Study On The Influence Of Mediating Effect Of Hospitalization Patients With Stroke On ADL

Objective:To understand the influence of the engagement level of hospitalized patients with stroke on ADL,and to explore the influencing factors of hospitalization patients' engagement in stroke,to provide evidence for improving the outcome of stroke patients by improving the engagement level of patients.Methods:A prospective longitudinal study was conducted,in which 139 hospitalized patients with stroke were included in the study.General baseline data,patient engagement and its influencing factors,and Activity of Daily Living(ADL)were recorded and assessed at the 1st,4th,and 8th week of admission.The modified Barthel Index(MBI)and the Pittsburgh Rehabilitation Participation Scale(PRPS)were used to assess their daily living ability and patient engagement;based on the PPCRO framework model constructed by Jesus and Silva,from emotional state,The factors affecting patient engagement were comprehensively investigated in seven aspects: self-efficacy level,social support level,motivation level,level of rehabilitation knowledge and degree of independent will,outcome expectation,and coping strategies.The data were analyzed by single factor analysis,repeated analysis of variance and multiple linear stepwise regression analysis.The mediation effect model of patient engagement was tested by SPSS 21.0 software Process plug-in.Path analysis using the Amos24.0 software structural equation model.Results:1.Patient engagement and ADL level status: From week 1 to week 8,the patient's PRPS scale score and MBI scale score showed an upward trend;week 1 and week 4,week 1 and week 8 and compared with the 8th week,the PRPS scale score and the MBI scale score of the stroke patients showed statistical difference at different time points(P<0.01);The Spearman correlation analysis was used for the 4th week.The differences between the PRPS scale and the MBI scale scores of the first week,the eighth week,and the first week were analyzed,and the patient engagement level was found in the correlation between the fourth week and the first week,the eighth week,and the first week.ADL was positively correlated(r=0.379,0.611,respectively).The ADL ability of the different engaging groups at the first week,the fourth week and the eighth week was analyzed by repeated measures analysis of variance.The results showed that the MBI score of the high participation group was significantly higher than that of the low engagement group(F=38.200,P<0.01).And there are significant time effects and interaction effects(P <0.01).2.The influence of related factors of stroke patients on patient engagementComparison of relevant factors in seven aspects of different engaging groups at three time points using repeated variance analysis,the different groups engaged in the three levels of depression level,self-efficacy level,motivation level,patient knowledge and independent consciousness,patient outcome expectation level,medical response surface pair and yield dimension were statistically significant(P<0.01),the difference of depression level between groups and time was statistically significant(P<0.05).There was no significant difference in the number of medical coping avoidance dimensions and social support between groups,time and interaction(P>0.05).Patient engagement mediates the influence of the dimensions of the medical response scale on the patient's ADL.The Sobel test effect value is 0.876(P<0.001).The difference between the motivation-mediation-patient engagement and the patient ADL level effect value There was no statistical significance;depression had a direct effect on ADL levels in patients(P < 0.001).Conclusion:The level of engagement in stroke patients has an important influence on ADL ability.The higher the patient's engagement level,the better the ADL ability.The level of depression,motivation level,and coping strategies are independent factors influencing patient engagement.The dimension in the coping strategy is to influence the patient's ADL level completely through the intermediary patient engagement,and the depression directly affects the patient's ADL level.