社区脑卒中患者居家康复准入及退出标准研究

Criteria of admission and discharge for stroke patients in home-based rehabilitation

根据研究主题，遴选16名专家，于2015年4—10月采用两轮德尔菲专家咨询法对社区脑卒中患者居家康复的准人退出标准进行研究，结果显示，两轮函询专家的积极性、权威程度均良好。完善后的脑卒中患者居家康复准人退出标准中，准入标准由居家康复介入时间、NIHSS得分、运动功能、触觉及本体感觉功能、交流功能、认知功能、日常生活能力、其他症状等8个方面，结合6个排除条件构成；其中，居家康复介入时间、NIHSS得分、6个排除条件为必要条件，在此基础上，运动功能、触觉及本体感觉功能、交流功能、认知功能、日常生活能力、其他症状等任一方面出现所限制的情况均可纳入。退出标准为以下任一方面：对应于准人标准中症状，运动功能、交流功能等症状达到平台期；病情恶化、深静脉血栓和脑卒中复发等其他状况的发生。该标准可信性较高，可供社区开展居家康复工作时借鉴及实际应用，也有助于脑卒中患者分级康复的实施。

Sixteen experts were invited and two-round Delphi expert consultation of admission and discharge criteria for stroke patients in home-based rehabilitation were conducted from April to October 2015. Results showed that the enthusiasm and authority degree of experts in two rounds consultation were favorable. The modified admission criteria included 8 inclusive conditions and 6 exclusive conditions. Among 8 inclusive conditions, home-based rehabilitation intervention time and NIHSS score were the necessary conditions for admission, in addition to 6 exclusion conditions. With the necessary conditions, if patients had disturbances of one or more following conditions： motor function, tactile and proprioceptive function, communication function, cognitive function, quality of life and other symptoms, they were eligible to be admitted in home-based rehabilitation in community. The discharged criteria contained two aspects： 1. the conditions in admitted criteria reaching the plateau ; 2. the occurrence of unexpected situations, including disease worsening, deep vein thrombosis and stroke recurrence. The admission and discharged criteria developed in this study has high credibility and can be recommended for practical application in other communities in home-based rehabilitation of stroke patients, which also can be used for implementation of ｜evel-classified rehabilitation for stroke patients.