脑卒中患者家庭康复现状调查研究

Study on home-based rehabilitation of stroke patients

目的了解脑卒中患者家庭康复状况，比较不同因素下卒中患者的家庭康复效果，并就家庭康复对策进行探讨。方法采用随机整群抽样方法，选取某三甲医院康复医学中心234例已出院脑卒中患者为研究对象，应用门诊随访、人户随访和电话随访调查的方式，采用一般情况调查表、改良Barthel指数评定量表（BI）、工具性日常生活活动能力量表（IADL）、患者自我感受负担量表（SPBS）和照顾者负担量表（ZBI）中文版对患者及其照顾者家庭康复状况进行调查。结果本组234例患者BI得分（61．77±22．83）分，IADL得分（7．25±6．26）分，SPBS得分（29．26±7．07）分，91．13％的患者有负担感；照顾者ZBI得分（43．97±12．28）分，59．40％照顾者有中／重度负担。脑卒中患者家庭康复状况单因素分析显示，不同性别患者BI、IADL、SPBS、ZBI得分差异均有统计学意义（P〈0．05）；不同年龄、主要照顾者、家庭康复时间、照顾者性别的患者BI、IADL得分差异均有统计学意义（P〈0．05）；不同文化程度患者IADL、SPBS得分差异均有统计学意义（P〈0．05）；不同疾病类型患者BI、ZBI得分差异均有统计学意义（P〈0．05）。结论脑卒中患者家庭康复状况较差，医务工作者要关注患者出院后的康复情况，尤其关注女性卒中患者、照顾者以及加大对男性照顾者的康复知识培训力度。建议大力发展社区康复、家庭医生责任制、医院一社区一家庭联合等延续服务方式，从而改善卒中患者家庭康复状况，降低再入院率和提高社会资源利用度。

Objective To investigate the home-based rehabilitation of stroke patients in China, and to compare the curative effects under different factors, so as to discuss the strategies for home-based rehabilitation. Methods A total of 234 cases of stroke patients who has been discharged from the center of rehabilitation medicine of a Class Ⅲ Grade A hospital were selected by random cluster sampling method. Family rehabilitation status of patients and their earegivers was investigated by outpatient follow-up, home follow-up and telephone follow-up survey. In the survey, the general information questionnaire, the Barthel Index （BI）, the Instrumental Activities of Daily Living （IADL）, the Self-perceived Burden Scale （SPBS） and the Zarit Caregiver Burden Interview （ZBI） were applied. Results The results showed that the BI score was （61.77 ± 22.83）. The average score of IADL was （7.25 ± 6.26）. The SPB score was （29.26 ± 7.07）. 91.13% of the patients in the study group had a sense of burden. The ZBI score of the caregivers was （43.97 ± 12.28）, 59.40% of which had moderate or severe burden. The result of single factor analysis showed that the differences in the scores of BI, IADL, SPBS and ZBI of patients in different gender were statistically significant （P 〈 0.05）. There were significant differences in BI and IADL scores among patients of different ages, main caregivers, family rehabilitation time and caregivers＇ gender （P 〈 0.05）. The differences in the scores of IADL and SPBS of patients with different educational level were statistically significant （P 〈 0.05）. The differences in BI and ZBI scores of patients with different disease types were statistically significant （P 〈 0.05）. Conclusions The family rehabilitation of stroke patients is poor. Medical workers should pay attention to the rehabilitation of patients after discharge, especially to female stroke patients, caregivers and to strengthen the rehabilitation knowledge training for male caregivers. It is suggested that community rehabilitation, family doctor responsibility system and hospital-community- family Union should be vigorously developed so as to improve the family rehabilitation of stroke patients, reduce readmission rate, increase the utilization of social resources, and improve the health level of the whole people.