| Research Purpose:In this study,a factorial design analysis method was adopted,combining two factors,two-level 2×2 factorial design,lemon ice stimulation（no use,use）and breathing training（no use,use）.The influence of quality and complication rate,to clarify the best intervention method to promote the recovery of swallowing function in this study design,to achieve the purpose of improving patients’ swallowing function and quality of life,and reducing the incidence of complications.Research Methods:A total of 96 stroke patients with dysphagia who were hospitalized in the rehabilitation department of a tertiary first-class hospital in Huzhou City from January 2021 to January 2022 were selected as the research subjects.The factorial design analysis method was adopted,factor 1:lemon ice stimulation,the two levels were not used and used;factor 2: breathing training,the 2levels were not used and used.The patients were randomly divided into four groups: A,B,C and D.Group A: routine nursing and swallowing function training,group B: lemon ice stimulation under routine nursing and swallowing function training,group C: routine nursing and swallowing function training implementation of breathing training,group D: lemon ice stimulation combined with breathing training under routine nursing and swallowing function training.The general data of the patients were collected before the intervention,the Standard Swallowing Assessment Scale（SSA）score and the Water Swallowing Test（WST）grade were collected before the intervention,the second week of the intervention,and the fourth week of the intervention;the swallowing test was collected before the intervention and the fourth week of the intervention Disability-specific quality of life scale（SWAL-QOL）scores,and the occurrence of aspiration and aspiration pneumonia during the intervention period were also recorded.SPSS25.0 software was used for statistical description and analysis of the data,and the main statistical methods included chi-square test,one-way ANOVA,nonparametric rank sum test,LSD method,and analysis of variance by factorial design.Research Results:In this study,the data of 92 patients（group A : 23 cases,group B : 22 cases,group C : 23 cases,group D : 24 cases）were statistically analyzed.The results are as follows :1.Swallowing function（1）SSA scores（1）Comparison results between groups and pairs of patients in the four groups: There were statistically significant differences in the SSA scores of the four groups of patients in the second week and the fourth week of intervention（P<0.001）.The results of pairwise comparison showed that there were significant differences in SSA scores between group A and groups B,C,and D at the 2nd week and 4th week of intervention respectively（P<0.05）.Statistical difference（P>0.05）,group B,group C and group D were all significantly different（P<0.05）,that is,the SSA scores of patients in each group in the second week of intervention and the fourth week of intervention were from high to low:A>B=C>D.（2）Results of factorial design analysis: The change of SSA scores of patients has time effect,the SSA scores in the second week of intervention and the fourth week of intervention has a significant statistical difference（P<0.001）,and the different measurement time is different from the lemon ice stimulation,breathing training had an interaction effect on SSA scores（P<0.001,P<0.001）.The between-group effect analysis showed that:lemon ice stimulation and breathing training had significant main effects on SSA scores respectively（P=0.004<0.01,P<0.001）,but there was no interaction between them（P=0.297>0.05）.（2）WST gradeThe comparison results between groups and pairs of patients in the four groups showed that the comparison results of WST grade between groups in the second week of intervention showed that the difference was statistically significant（P=0.003<0.01）.There was statistical significance in WST grade in groups C and D（P<0.05）,and there was no statistical difference between groups B,C,and D（P>0.05）.The comparison results of WST grade between groups at the 4th week of intervention showed that the difference was statistically significant（P<0.001）,there was no statistical difference between groups B and C（P>0.05）,and there was a statistical difference between groups B,C and D（P<0.05）.2.Quality of Life（1）Comparison of results between groups and pairs of four groups of patients: four groups of patients in terms of SWAL-QOL total score,psychological burden,eating time,eating desire,symptom frequency,food choice,fear,mental health,social interaction,and fatigue.There were statistical differences between groups（P<0.01）.The results of pairwise comparison showed that group A and groups B,C,and D had statistical differences in the total score of the scale and the dimensions of psychological burden,eating time,eating desire,symptom frequency,food choice,fear,mental health,and social interaction.（P<0.05）,there was no statistical difference between group B and group C in the total score of the scale and the dimensions of psychological burden,eating time,eating desire,symptom frequency,food choice,fear,mental health,and social interaction（P>0.05）,but both were significantly different from those in group D（P<0.05）,that is,after intervention,the total score of SWAL-QOL and the above-mentioned dimension scores in each group were ranked as D>C=B>A in descending order.In the dimension of excessive fatigue,group A had statistical differences with groups C and D respectively（P<0.05）,group B had statistical differences with groups C and D（P<0.05）,and groups A and B and C had statistical differences（P<0.05）.There was no statistical difference between group D and group D（P>0.05）.The scores of patients in each group were ranked from high to low in the dimension of fatigue as D=C>B=A.In addition,there was no statistical difference between the four groups of patients in the two dimensions of language communication and sleep（P>0.05）.（2）Results of factorial design analysis: Lemon ice stimulation and breathing training had significant main effects on SWAL-QOL total score and psychological burden,eating time,eating desire,symptom frequency,food choice,fear,mental health,and social interaction dimensions respectively（P<0.01,P<0.01）,there was no interaction effect between the two on SWAL-QOL total score and psychological burden,eating time,eating desire,symptom frequency,food choice,fear,mental health,and social interaction（P>0.05,P>0.05）;lemon ice stimulation and breathing training had no significant main effect on the verbal communication dimension score respectively（P=0.242>0.05,P=0.656>0.05）,and there was no interaction effect between the two on the verbal communication dimension score（P=0.640>0.05）;lemon ice stimulation and breathing training had no significant main effects on the sleep dimension score respectively（P=0.856>0.05,P=0.930>0.05）,and there was no interaction effect between the two on the sleep dimension score（P=0.973>0.05）;lemon The main effect of ice stimulation on the over-fatigue dimension score was not significant（P=0.493>0.05）,while the main effect of breathing training on the over-fatigue dimension score was significant（P<0.001）,and there was no interaction effect between the two on the over-fatigue dimension score（P=0.574>0.05）.3.In terms of related complications: the difference in the incidence of aspiration and aspiration pneumonia during the intervention period of this study was not statistically significant in any of the four groups（P=0.060>0.05,P=0.079>0.05）Research Conclusion:1.Lemon ice stimulation,respiratory training and the combination of the two can effectively improve the swallowing function of stroke patients with dysphagia,and the improvement effect of the combination of the two is better than the single lemon ice stimulation or respiratory training,but the intervention effect of lemon ice stimulation and respiratory training is similar.2.Lemon ice stimulation,respiratory training and the combination of the two can improve the quality of life of stroke patients with dysphagia,and the improvement effect of the combination of the two is better than the single lemon ice stimulation or respiratory training,but the intervention effect of lemon ice stimulation and respiratory training is similar.3.Lemon ice stimulation,breathing training and the combination of the two have no significant difference in reducing the incidence of dysphagia complications,and further exploration and verification are needed in the future. |
PDF Full Text Request