Study On Self-management Intervention Based On The Theory Of Enablement To Young And Middle-aged Stroke Patients With Hemiplegia

Objective1.To describe the level of self-management ability of young and middle-aged stroke patients with hemiplegia and its influencing factors.2.To construct a self-management intervention program for young and middle-aged stroke patients with hemiplegia based on the theory of enablement,and to implement and explore the effects of the intervention program on self-management behavior,mental state,body motor function and daily activity ability.Methods 1.Investigation,research and analysis stage.A total of 300 young and middle-aged stroke patients with hemiplegia who received treatment in a Grade A hospital of Zhengzhou from January 2020 to June 2020 were selected by convenience sampling method.The general information questionnaire,stroke patient self-management behavior rating scale,stroke rehabilitation self-efficacy scale,self-rating anxiety scale,self-rating depression scale,modified Babbitt index rating scale,and functional independence rating scale were distributed to the patients.To investigate the status of self-management behavior,rehabilitation self-efficacy,psychological status,daily living ability and limb motor function of the patients,and to explore the factors affecting the self-management of middle-aged and young stroke patients with hemiplegia.SPSS 26.0 software was used.The enumeration data were expressed as frequency and percentage,and the measurement data were normally distributed as " (?)±s ".The t test,one-way anova,Pearson correlation analysis and multivariate linear regression were used for statistical analysis to explore the influencing factors of the self-management of middle-aged and young stroke patients with hemiplegia.P < 0.05 was considered statistically significant.2.Intervention plan construction and implementation stage.On the basis of the previous status survey and analysis of influencing factors,combined with previous literature and based on the theory of empowerment,a preliminary draft of self-management intervention for middle-aged and young stroke patients with hemiplegia was developed,and an implementation draft was further developed after expert consultation and pre-test.A total of 98 middle-aged and young stroke patients with hemiplegia who met the requirements from July 2020 to February 2021 in a level-A hospital in Zhengzhou were selected by convenience sampling method.After consulting the random number table,the subjects were divided into control group and intervention group,with 49 cases in both groups.Patients in the intervention group were given self-management based on the enabling theory,and patients in the control group were given routine nursing.Patients in both groups were given in-hospital intervention for 5 weeks and out-of-hospital intervention for 4 weeks.Before intervention,1 month after intervention,and 3 months after intervention,the survey was conducted again to evaluate the effects of the two intervention schemes.SPSS 26.0 software was used to analyze the data of the two groups of patients in the study.The measurement data were normally distributed and represented as " (?)±s ".Repeated measurement analysis of variance was used to compare the study variables at each time point.χ~2test was used for counting data,and P < 0.05 indicated a statistically significant difference.Results1.Current status and influencing factors of self-management ability of young and middle-aged stroke patients with hemiplegia:(1)The self-management score of 300 middle-aged and young stroke patients with hemiplegia was 112.48±9.64 points.(2)The rehabilitation self-efficacy score of middle-aged and young stroke patients with hemiplegia was 62.97±8.91,modified Babar’s index score was 51.29±7.12,and functional independence score was 19.82±3.85.54.48±6.84 in the Self-Rating Anxiety Scale and 52.68±7.31 in the Self-Rating Depression Scale.Patients’ self-management behavior score was positively correlated with rehabilitation self-efficacy score,improved Bartot index score and functional independence score,and negatively correlated with self-rating anxiety scale score and self-rating depression scale score.(3)Univariate analysis results showed that there were significant differences in disease duration,education level,monthly family income,NIHSS score,muscle strength grade,and self-management behavior score between primary caregivers and patients(P< 0.05).Multiple linear regression analysis confirmed that disease duration,education level,primary caregivers,stroke rehabilitation self-efficacy score,Self-Rating Depression Scale score,and functional independence score were the influencing factors of self-management behavior of middle-aged and young stroke patients with hemiplegia(P< 0.05),which accounted for 70.4% variation of self-management behavior(F=65.517,R2=0.714,P< 0.05).Adjust R2=0.704).2.Self-management intervention for young and middle-aged patients with post-stroke hemiplegia based on the theory of empowerment:After intervention,1 case fell off in the control group and the intervention group,and 48 cases in the control group and 48 cases in the intervention group completed the study.(1)There was no statistical significance in the indicators of rehabilitation self-efficacy,psychological status,self-management behavior,daily living ability and limb function between the two groups when comparing the general information of patients such as gender,educational level,complications,age and course of disease(P> 0.05).(2)One month and three months after intervention,the rehabilitation self-efficacy score of the intervention group was higher than that of the control group,and the results of repeated measures analysis of variance showed that the difference between the two groups was statistically significant(P< 0.05).(3)At 1 month and 3 months after intervention,the total score of self-management behavior and scores of all dimensions in the intervention group were higher than those in the control group.Repeated measurement analysis of variance showed that the differences between the two groups were statistically significant(P< 0.05).(4)At 1 month and 3 months after intervention,the scores of the Self-Rating Anxiety Scale and the Self-Rating Depression Scale in the intervention group were lower than those in the control group,and the results of repeated measures analysis of variance showed that the differences between the two groups were statistically significant(P< 0.05).(5)One month and three months after intervention,the modified Pap index score of patients in the two groups was reevaluated,and the results showed that the score of the functional independence rating scale was higher than that of the control group.Repeated measurement analysis of variance showed that the difference between the two groups was statistically significant(P< 0.05).Conclusions 1.Middle-aged and young stroke patients with hemiplegia have a low level of self-management behavior,poor sense of rehabilitation self-efficacy,poor psychological status,and dysfunction in daily life and limb movement;In addition,patients’ self-management behavior is related to the course of disease,educational level,primary caregivers,rehabilitation self-efficacy,mental state,and physical functional activities.2.The application of self-management intervention based on the enabling theory in middle-aged and young stroke hemiplegia can enhance patients’ sense of rehabilitation self-efficacy,improve self-management behavior,relieve negative emotions,and improve patients’ daily living ability and limb motor function.