基于优化运动技巧的卒中偏瘫患者居家康复训练的短期及长期效果  

The short-term and long-term efficacy of home-based rehabilitation training on optimizing motor performance for stroke patients with hemiplegia

作　　者：王海鹏 姚晓东[2] 刘鹏 马慧萍[4] 李智[4] 胡风云[4] 秦昭[4] WANG Haipeng;YAO Xiaodong;LIU Peng;MA Huiping;LI Zhi;HU Fengyun;QIN Zhao(The Fifth Clinical Medical College of Shanxi Medical University,Taiyuan 030012,China;The Fifth Clinical Medical College of Shanxi Medical University Shanxi Provincial People’s Hospital,Taiyuan 030012,China;Linfen Orthopedic Hospital,Linfen 041099,China;Shanxi Provincial People’s Hospital,Taiyuan 030012,China)

机构地区：[1]山西医科大学第五临床医学院,山西太原030012 [2]山西医科大学第五临床医学院山西省人民医院,山西太原030012 [3]临汾市骨科医院,山西临汾041099 [4]山西省人民医院,山西太原030012

出　　处：《中国实用神经疾病杂志》2023年第6期661-667,共7页Chinese Journal of Practical Nervous Diseases

基　　金：山西省科学技术发展计划项目(编号:20130313020-4)。

摘　　要：目的探讨优化运动技巧训练在卒中偏瘫患者出院后居家康复的短期及长期效果。方法回顾分析2015-06—2015-12在山西省人民医院神经内科首次急性卒中Brunnstrom分期为II-IV期的接受康复治疗的偏瘫住院患者202例,按采用的康复治疗技术分为观察组(90例,采用优化运动技巧训练技术)、对照组(112例,采用Bobath技术为主的传统神经发育疗法)。第一阶段:出院后按原方案在康复师随访指导下开展居家康复6个月,观察患者的运动功能评定量表(MAS)、改良Barthel指数(MBI)、10 m步行时间、6 min步行距离和康复锻炼依从性量表(EAQ)。第二阶段:患者根据所掌握的康复技巧,自行进行居家康复训练,7年后(2023-02)对完成第一阶段患者进行集中电话回访,行MBI评分及满意度调查。结果观察组与对照组组间基线资料及干预前评估指标无差异(P>0.05)。第一阶段共完成研究164例,观察组完成78例,未完成12例;对照组完成86例,未完成26例,2组间完成率无差异(P=0.074)。实施居家康复治疗6个月后2组观察指标均较出院时明显改善(P<0.05)。观察组MAS得分(31.00±4.85)分、MBI得分(90.38±14.41)分、10 m步行时间(18.26±1.35)s、6 min步行距离(193.38±28.25)m均优于对照组(26.07±5.14、68.27±19.56、18.79±1.22 s、176.55±25.26 m,均P<0.05);EAQ量表结果提示2组中:中高依从性者总占比78.6%,组间对比观察组优于对照组(P<0.001);三维度得分观察组均优于对照组:锻炼监测(8.26±2.29 vs 6.83±2.02),主动寻求建议(8.13±2.01 vs 6.78±1.92),身体锻炼(22.28±3.76 vs 17.90±4.44),差异有统计学意义(P<0.001)。第二阶段共回访成功124例,失访40例。观察组成功61例,其中12例死亡;对照组成功63例,其中14例死亡。观察组MBI得分(88.84±20.67)分,优于对照组(76.2±23.19)分,P<0.05。观察组满意度优于对照组(P<0.05)。结论急性卒中偏瘫患者出院后在康复师指导下开展居家康复可改善患者Objective To investigate the short-term and long-term efficacy of home-based rehabilitation using optimizing motor performance for stroke patients with hemiplegia after discharge from the hospital.Methods From June 2015 to December 2015,202 inpatients with hemiplegia who received rehabilitation treatment for the first acute stroke in the Department of Neurology of Shanxi Provincial People’s Hospital with Brunnstrom as stage II-IV were reviewed and analyed,and were divided into observation group(90 cases,using optimizing motor performance)and control group(112 cases,using traditional neurodevelopmental therapy based on Bobath technique)according to the rehabilitation treatment.The first stage:after discharge,home-based rehabilitation was carried out for 6 months under the guidance of a rehabilitation therapist follow-up according to the originally trained techniques,and the patient’s motor function rating scale(MAS),Barthel index(MBI),10 m walking time and 6 min walking distance and rehabilitation exercise adherence scale(EAQ)were observed.The second stage:according to the rehabilitation skills mastered,the patients carried out home rehabilitation training on their own,and after 7 years(February 2023),patients who completed the first stage were intensively visited by phone,MBI scoring and satisfaction survey.Results There were no differences in baseline data and pre-intervention assessment indicators between the observation group and the control group(P>0.05).The first stage,a total of 164 cases were completed,78 cases were completed in the observation group,12 cases were not completed,86 cases were completed in the control group,26 cases were not completed,and there was no difference in the completion rate between the two groups(P=0.074).The observation indicators of both groups were significantly improved after 6 months of home rehabilitation treatment compared with those at discharge(P<0.05).The total scores of the MAS scale(31.00±5.48),the MBI scores(90.38±14.41),10 m walking time(18.26±1.35)s,6 min wal

关 键 词：卒中 优化运动技巧 任务导向性训练 居家康复 依从性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]