Equilibri de tronc predictor de la funció motora en l'emiplègic vascular

catalaTRUNK BALANCE AS A PREDICTOR OF MOTOR OUTCOME IN PATIENTS WITH STROKE EnglishBackground: The search for predictors of functional stroke outcome has always been matter of research in Physical Medicine and Rehabilitation. Outcome prediction at an early stage enables clinicians not only to inform patients and their families, but also to set realistic therapeutic goals. A lot of prognostic studies have evaluated several factors, which either individually or in combination claim to predict functional outcome in stroke. The Trunk Control Test (TCT) proposed by Collin & Wade administered at 6 weeks post-stroke is a predictor of the walking ability at 18 weeks. The TCT reliability and validity has been demonstrated in stroke patients, as well as its positive correlation with disability at hospital discharge from in-patient rehabilitation measured with the Functional Independence Measure (FIM). In a previous study, a predictive model which only includes the FIM and the TCT measured at admission of patients to a rehabilitation ward, predicts 66.5% of the variability of the functional level at discharge (total FIM). Objective: To develop an early model to predict motor function (disability, walking ability and balance)at 6 months, taking into account the TCT and other valid predictors evaluated in the first and second week after suffering a stroke. Patients and Methods: Seventy-five consecutive patients with first stroke who were admitted to a rehabilitation hospital were studied. Sex, age, the stroke type, urinary incontinence, the National Institutes of Health Stroke Scales (NIHSS) and the TCT scores (assessed at first and second week post-stroke) as independent variables. Motor function outcome at 6 months after stroke is defined by the use the Rankin score, the motor FIM and the Berg Balance Scale (BBS). Results: Older patients, women and those with initial urinary incontinence and lower TCT and NIHSS scores showed significantly worse motor outcomes at first and six months after the stroke (Rankin, motor FIM and BBS). A multiple regression reveals that only age and the TCT (at 14 days after stroke) accounts for the 61.1% of the variance in the motor FIM score at 6 months after stroke. When the TCT is registered at 7 days after stroke, age and the TCT accounts for the 51.7% of the motor FIM variance. A cluster analysis identifies 12 patients with low outcome scores: Rankin 4-5, motor FIM Discussion and conclusions: Age, sex, urinary incontinence, TCT and NIHSS scores are related with disability, balance and walking ability six months after the stroke. It is possible to approach to the motor functional outcome at 6 months after stroke by the early use of data easily recorded as age and the TCT. In this study the TCT even overcomes the NIHSS, a comprehensive neurological measure whose ability to predicts outcome has been well documented in stroke patients. The reproducibility of this model must be cross-validated in future studies. The TCT registered at 14 days provides better prediction values compared with those obtained at 7 days after stroke. This study shows that the TCT early administered predicts motor outcome at six months after stroke. EQUILIBRI DE TRONC: PREDICTOR DE LA FUNCIO MOTORA EN LHEMIPLEGIC VASCULAR RESUM Introduccio: La cerca de factors predictors del resultat funcional despres de patir un ictus es objecte constant dinvestigacio en Medicina Fisica i Rehabilitacio. Un pronostic funcional en fases inicials permet al clinic informar als pacients i a la seva familia, pero tambe establir objectius terapeutics realistes. Molts estudis han avaluat la capacitat predictora de diferents factors individual i combinadament. El Test de Control de Tronc (TCT) registrat a les 6 setmanes de lictus es un predictor de la capacitat de marxa a les 18 setmanes. La fiabilitat i validesa del TCT sha demostrat en pacients amb ictus, aixi com la seva correlacio positiva amb la discapacitat a lalta hospitalaria. Un model predictiu que inclou nomes el TCT i el Functional Independence Measure (FIM) registrats a lingres en la unitat de rehabilitacio dhospitalitzacio aguda prediu el 66.5% de la variabilitat del FIM a lalta. Objectius: Coneixer la relacio de les variables predictores amb els resultats de funcio motora global al mes i als sis mesos de lictus. Construir un model de prediccio precoc de la funcio motora (discapacitat, capacitat de marxa i equilibri) als 6 mesos, tenint en compte el TCT i altres predictors valids avaluats en la primera i en la segona setmana despres de patir lictus. Pacients i Metode: estudi longitudinal i prospectiu en 75 pacients consecutius ingressats per un primer episodi dictus. Les variables independents van ser: edat, sexe, tipus dictus, incontinencia urinaria, lescala dictus National Institutes of Health Stroke Scales (NIHSS) i el TCT (recollits en la primera i segona setmanes de lictus). Els resultats de funcio motora al mes i als 6 mesos de lictus es van definir amb lescala de Rankin, la subescala motora del FIM i lescala dequilibri Berg Balance Scale (BBS). Resultats: els pacients de mes edat, les dones i els que tenen incontinencia urinaria inicial i puntuacions mes baixes de TCT i NIHSS son els que presenten significativament pitjors resultats de funcio motora tant en el primer com en el sise mes de lictus (Rankin, FIM motor i BBS). Una analisi de regressio multipla determina que nomes amb ledat i el TCT de la segona setmana sexplica el 61.1% de la variabilitat del FIM motor als 6 mesos de lictus. Quan el TCT es registra en el sete dia de lictus, ledat i el TCT expliquen el 51.7% de la variabilitat del FIM motor. Una analisi de conglomerats identifica 12 pacients amb resultats baixos de funcio motora: Rankin 4-5, FIM motor Conclusions: Ledat, el sexe, la incontinencia urinaria, el TCT i el NIHSS inicials son factors relacionats amb la discapacitat, equilibri i capacitat de marxa 6 mesos despres de lictus. Es possible aproximar-nos al resultat funcional motor als 6 mesos despres de patir lictus amb la utilitzacio precoc de dades de facil recollida com ledat i el TCT. El TCT recollit en fases inicials prediu el resultat motor als 6 mesos de lictus.