Chen Tsen-Pei, Lin Ying-Jia, Wang Yu-Lin, Wu Li-Min, Ho Chung-Han
Department of Nursing, Chi Mei Medical Center, Tainan City, Taiwan.
School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
J Multidiscip Healthc. 2024 Aug 13;17:3945-3956. doi: 10.2147/JMDH.S467777. eCollection 2024.
Stroke survivors in post-acute care frequently experience physiological dysfunction and reduced quality of life. This study aims to assess the impact of the Post-Acute Care Interprofessional Collaborative Practice (PAC-IPCP) program across different care settings, and to identify sensitive tools for assessing physiological functions among post-acute stroke survivors.
This retrospective study involved 210 stroke survivors in Taiwan. Participants who self-selection for their preferred between hospital care setting and home care setting under PAC-IPCP. Multiple assessment tools were utilized, including the Barthel Index (BI), Functional Oral Intake Scale (FOIS), Mini Nutritional Assessment (MNA), EQ-5D-3L, and Instrumental Activities of Daily Living (IADL). The logistic regression was used to estimate the odds ratios of various functional assessment tools between hospital and home care settings. Additionally, the area under the ROC curves was used to determine which functional assessment tools had higher accuracy in measuring the association between care settings.
Of the study population, 138 stroke survivors (65.71%) selection hospital care setting and 72 stroke survivors (34.29%) selection home care setting. The PAC-IPCP program was equally effective in both care settings for physical function status and quality of life improvements. Specifically, the BI emerged as the most sensitive tool for assessing care settings, with an adjusted OR of 1.04 (95% CI:1.02-1.07, p < 0.0001; AUC = 0.7557). IPCP-based hospital and home care models are equally effective in facilitating improved functional outcomes in post-acute stroke survivors.
The PAC-IPCP program is versatile and effective across care settings. The BI stands out as a robust assessment tool for physiological functions, endorsing its broader clinical application. Future studies should also consider swallowing and nutritional status for a more holistic approach to rehabilitation.
急性后期护理中的中风幸存者经常经历生理功能障碍和生活质量下降。本研究旨在评估急性后期护理跨专业协作实践（PAC - IPCP）项目在不同护理环境中的影响，并确定用于评估急性后期中风幸存者生理功能的敏感工具。
这项回顾性研究涉及台湾的210名中风幸存者。参与者在PAC - IPCP下自行选择其偏好的医院护理环境或家庭护理环境。使用了多种评估工具，包括巴氏指数（BI）、功能性口服摄入量量表（FOIS）、微型营养评定量表（MNA）、EQ - 5D - 3L和日常生活活动能力量表（IADL）。采用逻辑回归来估计医院和家庭护理环境之间各种功能评估工具的比值比。此外，使用ROC曲线下面积来确定哪些功能评估工具在测量护理环境之间的关联时具有更高的准确性。
在研究人群中，138名中风幸存者（65.71%）选择医院护理环境，72名中风幸存者（34.29%）选择家庭护理环境。PAC - IPCP项目在改善身体功能状态和生活质量方面，在两种护理环境中同样有效。具体而言，BI成为评估护理环境最敏感的工具，调整后的比值比为1.04（95%置信区间：1.02 - 1.07，p < 0.0001；AUC = 0.7557）。基于IPCP的医院和家庭护理模式在促进急性后期中风幸存者功能改善方面同样有效。
PAC - IPCP项目在不同护理环境中具有通用性和有效性。BI作为一种强大的生理功能评估工具脱颖而出，支持其更广泛的临床应用。未来的研究还应考虑吞咽和营养状况，以采取更全面的康复方法。
