运动想象疗法对脑卒中患者下肢远程康复护理的随机对照研究

Effects of home-based motor imagery training on lower extremity function in chronic stroke patients：a randomized,controlled trial

目的 探讨远程家庭应用运动想象疗法对脑卒中患者下肢运动功能、平衡功能、日常生活活动能力的康复效果.方法 将52例脑卒中患者根据计算机产生的一组随机数字序列,按照1：1的比率,分为干预组和对照组各26例.2组均发放《脑卒中后康复训练指导手册》和包含传统运动疗法和作业疗法的肢体运动功能康复录像视频,接受神经内科常规出院健康指导.干预组在此基础上通过即时通讯软件（腾讯QQ）居家接受6周的运动想象远程下肢运动功能指导,3次/周,30 min/次.分别在出院前（T0）、干预6周（T1）、干预12周（T2）采用简式Fugl-Meyer运动功能评定量表（FMA）（下肢部分）评价下肢功能、Berg平衡功能量表（BBS）评估平衡能力、Barthel指数量表（BI）评估日常生活活动能力（ADL）.结果 干预前,干预组患者的运动功能、平衡功能、ADL得分分别为（15.12±4.19）、（24.50±2.72）、（54.04±17.44）分,对照组分别为（14.23±3.67）、（23.92±2.82）、（49.46±15.09）分,差异无统计学意义（t=0.810、0.750、1.012,均P〉0.05）;干预6周,干预组患者的运动功能、平衡功能、ADL得分分别为（17.38±4.10）、（37.38±4.30）、（74.62±11.22）分,对照组分别为（14.81±3.50）、（29.31±2.43）、（50.77±14.47）分,差异有统计学意义（t=2.438、8.326、6.641,P〈0.05或0.01）;干预12周,干预组患者的运动功能、平衡功能、ADL得分分别为（18.58±4.19）、（41.19±3.96）、（86.54±9.88）分,对照组分别为（15.54±3.44）、（32.35±1.98）、（59.08±13.85）分,差异有统计学意义（t=2.858、10.189、8.233,均P〈0.01）.组别对运动功能、平衡功能、ADL得分均存在显著效应（F=4.158、63.716、30.379,P〈0.05或0.01）,且时间与组别在运动功能、平衡功能、ADL方差分析模型中均存在交互作用（F=47.941、61.029、29.685,均P=0.000）.干预组患者不同时点下肢运动功能、平衡功能、ADL的两两比较,差异有统计学意义（P=0.000）.结论 远程家庭应用运动想象可以提高脑卒中患者下肢运动功能、平衡功能及ADL.

Objective To investigate the effect of home-based motor imagery training on the lower extremity motor function,balance ability and activities of daily living in post-stroke patients. Methods Fifty-six stroke survivors were divided into the control group and the intervention group by random number table method.All the patients got the conventional nursing, rehabilitation booklets and the video tapes which contained physical therapy and occupational therapy. Furthermore, the patients in the intervention group received 6 weeks motor imagery （MI） therapy through an instant messaging client （Tencent QQ）, three times a week, 30mins per time. The outcomes were measured before discharge （T0）, immediately after the intervention （T1）, and 6 weeks （T2） after the intervention using the Fugl-Meyer Motor Assessment Scale （FMA）, Berg Balance Scale （BBS）, Barthel Index （BI）. Results At baseline, the scores of FMA、BBS、BI in the intervention group were （15.12 ± 4.19）, （24.50 ± 2.72）, （54.04 ± 17.44） points, while in the control group were （14.23 ± 3.67）, （23.92 ± 2.82）, （49.46 ± 15.09） points. There were no differences on any scale between the two groups at baseline （t=0.810, 0.750, 1.012, P〉0.05）. At 6 weeks,the scores of FMA, BB, BI in the control group were （14.81 ± 3.50）, （29.31 ± 2.43）, （50.77 ± 14.47） points, and were significantly lower than （17.38 ± 4.10）, （37.38 ± 4.30）, （74.62 ± 11.22） pointsin the interventiongroup （t=2.438, 8.326, 6.641, P〈0.05 or 0.01）. At 12 weeks, the scores of FMA, BB, BI in the control group were （15.54±3.44）, （32.35±1.98）, （59.08±13.85） points, and were significantly lower than （18.58±4.19）, （41.19±3.96）, （86.54± 9.88） points in the intervention group （t=2.858, 10.189, 8.233, P〈0.01）. A main effect of intervention （F=4.158, 63.716, 30.379, P 〈 0.05） and an interactive effect of time and intervention （F=47.941, 61.029, 29.685, P=0.000） were observed in the model of FMA, BBS, BI using ANOVA of repeated measures. The factors were compared with each other and the difference was statistically significant （P=0.000）. Conclusions The home-based MI training can improve the lower extremity motor function, balance ability and activities of daily living in patients with stroke.