亚急性卒中患者康复的动机:一项定性研究。

Motivation for Rehabilitation in Patients With Subacute Stroke: A Qualitative Study.

作者信息

Yoshida Taiki, Otaka Yohei, Osu Rieko, Kumagai Masashi, Kitamura Shin, Yaeda Jun

机构信息

Tokyo Bay Rehabilitation Hospital, Narashino, Japan.

Graduate School of Human Sciences, Waseda University, Tokorozawa, Japan.

出版信息

Front Rehabil Sci. 2021 Jun 7;2:664758. doi: 10.3389/fresc.2021.664758. eCollection 2021.

Abstract

Motivation is essential for patients with subacute stroke undergoing intensive rehabilitation. Although it is known that motivation induces behavioral changes toward rehabilitation, detailed description has been lacking. Motivation can be intrinsic or extrinsic; however, it is unclear which type of factors mainly motivates patients' daily rehabilitation. This study aimed to examine the factors influencing patients' motivation and to explore the behavioral changes induced by motivation, especially age-related differences. Twenty participants (mean age 65.8 years [standard deviation 13.7]) who had a subacute stroke and underwent rehabilitation at a convalescent hospital were recruited using convenience sampling. Semi-structured interviews were conducted by an occupational therapist with an interview topic guide regarding factors influencing motivation and how it affects behavioral change. Interviews were recorded, transcribed to text, and analyzed by three occupational therapists using thematic analysis. The participants were divided into two groups: aged patients (aged ≥ 65 years) and middle-aged patients (aged < 65 years), and data were analyzed according to the groups. This study was conducted according to the consolidated criteria for reporting qualitative research. Seven core categories were identified as factors influencing patients' motivation: patients' goals, experiences of success and failure, physical condition and cognitive function, resilience, influence of rehabilitation professionals, relationships between patients, and patients' supporters. The first four and last three core categories were further classified as personal and social-relationship factors, respectively. The categories related to intrinsic motivation such as enjoyment of rehabilitation itself were not derived. In both age-groups, motivation affected the frequency of self-training and activity in daily lives. In some aged patients, however, high motivation restrained their self-training to conserve their physical strength for rehabilitation by professionals. Some aged patients do not express their high motivation through their facial expressions and conversations compared to middle-aged patients; therefore, motivation is not always observable in aged patients. Interventions tailored to extrinsic factors are important for maintaining patients' motivation. Observational evaluation may lead to mislabeling of their motivation, especially for aged patients. Rehabilitation professionals should use validated evaluation scales or patients' narratives to assess patients' motivation.

摘要

动机对于接受强化康复治疗的亚急性中风患者至关重要。尽管已知动机可促使患者在康复过程中产生行为改变,但对此缺乏详细描述。动机可分为内在动机和外在动机;然而,尚不清楚哪种类型的因素主要促使患者进行日常康复。本研究旨在探讨影响患者动机的因素,并探究动机引发的行为改变,尤其是年龄相关差异。采用便利抽样法招募了20名患有亚急性中风且在康复医院接受康复治疗的参与者(平均年龄65.8岁[标准差13.7])。由一名职业治疗师依据一份关于影响动机的因素及其如何影响行为改变的访谈主题指南,进行半结构化访谈。访谈进行录音,转录成文本,并由三名职业治疗师采用主题分析法进行分析。参与者被分为两组:老年患者(年龄≥65岁)和中年患者(年龄<65岁),并按组对数据进行分析。本研究依据定性研究报告的统一标准开展。确定了七个核心类别作为影响患者动机的因素:患者的目标、成败经历、身体状况和认知功能、恢复力、康复专业人员的影响、患者之间的关系以及患者的支持者。前四个和后三个核心类别分别进一步归类为个人因素和社会关系因素。未得出与内在动机相关的类别,例如对康复本身的享受。在两个年龄组中,动机均影响自我训练的频率和日常生活中的活动。然而,在一些老年患者中,高度的动机限制了他们的自我训练,以便为专业人员的康复治疗保存体力。与中年患者相比,一些老年患者在面部表情和交谈中未表现出高度的动机;因此,动机在老年患者中并不总是可观察到的。针对外在因素的干预措施对于维持患者的动机很重要。观察性评估可能导致对其动机的错误判断,尤其是对于老年患者。康复专业人员应使用经过验证的评估量表或患者的叙述来评估患者的动机。

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