The Effect Of Wheelchair Skill Training Program Combined With Rehabilitation Therapy On Hemiplegia Patients With Cerebral Apoplexy

Objective:To investigate the level of exercise fear in patients with acute myocardial infarction after PCI,analyze the causes of exercise fear,explore the mechanism of exercise fear,and develop a scale for exercise perception benefits and disorders in patients with coronary heart disease in order to enrich the exercise assessment tools for patients with coronary heart disease and provide a theoretical basis for improving their participation rate in exercise rehabilitation.Methods:1.Development,reliability,and validity of the exercise perception benefit/disorder scale for patients with coronary heart diseaseBased on the theory of health belief model,the items of the scale were formed through literature review,group discussion and patient group investigation.The scale was professionally evaluated by Delphi expert consultation method.The content of the scale was adjusted through cognitive interviews with 10 patients with coronary heart disease to form a test version of the scale.Using a convenient sampling method,a survey of 205 coronary heart disease patients attending a hospital in Nanchang,Jiangxi province,in September 2022 was conducted,and the credibility test was completed.2.Analysis of fear of movement and its influencing factors in patients with acute myocardial infarction after PCIUsing a convenient sampling method,280 patients after PCI surgery were selected from September 2022 to January 2023 at a hospital in Nanchang,Jiangxi Province,China,based on the"fear-avoidance"model,the theory of psychological resilience,and the cognitive behavior theory,and formed the theoretical framework model of this study using the general data survey table,the Chinese version of the fear of heart disease movement scale,the Chinese version of the psycho-resilience scale,and the social support evaluation scale.SPSS 26.0 was used to analyze the data.Statistical methods include descriptive analysis,the chi-square test,the t test,Pearson correlation analysis,and multiple linear regression analysis.3.The mechanism of exercise fear in patients with acute myocardial infarction after PCIAMOS 24.0 was used to construct a structural equation model of the influencing factors of fear of movement in patients with acute myocardial infarction after PCI.Results:1.The content validity index of the total scale was 0.79～1.0,the Cronbach’sαcoefficient was 0.917,and the retest reliability was 0.941.The results of confirmatory factor analysis showed thatχ~2/df=1.583,RMSEA=0.053,GFI=0.89,NFI=0.92,RFI=0.90,IFI=0.97,CFI=0.97,and the model fit was good.Finally,the scale of motion perception benefits and barriers in patients with coronary heart disease was formed,which included 6 dimensions and 22 items.2.In the cross-sectional survey,a total of 280 valid questionnaires were collected,and the total score of the fear of exercise scale was(43.64±8.55).Among the 280patients,there were 208 with a fear of exercise scale score>37 points,and the incidence of fear of exercise in patients with acute myocardial infarction after PCI was 74.29%.General data analysis showed that there were statistically significant differences in patients’age,gender,education level,occupation,family per capita monthly income,medical expense payment method,course of disease,number of stent implantations,and cardiac function grade(P<0.05).The results of the correlation analysis showed that patients’fear of exercise was negatively correlated with psychological resilience,social support,and exercise perception.The results of multiple linear regression analysis showed that education,course of disease,cardiac function,psychological resilience(optimism,tenacity,self-reliance),and motor perception(perceived benefits,perceived barriers)were independent influencing factors of motor fear in patients with acute myocardial infarction after PCI.3.The structural equation model was constructed to analyze the relationship between the influencing factors of exercise fear in patients with acute myocardial infarction after PCI.The model fitting results showed thatχ~2/df=2.169,RMSEA=0.065,GFI=0.996,AGFI=0.961,NFI=0.999,IFI=0.999,CFI=0.999.Social support can indirectly affect the fear of exercise in patients with acute myocardial infarction after PCI.The following path analysis was obtained:Path1:social support→resilience→fear of exercise;path 2:social support→motion perception→motion fear;path 3:social support→sports perception→psychological resilience→sports fear.Conclusion:1.The exercise perception benefit/disorder scale for patients with coronary heart disease developed in this study has good reliability and validity and can be used as an effective measurement tool to evaluate the exercise perception level of patients with coronary heart disease.2.The rate of fear of exercise in patients with acute myocardial infarction after PCI was as high as 74.29%,which was worthy of attention by medical staff.Attention should be paid to the participation of this group in exercise rehabilitation.Education,course of disease,cardiac function,psychological resilience,and exercise perception are independent influencing factors of exercise fear in patients with acute myocardial infarction after PCI.Clinical workers can formulate corresponding intervention programs according to the above factors to reduce the level of exercise fear in patients with acute myocardial infarction after PCI.3.Social support,resilience,and motion perception can affect the fear of movement in patients with acute myocardial infarction after PCI,among which resilience and motion perception can be used as direct influencing factors,and social support can indirectly affect the fear of movement in patients with acute myocardial infarction after PCI through resilience and motion perception.By improving the social support of patients and strengthening the propaganda and education of cardiac rehabilitation knowledge and psychological nursing,the understanding of cardiac rehabilitation can be improved,and the negative psychological state of patients can be improved.In order to reduce the level of fear of exercise in patients with acute myocardial infarction after PCI,improve the effect of cardiac rehabilitation,and improve the quality of life.