| Objective As the leading cause of death and disability among Chinese adults,stroke has characteristics of high morbidity,disability rate,recurrence rate and mortality.It has become one of the most harmful and serious diseases in China.This study targeted patients with acute ischemic stroke and aims to investigate the trajectories of and influential factors on their physical functioning,emotional well-being,and quality of life at different time points,including during acute stage,one month,three months and six months after the onset of the disease.It also focused on understanding patients’ changing care needs at onset of the disease,one month,three months,and six months after onset.Methods This study adopted mixed methods research design.It consisted of two parts.The first part was a quantitative study-a longitudinal study focusing on trajectory of patients’ changing emotions,quality of life and their influential factors at different stages of acute ischemic stroke.The subjects in this study were patients with acute ischemic stroke.From July to October 2017,the researcher recruited 194 subjects who met the inclusion criteria from three tertiary hospitals in Yangpu and Jing’an Districts,Shanghai by convenience clustering sampling.We collected patients’ sociodemographic and disease information during their acute stage.We also evaluated their level of disability,function,depression,anxiety,and quality of life during their acute stage and at one month,three months,and six months after the onset of the disease via telephone follow-ups.We conducted descriptive analysis of the sociodemographic data and disease-related data.We also used general linear mixed model to analyze trajectory of their changing function,emotions,quality of life and their influential factors.All the analyses were carried out in SAS 9.4.The second part was a qualitative study,focusing on patients’ care needs at different stages of acute ischemic stroke.A prospective and phenomenological design were adopted.We conducted semi-structured interviews with 14 patients with acute ischemic stroke to explore their care needs during their hospital stay,one month,three months,and six months after the onset of the disease.We also conducted semi-structured interviews with 7 health care providers about stroke to explore the restrictions in the caring process.The qualitative data was analyzed by Colaizzi method.Results The first part of the study showed that patients’ level of disability,anxiety,and depression decreased significantly over time,and their physical function and quality of life increased significantly over time.Factors affecting trajectory of patient’s disability level included educational level,cognitive function,rehabilitation during the first month after the onset.Factors affecting the trajectory of functional independent level(Barthel Index)include NIHSS score at admission,water swallowing test,pain,cognitive function,rehabilitation during the first month.Factors affecting the trajectory of depression level include NIHSS score at admission,intravenous thrombolysis,pain,obesity,disablity and Barthel Index.Factors affecting the trajectory of anxiety level include disablity,Barthel Index and the time from onset to emergency clinic.Factors affecting the trajectory of quality of life level include cognitive function,water swallowing test scores,disablity,Barthel Index,depression,anxiety,pain and OCSP classification.The qualitative study showed that: patients with acute ischemic stroke tended to have different care needs at different stages of the disease.At the acute stage of the disease,they had needs of identifying symptoms,timely doctor visits;During their hospitalization,they had needs of being involved in their medical decision-making,to understand health insurance policy,to receive early rehabilitation and psychological intervention;At discharge,they had needs of being involved in making their own discharge plans,to obtain information about the prevention of recurrence,and to keep continuous communication with their doctors.At one month after the onset,patients have needs to adapt to their family environment,help the caregivers to take care of the patients,and to carry out functional rehabilitation.At three months of the onset,patients need continuous access to professional support,symptom management,management of recurrence,and psychological support for fear of recurrence,depression and anxiety.They also had needs for improving their medicine adherence and access to sustainable rehabilitation.At six months of onset,patients have the need to adjust their awareness,adapt to disability,restore social and job needs.The restrictions of caring for patients with stroke included factors related to the public/patients/families,rehabilitation resources,cost of care and rehabilitation,management of inside acute hospital,and cooperation between acute hospitals and rehabilitation facilities.Conclusion Patients with acute ischemic stroke have different levels of disability,depression and anxiety,and quality of life from the acute stage to the recovery stage,and eventually to sequela stage.Thus,they have different care needs at different stages.During the acute phase in hospital,patients tend to have the highest level of disability,depression,and anxiety.At this stage,health care providers should give active treatment,stabilize their condition and begin early rehabilitation.During the recovery phase at home,patients have higher needs to adapt to their family environment and continue functional rehabilitation.In this situation,health care provides ought to provide continuous information support,emotional support and rehabilitation skills training.During sequela stage(usually six months after the onset of the disease),patients recover their functional ability to the greatest extent.Patients with disabilities need to learn to adjust their rehabilitation goals and expectations,to adapt to disability,reintegrate themselves into the community and their work.Patients at different stages of the disease have different needs and problems,health care providers should analyze their preferential needs.Thus,they should develop patient-centered and appropriate care programs for patients so as to provide patients with continuous quality care services. |
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