Study On The Effect Of Early Rehabilitation On Stroke Patients

Stroke is characterized by high morbidity,high mortality,high disability rate,high recurrence rate and high economic burden.It has the highest mortality rate in China and is an important cause of disability in Chinese adults.There may be a neuroplasticphase after stroke,and neuroplasticity can be further enhanced by rehabilitation therapy.The combination of rehabilitation intervention and critical period is crucial for a good recovery after stroke.Early rehabilitation training is an important part of stroke recovery and can improve the functional prognosis of patients.Many clinical management guidelines recommend rehabilitation training after 24 hours(h),but when is it more appropriate to carry out rehabilitation training after 24 hours? It's not clear yet.Most of the medical staff and patients and families pay more attention to the recovery of the patients' activity of daily life,but the depression after stroke,cognitive dysfunction and fatigue after stroke is a common problem of their life which have a negative impact to the patient.If we ignore these aspects,it may cause serious obstacles and challenges to the patient's recovery process,and lead to poor function and decreased quality of life.At present,no studies have been found comparing the different starting time of early rehabilitation training and simultaneously research on the activity of daily life(ADL),post-stroke depression,cognitive function and post-stroke fatigue of patients with acute stroke.Objective:We aimed at conducting rehabilitation training for stroke patients within 48 h,48h to 7 days(d)and after 7d,and to analyze the effectiveness of rehabilitation training on ADL,post-stroke depression,cognitive function,and post-stroke fatigue of stroke patient.To investigate the factors affecting ADL,post-stroke depression,cognitive function and post-stroke fatigue in patients with acute stroke,and to analyse the relationship between ADL,poststroke depression,cognitive function and poststroke fatigue.Methods:We selected 90 stroke patients who were admitted to the department of neurology of tertiary Class A general hospital in Heze city,Shandong province from November 2018 to March 2019.The 90 patients were randomly divided into three groups: IG1 is the intervention group with early rehabilitation training starting within 48 h of the onset;IG2 is the intervention group with early rehabilitation training starting within 48 h to 7d of the onset;and CG is the control group with routine rehabilitation treatment in accordance with the hospital.All patients in the three groups received routine nursing,and the rehabilitation training intervention continued at least until the 14 th day after the onset of the disease or until the patients were discharged.General data were collected and neurological deficits were assessed using the National Institutes of Health Stroke Scale(NIHSS)within 48 hours of onset.Before the intervention,the Barthel Index(BI)was used to assess the patient's activities of daily life(ADL),the Patient Health Questionnaire Depression Scale(PHQ-2)was used to assess the post-stroke depression,and the Mini Mental State Examination Scale(MMSE)was used to assess the cognitive function,the Fatigue Severity Scale(FSS)was used to assess the post-stroke fatigue.After the intervention,ADL,post-stroke depression,cognitive function and post-stroke fatigue were evaluated again.Statistical analysis:The R*C chi-square test or Fisher's exact test were used to compare the general data of the three groups of patients,and the Kruskal-Wallis test(K-W test)was used to compare the baseline data of the three groups of patients.The paired sample t test or Wilcoxon sign rank test were used to compare the intervention effect in the group.The k-w test was used to compare the effect of intervention between groups.The optimal scale regression was used to adjust the variables of age,stroke severity,baseline difference p<0.2,and baseline score.Spearman correlation analysis method was used for correlation analysis.The factors affecting BI,PHQ-2,MMSE and FSS were analyzed by optimal scale regression.Process v3.4 plug-in and Bootstrap method were used to analyze the mediation effect.Epidata3.1 software was used for data entry,and SPSS24.0 software was used for statistical analysis.P<0.05 indicated that the difference was statistically significant.Results:1.All the 90 patients included in the study completed the rehabilitation training intervention and outcome assessment.There was no statistical difference in general information among the three groups(p>0.05),and no significant difference in baseline BI,MMSE and FSS scores(p>0.05),but there was a significant difference in baseline PHQ-2 scores among the three groups(p<0.05).2.The comparison results in the IG1 group after intervention showed that the ADL,poststroke depression,cognitive function and poststroke fatigue of the IG1 group were significantly improved.In IG2 group,poststroke depression,cognitive function and poststroke fatigue were significantly improved,but ADL was not significantly improved.In the CG group,cognitive function was significantly improved,but poststroke depression and post-stroke fatigue symptoms were not relieved,and ADL significantly decreased.3.The k-w test results showed that the ADL,poststroke depression,cognitive function and poststroke fatigue of IG1 and IG2 groups were better than that of CG group(p<0.05),and there was no significant difference between IG1 group and IG2 group(p>0.05).After adjusting for age,stroke severity,PHQ-2 and baseline scores,the optimal scale regression analysis showed that the intervention effect was IG1>IG2>CG,but the rehabilitation effect change of IG1-IG2 was smaller than that of IG2-CG.No serious adverse events occurred in the three groups.4.The analysis results of influencing factors showed that age and NIHSS had negative effects on ADL.Age and education level had negative effects on post-stroke depression.Gender,age and NIHSS had negative effects on cognitive function,and the number of chronic diseases and NIHSS had negative effects on post-stroke fatigue.5.There is a complex and significant correlation between BI,PHQ-2,MMSE and FSS.In particular,there is significant positive correlation between BI and MMSE(p < 0.05,r = 0.260),there is significant negative correlation between BI and the FSS(p < 0.05,r = 0.238),there is significant negative correlation between BI and NIHSS(p < 0.01,r = 0.465).there is significant positive correlation between PHQ-2 and the FSS(p < 0.01,r = 0.412).There is significant negative correlation between MMSE and NIHSS(p < 0.05,r = 0.465).There is significant positive correlation between FSS and NIHSS(p < 0.05,R = 0.265).6.NIHSS plays a mediating role in the process of MMSE affecting BI completely.Conclusion:For patients with mild or moderate acute stroke,rehabilitation training within 48 hours can produce better results,but starting rehabilitation training within 48 h to 7d May not be very different from starting rehabilitation training within 48 hours,both of them can improve patients' ADL,post-stroke depression,cognitive function and poststroke fatigue.There is a complex relationship among BI,PHQ-2,MMSE,FSS and NIHSS,and NIHSS plays a role as a complete mediator in the process of MMSE's influence on BI.