社区康复三级网络对脑卒中患者独立生活能力的影响

The Effect of Three Level Network of Community Rehabilitation on ADL Ability in Stroke Patients

目的通过回顾性分析社区康复三级服务网络对脑卒中患者独立生活能力的影响,通过建立脑卒中社区康复三级服务网络,探讨及完善脑卒中患者社区康复服务,规范脑卒中社区康复治疗技术,并进行推广及应用。方法运用上海市心脑血管疾病报病系统对2009年1月至2012年3月发病1年内、已出院回归到社区的脑卒中患者,由经过康复培训的社区康复医师和康复治疗师进行社区康复治疗,治疗形式包括社区中心、门诊站点及家庭上门。康复治疗的时间为6个月。康复服务时间为前2个月每周1次,中间2个月每2周1次,最后2个月每月1次对患者进行康复干预。每个患者在康复服务开始及结束时进行巴士指数(BI)、肢体运动功能评测(Fugl-meger)及简易精神状态检查表(MMSE)。结果 11家社区卫生服务中心2009年1月至2012年3月共服务脑卒中患者3026例,康复干预6个月后(终期)的评定较服务前患者BI、Fugl-meger及MMSE明显提高(P<0.05),满意度达95%以上。结论脑卒中社区康复三级服务,规范了社区脑卒中康复治疗技术,可以明显提高脑卒中患者的独立生活能力和获得较高的患者与家属满意度(>99%)。

Objective To retrospectively analyze the effect of three level network of community rehabilitation on activity of daily life in stroke patients. And to investigate and improve the community service of rehabilitation and regulate community rehabilitation technique by establishing the three level network of community rehabilitation. Methods We analyzed the data of stroke patients between Jan 2009 to Mar 2012, and the inclusion criteria were disease duration less than a year and return to community. The assessment and training of the patients were done by community rehabilitation doctors and therapists. The pattern of therapies included： therapy in community center, therapy in outpatients department and therapy in patient＇s home. In the first 2 months, patients received rehabilitation therapy once a week, and in the middle 2 months, patients received rehabilitation therapy once every two week. In the last 2 months, patients received therapy once every month. The therapy was last for 6 months. Barthel index, Fugl-meger and MMSE were assessed at baseline and 6 months after the therapy. Results 3206 stroke patients from 11 community hospitals were enrolled in the study. Compared with the data of baseline, Barthel index, Fugl-meger and MMSE scores of all the patients improved significantly （P〈0.05）. And the satisfaction rate of the patients was above 95%. Conclusion Three level network of rehabilitation therapy for stroke patients might regulate the techniques of stroke rehabilitation and might improve the ADL ability and their satisfaction rate （〉99%）.