脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能

doi:10.3969/j.issn.1006-9771.2023.08.004

摘要/Abstract

摘要：

目的探讨脑卒中偏瘫患者站立平衡仪测试指标与Berg平衡量表(BBS)评分和Fugl-Meyer评定量表下肢部分(FMA-LE)评分的相关性，以及平衡仪测试指标对BBS的预测效能。
方法 2022年3月至10月，山东中医药大学附属医院康复科脑卒中偏瘫患者66例，采用平衡仪测试患者睁、闭眼静态站立状态下运动椭圆面积、运动长度，采用BBS和FMA-LE分别进行评定。采用Pearson相关性分析研究平衡仪指标与BBS评分和FMA-LE评分的相关性，采用接受者操作特征(ROC)曲线分析平衡仪指标对BBS评分的预测效能。
结果是否并发高血压、糖尿病、冠心病，是否吸烟和是否饮酒间，BBS评分和FMA-UE评分比较无显著性差异(|t| < 1.124, P > 0.05)。平衡仪测试中，睁眼运动椭圆面积、睁眼运动长度、闭眼运动椭圆面积、闭眼运动长度均与BBS评分和FMA-UE评分呈负相关(|r| > 0.250, P < 0.05)。睁眼运动椭圆面积预测BBS评分曲线下面积为0.685 (P = 0.019)，睁眼运动长度预测BBS评分曲线下面积为0.764 (P < 0.001)。
结论脑卒中偏瘫患者睁眼运动椭圆面积、睁眼运动长度、闭眼运动椭圆面积、闭眼运动长度4个平衡测试结果与BBS评分和FMA-UE评分均呈负相关。睁眼站立平衡仪测试指标对BBS评分具有良好的预测效能。

关键词: 脑卒中, 下肢, 运动功能, 平衡

Abstract:

Objective To explore the correlation of index of standing balance tester to score of Berg Balance Scale (BBS) and Fugl-Meyer Assment-Lower Extremites (FMA-LE) in stroke patients with hemiplegia, and analyze the predictive effect to BBS.
Methods From March to October, 2022, 66 stroke hemiplegic patients in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine were selected. The elliptical area and length of motion were measured with a balance tester when they were standing with eyes open or closed, respectively. They were also evaluated with BBS and FMA-LE. The correlation between the test results and the scores of BBS and FMA-LE was analyzed with Pearson's correlation analysis, and the predictive effect of the test results to the score of BBS was also analyzed with receiver operating characteristic (ROC) curve.
Results Hypertension, diabetes, coronary heart disease, smoking and alcohol drinking were not significant for the scores of BBS and FMA-LE (|t| < 1.124, P > 0.05). In the balance test, the eye opening movement ellipse area, eye opening movement length, eye closing movement ellipse area and eye closing movement length were negatively correlated with the scores of BBS and FMA-LE (|r| > 0.250, P < 0.05). The area under the ROC curve of eye opening movement ellipse area to the score of BBS was 0.685 (P = 0.019), and the area under the ROC curve of the eye opening movement length to the score of BBS was 0.764 (P < 0.001).
Conclusion The open eye movement ellipse area, open eye movement length, closed eye movement ellipse area and closed eye movement length are significantly negatively correlated with the scores of BBS and FMA-UE. The indexes of the balance test with eyes open may predict the score of BBS.

Key words: stroke, lower extremity, motor function, balance

中图分类号:

R743.3

王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.

WANG Ya'nan, LIU Xihua. Correlation and predictive effect of subjective and objective balance function measurements in stroke patients with hemiplegia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 890-895.

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参考文献 22

[1]	CHEN Y, WRIGHT N, GUO Y, et al. Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0.5 million Chinese adults[J]. Lancet Glob Health, 2020, 8(4): e580-e590.
[2]	WU S, WU B, LIU M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi: S1474-4422(18)30500-3 pmid: 30878104
[3]	LI J, ZHONG D, YE J, et al. Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis[J]. BMJ Open, 2019, 9(7): e026844. doi: 10.1136/bmjopen-2018-026844
[4]	杨婷, 钱兴皋, 张会慧, 等. 平衡反馈训练仪与Berg平衡量表在评定脑卒中偏瘫患者平衡功能中的相关性[J]. 中国康复医学杂志, 2012, 27(11): 1011-1014.
	YANG T, QIAN X G, ZHANG H H, et al. The study of correlation between Pro-Kin balance assessment equipment and Berg balance scale in assessing balance function of hemiplegic patients with stoke[J]. Chin J Rehabil Med, 2012, 27(11): 1011-1014.
[5]	王盛, 杨菊, 朱奕, 等. 平衡反馈训练仪用于脑损伤偏瘫患者静态平衡测试的信度与效度研究[J]. 中国康复医学杂志, 2011, 26(11): 1035-1038.
	WANG S, YANG J, ZHU Y, et al. Reliability and validity of static balance measures in hemiplegic patients using balance feedback training equipment[J]. Chin J Rehabil Med, 2011, 26(11): 1035-1038.
[6]	王亚囡, 张通, 杜雪晶, 等. 脑卒中偏瘫患者步态参数与平衡功能的关系[J]. 中国康复理论与实践, 2022, 28(1): 38-43. doi: 10.3969/j.issn.1006-9771.2022.01.006
	WANG Y N, ZHANG T, DU X J, et al. Correlation between gait parameters and balance in stroke hemiplegic patients[J]. Chin J Rehabil Theory Pract, 2022, 28(1): 38-43.
[7]	王亚囡, 张通, 刘元旻, 等. 脑卒中患者双侧站立动态姿势控制能力与平衡及步行功能相关性研究[J]. 中国康复医学杂志, 2022, 37(3): 336-342.
	WANG Y N, ZHANG T, LIU Y M, et al. The correlation between dynamic posture control of bilateral lower limb standing and balance and walking function in stroke patients[J]. Chin J Rehabil Med, 2022, 37(3): 336-342.
[8]	瓮长水, 王军, 王刚, 等. Berg平衡量表在脑卒中患者中的内在信度和同时效度[J]. 中国康复医学杂志, 2007, 22(8): 688-690.
	WENG C S, WANG J, WANG G, et al. Assessments of internal reliability and concurrent validity of Berg balance scale in stroke patients[J]. Chin J Rehabil Med, 2007, 22(8): 688-690.
[9]	金冬梅, 燕铁斌, 曾海辉. Berg平衡量表的效度和信度研究[J]. 中国康复医学杂志, 2003, 18(1): 24-26.
	JIN D M, YAN T B, ZENG H H. Validity and reliability of Berg Balance Scale on assessing balance function[J]. Chin J Rehabil Med, 2003, 18(1): 24-26.
[10]	王惠娟, 张盛全, 刘夏, 等. 动态平衡仪与Berg量表用于评定偏瘫患者平衡功能的相关性分析[J]. 中国康复医学杂志, 2013, 28(4): 339-343.
	WANG H J, ZHANG S Q, LIU X, et al. Application of dynamic balance instrument and Berg Balance Scale in assessing balance function of hemiplegic patients and analysis of its correlation[J]. Chin J Rehabil Med, 2013, 28(4): 339-343.
[11]	刘西花, 杨玉如, 张伟, 等. 脑卒中患者呼吸肌功能障碍及影响因素分析[J]. 中华物理医学与康复杂志, 2021, 43(8): 686-689.
	LIU X H, YANG Y R, ZHANG W, et al. Factors influencing respiratory muscle dysfunction among stroke survivors[J]. Chine J Phys Med Rehabil, 2021, 43(8): 686-689.
[12]	张建国. ROC曲线分析的基本原理以及在体质与健康促进研究中的应用[J]. 体育科学, 2008(6): 62-66.
	ZHANG J G. The basic principle of ROC curve analysis and its application in the study of physique and health promotion[J]. Sports Sci, 2008(6): 62-66.
[13]	中华神经科学会,中华神经外科学会. 各类脑血管疾病的诊断要点[J]. 中华神经科杂志, 1996, 29(6): 379-380.
[14]	CHANG M C, LEE B J, JOO N Y, et al. The parameters of gait analysis related to ambulatory and balance functions in hemiplegic stroke patients: a gait analysis study[J]. BMC Neurol, 2021, 21(1): 38. doi: 10.1186/s12883-021-02072-4 pmid: 33504334
[15]	GLADSTONE D J, DANELLS C J, BLACK S E. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties[J]. Neurorehabil Neural Repair, 2002, 16(3): 232-240. doi: 10.1177/154596802401105171
[16]	RECH K D, SALAZAR A P, MARCHESE R R, et al. Fugl-Meyer Assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke[J]. J Stroke Cerebrovasc Dis, 2020, 29(1): 104463. doi: 10.1016/j.jstrokecerebrovasdis.2019.104463
[17]	HARUYAMA K, KAWAKAMI M, OTSUKA T. Effect of core stability training on trunk function, standing balance, and mobility in stroke patients[J]. Neurorehabil Neural Repair, 2017, 31(3): 240-249. doi: 10.1177/1545968316675431 pmid: 27821673
[18]	贾桂锋. 人体平衡能力定量评估方法研究[D]. 杭州: 浙江大学, 2015.
	JIA G F. A methodological study on quantitative assessment of balance ability[D]. Hangzhou: Zhejiang University, 2015.
[19]	迪晓霞, 李鑫铭, 翟月萍. 平衡仪训练对脑卒中患者平衡功能及跌倒风险的影响[J]. 中国康复, 2017, 32(3): 196-198.
	DI X X, LI X M, ZHAI Y P. Effect of balance instrument training on balance function and fall risk in stroke patients[J]. Chin J Rehabil, 2017, 32(3): 196-198.
[20]	TASSEEL-PONCHE S, YELNIK A P, BONAN I V. Motor strategies of postural control after hemispheric stroke[J]. Neurophysiol Clin, 2015, 45(4-5): 327-333. doi: 10.1016/j.neucli.2015.09.003
[21]	王廷军. 等速肌力训练对脑卒中偏瘫患者下肢运动功能的影响[D]. 济南: 山东大学, 2015.
	WANG T J. Effect of isokinetic muscle strength training on lower limb motor function in stroke patients with hemiplegia[D]. Ji'nan: Shandong University, 2015.
[22]	张洪宇. 脑卒中偏瘫足下垂患者廓清障碍的步态特征及影响因素分析[D]. 合肥: 安徽医科大学, 2022.
	ZHANG H Y. Analysis of gait characteristics and influencing factors of clearance obstacle in stroke patients with hemiplegic foot drop[D]. Hefei: Anhui Medical University, 2022.

并发症		n	BBS评分	FMA-UE评分
高血压	是	48	28.60±9.25	20.63±6.30
	否	18	27.83±11.71	19.89±7.27
糖尿病	是	18	26.56±11.04	21.89±6.62
	否	48	29.08±9.46	19.88±6.48
冠心病	是	6	29.00±9.72	19.00±5.62
	否	60	28.33±9.99	20.57±6.64
吸烟史	是	22	28.98±12.01	21.05±6.89
	否	44	28.11±8.79	20.11±6.40
饮酒史	是	20	30.65±11.39	21.65±6.03
	否	46	27.41±9.13	19.89±6.73
t值^a			-0.280	-0.405
P值^a			0.780	0.687
t值^b			0.923	-1.118
P值^b			0.359	0.268
t值^c			0.390	0.937
P值^c			0.534	0.337
t值^d			-0.323	-0.544
P值^d			0.748	0.589
t值^e			-1.124	-1.006
P值^e			0.270	0.318

平衡测试指标	BBS评分		FMA-UE评分
平衡测试指标	r值	P值	r值	P值
睁眼运动椭圆面积	-0.370	0.002	-0.250	0.040
睁眼运动长度	-0.542	< 0.001	-0.360	0.003
闭眼运动椭圆面积	-0.267	0.028	-0.405	0.001
闭眼运动长度	-0.296	0.016	-0.349	0.004