Schnabel Stefanie, van Wijck Frederike, Kidd Lisa
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
Alice Salomon University of Applied Sciences Berlin, Alice-Salomon-Platz, Berlin, Germany.
Front Neurol. 2023 Jun 2;14:1089547. doi: 10.3389/fneur.2023.1089547. eCollection 2023.
This study explored what worked for whom, how and under what circumstances in a community-based augmented arm rehabilitation programme that was designed to enable stroke survivors to meet their personal rehabilitation needs.
A mixed methods realist-informed study of data from a randomised controlled feasibility trial, comparing augmented arm rehabilitation after stroke with usual care. The analysis was designed to develop initial programme theories and refine these through triangulation of qualitative and quantitative trial data. Participants with a confirmed stroke diagnosis and stroke-related arm impairment were recruited from five health boards in Scotland. Only data from participants in the augmented group were analysed. The augmented intervention comprised evidence-based arm rehabilitation (27 additional hours over 6 weeks) including self-managed practice, and focused on individual rehabilitation needs identified through the Canadian Occupational Performance Measure (COPM). The COPM indicated to which extent rehabilitation needs were met following the intervention, the Action Research Arm Test provided data on changes in arm function, and qualitative interviews provided information about the context and potential mechanisms of action.
Seventeen stroke survivors (11 males, age range 40-84 years, NIHSS median (IQR) 6 (8)) were included. Median (IQR) COPM Performance and Satisfaction scores (min.1-max.10) improved from pre-intervention 2 (5) to post-intervention 5 (7). Findings suggested that meeting rehabilitation needs was facilitated by strengthening participants' sense of intrinsic motivation (through grounding exercises in everyday activities linked to valued life roles, and enabling them to overcome barriers to self-managed practice), and via therapeutic relationships (through trust and expertise, shared decision-making, encouragement and emotional support). Collectively, these mechanisms enabled stroke survivors to build confidence and gain mastery experience necessary to engage in new self-managed practice routines.
This realist-informed study enabled the development of initial programme theories to explain how and in what circumstances the augmented arm rehabilitation intervention may have enabled participants to meet their personal rehabilitation needs. Encouraging participants' sense of intrinsic motivation and building therapeutic relationships appeared instrumental. These initial programme theories require further testing, refinement, and integration with the wider literature.
本研究探讨了在一项基于社区的强化上肢康复计划中，什么方法对谁有效、如何有效以及在何种情况下有效。该计划旨在使中风幸存者能够满足其个人康复需求。
一项基于现实主义的混合方法研究，数据来自一项随机对照可行性试验，比较中风后的强化上肢康复与常规护理。该分析旨在建立初步的项目理论，并通过定性和定量试验数据的三角验证来完善这些理论。从苏格兰的五个健康委员会招募了确诊为中风且有中风相关上肢损伤的参与者。仅对强化组参与者的数据进行了分析。强化干预包括循证上肢康复（6周内额外增加27小时），包括自我管理练习，并侧重于通过加拿大职业表现测量量表（COPM）确定的个人康复需求。COPM表明干预后康复需求得到满足的程度，行动研究上肢测试提供了上肢功能变化的数据，定性访谈提供了有关背景和潜在作用机制的信息。
纳入了17名中风幸存者（11名男性，年龄范围40 - 84岁，美国国立卫生研究院卒中量表（NIHSS）中位数（四分位间距）为6（8））。COPM表现和满意度得分的中位数（四分位间距）（最小值1 - 最大值10）从干预前的2（5）提高到干预后的5（7）。结果表明，通过增强参与者的内在动机会（通过将日常活动中的基础练习与有价值的生活角色联系起来，并使他们能够克服自我管理练习的障碍）以及通过治疗关系（通过信任和专业知识、共同决策、鼓励和情感支持），有助于满足康复需求。总体而言，这些机制使中风幸存者能够建立信心并获得参与新的自我管理练习常规所需的掌握经验。
这项基于现实主义的研究能够建立初步的项目理论，以解释强化上肢康复干预如何以及在何种情况下使参与者能够满足其个人康复需求。鼓励参与者的内在动机会和建立治疗关系似乎起到了重要作用。这些初步的项目理论需要进一步测试、完善，并与更广泛的文献进行整合。
