Saim AY, ŞEBNEM KOLDAŞ DOĞAN, Deniz EVCİK

İnmeli hastalarda risk faktörleri ve fonksiyonel iyileşme üzerine etkileri

İlk kez inme geçiren hastalarda rehabilitasyon sonrası fonksiyonel ve motor iyileşmeyi belirlemek, risk faktörle- rini saptamak ve bu risk faktörlerinin fonksiyonel bağım- sızlık üzerine etkisini belirlemek amaçlanmıştır. Rehabilite edilmek üzere kliniğe yatırılan 108 hasta retrospektif olarak incelendi. Hastaların demografik ve klinik özellikleri, risk faktörleri, etyolojileri, tedaviye baş-lama süreleri kaydedildi. Tedavi önce ve sonrası fonksi-yonel durumu Fonksiyonel Bağımsızlık Ölçümü (FBÖ) ile, motor değerlendirmesi Brunnstrom evrelemesi ile yapıldı. Çalışmaya 53 kadın, 55 erkek toplam 108 hasta alındı. Hastaların yaş ortalaması 65±10,94 yıl idi. En sık risk faktörü olarak hipertansiyon tespit edildi. Hastaların tedavi öncesi Brunnstrom evrelemeleri ile FBÖ skorları tedavi sonrası ölçümlerle karşılaştırıldığında istatiksel olarak anlamlı düzelme gösterdi (p0,05). İnme risk faktörlerinden fonksiyonel bağımsızlık ölçeğin- deki düzelme üzerine en önemli etkiyi yaş ve hemorajik tip inme etiyolojisine sahip olma göstermiş, diğer risk faktörlerinin ve rehabilitasyona erken başlama süresinin fonksiyonel iyileşmeyi etkileyen faktörler olmadığı gözlen-miştir.

Risk factors in patients with stroke and effects on functional recovery

The aim of this study was to determine the functional and motor improvement after rehabilitation programme in patients with stroke for the first time and also to assess the risk factors and to investigate the effect of these risk factors on functional independency. One hundred and eight patients who were admitted to rehabilitation were analysed retrospectively. The demographic and clinic characteristics, risk factors, etiologies and beginning time of the treatment of the patients were recorded. The functional status and motor assessments of the patients were evaluated with Functional Independency Measurement (FIM) and Brunnstrom staging respectively. One hundred and eight patients (53 female, 55 male) were recruited. The mean age of the patients were 65±10.94 years. Hipertension is determined as the most common risk factor. Statistically significant improvement was observed in Brunnstrom staging and FIM scores at posttreatment comparing as baseline measurement (p<0.001). The functional improvement in total FIM score was correlated with the ages of the patients negatively (p=0.000), but with the type of haemorragic stroke positively (p=0.021). No statistically significant correlation was found between functional improvement and other risk factors. The patients were divided into two groups according to the beginning time of the rehabilitation (up to 1 month and after 1 month). No significant difference was recorded in the improvement of the FIM scores between the groups (p>0.05). The most important risk factors affecting the improvement of FIM scores were determined as age and the etiology of haemorragic stroke. Other risk factors and beginning the therapy earlier are not found to be affective in functional improvement.

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1. Aho K, Harmsen S, Hataon S, Marquardsen J, Smirnow VE. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ 1980;58: 113-30.
2. Dalyan M, Çakçı A. inme rehabilitasyonu In: Oğuz H, Dursun E, Dursun N, editörler. Tıbbi Rehabilitasyon. istanbul: Nobel tıp kitapevleri 2004; p: 589-618.
3. Sudlow CL, Warlow CP. Comparing stroke incidence worldwide: What makes studies comparable? Stroke 1996;27: 550-8.
4. Hankey GJ. Potential new risk factors for ischemic stroke what is their potential? Stroke 2006;37: 2181-8.
5. Gündüz B. ?nme ve prognozu etkileyen faktörler. Türk Fiz Tp Rehab Derg 2006;52: 30-3.
6. Macciocicchi SN, Diamond PT, Alves WM, Mertz T. Ischemic Stroke: Relation of age, lesion localization, and initial neurologic deficit to functional
outcome. Arch Phys Med Rehabil 1998;79: 1255-57.
7. Küçükdeveci AA, Yavuzer G, Elhan AH, Sonel B. Adaptation of the functional independence measure for use in Turkey. Clin Rehabil 2001;15: 311-8.
8. Romero JR, Pikula A. Stroke prevention: modifying risk factors. Ther Adv Cardiovasc Dis 2008;2: 287-303.
9. Sanossian N, Ovbiagele B. Multimodality stroke prevention. Neurologist 2006;12: 14-31.
10. Brandstater ME. inme rehabilitasyonu In: Delisa AJ (Arasıl T çeviri editörü) Fiziksel Tıp ve Rehabilitasyon ilkeler ve Uygulamalar. Ankara: Güneş Tıp Kitapevler 2007;p: 1655-76.
11. Sputtitada A, Aksaranugrahan S, Granger CV, Sankaew M. Results of stroke rehabilitation in Thailand. Disabil Rehabil 2003;25: 1140-5.
12. Ingall T. Stroke-incidence, mortality, morbidity and risk. J Insur Med 2004;36: 143-52.
13. Chiou-Tan FY, Keng MJ, Graves DE, Chan KT, Rintala DH. Racial/ ethnic differences in FIM scores and lenght of stay for underinsured patients undergoing stroke inpatient rehabilitation. Am J Phys Med Rehabil 2006;85: 415-23.
14. Lin JH, Hsieh CL, Lo SK, Hsiao SF, Huang MH. Prediction of functional outcomes in stroke inpatients receiving rehabilitation. J Formos Med Assoc 2003;102: 695-700.
15. Lind K. A synthesis of studies on stroke rehabilitation. Stroke 1982;35: 133-49.
16. Bogousslavsky J, Van Melle G, Regli F: The Lausanne Stroke Registry: Analysis of 1000 consecutive patients with first stroke. Stroke 1998;19: 1083-92.
17. Kumral E, Özkaya B, Sa?duyu A, ?irin H, Vardarl E, Pehlivan M, The Ege Stroke Registry. A hospital based study in the Aegian Region, ?zmir, Turkey. Analysis of 2000 patients. Cerebrovascular Dis 1998;8: 278- 88.
18. Kelly PJ, Furie KL, Shafqat S, Rallis N, Chang Y, Stein J. Functional recovery following rehabilitation after hemorrhagic and ischemic. Stroke 2003;34: 2861-5.
19. Rohr J, Kittner S, Feeser B, Hebel JR, Whyte MG, Weinstein A, et al. Traditional risk factors and ischemic stroke in young adults: The Baltimore-Washington cooperative young stroke study. Archieve of Neurology 1996;53: 603-7.
20. Dimitroula HV, Hatzitolios AI, Karvounis HI. The role of uric acid instroke: the issue remains unresolved. Neurologist 2008;14: 238-42.
21. Howard G, Wagenknecht LE, Burke GL, Diez-Raux A, Evans GW, McGovern P, et al. Cigarette smoking and progression of atherosclerosis: the atherosclerosis risk in communities (ARIC) study. JAMA 1998;279: 119-24.
22. Sien J, Jung H, Tay SS, Bok CW, Chiong Y, Lim PA. Results from a prospective acute inpatient rehabilitation database: Clinical characteristic and functional outcomes using the functional indepence measure. Ann Acad Med Singapore 2007;36: 3-10.
23. Shah S, Vanclay F, Cooper B. Predicting discharge status at commencement of stroke rehabilitation. Stroke 1989;20: 766-69.
24. Gross JC. Urinary incontinence and stroke outcomes. Arch Phys Med Rehabil 2000;81: 22-7.
25. Gagnon D, Nadeau S, Tam V. Ideal timing to transfer from an acute care hospital to an interdisiplinary inpatient rehabilitation program following a stroke: an exploratory study. BMC Health Serv Res 2006;23: 151.