A Systematic Review Of The Effect Of Persistent Nursing Intervention In Stroke

Purpose:Evaluate the effectiveness of the continuity of care of stroke intervention in our country, in order to provide a reference for future clinical continued nursing research.Material and method:According to the strategy of searching literature, electronic searching China National Knowledge(CNKI), Chinese Science and Technology of Journal Full-text Database(VIP), Wan Fang knowledge service platform, Chinese Biomedical Literature Database(CBM) and PUBMED,EMBASE, Cochrane Library. According to the literature inclusion and exclusion criteria, the initial studies were screened to determine the final inclusion of studies. The information the final studies were extracted based on the standards of literature data extraction tables. The bias risk assessment tools was used to assess the methodological quality and the Rev Man software was used to analyze the data of the included studies. It was operated independently by two graduate students to search studies, screen literature and evaluate the methodological quality. It was judged by a third party(tutor) when the views were not different.Results 1. A total of 36 papers were Chinese literature, there were six academic dissertations, 30 journal articles. 2. The quality of literature study method was low, there was a high risk of bias. 12 included studies described the stochastic method,and the remaining 24 were not randomly; included 36 studies didn’t describe the method of allocation concealment and blinding; 10 included studies reported the loss of follow up; included 36 studies reported outcomes according to indicated outcomes of research methods, so the results of selective reporting bias didn’t exist; 6 included studies didn’t describe diagnostic criteria, which presented other risk of bias. 3. The results of stroke continuity of nursing intervention(1) The results of daily living ADL: ○1 BI WMD(95% CI)=11.80(9.42,14.18), P <0.00001; MBI WMD(95% CI)= 21.25(9.85,32.64), P=0.0003,the differences were statistically significant.○2 Subgroup analyzes results:1 month BI WMD(95% CI) =7.23(5.29,9.18), P <0.00001; 3 months BI WMD(95% CI)= 10.63(7.69,13.57), P <0.00001, MBI WMD(95% CI)=15.65(11.63,19.67);6 months BI WMD(95% CI)=13.5(8.73,18.26), P <0.00001,the differences were statistically significant.(2) The results of quality of life:○1 QOL scores SMD( 95% CI) = 1.13(0.61,1.66), P <0.0001; physiological state SMD(95% CI)= 0.83(0.57, 1.09), P <0.00001; mental state WMD(95% CI)= 14.07(8.89,19.26), P <0.00001; the social function of the state SMD(95% CI)= 9.25(7.43,11.08), P <0.00001; subjective feelings SMD(95% CI)= 1.12(0.80,1.44), P <0.00001, the differences were statistically significant. ○2 subgroup analyzes results: 1 month SMD(95% CI)= 0.95(0.12 1.77), P =0.02; 3 months SMD( 95% CI)= 0.87(0.41,1.33),P = 0.0003; 6 months SMD( 95% CI) =1.86(0.72,3.00), P = 0.001; 12 month SMD( 95% CI)=1.87(0.60,3.14), P=0.001,the differences were statistically significant.(3) The results of motor: WMD(95% CI)= 15.19(9.25, 20.93), P <0.00001, the differences was statistically significant.(4) The result of swallowing function: OR(95% CI)= 4.39(2.22,8.65), P <0.00001, the differences was statistically significant.(5) The result of self-care ability: WMD(95% CI)= 16.5(-8.69,41.70), P = 0.2> 0.05, the difference was not statistically significant.(6) The result of depression: SMD(95% CI) =-5.65(-8.83,-2.46), P = 0.0005, the difference was a statistically significant.(7) The results of the resource utilization of health: re-hospitalization rate OR(95% CI) = 0.77(0.32,1.87), P = 0.56, the difference was not statistically significant; accessing to emergency rate OR(95% CI)=0.74(0.29,1.89), P = 0.53, the difference was not statistically significant; outpatient visiting rate OR(95% CI) = 0.21(0.09,0.46), P <0.0001, the difference was statistically significant.(8) The results of compliance with treatment: ○1 Medication compliance OR(95% CI) = 4.71(1.79,12.34),P<0.00001, WMD(95% CI) = 0.7(0.17,1.22), P<0.00001; rehabilitation schedule adherence OR(95% CI) = 9.10(4.75,17.40), P<0.00001, WMD( 95% CI) = 0.85(0.68,1.02), P<0.00001; reasonable diet adherence OR(95% CI) = 4.86(3.37, 7.00), P<0.00001,WMD(95% CI) =1.17(0.91,1.42), P<0.00001; regular monitoring blood pressure compliance OR(95% CI) =14.94(5.57,40.13), P<0.00001; periodic review of compliance OR(95% CI) = 5.62(2.21,14.30),P<0. 00001,WMD(95% CI) = 0.61(0.46,0.76) P=0.003; regular life compliance WMD( 95% CI) = 0.80(0.66,0.94), P<0.00001, the regular life compliance WMD( 95% CI) = 0.80(0.66,0.94), P<0.00001, the regular life compliance WMD( 95% CI) = 0.80(0.66,0.94), P<0.00001, the differences were statistically significant. ○2 Subgroup analysis results: 3 months rehabilitation adherence OR(95% CI)= 3.33(1.61,6.89), P = 0.001; reasonable diet adherence OR(95% CI)= 2.47(1.29,4.70), P = 0.006; regular monitoring of blood pressure and compliance OR(95% CI) = 4.07(2.20,7.53), P <0.00001, the differences were statistically significant; regularly review compliance OR(95% CI) = 1.45(0.70,2.99), P = 0.32, the difference was not statistically significant; medication adherence OR(95% CI)= 1.10(0.54,2.25), P = 0.8, the difference was no statistically significant;6 months patient compliance interventions: medication adherence OR(95% CI)= 7.99(1.87,34.09), P = 0.005; rehabilitation adherence OR(95% CI)= 13.16(8.26,20.96), P <0.00001; reasonable diet adherence OR(95% CI) = 6.78(4.29,10.71), P <0.00001, regular monitoring of blood pressure compliance OR(95% CI)= 27.64(14.28,53.50), P <0.0001; regularly review compliance OR( 95% CI)= 9.56(3.21,28.44), P <0.00001, the differences were statistically significant.○3 intervention patient compliance 12 months OR(95% CI) = 9.83(0.45, 214.46), P = 0.15, the difference was not statistically significant.(9) The incidence of complications intervene Results: The incidence of pressure sores OR(95% CI) = 0.15(0.06,0.37), P <0.0001, the difference was not statistically significant; the incidence of aspiration pneumonia OR(95% CI) = 0.26(0.11,0.63), P = 0.003, the difference was not statistically significant. One study reported the incidence of stroke patients falling, one study reported the incidence of stroke patients swallowed choking and aspiration,and one study reported that the incidence of stroke in patients with constipation, they failed to conduct Meta-analysis.(10) The recurrence rate intervention effects: OR(95% CI)= 0.15(0.07,0.33), P <0.00001, the difference was statistically significant.(11) The results of laboratory measure of intervention: cholesterol(TC) WMD( 95% CI) =-0.94(-1.14,-0.73), P <0.00001; triglyceride(TG) WMD(95% CI) =-0.39(-0.56,-0.23), P <0.00001; homo cysteine(Hcy) WMD(95% CI) =-0.55,(-7.40,-3.71), P <0.00001,The differences were statistically significant. Only one study measured fasting blood glucose(GLU) value, which failed to conduct a Meta-analysis.(12) Stroke-related knowledge awareness intervention results: SMD(95% CI) = 2.22(1.40, 3.05), P <0.00001, the difference was statistically significant.(13) Nursing interventions satisfaction results: OR(95% CI) = 3.02(1.75, 5.21), P <0.0001; SMD(95% CI) = 2.07(1.46, 2.69), P <0.00001, the difference was statistically significant. 3.Publication bias: there were no publication bias in daily living, motor f unction,and rehabilitation adherence.there were publication bias in medication compliance, adherence to proper diet, regular monitoring of blood pressure and compliance,regularly review compliance and QOL. the overall presented publication bias.Conclusion:1.Continuity of care can improve activities daily living, motor function,quality of life,swallowing function,treatment compliance,relevant knowledge and awareness of the nursing satisfaction in patients with stroke,and reduce patient depression, concurrent reduction in stroke patients disease incidence an recurrence rates,lower cholesterol,triglycerides,homocysteine biochemical indicators. However, because the low methodological quality, mostly small studies,assessment tools different standards and the lack of long-term follow-up,the strength of this systematic review of the evidence was low. In the future large sample and multi-center randomized controlled trials will be required to research a long-term intervention effect of stroke continuity of care. 2.There are no evidence that showing the continuity of care can improve the self-care capacity,compliance to maintain optimism and resource utilization and health,lower fasting blood glucose levels, and lower the incidence of falling,choking and aspiration in swallowing disorders patients and constip ation of stroke patients. 3. Continuity of care research in our country is lack of comprehensive continuity of care team,standardized evidence-based continuity of care program,trad itional Chinese medicine nursing health education,the community support and evaluation of stroke caregivers neglect.