| ObjectiveIn this study,evidence-based nursing methods were applied.Through the retrieval of evidence,evidence integration,and Delphi expert consultation methods,scientific,practical and suitable rehabilitation exercises for the rehabilitation status of stroke dysphagia patients in China were developed to provide science for patients with stroke dysphagia.The basis and methods of rehabilitation will further improve patient compliance and rehabilitation efficacy.At the same time,pre-experiments were performed to determine its safety and effectiveness.Methods1.Construction of rehabilitation exercise for dysphagia in stroke(1)Establish a rehabilitation exercise research and development team: To understand the current application status and problems of rehabilitation training for patients with dysphagia in stroke,and determine the clinical significance of developing rehabilitation exercises for dysphagia of stroke in the context of stroke disease characteristics and the current national medical insurance policy.(2)Through searching the related guidelines,systematic evaluation,meta analysis and original research on dysphagia rehabilitation training of stroke at home and abroad,using AGREE? and Cochrane's evaluation manual on intervention research,the quality of the included guidelines and original research was evaluated,the relevant evidence of dysphagia rehabilitation training was extracted and integrated,and the content of dysphagia rehabilitation training of stroke was summarized To draw up the rehabilitation exercise of dysphagia in stroke and prepare the questionnaire of rehabilitation exercise of dysphagia in stroke according to the initial entry pool.(3)The Delphi Expert Correspondence Method was used for two rounds of expert correspondence to evaluate the importance and operability of the rehabilitation exercises items,and the indicators such as the positive coefficient,the Kendall coordination coefficient,the authority coefficient,and the coefficient of variation of each item were used The statistical analysis of the results of the correspondence forms stroke rehabilitation rehabilitation.2.Preclinical trial of rehabilitation exercise for dysphagia after strokeFrom January 2019 to April 2020,40 stroke patients admitted to the Department of Neurology,the second hospital of Lanzhou University were divided into two groups: experimental group(20 cases)and control group(20 cases).The intervention time was 2 weeks.The control group received conventional nursing and neuromuscular electrical stimulation treatment;the experimental group received interventions for rehabilitation of stroke and dysphagia based on the control group,and collected after the intervention: standard swallowing function score and rehabilitation of stroke and dysphagia.The complication rate of aerobics intervention verified the effectiveness and safety of rehabilitation exercises for stroke and dysphagia.Prepare for further large-scale clinical trials.Result1.The research and development team consists of 12 members,including evidence-based methodologists,statistics experts,clinical nursing experts,cerebrovascular disease experts,rehabilitation specialists,hospital managers,and nursing researchers.After discussions among members of the research and developmen team,the theme of stroke rehabilitation for dysphagia and its application scope were determined.2.Through systematic search,4 guides and 11 high-quality original studies were included;The quality of the literature included in the study was evaluated.Among the four guides,one was A-level guide and three were B-level guide.The overall quality of the guide included was relatively good;Of the 11 original research literatures,9 were of grade B and 2 were of grade C;Extraction and integration of rehabilitation contents related to dysphagia in stroke,including:Facial training,tongue training,lip training,jaw training,throat training,ventilator training,Masake training method,Shaker training method,etc.No evidence-based rehabilitation exercise has been found in stroke patients with dysphagia.Provide theoretical reference and evidence support for further construction of rehabilitation exercise.3.The research group analyzed and discussed the extracted and integrated rehabilitation training contents.According to its importance and operability,the research group initially developed a rehabilitation item pool with 39 items for stroke dysphagia rehabilitation,and compiled a rehabilitation letter volume for stroke dysphagia rehabilitation according to the initial item pool.4.Finally,20 correspondence experts were included.In the two rounds of inquiry,the positive coefficients of the experts were 0.9 and 1.0 respectively;the authoritative coefficients of the experts were 0.895 and 0.9 respectively;Kendall coordination coefficients are: first round importance of 0.385,operability of 0.304,second round importance of 0.429,operability of 0.419.In the first round,the average evaluation score of the importance of the entries was 2.8~5,and the average evaluation score of operability was 3.85~5.According to the results of the inquiry,6itemswere deleted,5items were modified,1items was added,and 2 items were adjusted.The average score of the second round of item importance is 3.8~5,and the average of the operability evaluation score is 3.8 ~ 5.After the two rounds of inquiry,the expert opinions tend to be consistent,and finally include eight first-level items Rehabilitation exercises for dysphagia after stroke in 26 secondary entries.5.Applying rehabilitation exercise for stroke and dysphagia to clinical verification,the results show:Before the intervention,there was no significant difference in the SSA score between the two groups of subjects(P>0.05);After the intervention,the SSA scores of the two groups were significantly improved,and the SSA scores of the patients in the experimental group were significantly better than those in the control group after the intervention,the difference was statistically significant(P < 0.05),and there were no complications caused by rehabilitation therapy in the experimental group.Rehabilitation exercises for stroke and dysphagia are effective and safe.ConclusionThis study should be based on evidence-based nursing.Through a comprehensive literature review,it constitutes a draft of rehabilitation exercises for patients with dysphagia in stroke.The enthusiasm,authority and coordination of the experts were relatively high,and the research results were objective,scientific,and reliable.Pre-experiments were performed to verify the safety and effectiveness of rehabilitation exercises.The results showed that there were no complications related to rehabilitation exercises in the experimental group It has good curative effect andbasically meets the purpose of this study.However,this rehabilitation exercise needs to further carry out large-sample,multi-center clinical application research and further evaluate its application effect. |
PDF Full Text Request