Intervention Of Transitional Care On Compliance Of Functional Exercise In Patients With Dysphagia After Stroke At Home

Objective:1.To investigate the compliance status of swallowing functional exercise in stroke patients with dysphagia at home and analyze the influencing factors。2.Combine the survey results,analysis of past literature and opinions of rehabilitation experts to formulate a continuing care plan based on the theory of planned behavior.To explore the effect of transitional care based on the theory of planned behavior on the compliance of swallowing functional exercise,swallowing function and incidence of inhalation pneumonia in stroke patients with dysphagia at home,and provide more references for the continuing care of stroke patients with dysphagia in the future.Method:1.Current Investigation Phase:Convenience sampling was used to select245 patients with home stroke dysphagia discharged from two tertiary class A hospitals in Guangxi from December 2021 to May 2022 according to the inclusion and exclusion criteria.A general information survey form,Barthel Index(BI index),Watanabe water test,and Stroke swallowing Functional Exercise Compliance Scale were used to investigate the patients by telephone follow-up two weeks after discharge.The data obtained were organized and entered into Excel to establish a database,and SPSS 26.0 was used for statistical description,single factor analysis,and multiple linear regression analysis.P<0.05 indicates that the difference is statistically significant.2.Intervention stage:64 discharged patients who meet the inclusion and exclusion criteria of the third class A hospital in Guangxi from June 2022 to December 2022 were randomly selected as research objects.They were divided into intervention group and control group with 32 cases in each group by random number table.The control group received conventional continuing care,and the intervention group received transitional care guidance based on the theory of planned behavior.The compliance of swallowing functional exercise and swallowing function of the patients were evaluated by the Stroke Swallowing Functional Exercise Compliance Scale,the Watanabe Water Drinking Test and the Eating Assessment Tool-10(EAT-10)questionnaire at the intervention before(3 days before discharge),4 weeks after discharge and 8weeks after discharge,respectively.The incidence of inhalation pneumonia was compared between the two groups.SPSS26.0 was used for statistical analysis.Chi-square test was used for count data,non-parametric Wilcoxon test was used for grade data,and two independent sample t-test was used for metric data with normal distribution and variance homogeneity at the same time point.Single factor repeated measurement variance analysis was used for comparison at different time points,and P<0.05 was considered statistically significant.Results:1.Current situation survey:A total of 245 subjects were included in the study,of which 9 were lost to follow-up,and the final study included 236subjects,with a lost follow-up rate of 3.7%.The results showed that the compliance of 236 patients with dysphagia after stroke at home ranged from 14to 41(25.83±5.67)points,The compliance rate was at a low level of 61.02%.Among them,the compliance dimension score of rehabilitation exercise is(15.70±3.90)points,the compliance dimension of exercise effect monitoring is(5.63±1.57)points,and the compliance dimension of actively seeking advice is(4.50±1.40)points.The compliance rate of the three dimensions is at a medium to low level.Multiple linear regression analysis showed that Caregiver type,self-care ability in daily life,knowledge of swallowing,and whether they were first stroke were independent influencing factors,and the variation that could explain the compliance level of swallowing functional exercise was 30.2%(After adjustment,R~2=0.302).2.Intervention:64 cases were included in the study,and 6 cases were shed during the study.Finally,28 cases were included in the control group and30 cases in the intervention group,with a shedding rate of 9.7%.There was no significant difference between the two groups in age,sex,stroke type,self-care ability,caregiver type,eating style and other aspects(P>0.05),and the general data were comparable and balanced.(1)Comparison of compliance with swallowing functional exercise after stroke:Before intervention(3 days before discharge),there was no difference in the scores of swallowing functional exercise compliance between the two groups(t=-1.37,P=0.176).4 weeks and 8 weeks after discharge,the compliance of swallowing functional exercise in the intervention group was significantly higher than that in the control group,the difference was statistically significant(t=-3.112,P=0.003;t=-5.176,P<0.001).Single factor repeated measurement analysis showed that there was interaction effect between time and group(F=8.332,P<0.05),intergroup effect(F=16.514,P<0.05),and time effect(F=69.578,P<0.05),indicating that patients’compliance with swallowing functional exercise decreased at different time and in different groups compared with before intervention,but the decreasing range in intervention group was significantly lower than that in control group.(2)Comparison of swallowing function:Before intervention,there were no significant differences in the results of drinking water test and the scores of Eating Assessment Scale(EAT-10)between the two groups(P>0.05).The results of drinking water test in depression fields at 4 weeks and 8 weeks after discharge were lower than before intervention,with statistical difference between groups(Z=-2.102,P=0.036;Z=-2.319,P=0.020).Compared with the scores of EAT-10 in the two groups,the scores of EAT-10 at 4 weeks after discharge and 8 weeks after discharge in the two groups were significantly lower than before intervention(t=2.882,P=0.006;t=3.002,P=0.004),and the time effect(F=48.476),component effect(F=8.634)and interaction effect between time and group(F=3.726)were statistically significant(P<0.05).The swallowing function of patients in different groups and at different time points was significantly improved,and the effect was more significant in the intervention group(P<0.05).(3)Incidence of aspiration pneumonia:there was no statistical significance between the two groups before intervention(x~2=0.007,P=0.936).4 weeks after discharge,there was no difference in the incidence of aspiration pneumonia between the two groups(x~2=0.817,P=0.366).8 weeks after discharge,there was statistical significance between the two groups(x~2=4.401,P=0.044),and the incidence of aspiration pneumonia in the intervention group was significantly lower than that in the control group.Conclusion:1.The swallowing functional exercise compliance of patients with dysphagia disorder after stroke at home needs to be improved.The caregiver as a spouse is a facilitator of swallowing functional exercise compliance.Medical personnel should focus on patients with high dependence on self-care ability and recurrent stroke,strengthen the knowledge of swallowing education,attach importance to the psychological state of patients,mobilize the social support system,and develop personalized intervention programs to improve the swallowing functional exercise compliance of patients.Prevent complications or reduce the incidence of adverse events.2.The continuous nursing guidance based on the theory of planned behavior can improve the swallowing functional exercise compliance of patients with dysphagia of stroke at home,improve the swallowing function,reduce the incidence of aspiration pneumonia,and the effect is better than the conventional continuous nursing guidance.