Wong Frances Kam Yuet, Yeung Siu Ming
School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
Health Soc Care Community. 2015 Nov;23(6):619-31. doi: 10.1111/hsc.12177. Epub 2014 Dec 3.
Stroke rehabilitation involves care issues concerning the physical, psychosocial and spiritual aspects. Hospital-based rehabilitation has its limitations because many of the care issues only emerge when patients return home. Transitional care models supporting patients after discharge from the hospital have proved to be effective among chronically ill patients, but limited studies were conducted among stroke survivors. This study was a randomised controlled trial conducted to test the effectiveness of a transitional care programme (TCP) which was a nurse-led 4-week programme designed based on the assessment-intervention-evaluation Omaha System framework. Between August 2010 and October 2011, 108 stroke patients who were discharged home, able to communicate, and had slight to moderate neurological deficits and disability were randomised into control (n = 54) and intervention groups (n = 54). Data on the patient-related and clinical outcomes were collected at baseline, 4 weeks when the TCP was completed and 8 weeks after discharge from hospital. Repeated measures analysis of variance with intention-to-treat strategy was used to examine the outcomes. There were significant between-group differences in quality of life, the primary outcome measure of this study, in both physical (F(1, 104) = 10.15, P = 0.002) and mental (F(1, 104) = 8.41, P = 0.005) domains, but only the physical domain achieved a significant time × intervention interaction effect (F(1, 103) = 7.73, P = 0.006). The intervention group had better spiritual-religion-personal measures, higher satisfaction, higher Modified Barthel Index scores and lower depression scores when compared with the control group. They also had lower hospital readmission and use of emergency room rates, but only the use of emergency room had significant difference when compared to control. This study is original in testing a transitional model among stroke patients discharged from hospital. The TCP shares common features that have been proved to be effective when applied to chronically ill patients, and the duration of 4 weeks seems to be adequate to bring about immediate effects.
中风康复涉及身体、心理社会和精神层面的护理问题。基于医院的康复存在局限性，因为许多护理问题只有在患者回家后才会出现。事实证明，支持患者出院后的过渡性护理模式在慢性病患者中是有效的，但针对中风幸存者的研究有限。本研究是一项随机对照试验，旨在测试一种过渡性护理计划（TCP）的有效性，该计划是一个由护士主导、基于奥马哈系统评估 - 干预 - 评价框架设计的为期4周的计划。在2010年8月至2011年10月期间，108名出院回家、能够沟通、有轻度至中度神经功能缺损和残疾的中风患者被随机分为对照组（n = 54）和干预组（n = 54）。在基线、TCP完成时的4周以及出院后8周收集与患者相关和临床结局的数据。采用意向性分析的重复测量方差分析来检验结局。本研究的主要结局指标即生活质量在身体（F(1, 104) = 10.15，P = 0.002）和精神（F(1, 104) = 8.41，P = 0.005）领域均存在显著的组间差异，但只有身体领域实现了显著的时间×干预交互效应（F(1, 103) = 7.73，P = 0.006）。与对照组相比，干预组在精神 - 宗教 - 个人测量方面表现更好，满意度更高，改良巴氏指数得分更高，抑郁得分更低。他们的再次住院率和急诊室使用率也更低，但与对照组相比，只有急诊室使用率存在显著差异。本研究在测试出院中风患者的过渡性模式方面具有创新性。TCP具有一些共同特征，这些特征在应用于慢性病患者时已被证明是有效的，而且4周的时长似乎足以产生即时效果。
