| Objective:(1)To construct a five-step physical rehabilitation program based on self-care ability grading according to guidelines and evidence-based medical evidence.(2)To verify the effect of five-step physical rehabilitation program through intervention research,provide reference for physical rehabilitation of patients with acute ischemic stroke and help them return to their families and society.Methods:This was a quasi-experimental study.Patients with acute ischemic stroke admitted to the Department of Neurology,Shaanxi Provincial People’s Hospital were selected as the research object,and divided into the control group and the intervention group according to the ward area,and 80 patients in each group were finally determined.The control group adopted the routine physical rehabilitation program in the Department of Neurology,while the nurses in the Department of Neurology provided rehabilitation training guidance for the patients under the guidance of the doctors and rehabilitation therapists,mainly focusing on the passive and active joint movement training on the bed as well as the walker-aided walking training.The intervention group implemented the five-step physical rehabilitation program on the basis of the control group,and patients’self-care ability was divided into five levels according to the modified Barthel index.The whole body multi-joint coordination and linkage training program including the upper limb,lower limb and trunk was formulated in each grade.The activity amount,difficulty and intensity were increased in a stepwise manner,and in a gradual manner.A multidisciplinary rehabilitation team were established.Rehabilitation therapists and neurologists evaluated the patients’condition to determine their self-care ability and the starting point of training.The program was led by nurses specializing in stroke rehabilitation to implement rehabilitation training for patients,and guide and supervise the patients’home rehabilitation training.This program gradually carries on the rehabilitation training,the activity amount,the difficulty,the intensity all gradually increases.The patients in the two groups received the same training time and frequency,with a cumulative training of 45 minutes per day and one training per item.Through the division and cooperation of nurses,doctors,rehabilitation therapists,patients and their caregivers,both groups implemented an integrated and continuous rehabilitation training from hospital admission.The intervention lasted for 3 months,and muscle strength,self-care score,and stroke specialized quality of life score were used as outcome measures.Outcomes were collected before intervention,1 month of intervention and 3months of intervention to compare the effects of intervention.Data were screened,checked and input by two people,sorted and analyzed by SPSS 25.0 software.Results:(1)There were no significant differences in baseline data,muscle strength,quality of life and self-care scores between the two groups before intervention(P>0.05).(2)In the intervention group,the muscle strength of both upper and lower limbs on the affected side was improved,and the muscle strength recovery of lower limb was faster than that of upper limb.The improvement effect of five-step limb rehabilitation program on the affected physical muscle strength was superior to that of the conventional limb rehabilitation program(upper limb:Z=-3.563,P<0.01,lower limb:Z=-3.470,P<0.01).However,only pairwise comparison of muscle strength of affected limbs in the intervention group before intervention,1 month and 3 months after intervention had statistical significance(all adjusted P<0.05).(3)The scores of quality of life were117.59±17.99,120.10±18.11 and 121.89±16.89 respectively after intervention in the control group.The scores of quality of life were 119.94±22.78,130.83±22.30 and137.46±21.70 respectively after intervention in the intervention group.The quality of life of patients in the intervention group was better than that of the control group 1 month after intervention(t=-3.339,P<0.01)and 3 months of intervention(t=-5.066,P<0.01).After analysis of variance with repeated measurements,the two groups still showed such a trend at 1 month of intervention(F=34.401,P<0.01)and 3 months of intervention(F=75.636,P<0.01),and the scores of the intervention group were higher than the control group.The quality of life scores of the control group(F=35.602,P<0.01)and the intervention group(F=433.476,P<0.01)were gradually increased.There was an interaction between time and group intervention(F=146.294,P<0.01).(4)The self-care ability score of the control group was slightly higher after three months of intervention than that before intervention,and the difference was statistically significant(Waldχ~2=204.967,P<0.01).However,the differences between the self-care ability scores of the intervention group and those before the intervention in one month of intervention(Waldχ~2=20.270,P<0.01)and those of the control group in one month of intervention and those before the intervention were statistically significant.The difference between the two groups before and after 3 months of intervention was also statistically significant(Waldχ~2=11.675,P<0.01).Conclusions:In the intervention period of 3 months,the effect of the the five-step physical rehabilitation program in stroke patients was better than conventional rehabilitation program,which improved the muscle strength of the affected limb and pay attention to the coordination of multiple joints in the body to fight against limb spasm.The program enhanced the patient’s ability to take care of themselves and reduces compensations and disuse and misuse of the affected limb through intensive training.The program also focused on changes in patients’physical and mental health,family status and social roles to improve their long-term quality of life. |
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