| ObJectives1.Through investigation,we will understand the core stability status and home rehabilitation needs of patients with limb dysfunction in ischemic stroke at the time of discharge.2.Based on the preliminary investigation and literature review,group discussion and expert interview,the core stability rehabilitation training program for patients with limb dysfunction of ischemic stroke at home was initially constructed.The program was revised by Delphi letter consultation method and formed through pre-test.3.Through the quasi-experimental study,verify the function and effect of the core stability rehabilitation training program for patients with limb dysfunction of ischemic stroke at home,promote the continuity of rehabilitation treatment,accelerate the rehabilitation process,and provide a feasible new rehabilitation nursing program for patients with home rehabilitation training.Methods1 Investigation phaseUsing the convenient sampling method,from January 2020 to January 2021,a survey was carried out in a tertiary first-class general hospital,and the survey was strictly in accordance with the criteria for inclusion,and the respondents were all patients with ischemic stroke limb dysfunction who had been ill for the first time and were about to be discharged,and a total of 211 people were investigated.Baseline data were collected using the General Data Questionnaire,the Patient Home Rehabilitation Needs Assessment Questionnaire,the Berg Balance Scale,and the Functional Walking Grading Scale.SPSS26.0 was used for statistical analysis,and the results were described in the form of number of cases(percentage),mean±standard deviation.2 Build the scenario phaseBased on the first stage and combined with the needs of patients for home rehabilitation,a draft of the core stability rehabilitation training program for patients with limb dysfunction after literature review,group discussion and expert interview was formed.The program was formed after two rounds of Delphi expert letter consultation and preliminary test.3 Intervention phaseFrom July to September 2021,the research subjects who meet the criteria for inclusion were selected and studied in a tertiary general hospital.Taking the Berg balance function score as the primary outcome indicator,according to the pre-trial results,the sample size calculation formula calculated that the sample size of each group was about 30 people,and considering the 20%loss of follow-up rate,36 people in the observation group and 36 people in the control group were finally determined.The control group was discharged with conventional discharge guidance and out-of-hospital follow-up,and the observation group adopted the core stability rehabilitation training program for patients with home ischemic stroke limb dysfunction on the basis of routine discharge guidance and out-of-hospital follow-up.After literature research,discussion by rehabilitation team members,and combined with clinical actual conditions and expert consultation,the study cycle was finally determined to be 8 weeks after the patient was discharged from the hospital.Inform the patient to return to the hospital for review on the weekend of the 4th week and the weekend of the 8th week of the study period,and the rehabilitation team members will assess their functions,and those who cannot return to the hospital for special reasons on the same day can float up and down for 2 days to return to the hospital for review,and for those who still cannot return to the hospital for review,the rehabilitation team members will enter the home for assessment.The Berg Balance Scale,the Stroke Patient Motor Function Assessment Scale,and the Functional Walking Scale were used to compare the changes in balance function and motor function of the two groups before the intervention,4 weeks after the intervention,and 8 weeks after the intervention.The Barthel Index Rating Scale,the Quality of Life Score SF-36 Scale,and the Behavioral Confidence Assessment(Chronic Disease Self-Efficacy Questionnaire)were used to compare the changes in daily living ability,quality of life,and behavioral confidence of the two groups before and after the intervention at eight weeks.Results1 Investigation Phase:A total of 211 questionnaires were sent out and 205 were effectively received,with effective recovery rate of 97.2%.The results showed that 60 patients with limb dysfunction were aged from 18 to 44 years old,accounting for 29.27%;125 45-59 years old,accounting for 60.97%;20≥60 years old,accounting for 9.76%;There were 132 males,accounting for 64.39%;73 women,accounting for 35.61%;175 people(85.37%)said they needed home rehabilitation training instruction;190 patients(92.68%)indicated that they needed to develop rehabilitation training programs to guide their rehabilitation after discharge.186 people(90.73%)said they needed health education about diseases and prevention of complications.196 people(95.61%)needed guidance to take medicine correctly and observe drug efficacy and adverse reactions.194 people(94.63%)said they needed guidance on diet,exercise and weight control.194 people(94.63%)expressed the need to give psychological support to patients and their families;196 people(95.61%)said they needed help after discharge.The BBS score of patients with ischemic stroke limb dysfunction was 20.58±4.78 at discharge,and FAC score was 2.01±0.59 at discharge,indicating that patients still had balance dysfunction and motor dysfunction to a certain extent at discharge,and their core stability was poor.Therefore,it is urgent to develop core stability rehabilitation training programs for ischemic stroke patients with limb dysfunction in line with their needs and realistically meet the needs of patients.2 Build scenario phase:Combined with the preliminary investigation,on the basis of literature review reading,group discussion and expert interview,the first draft of the core stability rehabilitation training program for patients with ischemic stroke limb dysfunction at home was formed,and the core stability rehabilitation training program for patients with ischemic stroke limb dysfunction was formed after two rounds of Delphi expert consultation and pre-test.3 intervention phasesIn this study,a total of 4 patients were lost during the intervention process,and 68 patients completed the study,including 34 in the observation group and 34 in the control group.3.1 Effect of the intervention on the indicators of the patients in the 4th and 8th weekends after discharge(1)The effects,time effects and interaction effects of FAC,BBS and MAS in the observation group were statistically significant.After adjusting the scores of FAC,BBS and MAS before intervention,the scores of FAC,BBS and MAS in the observation group were higher than those in the control group at 4 and 8 weeks after intervention.(2)The behavioral confidence,Barthel and QOL scores of the observation group and the control group were statistically significant after intervention,and the behavioral confidence,Barthel and QOL scores of the observation group were higher than those of the control group.3.2 Interventions compared patients within a group of indicators at the 4th and 8th weekends after discharge(1)The FAC,BBS and MAS scores of the observation group and the control group were significantly increased 4 weeks after intervention compared with before intervention,and the differences were statistically significant.(2)FAC,BBS,MAS,behavioral confidence assessment and QOL of the observation group and the control group were significantly increased 8 weeks after intervention compared with before intervention,and the differences were statistically significant.Barthel in the observation group increased significantly 8 weeks after intervention compared with before intervention,and the difference was statistically significant,while Barthel in the control group had no statistical significance.(3)There was no statistical significance in FAC between 4 weeks after intervention and 8 weeks after intervention in the control group,while FAC score in the observation group increased significantly with statistical difference.BBS and MAS scores of observation group and control group were significantly increased,and the difference was statistically significant.Conclusions1.The core stability rehabilitation training program for home ischemic stroke patients with limb dysfunction is highly practical and maneuverable,and can effectively improve the balance function and motor function of patients.2.The core stability rehabilitation training program for home ischemic stroke patients with limb dysfunction can improve their self-care ability and quality of life.3.The core stability rehabilitation training program for patients with limb dysfunction in home ischemic stroke effectively strengthens patients’ behavioral confidence in disease recovery. |
PDF Full Text Request