430 KB0 KB200820252023Burger, HelenaRutar, MihaVidmar, Gajštevilka:1letnik:22str. 1-9ISSN:1580-9315COBISSID_HOST:164096003URN:URN:NBN:SI:doc-7MW3Q20CenUniverzitetni rehabilitacijski inštitut Slovenije - SočaRehabilitacija (Ljubljana)amputacijaamputationAmputation, Surgicalcognitive assessmentizid rehabilitacijeLower Extremitylower limbocenjevanje spoznavnih sposobnostiopremljanje s protezoprosthesis fittingrehabilitationrehabilitation outcomespodnji udOdnos med kratkim presejalnim preizkusom spoznavnih sposobnosti in izidom rehabilitacije po amputaciji spodnjega uda| Relationship between brief cognitive screening and rehabilitation outcomes after lower limb amputation|Background: Fitting of prosthesis after lower limb amputation (LLA) requires not only physical, but also cognitive capacity. Hence, we wanted to evaluate how Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are associated with rehabilitation outcomes in patients after lower-limb amputation. Methods: Data from 155 patients (119 men; median age 69 years) after lower-limb amputation who had completed inpatient rehabilitation at the University Rehabilitation Institute in Ljubljana between September 2017 and February 2018 were analysed. Until January 2018, they were cognitively tested with MMSE (n=66), afterwards with MoCA (n=89). Primary study outcome was prosthesis fitting; secondary outcomes were ability to independently don the prosthesis, ability to independently climb stairs using the prosthesis, walking aid type and 6-minute-walk-test. Propensity-score-matching and regression models with matching variables as additional covariates were applied to adjust parameter estimates for group-imbalance. We also assessed how cognitive impairment cut-off agrees with the outcomes within each group. Results: Regression models showed no statistically significant difference between the groups regarding association with the outcomes. MMSE/MoCA score was statistically significantly positively associated with prosthesis fitting and result of 6-minute-walk-test. Observed agreement of cognitive impairment based on MMSE/MoCA score cut-off with prosthesis fitting was higher in MMSE group; agreement with independent prosthesis donning and climbing stairs was higher in MoCA group. A ceiling effect was observed with MMSE scores. Conclusion: When adjusted for relevant patient characteristics, both MMSE and MoCA proved useful for predicting rehabilitation outcomes in patients after lower limb amputationUvod: Paciente po amputaciji spodnjega lahko v rehabilitaciji opremimo s protezo, za kar morajo imeti ustrezne telesne in spoznavne zmožnosti. Zato smo želeli ovrednotiti, kako sta Kratki preizkus spoznavnih sposobnosti (KPSS) in Montrealski spoznavni preizkus (MSP) povezana z izidi rehabilitacije pri pacientih po amputaciji spodnjega uda. Metode: Analizirali smo podatke o 155 pacientih (119 moških; sredinska starost 69 let) po amputaciji spodnjega uda, ki so bili na bolnišnični rehabilitaciji na URI Soča med septembrom 2017 in februarjem 2018. Do januarja 2018 so njihove spoznavne sposobnosti ocenjevali s KPSS (n=66), potem z MSP (n=89). Primarni izid rehabilitacije je bila uspešnost opremljanja s protezo; sekundarni izidi so bili zmožnost samostojnega nameščanja/ snemanja proteze, zmožnost samostojnega vzpenjanja po stopnicah s protezo, vrsta pripomočka za hojo in dosežek na šestminutnem testu hoje. Uporabili smo uravnoteževanje na podlagi stopnje nagnjenosti (angl. propensity-score matching) in regresijske modele s spremenljivkami za uravnoteževanje kot dodatnimi napovednimi dejavniki; s tem smo ocene parametrov popravili za neuravnoteženost skupin. Ocenili smo tudi, koliko se pragovi za spoznavno okvaro skladajo z izidi znotraj vsake skupine. Rezultati: Regresijski modeli niso pokazali statistično značilne razlike med skupinama glede povezanosti spoznavnega preizkusa z obravnavanimi izidi. Dosežek na KPSS oziroma MSP je bil statistično značilno pozitivno povezan z uspešnim opremljanjem s protezo in dosežkom na šestminutnem testu hoje. Opažena skladnost spoznavne okvare glede na prag dosežka z uspešnim opremljanjem s protezo je bila višja v skupini s KPSS; skladnost s samostojnim nameščanjem proteze in vzpenjanjem po stopnicah pa pa je bila višja v skupini z MSP. Pri dosežkih na KPSS smo opazili učinek stropa. Zaključek: Če ustrezno upoštevamo značilnosti pacientov, sta se oba preizkusa spoznavnih sposobnosti pokazala kot uporabna za napovedovanje izidov rehabilitacije pri pacientih po amputaciji spodnjega udaTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaUniverzitetni rehabilitacijski inštitut RS – Soča