ICF康复理论与方法在老年脑卒中“治未病”体系中的应用效果研究

Application Effect of ICF Theoretical Framework and Methodology in the System of Preventive Treatment of Senile Stroke

目的探讨国际功能、残疾与健康分类(Intemational Classification of Functioning,Disability and Health,ICF)康复理论框架与方法论引入脑卒中‘饴未病"体系后,脑卒中偏瘫患者肢体功能障碍和心理障碍等临床改善效果。方法纳入"治未病"体系的患者60例,随机分为ICF应用与观察组(观察组)及常规康复对照组(对照组),每组30例。对照组仅行基础康复训练;观察组除进行与对照组相同的基础康复训练外,还采用ICF分类框架下的脑卒中"治未病"预防保健服务记录,每周制定调整中医、西医治疗宣教计划和家庭保健措施。2组治疗均5次/周,4周为1疗程,共2疗程。观察各组患者入院时及治疗前后的运动功能及心理功能。运动能力采用FMA评分(Fugl-Meyer assessment scale,FMA)评定,心理状况及生存质量分别采用汉密尔顿量表(Hamilton depression scale,HAMD)及生活满意感量表(satisfaction with life scale,SWLS)评定,并对评定结果进行比较与分析。结果 2组一般基线情况具有可比性,2组治疗前各项评分差异没有统计学意义;各组治疗前后FMA、HAMD及SWLS评分比较差异明显(均P<0.05),2组治疗后FMA、HAMD及SWLS评分比较均有显著差异(均P<0.05)。结论 ICF康复理论与方法纳入脑卒中"治未病"体系可有效改善患者偏瘫功能障碍、心理及生存质量。

Objective To discuss the clinical application effect of the theoretical framework and methodology of ICF（International Classification of Functioning,Disability and Health） in the system of preventive treatment（SPT） of senile stroke and to observe the clinical improvement of limb disorder and psychological disorder in patients with hemiplegia after stroke.Methods 60 patients were enrolled in the system and were randomly divided into 2 groups：observation group（observation of ICF application） and control group（conventional rehabilitation）,30 in each;conventional rehabilitation training was performed on patients in both groups while the prevention and health care recording in the system of preventive treatment of stroke of ICF was applied to patients in observation group and adjustment was made every week to the health education plan of treatment with western medicine and TCM and as well as to home healthcare measures;patients in both groups received the treatment5 times per week and 1 course covered 4 weeks,in total,2 courses were made;the motion function and psychological function of the patients in both group at admission,before treatment and after treatment were observed;Fugl-Meyer assessment scale（FMA） was applied in the evaluation of motion function while Hamilton depression scale（HAMD） in the evaluation of psychological status and satisfaction with life scale（SWLS） in the evaluation of quality of life.Results There were no significant differences between two groups at baseline before treatment and the difference in the scores before treatment between the 2 groups was of no statistical significance（P〈0.05）;after treatment,the scores of FMA,HAMD and SWLS in each group were obviously different from those before treatment（P〈0.05）;there existed a obvious difference in the scores of FMA,HAMD and SWLS between the 2 groups after treatment（P〈0.05）.Conclusions The application of ICF theoretical framework and methodology in the system of preventive treatment（SPT） of stroke can lead to an effective improvement of function disorder,psychological status and quality of life in patients with hemiplegia after stroke.