|关键词||日常生活活动能力 Barthel指数 康复效果 脑卒中|
|其他题名||The application of ADL function changes in rehabilitation effect evaluation of patients with stroke|
Objective:Analyze the changes of inpatients’Activities of Daily Living（ADL） with stroke and the possible influence factors, as well as , explore how the patients’ ADL in admission and disge could be used in the rehabilitation evaluation among inpatients with stroke.
Methods: This study was a deive research. The data source was the the public health information center of Beijing, all of the stroke patients hospitalized ≥30,＜180 days in secondary hospital and tertiary hospitals during 2013-2014 were included. And those samples were divided into the type of hemorrhagic stroke and the type of ischemic stroke. SPSS 17.0 was used to make the statistic analysis, for the statistical deion，frequency、ratio、median were used ,and the chi-square 、 rank-sum test 、logistic regression were for the statistical inference.
The situation of the research object included
Extracted data during the period of 2013.1.1~2014.12.31from the public health information center of Beijing, 5521 samples in 101 hospitals were included, of which 799 patients(14.47%)with hemorrhagic stroke and 4722(85.53%)with ischemic stroke;2495(45.19%) were hospitalized in secondary hospitals and 3026(54.81%) in tertiary hospitals.
The changes of ADL and cost-effectiveness of the rehabilitation
The ADL function changes of hemorrhagic stroke patients were:472 (59.07%) were increased, 300 (37.55%) were unchanged，27(3.38%) were decline; ADL function changes of ischemic stroke stroke patients were:1938 (41.04%) were increased, 2422 (51.29%) were unchanged，362(7.67%) were decline;
The median (P25, P75) of the absolut functional gain, rehabilitation efficiency, ADL recovery effectiveness, cost-effectiveness of the rehabilitation with hemorrhagic stroke patients were 10.00 (0.00, 30.00), 0.16 (0.00, 0.67) and 11.11% (0.00%, 41.67%), 0.20 (0.00, 0.78);when Ischemic were 0.00 (0.00, 10.00), 0.00 (0.00, 0.22) and 0.00% (0.00%, 22.22%), 0.00 (0.00, 0.30); the functional changes and cost-effectiveness of the rehabilitation between patients with hemorrhagic and ischemic stroke were significant different, and the patients with hemorrhagic stroke were better than patients with ischemic stroke （p＜0.001）.
3.According to single factor analysis,the influence factors associated with the ADL changes in patients with stroke were age, patterns of payment,types of diseases,concominant diseases,the way of admission,the classifications of ADL in admission and whether receivere habilitation treatment or not,etc(p＜0.05）.but the outcomes were not the same between patients with hemorrhagic stroke and ischemic stroke.
4.In the regression analysis, the efficient variables influencing the hemorrhagic stroke patients with moderate and severe whether can basically take care of themselves when disge were age , the way of admission , the classifications of ADL in admission and concominant diseases,while in ischemic stroke patients were age, the way of admission , the classifications of ADL in admission, and the classes of hospitals ; The correlations among the independent variables and the depedent variable were weaker , but the model’s goodness of fit was good，with the classification accuracy were 82.3% and 87.9%.
5. The proportions of receiving rehabilitation were 62.70%( hemorrhagic stroke )and 60.59%( ischemic stroke),and it was higher in tertiary hospitals than secondary hospitals（p＜0.001）.After controlling the confounding factors,the results showed the ADL changes couldn’t reflect the different rehabilitation efficacy in patients with hemorrhagic stroke (p≥0.05), but could in the patients with ischemic stroke(p＜0.05).
The ADL function were a certain improvement in hospitalized patients with stoke during 2013-2014，the functional recovery of inpatients with hemorrhagic stroke were better than patients with ischemic stroke,and the influence factors between two types of stoke were also different. The proportions of receiving rehabilitation were slightly lower,The ADLchanges could not reflect the different rehabilitation efficacy in patients with hemorrhagic stroke (p≥0.05), but could in the patients with ischemic stroke(p＜0.05) .It’s better to consult other outcomes for further research .
|廖艳芳. ADL功能变化在脑卒中患者康复效果评价中的应用[D]. 北京大学护理学院. 北京大学,2016.|