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中风后肢体功能障碍康复护理的进展

Advances in nursing care for post-stroke limb dysfunction rehabilitation.

作者信息

Bai Jie, Chen Kecheng

机构信息

Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.

出版信息

Front Neurol. 2025 Jul 24;16:1615500. doi: 10.3389/fneur.2025.1615500. eCollection 2025.

Abstract

Stroke-induced limb dysfunction has a significant impact on patients' functional independence and quality of life. While rehabilitation efficacy depends largely on patient motivation, psychological factors often impede treatment adherence and functional recovery. This narrative review synthesizes current evidence on psychological factors affecting rehabilitation motivation, assessment tools, and evidence-based interventions for stroke patients with limb dysfunction. Psychological barriers, including kinesiophobia, diminished self-efficacy, perceived burden, and inadequate social support, significantly predict rehabilitation outcomes. Clinically validated assessment tools demonstrate variable utility across recovery phases, with the Pittsburgh Rehabilitation Participation Scale offering efficiency in acute settings and the Motivation in Stroke Patients for Rehabilitation Scale providing comprehensive evaluation during subacute and chronic phases. Evidence supports multimodal intervention strategies that combine psychological approaches (such as motivational interviewing) with technological innovations (virtual reality, game-based therapy, wearable devices). Clinical implementation should prioritize early psychological screening within 72 h of admission, followed by integrated assessment protocols combining clinician-rated and self-report measures. Furthermore, personalized motivation enhancement protocols tailored to patients' cognitive status and recovery phase, along with robust interdisciplinary collaboration between rehabilitation nurses, physical therapists, and psychologists, are essential. Ultimately, this integrated approach optimizes rehabilitation outcomes by comprehensively addressing both physical and psychological dimensions of stroke recovery. In the future, studies should emphasize multidimensional analyses that incorporate individual patient characteristics to develop precise rehabilitation interventions, thereby proposing new strategies for optimizing functional recovery in stroke survivors.

摘要

中风引起的肢体功能障碍对患者的功能独立性和生活质量有重大影响。虽然康复效果很大程度上取决于患者的积极性,但心理因素常常阻碍治疗依从性和功能恢复。本叙述性综述综合了当前关于影响康复动机的心理因素、评估工具以及针对肢体功能障碍中风患者的循证干预措施的证据。心理障碍,包括运动恐惧、自我效能感降低、感知负担和社会支持不足,显著预测康复结果。经过临床验证的评估工具在不同恢复阶段显示出不同的效用,匹兹堡康复参与量表在急性环境中具有高效性,而中风患者康复动机量表在亚急性和慢性阶段提供全面评估。有证据支持将心理方法(如动机性访谈)与技术创新(虚拟现实、游戏疗法、可穿戴设备)相结合的多模式干预策略。临床实施应优先在入院72小时内进行早期心理筛查,随后采用结合临床医生评分和自我报告措施的综合评估方案。此外,根据患者的认知状态和恢复阶段量身定制的个性化动机增强方案,以及康复护士、物理治疗师和心理学家之间强大的跨学科合作至关重要。最终,这种综合方法通过全面解决中风恢复的身体和心理层面问题来优化康复结果。未来,研究应强调纳入个体患者特征的多维度分析,以制定精确的康复干预措施,从而为优化中风幸存者的功能恢复提出新策略。

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