The Effect Of Caregiver-mediated Rehabilitation Training Program On Inpatients With Hemiplegia After Stroke

Objective:Based on the current situation that patients with hemiplegia after stroke cannot get sufficient dose of rehabilitation exercise training,the objective of the present study is to explore the effect of caregiver-mediated rehabilitation training program on the limb function,balance function,activity of daily living,anxiety and depression of inpatients with post-stroke hemiplegia,and the impact on the burden of caregivers,and to provide an effective rehabilitation training program for inpatients with hemiplegia after stroke in Northeast China.Methods:This study was a randomized controlled trial.50 post-stroke hemiplegia patientswho met the inclusion and exclusion criteria in a third-class A hospital in Changchun were selected and divided into intervention group and control group,with 25 cases in each group.The control group received routine hospital rehabilitation training and health education.The patients from the intervention group received personalized rehabilitation training program-the caregivers were trained by the number from the rehabilitation team for a week,and the patients received a 21-day caregiver-mediated rehabilitation training（at least 40 minutes a day,6 days a week）,which included four modules:upper limb motor function training,lower limb motor function training,balance function training and transfer training on the basis of routine rehabilitation training.Outcome indexes were assessed at baseline,10 days,and 21 days after intervention.The assessment tools included the general data questionnaire,the Fugl-Meyer Motor Scale（FMA）,the Berg Balance Scale（BBS）,the Barthel Index（BI）,the Self-Rating Anxiety Scale（SAS）,the Self-Rating Depression Scale（SDS）,and the Zarit Caregiver Burden Scale（ZBI）.Epidata3.1 was used for data entry and SPSS 23.0 was used for statistical analysis.Using independent sample t-test,Mantel-Haenszel test and x² test to compare the baseline data of the two groups.Paired sample t-test,Mantel-Haenszel test and generalized estimate equation（GEE）were used to analyze the effect of this rehabilitation program on the limb function,balance function,activity of daily living,anxiety and depression of patients with hemiplegia after stroke,and caregivers’burden.Results:1.The baseline assessment:There were no statistical differences in the total FMA score,FMA upper limb score,FMA lower limb score,BBS score,BI score,SAS standard score,SDS standard score and ZBI score between the two groups at baseline,which meant the data were comparable from the two groups（P>0.05）.And there was no statistical difference in the grade distribution of SAS,SDS and ZBI（P>0.05）.2.Outcome analysis of limb function,balance function,activity of daily living:Compared with the control group,FMA total value,FMA lower limb score,FMA upper limb score,BBS score and BI score were significantly increased in the intervention group（P<0.05）after 10 days intervention;The FMA total score,FMA lower limb score,BBS score,BI score were significantly increased in the intervention group（P<0.05）after 21 days of intervention,but there was no significant difference in the FMA upper limb score between two groups（P>0.05）.Compared with the control group,the recovery degree of total FMA score,FMA upper limb score,FMA lower limb score,BBS score and BI score were significantly increased in the intervention group at 10^th day and 21^st day after intervention（P<0.05）.The results of GEE showed that the above indexes in the intervention group were significantly improved than those in the control group（P<0.05）.Compared with baseline,the total FMA score,FMA upper limb score,FMA lower limb score,BBS score,and BI score were significantly increased in both groups at 10 and 21 days after intervention（P<0.05）.3.Outcome analysis of anxiety and depression:Compared with the control group,the scores of SAS and SDS in the intervention group were significantly decreased after 21 days（P<0.05）,and the improvement was significantly greater than that in the control group（P<0.05）.Meanwhile,compared to baseline,the SAS and SDS scores were significantly lower in the intervention group at 21 days after intervention（P<0.05）.4.Outcome analysis of caregiver burden:Compared with the control group,the improvement of ZBI scores in the intervention group was significantly improved（P<0.05）;compared to baseline,patients in the intervention group had significantly lower ZBI scores after 21 days of intervention（P<0.05）.5.No adverse events related to caregiver-mediated rehabilitation training occurred during the intervention.Conclusion:1.Compared with the routine in-hospital rehabilitation group,the 21-day caregiver-mediated rehabilitation training program significantly improved the limb function,balance function and activity of daily living in inpatients with post-stroke hemiplegia,and the difference between the two groups was observed at 10 days after intervention.2.The caregiver-mediated rehabilitation training program can effectively improve the anxiety and depression of inpatients with hemiplegia after stroke without increasing the burden of caregivers.3.Caregiver-mediated in-hospital rehabilitation training is high safety,which is suitable for patients with post-stroke hemiplegia in Northeast China,which is worthy of promotion.