基于慢性疾病轨迹模式的脑卒中患者康复管理实践与效果评价

Effects of a rehabilitation management program based on chronic disease trajectory patterns in stroke patients

目的:评价基于慢性疾病轨迹模式的脑卒中患者康复管理的应用效果,为我国脑卒中等慢性病的康复管理提供理论参考。方法:便利选择2022年9月1日至2023年10月31日在上海市某康复医院住院治疗的脑卒中患者,在入院前采用随机数字表法分为对照组(63例)和观察组(65例),分别将对照组和观察组患者分配至医院南楼和北楼的2个病区。对照组采用常规护理康复干预;观察组在常规护理康复干预的基础上,按照慢性疾病轨迹模式进行康复管理。比较2组患者干预前及干预1个月、干预3个月时希望水平、日常生活活动能力及社会参与度的变化。结果:2组患者3个时间点的希望量表评分比较,差异有统计学意义(F_(时间)=389.492,P<0.001;F_(组间)=27.312,P<0.001;F_(交互)=14.059,P<0.001);2组患者3个时间点日常生活活动能力评分比较,差异有统计学意义(F_(时间)=203.751,P<0.001;F_(组间)=5.802,P=0.019,F_(交互)=6.704,P=0.002);2组患者3个时间点的自主参与问卷评分比较,差异有统计学意义(F_(时间)=340.061,P<0.001;F_(组间)=19.525,P<0.001;F_(交互)=7.984,P=0.001)。结论:基于慢性疾病轨迹模式的康复管理能提高脑卒中患者对治疗和生活的希望,同时提高日常生活活动能力,进而提高社会参与度。

Objective:To evaluate the effects of a rehabilitation management program based on chronic disease trajectory patterns in stroke patients.Methods:Stroke patients who were hospitalized at a rehabilitation hospital in Shanghai from September 1,2022 to October 31,2023 were randomly divided into the control group(63 cases)and the observational group(65 cases)using a random number table method.Patients in the control group and observational groups were respectively assigned to two wards in the south and north buildings of the hospital.Patients in the control group received routine care,including routine rehabilitation training in the neurology rehabilitation department,health education,disease observation,and telephone follow-up after discharge.On the basis of routine care,patients in the observational group received the rehabilitation management program based on chronic disease trajectory patterns,including establishing a rehabilitation management team,developing rehabilitation management plans based on the psychological characteristics and rehabilitation and care needs of patients at different stages of the chronic disease trajectory,and conducting a three-month rehabilitation management through evaluation,goal setting,planning,implementation,evaluation,and other procedures.The changes in hope level,daily life activity ability,and social participation of the two groups of patients were compared before intervention,1 month after the intervention,and 3 months after the intervention between the two groups.Results:The Herth Hope Scale scores of the two groups at three time points were 21.87±4.03,30.60±6.01,41.30±4.66 in the observational group,and 22.68±3.75,26.30±5.17,36.12±4.94 in the control group.The difference between the two groups was statistically significant(F_(time)=389.492,P<0.001;F_(between groups)=27.312,P<0.001;F_(interaction)=14.059,P<0.001).The daily living activity scores of two groups of patients at three time points were 34.02±11.13,43.17±12.76,62.68±13.09 in the observational group,and 35.06±11.74,39.03±13.48,55.14±13.28 in the control group.The difference between the two groups was statistically significant(F_(time)=203.751,P<0.001;F_(between groups)=5.802,P=0.019;F_(interaction)=6.704,P=0.002).The autonomous participation questionnaire scores of two groups of patients at three time points were 69.57±12.75,59.51±13.10,43.10±10.82 in the observational group,and 67.73±14.05,64.35±11.35,50.03±11.07 in the control group.The difference between the two groups was statistically significant(F_(time)=340.061,P<0.001;F_(between groups)=19.525,P<0.001;F_(interaction)=7.984,P=0.001).Conclusion:The rehabilitation management program based on chronic disease trajectory patterns can increase the hope of stroke patients for treatment and life,as well as improve their daily life activities and thus increase social participation.