一项关于职业治疗干预以增加中风后户外移动能力的随机对照试验。
Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke.
作者信息
Logan P A, Gladman J R F, Avery A, Walker M F, Dyas J, Groom L
机构信息
University of Nottingham, School of Community Health Sciences, University of Nottingham, Nottingham NG7 2RD.
出版信息
BMJ. 2004 Dec 11;329(7479):1372-5. doi: 10.1136/bmj.38264.679560.8F. Epub 2004 Nov 25.
OBJECTIVE
To evaluate an occupational therapy intervention to improve outdoor mobility after stroke.
DESIGN
Randomised controlled trial.
SETTING
General practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital.
PARTICIPANTS
168 community dwelling people with a clinical diagnosis of stroke in previous 36 months: 86 were allocated to the intervention group and 82 to the control group.
INTERVENTIONS
Leaflets describing local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group).
MAIN OUTCOME MEASURES
Responses to postal questionnaires at four and 10 months: primary outcome measure was response to whether participant got out of the house as much as he or she would like, and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale, Nottingham leisure questionnaire, and general health questionnaire.
RESULTS
Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37) and 10 months (1.74, 1.24 to 2.44). The treatment group reported more journeys outdoors in the month before assessment at both four months (median 37 in intervention group, 14 in control group: P < 0.01) and 10 months (median 42 in intervention group, 14 in control group: P < 0.01). At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group, but there were no significant differences in the other secondary outcomes. No significant differences were observed in these measures at 10 months.
CONCLUSION
A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke.
目的
评估一项职业治疗干预措施对改善中风后户外移动能力的效果。
设计
随机对照试验。
地点
全科医生登记册、社会服务部门、初级保健康复服务机构和老年日间医院。
参与者
168名在过去36个月内临床诊断为中风的社区居民：86人被分配到干预组，82人被分配到对照组。
干预措施
为对照组提供描述当地残疾人交通服务的传单，为干预组提供由职业治疗师进行评估及最多七次干预疗程的传单。
主要结局指标
在4个月和10个月时对邮寄问卷的回复：主要结局指标是对参与者是否按自己意愿出门的回复，次要结局指标是对过去一个月内户外出行次数的回复以及在诺丁汉日常生活活动扩展量表、诺丁汉休闲问卷和一般健康问卷上的得分。
结果
治疗组参与者在4个月（相对风险1.72，95%置信区间1.25至2.37）和10个月（1.74，1.24至2.44）时更有可能按自己意愿经常出门。治疗组在4个月（干预组中位数为37次，对照组为14次：P<0.01）和10个月（干预组中位数为42次，对照组为14次：P<0.01）评估前一个月报告的户外出行次数更多。在4个月时，干预组在诺丁汉日常生活活动扩展量表上的移动能力得分显著更高，但在其他次要结局指标上无显著差异。在10个月时，这些指标未观察到显著差异。
结论
在家中进行有针对性的职业治疗干预可提高中风患者的户外移动能力。
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