Study On The Relationship Between Health Literacy,functional Exercise Compliance And Rehabilitation Training Effect In Stroke Patients

Aim: To describe the status of health literacy,functional exercise compliance and rehabilitation training effect of stroke patients with hemiplegia;To detect the relationship between stroke health literacy,functional exercise compliance and rehabilitation training effect.And to provide scientific evidences for effective rehabilitation of stroke patients in the future.Methods: Hospitalized patients with first stoke were selected from three comprehensive hospitals in Zibo city of Shandong province during December 2018 to November 2019.The general data questionnaire,health literacy questionnaire for patients with chronic diseases,and functional exercise adherence scale for patients with stroke were used to collect data,Barthel index(BI),and Brunnstrom hemiplegic motor function questionnaire were used to assess the effect of rehabilitation training.A longitudinal survey was conducted.Baseline survey was complete to collect the basic and health literacy information at first hospitalization.Functional exercise adherence information was collected at baseline,second hospitalization,and third hospitalization.Effect of rehabilitation training was collected at baseline,first discharge,second hospitalization,second discharge,and after third hospitalization.Health literacy score,functional exercise adherence score and BI were presented as mean ± standard deviation.Repeated measure with analysis of variance was used to compare the difference of health literacy score between five time points.Brunnstrom motor function stage was presented as frequency.The univariate general estimation equation(GEE)was used to compare the difference of Brunnstrom motor function stage at five time points.GEE models were used to detect the association between health literacy and functional exercise adherence.The effects of health literacy and functional exercise adherence on rehabilitation training were estimated by GEE models.All the models adjusted for covariables such as age,sex,education,marital status,personal income,expense reimbursement,diagnosis type,hypertension,hypercholesterolemia,and diabetes.Results: A total of 335 patients were included in this study.In the baseline survey,the total score of health literacy was 90.55±14.12,with 66.9% of those who were inadequate health literacy.Among the four dimensions of health literacy,the proportion of adequateinformation acquisition ability was the highest,and the proportion of adequate financial support intention was the lowest.Functional exercise adherence score of stroke patients at baseline was 37.05±7.59,and the total and three dimensions of functional exercise adherence score showed increasing trends in the the two follow-up visits,while the proportion of low and medium level of functional exercise adherence gradually decreased.The average BI score was 28.30±21.34 at baseline and 58.43±23.36 at the fifth evaluation.In the assessment of Brunnstrom motor function stage,the upper limbs,hands and lower limbs all improved significantly as the hospital time increasing.The percentage of patients with Brunnstrom motor function stage IV or above increased the most(39.4%)in the lower limbs,followed by the upper limbs(38.51%),and the recovery of hand function was the smallest(16.72%).After adjusted all confounders,GEE models showed that the total and all dimensions of functional exercise adherence score were higher in the adequate health literacy group compared with the inadequate health literacy group at different time points,the difference was statistically significant(total β =-5.10,95%CI=3.66～ 6.53,P<0.001).However,with the passage of time,the differences of each dimension score between the two groups was gradually decreased;There was no significant difference between health literacy and BI index(β =-2.65,95%CI=-7.76～2.45,P=0.308).In the Brunnstrom stage,there was no statistically significant difference in the proportion of detached movements in the upper limbs,hands and lower limbs between the groups with adequate health literacy and those without(upper limbs:OR=0.76,95% CI=-0.41～1.42,P=0.397;Hand:OR=0.56,95% CI=0.30～1.06,P=0.077;lower limbs: OR=0.72,95% CI=0.39～1.32,P=0.290);There was no statistically significant difference in the BI index between the middle-level group and the low-level group in functional exercise adherence(β=7.69,95%CI=-0.27～15.66,P=0.058),but there was a statistically significant difference between the high-level group and the low-level group(β=18.44,95%CI=9.51～27.38,P<0.001).Out the stage in the separatist movement,in the functional exercise adherence comparison between middle level and low level group,there was no statistically significant difference(upper limbs: OR=1.16,95%CI=0.36～3.69,P=0.802;hand: OR = 0.85,95%CI=0.23～3.12,P=0.809;lower limbs:OR = 0.39,95% CI= 0.08～1.84,P=0.235).Compared with the low level,there was no statistically significant difference for upper limbs in high level(OR = 0.41,95%CI=0.12～1.39,P=0.153),but,there was statistically significant for hand and lower limb in high level(hand: OR=0.24,95%CI=0.06～0.9,P=0.035;lower limb: OR=0.11,95%CI=0.02 ～0.56,P=0.007).Conclusions:1.The baseline health literacy level of the stroke patients in this group was low.2.With the extension of rehabilitation time,the rehabilitation training is effective in improving the stroke patient’s function.3.Health literacy of stroke patients affects the functional exercise adherence.and improving health literacy level is conducive to improving the compliance of stroke patients with functional exercise,so as to improve the effectiveness of rehabilitation training.