脑卒中患者家庭康复护理干预及效果评价

目的 探讨家庭护理对提高出院后脑卒中患者康复的意义.家庭护理干预对患者运动功能及日常生活活动能力的影响.方法 选择经治疗好转出院的脑卒中偏瘫患者60例,随机分为干预组和对照组各30例,干预组进行家庭护理干预,每月上门随访指导,对照组采用传统家庭疗养,不施加干预.比较两组患者运动能力、日常生活能力改善情况.结果 出院时两组评分无差异性.6个月后干预组FIM及Barthel评分明显高于对照组(P＜0.01).结论 家庭护理干预能明显改善患者运动能力和日常生活自理能力,提高患者的生活质量.家庭护理延续了康复期脑卒中患者从医院到家庭支持护理,有效地促进了脑卒中康复期患者的康复.     

Rehabilitation and Therapy Research Society Third Annual Conference: Collaborative research … making it a reality

Abstract

This review is based on studies conducted in the Stockholm County that sought to explore and compare the behavior of patients and therapists during stroke rehabilitation sessions in the home and in the hospital. The study also describes a program of early supported discharge and continued rehabilitation at home for patients with moderate neurological impairments after stroke; and evaluates the effect of the program, in terms of patient outcome, resource use and cost of health-care in comparison with routine rehabilitation. Eighty-three patients were included in a randomized controlled trial: 41 were allocated to rehabilitation at home (HRG) and 40 to routine rehabilitation (RRG). Follow-up of patient outcome was performed at 3, 6 and 12 months, patient satisfaction at 3 months, and resource use over 12 months. Observations and semi-structured interviews were used to explore the behavior of therapists and patients during rehabilitation sessions, and to describe the content and implementation of the intervention program. The intervention program varied in duration (4–29 weeks, mean = 14), frequency of home visits (3–31 visits, mean = 12) and content. The rehabilitation was planned and carried out in partnership between the patient and the therapist. Face-to-face contact with the patient was spent in dialogue and training. Self-directed training was performed an average of 1½ h a day per patient. The home of the patient was found to provide an environment more amenable than the hospital for a stroke rehabilitation session whose aim was promoting active patient participation. In the RRG, 20 patients were discharged to their homes and 18 were transferred to departments of geriatrics or rehabilitation, where they had 1142 rehabilitation contacts. Patient satisfaction with participation in planning the rehabilitation was significantly better in the HRG than in the RRG (p = 0.021) and at least as good in all other domains. At 1 year, 77 patients — 39 in the HRG and 38 in the RRG — were followed-up. There was no difference in patient outcome. By multiple regression analysis, intervention was suggested to have a significant effect on independence in activities of daily living. During the first year after stroke a significant difference in in-patient hospital care was observed, with means of 18 (HRG) versus 33 days (RRG)(p = 0.002); there was no difference in other resource use. In Sweden, early supported discharge with continued rehabilitation at home proved no less beneficial than routine rehabilitation. The average cost of health-care for five patients in the HRG during 1 year was similar to that for four patients in the RRG.     

Use of healthcare, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in southwest Stockholm

We previously conducted a randomized controlled trial in which early supported discharge from the Department of Neurology at Huddinge Hospital in southwest Stockholm with continuity of rehabilitation at home (n = 41) was compared to routine rehabilitation services (n = 40) for moderately disabled selected stroke patients. No statistical significant differences were found in patient outcome at 3 or 6 months, but a moderately positive effect in the home rehabilitation group was suggested. In the present study we evaluated resource utilization of health and social care, impact on family caregivers during 6 months after acute stroke and patient satisfaction. A 50% reduction in total hospitalization (initial and recurrent) was observed, from 30 days in the routine rehabilitation group to 15 days in the home rehabilitation group (p < 0.001). After discharge, the mean number of home visits in the home rehabilitation group was 12. In total, the routine rehabilitation group had a higher frequency of therapy contacts and daycare in outpatient care. Seventy-eight percent received help from a family caregiver in activities of daily living, yet only 15% had formal home help service. No major differences were found in use of home help service or impact on family caregivers in the form of time devoted to helping the patient or subjective well-being of spouses as per Sickness Impact Profile. Patient satisfaction was in favour of the home rehabilitation group, but a significant difference was only found in active participation in rehabilitation programme planning. In conclusion, early supported discharge with continuity of rehabilitation at home, using goal-directed functional activities based on the patient's personal interests, should be the rehabilitation service of choice for moderately disabled stroke patients fulfilling certain criteria, provided that further evaluation during the first year after stroke reveals no great changes in outcome or resource use. More research into the effectiveness and cost implications of early supported discharge with continuity of rehabilitation at home is needed in other parts of Sweden and in other countries before it can be asserted that the conclusions drawn from this study are applicable elsewhere.     

针刺疗法对脑卒中患者的运动功能、平衡功能及日常生活活动能力的影响

目的:观察针刺疗法对不同阶段脑卒中患者的运动功能、平衡功能及日常生活活动能力所产生的影响,探讨针刺疗法在脑卒中患者康复过程中的作用。方法:我科住院的脑卒中患者64例,采用随机数字表法分为针刺康复组与常规康复组。常规康复组接受为期4周的常规康复训练,针刺康复组在接运动康复训练的同时,还接受4周的针刺治疗。分别采用Fugl-Meyer运动功能评分法(FMA)、Berg平衡量表(BBS)、Barthel指数(BI)评价患者的运动功能、平衡功能和日常生活活动能力。结果:①经过4周康复干预,针刺康复组FMA较常规康复组显著提高(P0.05),但BBS和BI与常规康复组相比差异无显著性(P0.05)。②经过4周康复干预,针刺康复组急性期亚组的FMA和BI较常规康复组急性期亚组显著升高(P0.05),而BBS在两个急性期亚组之间差异无显著性(P,0.05);③经过4周康复干预,FMA、BBS和BI在两个恢复期亚组之间差异均无显著性(P0.05)。结论:针刺疗法能够提高脑卒中患者的运动功能,而在脑卒中急性期进行针刺治疗,可显著提高患者的运动功能和日常生活活动能力。     

不同康复治疗计划对脑卒中患者功能恢复的影响

目的　观察急性脑卒中患者早期系统康复治疗的有效性 ,探讨恢复期不同康复治疗计划对功能恢复的影响。方法　将 45例发病在 2周内的脑卒中患者随机分为康复组 (2 3例 )和对照组 (2 2例 ) ,康复组又分为康复A组 1 1例 (住院系统康复治疗 1 2周 )和康复B组 1 2例 (住院系统康复治疗 4周后出院由治疗师上门指导家庭康复训练 8周 )。采用Fugl Meyer法、Barthel指数法于治疗前及治疗 4周和 1 2周后评定各组患者的运动功能和日常活动能力。结果　治疗前各组Fugl Meyer及Barthel积分相近 ,差异均无显著性意义(P >0 .0 5) ;治疗 4周和 1 2周后 ,康复组Fugl Meyer及Barthel积分均明显高于对照组 ,差异有非常显著性意义 (P <0 .0 1 ) ;治疗前和治疗 4周后康复A组和B组的Fugl Meyer及Barthel积分差异没有显著性意义 (P >0 .0 5) ;治疗 1 2周后康复A组Fugl Meyer值明显高于康复B组 ,差异有非常显著性意义 (P <0 .0 1 ) ,而两组Barthel积分差异没有显著性意义 (P >0 .0 5)。结论　早期系统康复治疗可以有效地提高患者的运动功能和改善ADL能力 ,恢复期继续给予至少 8周家庭指导康复训练则更有利于提高患者的独立生活能力 ,并可减少医疗费用、缩短住院时间及利用可用的资源 ,促进患者的全面康复     

Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial

OBJECTIVE: To assess the effect of three weeks of rehabilitation in the home setting for younger patients with stroke with the aim of improving activity level. DESIGN: A randomized controlled study with blinded evaluations at discharge, three weeks, three months and one year after discharge. SETTING: Home of the patient or the ordinary day rehabilitation clinic at the university hospital. SUBJECTS: Fifty-eight patients (median age 53 years) consecutively discharged from inpatient rehabilitation with a first occurrence of stroke participated in training directly after discharge. Intervention: Rehabilitation was given for 9 hours/week over three weeks. The home group received individually tailored training, based on the patient's needs and desires, with a focus on activities in their natural context. Support and information were also given. The intervention in the day clinic group was aimed mainly at improved functions. MAIN MEASURES: The main outcome was activity, assessed with the Assessment of Motor and Process Skill (AMPS). The impairment level was also evaluated. Costs were estimated. RESULT: There were no significant differences between the groups on any of the four assessments. However, there seemed to be an earlier improvement on some measures (including AMPS) for the home group. For both groups there was a greater improvement on the activity level than on the impairment level. the costs of the home group were less than half of the costs of the day clinic group. CONCLUSION: With the present results, both rehabilitation programmes could be recommended, however, further studies are needed to define patients who may specifically benefit from the home rehabilitation programme. Costs should be taken into consideration.     

Can rehabilitation in the home setting reduce the burden of care for the next-of-kin of stroke victims?

BACKGROUND: More evidence of the efficacy of caregiver interventions is needed. The aim of this study was to evaluate whether counselling in the home setting reduces the caregiver burden. METHODS: Thirty-six patients after stroke, median age 53 years, with a close family member, were selected for an evaluation of the burden of care and 35 participated. They were part of a randomized controlled trial, comparing rehabilitation in the home setting with outpatient rehabilitation. In the home setting, counselling about the stroke and its consequences was included. Assessments with the Caregiver Burden scale were made at 3 weeks, 3 months and one year after discharge. RESULTS: The burden of the 2 groups did not differ. After the intervention, there was a tendency to a lower burden for the home setting. The burden for the home setting was then unchanged from 3 weeks to 1 year, while outpatient rehabilitation showed a reduced burden over time. For the home setting, significant correlations to activity level were seen after the intervention. CONCLUSION: A positive effect of counselling was seen, as the home setting burden tends to be lower after the intervention, while outpatient rehabilitation seems to adjust with time. The results suggest that counselling reduces burden and the remaining burden is associated with the patient's ability.     

Values of activities of daily living. A survey of stroke patients and their home therapists

People's values influence their actions and efforts. Based on the assumption that a patient's values can be a guide to successful rehabilitation, the values of 15 activities of daily living as perceived by stroke patients and their home therapists were studied. Twenty-six stroke patients living at home and their 10 visiting occupational and physical therapists participated in the study. The study results indicated that the relative importance of each activity of daily living perceived by the patient group and by the therapist group was similar. Among the 29 therapist-patient pairs, however, only 1 pair showed significantly similar views regarding the values of these activities to the patient. Patients' age, gender, income level, duration since onset of stroke, impaired body side, and independence level in activities were significantly related to their values of certain activities of daily living. The relative value stroke patients living at home place on each activity of daily living could serve as a guide for sequencing learning steps during activities of daily living training in a hospital or rehabilitation setting. Determining patient rehabilitation goals as influenced by personal values may shorten rehabilitation time, be more cost-effective, and aid in the retention of gains made in the rehabilitation setting.     

脑卒中社区家庭康复协作网护理有效性研究

目的 对城市脑卒中社区家庭康复协作网康复护理干预的有效性进行分析.方法 将出院到社区的80名脑卒中后遗症期患者,随机分为干预组和对照组,由社区护士、卒中护士、社区医生、神经内科医生、康复治疗师、营养师等组成的协作网按"小组教育加康复训练加文体疗法"方案实施干预,3个月时评价.结果 干预组患者运动功能部分恢复,日常生活活...     

全科理念下基于Barthel指数评定量表在中老年高血压合并脑卒中患者康复护理中的应用

目的:探讨全科理念下基于Barthel指数评定量表在中老年高血压合并脑卒中患者康复护理中应用效果。方法:选取2017年1月至2018年12月在南京医科大学附属无锡第二医院的中老年高血压合并脑卒中患者110例,随机分为干预组和对照组,各55例。对照组患者接受常规的临床护理及健康教育,干预组患者经全科理念下Barthel指数评定量表开展康复护理。对两组患者治疗护理前,护理后3个月的血压水平、神经功能、肢体运动功能及日常生活活动能力进行对比分析。结果:护理后3个月两组患者的DBP、SBP水平均下降,干预组低于对照组;护理后3个月两组患者的神经功能、肢体运动功能改善,干预组改善效果优于对照组;护理后3个月两组患者的日常生活活动能力MBI评分均增高,且干预组高于对照组,差异有统计学意义(P<0.05)。结论:全科理念下基于Barthel指数评定量表在中老年高血压合并脑卒中患者康复护理中应用效果显著,能调节患者血压水平,促进患者神经功能、肢体运动功能恢复,增强患者的日常生活活动能力,从而改善患者日常生活质量。     

重复经颅磁刺激结合计算机认知训练对脑卒中患者认知功能评估和日常生活能力分析

目的:探讨重复经颅磁刺激(rTMS)结合计算机认知训练对脑卒中患者认知功能和日常生活能力的影响。方法:脑卒中患者84例随机分为观察组与对照组各42例,2组患者均予以常规药物治疗及康复训练,观察组在此基础上增用RTMS以及计算机认知训练。分别比较2组在干预前后认知功能、日常生活能力、生活质量变化情况以及患者满意度情况等方面的差异。结果:治疗4周后,2组MMSE评分、MoCA评分、Barthel指数及SS-QOL评分均较干预前明显提高(P<0.05,0.01),且观察组各项评分均明显高于对照组(P<0.05,0.01)。治疗后,2组患者满意度比较,观察组明显优于对照组(P<0.05)。结论:rTMS结合计算机认知训练可显著改善脑卒中患者的认知功能,同时有效提高日常生活能力以及生活质量,改善患者满意度,值得临床推广应用。     

结构化干预模式对脑卒中患者居家照护中的影响

目的探讨结构化干预对脑卒中患者居家照顾的影响,为脑卒中患者居家照顾提供依据。方法选取聊城市第二人民医院神经内科121例首次脑卒中患者,按照患者入院的先后顺序随机分为试验组61例和对照组60例。试验组接受结构化干预,即结合疾病发展阶段,分别在急性期、恢复期及后遗症期给予不同的干预措施,同时在居家照护的基础上增加对照顾者的干预。对照组按照脑卒中护理常规进行护理。分别于患者出院后1个月、3个月、6个月评价干预效果。结果两组患者干预后日常生活能力(ADL)、总生存质量、照顾者照顾能力、患者满意度方面比较差异均有统计学意义(均P<0.05),再住院率方面出院后1个月比较差异无统计学意义(P>0.05),出院后3个月、6个月比较差异有统计学意义(P<0.05)。结论结构化干预能提高患者日常生活能力、照顾者照顾能力、降低再住院率、改善患者生存质量及满意度。     

Functional activities and psychosocial factors in the rehabilitation of patients with low back pain

A four-week rehabilitation programme for back patients, focusing on functional activities and psychosocial factors in the demands of work and daily living, was evaluated. The programme is a combination of training of functional activities and increased psychological knowledge, body awareness and coping. A total of 40 patients with lumbago or lumbago ischias participated in the program and were compared with a matched control group. The results showed that the patients had significantly more ergonomic and psychosocial problems in their working environment than did the controls. A significant reduction in ratings of low back pain was noted in patients compared with controls after rehabilitation. Increased functional ability and physical fitness were shown in the patient group after rehabilitation. Significantly more patients than controls returned to work after the rehabilitation.     

The impact of discharge to a care home on longer term stroke outcomes

OBJECTIVE: To examine the impact of discharge to a care home on the longer term recovery after stroke. DESIGN: An uncontrolled naturalistic study of stroke survivors, matched for stroke severity, discharged from a stroke rehabilitation unit to either a care home (n = 65) or to their own home (n = 65). Stroke-related variables were assessed in both groups shortly before discharge and again at six months after discharge. SETTING: A stroke rehabilitation unit, care homes in the community and subjects' own homes. OUTCOME MEASURES: Functional activities of daily living (ADL), cognitive function, depression, health service utilization, health-related quality of life. RESULTS: Despite low levels of rehabilitation in both groups, at six months subjects discharged home had a better functional improvement in ADL (Barthel score 14.9 compared with 10.8) and health-related quality of life (HRQoL) (five-item EuroQol score 0.60 compared with 0.35). CONCLUSIONS: Poorer outcome in subjects discharged to care homes may be remediable and could respond to better rehabilitative efforts and increased social support and encouragement for this group of stroke survivors.     

Home care of the ventilator-dependent person.

Discharge of the ventilator-dependent person from a hospital requires careful advance planning by hospital personnel and rehabilitation of the patient to assure maximal functional ability in the home. The patient and family should be taught the techniques necessary for both routine and emergency care in the home. Respiratory equipment, including the type of mechanical ventilator best suited to the patient's needs and the home environment, and disposable supplies must be obtained, and payment from third-party payers must be assured. Equipment placement and the ability of the patient to perform self-care and activities of daily living following discharge can be facilitated by integrating results of a home care evaluation into the patient's rehabilitation program. Trips of gradually longer duration out of the hospital allow the patient to gain confidence in his ability to care for himself. Responsibilities for follow-up in the home can be shared by respiratory home care companies, visiting nurses, and pulmonary physicians.     

时间护理加咽部冷刺激在脑卒中吞咽障碍患者早期康复中的应用研究

目的运用时间护理理念,探讨脑卒中吞咽障碍患者早期康复的护理方案。方法将120例急性脑卒中吞咽障碍患者随机分为两组,观察组(60例)采用时间护理方案进行康复护理,对照组(60例)采用常规康复护理。4周后进行评定。结果两组康复护理后与康复护理前相比较,患者的吞咽功能均有改善,但观察组更加明显,与治疗前比较差异有显著意义(P0.01或P0.05)。结论运用时间护理方法对脑卒中吞咽障碍患者进行早期吞咽功能训练,使患者恢复了经口吞咽进食,促进了疾病的整体康复,提高了患者的日常生活能力。     

康复护理对脑卒中患者运动功能及日常生活活动能力的效果

目的探讨康复护理干预对脑卒中患者运动功能及日常生活活动能力的影响。方法将140 例脑卒中患者随机分为对照组和康复组各70 例,对照组给予神经内科常规药物、康复治疗与一般护理,康复组在此基础上进行康复护理干预。治疗前和治疗5 周后,分别采用简化Fugl-Meyer 运动功能评分量表(FMA)和改良Barthel 指数(MBI)对两组运动功能和日常生活活动能力进行比较分析。结果两组患者治疗前FMA和MBI评分无显著性差异(P>0.05);治疗5 周后康复组FMA和MBI评分均显著高于对照组(P<0.001)。结论康复护理干预对脑卒中患者运动功能及日常生活活动能力的恢复具有促进作用。     

基于循证护理的认知行为干预对脑卒中患者早期康复锻炼依从性的影响

目的 鉴于临床脑卒中患者主动康复功能锻炼依从性低,进而导致康复预后差的现状,采取具有循证护理依据的认知行为疗法对脑卒中患者进行干预,以达到提高患者对早期康复锻炼的依从性,改善患者的整体治疗效果的目的。方法 通过分析近年来的文献报道和Meta分析的结论,以循证护理的最佳证据为基础,制定认知行为疗法的临床护理决策。选取2017年6月—2019年6月收治的缺血性脑卒中伴偏瘫患者60例,按照组间基本特征具有可比性的原则将患者分为对照组和观察组,每组30例。观察组给于基于循证护理的认知行为干预;对照组给于一般主动康复功能锻炼。评价患者的功能锻炼依从性、运动功能、日常生活活动能力和抑郁状况。结果 干预后,观察组患者对主动康复功能锻炼的依从性明显好于对照组,两组患者治疗后日常生活能力、肢体运动功能和抑郁情绪均有不同程度提高,但观察组的效果改善情况好于对照组,差异有统计学意义（P<0.05）。结论 采用循证护理为基础的认知行为干预方法可以促进脑卒中后患者早期康复锻炼的依从性,提高肢体运动功能,改善患者抑郁情绪和生活质量。     

A randomized controlled trial of rehabilitation at home after stroke in Southwest Stockholm: outcome at six months

A 6-month follow-up of a single-blind, randomized, controlled trial in Southwest Stockholm was performed in order to evaluate the effect of early supported discharge and continued rehabilitation at home after stroke. Eighty-three stroke patients with moderate neurological impairments, continent, independent in feeding, and mental function within normal limits one week after onset were included in the study. The patients were allocated 1:1 to early supported discharge and continued rehabilitation at home by a specialized team, versus routine rehabilitation. Patient outcomes measured were motor capacity, dysphasia, activities of daily living, social activities, perceived dysfunction, mortality and reported falls. Data on length of stay in hospital; initial and recurrent during 6 months were compared. The 6-month follow-up of 78 patients showed no statistically significant differences in patient outcome. The results of multivariate logistic regression analysis suggest a positive effect of home rehabilitation on activities of daily living. At 3-6 months the frequency of significant improvements was higher in the intervention group. Death or dependency in activities of daily living was 24% in the intervention group compared with 44% in the control group. The mean initial hospitalization was 29 days in routine rehabilitation group versus 14 days in the home rehabilitation group. We conclude that for moderately disabled stroke patients with mental function within normal limits, early supported discharge and continued rehabilitation at home had no less a beneficial effect on patient outcome than routine rehabilitation, reduced initial hospitalization significantly and had no adverse effects on mortality and number of falls.