自我管理项目对脑卒中患者生活质量和负性情绪影响的Meta分析

Improvement Effects of Self-management Programs on Quality of Life and Negative Mood in Patients with Stroke:a Meta-analysis

背景现代康复理论和实践表明,有效的康复训练能够减轻脑卒中患者功能上的残疾,加速康复进程,降低医疗成本。自我管理项目作为一种新型的健康管理方法,具有“低投入、广覆盖”的优势,为脑卒中幸存患者提供了促进康复的途径,脑卒中康复的基础有赖于患者自我管理健康的能力。目的系统评价自我管理项目对脑卒中患者生活质量和负性情绪的影响。方法计算机检索PubMed、Web of Science、EBSCO、CENTRAL(Cochrane Register of Controlled Trials)、EMBase和中国知网、万方数据知识服务平台、中国生物医学文献数据库、维普数据库等。检索时限为建库至2018年5月。纳入试验组给予有组织的、系统的自我管理项目干预,对照组给予常规照护和/或空白对照的随机对照试验(RCT)。结局指标包括生活质量、负性情绪、自我效能和日常生活活动能力。采用RevMan 5.3软件进行数据分析。结果共纳入9篇RCT,694例患者,文献质量等级均为“B”,总体质量中等。Meta分析结果显示:试验组生活质量评分高于对照组[标准化均数差(SMD)=0.32,95%CI(0.15,0.49),P=0.0002],亚组分析结果显示:试验组卒中专门生存质量量表(SSQOL)评分和健康调查简表(SF-36)评分均高于对照组[SMD=0.35,95%CI(0.13,0.57),P=0.002;SMD=0.29,95%CI(0.02,0.56),P=0.04]。试验组医院焦虑抑郁量表(HADS)评分低于对照组[MD=-1.01,95%CI(-2.00,-0.02),P=0.05]。试验组自我效能评分高于对照组[SMD=0.45,95%CI(0.21,0.69),P=0.0003],亚组分析结果显示:两组脑卒中康复自我效能量表(SSEQ)评分比较,差异无统计学意义[SMD=0.31,95%CI(-0.11,0.73),P=0.15],试验组一般自我效能量表(GSES)评分高于对照组[SMD=0.52,95%CI(0.22,0.81),P=0.0006]。试验组日常生活活动能力评分高于对照组[SMD=0.84,95%CI(0.07,1.61),P=0.03],亚组分析结果显示:两组短期干预和长期干预日常生活活动能力比较,差异均无统计学意义[SMD=0.70,95%C(I-0.15,1.54),P=0.11;SMD=1.00,95%CI(-0.52,2.52),P=0.20]。结论自我管理项目可有效改善脑卒中患者生活质量和负性情绪,也可以提高其一般自我效能和日常生活活动能力,但对脑卒中康复自我效能和其他健康行为的疗效仍需进一步研究。

Background Modern rehabilitation theory and practice have shown that effective rehabilitation training can alleviate the functional disability of stroke patients,accelerate the recovery and reduce medical costs.As a new type of health management method,self-management project has the advantage of"low input and wide coverage",which provides a way for stroke survivors to promote rehabilitation.The rehabilitation basis of stroke patients depends on their health self-management abilities.Objective To systematically assess the improvement effects of self-management interventions on the quality of life and negative mood in patients with stroke.Methods We searched the databases such as PubMed,Web of Science,EBSCO,Cochrane Register of Controlled Trials(CENTRAL),EMBase,China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform,CBM,and VIP from inception to May 2018 for RCTs conducted in adults with stroke receiving organized,systematic self-management interventions(experimental group)and those receiving usual care or receiving no interventions(control group)with outcome evaluation indicators consisting of changes in quality of life,negative mood,self efficacy and activities of daily living(ADL).Data were analyzed with RevMan 5.3.Results Nine RCTs with 694 participants were included.The quality of all of them was evaluated as"B",and the overall level of quality was intermedium.Meta-analysis showed that the overall QOL score in the experimental group was much higher than that of the control group〔SMD=0.32,95%CI(0.15,0.49),P=0.0002〕.Subgroup analyses showed that mean SSQOL score and SF-36 score of the experimental group were both higher than those of the control group〔SMD=0.35,95%CI(0.13,0.57),P=0.002;SMD=0.29,95%CI(0.02,0.56),P=0.04〕.The experimental group showed much lower mean HADS score than the control group〔MD=-1.01,95%CI(-2.00,-0.02),P=0.05〕.The mean self-efficacy score of the experimental group was higher than that of the control group〔SMD=0.45,95%CI(0.21,0.69),P=0.0003〕;there was no significant difference in the mean score of the Stroke Self-efficacy Questionnaire(SSEQ)between the two groups〔SMD=0.31,95%CI(-0.11,0.73),P=0.15〕;the experimental group obtained much higher mean General Self-efficacy Scale(GSES)score than the control group〔SMD=0.52,95%CI(0.22,0.81),P=0.0006〕.The experimental achieved significantly higher mean ADL score than the control group〔SMD=0.84,95%CI(0.07,1.61),P=0.03〕;there were no significant differences in mean ADL score between the two groups either after short-term interventions or long-term interventions〔SMD=0.70,95%CI(-0.15,1.54),P=0.11;SMD=1.00,95%CI(-0.52,2.52),P=0.20〕.Conclusion Self-management programs can effectively improve the quality of life and negative mood,as well as general self-efficacy and ADL in stroke patients.However,the effects on the SSEQ score and other health related behaviors need to be verified by further studies.