(35.175.212.130) 您好!臺灣時間:2021/05/15 09:06
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:陳思遠
研究生(外文):Ssu-Yuan Chen
論文名稱:腦中風復健患者功能預後與長期存活之研究
論文名稱(外文):Functional Outcomes and Long-term Survival in Patients After Stroke Rehabilitation
指導教授:季瑋珠季瑋珠引用關係
指導教授(外文):Wei-Chu Chie
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:流行病學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:英文
論文頁數:110
中文關鍵詞:功能預後存活分析步行能力吸入現象吞嚥困難腦中風復健管灌飲食電視螢光錄影吞嚥檢查
外文關鍵詞:functional outcomedysphagiastroke rehabilitationwalking abilitysurvival analysistube feedingvideofluoroscopyaspiration
相關次數:
  • 被引用被引用:5
  • 點閱點閱:464
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:3
背景與目標:腦中風復健患者之功能預後對其長期存活之影響屆今仍不清楚。本研究之目的是想探討影響腦中風復健患者功能預後之預測因子,並藉由存活分析探討腦中風患者之功能預後是否為其長期存活之獨立預測因子。本研究乃針對腦中風患者復健後之「步行能力」及「管灌飲食依賴性」等兩項功能預後進行探討。
研究對象與方法:本研究的第一部份以西元1990-1995年間,曾於臺大醫院復健部接受住院復健的590位45歲以上腦中風患者為研究世代,依據病歷記載將患者出院時之步行能力分成「適當」及「不良」兩組,並根據追蹤至西元2000年底患者之存活狀態,利用考克斯迴歸模式進行存活分析,以探討影響腦中風住院復健患者出院後長期存活之預測因子。第二部分以西元1994-1999年間,曾於臺大醫院影像醫學部接受電視螢光錄影吞嚥檢查的182位腦中風合併吞嚥障礙患者為研究世代,記錄其亞急性期之電視螢光錄影吞嚥檢查結果及管灌飲食依賴性,並根據追蹤至西元2000年底患者之存活狀態,利用考克斯迴歸模式進行存活分析,以探討影響腦中風合併吞嚥障礙患者之長期存活預測因子。第三部分以西元1994-1999年間,曾於臺大醫院影像醫學部接受電視螢光錄影吞嚥檢查的181位需使用管灌飲食之腦中風住院患者為研究對象,利用羅吉斯迴歸預測模式探討患者出院管灌飲食依賴性之相關因子。
結果:第一部份:在出院後追蹤71.1個月(中位數)的情況下,出院時仍為不良步行能力的腦中風復健患者,相較於適當步行能力的患者,其追蹤期間之死亡危險比(hazard ratio)為2.01(95%信賴區間:1.55-2.61)。僅於65歲以上老年腦中風患者中,方可發現患者年齡與之其出院時步行能力及長期存活具有統計學上顯著意義的相關性(P < 0.05)。第二部份:在接受電視螢光錄影吞嚥檢查後追蹤30.8個月(中位數)的情況下,年齡(每增加10歲之死亡危險比為1.46,95%信賴區間:1.13-1.89)、多次腦中風(死亡危險比為1.74,95%信賴區間:1.06-2.85)、出院時仍依賴管灌飲食(死亡危險比為2.07,95%信賴區間:1.19-3.59)、以及出院時僅能以輪椅活動無法行走(死亡危險比為2.83,95%信賴區間:1.54-5.19)等為長期存活之獨立預測因子。第三部份:年齡(每增加1歲之勝算比(Odds ratio)為1.07,95%信賴區間:1.02-1.12)、多次腦中風(勝算比為2.85,95%信賴區間:1.15-7.07)、出院時僅能以輪椅活動無法行走(勝算比為8.54,95%信賴區間:3.29-22.15)、以及電視螢光錄影吞嚥檢查結果(吸入現象、谿域或梨狀窩滯留現象)等為患者出院時仍依賴管灌飲食之獨立相關因子。依據羅吉斯迴歸模式之結果,我們提出一個初步的預測公式,以預測腦中風合併吞嚥困難患者其出院時之管灌飲食依賴性。
結論:腦中風住院復健患者出院時之步行能力為其長期存活之獨立預測因子,出院時仍依賴管灌飲食為腦中風合併吞嚥困難患者其長期存活之獨立預測因子,電視螢光錄影吞嚥檢查中之吸入現象則與腦中風合併吞嚥困難患者之長期存活無關。然而電視螢光錄影吞嚥檢查中之吸入現象及滯積現象,則為腦中風合併吞嚥困難患者出院時仍依賴管灌飲食之獨立相關因子。本研究證實腦中風患者之復健功能預後(包括步行能力與管灌飲食依賴性)為其長期存活之獨立預測因子,腦中風復健不僅能增進腦中風患者之生活品質,也能改善其長期存活。


Background and Objectives: The effect of functional outcomes after rehabilitation on the long-term survival of patients with stroke is unclear. The aims of the study are to explore the predictors of functional outcomes after rehabilitation, and to determine the effect of functional outcomes after rehabilitation on long-term survival in patients with stroke. The functional outcomes of interest in the study are the patient’s walking ability and tube feeding dependency due to stroke-related dysphagia after rehabilitation.
Materials and Methods: Part I: A cohort of 590 patients, aged 45 years and older, admitted for inpatient stroke rehabilitation from 1990 to 1995 was constructed. The walking ability of patients after rehabilitation was classified as either adequate or poor based on chart records. Cox proportional hazards regression analysis was used to identify independent predictors of survival until the end of 2000. Part II: A cohort of 182 patients with stroke-related dysphagia referred for videofluoroscopic swallowing study (VSS) from 1994 to 1999 was constructed. VSS findings and clinical features in the post-acute phase of stroke were recorded. Cox proportional hazards regression analysis was used to identify independent predictors of survival until the end of 2000. Part III: A total of 181 tube-fed inpatients referred for VSS from 1994 to 1999 due to stroke-related dysphagia were enrolled. Multivariate logistic regression analysis was used to identify independent predictors of tube feeding dependency at discharge.
Results: Part I: In the median follow-up time of 71.1 months after discharge, poor walking ability was independently associated with long-term survival, with a hazard ratio (HR) of 2.01 (95% confidence intervals (CI) = 1.55-2.61). The associations of increasing age with poor long-term survival and poor walking ability after stroke rehabilitation were observed in the older group (age ≥ 65), but not in the middle-aged group (age 45-64). Part II: In the median follow-up time of 30.8 months after VSS, advanced age (HR = 1.46, 95% CI = 1.13-1.89, every 10 years of increase), recurrent stroke (HR = 1.74, 95% CI = 1.06-2.85), the need of tube-feeding (HR = 2.07, 95% CI = 1.19-3.59), and being wheelchair-confined (HR = 2.83, 95% CI = 1.54-5.19) during follow-up were independent predictors of long-term survival. Part III: Advanced age (Odds ratio (OR) = 1.07, 95% CI = 1.02-1.12, every 1 year of increase), recurrent stroke (OR = 2.85, 95% CI = 1.15-7.07), wheelchair-confined at discharge (OR = 8.54, 95% CI = 3.29-22.15), long duration from stroke onset to VSS (OR = 1.02, 95% CI = 1.01-1.04, every 1 day of increase), and findings of VSS (stasis in valleculae or pyriform sinus, and aspiration) were independently associated with tube feeding dependency at discharge. Based on the final regression model, a preliminary equation was proposed to help clinicians better predict the tube feeding dependency at discharge in stroke patients with dysphagia.
Conclusions: The patient’s walking ability after inpatient rehabilitation independently predicts long-term survival in patients with stroke. Tube feeding dependency independently predicts long-term survival in stroke patients with dysphagia. VSS-detected aspiration during the post-acute phase of stroke was not predictive for the long-term survival in stroke patients with dysphagia. However, findings of VSS are associated with tube feeding dependency at discharge in stroke patients with dysphagia. The functional outcomes after rehabilitation, such as walking ability and tube feeding dependency, predict long-term survival of patients with stroke. Stroke rehabilitation not only adds quality of life but also improves long-term survival of patients with stroke.


圖目錄 (List of Figures) XI
表目錄 (List of Tables) XII
縮寫目錄 (List of Abbreviations) XIV
Chapter 1 Introduction 1
1.1 DEFINITION OF STROKE 1
1.2 METHODOLOGICAL ASPECTS OF EPIDEMIOLOGICAL STUDIES OF STROKE 1
1.3 REVIEW OF LONG-TERM SURVIVAL STUDIES OF STROKE 3
1.3.1 Definitions of survival and mortality 3
1.3.2 Predictors of long-term survival in patients with stroke 3
1.3.2.1 Age 3
1.3.2.2 Gender 4
1.3.2.3 Heart diseases 4
1.3.2.4 Hypertension 5
1.3.2.5 Diabetes mellitus 5
1.3.2.6 Stroke types and subtypes 5
1.3.2.7 Laboratory findings 6
1.3.2.8 Status of physical function 6
1.3.2.9 Status of mental function and social function 8
1.3.2.10 Miscellaneous 9
1.4 SURVIVAL STUDIES OF STROKE IN TAIWAN 9
1.4.1 Short-term survival studies of stroke in Taiwan 9
1.4.5 Long-term survival studies of stroke in Taiwan 10
1.5 PREDICTORS OF FUNCTIONAL OUTCOMES AFTER STROKE REHABILITATION 12
1.6 FUNCTIONAL OUTCOMES AFTER REHABILITATION AND LONG-TERM SURVIVAL OF PATIENTS WITH STROKE 13
Chapter 2 Aim and Hypothesis of the Study 15
2.1 AIM OF THE STUDY 15
2.2 HYPOTHESIS OF THE STUDY 16
Chapter 3 Subjects and Methods 17
3.1 WALKING ABILITY AFTER INPATIENT REHABILITATION: ITS DETERMINANTS AND EFFECT ON LONG-TERM SURVIVAL OF PATIENTS WITH STROKE 17
3.1.1 Study population 17
3.1.2 Assessment of clinical features and risk factors 18
3.1.3 Assessment of end point 19
3.1.4 Statistical analyses 19
3.2 THE EFFECTS OF ASPIRATION DETECTED BY VIDEOFLUOROSCOPIC SWALLOWING STUDIES AND TUBE FEEDING DEPENDENCY ON LONG-TERM SURVIVAL OF STROKE PATIENTS WITH DYSPHAGIA 22
3.2.1 Study population 22
3.2.2 Assessment of clinical features and risk factors 23
3.2.3 Assessment of dysphagia 24
3.2.4 Assessment of end point 25
3.2.5 Statistical analyses 25
3.3 FACTORS ASSOCIATED WITH TUBE FEEDING DEPENDENCY AT DISCHARGE IN STROKE PATIENTS WITH DYSPHAGIA 27
3.3.1 Study population 27
3.3.2 Assessment of clinical features and risk factors 28
3.3.3 Assessment of dysphagia 28
3.3.4 Assessment of outcome 30
3.3.5 Statistical analyses 30
Chapter 4 Results 32
4.1 WALKING ABILITY AFTER INPATIENT REHABILITATION: ITS DETERMINANTS AND EFFECT ON LONG-TERM SURVIVAL OF PATIENTS WITH STROKE 32
4.1.1 Demographic and clinical characteristics 32
4.1.2 Walking ability after inpatient stroke rehabilitation and long-term survival 32
4.1.3 Factors associated with walking ability after inpatient stroke rehabilitation 34
4.2 THE EFFECTS OF ASPIRATION DETECTED BY VIDEOFLUOROSCOPIC SWALLOWING STUDIES AND TUBE FEEDING DEPENDENCY ON LONG-TERM SURVIVAL OF STROKE PATIENTS WITH DYSPHAGIA 35
4.2.1 Demographic and clinical characteristics 35
4.2.2 Factors associated with long-term survival in stroke patients with dysphagia 36
4.3 FACTORS ASSOCIATED WITH TUBE FEEDING DEPENDENCY AT DISCHARGE IN STROKE PATIENTS WITH DYSPHAGIA 37
4.3.1 Demographic and clinical characteristics 37
4.3.2 Predictive equation for tube feeding dependency at discharge 38
Chapter 5 Discussion 40
5.1 WALKING ABILITY AFTER INPATIENT REHABILITATION: ITS DETERMINANTS AND EFFECT ON LONG-TERM SURVIVAL OF PATIENTS WITH STROKE 40
5.1.1 Main findings of this work 40
5.1.2 Argument for the findings of this work 40
5.1.3 Study limitation of this work 42
5.1.4 Conclusions and future work 43
5.2 THE EFFECTS OF ASPIRATION DETECTED BY VIDEOFLUOROSCOPIC SWALLOWING STUDIES AND TUBE FEEDING DEPENDENCY ON LONG-TERM SURVIVAL OF STROKE PATIENTS WITH DYSPHAGIA 44
5.2.1 Main findings of this work 44
5.2.2 Argument for the findings of this work 44
5.2.3 Study limitation of this work 46
5.2.4 Conclusions and future work 47
5.3 FACTORS ASSOCIATED WITH TUBE FEEDING DEPENDENCY AT DISCHARGE IN STROKE PATIENTS WITH DYSPHAGIA 48
5.3.1 Main findings of this work 48
5.3.2 Argument for the findings of this work 48
5.3.3 Study limitation of this work 51
5.3.4 Conclusions and future work 52
5.4 PERSPECTIVE OF THE STUDY 53
Tables 54
Figures 70
Appendix 74
APPENDIX A: SUMMARY OF STUDIES OF LONG-TERM SURVIVAL IN PATIENTS WITH STROKE 74
APPENDIX B: DEFINITIONS OF SELECTED RISK FACTORS OF STROKE 86
APPENDIX C: BRUNNSTROM STAGES OF MOTOR IMPAIRMENT 89
APPENDIX D: DEFINITIONS OF ABNORMAL FINDINGS IN VIDEOFLUOROSCOPIC SWALLOWING STUDY 90
References 91
Publications 105
Journal papers related to dissertation 110



(1) WHO MONICA Project Principal Investigators. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. J Clin Epidemiol 1988; 41(2):105-114.
(2) WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989; 20(10):1407-1431.
(3) Labarthe DR. Stroke. Epidemiology and prevention of cardiovascular diseases: A global challenge. Gaithersburg, Maryland: Aspen Publishers, Inc., 1998: 73-89.
(4) Moolgavkar SK, Lee JAH, Stevens RG. Analysis of vital statistics data. In: Rothman KJ, Greenland S, editors. Modern epidemiology. Philadelphia, PA: Lippincott-Raven Publishers, 1998: 481-497.
(5) Chang SF, Su CL, Hung TP. Epidemiological study of cerebrovascular disease in the Taiwan area: current status. J Formos Med Assoc 1993; 92 Suppl 3:S112-S120.
(6) Bogousslavsky J, van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988; 19(9):1083-1092.
(7) Jeng JS, Lee TK, Chang YC, Huang ZS, Ng SK, Chen RC, Yip PK. Subtypes and case-fatality rates of stroke: a hospital-based stroke registry in Taiwan (SCAN-IV). J Neurol Sci 1998; 156(2):220-226.
(8) Ricci S, Celani MG, Righetti E. Clinical methods for diagnostic confirmation of stroke subtypes. Neuroepidemiology 1994; 13(6):290-295.
(9) Heller RF, Fisher JD, D''Este CA, Lim LL, Dobson AJ, Porter R. Death and readmission in the year after hospital admission with cardiovascular disease: the Hunter Area Heart and Stroke Register. Med J Aust 2000; 172(6):261-265.
(10) Petty GW, Brown RD, Jr., Whisnant JP, Sicks JD, O''Fallon WM, Wiebers DO. Ischemic stroke subtypes : a population-based study of functional outcome, survival, and recurrence. Stroke 2000; 31(5):1062-1068.
(11) House A, Knapp P, Bamford J, Vail A. Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke 2001; 32(3):696-701.
(12) Longstreth WT, Jr., Bernick C, Fitzpatrick A, Cushman M, Knepper L, Lima J, Furberg CD. Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study. Neurology 2001; 56(3):368-375.
(13) Samsa GP, Bian J, Lipscomb J, Matchar DB. Epidemiology of recurrent cerebral infarction: a medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost. Stroke 1999; 30(2):338-349.
(14) Petty GW, Brown RD, Jr., Whisnant JP, Sicks JD, O''Fallon WM, Wiebers DO. Survival and recurrence after first cerebral infarction: a population- based study in Rochester, Minnesota, 1975 through 1989. Neurology 1998; 50(1):208-216.
(15) Brainin M, McShane LM, Steiner M, Dachenhausen A, Seiser A. Silent brain infarcts and transient ischemic attacks. A three-year study of first-ever ischemic stroke patients: the Klosterneuburg Stroke Data Bank. Stroke 1995; 26(8):1348-1352.
(16) Falke P, Lindgarde F, Stavenow L. Prognostic indicators for mortality in transient ischemic attack and minor stroke. Acta Neurol Scand 1994; 90(2):78-82.
(17) Sacco RL, Shi T, Zamanillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994; 44(4):626-634.
(18) Friedman P. Predictors of survival after cerebral infarction: importance of cardiac factors. Aust N Z J Med 1994; 24(1):51-54.
(19) Brainin M, Seiser A, Czvitkovits B, Pauly E. Stroke subtype is an age-independent predictor of first-year survival. Neuroepidemiology 1992; 11(4-6):190-195.
(20) Kojima S, Omura T, Wakamatsu W, Kishi M, Yamazaki T, Iida M, Komachi Y. Prognosis and disability of stroke patients after 5 years in Akita, Japan. Stroke 1990; 21(1):72-77.
(21) Howard G, Evans GW, Murros KE, Toole JF, Lefkowitz D, Truscott BL. Cause specific mortality following cerebral infarction. J Clin Epidemiol 1989; 42(1):45-51.
(22) Gandolfo C, Moretti C, Dall''Agata D, Primavera A, Brusa G, Loeb C. Long-term prognosis of patients with lacunar syndromes. Acta Neurol Scand 1986; 74(3):224-229.
(23) Wade DT, Skilbeck CE, Wood VA, Langton HR. Long-term survival after stroke. Age Ageing 1984; 13(2):76-82.
(24) Miah K, von Arbin M, Britton M, de Faire U, Helmers C, Maasing R. Prognosis in acute stroke with special reference to some cardiac factors. J Chronic Dis 1983; 36(3):279-288.
(25) Lewis SC, Dennis MS, O''Rourke SJ, Sharpe M. Negative attitudes among short-term stroke survivors predict worse long- term survival. Stroke 2001; 32(7):1640-1645.
(26) Wang SL, Pan WH, Lee MC, Cheng SP, Chang MC. Predictors of survival among elders suffering strokes in Taiwan: observation from a nationally representative sample. Stroke 2000; 31(10):2354-2360.
(27) Laska AC, Hellblom A, Murray V, Kahan T, von Arbin M. Aphasia in acute stroke and relation to outcome. J Intern Med 2001; 249(5):413-422.
(28) Marini C, Totaro R, Carolei A. Long-term prognosis of cerebral ischemia in young adults. National Research Council Study Group on Stroke in the Young. Stroke 1999; 30(11):2320-2325.
(29) Anderson CS, Jamrozik KD, Broadhurst RJ, Stewart-Wynne EG. Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study. Stroke 1994; 25(10):1935-1944.
(30) Sacco RL, Hauser WA, Mohr JP, Foulkes MA. One-year outcome after cerebral infarction in whites, blacks, and Hispanics. Stroke 1991; 22(3):305-311.
(31) Sacco RL, Wolf PA, Kannel WB, McNamara PM. Survival and recurrence following stroke. The Framingham study. Stroke 1982; 13(3):290-295.
(32) Bronnum-Hansen H, Davidsen M, Thorvaldsen P. Long-term survival and causes of death after stroke. Stroke 2001; 32(9):2131-2136.
(33) Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001; 32(10):2426-2432.
(34) van Straten A, Reitsma JB, Limburg M, van den Bos GA, de Haan RJ. Impact of stroke type on survival and functional health. Cerebrovasc Dis 2001; 12(1):27-33.
(35) Patel M, Coshall C, Rudd AG, Wolfe CD. Natural history and effects on 2-year outcomes of urinary incontinence after stroke. Stroke 2001; 32(1):122-127.
(36) Di Napoli M, Papa F, Bocola V. Prognostic influence of increased C-reactive protein and fibrinogen levels in ischemic stroke. Stroke 2001; 32(1):133-138.
(37) Di Napoli M, Papa F, Bocola V. C-reactive protein in ischemic stroke: an independent prognostic factor. Stroke 2001; 32(4):917-924.
(38) Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke 2003; 34(8):1951-1956.
(39) Deanfield JE. Clinical trials: Evidence and unanswered questions--hyperlipidaemia. Cerebrovasc Dis 2003; 16 Suppl 3:25-32.
(40) Di Mascio R, Marchioli R, Tognoni G. Cholesterol reduction and stroke occurrence: an overview of randomized clinical trials. Cerebrovasc Dis 2000; 10(2):85-92.
(41) Vaughan CJ, Delanty N. Neuroprotective properties of statins in cerebral ischemia and stroke. Stroke 1999; 30(9):1969-1973.
(42) International classification of impairments, disability, and handicaps. Geneva, Switzerland: World Health Organization, 1980.
(43) Roberts L, Counsell C. Assessment of clinical outcomes in acute stroke trials. Stroke 1998; 29(5):986-991.
(44) Brott T, Adams HP, Jr., Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, . Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20(7):864-870.
(45) VA/DoD Clinical Practice Guideline Working Group. Management of stroke rehabilitation in primary care. Washington, DC: Office of Quality and Performance, 2003.
(46) Demeurisse G, Demol O, Robaye E. Motor evaluation in vascular hemiplegia. Eur Neurol 1980; 19(6):382-389.
(47) Kapral MK, Wang H, Mamdani M, Tu JV. Effect of socioeconomic status on treatment and mortality after stroke. Stroke 2002; 33(1):268-275.
(48) Lincoln NB, Husbands S, Trescoli C, Drummond AE, Gladman JR, Berman P. Five year follow up of a randomised controlled trial of a stroke rehabilitation unit. BMJ 2000; 320(7234):549.
(49) Ronning OM, Guldvog B. Stroke units versus general medical wards, I: twelve- and eighteen- month survival: a randomized, controlled trial. Stroke 1998; 29(1):58-62.
(50) Wong KS. Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: A prospective hospital-based study in Asia. Asian Acute Stroke Advisory Panel. Stroke 1999; 30(11):2326-2330.
(51) Hu HH, Sheng WY, Chu FL, Lan CF, Chiang BN. Incidence of stroke in Taiwan. Stroke 1992; 23(9):1237-1241.
(52) Hung TP, Study Group on Stroke. Prospective Survey and Registry of Stroke in Taiwan Area. Taipei, Taiwan: Department of Health, ROC, 1992.
(53) Huang ZS, Chiang TL, Lee TK. Stroke prevalence in Taiwan. Findings from the 1994 National Health Interview Survey. Stroke 1997; 28(8):1579-1584.
(54) Roth EJ, Harvey RL. Rehabilitation of stroke syndromes. In: Braddom RL, editor. Physical Medicine & Rehabilitation. Philadelphia, PA: W.B. Saunders Company, 2000: 1117-1160.
(55) Brandstater ME. Stroke rehabilitation. In: DeLisa JA, Gans BM, editors. Rehabilitation medicine: principles and practice. Philadelphia: Lippincott-Raven Publishers, 1998: 1165-1189.
(56) Jongbloed L. Prediction of function after stroke: a critical review. Stroke 1986; 17(4):765-776.
(57) Dombovy ML, Sandok BA, Basford JR. Rehabilitation for stroke: a review. Stroke 1986; 17(3):363-369.
(58) Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Stroke unit treatment. 10-year follow-up. Stroke 1999; 30(8):1524-1527.
(59) Brott T, Bogousslavsky J. Treatment of acute ischemic stroke. N Engl J Med 2000; 343(10):710-722.
(60) Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, Wolfe CD. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke 2001; 32(6):1279-1284.
(61) Smithard DG, O''Neill PA, England RE, Park CL, Wyatt R, Martin DF, Morris J. The natural history of dysphagia following a stroke. Dysphagia 1997; 12(4):188-193.
(62) Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis 2000; 10(5):380-386.
(63) Kidd D, Lawson J, Nesbitt R, MacMahon J. The natural history and clinical consequences of aspiration in acute stroke. QJM 1995; 88(6):409-413.
(64) Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79(1):14-19.
(65) Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil 1995; 76(12):1130-1133.
(66) Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 1989; 52(2):236-241.
(67) DePippo KL, Holas MA, Reding MJ. The Burke dysphagia screening test: validation of its use in patients with stroke. Arch Phys Med Rehabil 1994; 75(12):1284-1286.
(68) Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30(4):744-748.
(69) Smithard DG, O''Neill PA, Parks C, Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996; 27(7):1200-1204.
(70) Teasell RW, Bach D, McRae M. Prevalence and recovery of aspiration poststroke: a retrospective analysis. Dysphagia 1994; 9(1):35-39.
(71) Logemann JA. Evaluation of swallowing disorder. In: Logemann JA, editor. Evaluation and treatment of swallowing disorders. San Diego, CA: College-Hill Press, 1983: 89-100.
(72) Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia 2001; 16(1):7-18.
(73) McCullough GH, Wertz RT, Rosenbek JC, Mills RH, Webb WG, Ross KB. Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia 2001; 16(2):110-118.
(74) Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol 1994; 51(10):1051-1053.
(75) Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia 1994; 9(1):7-11.
(76) Brunnstrom S. Movement therapy in hemiplegia: a neurophysiological approach. New York: Harper & Row, 1970.
(77) Efron B. The efficiency of Cox''s likelihood function for censored data. J Am Stat Assoc 1977; 72(359):557-565.
(78) SAS Institute Inc. SAS/STAT software: changes and enhancements through release 6.11. Cary, NC: SAS Institute Inc, 1996: 880-893.
(79) Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143(1):29-36.
(80) Henderson AR. Assessing test accuracy and its clinical consequences: a primer for receiver operating characteristic curve analysis. Ann Clin Biochem 1993; 30 ( Pt 6):521-539.
(81) SAS Institute Inc. SAS/STAT software: changes and enhancements through release 6.11. Cary, NC: SAS Institute Inc, 1996: 465-467.
(82) Lemeshow S, Hosmer DW, Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115(1):92-106.
(83) Chang YC, Chen SY, Lui LT, Wang TG, Wang TC, Hsiao TY, Li YW, Lien IN. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 2003; 18(2):135-143.
(84) Palmer JB, Kuhlemeier KV, Tippett DC, Lynch C. A protocol for the videofluorographic swallowing study. Dysphagia 1993; 8(3):209-214.
(85) Perlman AL, Booth BM, Grayhack JP. Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia 1994; 9(2):90-95.
(86) Fleiss JL. Statistical methods for rates and proportions. 2nd ed. Singapore: John Wiley & Sons, Inc., 1981.
(87) Brandstater ME, de Bruin H, Gowland C, Clark BM. Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil 1983; 64(12):583-587.
(88) Wade DT, Hewer RL. Motor loss and swallowing difficulty after stroke: frequency, recovery, and prognosis. Acta Neurologica Scandinavica 1987; 76(1):50-54.
(89) Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. N Engl J Med 1995; 333(21):1392-1400.
(90) Wannamethee SG, Shaper AG. Physical activity in the prevention of cardiovascular disease: an epidemiological perspective. Sports Med 2001; 31(2):101-114.
(91) Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc 2001; 33(6 Suppl):S459-S471.
(92) Oguma Y, Sesso HD, Paffenbarger RS, Jr., Lee IM. Physical activity and all cause mortality in women: a review of the evidence. Br J Sports Med 2002; 36(3):162-172.
(93) Rimmer JH, Riley B, Creviston T, Nicola T. Exercise training in a predominantly African-American group of stroke survivors. Med Sci Sports Exerc 2000; 32(12):1990-1996.
(94) Hankey GJ. Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis 2003; 16 Suppl 1:14-19.
(95) Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ. Predicting disability in stroke--a critical review of the literature. Age Ageing 1996; 25(6):479-489.
(96) Falconer JA, Naughton BJ, Strasser DC, Sinacore JM. Stroke inpatient rehabilitation: a comparison across age groups. J Am Geriatr Soc 1994; 42(1):39-44.
(97) Kalra L. Does age affect benefits of stroke unit rehabilitation? Stroke 1994; 25(2):346-351.
(98) Rusin MJ. Stroke rehabilitation: a geropsychological perspective. Arch Phys Med Rehabil 1990; 71(11):914-922.
(99) Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994; 25(4):808-813.
(100) Adler MK, Brown CC, Jr., Acton P. Stroke rehabilitation--is age a determinant? J Am Geriatr Soc 1980; 28(11):499-503.
(101) Bagg S, Pombo AP, Hopman W. Effect of age on functional outcomes after stroke rehabilitation. Stroke 2002; 33(1):179-185.
(102) Rosamond WD, Folsom AR, Chambless LE, Wang CH, McGovern PG, Howard G, Copper LS, Shahar E. Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke 1999; 30(4):736-743.
(103) Shi FL, Hart RG, Sherman DG, Tegeler CH. Stroke in the People''s Republic of China. Stroke 1989; 20(11):1581-1585.
(104) Patel MD, Coshall C, Rudd AG, Wolfe CD. Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes. J Am Geriatr Soc 2002; 50(4):700-706.
(105) Wang Y, Lim LL, Levi C, Heller RF, Fischer J. A prognostic index for 30-day mortality after stroke. J Clin Epidemiol 2001; 54(8):766-773.
(106) Di Carlo A, Lamassa M, Pracucci G, Basile AM, Trefoloni G, Vanni P, Wolfe CDA, Tilling K, Ebrahim S, Inzitari D. Stroke in the very old : clinical presentation and determinants of 3-Month functional outcome: a European perspective. Stroke 1999; 30(11):2313-2319.
(107) Black-Schaffer RM, Kirsteins AE, Harvey RL. Stroke rehabilitation. 2. Co-morbidities and complications. Arch Phys Med Rehabil 1999; 80(5 Suppl 1):S8-16.
(108) Blackmer J. Tube feeding in stroke patients: a medical and ethical perspective. Can J Neurol Sci 2001; 28(2):101-106.
(109) Campbell-Taylor I. Dysphagia after stroke. Neurology 1995; 45(9):1786-1788.
(110) Huxley EJ, Viroslav J, Gray WR, Pierce AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64(4):564-568.
(111) Smithard DG. Swallowing and Stroke. neurological effects and recovery. Cerebrovasc Dis 2002; 14(1):1-8.
(112) Ciocon JO, Silverstone FA, Graver LM, Foley CJ. Tube feedings in elderly patients. Indications, benefits, and complications. Arch Intern Med 1988; 148(2):429-433.
(113) Norton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GK. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 1996; 312(7022):13-16.
(114) Lu TH, Lee MC, Chou MC. Accuracy of cause-of-death coding in Taiwan: types of miscoding and effects on mortality statistics. Int J Epidemiol 2000; 29(2):336-343.
(115) Di Carlo A, Lamassa M, Pracucci G, Basile AM, Trefoloni G, Vanni P, Wolfe CDA, Tilling K, Ebrahim S, Inzitari D. Stroke in the very old : clinical presentation and determinants of 3-Month functional outcome: a European perspective. Stroke 1999; 30(11):2313-2319.
(116) O''Neill PA. Swallowing and prevention of complications. Br Med Bull 2000; 56(2):457-465.
(117) Wojner AW, Alexandrov AV. Predictors of tube feeding in acute stroke patients with dysphagia. AACN Clin Issues 2000; 11(4):531-540.
(118) Wilkinson TJ, Thomas K, MacGregor S, Tillard G, Wyles C, Sainsbury R. Tolerance of early diet textures as indicators of recovery from dysphagia after stroke. Dysphagia 2002; 17(3):227-232.
(119) Mann G, Hankey GJ. Initial clinical and demographic predictors of swallowing impairment following acute stroke. Dysphagia 2001; 16(3):208-215.
(120) Martino R. When to PEG? Dysphagia 2002; 17(3):233-234.
(121) Allison MC, Morris AJ, Park RH, Mills PR. Percutaneous endoscopic gastrostomy tube feeding may improve outcome of late rehabilitation following stroke. J R Soc Med 1992; 85(3):147-149.
(122) Finucane TE, Bynum JP. Use of tube feeding to prevent aspiration pneumonia. Lancet 1996; 348(9039):1421-1424.
(123) Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. J Am Geriatr Soc 2003; 51(2):213-221.
(124) Suiter DM, McCullough GH, Powell PW. Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia 2003; 18(4):284-292.
(125) Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med 1980; 303(3):130-135.
(126) Vita AJ, Terry RB, Hubert HB, Fries JF. Aging, health risks, and cumulative disability. N Engl J Med 1998; 338(15):1035-1041.
(127) Ricci S, Celani MG, La Rosa F, Righetti E, Duca E, Caputo N. Silent brain infarctions in patients with first-ever stroke. A community-based study in Umbria, Italy. Stroke 1993; 24(5):647-651.
(128) Giroud M, Milan C, Beuriat P, Gras P, Essayagh E, Arveux P, Dumas R. Incidence and survival rates during a two-year period of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischaemic attacks. The Stroke Registry of Dijon: 1985-1989. Int J Epidemiol 1991; 20(4):892-899.
(129) Turney TM, Garraway WM, Whisnant JP. The natural history of hemispheric and brainstem infarction in Rochester, Minnesota. Stroke 1984; 15(5):790-794.
(130) Sander D, Winbeck K, Klingelhofer J, Etgen T, Conrad B. Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke. Neurology 2001; 57(5):833-838.
(131) Miyao S, Takano A, Teramoto J, Takahashi A. Leukoaraiosis in relation to prognosis for patients with lacunar infarction. Stroke 1992; 23(10):1434-1438.
(132) Chen QT. A 3 to 6-year follow-up study of 414 cases of cerebral infarction and cerebral hemorrhage. Chung Hua Shen Ching Ching Shen Ko Tsa Chih 1989; 22(4):202-4, 252.
(133) Schmidt R, Breteler MM, Inzitari D, Fratiglioni L, Hofman A, Launer LJ. Prognosis with stroke in Europe: A collaborative study of population- based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54(11 Suppl 5):S34-S37.




QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊