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İNMELİ OLGULARIN ÖZELLİKLERİ VE FONKSİYONEL DURUM SONUÇLARI

CHARACTERISTICS AND FUNCTIONAL OUTCOMES OF STROKE PATIENTS

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2005

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective: The aims of this study were to describe demographic characteristics, to evaluate functional status, and to assess factors that might influence the functional outcome of the stroke patients admitted to our clinic. Materials and methods: The demographic data, etiologies and risk factors for stroke and functional status of 193 stroke survivors were evaluated. The Functional Independence Measure (FIM) and Barthel Index (BI) were used to assess functional outcome of the patients. Variables were compared using “Students t test” and analysis of variance (ANOVA). “Pearson correlation analysis” was used to determine the relationship between variables. Results: The mean age of the stroke patients admitted to our clinics was 61.43±12.72 years. There were no significant differences between male and females with regard to mean ages, affected hemispheres and stroke etiologies (p>0.05). Hemispheric lesion in the dominant side was detected in %53.9 of all cases (in %54.7 of males and in %53.12 of females) and ischemic etiology was found in %66.3 of our stroke patients. The most frequent comorbid disease seen in our stroke cases was hypertension which was followed by cardiovascular diseases, diabetes and transient ischemic attack. The mean self care, transfer, mobility, using wheelchair subgroup scores of FIM, total FIM and Barthel Index were statistically significantly lower in women than those in men (p< 0.05). The mean sphincter, transfer, mobility, social cognition subgroup scores of FIM, total FIM and Barthel Index were statistically significantly lower in stroke patients with dominant hemisphere lesions than in those with non-dominant hemisphere lesions (p<0.05). Total FIM and Barthel Index mean scores were statistically significantly higher in the seventh month than those obtained in the third month (for FIM p<0.05; for BI p=0.001). The FIM and BI mean scores did not differ significantly according to the education status, occupation and the stroke etiology (p>0.05). However, there was a statistically significant positive correlation between total FIM and BI scores. Total FIM scores showed an inverse correlation with age in our stroke patients (r= 0.281, p<0.01). FIM gain per day of hospitalization was 0.32±0.62 in our hospitalized stroke patients. There were no statistically significant correlation between length of stay and total FIM, BI and FIM gain scores (p>0.05). Conclusion: There were no significant differences between male and females with regard to stroke etiologies. The most frequent comorbid disease seen in our stroke cases was hypertension; therefore, modification of comorbid diseases is very important. Regardless of affected hemispheres and stroke etiologies, all stroke patients were functionally impaired, patients with dominant hemisphere lesions being more impaired than those with nondominant hemisphere lesions. Total FIM scores showing an inverse correlation with age indicated that functional impairments increase with age in stroke patients. Gains achieved as motor gains in the early periods following the disease, which subsequently proceeds as functional gains should be supported with rehabilitation programs.
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Abstract (Original Language): 
Amaç: Çal›flmam›z›n amac›, inme sonras› klini¤imize baflvuran hastalar›n demografik özelliklerini ve fonksiyonel durumlar›n› belirlemek ve fonksiyonel durumlar›n› etkileyebilecek faktörleri de¤erlendirmekti. Gereç ve yöntem: ‹nme birimimize baflvuran 193 inmeli hastan›n demografik özellikleri, inme etyolojileri, inme risk faktörleri ve fonksiyonel durumlar› de¤erlendirildi. Fonksiyonel durum ölçütleri olarak, Barthel ‹ndeksi (B‹) ve Fonksiyonel Ba¤›ms›zl›k Ölçütü (FBÖ) kullan›ld›. Ortalama ve standart deviasyonlar›n karfl› laflt›r›lmas›nda “Student’s t test” ve “ANOVA”, korelasyon de¤erlendirmeleri için “Pearson korelasyon analizi” yöntemleri uyguland›. Bulgular: ‹nme birimimize baflvuran hastalar›n yafl ortalamalar› 61,43 ± 12,72 y›l olup, kad›n ve erkek gruplar› nda yafl ortalamalar›, hemisfer tutulumu, inme etyolojileri aç›s›ndan fark belirlenmemifltir (p>0,05). Olgular› n %53,9’unda, erkeklerin %54,7’si ve kad›nlar›n %53,12’sinde dominant hemisfer hasar› saptan›rken, tüm olgular›n %66,3’ünde iskemik etyoloji saptand›. Kad›n ve erkeklerde inme etyolojisi aç›s›ndan farkl›l›k yoktu (p>0,05). ‹nmeli olgularda en s›k görülen komorbid hastal›k hipertansiyon (%72) olup, bunu kardiyovasküler hastal›klar, diabet ve geçirilmifl iskemik atak izliyordu. FBÖ alt gruplar›ndan kendine bak›m, transfer, hareket, tekerlekli iskemle kullan›m›, toplam FBÖ skoru ve B‹ skor ortalamalar› kad›nlarda erkeklere k›- yasla istatistiksel olarak anlaml› düzeyde daha düflüktü (p<0,05). FBÖ alt gruplar›ndan sfinkter kontrolü, transfer, hareket, sosyal durum, FBÖ toplam skor ve B‹ skor ortalamalar› dominant hemisfer lezyonu olanlarda dominant hemisfer lezyonu olmayanlara göre istatistiksel olarak anlaml› düzeyde düflüktü (p<0,05). Toplam FBÖ skor ve B‹ skor ortalama de¤erleri inmeden sonraki 7. aydan sonra ilk 3 ay de¤erlerine k›yasla istatistiksel olarak anlaml› olarak daha yüksekti (FBÖ için p<0,05; B‹ için p= 0,001). E¤itim düzeyi, meslek, inme etyolojilerine göre toplam FBÖ, FBÖ alt grup ve B‹ skor ortalamalar›nda istatistiksel düzeyde anlaml› farkl›l›k yoktu (p>0,05). Çal›flmam›zda olgular›m›z›n yafl ile toplam FBÖ skorlar› aras›nda negatif korelasyon bulunmaktayd› (r= 0,281, p<0,01). Klini¤imizde yat›r›larak rehabilite edilen olgularda yat›fl günü bafl›na FBÖ kazanc› 0,32 ± 0,62 olup; yat›fl süresi ile toplam FBÖ, B‹ ve FBÖ kazanc› aras›nda anlaml› bir iliflki bulunmam›flt›r ( p>0,05). Sonuç: Kad›n ve erkeklerde inme etyolojisi aç›s›ndan farkl›l›k olmay›p, inmeli olgular›m›zda en s›k görülen komorbid hastal›k hipertansiyondur; bu da inmeli hastalarda risk faktörlerinin modifikasyonunun önemini göstermektedir. ‹nme etyolojisi ve tutulan taraf fark› olmaks›z›n, tüm hastalar›m›z çeflitli düzeylerde fonksiyonel ba¤›ml›l›k göstermekte, dominant hemisfer lezyonu olan hastalar, dominant hemisfer lezyonu olmayan hastalardan, fonksiyonelli¤in çeflitli yönleri ve ba¤›ms›zl›k aç›s›ndan daha olumsuz etkilenmektedirler. Toplam FIM skorlar›n›n yafl ile ters iliflkili bulunmufl olmas›, inmeli hastalarda fonksiyonel ba¤›ml›l›¤›n ilerleyen yaflla artt›¤›n› göstermektedir. Erken dönemde motor, sonraki aylarda fonksiyonel iyileflmeyle devam eden kazançlar›n rehabilitasyon programlar› ile desteklenmesi uygundur.
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