认知行为疗法对脑卒中后残疾患者伤残接受度及日常生活活动能力的影响

Effects of cognitive behavioral therapy on disability acceptance and activities of daily living in disabled patients after stroke

目的:评估认知行为疗法对脑卒中后残疾患者伤残接受度及日常生活活动能力(Activities of Daily Living,ADL)的影响。方法:采用随机数字表法将112例脑卒中后残疾患者分为干预组和对照组各56例。对照组进行常规健康教育干预组在常规健康教育基础上实施认知行为疗法。在干预前、干预结束及干预结束后3个月用伤残接受度修订版量表、Barthel指数评定量表(Barthel Index,BI)对干预效果进行评定。结果:两因素重复测量方差分析结果显示,分组因素在伤残接受度(Acceptance of Disabiliy,AOD)总分、包容维度、ADL水平上的主效应均差异有统计学意义(P<0.05);时间因素在AOD总分及扩大、从属、包容、转变维度、ADL水平上的主效应均差异显著(P<0.01);此外,两组AOD总分及扩大、从属、包容、转变维度、ADL水平在干预因素和时间因素之间存在交互作用(P<0.05)。简单效应分析结果显示:两组AOD总分及包容维度得分、ADL水平在干预结束、干预结束后3个月组间比较均存在显著性差异(P<0.01);在干预前、干预结束和干预后3个月不同时间点,对照组和干预组的AOD总分及各维度得分、ADL水平的差异均具有统计学意义(P<0.05)。结论:认知行为疗法干预能够改善卒中后残疾患者的AOD及ADL水平。

Objective:To investigate the effects of cognitive behavioral therapy on the disability acceptance and activities of daily living in patients with post-stroke disability.Methods:A total of 112 patients with post-stroke disability were divided into the intervention group and control group,with 56 cases in each group.The control group received routine health education,the intervention group implemented cognitive behavioral intervention on the basis of routine health education.Before intervention,at the end of the intervention and 3 months after the intervention,the intervention effect was evaluated allording to the modified disability acceptability scale(AODS)and Barthel index rating scale.Results:The results of anova of repeated measurement of two factors showed that the main effects of grouping factors on the total AOD score,inclusive dimension and ADL level were all significant(P<0.05);The time factor had significant main effects on the total AOD score,the dimensions of expansion,subordination,inclusion and transformation,the level of ADL(P<0.01).In addition,the total AOD score,enlargement,subordination,inclusion,transformation dimension and ADL level in the two groups had an interaction between intervention factors and time factors(P<0.05).The results of simple effect analysis showed that there were significant differences in the total AOD score,inclusive dimension score and ADL level between the two groups at the end of intervention and 3 months after intervention(P<0.01).At different time points of before intervention,at the end and 3 months after the intervention,the total AOD score and it’s dimensions and ADL level in the control group and the intervention group were statistically significant(P<0.05).Conclusion:Cognitive behavioral intervention can improve the level of AOD and ADL in post-stroke disabled patients.