Effect Of Motor Imagery On The Fear Of Falling In Elderly Patients After Ischemic Stroke

ObjectiveThis study aimed to establish a motor imagery（MI）rehabilitation nursing program on the fear of falling（FOF）in older people with ischemic stroke;and then evaluate the discrepancy between MI group and control group in fall-related efficacy,balance,mobility,activities of daily living（ADL）,fear of falling,and falls.Finally,idetify the effectiveness of the MI training program in improving the fall-related efficacy with FOF individuals and provide the evidence for further study in making intervention strategies about FOF for this target group.Methods1.160 older people with ischemic stroke were included from the hospital from Sepetember 2017 to April 2018.The paticipants were randomly divided into an intervention group（n=80）or a control group（n=80）.All individuals were given rehabilitation booklets and routine rehabilitation nursing.In addition,the patients in the intervention group received 3 months motor imagery（MI）rehabilitation nursing program.2.Patients were assessed by using the single-item method about FOF to determine whether they had the FOF.Before intervention（T₁）,one month after intervention（T₂）and three months after intervention（T₃）,the data were collected.The Modified Falls Efficacy Scale（MFES）,Berg Balance Scale（BBS）,Time Up and go Test（TUGT）and modified Barthel index（MBI）were used to measure the level of FOF and their ability in the ADL,respectively.Moreover,the FOF,fall incidence and the number of falls of all patients were calculated and recorded before and after the3-month intervention.3.IBM SPSS Statistics 21.0 was used for statistical analysis.Descriptive statistics were presented using the means,standard deviation,frequency and percentages.Chi-square test,nonparametric test,Two dependent sample T test and repeated-measures analysis of variance were carried out for factor analysis.P<0.05was considered statistically significant difference.Results1.A total of 160 older stroke patients with FOF were randomly divided into two groups at the beginning of the study,80 cases in intervention group and 80 in control group.However,2 older stroke patients were withdrawn from the intervention group and 3 from the control group during the study,the total drop-out rate was 3.23%.Finally,the study included 155 older stroke patients,78 in the intervention group and77 in the control group.Two groups of patients with general data show that the average age was 68.99±5.76 years,the average BMI was 24.83±2.01 kg/m²,and the mean score of mRS was 2.45±0.69.Of 155 cases 54.84%of them were male and45.16%are female.Compared the scores of MFES,BBS,TUGT,MBI and the general data of cases in the two groups,differences were not statistically significant（all P>0.05）.2.Comparison of the status of fall between the two groups:FOF,fall incidence and the number of falls were calculated and recorded before and after the 3-month intervention by two independent sample t test and paired sample t test or Chi-square test.The results showed that there was no statistically significant difference of FOF between the two groups before intervention（P=0.434）,and 37 patients（23.87%）had fallen experience,the average number of falls before the intervention was（0.74±0.77）and there was no significant difference between the two groups（P=1.000,0.101）.After the 3-month intervention,70.97%of older stroke patients had FOF,there was no statistically significant difference between the two groups（P=0.428）;16patients（10.32%）had falls and the average number of falls was（0.14±0.35）and the difference between two groups were significant（P=0.037,0.020）.3.Comparison of fall-related efficacy between the two groups:Before intervention（T₁）,one month after intervention（T₂）and three months after intervention（T₃）,the ANOVA for repeated measures anova was used to perform the data of the MFES in the two groups.The results show that the interaction between group-by-time effects was significant（F=149.108,P<0.001）,the group effects（F=4.801,P<0.05）and the time effect（F=1602.192,P<0.001）were significant.At different stages,the fall-related efficacy scores of the intervention group were all better than those of the control group,and the differences were statistically significant（P<0.05）.4.Comparison of balance between the two groups:Before intervention（T₁）,one month after intervention（T₂）and three months after intervention（T₃）,the ANOVA for repeated measures anova was used to perform the data of the BBS in the two groups.The results show that the interaction between group-by-time effects was significant（F=93.010,P<0.001）,the group effects（F=4.014,P<0.05）and the time effect（F=473.184,P<0.001）were significant.At different stages,the balance scores of the intervention group were all better than those of the control group,and the differences were statistically significant（P<0.05）.5.Comparison of mobility between the two groups:Before intervention（T₁）,one month after intervention（T₂）and three months after intervention（T₃）,the ANOVA for repeated measures anova was used to perform the data of the TUGT in the two groups.The results show that the group effects（F=0.043,P=0.836）was not significant,and the interaction between group-by-time effects was significant（F=8.178,P<0.001）,the time effect（F=1834.831,P<0.001）was significant too.At different stages,the differences were statistically significant（P<0.05）.6.Comparison of ADL between the two groups:Before intervention（T₁）,one month after intervention（T₂）and three months after intervention（T₃）,the ANOVA for repeated measures anova was used to perform the data of the MBI in the two groups.The results show that the interaction between group-by-time effects was significant（F=61.279,P<0.001）,the group effects（F=4.086,P<0.05）and the time effect（F=473.184,P<0.001）were significant.At different stages,the ADL scores of the intervention group were all better than those of the control group,and the differences were statistically significant（P<0.05）.ConclusionsCompared with the routine rehabilitation nursing,the MI can not only improve the fall-related efficacy,balance ability and the ADL of elderly patients with ischemic stroke,but also alleviate the level of FOF to some extent,reducing the number of falls.