Research And Analysis On The Need Of Stroke Patients During Community Rehabilitation Period In Jinan City

ObjectiveTo explore stroke patients' need in various aspects during community rehabilitation period,develop a scale(The Scale of Stroke Patient's Need During Community Rehabilitation Period),which can reflect patients' need extensively and extensively.To research and analysis the factors which affect the patients' rehabilitation need;provide the professional assistance from the perspective of care for patients so as to promote the rehabilitation of patients and improve their quality of life.To provide the strategy for development of community based rehabilitation.Methods1.Sample of 226 stroke patients in communities of Jinan city including community of Railway Hospital,Biaoshan,Baotuquan,Xiyuan and Tianfuyuan were studied.Data collection was conducted from Apr.2008 to Nov.2008.Patients selected in line with the requirements of the stroke diagnostic criteria which formulated on the Fourth National Cerebrovascular Disease Symposium in 1995;Based on imaging diagnosis of CT and MRI;Willing to accept the investigation and assessment.2.Methods including quantitative and qualitative research.(1) According to the results of literature review,combined with the results of in-depth interview of 11 community stroke patients and their primary caregivers to develop the scale.(2) By disseminating brochures of rehabilitation knowledge in community health center,investigator selected patients who fulfilled the criteria and agreed to accept investigation to completed the scale on the spot or at home. Completed scale was checked for integrity and authenticity.To the patient who was unable to complete independently,the primary caregiver or researcher would read the scale and filled out on patients' behalf.3.Data analysisData was processed by SPSS11.5 software.Frequency,percentage or(?)±s were used to describe the general information;Spearman correlation analysis,reliability test and factor analysis were adopted for scale's reliability and structure validity tests; One-way ANOVA and t-test were introduced to analysis the impact of general information on community rehabilitation need;Multiple stepwise regression was used to analysis the affects of need to ADL,general self-efficacy and depression respectively.Results1.Qualitative research on the need of stroke patients during community rehabilitation periodBy the in-depth interviewing of 11 cases of stroke patients and their primary caregivers,the results of qualitative research showed that:During the rehabilitation process,patients had 4 aspects of need including daily living activities;emotional and psychological;social and family relations,as well as professional guidance.2.Reliability and validity of the scaleAfter evaluating by experts,items filtration and factor analysis,the scale was developed with eight factors and 60 entries.Reliability test was used to analysis all collected data.The total Cronbach's a coefficient of Q Scale(Question scale) was 0.9040;the overall Cronbach'sαcoefficient of N Scale(Need scale) was 0.9692,those results showed that the scale had high internal consistency.Cronbach'sαcoefficient of each factor was greater than 0.8.At last,eight factors were extracted by the factor analysis.The results of Spearman correlation analysis showed that each factor was significant positive correlation(P＜0.01) with the N scale and inter-entries.It illustrated that high internal consistency existed in the inter-factors as well as inter-entries.According to eigenvalue＞1 factor extraction,9 factors were extracted by using the method of main axis factor extraction.The cumulative variance contribution rate was 60.334%after 8 times of iteration.Using the method of varimax rotation,8 common factors had stronger factor loading on the corresponding items.According to original variable corresponding to the maximum factor loading,the original variable was grouped into 8 categories.That was in line with the designed scale,which had 9 dimensions.It showed that the scale had higher discriminant validity.3.Study of stroke patients' need during the period of community rehabilitationAccording to results of factor analysis,8 factors were extracted,namely,stroke patients existence eight aspects of need during the community rehabilitation period as followed:psychological support need;information support need;daily activity support need;social-adapting support need;professional support need; sequelae-coping support need;social support need and complication-supporting need. Whether having medical insurance had significant different in psychological support need(＜0.01);and had different in social-adapting support need(P＜0.05), professional support need(P＜0.05) and social support need(＜0.05) respectively. Whether having received rehabilitation guidance was different in professional support need(＜0.05).Patients with different occupation had significant difference in social-adapting support need(＜0.01),and had different in sequelae-coping support need(＜0.05);patients with different levels of education had significant difference in information support need and information support need(＜0.01),as well as had difference in psychological support need,social-adapting support need and social support need(＜0.05);patients with different economic levels had significant difference in social-adapting support need(＜0.01).The rest general information has no impact on patients' need during the period of community rehabilitation(P＞0.05).Patients' ADL was related to daily activity support need and sequelae-coping support need(R~2=0.314,Adjusted R~2=0.308,F=51.015,P=0.000);General self-efficacy was related to daily activity support need(R~2=0.046,Adjusted R~2= 0.041,F=10.597,P=0.001),but the correlation had little significance which suggesting that there was more important factors to be further studied;Depression was related to psychological support need and sequelae-coping support need (R~2=0.212,Adjusted R~2=0.205,F=29.276,P=0.000).The rest rehabilitation need had no effect on patients' ADL,general self-efficacy and depression.Conclusions1.The Scale of Stroke Patient's Need During Community Rehabilitation Period has good reliability and validity.2.The Scale contains 56 entries and eight factors which reflect the content of patients' rehabilitation need,including psychological support need,information support need, daily activity support need,social-adapting support need,professional support need, sequelae-coping support need,social support need and complication-supporting need.3.Whether having medical insurance,having received professional guidance,levels of education and economic effect patients' community rehabilitation need,whereas the impact of medical insurance and education was more remarkable.4.Patients' ADL was effected by daily activity support need and sequelae-coping support need;general self-efficacy was little influenced by daily activity support need; depression was impacted by psychological support need and sequelae-coping support need.