护理干预对脑卒中患者康复效果的影响

目的探讨康复护理干预对脑卒中患者康复效果的影响。方法将108例患者随机分为干预组和对照组各54例,2组患者入院后均接受常规治疗及护理,干预组患者在此基础上再接受康复护理干预,采用独立功能评定量表(FIM)评定2组患者入院时与出院时的躯体功能、言语、认知和社会功能情况。结果干预组出院时FIM评分高于对照组,差异具有统计学意义(P<0.05);干预组功能改善指数(FII)高于对照组(P<0.05)。结论康复护理干预可以改善脑卒中患者的康复效果,并能促进患者躯体功能、言语、认知和社会功能的恢复。     

髋部骨折老年患者的康复效果评定

使用功能独立性评定 (functionalindependencemeasure,FIM )工具评定 1 0 0例髋部骨折患者入院和出院时的躯体和认知功能 ,使用Montebello康复因素评分法反映康复效果和效率 ,并于出院后6周对部分患者进行电话FIM调查问卷随访。结果出院时患者整体FIM分数有所改善 ,表明在住院康复期间患者功能改善 ,出院时运动FIM亚项中转移运动项和行动项得分比自理和括约肌控制低 ,在出院后 6周更明显。因此 ,在住院康复领域里改善行动技能和扩大独立转移能力应成为未来改善髋部骨折老年患者功能的目标     

综合护理干预对社区康复期中风患者肢体功能的影响

目的研究综合护理干预对社区康复期中风患者肢体康复的影响。方法选择2006年8月至2008年12月某校第一附属医院出院的200例社区康复期中风患者,随机分为实验组、对照组各100例,对照组应用常规治疗和随访,实验组除接受常规治疗外,还接受综合护理干预。以简式Fugl-Meyer评定量表（FMA）、ADL（FIM）评定量表等评定两组患者治疗前后的变化,以观察疗效。结果两组患者治疗前后FMA、FIM评分均显著提高（P〈0.01）,且实验组优于对照组（P〈0.01）。结论综合护理干预能更好地促进社区康复期中风患者肢体功能的恢复。     

康复护理对脑卒中患者功能恢复的影响

目的：观察综合康复护理对脑卒中患者功能恢复的影响。方法：脑卒中患者70例随机分为康复组和对照组各35例,2组均按脑卒中常规治疗,康复组在病情稳定48h后实施心理疏导及康复训练等系统康复护理。采用Barthel指数和简易Fugl Meyer（FIM）积分评定法,对2组患者分别于入院时、干预3及6个月后进行评定。结果：干预3个月时,2组ADL及FIM评分均较入院时明显提高（P〈0.05）,且康复组显著高于对照组（P〈0.05）;干预6个月后,2组ADL及FIM评分呈升高趋势（P〈0.01）,且康复组更高于对照组（P〈0.05）。结论：系统康复护理能使脑卒中的康复措施落到实处,使患者得到正规系统的康复训练,有效促进脑卒中患者功能恢复。     

护理随访对腰椎间盘突出症行微创手术患者康复功能的影响

目的探讨护理随访在腰椎间盘突出症（简称腰突症）患者微创手术后躯体功能恢复中的作用。方法将2005年6月－2008年6月220例行微创手术患者随机分为实验组和对照组,每组各110例。实验组在出院后进行护理随访,实施康复干预;对照组实施常规护理。于患者出院半年后,分析评估两组患者的遵医行为及自觉症状的改善情况。结果出院半年后。实验组患者遵医行为和自觉症状改善情况优于对照组,其差异存在统计学意义（均P〈0．001）。结论对腰突症微创手术患者进行护理随访,实施康复干预,可提高患者的遵医行为,促进躯体功能的恢复,从而有利于患者获得良好的康复效果。     

术后康复护理指导对行 PKP 术骨质疏松性脊柱多发骨折患者康复的作用

目的：探讨术后康复护理指导对行经皮椎体后凸成形术（ PKP）术后患者康复的效果。方法选取我院收治的行PKP术的骨质疏松性脊柱多发骨折患者82例,随机分为指导组和对照组。两组患者术后均行常规康复,对照组接受常规护理,指导组加行康复护理指导。比较两组患者住院天数、疼痛缓解时间、恢复正常生活天数,在术前和出院前测量患者视觉模拟评分（VAS）及功能独立性评分（FIM）。结果指导组患者住院天数、疼痛缓解时间、恢复正常生活天数均显著少于对照组（均P＜0.05）;出院前指导组VAS评分显著低于对照组（ P＜0.05）,FIM评分显著高于对照组（ P＜0.05）;FIM自理、括约肌控制、转移、行进方面评分均显著高于对照组（均P＜0.05）;交流和社会认知方面评分与对照组无显著差异。结论术后行康复护理指导对骨质疏松性脊柱多发骨折患者PKP术后康复有明显促进作用。     

个体化健康教育对深度烧伤患者生活质量的影响

目的 探讨个体化健康教育对深度烧伤患者生活质量的影响.方法 将116例深度烧伤患者随机分为研究组(58例)和对照组(58例),对照组给予常规的治疗和护理,研究组在常规的治疗和护理的基础上,进行个体化健康教育.使用生活质量综合评定问卷(GQOLI-74)分别于入院时及出院时对烧伤患者生活质量进行评定.结果 出院时研究组躯体功能维度、心理功能维度评分高于对照组(p＜0.01);研究组进行自身前后对照,躯体功能维度、心理功能维度、社会功能维度及生活质量总分的差别有统计学意义(p＜0.01),出院时评分显著高于入院时评分;而对照组入院时及出院时评分差别无统计学意义(p＞0.05).结论 个体化健康教育可提高深度烧伤患者的生活质量.     

延伸护理对肺癌患者术后生存时间及生活质量的影响

目的探讨延伸护理对肺癌患者术后生存时间及生活质量的影响。方法选择我院2016年3月至2018年3月收治的90例肺癌患者为研究对象,依据护理方式不同分为对照组和试验组,各45例。对照组接受常规护理,试验组在对照组基础上接受延伸护理。比较两组患者的护理效果。结果试验组中位生存时间为6.55个月,对照组中位生存时间为4.98个月,差异无统计学意义(P>0.05,RR=1.209,95%CI=0.728~1.236)。出院前,两组心理痛苦评分无显著差异(P>0.05);随访时,试验组心理痛苦评分低于出院前及对照组(P<0.05)。出院前,两组躯体功能、角色功能、情绪功能、认知功能、社会功能评分无显著差异(P>0.05);随访时,两组躯体功能、角色功能、情绪功能、认知功能、社会功能评分均高于出院前,且试验组高于对照组,差异具有统计学意义(P<0.05)。结论延伸护理是对肺癌患者住院护理的延续和补充,尽管不能明显延长患者长期生存时间,但能有效改善患者的生活质量。     

快速康复外科理念联合临床护理路径模式对胃癌患者相关康复指标和心理状态的影响

目的 探讨快速康复外科(ERAS)理念联合临床护理路径(CNP)模式对胃癌患者相关康复指标和心理状态的影响.方法 将接受手术治疗的胃癌患者200例纳入本研究,按照随机数字表法分为对照组(130例)和观察组(70例).对照组给予常规护理,观察组在常规护理的基础上予以ERAS理念联合CNP模式护理干预,比较2组胃癌患者护理后相关康复指标和心理状态的变化.结果 观察组护理后总蛋白水平、血红蛋白水平、前清蛋白水平和转铁蛋白水平高于对照组,首次进食时间、排气时间、肠鸣音恢复时间、排便时间短于对照组,角色功能评分、躯体功能评分、社会功能评分、情绪功能评分高于对照组,术后焦虑评分、抑郁评分均低于对照组,差异有统计学意义(P＜0.05).结论 ERAS理念联合CNP模式护理干预在胃癌患者的临床护理中有重要临床意义,可显著改善患者术后各项康复指标和心理状态,提升出院后生活质量.     

优质护理干预对针灸康复治疗的脑卒中偏瘫患者康复的影响

目的探讨优质护理干预对针灸康复治疗脑卒中偏瘫患者康复的影响。方法 80例恢复期的脑卒中偏瘫患者随机分为观察组和对照组,各40例,均给予基础针灸康复治疗。对照组采用常规护理,观察组采取优质护理模式,比较2组护理干预前、干预1个月、干预3个月后四肢简化Fugl-Meyer运动功能量表(FMA)评分及功能独立性评定量表(FIM)评分。结果干预3个月后,2组FMA及FIM评分均较干预前及干预1个月后显著提高(P0.01)。观察组干预1个月和干预3个月后FMA及FIM评分均显著高于对照组(P0.01)。结论优质护理干预模式用于针灸康复治疗的脑卒中偏瘫患者中,能有效促进运动功能和躯体功能恢复。     

Prediction of functional outcome after stroke rehabilitation

OBJECTIVE: The purpose of this study is to identify predictors of functional outcome after acute stroke inpatient rehabilitation using raw Functional Independence Measure (FIM) total scores. DESIGN: Multivariate analysis was performed on data collected retrospectively from stroke rehabilitation patients. Six independent variables were obtained from patients' medical records. RESULTS: The FIM total scores at the time of discharge from the hospital correlated strongly with FIM total scores at the time of admission to the hospital and correlated negatively with age and OAI using the Spearman's rank correlation method. The FIM total scores at the time of hospital admission were the best predictor of FIM total scores at the time of discharge from the hospital. However, the nature of the stroke, gender, and LOHS did not correlate with FIM total scores at the time of discharge from the hospital. CONCLUSIONS: Because FIM total scores at the time of hospital admission and discharge are highly correlated, FIM total scores at the time of hospital admission can be used to establish a rehabilitation program, to inform the patient and family about the possibility of recovery, and to assess the amount and quality of care given in the home or discharge placement.     

The relationship between mean flow velocity and functional and neurologic parameters of ischemic stroke patients undergoing rehabilitation

OBJECTIVE: To investigate the correlation between mean flow velocity (MFV) as measured by transcranial Doppler ultrasonography (TCD) and functional and neurologic impairment during inpatient rehabilitation after acute stroke. DESIGN: Prospective study comparing results of rehabilitation in patients with different TCD findings. SETTING: Acute neurologic rehabilitation department. PARTICIPANTS: Twenty-four consecutive patients admitted to a rehabilitation center with a diagnosis of a first ischemic stroke in the middle cerebral artery (MCA) territory. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Impairment as measured with the National Institutes of Health Stroke Scale (NIHSS) and disability as assessed with the FIM instrument. RESULTS: Normative or high blood-flow velocity in the MCA of the damaged hemisphere was associated on admission with higher FIM and lower NIHSS scores during 2 months of hospitalization. Absent or low flow velocity correlated with much worse functional and neurologic outcome, especially after 1 and 2 months of inpatient rehabilitation. Statistical correlation was found between MFV in the MCA of the damaged hemisphere, measured by admission TCD, and FIM score on admission and 1 month later. NIHSS scores during hospitalization also correlated with MFV in the MCA of the damaged hemisphere on admission and after 1 month. MFV in the MCA of the undamaged hemisphere 1 month after admission correlated negatively with FIM scores during inpatient rehabilitation. CONCLUSIONS: Our data showed a correlation between blood-flow velocity in the MCA of both hemispheres and the parameters of functional and neurologic status at different stages of acute inpatient rehabilitation after first ischemic stroke in MCA territory. Cerebral blood flow as measured by TCD can be an additional tool for monitoring the rehabilitation process after stroke.     

Serum albumin and comorbidity relative to rehabilitation outcome in geriatric stroke, and possible links with stroke etiology

Factors that describe the disability status of the stroke patient on discharge are important when starting a rehabilitation program, both from a psychosocial and a financial point of view. The objective of this study was to assess how comorbidity and serum albumin levels relate to rehabilitation outcome in geriatric stroke patients. Another aim was to assess whether stroke etiology (ischemic or hemorrhagic) influences these links. Medical records of 80 patients (68 ischemic and 12 hemorrhagic strokes) older than 65 years, who had suffered their first stroke, were investigated. Functional performance levels at admission and discharge were evaluated using the Functional Independence Measure (FIM). Length of stay in hospital was recorded. Serum albumin levels and comorbidity scores on admission were noted. Correlations between these variables and differences between the groups categorized according to stroke etiology were analyzed. In the group of geriatric stroke patients as a whole, serum albumin level was correlated with FIM score at admission and discharge. Comorbidity score was negatively correlated with length of stay. In the ischemic stroke subgroup, serum albumin level was positively correlated with length of stay and with functional gain, and comorbidity score was negatively correlated with functional gain. Analysis of the data for the hemorrhagic stroke subgroup revealed none of these correlations. It was concluded that serum albumin level and comorbidity are useful indices in geriatric ischemic stroke patients for predicting functional outcome and time spent in rehabilitation.     

Functional outcomes and quality of life in patients with brain tumors: a preliminary report.

OBJECTIVES: To determine the relationship between functional outcome and quality of life (QOL) in patients with brain tumors receiving inpatient rehabilitation, and to assess the sensitivity of 4 assessment tools in measuring changes in that population. DESIGN: Prospective study using longitudinal data collected from consecutively admitted patients. SETTING: Acute inpatient rehabilitation unit. PARTICIPANTS: Ten patients with primary brain tumors admitted to an acute inpatient rehabilitation unit. INTERVENTIONS: Patients participated in an inpatient interdisciplinary rehabilitation program that used the following disciplines: occupational therapy, rehabilitation therapy, recreational therapy, speech therapy, physical therapy, rehabilitation nursing and case management. MAIN OUTCOME MEASURES: The FIM instrument, Disability Rating Scale (DRS), Karnofsky Performance Status Scale (KPS), Functional Assessment of Cancer Therapy-Brain (FACT-BR). RESULTS: Improvement in total functional outcome was indicated by all 3 functional measures (FIM: F = 46.84, p < .05; DRS: F = 19.25, p < .05; KPS: F = 10.11, p < .05). Significant improvements were found between admission and discharge scores for the FIM and DRS. The KPS revealed significant improvement between admission and 3-month follow-up scores. All admission and discharge functional scales (FIM, DRS, KPS) correlated significantly with each other. No significant change was noted in the FACT-BR between admission and discharge scores, but FACT-BR scores did improve at 1- and 3-months postdischarge relative to admission. The FIM, KPS, and DRS did not show significant correlation with the FACT-BR. Ninety percent of patients were initially discharged to a home environment. CONCLUSION: Although patients make functional gains during and after inpatient rehabilitation, gains in QOL are not significant until 1 month postdischarge. QOL does not appear to correlate well with functional outcomes. Further, the KPS is less sensitive than the FIM and DRS in detecting change in functional status.     

脑卒中患者出院时功能结局的预测研究

目的根据患者人院时的各项资料预测脑卒中患者出院时的功能结局以及它与Fugl-Meyer平衡(FMB)得分、Berg平衡量表(Berg Balance Scale，BBS)得分的相关性。方法收集的资料包括患者的病史、体格检查、入院时FMB评分、BBS评分、日常生活活动能力(ADL)及功能独立性评定(Functional Indepen-dence Measure，FIM)得分，出院时评定FIM作为功能结局，资料采用简单线性相关分析、逐步回归分析。结果简单线性相关分析提示BBS、FMB得分与人院、出院FIM得分有较强的相关性，逐步回归分析发现人院时FIM、ADL、BBS评分可以预测脑卒中患者出院时的功能结局。结论人院时功能状态如FIM、ADL、BBS评分可以预测脑卒中患者出院时的功能结局，并且出院时的功能结局与患者人院时的BBS有较强的相关性。     

Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke.

OBJECTIVE: Delayed admission to rehabilitation may result in poorer outcomes by reducing exposure to therapeutic interventions at a time when the brain is primed for neurological recovery. The present study examined the effects of early vs delayed admission on functional outcome and length of stay in patients admitted to a rehabilitation unit for first-ever unilateral stroke. DESIGN: Retrospective chart review. METHODS: Differences in length of rehabilitation stay and functional outcome variables among 435 patients, grouped by interval from stroke event to rehabilitation admission (=30 days vs 31-150 days and 5 additional subgroups) were examined using a multivariate technique. RESULTS: Admission and discharge FIM scores, FIM change and FIM efficiency were significantly higher among early admission patients (p<0.01), while length of stay was significantly longer among delayed admission patients (p<0.01). A significant association was identified between age and admission (p<0.01) and discharge FIM (p<0.01) scores as well as FIM change scores (p=0.017). Subgroup analyses revealed significant differences in FIM scores, FIM change and length of stay between groups of patients admitted 0-15 and 16-30 days (p<0.01) and between patients admitted 16-30 days and 31-60 days post-stroke (p<0.01). No significant differences were noted between patients admitted from 31-60 and 61-90 or 61-90 and 91-150 days. CONCLUSION: Patients admitted to stroke rehabilitation within 30 days of first-ever, unilateral stroke experienced greater functional gains and shorter lengths of stay than those whose admission to rehabilitation was delayed beyond 30 days.     

Rehabilitation outcome of Turkish stroke patients: in a team approach setting

The aim of this study was to identify the efficacy of in-patient stroke rehabilitation, to evaluate the relationship between clinical characteristics and functional outcome, and to determine factors predicting functional outcome at discharge in Turkish stroke patients with a team approach. Retrospective data were collected from 102 of 116 patients with first stroke who were admitted to our rehabilitation unit at Ankara University. Demographic data, length of hospital stay (LOHS), onset to admission interval (OAI), type, side and location of stroke lesion, and most common medical complications were recorded. Functional Independence Measure (FIM) and Brunnstrom's motor recovery stages (BMRS) were assessed on admission and at discharge. The mean age was 61.6 +/- 10.9 years and the mean LOHS was 69.7 +/- 28.2 days. The mean FIM total scores were 69.2 +/- 27.4 and 83.2 +/- 25.7 on admission, and at discharge, respectively. The mean FIM total score was significantly correlated to age, LOHS and motor recovery. The FIM total scores of patients with aphasia and depression were found to be lower than those of patients without aphasia and depression. In a stepwise multiple regression analysis, FIM total score on admission, age and OAI were found to be valid predictors of FIM total score at discharge. Functional Independence Measure total score on admission was the strongest variable. Our results suggest that knowledge of the poor prognostic factors effecting functional outcome on admission can provide information to clinicians in identifying severity of stroke. Admission FIM total score, can be used to predict the patients' functional recovery. Advanced age, aphasia and post-stroke depression contribute to lower FIM scores.     

Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program

OBJECTIVE: To evaluate in an inpatient cardiac rehabilitation program (a phase IB) whether length of stay (LOS), discharge to home, and improvement in physical function differed between patients with lower and higher degrees of functional independence on admission. DESIGN: A retrospective study. SETTING: A public acute long-term care hospital. PATIENTS: All cardiac rehabilitation patients (N = 143) admitted to the hospital from January 1998 through June 1999. Patients were divided into a higher- and a lower-functioning group by using the admission FIM instrument scores above and below the midpoint of 72. Comparisons in LOS, discharge disposition, and functional gains between these 2 groups were then performed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM scores, FIM change, FIM gains per week, LOS, and discharge disposition. RESULTS: Total FIM scores at discharge were significantly higher than those on admission (25%, P <.0001). The median value of total FIM gains per week was 7.78 with a stay of 17 days and a home discharge rate of 76%. The higher-functioning group (n = 106) differed from the lower group (n = 37) with shorter stay (15 vs 23d, P <.0001), greater FIM gains per week (8.6 vs 4.8, P =.002), and greater likelihood of discharge to home or community (84% vs 54%, P <.001). The average incremental FIM change in each group was the same. In multivariate analysis, both admission (P =.001) and discharge (P <.001) FIM scores were the best predictors of patients' discharge disposition to home. CONCLUSIONS: Admission FIM scores are important predictors for the clinical course and discharge outcomes of cardiac rehabilitation patients, with those with higher admission FIM scores having a shorter LOS and greater likelihood of discharge to home. The admission FIM scores can help to establish realistic goals.     

Time to rehabilitation admission and associated outcomes for patients with traumatic brain injury

OBJECTIVE: To examine the association between time from injury to rehabilitation admission and outcomes for patients with traumatic brain injuries (TBIs). DESIGN: Retrospective chart review. SETTING: One hundred-bed inpatient rehabilitation facility with a 20-bed brain injury unit. PARTICIPANTS: Patients with TBIs discharged from initial inpatient rehabilitation between 2003 and 2004 (N=158). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcomes examined were functional independence at discharge (motor, cognitive, total FIM scores), rehabilitation length of stay (LOS), and rehabilitation cost. RESULTS: Significant linear trends were observed for time to admission and motor FIM scores, total FIM scores, rehabilitation LOS, and cost. All linear regression models contained time to admission as a significant predictor of rehabilitation outcomes. Over half of the variability in outcomes was explained by predictors including time to admission and case-mix group or individual FIM scores with the exception of discharge motor FIM score, for which only 45% of the variability was explained. CONCLUSIONS: Patients who progress to rehabilitation earlier do better functionally and have lower costs and shorter LOSs. Furthermore, the time to rehabilitation admission is easily calculated and could be used by rehabilitation providers in adjunct with admission FIM scores to estimate resource utilization.