| Background:Stroke,characterized by high morbidity,disability and mortality rate,has become the first leading cause of death and a major cause of disability in China.More than fifty percent patients survived from stroke have dysfunctional disability.Over the last three decades,due to considerable research on stroke prevention and treatment of TCM,the integrated rehabilitation program(IRP)of TCM,which consisted of decoction,herbal bath,acupuncture,moxibustion,massage and modern rehabilitation therapy,has been shown to be efficacious in several clinical trials.However,the correlation between the adherence of IRP and long-term outcome after stroke is still unknown up to date.Objective:The main purpose of this study is to find the correlation between the adherence of IRP and long-term outcome after stroke,as well as the predictor factors prior to IRP in patients with stroke.What's more,prognostic model will be established preliminarily based on the characteristics of the community stroke patients.Methods:This is a cohort study on community-based population with stroke in China.Patients who suffered from stroke in the past six month were recruited.Those who received the IPR were evaluated for baseline characteristics including demographics,medical history,medication use,diagnosis,comorbidity,as well as disease status(i.e.stroke subtypes,NIHSS,Barthel Index,modified Rankin scale,Fugl-Meyer motor scale,Brunnstromon scale,and modified Ashworth scale).And then,they were followed by investigators at the 2nd week,4th week,6th week,8th week,10th week,4th month,5th month and 6th month after included.Correlation and multiple regression analyses were performed to find the correlation between the potential predictors and good outcome at six month,which defined as the Barthel Index scale>85.Furthermore,we established a Logistic regression model,and the ROC curve was used to evaluate the predictive ability of this model.SPSS 17.0 software was used for analysis.Results:471 subjects were enrolled from 30 community health service centers in China between December 2011 and November 2014.we defined the BI>85 as the good outcome and BI<85 as the poor outcome at six month after enrollment.Based on the Logistic regression analysis,we found that the position of stroke,the complication of shoulder-hand syndrome,the treatment of massage therapy,the course of stroke are the risk factors,while the good adherence to IRP,acupuncture,alcohol consumption,the baseline BI score,FMA score were the protective factors of good outcome at six month.The logistic regression equation:Log(p)=4.756+2.496*in viscera+0.829*the Shoulder-hand syndrome+1.369*massage therapy+0.009*the course of disease-0.699*the adherence to IRP-1.065*acupuncture-0.522*alcohol consumption-0.039*the baseline BI score-0.016*the baseline FMA score,(OR_in viscera=12.130,95%CI 1.480?99.421,P=0.020)?(OR_the Shoulder-hand syndrome=2.290,95%CI 1.254?4.181,P=0.007)?(OR_massage therapy=3.390,95%CI 2.125?7.270,P=0.000)?(OR_the course of disease?1.009,95%CI 1.003?1.015,P=0.004)?(OR_the adherence to IRP=0.497,95%CI 0.351?0.704,P=0.000)?(OR_acupuncture=0.345,95%CI 0.195?0.610,P=0.000)?(OR_alcohol consumption=0.593,95%Cl 0.373?0.944,P=0.028)?(OR_the baseline BI score=0.962,95%CI 0.947?0.977,P=0.000)?(OR_the baseline FMA score=0.984,95%CI 0.972?0.997,P=0.013).The area under the ROC curve is 0.821>0.7 and its specificity and sensitivity is 69.7%and 79.7%respectively?Conclusion:Based on the findings,we concluded that the IRP of TCM is a predictor for good outcome in patients with stroke,and good adherence to the IRP of TCM is an protective predictor of good outcome.The complication of shoulder-hand syndrome and the course of stroke are the risk factors of stoke prognosis,suggesting that the Implementation of IRP early and prevention of complications after stroke might be important and urgent since stroke onset.Theprognostic model has a moderate ability to predict the outcome at six months,and might be helpful for community physicians to manage patients with stroke. |
PDF Full Text Request