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基于教练的远程作业指导对居家脑卒中幸存者及其家庭照护者的效果:一项先导随机对照试验。

Effects of Coaching-Based Teleoccupational Guidance for Home-Based Stroke Survivors and Their Family Caregivers: A Pilot Randomised Controlled Trial.

机构信息

Graduate School, Hebei Medical University, Shijiazhuang 050051, China.

Department of Rehabilitation Medicine, Hebei General Hospital, Shijiazhuang 050051, China.

出版信息

Int J Environ Res Public Health. 2022 Dec 6;19(23):16355. doi: 10.3390/ijerph192316355.

Abstract

The aim of this pilot study was to investigate the feasibility and effectiveness of a 3-month coaching-based teleoccupational guidance (CTG) programme for home-based stroke survivors and their family caregivers. An assessor-blind pilot randomised controlled study was conducted. Twenty-five participant dyads (each dyad consisted of one home-based stroke patient and their caregivers) were randomised to a control group (RTG, = 12) or an experimental group (CTG, = 13). Participant dyads in the RTG group received routine teleoccupational guidance. Participant dyads in the CTG group received a six-step procedure: coaching-based teleoccupational guidance over 3 months via WeChat. Participant dyad compliance, the difficulty and suitability of outcome measures, and adverse effects were used to assess feasibility. The Reintegration to Normal Living Index, the Lawton Instructive Activities of Daily Life (Lawton IADL) scale, the Intrinsic Motivation Inventory, the Fugl-Meyer Assessment-Upper Extremity scale, the 6 min walking test, and the Stroke-Specific Quality of Life Scale were used to assess effectiveness outcomes of home-based stroke survivors; the Caregiver Benefit Finding Scale and the Zarit Caregiver Burden Interview were used to assess the effectiveness outcomes of family caregivers. Feasibility measures were assessed at the end of the pilot trial, and effectiveness measures were evaluated pre-intervention and post-intervention (after 3 months). The CTG programme significantly improved home-based stroke survivors' participation in daily life, IADL score, and intrinsic motivation, and increased caregivers' perceived benefit, and tended (not significantly) to reduce care burden. CTG has the potential to promote better integration of home-based stroke patients into their families and society, improve their quality of life and family well-being, and provide a reference for home rehabilitation of other clinical chronic diseases. CTG is a safe, effective, and promising intervention for home-based stroke populations and their caregivers and warrants further investigation in a larger randomised controlled trial.

摘要

本研究旨在探索为期 3 个月的基于教练的远程职业指导(CTG)计划对居家脑卒中幸存者及其家庭照顾者的可行性和有效性。采用盲法评估的前瞻性随机对照研究。共纳入 25 对参与者(每对包括 1 名居家脑卒中患者及其照顾者),随机分为对照组(RTG,n = 12)和实验组(CTG,n = 13)。RTG 组接受常规远程职业指导,CTG 组则接受六步 CTG:通过微信进行为期 3 个月的基于教练的远程职业指导。通过参与者对方案的依从性、结局测量的难度和适宜性以及不良事件等来评估可行性。采用日常生活活动能力量表(Reintegration to Normal Living Index,RNI)、洛文斯顿日常生活活动量表(Lawton Instructive Activities of Daily Life Scale,Lawton IADL)、内在动机量表(Intrinsic Motivation Inventory,IMI)、Fugl-Meyer 上肢运动功能评估量表(Fugl-Meyer Assessment-Upper Extremity scale,FMA-UE)、6 分钟步行测试(6 min walking test,6MWT)和脑卒中患者生活质量量表(Stroke-Specific Quality of Life Scale,SS-QOL)评估居家脑卒中幸存者的有效性结局,采用照顾者受益发现量表(Caregiver Benefit Finding Scale,CBFS)和照顾者负担量表(Zarit Caregiver Burden Interview,ZBI)评估家庭照顾者的有效性结局。在研究结束时评估可行性指标,在干预前和干预后(3 个月后)评估有效性指标。与 RTG 组相比,CTG 组显著改善了居家脑卒中幸存者的日常生活参与度、IADL 评分和内在动机,增加了照顾者的受益感,且有降低照顾负担的趋势(但无统计学意义)。CTG 可能促进居家脑卒中患者更好地融入家庭和社会,提高其生活质量和家庭幸福感,为其他临床慢性病的居家康复提供参考。CTG 是一种安全、有效且有前途的居家脑卒中患者及其照顾者的干预措施,值得进一步在更大规模的随机对照试验中进行研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e43/9739622/be4d8e8d8861/ijerph-19-16355-g001.jpg

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