Horne Maria, Thomas Nessa, McCabe Candy, Selles Rudd, Vail Andy, Tyrrell Pippa, Tyson Sarah
a School of Health, University of Bradford , Bradford , UK .
b Stroke Research Centre, Manchester Academic Health Sciences Centre .
Disabil Rehabil. 2015;37(25):2344-9. doi: 10.3109/09638288.2015.1024341. Epub 2015 Apr 28.
Patient-led therapy, in which patients work outside therapy sessions without direct supervision, is a possible way to increase the amount of therapy stroke patients' receive without increasing staff demands. Here, we report patients' views of patient-led mirror therapy and lower limb exercises.
94 stroke survivors with upper and lower limb limitations at least 1-week post-stroke undertook 4 weeks of daily patient-led mirror therapy or lower limb exercise, then completed questionnaires regarding their experience and satisfaction. A convenience random sample of 20 participants also completed a semi-structured telephone interview to consider their experience in more detail and to capture their longer term impressions.
Participants were generally positive about patient-led therapy. About 71% found it useful; 68% enjoyed it; 59% felt it "worked" and 88% would recommend it to other patients. Exercise was viewed more positively than the mirror therapy. Difficulties included arranging the equipment and their position, particularly for more severe strokes, loss of motivation and concerns about working unsupervised.
Patient-led mirror therapy and lower limb exercises during in-patient rehabilitation is generally feasible and acceptable to patients but "light touch" supervision to deal with any problems, and strategies to maintain focus and motivation are needed. Implications for Rehabilitation Most stroke patients receive insufficient therapy to maximize recovery during rehabilitation. As increases in staffing are unlikely there is an imperative to find ways for patients to increase the amount of exercise and practice of functional tasks they undertake without increasing demands on staff. Patient-led therapy (also known as patient-directed therapy or independent practice), in which patients undertake exercises or functional tasks practice prescribed by a professional outside formal therapy sessions is one way of achieving this. It is widely used in community-based rehabilitation but is uncommon in hospital-based stroke care. We explored the feasibility and acceptability of two types of patient-led therapy during hospital-based stroke care; mirror therapy for the upper limb and exercises (without a mirror) for the lower limb. Here, we report patients' experiences of undertaking patient-led therapy. Patient-led mirror therapy and lower limb exercises during in-patient stroke rehabilitation is generally feasible and acceptable to patients but "light touch" supervision to deal with any problems, and strategies to maintain focus and motivation are needed.
患者主导疗法是指患者在无直接监督的情况下在治疗时段之外进行训练，这是一种在不增加工作人员需求的情况下增加中风患者接受治疗量的可行方法。在此，我们报告患者对患者主导的镜像疗法和下肢锻炼的看法。
94名中风后至少1周存在上肢和下肢功能受限的中风幸存者，进行了为期4周的每日患者主导的镜像疗法或下肢锻炼，然后完成了关于他们的体验和满意度的问卷调查。对20名参与者的便利随机样本还进行了半结构化电话访谈，以更详细地了解他们的体验并获取他们的长期印象。
参与者总体上对患者主导疗法持积极态度。约71%的人认为其有用；68%的人喜欢它；59%的人觉得它“有效果”，88%的人会向其他患者推荐。锻炼比镜像疗法得到更积极的评价。困难包括安排设备及其位置，尤其是对于病情较重的中风患者，失去动力以及对无监督训练的担忧。
住院康复期间患者主导的镜像疗法和下肢锻炼对患者来说总体上是可行且可接受的，但需要“轻度”监督以处理任何问题，以及保持专注和动力的策略。
大多数中风患者在康复期间接受的治疗不足，无法实现最大程度的恢复。由于增加工作人员不太可能，因此迫切需要找到方法，让患者在不增加对工作人员需求的情况下增加他们进行的锻炼量和功能任务练习。患者主导疗法（也称为患者指导疗法或自主练习），即患者在正式治疗时段之外进行由专业人员规定的锻炼或功能任务练习，是实现这一目标的一种方法。它在社区康复中广泛使用，但在医院中风护理中并不常见。我们探讨了在医院中风护理期间两种类型的患者主导疗法的可行性和可接受性；上肢的镜像疗法和下肢的（无镜像）锻炼。在此，我们报告患者进行患者主导疗法的体验。住院中风康复期间患者主导的镜像疗法和下肢锻炼对患者来说总体上是可行且可接受的，但需要“轻度”监督以处理任何问题，以及保持专注和动力的策略。
