Effect Of Montessori Daily Life Education Method On Cognitive Function And Quality Of Life In Patients With Post-Stroke Cognitive Impairment

Objective:Based on the Montessori daily life education method,the cognitive function rehabilitation program for stroke patients with cognitive impairment was constructed,and the impact of the program on cognitive function and quality of life in patients with post-stroke cognitive impairment was explored,so as to provide practical reference and theoretical basis for the development and improvement of nursing intervention of post-stroke cognitive dysfunction.Methods:1.On the basis of semi-structured interview,literature review and group discussion,the cognitive function rehabilitation program of in patients with post-stroke cognitive impairment on Montessori daily life education method was constructed,and two rounds of letters inquiries were conducted among15 experts by using Delphimethod to further improve the rehabilitation plan.2.A total of 70 patients who meet the inclusion and exclusion criteria in a Grade 3A hospital in Hebei Province from December 2021 to September2022.34 subjects in the first ward of the Rehabilitation Department were selected as the control group and was given routine nursing.Then 36 subjects in the second ward of the Rehabilitation Department as the experimental group and was treated with Montessori daily life education on the basis of routine nursing.Mo CA,MMSE,BI and SS-QOL scale were used to evaluate and compare the cognitive function,daily living ability and quality of life between the two groups within before intervention and 4 weeks,8weeks,12 weeks after intervention.SPSS23.0 software is used for data statistics and analysis.Results:1.In this study,the collection rate of two rounds of expert letters was100%;the expert authority coefficient was 0.75～0.80;the variation coefficients of the first,second and third rounds were 0.12～0.14,0.05～0.14,0.00～0.26 and 0.06～0.11,0.05～0.11,0.00～0.12,the Kendall’s W was 0.469～0.486,0.221～0.257,0.225～0.250.The final rehabilitation program contains 4first-level items(movement education,taking care of oneself,taking care of the environment and social interaction),7 second-level items(big movements,fine movements,grooming,clothing wearing,cleaning,finishing and civilized language exercises),16 third-level items(return to the original place,walking flat,inserting,pinching,pinch,squeezing,etc.).2.A total of 36 patients in the intervention group and 34 patients in the control group were included in this study.There were no differences in baseline data such as age,gender,educational level,occupation,type of stroke,location of incidence,hemiplegic myodynamia grade(IV/V)and hemiplegic Brunnstrom staging(IV/V/VI)between the two groups(P>0.05).3.Effect of intervention on the score of Mini Mental State examination(MMSE)in patients(1)The effect of intervention on the total score of MMSE and the score of each dimension in the two groups at different time points:(1)There were significant differences in MMSE total score and orientation score in time effect,inter-group effect and interaction effect(P<0.05),(2)Language ability score had significant statistical significance in time effect and interaction effect(P<0.05),but there was no significant difference in inter-group effect(P>0.05).(3)Recall ability,immediate memory,attention and computing power score had significant statistical significance in time effect(P<0.05),but there was no significant difference in inter-group effect and interaction effect(P>0.05).(2)Comparison of MMSE total score and each dimension score at different time points in the intervention group:(1)4 weeks after intervention compared with before intervention,12 weeks after intervention compared with 8 weeks after intervention: there were significant differences in MMSE total score and each dimension score(except immediate memory)(P<0.05),(2)4 weeks,8 weeks after intervention compared with before intervention and4 weeks after intervention:there were significant differences in MMSE total score and each dimension score(P<0.05).4.Effect of intervention on the score of Cognitive Assessment Scale(Mo CA)in patients(1)The effect of intervention on the total score of MOCA and the score of each dimension in the two groups at different time points:(1)The MOCA total scores and the score of orientation,recall ability,attention were statistically significant in time effect,inter-group effect and interaction effect(P<0.05),(2)The time effect and interaction effect of visual space and executive function score were statistically significant(P<0.05),but the effect between groups was not statistically significant(P>0.05).(3)There was significant statistical significance in the time effect of language,naming and abstract ability score(P<0.05),but there was no significant difference in inter-group effect and interaction effect(P>0.05).(2)Comparison of MOCA total score and each dimension score at different time points in the intervention group:(1)4 weeks after intervention compared with before intervention:there were significant differences in MOCA total score,orientation,recall ability,attention,visual space and executive function score(P<0.05).(2)8 weeks after intervention compared with before intervention,12 weeks after intervention compared with 4 and 8weeks after intervention: MOCA total score and each dimension score(except abstract ability)were significantly different(P<0.05).(3)8 weeks after intervention compared with 4 weeks after intervention: there were significant differences in MOCA total score,orientation,recall ability,attention,visual space and executive function,and language ability(P<0.05).(4)12 weeks after intervention compared with before intervention: the total score of MOCA and the scores of each dimension were significantly different(P<0.05).5.Effect of intervention on the score of Barthel Index(BI)in patients(1)Effect of intervention on BI score of the two groups at different time points: the time effect and interaction effect of BI score of the two groups had significant statistical significance(P<0.05),but there was no significant difference between the two groups(P>0.05).(2)Comparison of BI score at different time points in the intervention group:4 weeks,8 weeks and 12 weeks after intervention compared with before intervention,8 weeks after intervention compared with 4 weeks after intervention,12 weeks after intervention compared with 4 weeks and 8 weeks after intervention:the BI score were significantly different(P<0.05).6.Effect of intervention on the score of Stroke-specific Quality of Life Scale(SS-QOL)in patients(1)The effect of intervention on SS-QOL total score and each dimension score of the two groups at different time points:(1)There were significant differences in time effect,inter-group effect and interaction effect of1SS-QOL total score and each dimension score(except vision and emotion)(P<0.05),(2)Emotional dimension score had significant statistical significance in time effect and interaction effect(P<0.05),but inter-group effect between groups was not statistically significant(P>0.05).(3)There was significant difference in time effect of visual dimension score(P<0.05),but there was no significant difference in inter-group effect and interaction effect between groups(P>0.05).(2)Comparison of SS-QOL total score and each dimension score at different time points in the intervention group:(1)4 weeks after intervention compared with before intervention,8 weeks and 12 weeks after intervention compared with 4 weeks after intervention:there were significant differences in SS-QOL total score and each dimension score(except visual acuity)(P<0.05),(2)8 weeks and 12 weeks after intervention compared with before intervention,12 weeks after intervention compared with 8 weeks after intervention:there were significant differences in the total score of SS-QOL and the scores of each dimension(P<0 05).7.In terms of clinical efficacy(1)The total effective rate of the improvement in the level of cognitive function was higher in the Montessori daily life education rehabilitation program intervention group than in the control group with the MMSE,in which the intervention group had a significant effect of 20 cases,13 cases were effective and 3 cases were ineffective,the total effective rate was91.67%.There were 3 cases in the control group,19 cases were effective and12 cases were ineffective,the total effective rate was 64.71%.The difference between the two groups was statistically significant(P<0.05).(2)The total effective rate of the improvement in the level of cognitive function was higher in the Montessori daily life education rehabilitation program intervention group than in the control group with the Mo CA,in which 20 cases were markedly effective,14 cases were effective and 2 cases were ineffective in the intervention group,the total effective rate was 94.44%.The control group was markedly effective in 3 cases,effective in 22 cases and ineffective in 9 cases,the total effective rate was 73.53%.The difference between the two groups was statistically significant(P<0.05).Conclusion:The rehabilitation program of Montessori daily life education method on cognitive function in patients with post-stroke cognitive disorder is scientific and practical,which can effectively improve the cognitive function,ability of life and quality of life of the patients.