Sackley Catherine, Wade Derick T, Mant David, Atkinson Jo Copley, Yudkin Patricia, Cardoso Karina, Levin Sonya, Lee Vanessa Blanchard, Reel Kevin
School of Health Sciences, University of Birmingham, UK.
Stroke. 2006 Sep;37(9):2336-41. doi: 10.1161/01.STR.0000237124.20596.92. Epub 2006 Aug 3.
A pilot evaluation of an occupational therapy intervention to improve self-care independence for residents with stroke-related disability living in care homes was the basis of this study.
A cluster randomized controlled trial with care home as the unit of randomization was undertaken in Oxfordshire, UK. Twelve homes (118 residents) were randomly allocated to either intervention (6 homes, 63 residents) or control (6 homes, 55 residents). Occupational therapy was provided to individuals but included carer education. The control group received usual care. Assessments were made at baseline, postintervention (3 months) and at 6-months to estimate change using the Barthel Activity of Daily Living Index (BI) scores, "poor global outcome", (defined as deterioration in BI score, or death) and the Rivermead Mobility Index.
At 3 months BI score in survivors had increased by 0.6 (SD 3.9) in the intervention group and decreased by 0.9 (2.2) in the control group; a difference of 1.5 (95% CI allowing for cluster design, -0.5 to 3.5). At 6 months the difference was 1.9 (-0.7 to 4.4). Global poor outcome was less common in the intervention group. At 3 months, 20/63 (32%) were worse/dead in the intervention group compared with 31/55 (56%) in the control group, difference -25% (-51% to 1%). At 6 months the difference was similar, -26% (-48% to -3%). Between-group changes in Rivermead Mobility Index scores were not significantly different.
Residents who received an occupational therapy intervention were less likely to deteriorate in their ability to perform activities of daily living.
本研究基于一项职业疗法干预的初步评估，该干预旨在提高居住在养老院的中风相关残疾居民的自我护理独立性。
在英国牛津郡进行了一项以养老院为随机分组单位的整群随机对照试验。12所养老院（118名居民）被随机分配到干预组（6所养老院，63名居民）或对照组（6所养老院，55名居民）。对个体提供职业疗法，但包括护理人员教育。对照组接受常规护理。在基线、干预后（3个月）和6个月时进行评估，使用巴氏日常生活活动指数（BI）评分、“总体预后不良”（定义为BI评分恶化或死亡）和Rivermead运动指数来估计变化。
在3个月时，干预组幸存者的BI评分增加了0.6（标准差3.9），而对照组下降了0.9（2.2）；差异为1.5（考虑整群设计的95%置信区间，-0.5至3.5）。在6个月时，差异为1.9（-0.7至4.4）。干预组总体预后不良的情况较少见。在3个月时，干预组20/63（32%）情况变差/死亡，而对照组为31/55（56%），差异为-25%（-51%至1%）。在6个月时，差异相似，为-26%（-48%至-3%）。两组之间Rivermead运动指数评分的变化无显著差异。
接受职业疗法干预的居民在进行日常生活活动的能力方面恶化的可能性较小。
