School of Public Health, Shandong Second Medical University, Weifang 261053, China.
School of Medicine, University College Cork, Cork T12YF78, Ireland.
Geriatr Nurs. 2024 May-Jun;57:80-90. doi: 10.1016/j.gerinurse.2024.03.004. Epub 2024 Apr 9.
Long-term rehabilitation of stroke survivors is often difficult and new tools to improve quality of life should be proposed. Community nursing can be a cost-effective tool to positively impact the lives of stroke survivors. This meta-analysis aimed to comprehensively evaluate the effects of community nursing on rehabilitation for stroke survivors.
The Cochrane Library, PubMed, Web of Science, CINAHL Plus, Embase, PEDro, China Knowledge Resource Integrated Database (CNKI), WANFANG, and WEIPU databases were comprehensively searched from their inception to April 18, 2023. The revised Cochrane risk-of-bias tool for RCTs(RoB 2 tool) was used to assess the quality of the included studies. Meta-analysis was conducted using the Stata 12.0 software package and Review Manager v5.3 software.
A total of 25 randomized controlled trials with 2537 participants were included in the meta-analysis. Compared with the control group, community nursing combined with routine nursing had a significantly superior effect on the Barthel Index(BI), Fugl-Meyer(FMA), National Institutes of Health Stroke Scale(NIHSS), Self-rating Anxiety Scale(SAS), and Self-rating Depression Scale(SDS) scores for stroke survivors (BI: MD: 18.48, 95 % CI [16.87, 20.08], P < 0.00001; FMA: MD: 12.61, 95 % CI [10.44, 14.78], P < 0.00001; NIHSS: MD: -2.94, 95 % CI [-3.50, -2.37], P < 0.00001; SAS: MD: -8.19; 95 % CI: [-9.46, -6.92], P < 0.00001; SDS: MD: -6.46 95 % CI [-7.23, -5.70], P < 0.00001). Subgroup analysis demonstrated that routine nursing, health education, exercise rehabilitation nursing and psychological nursing combined with different community nursing measures were significant in rehabilitation for stroke survivors and there was no heterogeneous in the studies of each subgroup(P > 0.1, I < 50 %).
This meta-analysis demonstrated that community nursing combined with routine nursing might improve activities of daily living, motor function and nerve function, and relieve anxiety and depression in stroke survivors. Overall, community nursing had a significant effect on rehabilitation of stroke survivors. However, this study still has limitations such as the overestimation effects caused by the sample size and the risk of bias caused by interventions. Future research will attempt to overcome these limitations and comprehensively assess the effect of community nursing on the rehabilitation of stroke survivors.
脑卒中幸存者的长期康复往往较为困难，因此应提出新的工具来提高其生活质量。社区护理可以成为一种具有成本效益的工具，对脑卒中幸存者的生活产生积极影响。本荟萃分析旨在全面评估社区护理对脑卒中幸存者康复的影响。
系统检索了 Cochrane 图书馆、PubMed、Web of Science、CINAHL Plus、Embase、PEDro、中国知识资源总库（CNKI）、万方数据库和维普数据库，检索时间均从建库至 2023 年 4 月 18 日。使用 Cochrane 偏倚风险评估工具（修订版 2 工具）（RoB 2 工具）评估纳入研究的质量。使用 Stata 12.0 软件包和 Review Manager v5.3 软件进行荟萃分析。
共纳入 25 项随机对照试验，共 2537 名参与者。与对照组相比，社区护理联合常规护理对脑卒中幸存者的巴氏指数（BI）、Fugl-Meyer 运动功能评估量表（FMA）、国立卫生研究院卒中量表（NIHSS）、焦虑自评量表（SAS）和抑郁自评量表（SDS）评分的改善效果更为显著（BI：MD：18.48，95%CI[16.87，20.08]，P<0.00001；FMA：MD：12.61，95%CI[10.44，14.78]，P<0.00001；NIHSS：MD：-2.94，95%CI[-3.50，-2.37]，P<0.00001；SAS：MD：-8.19；95%CI[-9.46，-6.92]，P<0.00001；SDS：MD：-6.46，95%CI[-7.23，-5.70]，P<0.00001）。亚组分析表明，常规护理、健康教育、运动康复护理和心理护理联合不同的社区护理措施对脑卒中幸存者的康复均有显著效果，且各亚组研究之间无异质性（P>0.1，I<50%）。
本荟萃分析表明，社区护理联合常规护理可能改善脑卒中幸存者的日常生活活动能力、运动功能和神经功能，并缓解其焦虑和抑郁情绪。总体而言，社区护理对脑卒中幸存者的康复具有显著效果。然而，本研究仍存在一些局限性，如样本量过大导致的效果高估以及干预措施带来的偏倚风险。未来的研究将尝试克服这些局限性，并全面评估社区护理对脑卒中幸存者康复的影响。
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