| Objective:Translation,cultural adaptation,validation of Environment Factor Item Bank into Mandarin amonge Chinese stroke population;To understand the social participation status,construct the influencing factor model of social participation and explore the recognition mode of work participation ability for the post-stroke,in the sequelae stage;To explore the distribution of TCM syndrome and the assocation with social participation in the post-stroke.Study Design:Cross-sectional survey.Method:Cros-cultural adjustment was conducted with according to FACIT method,and 229 post-stroke were recruited into psychometrics test.Sencondly,from June 2016 to November 2017,a total of 248 post-stroke patients were selected as the subjects in the questionnaire survey in Fuzhou community and surrounding rural areas by the convenience sampling method,including the general information,ability of daily life(MBI),Community Participation Index(CPI),cognitive function(MoCA),balance function(BBS),as well as the Access to Information and Technology(AIT),artificial and natural environment(BNE),Systems,Services and Policies(SSP),social environment(SE),etc.SPSS was used for the data statistical analysis and AMOS21.0 was used for the model construction.Result:1.Total of 30 adjustmented items(23.26%),8 deleted items(6.20%),4 added item(3.31%)were conducted in the process of translation and expert evaluation,the final items were 102 items in the final Chinese version of EFIB.Exploratory Factor Analysis(EFA)of the AIT,BNE,SSP,SE yielded four,five,four,three factors,all of the KMO were more than 0.8,explained 68.86%,78.56%,56.93%,75.71%of variance.The ATI,BNE,SSP,SSP have satisfactory internal consistency(0.904-0.940),and moderate correlation with with CHIEF at the total score level.2.The status of social participation were relatively moderate to low in post-stroke patients,low in participation engagement(2.06±0.64)and moderate in participation feeling(3.18±0.71).Univariate analysis of the community participation engagement with total score:there were statistically significant differences(P<0.05)in the age,course and stroke type.And the education level and living in rural areas had statistical significance in the social participation sense.Again obtain employment,number of strokes,Rankin index,BBS,CSS,MBI,MMSE,depressive state,residence with/without the elevator were co-influencing factor in the social engagement and sense of participation(P<0.05).Furthermore,AIT showed moderate correlation strength(r>0.4,P<0.05).BNE had a moderate correlation with social participation ability(r>0.4,P<0.05),especially in the movation dimension and safety environment(r>0.6,r>0.4).SSP was moderately correlated with social participation(r>0.4,P<0.05),especially in community life service and traffic service.SE had a moderate correlation with social participation,among which public attitude had a great influence on patients' participation sence(r=-0.518),followed by family support attitude(r=-0.42).The model fits were well with RMSEA=0.054,CFI=0.905.it showed Community living environment was an important external affected factor of social participation engagement and sence with the explaination of-0.75 of and 0.884;Depression was a key mediating factor with 0.24 and-0.12 direct effect on the social participation engagement and feeling.It was found-0.50 direct effect of social participation sence on participation engagement.Neurologic deficits and cognitive states had little overall effect on social participation or perception(P<0.05).A set of work participation recognition patterns was obtained in two major branches,four levels,12 nodes and 7 terminal nodes by using decision tree reasoning,which was 82.26%in the overall accuracy and 66.67%for patients who could return to work after stroke.3.The results of apoplexy syndrome dialectical diagnosis showed that phlegm syndrome,blood stasis syndrome,qi deficiency,Yin deficiency and Yang hyperengagement syndrome were high frequency of basic syndromes,moreover,the most common syndromes in the distribution of syndromes are two-syndromes(44.3%),followed by multi-syndromes(29.9%)and least single syndromes(25.9%).the most common TCM syndrome are qi deficiency and blood stasis syndrome(9.45%),phlegm and blood stasis syndrome(8.96%),phlegm and blood stasis syndrome(6.47%),etc.in patients with stroke sequelae.Using one-way anova,it was found that the more severe the syndrome of TCM,the worse the social participation amonge the patients who with hot syndrome,phlegm syndrome or blood stasis syndrome,performance(P<0.05).The correlation between syndrome integration and social participation engagement,social participation perception and neural function defect were medium to low(0.2<r<0.4).Conclusion:1.The AIT,BNE,SSP,SE were valid and reliable instruments to assess community living environmental factor on Chinese post-stroke patients.2.The status of social participation was not ideal on the post-stroke in the Community.Various factors were interacted to affect social participation.Community living environment was an important external affected factor of social participation.Depression was a key mediating factor in the level of social participation.Inner participation sence in desire and confidence affects social engagement.3.The recognition mode of the work ability has good accuracy,which could explain the participation outcome of most stroke patients.It was beneficial to provide the judgment and screening the patient's work participation ability in stroke rehabilitation..4.It was common basic syndrome in the patients with phlegm syndrome,blood stasis syndrome,qi deficiency,Yin deficiency fire in port in stroke sequela period,the combination type was relatively complex,only one certificate less.Phlegm syndrome were often mixed with the blood stasis syndrome;Qi deficiency or Yin deficiency were mixed with blood stasis.The combination of stroke syndromes could,to a certain extent,reflect the neurological deficit and social participation ability of patients.However,there was a more complex nonlinear relationship between TCM syndromes integration,community participation and neurological deficit:These three instruments could be reflected the changes and functional status of patients from multiple directions,and can be used as a supplement for each other in the outcome evaluation of stroke rehabilitation... |
PDF Full Text Request