脑卒中患者跌倒恐惧变化轨迹及影响因素分析

Trajectory of change in fear of falling and its influencing factors among stroke patients

目的 分析脑卒中患者跌倒恐惧变化轨迹及影响因素,为制订针对性的护理措施缓解脑卒中患者跌倒恐惧提供参考。方法 便利选择神经内科住院的223例脑卒中患者,采用一般资料调查表、简易版国际跌倒效能感量表、医院焦虑抑郁量表于患者出院当天进行调查,并于出院后1、3、6个月追踪患者的跌倒恐惧程度。采用潜变量增长模型识别跌倒恐惧变化轨迹的潜在类别,logistic回归分析其影响因素。结果 跌倒恐惧变化轨迹可分为跌倒恐惧缓慢下降组(50%)、持续跌倒恐惧组(28%)、跌倒恐惧快速下降组(22%)。logistic回归分析结果显示,性别、职业、日常生活活动能力、近6个月跌倒史、步行能力、焦虑、抑郁影响跌倒恐惧的轨迹类别(均P<0.05)。结论 脑卒中患者跌倒恐惧分为3种不同的变化轨迹,其跌倒恐惧存在群体异质性,应基于患者跌倒恐惧变化轨迹的同质群体,有针对性地进行评估和干预。

Objective To analyze the change trajectory and its influencing factors of fear of falling among stroke patients, so as to provide a reference for developing targeted nursing intervention to alleviate their fear of falling.Methods A total of 223 stroke patients hospitalized in neurology department were selected by convenience sampling, then they were investigated at discharge by using a general information questionnaire, the Falls Efficacy Scale International(ESF-I) and the Hospital Anxiety and Depression Scale(HADS), and they were followed up to assess their degree of fear of falling at one, three and six months after discharge.The potential categories of the change trajectory of fear of falling were identified by latent class growth model, and the influencing factors were analyzed by logistic regression.Results The change trajectory of fear of falling was divided into a slow decline fear of fal-ling group(50%), a persistent fear of falling group(28%) and a rapid decline fear of falling group(22%).The results of logistic regression analysis showed that, gender, occupation, activity of daily living, history of fall in the past 6 months, walking ability, anxiety and depression symptom were influencing factors of change trajectory of fear of falling(all P<0.05).Conclusion The change trajectory of fear of falling in stroke patients can be divided into three different groups, and there is group heterogeneity.It is necessary to conduct targeted assessment and intervention based on the homogeneous groups of their fear of falling.