住院康复期间的策略训练可能预防急性中风后的冷漠症状。
Strategy Training During Inpatient Rehabilitation May Prevent Apathy Symptoms After Acute Stroke.
作者信息
Skidmore Elizabeth R, Whyte Ellen M, Butters Meryl A, Terhorst Lauren, Reynolds Charles F
机构信息
Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA(∗).
Department of Physical Medicine & Rehabilitation and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA(†).
出版信息
PM R. 2015 Jun;7(6):562-70. doi: 10.1016/j.pmrj.2014.12.010. Epub 2015 Jan 13.
BACKGROUND
Apathy, or lack of motivation for goal-directed activities, contributes to reduced engagement in and benefit from rehabilitation, impeding recovery from stroke.
OBJECTIVE
To examine the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke.
DESIGN
Secondary analysis of randomized controlled trial.
SETTING
Acute inpatient rehabilitation.
PARTICIPANTS
Participants with acute stroke who exhibited cognitive impairments (Quick Executive Interview Scores ≥3) and were admitted for inpatient rehabilitation were randomized to receive strategy training (n = 15, 1 session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (n = 15, same dose).
METHODS
Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following, and responding).
MAIN OUTCOME MEASURES
Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 months, and 6 months. Data were analyzed with repeated-measures fixed-effects models.
RESULTS
Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission (strategy training, mean = 25.79, standard deviation = 7.62; reflective listening, mean = 25.18, standard deviation = 4.40). A significant group × time interaction (F2,28 = 3.61, P = .040) indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large (d = -0.99, t28 = -2.64, P = .013) at month 3 and moderate to large (d = -0.70, t28 = -1.86, P = .073) at month 6.
CONCLUSION
Strategy training shows promise as an adjunct to usual rehabilitation for maintaining low levels of poststroke apathy.
背景
冷漠，即缺乏进行目标导向活动的动力，会导致康复参与度降低及康复收益减少，阻碍中风后的恢复。
目的
研究策略训练（一种用于强化常规住院康复的行为干预措施）对中风后前6个月冷漠症状的影响。
设计
随机对照试验的二次分析。
设置
急性住院康复。
参与者
患有急性中风且表现出认知障碍（快速执行访谈得分≥3）并接受住院康复治疗的参与者被随机分为接受策略训练组（n = 15，除常规住院康复外，每天1次，每周5天）或反思性倾听组（n = 15，剂量相同）。
方法
策略训练课程聚焦于参与者选择的目标以及参与者制定的实现这些目标的策略，采用整体策略训练方法（目标 - 计划 - 执行 - 检查）。反思性倾听课程聚焦于参与者对其康复目标和经历的反思，通过开放式问题和积极倾听技巧（专注、跟进和回应）来促进。
主要结局指标
对分组不知情的经过培训的评估者在研究入组时、3个月和6个月时使用冷漠评估量表进行评估。数据采用重复测量固定效应模型进行分析。
结果
两组参与者在研究入组时的亚综合征水平的冷漠症状相似（策略训练组，均值 = 25.79，标准差 = 7.62；反思性倾听组，均值 = 25.18，标准差 = 4.40）。显著的组×时间交互作用（F2,28 = 3.61，P = .040）表明，随着时间推移，两组之间冷漠症状水平的变化有所不同。在第3个月时，两组变化得分的差异幅度较大（d = -0.99，t28 = -2.64，P = .013），在第6个月时为中度至较大（d = -0.70，t28 = -1.86，P = .073）。
结论
策略训练有望作为常规康复的辅助手段，以维持中风后较低水平的冷漠症状。
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