Rehabilitative treatment of cerebral apoplectic insults in advanced age and evaluating its effectiveness--results of a model project

This report is of a two year study of stroke rehabilitation. Given certain conditions with specialized personnel and equipment the rehabilitation of elderly stroke patients can be managed co-operatively in hospitals and old age care centres. The rehabilitation of stroke affected is based on the support of multidisciplinary diagnosis and interdisciplinary teamwork between physicians, physiotherapists, occupational therapists, speech therapists, psychologists and social workers. Each patient requires an individual treatment program. In this study were 72 patients ranging in age from 42-87 years, average age 73 years. They had been judged as progressively degenerative and helpless following their stroke and consequently regarded as patients for a nursing home. Following special rehabilitation treatment 75% (54 patients) had improved enough that it was possible for them to return to their homes. Only 12.5% (9 patients) had to remain in a nursing home. 6.6% (4 patients) transferred to an old people's home. 6.9% (9 patients) were readmitted to hospital because of additional serious complications. The average duration of rehabilitative treatment was 72.3 days. The degree of hemiplegia and the patients ability to lead their own active daily independent life was reviewed before and after rehabilitation and used as control. 76.6% showed an improvement in their motor function. 61.1% returned to their own independent daily life as measured by ADL-Indices. (a. Barthel Index, b. ADL-Index-Katz-, c. Patient Classification for Long Term Care-Jones-, d. Crichton Royal Behavioural Rating Scale-Robinson-.).(ABSTRACT TRUNCATED AT 250 WORDS)     

A cost analysis of the first year after stroke - early triage and inpatient rehabilitation may reduce long term costs

AIM OF THE STUDY: To analyse the costs of stroke in the first year covered by insurance companies and to correlate them with the clinical outcome data. METHODS: We contacted the insurance companies of 172 consecutive stroke patients of a single institution cohort for a detailed report of the stroke costs. A complete data set over one year was obtained from 131 patients (76%). RESULTS: Severity of stroke was significantly associated with increasing total costs (p = 0.0002). The rehabilitation clinic made up 37% of the total costs followed by nursing home with 21% and acute hospital with 21%. Mean cost of stroke per patient was 31,115 CHF in the first year. Costs per patient for inpatient rehabilitation were similar to those for the nursing home after one year; however, the Barthel-index of patients with inpatient rehabilitation increased by 42 +/- 29 points as compared to patients without inpatient rehabilitation by 23 +/- 26 points (p <0.05), and 86% resp. 81% of patients with inpatient stroke rehabilitation lived independently after 6 and 12 months respectively. CONCLUSIONS: The high level of independence after inpatient stroke rehabilitation underlines the importance of patient selection and/or rehabilitation. Therefore, long-term stroke costs may be significantly reduced by an early and careful triage in the case management after stroke and a case-dependent investment in initial costly appearing inpatient rehabilitation.     

Rehabilitation home visits

This chart review study describes 40 geriatric hip fracture patients focusing on the in-home functional and environmental assessment done before discharge from a rehabilitation hospital. Patients were aged 65 to 96 years. Before hospitalization all ambulated independently and three-quarters required limited or no social support. On discharge, none ambulated independently and all required support. Discharge plans for three patients were changed by the home visit, resulting in two nursing home placements. The role and structure of the rehabilitation home visit are outlined together with the common safety recommendations and equipment needs. The home visit assessment form is presented. The rehabilitation home visit is a practical tool to help achieve successful home discharge for elderly hip fracture patients. It is particularly useful in discharge planning for elderly patients with hip fracture, amputation, or stroke.     

A mobile rehabilitation team program to assist patients in nursing homes rehabilitate and return to their homes

A slow-stream rehabilitation program for frail elderly patients was developed utilising nursing homes visited by a mobile rehabilitation team (MRT) based at the hospital from which these patients had been discharged following major illness. The nursing homes were able to provide physiotherapy and the MRT contributed medical, nursing, occupational therapy and social work support through weekly visits. The supported group and a control group (also discharged to nursing homes from the same hospital but unsupported) were matched for age, sex and ADL level. Outcomes for the two groups were compared and were significantly different. Of the supported group (N = 33), 64% (N = 21) were discharged home compared with only 9% (N = 2) of the 23 control subjects (χ² = 15.6, df. = 1, P < 0.05). The potential for patient rehabilitation in a modestly supported nursing home was realised.     

农村脑血管病患者和照顾者的需求及其影响因素

目的 探讨农村脑血管病患者和照顾者的需求及其影响因素.方法 本研究采用由世界卒中组织设计的针对卒中患者及其照顾者的网上调查问卷,并根据中国国情进行修改.对住院的农村脑血管病患者及其照顾者的一般情况、心理支持、卒中相关知识、诊疗及护理、社会支持及功能恢复需求方面进行问卷调查.结果 共514例卒中患者及其照顾者(514名)完成问卷调查.93.0％的患者对心理支持方面有需求,其次是临床诊疗及护理(84.8％)、卒中知识(74.7％)、社会支持及功能恢复(53.5％);95.1％的照顾者对心理支持方面有需求,其次是卒中知识(89.9％)、临床诊疗及护理(84.0％)、社会支持及功能恢复(66.3％).照顾者在卒中知识、社会支持及功能恢复需求方面程度高于患者(P均＜0.05).多元线性回归分析显示,年龄、性别、文化程度、美国国立卫生研究院卒中量表评分、距首次卒中发病时间是脑血管病患者及其照顾者需求的影响因素.结论 脑血管病患者及其照顾者的许多需求未得到满足,特别是心理需求.应根据脑血管病患者及其照顾者的不同需求提供区域性和个体化的服务,增强群众的卒中防治意识,并不断完善农村卫生服务体系的建设.     

Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke

OBJECTIVE: Older persons with general medical and surgical conditions increasingly receive posthospital rehabilitation care in nursing homes and rehabilitation hospitals. This study describes the characteristics of such patients, contrasted with patients with traditional rehabilitation diagnoses of hip fracture and stroke. DESIGN: Prospective cohort study. SETTING: Seventeen skilled nursing facilities and six rehabilitation hospitals in seven states. PARTICIPANTS: Medicare patients age 65 or older receiving posthospital rehabilitation. METHODS: A total of 290 medical/surgical patients were compared with 336 hip fracture and 429 stroke patients. Data were collected prospectively from charts, nursing assessments, and patient interviews. Patient characteristics associated with functional recovery and mortality were estimated using multivariate regression. RESULTS: Medical/surgical patients had greater premorbid activities of daily living (ADL) (P < .001) and instrumental activities of daily living (IADL) (P < .01) disability, but suffered less decline with the acute event than hip fracture or stroke patients (P < .001). Medical/surgical patients were more likely to recover premorbid ADL function (P < .05) but 1-year mortality was significantly greater (30% vs. 14% hip fracture; 18% stroke; P < .001). Predictors of functional recovery and mortality differed between the three groups. Among medical/surgical patients, premorbid ADL difficulty, cognitive impairment, a pressure ulcer at rehabilitation admission, and depression were associated with failure to recover premorbid function whereas increasing comorbidity and incontinence were associated with mortality. CONCLUSIONS: Medical/surgical patients represent a unique rehabilitation population. They experienced greater premorbid functional disability, less acute decline, but greater mortality than patients with traditional rehabilitation diagnoses. Further study of this distinct rehabilitation population may help identify patients most likely to benefit from rehabilitation.     

癌症患者出院后心理支持需求分析及干预措施研究

目的探讨癌症患者出院后对心理支持的需求及有效干预措施的研究。 方法随机抽取中国医学科学院肿瘤医院2018年1月至2018年5月之间收治的癌症患者560例，进行出院后心理支持需求的问卷调查，结合中国医学科学院肿瘤医院开展的心理讲座、心理知识手册、个案心理疏导、团体支持小组、康复者交流、心灵热线及在线心理咨询等7项服务，探讨癌症患者出院后心理支持干预的措施。 结果心理康复手册、心理讲座、心灵热线是最容易被接受的心理支持干预措施；随着年龄增长对心理支持需求下降；女性癌症患者的需求显著高于男性；教育程度和病种也影响心理支持的需求。 结论癌症患者出院后的心理支持需求呈专业化的特点，建议肿瘤专科护士和心理专业人员相结合，运用医务社工的方法，根据患者的性别、年龄、病种开展有针对性的多种心理支持干预措施。     

分析神经内科护理对脑卒中糖尿病患者康复的效果

目的分析神经内科护理对脑卒中糖尿病患者康复的护理效果。方法选择2017年1月—2019年12月在该院神经内科进行治疗的60例脑卒中糖尿病患者进行研究,根据给予的护理措施不同进行分组,即常规护理分为常规组(30例),针对性康复护理干预分为实验组(30例),采取日常生活能力评分(ADL)评价患者的ADL评分,对比两组治疗效果。结果实验组的康复护理效果为90.0%,显著优于常规组康复总有效率,差异有统计学意义(P<0.05);护理后,实验组的ADL评分显著高于常规组,差异有统计学意义(P<0.05),且护理后实验组空腹血糖、餐后2 h血糖及尿微量蛋白含量明显优于常规组,差异有统计学意义(P<0.05)。结论采取康复护理措施干预脑卒中糖尿病患者,能较好地帮助患者恢复神经功能,防止肢体偏瘫等多种严重并发症的发生,有效提高患者的生活质量,值得推广。     

Outcome and utilization differences for older persons with stroke in HMO and fee-for-service systems

OBJECTIVES: To compare treatment and outcomes for older persons with stroke in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) systems. DESIGN: Inception cohort stratified by payer and followed for 1 year. SETTING: Six HMOs and five FFS systems with large Medicare populations in the West, Midwest, and Eastern United States. PARTICIPANTS: A total of 429 randomly selected stroke patients receiving rehabilitation in nursing homes or rehabilitation hospitals (RHs) from June 1993 to June 1995. MEASUREMENTS: Improvement in activities of daily living (ADLs) during rehabilitation, and ADL recovery, community residence, and utilization until 12 months after stroke. Outcomes were adjusted for premorbid function, marital status, comorbid illness, posthospital function, cognition, psychological problems, and stroke deficits. RESULTS: At baseline, HMO patients were more likely to be married, and less likely to be blind or have psychiatric diagnoses. HMO patients had shorter hospitalizations (P < .001), were less likely to be admitted to RHs (13% vs 85%, P < .001), and received fewer therapy and physician specialist visits (P < .001) but more home health visits (P < .001). During rehabilitation, FFS patients made greater improvement in ADLs (difference, 0.73 ADLs; 95% CI, .37-1.09). At 1 year, there was no difference in ADL recovery (difference, -0.24 ADL; 95% CI, -0.64-0.16), but FFS patients were more likely to reside in the community (adjusted OR, 1.8; 95% CI, 1.1-3.1), and HMO patients were more likely to reside in nursing homes (adjusted OR, 2.4; 95% CI, 1.1-5.5). CONCLUSION: Study findings suggest that short-term functional outcomes and eventual community residence rates are poorer for Medicare HMO patients with stroke than for stroke patients receiving FFS care, consistent with the lower intensity of rehabilitation (in nursing homes vs RHs) and less specialty physician care.     

康复护理对脑卒中患者的应用价值

目的：探讨康复护理对脑卒中患者护理的应用价值。方法：97例脑卒中患者按数字表法被随机分为：康复护理组（50例,接受早期康复护理）;常规护理组（47例,只进行常规护理）。比较入院时及出院后在我国卒中患者神经功能缺损程度评分量表（CSS）和日常生活活动能力量表（ADL）的得分情况。结果：两组患者入院时 CSS和 ADL评分均无显著差异（P 均＜0.05）;出院后,与常规护理组比较,康复护理组患者 CSS评分[（14.27±7.45）分比（7.87±6.25）分]显著减少,ADL评分[（50.52±19.59）分比（74.52±20.61）分]显著增加（P＜0.05或＜0.01）;住院期间康复护理组各类并发症发生率显著低于常规护理组（18.0％比89.36％,P＜0.01）。结论：对脑卒中患者早期采用有针对性的康复护理,有利于促进患者恢复神经功能,改善预后,提高生活质量。     

Veränderungen der Lebensqualität geriatrischer Schlaganfallpatienten im ersten Jahr nach der Rehabilitation

The aim of the study was to identify and analyze significant changes in the quality of life of elderly persons in the first year after rehabilitation from cerebral stroke. Data of 138 geriatric patients investigated on admission in a stationary rehabilitation program and one year later at home were used for this analysis. Multivariate logistic modelling tested differences between first investigation and follow-up in several domains: IADL functionality, subjective well-being, locus of control, subjective coping with stroke, stroke-related quality of life, social support. Age, gender, living alone and educational status were used as control variables. Compared to first investigation, subjects on follow-up showed an increased IADL functionality (OR = 1.40) but a decline in subjective well-being (OR = 0.91) and a more external locus of control (OR = 0.57). Coping with stroke has ameliorated (OR = 1.82), while stroke-related quality of life in six life domains was more negatively presented (OR = 0.82). Marked modifications in social exchange were found: the quantity of social contacts increased (OR = 4.70), while their variety reduced (OR = 0.38), significant others became more important (OR = 7.42) while the respondents' importance as a significant person for others diminished (R = 0.20). The findings suggest that recovery in IADL functionality after rehabilitation does not ensure a subsequent improvement in the subjective well-being nor does a positive trend in coping with stroke impede declines in stroke-related quality of life. Increased social exchange, which becomes more concentrated and less reciprocal, indicates a growing need of receiving social support. The findings are commented and implications for rehabilitation are mentioned.     

非正式护理对居家老年脑卒中合并功能性消化不良患者生命质量的影响:基于衰弱和抑郁的中介作用

背景关注老年人群的健康问题是医护工作人员面临的重要问题.既往研究对出院后患者的护理及健康问题很少引起关注和重视.因此,本研究重点研究居家老年脑卒中合并功能性消化不良(functional dyspepsia,FD)患者应用非正式护理后对其生命质量的影响,旨在为解决养老问题提供新的思路.目的探讨非正式护理对居家老年脑卒中合并FD患者生命质量的影响:基于衰弱和抑郁的中介作用.方法选择2018-09/2019-11在浙江省金华市第二医院住院治疗后出院的老年脑卒中合并FD患者155例,采用非正式护理满足情况量表,衰弱表型,抑郁量表和生活质量量表进行调查分析.结果患者非正式护理满足情况评分为3.22分±0.48分;衰弱评分为1.51分±0.43分;抑郁评分为11.93分±2.68分,其中非抑郁60例占40.0%,轻度抑郁60例占40.0%,重度抑郁30例占20.0%;生命质量评分为105.72分±18.34分.通过Spearman相关分析表明,非正式护理满足情况的3个因子与衰弱,抑郁呈负相关(P<0.05,或P<0.01),与生命质量之间呈正相关(P<0.05).以衰弱和抑郁为中介变量,以非正式护理满足情况3个因子为自变量,生命质量为因变量构建模型进行预测分析,社会支持3个维度日常生活照料、心理支持指导及疾病相关护理对生命质量的总效应分别为0.223、0.257、0.289.在日常生活照料对生命质量的衰弱中介效应为0.051,占总效应的22.87%,抑郁无中介效应;在心理支持指导对生命质量的抑郁中介效应为0.135,占总效应的52.53%,衰弱无中介效应;在疾病相关护理对生命质量的衰弱中介效应为0.152,占总效应的52.60%.结论非正式护理对老年脑卒中合并FD患者生命质量的影响应受到重视,在临床工作中要采取积极措施提高非正式护理方法以提高患者生命质量,对改善健康老龄化患者生命质量具有重要意义.     

脑卒中早期康复护理干预效果分析

目的探讨脑卒中早期康复护理干预方法和护理干预效果。方法选取2011年1月到2013年1月于我院就诊的脑卒中患者共86例,将患者按照入院编号,随机分为两组,观察组和对照组患者各43例,观察组患者在常规护理的基础之上,给予患者一些护理干预;对照组患者给予常规护理,观察和分析两组患者护理干预效果,比较两组患者的治疗效果。结果观察组43例患者在接受具有针对性和科学性的护理之后,其中基本痊愈患者18例(41.9%),好转22例(51.2%),无效3例(7.0%),总有效率为93.0%;对照组患者中痊愈患者共15例(34.9%),好转18(41.9%),无效10例(23.5%),总有效率为76.5%。观察组患者治疗总有效率和痊愈率要明显高于对照组患者,组间治疗效果比较具有明显差异,P0.05。结论临床上在治疗脑卒中偏瘫疾病时,可以在治疗中给予患者科学的、系统的护理,加强患者心理护理,进行全面、系统性的护理,能有效改善患者治疗效果,提高预后质量,获得非常理想的治疗效果。     

综合康复护理对脑卒中后肩手综合征周围神经保护的研究

目的探讨综合性康复护理对肩-手综合征周围神经损伤的疗效。方法将40例脑卒中后并发肩-手综合征患者分为观察组20例和对照组20例,观察组采用体位疗法、冰水浸泡法、向心性缠绕法、中频电治疗、被动、主动运动等综合康复治疗及护理,对照组采用常规治疗及护理,14 d后评定疗效。结果两组患者偏瘫侧肩手痛、关节活动度、水肿、神经电生理指标与治疗前比较均有明显改善,观察组改善程度比对照组显著,差异有统计学意义（P〈0.05）。结论综合康复治疗和护理能有效地维持肩-手综合征患者关节活动度,缓解疼痛及保护周围神经,从而有利于脑卒中患者周围神经功能的恢复。     

Social support as a predictor of participation in cardiac rehabilitation after coronary artery bypass graft surgery

PURPOSE: Cardiac rehabilitation promotes recovery and enhances quality of life after a coronary artery bypass graft (CABG), but participation in such rehabilitation is low. The role of social support in promoting participation has been suggested by prior studies, but is not clearly defined. The purpose of this study was to investigate the role of social support as an independent predictor of participation in cardiac rehabilitation. METHODS: This study examined 944 patients who underwent first isolated CABG between May 1999 and February 2001, then were followed for 6 months after surgery. Social support before CABG and 6 weeks after CABG was assessed using the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory (ESSI) and evaluated for its association with participation in cardiac rehabilitation. RESULTS: Of 944 patients, 524 (56%) reported participation in rehabilitation. The participants were younger, better educated, more often employed, and less financially strained. The participants also had a lower prevalence of cardiovascular disease risk factors and better physical function. According to unadjusted analysis, the patients with low social support (ESSI 相似文献   

Epidemiology of stroke-related disability.

This article describes basic characteristics and primary outcomes of unselected patients with stroke. These patients were part of the Copenhagen Stroke Study, a prospective, consecutive, and community-based study of 1197 acute stroke patients. The setting and care was multidisciplinary and all treatment was performed within the dedicated stroke unit. Neurologic impairment was measured at admission, weekly throughout the hospital stay, and again at the 6-month follow up. Basic activities of daily living, as measured by the Barthel Index, were assessed within the first week of admission, weekly throughout the hospital stay, and again after 6 months. Upon completion of the in-hospital rehabilitation, which averaged 37 days, two-thirds of surviving patients were discharged to their homes, with another 15% being discharged to a nursing home. Only 4% of the patients with very severe strokes reached independent function, as compared with 13% of patients with severe stroke, 37% of patients with moderate stroke, and 68% of patients with mild stroke.     

脑卒中后患者生存质量和康复护理干预的研究

目的：对脑卒中后患者生存质量和康复护理干预效果进行探讨和分析。方法选择100例于2011年1月至2013年10月间在我院进行脑卒中治疗的患者资料进行研究和分析,将患者分为对照组和观察组两组,每组各有50例患者,对对照组患者进行常规护理和健康知识教育,在此护理基础上对观察组患者进行早期康复护理,比较和分析不同护理方法对两组患者生存质量的影响。结果两组患者护理前生活质量差异不具有统计学意义（P〉0.05）,护理后对照组SDS以及SAS评分下降幅度明显低于观察组患者,差异具有统计学意义（P〈0.05）,观察组Fugl-Meyer评分以及Brathel指数均高于对照组,差异具有统计学意义（P〈0.05）。结论对脑卒中后患者进行心理护理以及早期康复护理等护理干预能够使患者的生存质量获得有效改善,值得推广和应用。     

社区家庭康复护理干预对脑卒中患者康复的影响

目的评价社区家庭康复护理干预对脑卒中患者日常生活活动能力、心理的影响。方法将我社区内脑卒中患者60例随机分为干预组和对照组各30例,干预组做好出院指导后并执行一套为期3个月的社区家庭康复护理综合干预,对照组仅在患者出院时进行出院指导。分别于干预前及干预后3个月对两组患者采用Barthel指数评分量表和汉密尔顿抑郁量表（HAMD）进行评价。结果社区家庭康复护理干预3个月后,干预组Barthel指数评分及HAMD评分均优于对照组（P〈0.05）。结论系统的社区家庭康复护理干预能有效提高脑卒中患者的日常生活活动能力,减轻抑郁程度。     

Nursing in the framework of long-term care insurance as a basic principle of a specific nursing approach of rehabilitation?

Activating nursing based on the criteria of the long-term care insurance may be understood as a second specific and nursing approach of rehabilitation beneath medical rehabilitation. Activating nursing is unspecific, characterized by the norms and guidelines of the long-term care insurance, but defined as the general norm of practical nursing. A professional nursing definition for a specific concept is lacking just as funding of nursing science. Adhering to activating nursing as a nursing complement to medical rehabilitation in the framework of long-term care insurance requires professional development and funding. Furthermore, more support of social law is necessary, which depends on professional nursing and nursing science-based indication and the intervention approach. The article develops an approach--based on a study about rehabilitation of people in need for care--and reflects on implementation and acceptance by people in the need of care.     

How do we deal with the mentally retarded in nursing homes?

The author casts a retrospective glance on move recent results of research, which shook unbalanced structure of the construction of "mental retardation". He discusses some problems of rehabilitation of mentally retarded people in nursing homes (several years of hospitalisation, different degrees of impairment, scarce contacts to networks outside nursing homes). He comprises the pros and cons of popular ideology of rehabilitation and goes into details of social support of mentally retarded people. The author recapitulates, that work with mentally retarded people finds itself in an unbalanced situation between obstructive (complex care with conventional methods) and advanced forces (as to the rehabilitation of the education of patients).