作者：Caroline Cassels
出處：WebMD醫學新聞
September 30, 2008 — 中風病患在症狀發生後24小時開始下床運動可以顯著降低其憂鬱比率。
最新版A Very Early Rehabilitation Trial (AVERT)第2期試驗發現，發生中風的病患，在症狀發生後24小時內下床走動，將可以減少中風7天後的嚴重憂慮比率達50%。
國家中風研究中心的研究者、Toby Cumming博士向Medscape Psychiatry表示，我們對這些結果的強度、以及及早運動對嚴重憂鬱症狀的影響感到驚訝— 控制組42%與介入組21%這兩個數據是相當顯著的差異。
他表示，我們需要強調，這些是相當小型研究的初步結果，不過，此結果令人振奮且意想不到；根據這些結果與我們稍早的發現，我認為我們應該鼓勵大家考慮讓中風病患早點運動，因為它有助益，且可減少憂鬱。
此研究登載於9月版的復健醫學期刊(Journal of Rehabilitation Medicine)。
【常有中風後憂鬱】
之前的研究顯示，將近三分之一的中風病患發生過憂鬱；再者，Cumming博士表示，中風後憂鬱也與預後不佳有關，包括增加死亡率、恢復狀況不佳、生活品質差，降低參與復健計畫的比率。
此外，檢視中風後憂鬱的治療和檢查的研究顯示，它常未被診斷或未被治療。
他表示，如果我們可以找到一種減少中風後憂鬱的方法，或許可以產生大量影響，這對中風預後相當重要，而這的確有可能性。
目前的結果建立在AVERT的安全結果和早期的可行性，AVERT是一個隨機控制試驗，設計來比較接受及早運動(very early mobilization，VEM)和接受標準照護(standard care，SC)中風病患的結果。
該研究包括71名確認中風病患，在中風發生之後24小時內住進兩家大型醫學中心之一，且隨機接受SC或者VEM；兩組在人口統計資料、缺損情況、失能情況和其他各種基準測量等方面是一致的。
VEM組的病患在狀況許可時立即准予運動，目標是在症狀發生後24小時內進行第一次運動；VEM組有護士和物理治療師在住院內14天內提供協助，或者到出院為止，這兩種期限以先到者為準。
【無持續效果】
該研究的主要結果是「易怒、憂鬱、焦慮(Irritability, Depression, and Anxiety/ IDA)量表」檢測狀況；在中風後第7、14天和第3、6、12個月進行評估。
第7天時，研究者發現SC組病患的憂鬱症狀顯著比VEM組明顯，而VEM組的焦慮有減少的傾向，只是沒有統計上的顯著差異。
據研究者表示，已知體能活動可以減少健康者的憂鬱，但是還不知道當運動停止之後，此效果是否持續。
研究顯示VEM減少立即中風後時期的憂鬱，不過，兩組在1年時並無差異，此發現認為，需要持續體能活動介入，以維持此類病患不發生憂鬱。
Cumming博士表示，需要後續研究，以釐清潛在的機轉，是心理、生理，或者這兩者的一些結合；他表示，他也對及早運動是否可以幫助改善中風病患的認知感到興趣。
此研究接受澳洲國家心臟基金會、 Affinity Health、 Austin健康醫學研究基金與國家健康與醫學研究委員會等支持。
Very Early Mobilization Cuts Rates of Poststroke Depression by 50%
By Caroline Cassels
Medscape Medical News
September 30, 2008 — Very early mobilization of stroke patients within 24 hours of symptom onset significantly reduces rates of depression in this population.
These latest phase 2 findings from A Very Early Rehabilitation Trial (AVERT), show getting stroke patients up and out of bed within 24 hours of symptom onset cuts rates of severe depression by 50% 7 days after the stroke.
"We were surprised at the strength of these results and the impact very early and frequent mobilization had on severe depressive symptoms — 42% for controls vs 21% for those in the intervention group is quite a marked difference," study investigator Toby Cumming, PhD, from the National Stroke Research Institute, in Victoria, Australia, told Medscape Psychiatry.
"We need to stress that these are preliminary findings from quite a small study. Nevertheless, the results are exciting and quite unexpected. Based on these results and our earlier findings, I think we'd encourage people to consider mobilizing stroke patients earlier, because it may have beneficial effects, and reducing depression may be 1 of them," he said.
The study is published in the September issue of the Journal of Rehabilitation Medicine.
Poststroke Depression Common
Previous research shows approximately one-third of all stroke patients experience depression. Further, said Dr. Cumming, poststroke depression has also been associated with poor outcomes, including increased mortality, poorer rate and extent of recovery, poorer quality of life, and reduced participation in rehabilitation programs.
In addition, studies examining detection and treatment of poststroke depression show that it is commonly underdiagnosed and undertreated.
"If we can find a way to reduce poststroke depression, we may be able to positively affect many of these other, very important stroke outcomes, which is a really exciting possibility," he said.
The current results build on earlier feasibility and safety results from AVERT, a randomized controlled trial designed to compare outcomes in stroke patients who undergo very early mobilization (VEM) with those who receive standard care (SC).
The study included 71 patients with confirmed stroke who were admitted to 1 of 2 large centers within 24 hours of symptom onset and randomized to receive SC or VEM. Both groups were comparable with respect to demographics, impairment, disability, and all other baseline measures.
Patients in the VEM group began mobilization as soon as it was practical, with the aim of first mobilization within 24 hours of symptom onset. A nurse and physiotherapist team delivered VEM for the first 14 days after admission or until the patient was discharged, whichever came first.
No Sustained Effect
The study's primary outcome was patient well-being measured using the Irritability, Depression, and Anxiety (IDA) scale. Subjects were assessed at day 7 and 14 and again at 3, 6, and 12 months after stroke.
At 7 days, investigators found depressive symptoms were significantly more common in the SC group than in VEM patients. While there was a trend toward anxiety reduction in the VEM group, this was not statistically significant.
According to the investigators, it is well know that physical activity reduces depression in healthy individuals, but it is not known whether this effect endures once exercise ceases.
The study showed that VEM reduced depression in the immediate poststroke phase. However, at 1 year there was no difference between the 2 groups, a finding that may suggest the need for ongoing physical activity intervention to keep depressive symptoms at bay in this patient population.
Further research, said Dr. Cumming, is needed to shed light on whether the potential mechanism is psychological, physiological, or some combination of the 2. He said he is also interested examining the possibility that early mobilization may help improve cognition in stroke patients.
The study was supported by the National Heart Foundation of Australia, Affinity Health, Austin Health Medical Research Fund, and the National Health and Medical Research Council.
J Rehabil Med. 2008;40:609-614.
[ 本帖最後由 goodcat1111 於 2008-10-9 09:41 編輯 ] |
|
