Application Research Of Distress Thermometer In Patients With Stroke

Objective:1 To translate the Distress Thermometer(DT)into Chinese for stroke,test the reliable and validity of DT and explore the optimum cut-off score on DT,thereby providing a comprehensive and simple screening instrument for distress after stroke.2 To investigate psychological distress levels and Problem List(PL)distribution in stroke patients,analyses the sources and influencing factors of distress,thus providing reference for developing appropriate preventive or therapeutic interventions.Method:1 A total of 200 neurological stroke patients from May 2017 to August 2017 in a tertiary hospital of Sichuan province were investigated by convenience sampling.The Chinese version of DT for stroke was developed by translating and culturally adjusted.Collecting general demographic and clinical data,Hamilton Depression Rating Scale scores(HAMD),DT scores,PL distribution,Hospital Anxiety and Depression Scale scores(HADS)and Symptom Checklist 90 scores(SCL-90).All data were analyzed by SPSS20.0 software,reliability was described by Cronbach's Alpha and Kappa value,validity was described by content validity and criterion-related validity,the optimum cut-off score was described by ROC curve according to HAMD,HADS and SCL-90.2 A total of 230 neurological stroke patients from September 2017 to November 2017 in a tertiary hospital of Sichuan province were investigated by convenience sampling.Collecting general demographic and clinical data,DT scores,PL distribution,Barthel Index scores and NIHSS scores,exploring the causes and influencing factors of distress.All data were analyzed by SPSS20.0 software,univariate analyses were performed using the student t-test,the chi-square test,ANOVA,correlation analyses were performed using spearman rho correlation coefficient and multivariate analyses were performed using the binary logistic regression analysis.Result:1 Cronbach's Alpha for the total PL was 0.808,Kappa value was 44.20%-53.20%.The correlation coefficient were 0.658?0.664?0.628?0.641?0.687 respectively comparing HAMD,HADS,HADS-D,HADS-A,SCL-90,content validity was greater than 0.75.When a cut-off score on DT was 5,all the Youden index were highest comparing HAMD,SCL-90,HADS,HADS-D and HADS-A,the AUC was 0.774-0.813(P=0.000<0.05),the sensitivity was 0.809-0.877,the specificity was 0.621-0.685.2 The mean scores on DT was 5.270±2.676,scores were mainly 4 points(18.26%),the prevalence of significant distress was 55.22%.3 The main sources of psychological distress in stroke patients were activity,weakness of limbs,worry,dizziness,economy,bathing / dressing,hand / foot weakness,depression,sleep and constipation.4 The score of DT was negatively correlated with the Barthel index(r=-0.355,P<0.01)and was positively correlated with the NIHSS(r=0.326,P<0.01).5 Gender,family income per capita,and the NIHSS in the general demographic were the influencing factors of significant psychological distress.Pain,depression,loss of interest in daily activities,and economic distress in the problem lists were the influencing factors of significant psychological distress.Conclusion1 The DT for stroke showed good reliable and validity when PL was used as one whole scale,DT and stroke specific PL offers a valuable tool for assessing and understanding distress after stroke,the optimum cut-off score was 5 for the significant distress.2 The psychological distress in stroke patients was common,the prevalence of significant distress was 55.22%.The psychological distress in stroke patients mainly came from the physical and emotional problems.The clinical medical staff should make clear the key cause and give the patients personalized treatment and nursing.3 The psychological distress related factors of stroke patients were complex.Distress thermometer can comprehensively evaluate the potential factors of psychological distress.In problem lists:pain,depression,loss of interest in daily activities,and economy were the important influencing factors of significant psychological distress.