老年急性脑卒中后偏瘫患者康复训练依从性的影响因素
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(南京医科大学附属南京医院康复医学科,南京 210006)

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R743.3

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南京医科大学科技发展基金项目(KY20211224-03)


Influencing factors of rehabilitation training compliance in elderly acute stroke patients with hemiplegia
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(Department of Rehabilitation Medicine, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China)

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    摘要:

    目的 探讨老年急性脑卒中后偏瘫患者康复训练依从性的影响因素。方法 回顾性分析南京医科大学附属南京医院2021年4月至2023年4月收治的149例老年急性脑卒中后偏瘫患者的临床资料。使用康复锻炼依从性量表评估老年急性脑卒中后偏瘫患者康复训练的依从性,比较不同临床特征患者身体锻炼依从性评分、锻炼监测依从性评分、主动寻求建议依从性评分的差异。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或方差分析进行组间比较。通过多因素logistic回归分析老年急性脑卒中后偏瘫患者康复训练依从性的影响因素。结果 149例老年急性脑卒中后偏瘫患者身体锻炼依从性评分为(20.19±5.15)分,锻炼监测依从性评分为(7.21±2.88)分,主动寻求建议依从性评分为(7.42±2.64)分。不同文化程度、婚姻情况、家庭月收入、神经功能缺损程度及是否焦虑或抑郁的患者身体锻炼依从性评分比较,差异有统计学意义(P<0.05)。不同文化程度及是否焦虑或抑郁患者锻炼监测依从性评分比较,差异有统计学意义(P<0.05)。不同文化程度、婚姻情况及是否焦虑或抑郁患者主动寻求建议依从性评分比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,初中文化程度(OR=2.469,95%CI 1.244~4.900)、离婚或丧偶或未婚(OR=3.109,95%CI 1.437~6.726)、家庭月收入<2000元/月(OR=2.436,95%CI 1.228~4.832)、焦虑或抑郁(OR=1.346,95%CI 1.038~1.745)、重度神经功能缺损(OR=3.775,95%CI 1.841-7.741)是影响患者身体锻炼依从性的危险因素;初中文化程度(OR=1.190,95%CI 1.006~1.408)、焦虑或抑郁(OR=1.438,95%CI 1.118~1.850)是影响患者锻炼监测依从性的危险因素;初中文化程度(OR=3.987,95%CI 1.419~11.202)、离婚或丧偶或未婚(OR=3.883,95%CI 1.502~10.038)、焦虑或抑郁(OR=1.927,95%CI 1.333~2.786)是影响患者主动寻求建议依从性的危险因素。结论 老年急性脑卒中后偏瘫患者康复训练依从性受到较多因素的影响,如文化程度、婚姻情况、家庭月收入、焦虑或抑、神经功能缺损程度,临床医师应予以重视。

    Abstract:

    Objective To explore the related influencing factors of rehabilitation training compliance in elderly patients with hemiplegia after acute stroke. Methods Clinical data of 149 elderly patients with acute post-stroke hemiplegia admitted to our hospital from April 2021 to April 2023 were collected and retrospectively analyzed. Rehabilitation exercise compliance scale was used to evaluate their compliance, and the scores of physical exercise compliance, exercise monitoring compliance and proactively seeking advices on compliance were compared among the patients with different clinical characteristics. SPSS statistics 22.0 was employed for data analysis. Depending on the data type, student′s t test or ANOVA was applied for inter-group comparison. Multivariate logistic regression analysis was conducted to analyze the influencing factors of the compliance in these elderly patients. Results For the 149 elderly patients with acute post-stroke hemiplegia, the score of physical exercise compliance, exercise monitoring compliance and proactively seeking advice on compliance was (20.19±5.15), (7.21±2.88), and (7.42±2.64) points, respectively. Significant difference was observed in the physical exercise compliance score among the patients with different education level, marital status, family monthly income, severity of neurological deficit and anxiety or depression (P<0.05), so was in the score of exercise monitorin compliance among the patients with different education levels and anxiety or depression (P<0.05), and in the score to proactively seeking advice on compliance in the patients with different education level, marital status and being anxious or depressed (P<0.05). Multivariate logistic regression analysis showed that education level at junior high school (OR=2.469,95%CI 1.244-4.900), divorced or widowed or unmarried (OR=3.109,95%CI 1.437-6.726), monthly family income <2 000 yuan/month (OR=2.436,95%CI 1.228-4.832), anxiety or depression (OR=1.346,95%CI 1.038-1.745), and severe neurological deficit (OR=3.775,95%CI 1.841-7.741) were the risk factors for compliance to physical exercise. Education level of junior high school (OR=1.190,95%CI 1.006-1.408) and anxiety or depression (OR=1.438,95%CI 1.118-1.850) were the risk factors for patients′ compliance to exercise monitoring. Education level of junior high school (OR=3.987, 95%CI 1.419-11.202), divorce or widowed or unmarried (OR=3.883,95%CI 1.502-10.038), and anxiety or depression (OR=1.927,95%CI 1.333-2.786) were risk factor for compliance to proactively seeking advice. Conclusion The rehabilitation training compliance in elderly patients with acute post-stroke hemiplegia is affected by many factors, such as education level, marital status, family monthly income, anxiety or depression, and severity of neurological deficit, and all of these factors should be paid attention to by clinicians.

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沃丽,杨蓓,徐梅.老年急性脑卒中后偏瘫患者康复训练依从性的影响因素[J].中华老年多器官疾病杂志,2024,23(5):373~377

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  • 收稿日期:2023-06-16
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  • 在线发布日期: 2024-05-15
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