《中国康复理论与实践》

《中国康复理论与实践》 ›› 2014, Vol. 20 ›› Issue (8): 789-793.

• 社区康复 • 上一篇    下一篇

自我管理对提高社区脑卒中患者日常生活活动能力及生活质量的效果

高春华1，黄晓琳1，黄杰1，张威2，汪文2，蔡建华3
   

  1. 1.华中科技大学同济医学院附属同济医院康复医学科，湖北武汉市430030；2.武钢总医院康复医学科，湖北武汉市430081；3.武钢总医院钢都社区卫生服务中心，湖北武汉市430083。
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2014-08-25 发布日期:2014-08-25

Effect of Chronic Disease Self-management on Activities of Daily Living and Quality of Life of Stroke Patients in Community

GAO Chun-hua, HUANG Xiao-lin, HUANG Jie, ZHANG Wei, WANG Wen, CAI Jian-hua.
  

  1. Department of Rehabilitation Medicine, Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2014-08-25 Online:2014-08-25

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摘要： 目的探讨脑卒中自我管理对社区脑卒中恢复期患者运动功能、日常生活活动能力、生活质量及抑郁程度的影响。方法选取武汉市钢都社区居民中脑卒中患者120 例，按照随机数字表法分为自我管理组(简称自管组，n=60)和对照组(n=60)。对照组均自行在家进行居家康复，自行功能锻炼，定期门诊复查，不适时随诊。自管组采用自我管理模式干预，由专家指导，社区医生、治疗师及家属共同对患者进行康复评定，分小组指导、制定个性化康复训练计划、家庭访视流程及社区脑卒中患者小组活动。两组分别于干预前及干预6 个月后采用简式Fugl-Meyer 运动功能评分法(FMA)、改良Barthel 指数(MBI)、汉密尔顿抑郁量表(HAMD)和世界卫生组织生存质量测评量表(WHOQOL-100)进行评定。结果干预前，两组FMA上下肢评分、MBI、HAMD和WHOQOL-100 评分比较均无显著性差异(P>0.05)。干预6 个月后，自管组FMA上下肢评分、MBI和WHOQOL-100 评分均较干预前及对照组提高(P<0.05)，对照组亦有改善，但无显著性差异(P>0.05)；自管组HAMD评分较干预前及对照组降低(均P<0.05)，对照组亦有下降，但无显著性差异(P>0.05)。结论对社区脑卒中恢复期患者实施脑卒中自我管理能提高社区脑卒中恢复期患者运动功能、日常生活活动能力和生活质量，且能降低脑卒中患者的抑郁程度。

关键词: 脑卒中, 慢性病自我管理, 社区康复, 日常生活能力, 生活质量

Abstract: Objective To investigate the impact of chronic disease self-management on motor function, activities of daily living, quality of life, and depression of patients in poststroke rehabilitation in community. Methods 120 stroke patients living in Gangdu community, Wuhan city were selected and randomly divided into self-management group (n=60) and control group (n=60). The control group experienced home rehabilitation and functional training by themselves, meanwhile they were asked to have regular outpatient referral and do the followup clinic when feeling indisposed. Self-management mode was used in the self-management group instructed by the professor and under the rehabilitation assessment by community doctors, therapist and family members. Also group separated instruction, individualized rehabilitation plan, home visit processes and patients' group activity had been organized. They were evaluated with Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), Hamilton Depression Rating Scale (HAMD) and the World Health Organization Quality of Life (WHOQOL-100) before and 6 months after intervention. Results There were no difference in FMA upper and lower limbs scores as well as the MBI score, HAMD score and WHOQOL-100 score before intervention (P>0.05). The FMA upper and lower limbs score, MBI score and WHOQOL- 100 score significantly improved in the self-management group and were better than in the control group 6 months after intervention (P<0.05). The control group also improved in the above items, however, the differences were not statistically significant (P>0.05). HAMD score significantly reduced in the self-management group and less than in the control group 6 months after intervention (P<0.05). The control group also reduced in the above scores, however, the differences were not statistically significant (P>0.05). Conclusion Chronic disease self-management for stroke patients in community can significantly improve their motor function, activities of daily living and quality of life, and reduce depression caused by stroke.

Key words: stroke, chronic disease self-management, community-based rehabilitation, activities of daily living, quality of life