基于PEO模式的家庭作业治疗对卒中偏瘫患者功能预后的影响

Effects of Home Occupational Therapy Based on Person-Environment-Occupation Model on Functional Prognosis of Stroke Patients with Hemiplegia

目的研究基于人-环境-作业(person-environment-occupation,PEO)模式的家庭作业治疗对卒中偏瘫患者上肢功能、日常生活活动能力及生活质量的影响。方法前瞻性、连续纳入2020年1月—2020年12月南京市浦口人民医院(原南京市浦口区中心医院)康复医学科出院的卒中偏瘫患者,随机分为试验组和对照组,并分别建立微信群聊,对照组定期更新康复小视频,有任何问题随时咨询。试验组基于PEO模式,个性化更新每位患者的小视频,两组分别于出院时、出院3个月、6个月和12个月分别进行Fugl-Meyer运动功能量表上肢部分(Fugl-Meyer assessment upper extremity scale,FMA-UE)、日常生活活动能力Barthel指数(Barthel index,BI)及卒中专用生活质量量表(stroke-specific quality of life scale,SS-QOL)的评定。结果最终纳入卒中偏瘫患者60例,平均年龄(63.10±6.83)岁,其中男性30例。将入组患者随机分为对照组和试验组各30例。组内比较显示,试验组出院3个月BI评分[(57.00±7.83)分vs.(53.17±8.36)分,P<0.001]、FMA-UE评分[(46.57±6.67)分vs.(45.47±6.63)分,P<0.001]、SSQOL评分([162.77±11.98)分vs.(157.90±13.2)分,P<0.001]均高于出院时。试验组出院6个月BI评分([57.33±7.58)分vs.(53.17±8.36)分,P<0.001]、FMA-UE评分[(47.23±6.66)分vs.(45.47±6.63)分,P<0.001]均高于出院时;出院12个月FMA-UE评分[(46.57±6.39)分vs.(45.47±6.63)分,P<0.001]高于出院时。对照组出院6个月BI评分[(51.00±6.87)分vs.(54.00±7.59)分,P<0.001]、FMA-UE评分[(43.67±6.99)分vs.(45.60±6.96)分,P<0.001]均较出院时下降;出院12个月BI评分[(48.50±6.45)分vs.(54.00±7.59)分,P<0.001]、FMA-UE评分([41.97±6.61)分vs.(45.60±6.96)分,P<0.001]和SS-QOL评分([152.77±8.11)分vs.(158.43±10.07)分,P<0.001]均较出院时下降。组间比较显示,试验组出院6个月的BI评分[(57.33±7.58)分vs.(51.00±6.87)分,P=0.010]、FMAUE评分[(47.23±6.66)分vs.(43.67±6.99)分,P=0.048],出院12个月BI评分[(55.67±6.92)分vs.(48.50±6.45)分,P<0.001]、FMA-UE评分([46.57±6.39)分vs.(41.97±6.61)分,P=0.008]和SSQOL评分([159.10±10.66)分vs.(152.77±8.11)分,P=0.012]均高于对照组。结论基于PEO模式的家庭作业治疗对卒中偏瘫患者上肢功能、日常生活活动能力及生活质量的效果维持显著有效。

Objective To investiage the effects of home occupational therapy based on person-environmentoccupation(PEO)model on upper limb function,activity of daily living and quality of life in stroke patients with hemiplegia.Methods This study prospectively enrolled the patients with hemiplegia after stroke from Department of Rehabilitation Medicine of Nanjing Pukou People's Hospital(Formerly Nanjing Pukou Central Hospital)from January 2020 to December 2020.The patients were randomly divided into observation group and control group.The Wechat group was established in both groups.The rehabilitation video updated regularly in the control group,and the personalized PEO-based video updates for each patient were performed in observation group.The Fugl-Meyer assessment upper extremity scale(FMA-UE)for upper limb motor function,Barthel index(BI)and stroke-specific quality of life(SS-QOL)were assessed in both groups at discharge,and at 3,6 and 12 months after discharge.Results A total of 60 patients were eventually included,with a mean age of 63.10±6.83 years old and 30 males,and 30 patients in each group.①Comparison within a group:for observation group,the BI score(57.00±7.83 vs.53.17±8.36,P<0.001)and FMA-UE score(47.23±6.66 vs.45.47±6.63,P<0.001)at 3 months after discharge were higher than those at discharge;the BI score(57.33±7.58 vs.53.17±8.36,P<0.001)and FMA-UE score(47.23±6.66 vs.45.47±6.63,P<0.001)at 6 months after discharge were higher than those at discharge;the FMA-UE score(46.57±6.39 vs.45.47±6.63,P<0.001)at 12 months after discharge was higher than that at discharge.For control group,the BI score(51.00±6.87 vs.54.00±7.59,P<0.001)and FMA-UE score(43.67±6.99 vs.45.60±6.96,P<0.001)at 6 months after discharge were lower than those at discharge;the BI score(48.50±6.45 vs.54.00±7.59,P<0.001),FMA-UE score(41.97±6.61 vs.45.60±6.96,P<0.001)and SS-QOL scores(152.77±8.11 vs.158.43±10.07,P<0.001)at 12 months after discharge were lower than those at discharge.②Comparison between two groups:the BI score(57.33±7.58 vs.51.00±6.87,P=0.010)and FMA-UE score(47.23±6.66 vs.43.67±6.99,P=0.048)at 6 months after discharge,and the BI score(55.67±6.92 vs.48.50±6.45,P<0.001),FMA-UE score(46.57±6.39 vs.41.97±6.61,P=0.008)and SS-QOL scores(159.10±10.66 vs.152.77±8.11,P=0.012)at 12 months after discharge in observation group were higher than those in the control group.Conclusion The PEO-based home occupational therapy can obviously improve upper limb function,activity of daily living and quality of life in stroke patients with hemiplegia.