Lo Suzanne Hoi Shan, Chau Janita Pak Chun, Choi Kai Chow, Shum Edward Wai Ching, Yeung Jonas Hon Ming, Li Siu Hung
The Nethersole School of Nursing, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
New Territories East Cluster, Hospital Authority, Hong Kong SAR, China.
BMC Neurol. 2021 Jan 4;21(1):3. doi: 10.1186/s12883-020-02015-5.
Stroke in adults aged between 18 and 64 years old is increasing significantly worldwide. Studies have reported that this group of young stroke survivors encounters enormous difficulties reintegrating into their social roles. Individualised discussions with healthcare professionals and learning from other survivors are imperative for them to reconstruct their identities after stroke. There is also great demand for community support during their chronic stage of recovery to help them rebuild life skills to promote reintegration.
METHODS/DESIGN: This is a randomised controlled trial to investigate the effects of a 24-week Narrative and Skills-building Intervention (NSI) on young stroke survivors' community reintegration and psychosocial outcomes. A total of 208 adults aged 18-64 years old with a first-ever or recurrent ischaemic or haemorrhagic stroke and have been discharged home will be recruited and randomly assigned to receive usual care or usual care with NSI. The NSI is grounded in Narrative Theory and Bandura's principles of Self-efficacy and Outcome Expectation, consisting of successive eight individual sessions over six months delivered by a trained facilitator (a registered nurse). Participants will be facilitated to narrate their survival experiences and rebuild core life skills. Videos of peer young stroke survivors' experiences of recovery will be provided. Outcomes including community reintegration, depressive symptoms, health-related quality of life, self-efficacy, outcome expectation and satisfaction with performance of self-management behaviours will be measured before (T0) and immediately after NSI (T1), then six (T2) and 12 months after NSI (T3). Generalised estimating equations models will be used to compare the differential changes in outcomes across time between the two groups. Focus group interviews will be conducted with the facilitator at T1 and with the participants in the intervention group at T1 and T3.
This study will evaluate the short and long-term effects of a theory-based NSI on young stroke survivors' community reintegration and establish a new model of community reintegration after stroke to inform future research. The results will also provide valuable evidence to develop clinical guidelines for young stroke survivors' community reintegration.
ClinicalTrials.gov identifier: NCT04560140 , registered on 23 September, 2020.
在全球范围内，18至64岁成年人的中风发病率正在显著上升。研究报告称，这群年轻的中风幸存者在重新融入社会角色方面面临巨大困难。与医疗保健专业人员进行个性化讨论并向其他幸存者学习，对于他们中风后重建身份至关重要。在他们的慢性康复阶段，对社区支持也有很大需求，以帮助他们重建生活技能，促进重新融入社会。
方法/设计：这是一项随机对照试验，旨在研究为期24周的叙事与技能培养干预（NSI）对年轻中风幸存者社区重新融入及心理社会结局的影响。总共将招募208名年龄在18 - 64岁之间、首次或复发性缺血性或出血性中风且已出院回家的成年人，并随机分配接受常规护理或常规护理加NSI。NSI基于叙事理论以及班杜拉的自我效能感和结果期望原则，由一名经过培训的主持人（一名注册护士）在六个月内连续进行八次个人辅导课程。将促使参与者讲述他们的生存经历并重建核心生活技能。还将提供同龄年轻中风幸存者康复经历的视频。将在NSI之前（T0）、NSI刚结束后（T1）、然后在NSI后六个月（T2）和12个月（T3）测量包括社区重新融入、抑郁症状、健康相关生活质量、自我效能感、结果期望以及对自我管理行为表现的满意度等结局。将使用广义估计方程模型来比较两组在不同时间点结局的差异变化。将在T1与主持人进行焦点小组访谈，并在T1和T3与干预组的参与者进行焦点小组访谈。
本研究将评估基于理论的NSI对年轻中风幸存者社区重新融入的短期和长期影响，并建立一种中风后社区重新融入的新模式，为未来研究提供参考。研究结果还将为制定年轻中风幸存者社区重新融入的临床指南提供有价值的证据。
ClinicalTrials.gov标识符：NCT04560140，于2020年9月23日注册。
