作业技能再学习策略对脑卒中偏瘫上肢功能效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.07.011

摘要/Abstract

摘要：

目的探讨作业技能再学习策略对脑卒中偏瘫手上肢功能和日常生活活动能力(ADL)的疗效。
方法 2022年2月至2023年8月，广东省工伤康复医院脑卒中偏瘫患者74例随机分成对照组(n = 37)和试验组(n = 37)。对照组每天接受常规康复治疗，试验组在对照组基础上增加作业技能再学习训练。治疗前和治疗3周后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE)，偏瘫上肢功能测试香港版(FTHUE-HK)，运动活动日记(MAL)-使用数量(AOU)、MAL-活动质量(QOM)，改良Bathel指数(MBI)，脑卒中影响量表(SIS)-手功能(Hand)、SIS-ADL进行评定。
结果治疗后，两组各项评估指标均改善(|t| > 3.597, P < 0.05)，试验组FMA-UE、FTHUE-HK、MAL-AOU、MAL-QOM评分优于对照组(|t| > 2.352, P < 0.05)。
结论作业技能再学习策略能有效改善脑卒中偏瘫上肢的运动和活动功能，并促进偏瘫上肢在日常生活中的使用。

关键词: 脑卒中, 作业技能再学习, 上肢, 运动功能, 日常生活活动, 随机对照试验

Abstract:

Objective To explore the effect of occupational skills relearning programme on hemiplegic arm motor function and activities of daily living (ADL) in stroke patients.
Methods From February, 2022 to August, 2023, 74 stroke patients in Guangdong Work Injury Rehabilitation Hospital were enrolled and randomly divided into control group (n = 37) and experimental group (n = 37). The control group received conventional rehabilitation training, and the experimental group received additional occupational skills relearning programme, for three weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Functional Test for the Hemiplegic Upper Extremity-Hong Kong (FTHUE-HK), Motor Activity Log (MAL)-amount of use (AOU) and MAL-quality of movement (QOM), modified Barthel Index (MBI), and Stroke Impact Scale (SIS)-Hand and SIS-ADL before and after treatment.
Results The scores in all assessments improved significantly in both groups (|t| > 3.597, P < 0.05) after treatment, while the scores of FMA-UE, FTHUE-HK, MAL-AOU, MAL-QOM were higher in the experimental group than in the control group (|t| > 2.352, P < 0.05).
Conclusion Occupational skills relearning programme could promote the recovery of hemiplegic arm motor and activity, and facilitate the use of the hemiplegic arm in daily life in stroke patients.

Key words: stroke, occupational skills relearning, upper limb, motor function, activities of daily living, randomized controlled trial

中图分类号:

R743.3

何爱群, 黎景波, 何茂莉, 叶思媚, 宋秋爽, 刘海鸥, 谢有书. 作业技能再学习策略对脑卒中偏瘫上肢功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(7): 823-830.

HE Aiqun, LI Jingbo, HE Maoli, YE Simei, SONG Qiushuang, LIU Haiou, XIE Youshu. Effect of occupational skills relearning on hemiplegic arm function after stroke: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 823-830.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中类型(出血/梗死)/n	偏瘫侧(左/右)/n	利手(左/右)/n
对照组	37	27/10	54.19±13.37	77.11±41.79	14/23	18/19	0/37
试验组	37	32/5	48.14±14.69	75.86±49.68	16/21	18/19	1/36
χ²/t值		2.090	-1.854	-0.116	0.224	0.000
P值		0.148	0.068	0.908	0.636	1.000	0.314^a

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	28.81±10.68	8.290	< 0.001
		后测	37.00±13.52
试验组	37	前测	30.39±12.23	9.693	< 0.001
		后测	44.49±13.86
治疗前两组均值差			1.57±14.98	0.590	0.557
治疗后两组均值差			7.49±19.38	2.352	0.021

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	3.68±0.67	3.597	0.001
		后测	4.08±1.09
试验组	37	前测	3.65±0.68	6.524	< 0.001
		后测	4.78±1.23
治疗前两组均值差			0.03±0.76	-0.173	0.863
治疗后两组均值差			0.70±1.71	2.604	0.011

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	1.23±0.76	6.093	< 0.001
		后测	1.74±1.04
试验组	37	前测	1.10±0.85	10.137	< 0.001
		后测	2.30±0.80
治疗前两组均值差			0.13±0.80	-0.703	0.484
治疗后两组均值差			0.56±0.90	2.602	0.011

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	1.27±0.79	9.374	< 0.001
		后测	1.76±0.84
试验组	37	前测	1.32±0.90	8.511	< 0.001
		后测	2.34±0.72
治疗前两组均值差			0.05±0.65	0.274	0.785
治疗后两组均值差			0.58±0.44	3.170	0.002