after stroke:the wolf motor function test and the action research arm test[J].J Rehabil Med,2010,42(7):694-696.
[4]Saposnik G,Cohen LG,Mamdani M,et al.Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation(EVREST):a randomised,multicentre.single-blind,controlled trial[J].Lancet Neurol,2016,15(10):1019-1027.
[5]Broetz D,Del Grosso NA,Rea M,et al.A new hand assessm ent instrum ent for severely affected stroke patients[J].Neurorehabilitation,2014,34(3):409-427.
[6]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[7]Folstein MF,Folstein SE,Mc Hugh PR.“Mini-mental state”.A practical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[8]Woytowicz EJ,Rietschel JC,Goodman RN,et al.Determining levels of upper extremity movement impairment by applying cluster analysis to upper extremity fugl-meyer assessment in chronic stroke[J].Arch Phys Med Rehabil,2017,98(3):456-462.
[9]Etoom M,Hawamdeh M,Hawamdeh Z,et al.Constraintinduced movement therapy as a rehabilitation intervention for upper extremity in stroke patients:systematic review and meta-analysis[J].Int J Rehabil Res,2016,39(3):197-210.
[10]Wolf SL,Thompson PA,Morris DM,et al.The excite trial:attributes of the Wolf motor function test in patients with subacute stroke[J].Neurorehabil Neural Repair,2005,19(3):194.
[2]陈秀玲,刘明.Barthel指数评定量表在临床康复患者中的应用[J].医药前沿,2016,6(16):100-101.
[3]Nijland R,van Wegen E,Verbunt J,et al.A comparison of two validated tests for upper limb function after stroke:the wolf motor function test and the action research arm test[J].J Rehabil Med,2010,42(7):694-696.
[4]Saposnik G,Cohen LG,Mamdani M,et al.Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation(EVREST):a randomised,multicentre.single-blind,controlled trial[J].Lancet Neurol,2016,15(10):1019-1027.
[5]Broetz D,Del Grosso NA,Rea M,et al.A new hand assessm ent instrum ent for severely affected stroke patients[J].Neurorehabilitation,2014,34(3):409-427.
[6]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[7]Folstein MF,Folstein SE,Mc Hugh PR.“Mini-mental state”.A practical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[8]Woytowicz EJ,Rietschel JC,Goodman RN,et al.Determining levels of upper extremity movement impairment by applying cluster analysis to upper extremity fugl-meyer assessment in chronic stroke[J].Arch Phys Med Rehabil,2017,98(3):456-462.
[9]Etoom M,Hawamdeh M,Hawamdeh Z,et al.Constraintinduced movement therapy as a rehabilitation intervention for upper extremity in stroke patients:systematic review and meta-analysis[J].Int J Rehabil Res,2016,39(3):197-210.
[10]Wolf SL,Thompson PA,Morris DM,et al.The excite trial:attributes of the Wolf motor function test in patients with subacute stroke[J].Neurorehabil Neural Repair,2005,19(3):194.