脑卒中半失能老年患者社会疏离的调查研究

目的 调查脑卒中半失能老年患者脑卒中社会疏离的现状,并分析其影响因素.方法 随机选取2021年1-7月在山东省烟台市芝罘区、福山区及牟平区等莱山区14个社区的292例脑卒中半失能老年患者为研究对象,采用一般资料调查表、一般疏离感量表、简易疾病感知问卷及社会支持评定量表进行调查.结果 脑卒中半失能老年患者脑卒中社会疏离水...     

滨州市某三甲医院脑卒中患者卒中复发恐惧现状及影响因素分析

目的：探讨滨州市某三甲医院脑卒中患者卒中复发恐惧现状,并分析其影响因素。方法：选取2019年1月1日～2021年1月1日在滨州市某三甲医院治疗的437例脑卒中患者为研究对象,采用一般资料调查表、恐惧疾病进展简化量表(FoP-Q-SF)、日常生活活动能力量表(ADL)进行调查。结果：本组患者FoP-Q-SF评分为(45.13±6.73)分,ADL评分为(41.17±5.08)分,其中≥34分者355例(81.24%);由多元逐步回归分析结果可知,年龄、日常生活活动能力、病程及疾病复发次数均为脑卒中复发恐惧相关影响因素(P<0.05)。结论：脑卒中患者卒中复发恐惧呈偏高水平,且发生率也相对较高,因此,医务工作人员应根据脑卒中复发恐惧的影响因素制订干预对策,提高脑卒中患者对疾病的认知度,改善其日常生活活动能力,降低复发恐惧感。     

老年脑卒中患者恐惧跌倒的心理干预

目的探讨恐惧跌倒心理干预对老年脑卒中患者早期康复训练效果的影响。方法选择68例老年脑卒中患者,按入院顺序随机分为观察组和对照组各34例。从入院第3天开始,两组均接受常规早期康复训练,观察组在此基础上融入恐惧跌倒的心理干预。分别在训练前、训练后第15天采用巴氏指数评估患者日常生活活动能力(ADL)。结果训练前所有患者BI评分普遍低下,两组差异无统计学意义(P0.05);训练后第15天,观察组BI评分高于对照组(P0.05)和本组训练前(P0.01);对照组训练后第15天的BI评分高于训练前(P0.05)。结论恐惧跌倒的心理干预能够提高患者的认知能力,促进躯体运动功能恢复和心理康复,增强日常生活自理能力。     

脑卒中失能老年患者健康促进与家庭功能相关性研究

目的探究脑卒中失能老年患者健康促进行为水平,并分析其家庭功能与健康促进行为水平的相关性。方法采用便利抽样法抽取2017年6月至2019年6月在某院接受治疗的174例脑卒中失能老年患者作为研究对象,运用患者一般资料调查问卷、健康促进生活方式量表以及家庭功能评估量表对患者的健康促进水平及家庭功能水平进行调查,并对二者的相关性进行探究。结果老年脑卒中失能患者健康促进生活方式总分为(121.07±15.93)分,条目均分为(2.34±0.43)分,自我实现条目均分最高,人际关系条目均分最低;家庭功能总分为(153.95±6.02)分,条目均分为(3.38±0.51)分,问题解决条目均分最高,情感反应条目均分最低,两者总体水平均处于中低等水平;老年脑卒中失能患者健康促进行为水平与家庭功能呈正相关。结论老年脑卒中失能患者健康促进行为水平及家庭功能水平较低,且家庭功能会影响健康促进水平,因此应对患者家庭功能予以关注,提升患者家庭的沟通,促进患者的健康水平。     

老年脑卒中病人失能影响因素的研究进展

对老年脑卒中失能概念、流行病学现状、老年脑卒中病人失能影响因素进行综述,为医护人员针对主要影响因素制定治疗、护理、康复方案,降低老年脑卒中病人失能风险,避免失能程度进一步加重,提高老年病人生活质量提供参考。     

滨州市某三甲医院半失能脑卒中患者运动自我效能现状及其影响因素分析

目的：探讨滨州市某三甲医院半失能脑卒中患者运动自我效能现状及其影响因素,为患者实施有效的临床干预提供依据。方法：应用便利抽样的方法,选取157例半失能脑卒中患者为研究对象,分别采用运动自我效能量表、Barthel指数量表及社会支持评定量表对患者进行调查。结果：本组患者运动自我效能评分(6.54±1.80)分;经单因素和多因素分析显示,受教育程度、疾病复发次数、对锻炼的益处是否了解、患病前是否有规律的运动锻炼习惯和患病病程是半失能脑卒中患者运动自我效能的影响因素(P<0.05);Pearson相关分析结果显示,半失能脑卒中患者的运动自我效能总分与社会支持总分、Barthel指数总分均呈正相关(P<0.01)。结论：半失能脑卒中患者运动自我效能水平为中等,有待进一步提高,因此,临床医护工作者可根据患者的相关影响因素,有针对性地实施干预措施,从而提高患者运动自我效能感。     

首发脑卒中患者溶栓康复期复发恐惧水平现状及其影响因素调查

目的 探究首发脑卒中患者经溶栓治疗后康复期的复发恐惧水平及其影响因素。方法 选择医院2020年1月—2021年12月收治的接受溶栓治疗的首发脑卒中患者共160例为研究对象,采用一般资料问卷调查患者基础信息,借助恐惧疾病进展简化量表进行调查,通过单因素分析、多因素Logistic回归分析筛选首发脑卒中患者经溶栓治疗后康复期复发恐惧水平的影响因素。结果 量表评价得出,首发脑卒中患者经溶栓治疗后康复期的复发恐惧评分为32.50±8.03分,根据恐惧疾病进展简化量表评分对患者进行分组,其中复发恐惧组54例,无复发恐惧组106例。单因素分析得到,首发脑卒中患者经溶栓治疗后康复期复发恐惧水平的影响因素有年龄、文化水平、家庭人均月收入、改良的Rankin量表（MRS）评分、身边复发病例、延续性护理宣教、家庭关怀度、领悟社会支持、疾病不确定感（P<0.05）;多因素Logistic回归分析显示,首发脑卒中患者经溶栓治疗后康复期复发恐惧水平的影响因素有初中及以下文化水平、家庭人均月收入<3000元、MRS≥3分、身边有复发病例、未接受延续性护理宣教、家庭关怀度<7分、领悟社会支持<...     

脑卒中失能老年人中后期ADL能力及辅助器具使用现状调查

目的 调查脑卒中失能老年人对生活辅助器具使用现状,为开展针对性的健康教育提供参考依据.方法 采用自行编制的调查问卷对88例脑卒中患者进行调查,了解患者对生活辅助器具的使用知识、危险因素、缺乏自理能力时的应对方式等方面的掌握情况.结果 失能老人对生活辅助器具的规范化使用需求较高,ADL得分前3位为转移、行走、上下楼梯,后3位为穿衣、进食、修饰.使用辅助器具者66例,占75%,其中大多数老年人缺乏生活辅助器具的规范化使用指导;不使用辅助器具者仅22例,占25%,仅5例下肢肌力正常,可自行移动.结论 医护人员应根据失能老人对生活辅助器具的认识误区,采取针对性的健康教育,提高失能老人正确使用辅助器具的意识和自理能力.     

脑卒中半失能患者自我接纳的潜在剖面分析及影响因素研究

目的 探讨脑卒中半失能患者自我接纳的潜在类别并分析其影响因素。方法 采用便利抽样法,选取河南省郑州市某2所三级甲等医院神经内科及神经康复科的308例脑卒中半失能患者为研究对象,采用一般资料调查表、自我接纳问卷、中文版事件相关性反刍性沉思问卷和慢性病自我效能量表对其进行调查。采用潜在剖面分析法分析患者自我接纳的潜在类别,采用无序多分类Logistic回归分析检验不同类别的影响因素。结果 脑卒中半失能患者自我接纳分为3种类别：低接纳-低自评组（27.9%）、中等接纳-自评中庸组（43.8%）与高接纳-理性自评组（28.3%）。无序多分类Logistic回归分析结果显示,年龄、文化程度、家庭人均月收入、症状数量、侵入性沉思、目的性沉思以及慢性病自我效能是脑卒中半失能患者自我接纳潜在剖面分类的影响因素（P<0.05）。结论 脑卒中半失能患者的自我接纳存在3种潜在类别,医护人员应重视年龄18~45岁、初中及以下文化程度、家庭人均月收入较低以及症状≥3个的脑卒中半失能患者,并通过减少患者的侵入性反刍、增强目的性反刍和自我效能感等干预措施来提升其自我接纳水平。     

综合康复对老年脑卒中患者日常生活能力的影响

目的 探讨康复治疗对老年脑卒中患者日常生活能力的影响。方法 对56例老年脑卒中患者综合使用Bobath疗法、Brunnstrom疗法、Rood疗法、本体感神经肌肉促进疗法及心理疗法等技术对其进行3个月的康复，用修订的Barthel指数(MBI)评定治疗前后日常生活活动能力。结果 康复治疗前后MBI有高度显著性差异(P＜0．01)，并与运动功能和心理恢复相关(P＜0．01)。结论 康复可改善老年脑卒中患者日常生活能力。     

脑卒中患者疾病体验及其复发风险感知的质性研究

目的 了解首发与复发脑卒中患者的疾病体验,探讨脑卒中患者复发风险感知的特征及变化.方法 采用现象学研究方法,对19例脑卒中患者进行半结构式深入访谈,运用Colaizzi 7步分析法对访谈资料进行分析.结果 首发、首次复发和多次复发脑卒中患者的疾病体验和复发风险感知各有特征.首发脑卒中患者:可识别异常但缺乏专业信息渠道,...     

Assessment of arm activity using triaxial accelerometry in patients with a stroke

van der Pas SC, Verbunt JA, Breukelaar DE, van Woerden R, Seelen HA. Assessment of arm activity using triaxial accelerometry in patients with a stroke.

Objective

To study the validity of accelerometry in the assessment of arm activity of patients with impaired arm function after stroke.

Design

Cross-sectional concurrent validity study.

Setting

Rehabilitation center.

Participants

Patients (N=45) at different stages after stroke.

Interventions

Not applicable.

Main Outcome Measures

All patients wore 2 triaxial accelerometers around their wrists during 3 consecutive days. Arm activity was assessed, based on unilateral (activity of the affected arm) and bilateral accelerometry (ratio between the activity of the affected and nonaffected arm). The Motor Activity Log-26 (MAL-26) Amount of Use (AOU) scale was used as the main external criterion to test the concurrent validity of arm accelerometry. In addition, the MAL-26 Quality of Movement (QOM) scale and the Stroke Impact Scale (SIS) subscale Hand Function were used. To test the divergent validity, the SIS subscale Mobility was used. Spearman correlation coefficients were calculated. In an additional regression analysis, the hypothesized confounding influence of spasm, therapy intensity, and interobserver differences was studied.

Results

Both unilateral (ρ=.58, P<.001) and bilateral (ρ=.60, P<.001) accelerometry were significantly related to the MAL-AOU scale. Associations of both unilateral and bilateral accelerometry with the MAL-QOM and SIS subscale Hand Function corroborated these findings. The SIS subscale Mobility was not significantly associated with unilateral accelerometry (ρ=.41, P=.01) or bilateral accelerometry (ρ=.23, P=.11). None of the hypothesized confounders influenced these associations significantly.

Conclusions

Based on the results, both the concurrent and divergent validity of unilateral and bilateral arm accelerometry for measuring arm activity after stroke are good.     

基于住院患者直接护理时间的综合护理分级可行性研究

目的 比较不同护理级别分类方法在住院患者中直接护理时间的差异,探索综合护理分级的可行性.方法 通过实时观察某三级甲等医院461例住院患者24h直接护理时间,比较直接护理时间在医嘱护理分级、日常生活活动能力(ADL)护理分级以及综合护理分级之间的差异.结果 不同医嘱护理级别、ADL护理分级及综合护理分级患者的直接护理时间的差异有统计学意义.结论 以医嘱护理分级作为病情观察需要、ADL护理分级作为患者生活护理需求为依据的综合护理分级,更能满足患者病情和生活护理需求.     

急性脑卒中患者早期康复治疗预防并发症的效果

目的分析早期康复治疗对预防急性脑卒中患者并发症的疗效。方法随机将218例急性脑卒中患者分为康复治疗组和常规观察组,两组各109例患者,其中康复治疗组患者在发病后除给予内科药物治疗外并于2 d后即给予康复锻炼治疗,包括电疗和运动锻炼等;常规观察组患者给予内科常规药物治疗。结果急性脑卒中患者运动功能和生活自理能力经1个月的治疗,康复治疗的患者提高程度明显优于常规观察组,差异有统计学意义(P0.01)。结论急性脑卒中患者在治疗早期即给予康复治疗,可以明显促进患者运动和自理能力的康复。     

提高脑卒中患者日常生活活动能力的干预研究现状

脑卒中发生后,70%～80%的患者遗留有不同程度的残疾,严重影响着其日常生活活动(activties of daily living,ADL),导致自理能力下降[1]。日常生活不能自理将会使患者产生无用感、内疚等情绪,缺乏生活热情[2],并且给家庭及社会带来沉重的负担。脑卒中在治疗和功能恢复方面,除了药物治疗     

Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation

Wu C-Y, Chuang L-L, Lin K-C, Lee S-D, Hong W-H. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living scale in patients with improved performance after stroke rehabilitation.

Objectives

To determine the responsiveness, minimal detectable change (MDC), and minimal clinically important differences (MCIDs) of the Nottingham Extended Activities of Daily Living (NEADL) scale and to assess percentages of patients' change scores exceeding the MDC and MCID after stroke rehabilitation.

Design

Secondary analyses of patients who received stroke rehabilitation therapy.

Setting

Medical centers.

Participants

Patients with stroke (N=78).

Interventions

Secondary analyses of patients who received 1 of 4 rehabilitation interventions.

Main Outcome Measures

Responsiveness (standardized response mean [SRM]), 90% confidence that a change score at this threshold or higher is true and reliable rather than measurement error (MDC₉₀), and MCID on the NEADL score and percentages of patients exceeding the MDC₉₀ and MCID.

Results

The SRM of the total NEADL scale was 1.3. The MDC₉₀ value for the total NEADL scale was 4.9, whereas minima and maxima of the MCID for total NEADL score were 2.4 and 6.1 points, respectively. Percentages of patients exceeding the MDC₉₀ and MCID of the total NEADL score were 50.0%, 73.1%, and 32.1%, respectively.

Conclusions

The NEADL is a responsive instrument relevant for measuring change in instrumental activities of daily living after stroke rehabilitation. A patient's change score has to reach 4.9 points on the total to indicate a true change. The mean change score of a stroke group on the total NEADL scale should achieve 6.1 points to be regarded as clinically important. Our findings are based on patients with improved NEADL performance after they received specific interventions. Future research with larger sample sizes is warranted to validate these estimates.     

家属参与同伴教育配合康复治疗对老年脑卒中患者生活能力的影响

目的探讨家属参与同伴教育配合康复治疗对老年脑卒中患者生活能力的影响。方法将70例老年脑卒中患者随机分为试验组和对照组各35例。试验组除采用常规的治疗、护理措施外,同时配合为期3个月的家属参与同伴教育;对照组仅给予神经内科的常规药物治疗、护理和康复训练治疗。在治疗前及治疗后3个月,采用Barthel指数和Fugl-Meyer运动功能积分法,分别对两组的日常生活能力(ADL)和肢体运动功能进行评定。结果治疗后,试验组ADL和肢体运动功能指标均优于对照组,两组比较差异有统计学意义(P<0.05)。结论家属参与同伴教育配合康复治疗,有利于老年脑卒中患者运动功能的恢复、日常生活能力的提高及健康行为的管理,是一种可行、有效的健康教育形式。     

Reduction of disability after stroke is a more informative predictor of long-time survival than initial disability status

Purpose. Few studies have evaluated the roles of reducing disability after stroke in predicting survival. This study aimed to investigate the effects of improvement in the Barthel Index (BI) and other prognostic factors on survival in patients with first-time noncardioembolic ischemic stroke.

Method. BI effectiveness was defined as the improvement of BI between initial stroke (within 3 days) and 2 months after stroke. Cox regression analysis and Kaplan-Meier methods were used to evaluate the predictive roles of various prognostic factors.

Results. A total of 111 patients were enrolled. Mean age at the time of stroke was 68 (±11.2) years. Median follow-up time was 77.4 months. Mean initial BI was 36.1 (±28.5) and mean BI effectiveness was 46.9 ± 29.0. Overall, 55 deaths (49.5%) of the cohort were ascertained. The BI effectiveness had significant effects on long-time survival while initial BI was not a significant predictor. Higher BI effectiveness led to lower risk of mortality (hazard ratio = 0.44, 95% CI 0.24 – 0.80, p = 0.007). Elder age was correlated with poor survival (overall p = 0.006). Subjects in the eldest age group (≧70 years) showed a significant elevated risk for death (hazard ratio = 3.42, 95% CI 1.18 – 9.92). There was a trend indicating that the smaller the lesion size, the more favourable the prognosis (overall p = 0.057).

Conclusions. BI effectiveness in the first 2 months after first-time noncardioembolic stroke was more informative than initial disability status for predicting long-time mortality. It highlights the potential benefit in maximizing functional performance in patients with stroke.     

Reduction of disability after stroke is a more informative predictor of long-time survival than initial disability status

Purpose. Few studies have evaluated the roles of reducing disability after stroke in predicting survival. This study aimed to investigate the effects of improvement in the Barthel Index (BI) and other prognostic factors on survival in patients with first-time noncardioembolic ischemic stroke.

Method. BI effectiveness was defined as the improvement of BI between initial stroke (within 3 days) and 2 months after stroke. Cox regression analysis and Kaplan-Meier methods were used to evaluate the predictive roles of various prognostic factors.

Results. A total of 111 patients were enrolled. Mean age at the time of stroke was 68 (±11.2) years. Median follow-up time was 77.4 months. Mean initial BI was 36.1 (±28.5) and mean BI effectiveness was 46.9 ± 29.0. Overall, 55 deaths (49.5%) of the cohort were ascertained. The BI effectiveness had significant effects on long-time survival while initial BI was not a significant predictor. Higher BI effectiveness led to lower risk of mortality (hazard ratio = 0.44, 95% CI 0.24 - 0.80, p = 0.007). Elder age was correlated with poor survival (overall p = 0.006). Subjects in the eldest age group (≧70 years) showed a significant elevated risk for death (hazard ratio = 3.42, 95% CI 1.18 - 9.92). There was a trend indicating that the smaller the lesion size, the more favourable the prognosis (overall p = 0.057).

Conclusions. BI effectiveness in the first 2 months after first-time noncardioembolic stroke was more informative than initial disability status for predicting long-time mortality. It highlights the potential benefit in maximizing functional performance in patients with stroke.     

脑卒中患者复发风险感知评估量表的编制及信效度检验

目的编制脑卒中患者复发风险感知评估量表并检验其信效度。方法基于健康信念模式及风险感知态度框架,通过文献回顾、半结构式访谈,初步构建量表的维度及条目池;通过专家函询形成初始量表;通过认知性访谈对量表条目进行预测试及调整;便利选取327例脑卒中患者进行调查,检验量表信效度。结果脑卒中患者复发风险感知评估量表包括2个部分,共20个条目,第1部分包括3个条目,第2部分包括3个维度(累计方差贡献率为61.103%),共17个条目。总量表的内容效度指数为0.926～0.954;第2部分的Cronbach’sα系数为0.850,折半信度为0.656,2周重测信度为0.710,1个月重测信度为0.635。结论脑卒中患者复发风险感知评估量表信效度较高,可用于评估脑卒中患者复发风险感知水平。