护士主导的同伴支持干预对脑卒中幸存者心理社会结局的影响：一项随机对照试验。

Effects of a nurse-led peer support intervention on psychosocial outcomes of stroke survivors: A randomised controlled trial.

机构信息

School of Nursing, Yangzhou University, 136#, Hanjiang Middle Road, Yangzhou, Jiangsu Province, China.

The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.

出版信息

Int J Nurs Stud. 2024 Dec;160:104892. doi: 10.1016/j.ijnurstu.2024.104892. Epub 2024 Sep 4.

DOI:10.1016/j.ijnurstu.2024.104892

PMID:39303644

Abstract

BACKGROUND

Living with stroke poses many psychosocial challenges. Interventions for improving stroke survivors' psychosocial outcomes are lacking. Peer support interventions may contribute to recovery after stroke. However, current evidence is insufficient to suggest their application in enhancing stroke survivors' psychosocial well-being.

OBJECTIVE

This study aimed to evaluate the effectiveness of a nurse-led peer support intervention for improving the psychosocial outcomes of stroke survivors.

DESIGN

An assessor-blinded two-arm randomised controlled trial with an attention control group.

SETTINGS

A community health centre and a rehabilitation unit in Yangzhou, China.

PARTICIPANTS

First-ever or recurrent ischaemic or haemorrhagic stroke survivors.

METHODS

A convenience sample of 120 stroke survivors was recruited with 60 participants randomly assigned to each of the intervention and control groups. Intervention group participants received the nurse-led peer support intervention. Control group participants received attention care. The primary outcomes were social participation and participation self-efficacy. The secondary outcomes were psychological distress, perceived social support, stigma towards diseases, and quality of life. Data were collected at baseline (T0), immediately post-intervention (T1) and three months post-intervention (T2). Generalised estimating equations models were used to determine the effects of the intervention on the outcomes.

RESULTS

The intervention significantly improved social participation (T1: adjusted mean difference = -18.45, 95 % CI: -22.89 to -14.01, p < 0.001; T2: adjusted mean difference = -14.71, 95 % CI: -22.36 to -7.05, p < 0.001), participation self-efficacy (T1: adjusted mean difference = 47.92, 95 % CI: 37.56 to 58.27, p < 0.001; T2: adjusted mean difference = 39.58, 95 % CI: 17.88 to 61.28, p < 0.001) and perceived social support (T1: adjusted mean difference = 7.56, 95 % CI: 4.93 to 10.19, p < 0.001; T2: adjusted mean difference = 7.41, 95 % CI: 4.01 to 10.80, p < 0.001), and reduced psychological distress (T1: adjusted mean difference = -4.97, 95 % CI: -6.25 to -3.69, p < 0.001; T2: adjusted mean difference = -4.67, 95 % CI: -6.24 to -3.11, p < 0.001) and stigma towards diseases (T1: adjusted mean difference = -3.83, 95 % CI: -5.14 to -2.51, p < 0.001; T2: adjusted mean difference = -3.19, 95 % CI: -5.20 to -1.19, p < 0.001) at both T1 and T2. The intervention significantly improved quality of life at T1 only (adjusted mean difference = 0.12, 95 % CI: 0.06 to 0.19, p = 0.02).

CONCLUSIONS

The results provide empirical support for the effectiveness of the nurse-led peer support intervention in improving the psychosocial outcomes of stroke survivors and provide additional evidence to support their inclusion in stroke rehabilitation.

REGISTRATION

ChiCTR.org.cn (ChiCTR2100050853), Start of recruitment: October 2021.

摘要

背景

中风后会带来许多心理社会挑战。缺乏改善中风幸存者心理社会结局的干预措施。同伴支持干预措施可能有助于中风后康复。然而，目前的证据还不足以表明其在增强中风幸存者的心理社会幸福感方面的应用。

目的

本研究旨在评估护士主导的同伴支持干预措施对改善中风幸存者心理社会结局的有效性。

设计

一项评估者设盲的两臂随机对照试验，设对照组。

设置

中国扬州的社区卫生中心和康复病房。

参与者

首次或复发性缺血性或出血性中风幸存者。

方法

采用便利抽样法招募了 120 名中风幸存者，将 60 名参与者随机分配到干预组和对照组。干预组参与者接受护士主导的同伴支持干预。对照组参与者接受常规护理。主要结局是社会参与和参与自我效能感。次要结局是心理困扰、感知社会支持、对疾病的污名化和生活质量。在基线（T0）、干预后即刻（T1）和干预后 3 个月（T2）收集数据。使用广义估计方程模型确定干预对结局的影响。

结果

干预显著改善了社会参与（T1：调整后的平均差异= -18.45，95%置信区间：-22.89 至-14.01，p<0.001；T2：调整后的平均差异= -14.71，95%置信区间：-22.36 至-7.05，p<0.001）、参与自我效能感（T1：调整后的平均差异= 47.92，95%置信区间：37.56 至 58.27，p<0.001；T2：调整后的平均差异= 39.58，95%置信区间：17.88 至 61.28，p<0.001）和感知社会支持（T1：调整后的平均差异= 7.56，95%置信区间：4.93 至 10.19，p<0.001；T2：调整后的平均差异= 7.41，95%置信区间：4.01 至 10.80，p<0.001），同时降低了心理困扰（T1：调整后的平均差异= -4.97，95%置信区间：-6.25 至-3.69，p<0.001；T2：调整后的平均差异= -4.67，95%置信区间：-6.24 至-3.11，p<0.001）和对疾病的污名化（T1：调整后的平均差异= -3.83，95%置信区间：-5.14 至-2.51，p<0.001；T2：调整后的平均差异= -3.19，95%置信区间：-5.20 至-1.19，p<0.001）在 T1 和 T2 时均有改善。干预仅在 T1 时显著改善了生活质量（调整后的平均差异= 0.12，95%置信区间：0.06 至 0.19，p=0.02）。