超早期下肢强化训练对缺血性脑卒中患者行走功能恢复的影响

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Abstract Objective: To investigate the effect of very early mobilization of the lower extremity on the recovery of ambulatory function in stroke patients. Methods: We performed a randomized controlled clinical trial on thirty-one eligible patients who were divided as control and experimental groups. Both the groups received conventional treatments. However, the experimental group received additional interventions to intensify lower extremity motion within 48 hours after the stroke by using a leg cycle ergometer system while practicing sitting and standing under the guidance of the therapist. The primary outcome measure for this analysis was the number of days required for the patient to walk for at least 50 m unassisted. Further, the patients were evaluated based on the prognosis with Modified Rankin Score (mRS) and Barthel index score after 3 months. Results: There were no significant differences in demographic data and clinical outcomes between the two groups. After 3 months, 77.4% (24/31) patients recommenced walking unassisted for 50 m and 45.2% (14/31) of them were able to walk unassisted within 2 weeks. When age, gender, and NIHSS scores were corrected, the independent walking time was significantly shorter in the experimental group than in the control group (median 10 vs 39 days, P=0.005). Stratified analysis of mild and moderate-heavy strokes after correction for related factors showed that the recovery time of walking in the experimental group was significantly shorter than that of the control group (median 6 vs 23 days, P=0.008), while there was no significant difference in the time of independent walking in moderate stroke cases between the two groups (P=0.303). The mRS and MBI were significantly higher in patients after treatment than before treatment (F=164.170, P<0.001; F=70.947, P<0.001), but did not show any significant difference between the two groups (F=0.001, P=0.997; F=0.291, P=0.594). Of note, there were no significant differences in the occurrence of complications such as pulmonary infection and venous thrombosis in either group. Conclusion: Early enhancement training of the lower extremity after stroke can promote the recovery of ambulatory function in patients with mild stroke, but has no obvious effect on the improvement of walking ability in moderate-to-severe stroke patients. Our study concludes that very early mobilization is safe without any adverse effects, and it is effective in stroke patients.

Key words： ischemic stroke very early mobilization functional recovery

Received: 22 October 2018

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	WU Wenxiu1
	WANG Zhewei
	CHEN Xiaoli
	CHEN Guoqian
	JIN Haimin
	HE Dongrui
	ZHOU Chengye

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2019/V49/I3/198

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