脑卒中患者居家远程康复指导效果的观察

doi:10.3969/j.issn.1006-9771.2021.07.012

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (7): 807-811.doi: 10.3969/j.issn.1006-9771.2021.07.012

脑卒中患者居家远程康复指导效果的观察

刘惠林^1,²,周斌^1,²(),赵政³,杨岩⁴,吕雪琴^1,²,王月^1,²,于婷⁵

1.中国康复研究中心北京博爱医院,北京市 100068
2.首都医科大学康复医学院,北京市 100068
3.北京丰台医院,北京市 100071
4.北京丰台区新村社区卫生服务中心,北京市 100070
5.山东协和学院,山东济南市 250100

收稿日期:2021-03-08 修回日期:2021-05-31 出版日期:2021-07-25 发布日期:2021-07-28
通讯作者: 周斌 E-mail:zhoubin1026@sohu.com
作者简介:刘惠林(1966-),男,汉族,北京市人,硕士,副主任治疗师,主要研究方向：脑卒中康复、呼吸康复、社区康复。
基金资助:
北京市丰台区卫生计生系统科研项目(2015-01)

Home-based Telerehabilitation Guidance for Stroke Patients

LIU Hui-lin^1,²,ZHOU Bin^1,²(),ZHAO Zheng³,YANG Yan⁴,LÜ Xue-qin^1,²,WANG Yue^1,²,YU Ting⁵

1. Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
3. Fengtai Hospital, Beijing 100071, China
4. Xincun Community Healthcare Center, Beijing 100070, China
5. Shandong Xiehe University, Ji'nan, Shandong 250100, China

Received:2021-03-08 Revised:2021-05-31 Published:2021-07-25 Online:2021-07-28
Contact: ZHOU Bin E-mail:zhoubin1026@sohu.com
Supported by:
Beijing Fengtai District Health and Family Planning System Scientific Research Project(2015-01)

摘要/Abstract

摘要：

目的探索居家远程康复指导模式,及其对脑卒中患者身体功能和日常生活活动能力的影响。

方法 2015年9月至2018年3月在北京市丰台区3家社区卫生服务中心门诊康复的脑卒中恢复期患者240例,随机分为对照组和远程组各120例。两组均接受门诊康复6个月;远程组接受远程康复指导。治疗前后采用Fugl-Meyer评定量表(FMA)和改良Barthel指数(MBI)进行评定。

结果治疗后,两组各项评分均显著提高(|t| > 14.536, P< 0.001);远程组评分高于对照组(|t| > 2.200, P< 0.05)。

结论脑卒中患者社区门诊康复时接受居家远程康复指导能提高康复效果。

关键词: 脑卒中, 社区康复, 远程康复, 居家康复

Abstract:

Objective To explore the effects of home-based telerehabilitation guidance on physical function and activities of daily living for stroke patients.

Methods From September, 2015 to March, 2018, 240 stroke recovering patients from three community health service centers in Fengtai District, Beijing for outpatient rehabilitation were randomly divided into control group (n = 120) and tele-rehab group (n = 120). Both groups accepted routine rehabilitation for six months, while the tele-rehab group received telerehabilitation guidance in addition. They were assessed with Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) before and after treatment.

Results The scores of FMA and MBI improved after treatment in both groups (|t| > 14.536, P< 0.001), and improved more in the tele-rehab group than in the control group (|t| > 2.200, P< 0.05).

Conclusion Home-based telerehabilitation guidance may enhance the effect of community-based outpatient rehabilitation for stroke patients.

Key words: stroke, community-based rehabilitation, telerehabilitation, home-based rehabilitation

中图分类号:

R743.3

刘惠林,周斌,赵政,杨岩,吕雪琴,王月,于婷. 脑卒中患者居家远程康复指导效果的观察[J]. 《中国康复理论与实践》, 2021, 27(7): 807-811.

LIU Hui-lin,ZHOU Bin,ZHAO Zheng,YANG Yan,LÜ Xue-qin,WANG Yue,YU Ting. Home-based Telerehabilitation Guidance for Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 807-811.

图/表 4

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表4

参考文献 36

[1]	詹青, 王丽晶. 2016 AHA/ASA成人脑卒中康复治疗指南解读[J]. 神经病学与神经康复学杂志, 2017, 13(1):1-9.
	ZHAN Q, WANG L J. Interpretation on 2016 AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery[J]. Neurol Neurorehabil, 2017, 13(1):1-9.
[2]	谢静. 脑血管病偏瘫后遗症的康复干预模式分析[J]. 中国实用神经疾病杂志, 2013, 16(8):92-93.
	XIE J. Chin J Prac Nerv Dis, 2013, 16(8):92-93.
[3]	SCOBBIE L, MCLEAN D, DIXON D, et al. Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation[J]. BMC Health Serv Res, 2013, 13(1):190-203. doi: 10.1186/1472-6963-13-190
[4]	林航, 王爱红, 李丹丹, 等. 脑卒中社区康复模式研究进展[J]. 中国康复医学杂志, 2017, 32(10):1203-1206.
	LIN H, WANG A H, LI D D, et al. Chin J Rehabil Med, 2017, 32(10):1203-1206.
[5]	CHEN Y, ABEL K T, JANECEK J T, et al. Home-based technologies for stroke rehabilitation: a systematic review[J]. Int J Med Inform, 2019, 123:11-22. doi: 10.1016/j.ijmedinf.2018.12.001
[6]	LLORENS R, NOÉ E, COLOMER C, et al. Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2015, 96(3):418-425, e2. doi: 10.1016/j.apmr.2014.10.019
[7]	LIN K H, CHEN C H, CHEN Y Y, et al. Bidirectional and multi-user telerehabilitation system: clinical effect on balance, functional activity, and satisfaction in patients with chronic stroke living in long-term care facilities[J]. Sensors, 2014, 14(7):12451-12466. doi: 10.3390/s140712451
[8]	黄奕云, 谢满容, 孙闯, 等. 医联体模式下对脑卒中患者社区康复成本-效益的评价[J]. 实用临床医学, 2017, 18(4):94-97.
	HUANG Y Y, XIE M R, SUN C, et al. Cost-benefit analysis of community rehabilitation in stroke patients in medical integration mode[J]. Prac Clin Med, 2017, 18(4):94-97.
[9]	KIRK P, GRIERSON M, BODAK R, et al. Motivating stroke rehabilitation through music: a feasibility study using digital musical instruments in the home[C]. Proceed 2016 zCHI Conference of Humam Factors Computer System, 2016: 1781-1785.
[10]	LANGAN J, DELAVE K, PHILLIPS L, et al. Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study[J]. J Rehabil Med, 2013, 45(2):217-220. doi: 10.2340/16501977-1115
[11]	中华神经科学会. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6):379-380.
	Chinese Society of Neurology. Chin J Neurol, 1996, 29(6):379-380.
[12]	刘惠林, 胡昔权. 神经疾患康复治疗技术[M]. 北京: 人民卫生出版社, 2019: 172.
	LIU H L, HU X Q. Techniques for Rehabilitation and Treatment of Neurological Disorders [M]. Beijing: People's Medical Publishing House, 2019: 172.
[13]	王玉龙. 康复功能评定学[M]. 北京: 人民卫生出版社, 2018: 288-290.
	WANG Y L. Evaluation of Rehabilitation Function [M]. Beijing: People's Medical Publishing House, 2018: 288-290.
[14]	闵瑜, 吴媛媛, 燕铁斌. 改良Barthel指数(简体中文版)量表评定脑卒中患者日常生活活动能力的效度和信度研究[J]. 中华物理医学与康复杂志, 2008, 30(3):185-188.
	MIN Y, WU Y Y, YAN T B. Validity and reliability of the simplified Chinese version of modified Barthel index for Chinese stroke patients[J]. Chin J Phys Med Rehabil, 2008, 30(3):185-188.
[15]	REDZUAN N S, ENGKASAN J P, MAZLAN M, et al. Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2012, 93(12):2177-2183. doi: 10.1016/j.apmr.2012.06.025
[16]	BAE J, ZHANG W, TOMIZUKA M. Network-based rehabilitation system for improved mobility and tele-rehabilitation[J]. IEEE Trans Control Syst Technol, 2013, 21(5):1980-1987. doi: 10.1109/TCST.2012.2217965
[17]	Fraunhofer Institute for Open Communication Systems. FOKUS, Physio for the Home[Z]. Berlin: Research News Fraunhofer, 2013.
[18]	AZAD N, AMOS S, MILNE K, et al. Telemedicine in a rural memory disorder clinic: remote management of patients with dementia[J]. Can Geriatr J, 2012, 15(4):96-100.
[19]	BARTON C, MORRIS R, ROTHLIND J, et al. Video-telemedicine in a memory disorders clinic: evaluation and management of rural elders with cognitive impairment[J]. Telemed J E Health, 2011, 17(10):789-793. doi: 10.1089/tmj.2011.0083
[20]	张金明, 赵悌尊. 中国残疾人社区康复30年回顾与展望[J]. 中国康复理论与实践, 2017, 23(11):1357-1360.
	ZHANG J M, ZHAO T Z. Community-based rehabilitation for persons with disabilities in China: development of 30 years andperspectives[J]. Chin J Rehabil Theory Pract, 2017, 23(11):1357-1360.
[21]	郝曼, 张志明, 汪超. 紧缺型社区康复治疗师创新培养与实践[J]. 中国康复医学杂志, 2017, 32(2):217-219.
	HAO M, ZHANG Z M, WANG C. Chin J Rehabil Med, 2017, 32(2):217-219.
[22]	高明明, 恽晓平, 张慧丽, 等. 记忆障碍远程康复训练模式的疗效[J]. 中国康复理论与实践, 2016, 22(5):518-522.
	GAO M M, YUN X P, ZHANG H L, et al. Efficacy of telerehabilitation mode on memory disorders[J]. Chin J Rehabil Theory Pract, 2016, 22(5):518-522.
[23]	CHERNEY L R, VAN VUUREN S. Telerehabilitation, virtual therapists, and acquired neurologic speech and language disorders[C]. Seminars in Speech and Language, NIH Public Access, 2012: 243.
[24]	CONSTANTINESCU G, THEODOROS D, RUSSELL T, et al. Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial[J]. Int J Lang Commun Disord, 2011, 46(1):1-16.
[25]	MEYER A M, GETZ H R, BRENNAN D M, et al. Telerehabilitation of anomia in primary progressive aphasia[J]. Aphasiology, 2016, 30(4):483-507. doi: 10.1080/02687038.2015.1081142
[26]	WARD E C, SHARMA S, BURNS C, et al. Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation[J]. Dysphagia, 2012, 27(4):460-472. doi: 10.1007/s00455-011-9390-9
[27]	DECHENE L, TOUSIGNANT M, BOISSY P, et al. Simulated in-home teletreatment for anomia[J]. Int J Telerehab, 2011, 3(2):3-10.
[28]	AGOSTINI M, GARZON M, BENAVIDES-VARELA S, et al. Telerehabilitation in poststroke anomia[J]. Biomed Res Int, 2014, 2014:706909.
[29]	TEY C K, AN J, CHUNG W Y. A novel remote rehabilitation system with the fusion of noninvasive wearable device and motion sensing for pulmonary patients[J]. Comput Math Methods Med, 2017, 2017(8):5823740.
[30]	PANI D, BARABINO G, DESSÌ A, et al. A device for local or remote monitoring of hand rehabilitation sessions for rheumatic patients[J]. IEEE J Trans Eng Health Med, 2014, 2:2100111.
[31]	TOUSIGNANT M, MOFFET H, NADEAU S, et al. Cost analysis of in-home telerehabilitation for post-knee arthroplasty[J]. J Med Internet Res, 2015, 17(3):e83. doi: 10.2196/jmir.3844
[32]	MAS M À, INZITARI M. A critical review of early supported discharge for stroke patients: from evidence to implementation into practice[J]. Int J Stroke, 2015, 10(1):7-12. doi: 10.1111/j.1747-4949.2012.00950.x
[33]	LEVY C E, SILVERMAN E, JIA H, et al. Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes[J]. J Rehabil Res Dev, 2015, 52(3):361. doi: 10.1682/JRRD.2014.10.0239
[34]	谢俊祥. 远程医疗及其发展[J]. 中国医疗器械信息, 2015(3):6-10.
	XIE J X. Telemedicine and its development[J]. Chin Med Device Inform, 2015(3):6-10.
[35]	都天慧, 屈云. 远程康复在脑卒中后患者康复中的应用及发展[J]. 中华物理医学与康复杂志, 2016, 38(12):955-957.
	DU T H, QU Y. Application and development of tele-rehabilitation in the rehabilitation of patients after stroke[J]. Chin J Phys Med Rehabil, 2016, 38(12):955-957.
[36]	翟运开, 谢锡飞, 孙东旭, 等. 我国远程医疗发展的法律与医疗伦理的限制及其化解[J]. 中国卫生事业管理, 2014, 31(11):808-811.
	ZHAI Y K, XIE X F, SUN D X, et al. Discussing the legal and medical ethical restrictions on the development of telemedicine in China and its countermeasures[J]. Chin Health Serv Manag, 2014, 31(11):808-811.

组别	n	性别(男/女, n)	年龄(岁)	病程(月)	卒中类型(出血/梗死, n)	偏瘫侧(左/右, n)
对照组	114	68/46	63.79±11.14	3.44±1.49	48/66	58/56
远程组	108	52/56	65.70±13.06	3.59±1.30	58/50	70/38
χ²/t值		1.477	-0.908	-0.580	1.495	2.206
P值		0.224	0.366	0.563	0.221	0.137

组别	n	治疗前	治疗后	t值	P值
对照组	114	18.70±9.70	33.60±10.09	-14.536	< 0.001
远程组	108	17.22±9.99	38.04±11.17	-20.391	< 0.001
t值		0.792	-2.200
P值		0.430	0.030

组别	n	治疗前	治疗后	t值	P值
对照组	114	13.47±5.30	20.63±4.75	-16.273	< 0.001
远程组	108	14.35±5.00	23.07±5.27	-16.984	< 0.001
t值		-0.896	-2.567
P值		0.372	0.012

组别	n	治疗前	治疗后	t值	P值
对照组	114	31.32±11.52	56.04±11.36	-26.376	< 0.001
远程组	108	29.19±12.05	65.46±11.21	-18.788	< 0.001
t值		0.952	-4.399
P值		0.343	< 0.001

脑卒中患者居家远程康复指导效果的观察

Home-based Telerehabilitation Guidance for Stroke Patients

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