KAP-HBM模式下康复训练干预对脑卒中后偏瘫患者神经和运动功能的影响

Effects of health guidance under KAP-HBM mode on neurological and motor function in patients with post-stroke hemiplegia

目的 分析知信行(KAP)-健康信念(HBM)模式下的康复训练干预对脑卒中偏瘫患者神经和运动功能的影响。方法 选取脑卒中后偏瘫患者74例均分为观察组和对照组,对照组给予常规康复训练,观察组在对照组基础上给予KAP-HBM康复训练干预,干预时间为3个月;于干预前、干预3个月时,采用肢体运动功能评定量表(FMA)、平衡功能评定量表(FMB)评估两组患者肢体功能和平衡能力,美国国立卫生研究院卒中量表(NIHSS)评价神经功能缺损,日常生活能力量表(ADL)评价日常生活活动能力,焦虑自评量表(SAS)和社会适应量表(SAFE)评估社会功能,个体与社会功能量表(PSP)和抑郁自评量表(SDS)评估负性情绪,自制康复训练依从性量表评价患者依从性。结果 干预3个月时,两组脑卒中后偏瘫患者FMA上肢及下肢运动功能和FMB平衡能力评分均较干预前上升,且观察组高于对照组,差异有统计学意义(P <0.05);NIHSS和ADL评分均较干预前升高,且观察组高于对照组,差异有统计学意义(P <0.05);SAS、SDS评分均较干预前降低,且观察组低于对照组,差异有统计学意义(P <0.05);与干预前比较,观察组患者干预3月时PSP评分升高、SAFE评分降低,PSP评分高于对照组、SAFE评分低于对照组,差异有统计学意义(P <0.05);观察组康复训练依从性高于对照组,差异有统计学意义(P <0.05)。结论 KAP-HAM干预可提高脑卒中偏瘫患者肢体功能和平衡能力,促进受损神经功能恢复,改善心理状况,提高康复训练依从性。

Objective To analyze the effects of health guidance under knowledge-attitude-practice(KAP)combined with heath belief model(HBM)on neurological and motor functions of post-stroke hemiplegia patients.Methods Seventy-four patients with post-stroke hemiplegia were randomly divided into observation group(KAP-HBM rehabilitation training in addition to control group routine training)and control group(routine rehabilitation training)with even number in each group.All were intervened for 3 months.The limb function and balance ability were evaluated by Fugl-Meyer assessment scale(FMA)and Fugl-Meyer balance scale(FMB)before and after intervention.The neurological deficiency was evaluated by National Institutes of Health Stroke Scale(NIHSS).Activities of daily living were evaluated by activity of daily living scale(ADL).The negative emotions were evaluated by self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Individual and social function scale(PSP)and self-rating depression scale(SDS)were used to evaluate negative emotion.The patient's compliance was assessed by self-formulated rehabilitation training compliance scale.Results After intervention for three months,scores of upper limb and lower limb motor function in FMA,and score of balance ability in FMB were all increased in both groups.It was higher in observation group than control group,differences were statistically significant(P<0.05).After intervention,scores of NIHSS and ADL were increased in both groups,which were higher in observation group than control group,differences were statistically significant(P<0.05).SAS and SDS scores were decreased in both groups.Scores were lower in observation group than control group,differences were statistically significant(P<0.05).Compared with before treatment,PSP score of observation group increased after three months intervention and the SAFE score decreased.PSP score of the observation group was higher than that of the control group,and its SAFE score was lower than that of control group,differences were statistically significant(P<0.05).The compliance of rehabilitation training in observation group was significantly higher than that of control group(P<0.05).Conclusion KAP-HAM intervention can improve limb function and balance ability,promote the recovery of damaged neurological function,improve psychological status and compliance of rehabilitation training in patients with post-stroke hemiplegia.