| 제목 |
Critical Appraisal on Proportional Recovery of Lower Extremity in Terms of Ceiling Effect of FMA |
| 소속 |
Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, Korea, Department of Rehabilitation Medicine1, Yonsei University College of Medicine, Department and Research Institute of Rehabilitation Medicine2, Chungnam National University School of Medicine, Department of Rehabilitation Medicine3, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Department of Rehabilitation Medicine4, Wonkwang University, School of Medicine, Department of Preventive Medicine5, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Department of Rehabilitation Medicine6, Wonkwang University School of Medicine, Department of Rehabilitation Medicine, 7, Jeju National University Hospital, Jeju National University School of Medicine, Department of Rehabilitation Medicine8, Hallym University, Department of Statistics and Institute of Statistics9, Ewha Womans University, Department of Health Convergence10, Korea Centers for Disease Control and Prevention, Center for Disease Prevention, Division of Chronic Disease Prevention11, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , Department of Physical and Rehabilitation Medicine12, SAIHST, Sungkyunkwan University, Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Health13 |
| 저자 |
Hyun Haeng Lee1*, Minsun Kim1, Deog Yung Kim2, Min Kyun Sohn3, Yong-il Shin4, Gyung-Jae Oh5, Yang-Soo Lee6, Min Cheol Joo7, So Young Lee8, Junhee Han9, Jeonghoon Ahn10, Ilyoel Kim11, Soo Mi Choi11, Won Hyuk Chang12, Yun-Hee Kim12,13, Jongmin Lee1† |
Objective: We aim to verify the validity of the proportional recovery model in terms of ceiling effect of Fugl-Meyer Assessment.
Method: We reviewed the medical records of patients who were enrolled between August 2012 and May 2015 in the Korean Stroke Cohort for Functioning and Rehabilitation. We excluded patients with hemorrhagic stroke, cerebellar lesions or lesions in the bilateral hemispheres, a history of surgery including craniectomy, progression of ischemic lesion, hemorrhagic transformation, stroke recurrence or any neurological deterioration up to 6 months after stroke, or history of post stroke complication. We collected clinical variables such as age, sex, body mass index, comorbidities, etiology and location of ischemic lesions, and type of intervention. Recovery proportion was defined as the actual change in Fugl-Meyer Assessment score of lower extremity between 7 days and 6 months post stroke to the initial neurological impairment, '34 - initial Fugl-Meyer Assessment score of lower extremity'. We used logistic regression to demonstrate ceiling effect of Fugl-Meyer Assessment score of lower extremity and verify the validity of proportional recovery rule.
Results: We screened 10,636 patients and analyzed 718 patients (mean age, 65.2 ± 12.5; female, 288 [40.1%]) with first-ever ischemic stroke. Mean recovery proportion was 0.71 ± 0.41. The logistic model showed that a one-unit increase in initial Fugl-Meyer Assessment score of lower extremity increased the odds ratio of reaching full score of Fugl-Meyer Assessment score of lower extremity at post stroke 6 months to 1.0315, and a one-unit increase in stroke onset age decreased the odds ratio to 0.9723.
Conclusion: We showed that the ceiling effect of Fugl-Meyer Assessment score of lower extremity is pronounced in patients with mild initial motor deficit of lower extremity, which means that proportional recovery model is lack of generalizability. |
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