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|Title: ||Caregiver-Mediated, Home-Based Intervention (CHI) Can Improve Functional Recovery of Patients With Chronic Stroke--A Randomized, Controlled Study|
|Authors: ||Wang, Tzu-Chi|
|Keywords: ||Stroke;Rehabilitation;Caregiver;Home-based rehabilitation;Functional recovery|
|Issue Date: ||2015-10-16 11:19:59 (UTC+8)|
|Abstract: ||Background and Purpose: Patients with chronic stroke may benefit from continuing rehabilitation training after hospital discharge. This study examined whether caregiver-mediated, home-based intervention (CHI) could improve functional recovery and reintegration to the community of patients with chronic stroke through improving caregivers' care capabilities.
Methods: A single-blind, randomized, controlled, 12-week trial was conducted in 51 patients with chronic (>6 months) Brunnstrom Scale III–V stroke from three hospitals in Taiwan. Patients and their caregivers in the intervention arm (N = 25) were given weekly personalized CHI trainings designed by a physical therapist. Patients in the control arm (N = 26) received visits from the therapist without training. All subjects were evaluated for physical recovery using the Stroke Impact Scale, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, Barthel Index, Fugl–Meyer Assessment Scale (FMA), and Mini-Nutritional Assessment (MNA); and reintegration to the community using the Reintegration to Normal Life Index (RNLI), and evaluation of leisure activity at baseline and endpoint. In addition, we used the 10-item Center for Epidemiologic Studies Depression Scale to assess subjects' psychological health. Care burden of the caregivers were evaluated using the Caregiver Burden Scale. Simple statistics were used for descriptive data. The Mann-Whitney U test and ANCOVA were used to determine the intervention effects controlled for age, sex, and disease history. Generalized Estimating Equations was used to determine the effects of the CHI on the nutritional status. Wilcoxon Signed-rank Test was used to examine the within-group effects.
Results: After 12 weeks of intervention, the CHI significantly improved strength 1.4 (control) vs 15.5 scores (intervention) (P = .002), mobility (-0.5 vs 13.7 scores ; P < .001), composite physical (-0.7 vs 11.2 scores; P < .001), and general recovery domain (0.2 vs 17.4 scores; P < .001) of the Stroke Impact Scale; free-walking velocity (-1.4 vs 7.5 cm/s; P = .006); 6-minute walk distance (-10.5 vs 15.8 m; P = .003); Berg Balance score (-0.8 vs 4.5; P = .006); and Barthel Index score (0.6 vs 7.2 scores; P = .008); RNLI total score (-1.7 vs 10.2 score; P = .001), and Fugl–Meyer Balance score (-0.6 vs 0.9 score; P = .008), and MNA score ( -1.4 vs 2.5; P = .001). However, the CHI did not improve the frequency of leisure activity, depressive symptoms, or other FMA indicators. CHI did not significantly increase caregiver burden score.
Conclusion: A 12-week caregiver-mediated rehabilitation program based on the International Classification of Functioning, Disability, and Health (ICF) conceptual framework and emphasizing home-based repetitive training, outdoor activities, and community reintegration intervention is effective in improving physical functional recovery, daily activity independently and reintegration to community for patients with chronic stroke. Therefore, CHI may be useful in clinical practice.
|Appears in Collections:||[健康管理組] 博碩士論文|
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