本文選題：社區(qū) + 腦卒中后遺癥患者��； 參考：《復旦大學》2014年碩士論文

【摘要】：[目的]本課題通過在寶山社區(qū)建立并實施腦卒中后遺癥患者社區(qū)康復“四站式”服務方案,使腦卒中后遺癥患者社區(qū)康復服務規(guī)范化和系統(tǒng)化,并對應用效果開展評價。[方法]采用干預前后與平行對照設計,定量與定性研究結合方法,①設立寶山社區(qū)和共和新社區(qū)分別為干預組和對照組,運用上海市心腦血管疾病報病系統(tǒng),根據(jù)樣本納入與排除標準對兩個社區(qū)2011年1月至2012年3月發(fā)病1年內、已出院回歸到社區(qū)的缺血型腦卒中患者進行分層抽樣,干預組和對照組各確定50名研究對象。②對100名研究對象開展現(xiàn)場調查,了解社區(qū)康復人員基本情況、腦卒中后遺癥患者康復服務項目、患者的需求與利用及滿意度等情況；③根據(jù)現(xiàn)場調查結果,以及定性訪談和專家小組法等方法,確定社區(qū)康復“四站式”服務方案,建立服務標準、流程、內容、制度等,為患者在病房、門診、站點以及家庭每一站提供相對應的康復服務；④利用康復“四站式”服務信息管理數(shù)據(jù)庫,對干預組50名患者實施“四站式”服務方案,干預時間為4個月；⑤康復“四站式”服務方案應用效果評價：干預組和對照組均開展二次問卷調查了解患者對社區(qū)康復的滿意度、知曉率、康復服務項目利用率,并在每個患者康復服務開始及結束時進行巴氏指數(shù)、肢體運動功能評測,評定患者社區(qū)康復效果。[結果]①社區(qū)康復“四站式”方案實施前,干預組與對照組對腦卒中康復治療的認知度及對社區(qū)康復治療滿意度的比較無統(tǒng)計學意義上顯著差異,兩組具有可比性。方案實施后,干預組對康復服務認知度、滿意度上好于對照組,且有統(tǒng)計學意義上顯著差異(P0.05)；②課題實施前后干預組腦卒中后遺癥患者“四站”總體利用情況較對照組有顯著差異(P0.01),以門診、站點差異更為明顯；在站點治療項目的總體利用情況較對照組有顯著差異(P0.01),以關節(jié)松動、低頻、微波、超短波及推拿差異更為明顯；在門診治療項目的總體利用情況較對照組有顯著差異(P0.01),以偏癱訓練、言語治療、關節(jié)松動、運動療法、低頻、微波、超短波及推拿差異更為明顯；在家庭治療項目的利用情況較對照組而言運動療法、推拿差異有顯著意義；在病房治療項目的利用情況較對照組而言作業(yè)治療、微波及推拿差異有顯著意義；③社區(qū)康復“四站式”方案實施前,干預組與對照組FMA比較無統(tǒng)計學意義上顯著差異,兩組具有可比性。在方案實施后,兩組患者FMA均較治療前有所改善,干預組FMA較對照組而言改善更明顯(P0.05)；④社區(qū)康復“四站式”方案實施前,干預組與對照組MBI比較無統(tǒng)計學意義上顯著差異,兩組具有可比性。在方案實施后,兩組患者MBI均較治療前有所改善,對照組MBI較對照組而言改善更明顯(P0.05)。[結論]腦卒中發(fā)病率致殘率高,康復的介入對于患者的功能恢復乃至生活質量的影響至關重要。面對目前綜合醫(yī)院普遍的存在病人多床位少,腦卒中后遺癥患者常因未系統(tǒng)康復而反復發(fā)作,影響功能恢復的現(xiàn)狀,本課題通過對寶山社區(qū)“四站式”康復服務方案的設計與研究,并利用信息管理數(shù)據(jù)庫在寶山社區(qū)實現(xiàn)了病房、門診、站點以及家庭的社區(qū)全程管理,促進了腦卒中后遺癥患者的康復認知水平,建立了較為行之有效的康復方案,為更好地開展社區(qū)康復服務提供了理論和實踐依據(jù)。
[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 ) .
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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本文編號：1964645