Huijbregts Maria P J, McEwen Sara, Taylor Denise
Risk and Patient Safety, Baycrest Geriatric Healthecare System Toronto, ON, Canada.
Physiother Can. 2009 Fall;61(4):210-20. doi: 10.3138/physio.61.4.210. Epub 2009 Nov 12.
Moving On after STroke (MOST) is an established self-management programme for persons with stroke and their care partners. Through 18 sessions over 9 weeks, each including discussion and exercise, participants learn about goal-setting, problem-solving, exercise, and community-reintegration skills. This study was undertaken to evaluate the feasibility and efficacy of telehealth delivery of MOST.
Efficacy was evaluated using an experimental non-randomized trial comparing a telehealth MOST intervention group (T-MOST) (n = 10) with a waiting list control group (WLC) (n = 8). Outcome measures included the Berg Balance Scale (BBS), the Reintegration to Normal Living Index, the Stroke-Adapted Sickness Impact Profile, Goal Attainment Scaling, and the Geriatric Depression Scale. The feasibility evaluation included attendance rates, focus groups, and facilitator logs. In MOST Telehealth, one co-facilitator was local and the other was connected by videoconference.
Attendance rates for persons with stroke (83.9%, SD = 2.6) and care partners (76.7%, SD = 2.9) and participant and facilitator experiences indicated feasibility of this mode of programme delivery. There was a significant difference in BBS scores between the T-MOST group and the WLC group (mean difference -4.27, 95%CI: -6.66 to -1.87). Participants reported additional benefits, including increased motivation and awareness of partners' needs. Videoconferencing was reported to decrease their sense of isolation.
It appears feasible to deliver the MOST programme with two facilitators, one connected by videoconference and one in person. In addition, preliminary evidence suggests that the programme is associated with improved well-being in persons with stroke and their care partners. Practitioners delivering self-management programmes may consider wider dissemination using videoconferencing.
中风后继续前行（MOST）是一项针对中风患者及其护理伙伴的既定自我管理计划。该计划为期9周，共18节课程，每节课程都包含讨论和练习，参与者将学习目标设定、问题解决、锻炼以及重新融入社区的技能。本研究旨在评估通过远程医疗提供MOST计划的可行性和有效性。
采用非随机实验性试验评估有效性，将远程医疗MOST干预组（T-MOST）（n = 10）与候补名单对照组（WLC）（n = 8）进行比较。结果测量指标包括伯格平衡量表（BBS）、重新融入正常生活指数、中风适应性疾病影响概况、目标达成量表以及老年抑郁量表。可行性评估包括出勤率、焦点小组讨论以及主持人日志。在MOST远程医疗计划中，一名共同主持人在当地，另一名通过视频会议参与。
中风患者（83.9%，标准差 = 2.6）和护理伙伴（76.7%，标准差 = 2.9）的出勤率以及参与者和主持人的反馈表明这种计划交付模式具有可行性。T-MOST组和WLC组的BBS评分存在显著差异（平均差异 -4.27，95%置信区间：-6.66至-1.87）。参与者报告了其他益处，包括动力增强以及对伙伴需求的认识提高。据报告，视频会议减少了他们的孤独感。
由一名通过视频会议参与和一名现场参与的两名主持人来实施MOST计划似乎是可行的。此外，初步证据表明该计划与中风患者及其护理伙伴的幸福感改善相关。实施自我管理计划的从业者可考虑通过视频会议进行更广泛的推广。
