基于芬兰老年认知障碍预防模式的多因素干预对首发卒中后认知障碍患者的康复效果研究

A study of the rehabilitation effects of a multi-factor intervention based on the Finnish model of prevention of cognitive impairment in the elderly on patients with cognitive impairment after first-episode stroke

目的探讨基于芬兰老年认知障碍预防模式的多因素干预对首发卒中后认知障碍患者的康复效果,为卒中后认知障碍患者的康复护理工作提供参考依据。方法采用类实验研究设计。采用方便抽样法选取天津医科大学总医院空港医院住院的首发卒中后认知障碍患者为研究对象,按入院时间进行分组,2022年1—6月入院患者50例为对照组,2022年7—12月入院患者50例为干预组,对照组实施常规康复护理及健康教育,干预组在对照组基础上于出院前接受基于芬兰老年认知障碍预防模式的多因素干预。应用简明精神状态检查量表(MMSE)和脑卒中患者健康教育依从性评估量表评价患者干预前和干预后第3、6个月的总体认知功能及康复依从性变化情况。结果最终对照组纳入49例,其中男35例,女14例,年龄(64.67±7.47)岁;干预组纳入50例,其中男32例,女18例,年龄(66.68±8.75)岁。干预前2组的总体认知功能和康复依从性总分比较差异均无统计学意义(均P>0.05),干预后第3、6个月干预组的总体认知功能得分、康复依从性总分、饮食依从性、康复锻炼依从性及健康行为依从性得分分别为(26.36±2.36)、(125.96±13.80)、(23.30±5.26)、(27.72±4.46)、(43.66±6.80)分和(27.26±3.71)、(152.44±9.06)、(30.12±6.42)、(33.32±3.02)、(52.36±4.70)分,与对照组的(24.04±4.50)、(116.67±10.26)、(19.31±3.95)、(25.29±3.45)、(40.59±4.33)分和(24.27±4.33)、(138.92±16.71)、(24.20±4.48)、(30.00±5.53)、(47.65±8.03)分比较,差异均有统计学意义(t值为-5.31~-2.67,均P<0.05)。重复测量方差分析显示,组间和时间因素、组间与时间的交互作用对患者的总体认知功能得分及康复依从性总分、饮食、康复锻炼、健康行为依从性得分有影响,差异均有统计学意义(F组间值为8.33~18.08,F时间值为135.71~944.69,F交互值为5.46~27.30,均P<0.05);时间因素对患者服药依从性得分有影响,差异有统计学意义(F时间=206.23,P<0.05)。结论基于芬兰老年认知障碍预防模式的多因素干预可以改善首发卒中后认知障碍患者的总体认知功能及康复依从性。

Objective To explore the rehabilitation effect of multi-factor intervention based on the Finnish model of prevention of cognitive impairment in the elderly on patients with cognitive impairment after first-episode stroke,and to provide reference for rehabilitation nursing of cognitive impairment after stroke.Methods The quasi-experiment research scheme was adopted and convenience sampling method was used to select participants with first-episode stroke cognitive impairment hospitalized in the General Hospital of Tianjin Medical University Airport Site.The 50 patients admitted from January to June 2022 were selected as the control group,and 50 patients admitted from July to December 2022 were selected as the intervention group.The control group received routine rehabilitation nursing and health education,and the intervention group received the Finnish model of prevention of cognitive impairment in the elderly on patients before discharge on the basis of the control group.The Mini-Mental State Examination(MMSE)and Health Education Compliance Assessment Scale for Stroke Patients were used to evaluate the changes of overall cognitive function and rehabilitation compliance before intervention,3 and 6 months after intervention.Results The final control group included 49 cases,including 35 males and 14 females,aged(64.67±7.47)years old;the intervention group included 50 cases,32 males and 18 females,aged(66.68±8.75)years old.Before intervention,there were no significant differences in overall cognitive function and compliance of rehabilitation score(P>0.05).At 3 and 6 months after intervention,the overall cognitive function score,the total score on compliance of rehabilitation,dimension scores of diet compliance,exercise rehabilitation compliance and health behavior compliance of the intervention group were(26.36±2.36),(125.96±13.80),(23.30±5.26),(27.72±4.46),(43.66±6.80)and(27.26±3.71),(152.44±9.06),(30.12±6.42),(33.32±3.02),(52.36±4.70),respectively.They were higher than the control group(24.04±4.50),(116.67±10.26),(19.31±3.95),(25.29±3.45),(40.59±4.33)and(24.27±4.33),(138.92±16.71),(24.20±4.48),(30.00±5.53),(47.65±8.03),and the differences had statistical significance(t values were-5.31--2.67,all P<0.05).According to the variance analysis of repeated measurement,intergroup and time factor,the interaction between groups and time had significant impact on general cognitive function score,the total score of rehabilitation compliance,the dimension scores of diet,exercise rehabilitation and health behavior compliance(Fgroup values were 8.33-18.08,Ftime values were 135.71-944.69,Finteraction values were 5.46-27.30,all P<0.05).Time factor had significant impact on patient medication adherence score(Ftime=206.23,P<0.05).Conclusions Multi-factor intervention based on the Finnish model of prevention of cognitive impairment in the elderly can improve the overall cognitive function and rehabilitation compliance of patients with cognitive impairment after first-episode stroke.