老年脑卒中患者家庭锻炼依从性的影响因素：一项多视角定性研究。
Influencing factors of home exercise adherence in elderly patients with stroke: A multiperspective qualitative study.
作者信息
Zhang Yuanxing, Qiu Xichenhui, Jin Qiansheng, Ji Cuiling, Yuan Ping, Cui Mengjiao, Zhang Juanjuan, Chen Lu
机构信息
Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
出版信息
Front Psychiatry. 2023 Apr 5;14:1157106. doi: 10.3389/fpsyt.2023.1157106. eCollection 2023.
INTRODUCTION
Evidence has shown that stroke exercise rehabilitation is the most effective way to improve disease prognosis, but home exercise adherence in elderly patients with stroke is low due to they are more likely to have movement disorders, cognitive disorders, mental disorders, etc. Currently, most studies on exercise adherence in elderly patients with stroke are quantitative, and there is a lack of qualitative studies from the perspective of patients, caregivers, and medical staff. Considering the importance of home exercise adherence in elderly patients with stroke, the present study aimed to explore the influencing factors of home exercise adherence in them and summarize the potential ways to improve it.
METHODS
From October to December 2022, 9 medical staff, 12 elderly patients with stroke and 7 caregivers from a level A tertiary hospital and community health service center in Nanjing, Jiangsu Province were selected by the purposive sampling and were interviewed in a face-to-face semi-structured way. The data were analyzed and summarized by the phenomenological analysis of Colaizzi's method.
RESULTS
The influencing factors of home exercise adherence in elderly patients with stroke can be summarized into 3 themes and 8 subthemes. These were individual factors (physical impairment, exercise self-efficacy, and depression), family factors (caregiving ability and emotional support); and stroke rehabilitation environment (exercise prescription, monitoring and feedback, and organizational policy).
CONCLUSION
Home exercise adherence in elderly patients with stroke was influenced by many factors. Medical staff should assess the patient's physical function and depression, establish a multi-support system, formulate personalized exercise prescription, pay attention to the monitoring and feedback of home-based exercise rehabilitation, and improve the home-based rehabilitation model for stroke, so as to improve the home exercise adherence in elderly patients with stroke and promote the best rehabilitation effect.
引言
有证据表明，中风运动康复是改善疾病预后的最有效方法，但老年中风患者的家庭锻炼依从性较低，因为他们更有可能出现运动障碍、认知障碍、精神障碍等。目前，大多数关于老年中风患者运动依从性的研究都是定量研究，缺乏从患者、照顾者和医务人员角度进行的定性研究。考虑到家庭锻炼依从性对老年中风患者的重要性，本研究旨在探讨其家庭锻炼依从性的影响因素，并总结提高依从性的潜在方法。
方法
2022年10月至12月，采用目的抽样法，选取江苏省南京市某三级甲等医院和社区卫生服务中心的9名医务人员、12名老年中风患者和7名照顾者，进行面对面半结构式访谈。采用Colaizzi现象学分析法对数据进行分析和总结。
结果
老年中风患者家庭锻炼依从性的影响因素可归纳为3个主题和8个子主题。这些因素包括个体因素（身体损伤、运动自我效能感和抑郁）、家庭因素（照顾能力和情感支持）；以及中风康复环境（运动处方、监测与反馈、组织政策）。
结论
老年中风患者的家庭锻炼依从性受多种因素影响。医务人员应评估患者的身体功能和抑郁情况，建立多支持系统，制定个性化运动处方，关注家庭运动康复的监测与反馈，完善中风家庭康复模式，以提高老年中风患者的家庭锻炼依从性，促进最佳康复效果。
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