宝山社区脑卒中后遗症患者康复四站式服务应用研究

发布时间：2018-06-01 15:17

本文选题：社区 + 脑卒中后遗症患者　；参考：《复旦大学》2014年硕士论文

【摘要】：[目的]本课题通过在宝山社区建立并实施脑卒中后遗症患者社区康复“四站式”服务方案,使脑卒中后遗症患者社区康复服务规范化和系统化,并对应用效果开展评价。[方法]采用干预前后与平行对照设计,定量与定性研究结合方法,①设立宝山社区和共和新社区分别为干预组和对照组,运用上海市心脑血管疾病报病系统,根据样本纳入与排除标准对两个社区2011年1月至2012年3月发病1年内、已出院回归到社区的缺血型脑卒中患者进行分层抽样,干预组和对照组各确定50名研究对象。②对100名研究对象开展现场调查,了解社区康复人员基本情况、脑卒中后遗症患者康复服务项目、患者的需求与利用及满意度等情况；③根据现场调查结果,以及定性访谈和专家小组法等方法,确定社区康复“四站式”服务方案,建立服务标准、流程、内容、制度等,为患者在病房、门诊、站点以及家庭每一站提供相对应的康复服务；④利用康复“四站式”服务信息管理数据库,对干预组50名患者实施“四站式”服务方案,干预时间为4个月；⑤康复“四站式”服务方案应用效果评价：干预组和对照组均开展二次问卷调查了解患者对社区康复的满意度、知晓率、康复服务项目利用率,并在每个患者康复服务开始及结束时进行巴氏指数、肢体运动功能评测,评定患者社区康复效果。[结果]①社区康复“四站式”方案实施前,干预组与对照组对脑卒中康复治疗的认知度及对社区康复治疗满意度的比较无统计学意义上显著差异,两组具有可比性。方案实施后,干预组对康复服务认知度、满意度上好于对照组,且有统计学意义上显著差异(P0.05)；②课题实施前后干预组脑卒中后遗症患者“四站”总体利用情况较对照组有显著差异(P0.01),以门诊、站点差异更为明显；在站点治疗项目的总体利用情况较对照组有显著差异(P0.01),以关节松动、低频、微波、超短波及推拿差异更为明显；在门诊治疗项目的总体利用情况较对照组有显著差异(P0.01),以偏瘫训练、言语治疗、关节松动、运动疗法、低频、微波、超短波及推拿差异更为明显；在家庭治疗项目的利用情况较对照组而言运动疗法、推拿差异有显著意义；在病房治疗项目的利用情况较对照组而言作业治疗、微波及推拿差异有显著意义；③社区康复“四站式”方案实施前,干预组与对照组FMA比较无统计学意义上显著差异,两组具有可比性。在方案实施后,两组患者FMA均较治疗前有所改善,干预组FMA较对照组而言改善更明显(P0.05)；④社区康复“四站式”方案实施前,干预组与对照组MBI比较无统计学意义上显著差异,两组具有可比性。在方案实施后,两组患者MBI均较治疗前有所改善,对照组MBI较对照组而言改善更明显(P0.05)。[结论]脑卒中发病率致残率高,康复的介入对于患者的功能恢复乃至生活质量的影响至关重要。面对目前综合医院普遍的存在病人多床位少,脑卒中后遗症患者常因未系统康复而反复发作,影响功能恢复的现状,本课题通过对宝山社区“四站式”康复服务方案的设计与研究,并利用信息管理数据库在宝山社区实现了病房、门诊、站点以及家庭的社区全程管理,促进了脑卒中后遗症患者的康复认知水平,建立了较为行之有效的康复方案,为更好地开展社区康复服务提供了理论和实践依据。
[Abstract]:The purpose of this study was to establish and implement community rehabilitation " four - station " service plan in the community rehabilitation service in Baoshan community to normalize and systematize community rehabilitation services in patients with cerebral apoplexy sequelae .
( 3 ) Determine community rehabilitation " four - station " service plan , establish service standard , process , content , system , etc . according to the results of the site , qualitative interview and expert group method , etc . , and provide corresponding rehabilitation services for each station of the ward , clinic , site and family for the patient ;
( 4 ) using the rehabilitation " four - station " service information management database to implement the " four - station " service plan for 50 patients in the intervention group , and the intervention time is 4 months ;
The effect of rehabilitation " four - station " service plan was evaluated : the intervention group and the control group carried out a second questionnaire to understand the satisfaction , awareness rate and rehabilitation service utilization rate of the patients to the community rehabilitation .
( 2 ) The overall utilization of " four stations " in the post - stroke patients with post - stroke intervention group was significantly different than that in the control group ( P0.01 ) .
The overall utilization of the site treatment project was significantly different from that of the control group ( P0.01 ) , and the difference of joint loosening , low frequency , microwave , ultrashort wave and massage was more obvious .
The overall utilization of the outpatient treatment project was significantly different from that of the control group ( P0.01 ) , and the difference of hemiparalysis training , speech therapy , joint loosening , motion therapy , low frequency , microwave , ultrashort wave and massage is more obvious ;
There was a significant difference between the use of family therapy and the exercise therapy in the control group .
Compared with the control group , the utilization of the treatment project in the ward was significantly higher than that in the control group .
There was no significant difference between the intervention group and the control group before the implementation of the " four - station " scheme of community rehabilitation . After the implementation of the protocol , both groups of patients improved significantly before the treatment , and in the intervention group , the improvement was more obvious than that of the control group ( P0.05 ) .
Conclusion : Before the implementation of the four - station rehabilitation scheme , there was no significant difference between the intervention group and the control group , and MBI in the control group was more obvious than that of the control group ( P0.05 ) .
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【参考文献】