养老院中运动导向式康复护理的实施与效果——一项准实验研究。
Implementation and effects of Movement-oriented Restorative Care in a nursing home - a quasi-experimental study.
机构信息
Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands.
Department of Neurology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
出版信息
BMC Geriatr. 2017 Oct 23;17(1):243. doi: 10.1186/s12877-017-0642-x.
BACKGROUND
The prevalence of dementia is expected to increase rapidly, and institutionalization is a common consequence of the disease. Dependence in activities of daily living (ADL) is a predictor for institutionalization and a determinant for the quality of life (QoL). A promising method to increase functional independence in nursing homes is a restorative care or function focused care (FFC) approach. Movement-oriented restorative care (MRC) is derived from the concept of FFC and restorative care and focuses on the integration of physical activity in the daily lives of nursing home residents with dementia using a multidisciplinary approach. The objective of this study was to assess the effectiveness of MRC in preservation of ADL independence and QoL in nursing home residents with dementia.
METHODS
In this quasi-experimental 12-month study, the effects of MRC were compared to care as usual in 61 nursing home residents with moderate to severe dementia. The outcome measures were ADL independence and QoL. These outcomes were measured five times (i.e. at baseline, and after 3, 6, 9, and 12 months). Additionally, data was collected regarding the degree of implementation, and the barriers to the implementation process. The effect of the intervention was analyzed using linear mixed model analyses.
RESULTS
There was no significant overall intervention effect on ADL independence and QoL. A significant group-by-time interaction was found for the QoL subscale positive self-image: after a 12 month intervention period, the MRC group scored significantly better than the control group on positive self-image. Regarding the other subscales and the total score of the QoL, as well as ADL, no significant group-by-time interactions were found.
CONCLUSIONS
MRC did not demonstrate significant improvements in ADL or QoL. After a 12-month intervention period, residents who received MRC showed higher scores on positive self-image compared to the control group. This study contributes to the limited research regarding the effect of MRC on resident outcomes. Further large-scale studies are recommended.
TRIAL REGISTRATION
The trial was retrospectively registered in http://clinicaltrials.gov on February 2, 2017: NCT03001232 .
背景
痴呆症的患病率预计将迅速增加，而机构化是该疾病的常见后果。日常生活活动（ADL）的依赖是机构化的预测因素，也是生活质量（QoL）的决定因素。提高疗养院中功能独立性的一种有前途的方法是恢复性护理或功能为重点的护理（FFC）方法。以运动为导向的恢复性护理（MRC）源自 FFC 和恢复性护理的概念，侧重于使用多学科方法将身体活动融入患有痴呆症的疗养院居民的日常生活中。本研究的目的是评估 MRC 在保留患有痴呆症的疗养院居民的 ADL 独立性和 QoL 方面的有效性。
方法
在这项为期 12 个月的准实验研究中，将 MRC 的效果与常规护理进行了比较，共有 61 名中度至重度痴呆的疗养院居民参与了研究。主要观察指标为 ADL 独立性和 QoL。这些结果在 5 次测量时（即基线时以及 3、6、9 和 12 个月后）进行测量。此外，还收集了有关实施程度和实施过程障碍的数据。使用线性混合模型分析来分析干预效果。
结果
ADL 独立性和 QoL 方面没有显示出整体干预效果。在干预 12 个月后，在 QoL 的积极自我形象亚量表中发现了显著的组间时间交互作用：MRC 组的评分明显优于对照组。在其他亚量表和 QoL 的总分以及 ADL 方面，未发现显著的组间时间交互作用。
结论
MRC 并未显示出在 ADL 或 QoL 方面有显著改善。在 12 个月的干预期后，接受 MRC 的居民在积极自我形象方面的得分高于对照组。这项研究为 MRC 对居民结果的影响方面的有限研究做出了贡献。建议开展进一步的大规模研究。
试验注册
该试验于 2017 年 2 月 2 日在 http://clinicaltrials.gov 进行了回顾性注册：NCT03001232。
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