School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing 400016, China.
School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing 400016, China.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105382. doi: 10.1016/j.jstrokecerebrovasdis.2020.105382. Epub 2020 Oct 20.
Stroke rehabilitation was seriously inadequate in rural regions of China. This study aimed to evaluate the feasibility of a novel nurse-trained, family member-delivered rehabilitation model for disabled stroke patients in rural southwest China.
A single-center randomized controlled trial was conducted at a rural county hospital in Chongqing, China. Eligible stroke patients were randomly assigned to an intervention group or to a control group. In the intervention group, patients and their caregivers received stroke rehabilitation training focusing on mobility, self-care, and toileting delivered by trained nurses before discharge, and 3 post-discharge telephone calls at 2nd, 4th, and 8th week. The control group received routine care. The primary outcome was functional independence indicating by Barthel Index (BI) scores, and secondary outcomes included health-related quality of life (EuroQol five dimensions questionnaire, EQ-5D) and caregiver burden (Caregiver Burden Inventory, CBI). Outcome assessment was carried out at pre-discharge, 3- and 6-months after discharge.
A total of 61 stroke patients were recruited and randomly assigned to the intervention group (n=31) or the control group (n = 30). Compared with that in the control group, BI increased more at 3 months and decreased less at 6 months in the intervention group, there was a significant difference in mean BI scores across the three time points (F = 21.96, p = 0.0001), but no significant between-group difference (F = 0.94, p = 0.3371). In the intervention group, BI scores at 3-and 6-months post-discharge were higher than that before discharge (t = 8.38, p = 0.0001; t = 4.14, p = 0.0003). In the control group, BI scores at 3 months were higher than that before discharge (t = 5.29, p = 0.0001), but no significant difference at 6 months. At 6 months post-discharge, the intervention group and the control group had similar EQ-5D scores (p = 0.91), and similar CBI scores (3.67 vs 3.68, p = 0.98).
The study showed that the novel nurse-trained, family member-delivered rehabilitation model improved physical recovery indicated by BI scores without increasing caregiver burden, compared to usual care, for rural stroke patients in southwest China.
中国农村地区的脑卒中康复治疗严重不足。本研究旨在评估一种新型的由护士培训、家庭成员提供的康复模式，用于治疗中国西南部农村地区的残疾脑卒中患者的可行性。
这是一项在重庆市某农村县级医院进行的单中心随机对照试验。符合条件的脑卒中患者被随机分配到干预组或对照组。在干预组中，患者及其照顾者在出院前接受由经过培训的护士提供的侧重于移动能力、自理能力和如厕能力的脑卒中康复培训，以及出院后第 2、4 和 8 周的 3 次电话随访。对照组接受常规护理。主要结局是采用 Barthel 指数（BI）评分评估的功能独立性，次要结局包括健康相关生活质量（EuroQol 五维问卷，EQ-5D）和照顾者负担（照顾者负担量表，CBI）。在出院前、出院后 3 个月和 6 个月进行结局评估。
共纳入 61 例脑卒中患者，随机分为干预组（n=31）或对照组（n=30）。与对照组相比，干预组在出院后 3 个月时 BI 增加更多，6 个月时 BI 减少更少，3 个时间点的平均 BI 评分存在显著差异（F=21.96，p=0.0001），但组间差异无统计学意义（F=0.94，p=0.3371）。在干预组中，出院后 3 个月和 6 个月的 BI 评分均高于出院前（t=8.38，p=0.0001；t=4.14，p=0.0003）。在对照组中，出院后 3 个月的 BI 评分高于出院前（t=5.29，p=0.0001），但出院后 6 个月时无显著差异。出院后 6 个月时，干预组和对照组的 EQ-5D 评分相似（p=0.91），CBI 评分相似（3.67 分比 3.68 分，p=0.98）。
与常规护理相比，该研究表明，新型的由护士培训、家庭成员提供的康复模式可改善 BI 评分所反映的身体康复情况，且不会增加照顾者负担，适用于中国西南部农村地区的脑卒中患者。
