基于患者健康参与模型的肢体运动康复方案在出血性脑卒中患者中的应用

Application of limb motor rehabilitation program based on the patient health engagement model in patients with hemorrhagic stroke

目的探讨基于患者健康参与(PHE)模型的肢体运动康复方案在出血性脑卒中患者中的应用效果,为出血性脑卒中患者肢体运动康复管理提供参考。方法通过文献回顾及德尔菲专家函询构建基于PHE模型的肢体运动康复方案。采用非同期前后对照研究,便利抽样法选取2022年3—8月在山西白求恩医院神经外科住院的45例出血性脑卒中患者作为对照组,给予常规运动康复措施,2022年9月至2023年2月住院的45例出血性脑卒中患者作为干预组,在对照组的基础上实施基于PHE模型的肢体运动康复方案。分别于干预前和干预后1、3个月,观察2组患者的功能锻炼依从性、肢体运动功能、日常活动能力、情绪和社会功能障碍水平。结果最终纳入出血性脑卒中患者85例。干预组患者42例,男25例,女17例,年龄(52.07±9.91)岁;对照组患者43例,男21例,女22例,年龄(53.93±10.52)岁。2组干预前功能锻炼依从性、肢体运动功能、日常活动能力、情绪和社会功能障碍水平比较差异均无统计学意义(均P>0.05)。干预后3个月,干预组患者功能锻炼依从性得分为(40.83±7.92)分,高于对照组的(37.14±6.44)分,差异有统计学意义(t=2.36,P<0.05);干预后1、3个月,干预组患者肢体运动功能、日常活动能力得分分别为(27.12±6.74)、(33.67±6.54)分和(61.31±6.72)、(74.40±8.71)分,均高于对照组的(24.91±6.03)、(27.02±6.59)分和(52.33±9.78)、(60.12±10.03)分,差异均有统计学意义(t值为2.06~7.01,均P<0.05),情绪和社会功能障碍得分分别为(75.52±22.09)、(58.33±18.88)分,均低于对照组的(86.02±23.04)、(78.51±21.67)分,差异均有统计学意义(t=-2.14、-4.57,均P<0.05)。结论基于PHE模型的肢体运动康复方案可提高出血性脑卒中患者锻炼依从性,改善患者肢体运动功能、日常活动能力,缓解负面情绪,降低社会功能障碍水平。

ObjectiveTo explore the effectiveness of limb motor rehabilitation program based on patient health engagement(PHE)model in patients with hemorrhagic stroke,and to provide reference for the limb motor rehabilitation management of hemorrhagic stroke patients.MethodsThrough literature review and Delphi expert correspondence,a limb motor rehabilitation program for hemorrhagic stroke patients based on the PHE model was constructed.A non-contemporaneous controlled study was conducted,45 hemorrhagic stroke patients hospitalized in the Department of Neurosurgery of Shanxi Bethune Hospital from March to August 2022 were selected by convenience sampling method as the control group,and routine exercise rehabilitation measure was given,45 hemorrhagic stroke patients from September 2022 to February 2023 were selected as the intervention group,a limb motor rehabilitation program based on PHE model was implemented on the basis of control group.The functional exercise compliance,limb motor function,daily activity ability,emotional and social dysfunction of patients in the two groups were observed before intervention,1 and 3 months after intervention respectively.ResultsA total of 85 patients with hemorrhagic stroke were included.There were 42 patients in the intervention group,25 males and 17 females,aged(52.07±9.91)years old,and 43 patients in the control group,21 males and 22 females,aged(53.93±10.52)years old.There were no significant differences in the functional exercise compliance,limb motor function,daily activity ability,emotional and social dysfunction of patients before intervention between the two groups.At 3 months after intervention,the functional exercise compliance score in the intervention group was(40.83±7.92)points,higher than that in the control group(37.14±6.44)points,and the difference was statistically significant(t=2.36,P<0.05).At 1 and 3 months after intervention,the scores of limb motor function and daily activity ability in the intervention group were(27.12±6.74),(33.67±6.54)points and(61.31±6.72),(74.40±8.71)points,which were higher than(24.91±6.03),(27.02±6.59)points and(52.33±9.78),(60.12±10.03)points of the control group,the differences were statistically significant(t values were 2.06-7.01,all P<0.05),the scores of emotional and social dysfunction were(75.52±22.09)and(58.33±18.88)points,which were lower than(86.02±23.04),(78.51±21.67)points of the control group,and the differences were statistically significant(t=-2.14,-4.57,both P<0.05).ConclusionsThe limb motor rehabilitation program based on the PHE model could improve the exercise compliance of patients with hemorrhagic stroke,improve the limb motor function and daily activity ability of patients,alleviate negative emotions,and reduce the level of social dysfunction.