Murdolo Yuki, Brown Ted, Fielding Leesa, Elliott Stephen, Castles Elizabeth
Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia.
Department of Occupational Therapy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.
Aust Occup Ther J. 2017 Aug;64(4):305-313. doi: 10.1111/1440-1630.12363. Epub 2017 Apr 5.
BACKGROUND/AIM: The Graded Repetitive Arm Supplementary Program (GRASP) has been designed to increase the frequency of upper limb therapy sessions occurring without the presence of a therapist. Its use has not been studied when implemented in acute care settings with patients presenting with a stroke within the first week of onset. To investigate patients' experiences of using the GRASP when provided within the first week in an acute stroke setting.
A concurrent nested mixed methods design was used. Participants were assessed prior and post the GRASP implementation using the CAHAI-9, the UL-MAS, and the SIS 3.0 physical dimensions and interviewed regarding their GRASP experience.
Participants (n = 8, mean days post stroke =2.75 days, SD = 2.05 at recruitment, mean age = 69.63years, SD = 11.73) used the GRASP regularly while in the acute stroke care setting (mean GRASP use = 28.44minutes/day, SD = 20.40, range = 10-45 minutes, median = 15 minutes). The perceived benefits of the GRASP use reported by patients included 'it's good for your hand', 'they makes other jobs easier' and 'I've got to be doing something'. Categories regarding the participants' motivation to use the GRASP included 'to get my hand better', 'being able to do the things I did before' and 'to get out of here [the hospital]'. Participants experienced clinically significant changes in mean change scores of the CAHAI-9 and UL-MAS at the group level. Wilcoxon Signed Ranks Test revealed no statistically significant changes.
A clinical trial to evaluate the effectiveness of the GRASP when provided to patients within the first week is recommended.
背景/目的：分级重复手臂辅助计划（GRASP）旨在增加在没有治疗师在场的情况下进行上肢治疗的频率。在发病第一周内患有中风的患者的急性护理环境中实施该计划时，尚未对其使用情况进行研究。本研究旨在调查在急性中风环境中第一周内提供GRASP时患者使用该计划的体验。
采用并行嵌套混合方法设计。在GRASP实施前后，使用CAHAI-9、UL-MAS和SIS 3.0身体维度对参与者进行评估，并就他们的GRASP体验进行访谈。
参与者（n = 8，中风后平均天数 = 2.75天，招募时标准差 = 2.05，平均年龄 = 69.63岁，标准差 = 11.73）在急性中风护理环境中定期使用GRASP（平均GRASP使用时间 = 28.44分钟/天，标准差 = 20.40，范围 = 10 - 45分钟，中位数 = 15分钟）。患者报告的使用GRASP的感知益处包括“对手有好处”、“使其他工作更容易”和“我得做点什么”。参与者使用GRASP的动机类别包括“让我的手更好”、“能够做我以前做的事情”和“离开这里（医院）”。在组水平上，参与者的CAHAI-9和UL-MAS平均变化分数有临床显著变化。Wilcoxon符号秩检验显示无统计学显著变化。
建议进行一项临床试验，以评估在第一周内为患者提供GRASP的有效性。
