运动想象疗法对脑卒中患者上肢远程康复护理的随机对照研究

Effects of home-based motor imagery training on upper extremity function in chronic stroke patients：a randomized and controlled trial

目的：探讨家庭中应用远程运动想象疗法对脑卒中患者上肢运动功能及日常生活活动能力（ADL）的影响。方法将56例脑卒中患者按照随机数字表法分为干预组27例和对照组29例，2组均接受常规神经内科出院健康宣教，发放以常规运动疗法和作业疗法为主的康复录像视频，干预组患者在此基础上通过即时通讯软件远程接受6周运动想象疗法干预，2次/周，30 min/次。2组患者在干预前、干预后6、12周时分别采用Fugl-Meyer运动功能评定量表（上肢）（FMA）、Barthel指数量表（BI）对患者上肢运动功能、ADL进行评价。数据分析采用重复测量方差分析。结果对照组在出院前及干预后6、12周时FMA上肢部分得分分别为（48.42±1.60）、（49.19±1.77）、（49.46±1.84）分，干预组分别为（49.46±3.20）、（51.81±3.16）、（52.73±3.72）分。对照组在出院前及干预后6、12周时BI得分分别为（49.46±15.09）、（50.77±14.47）、（59.08±13.85）分，干预组分别为（54.04±17.44）、（74.62±11.22）、（86.54±9.88）分。干预后6、12周时组别对FMA、BI得分均存在显著效应（F=10.641、30.379，P<0.01），且时间与组别在FMA、BI方差分析模型中均存在交互作用（F=16.677、29.685，均P<0.01）。结论通过即时通讯软件在家庭中远程应用运动想象疗法能够改善脑卒中偏瘫患者上肢运动功能，提高日常生活能力。

Objective To explore the effects of home-based motor imagery training on upper extremity function, activities of daily living (ADL) in chronic stroke patients. Methods The study included 56 stroke survivors who were randomized to an intervention group or a control group. In both groups, patients received a video tape and routine rehabilitation nursing before discharge. Moreover, the patients in the experimental group received 6- week motor imagery (MI) therapy through an instant messaging client, twice a week, 30 minutes per time. The outcomes were assessed using the Fugl- Meyer Motor Assessment Scale (FMA) and the Barthel Index (BI) before the intervention, immediately after the intervention, and 6 weeks after the intervention. Data analysis included ANOVA of repeated measures. Results At baseline, 6 weeks, 12 weeks, the scores of FMA in the control group were 48.42 ± 1.60, 49.19 ± 1.77, 49.46 ± 1.84, while in the intervention group were 49.46 ± 3.20,51.81 ± 3.16,52.73 ± 3.72 respectively. The scores of BI in the control group were 49.46 ± 15.09,50.77 ± 14.47, 59.08±13.85, while in the intervention group were 54.04±17.44,74.62±11.22,86.54±9.88 respectively. At 6 and 12 weeks after intervention, a main effect of intervention (F=10.641,30.379, P<0.01) and an <br> interactive effect of time and intervention (F=16.677,29.685,P<0.01) were observed in the model of FMA, BI using ANOVA of repeated measures. Conclusions The MI provided by an instant messaging client might be effective for improving upper extremity motor function and ADL in stroke survivors.