本文選題：社區(qū) + 腦卒中后遺癥患者　； 參考：《復(fù)旦大學(xué)》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(shí)施腦卒中后遺癥患者社區(qū)康復(fù)“四站式”服務(wù)方案,使腦卒中后遺癥患者社區(qū)康復(fù)服務(wù)規(guī)范化和系統(tǒng)化,并對應(yīng)用效果開展評價(jià)。[方法]采用干預(yù)前后與平行對照設(shè)計(jì),定量與定性研究結(jié)合方法,①設(shè)立寶山社區(qū)和共和新社區(qū)分別為干預(yù)組和對照組,運(yùn)用上海市心腦血管疾病報(bào)病系統(tǒng),根據(jù)樣本納入與排除標(biāo)準(zhǔn)對兩個社區(qū)2011年1月至2012年3月發(fā)病1年內(nèi)、已出院回歸到社區(qū)的缺血型腦卒中患者進(jìn)行分層抽樣,干預(yù)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(diào)查,了解社區(qū)康復(fù)人員基本情況、腦卒中后遺癥患者康復(fù)服務(wù)項(xiàng)目、患者的需求與利用及滿意度等情況；③根據(jù)現(xiàn)場調(diào)查結(jié)果,以及定性訪談和專家小組法等方法,確定社區(qū)康復(fù)“四站式”服務(wù)方案,建立服務(wù)標(biāo)準(zhǔn)、流程、內(nèi)容、制度等,為患者在病房、門診、站點(diǎn)以及家庭每一站提供相對應(yīng)的康復(fù)服務(wù)；④利用康復(fù)“四站式”服務(wù)信息管理數(shù)據(jù)庫,對干預(yù)組50名患者實(shí)施“四站式”服務(wù)方案,干預(yù)時間為4個月；⑤康復(fù)“四站式”服務(wù)方案應(yīng)用效果評價(jià)：干預(yù)組和對照組均開展二次問卷調(diào)查了解患者對社區(qū)康復(fù)的滿意度、知曉率、康復(fù)服務(wù)項(xiàng)目利用率,并在每個患者康復(fù)服務(wù)開始及結(jié)束時進(jìn)行巴氏指數(shù)、肢體運(yùn)動功能評測,評定患者社區(qū)康復(fù)效果。[結(jié)果]①社區(qū)康復(fù)“四站式”方案實(shí)施前,干預(yù)組與對照組對腦卒中康復(fù)治療的認(rèn)知度及對社區(qū)康復(fù)治療滿意度的比較無統(tǒng)計(jì)學(xué)意義上顯著差異,兩組具有可比性。方案實(shí)施后,干預(yù)組對康復(fù)服務(wù)認(rèn)知度、滿意度上好于對照組,且有統(tǒng)計(jì)學(xué)意義上顯著差異(P0.05)；②課題實(shí)施前后干預(yù)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(diǎn)差異更為明顯；在站點(diǎn)治療項(xiàng)目的總體利用情況較對照組有顯著差異(P0.01),以關(guān)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(xiàng)目的總體利用情況較對照組有顯著差異(P0.01),以偏癱訓(xùn)練、言語治療、關(guān)節(jié)松動、運(yùn)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(xiàng)目的利用情況較對照組而言運(yùn)動療法、推拿差異有顯著意義；在病房治療項(xiàng)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(fù)“四站式”方案實(shí)施前,干預(yù)組與對照組FMA比較無統(tǒng)計(jì)學(xué)意義上顯著差異,兩組具有可比性。在方案實(shí)施后,兩組患者FMA均較治療前有所改善,干預(yù)組FMA較對照組而言改善更明顯(P0.05)；④社區(qū)康復(fù)“四站式”方案實(shí)施前,干預(yù)組與對照組MBI比較無統(tǒng)計(jì)學(xué)意義上顯著差異,兩組具有可比性。在方案實(shí)施后,兩組患者M(jìn)BI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(jié)論]腦卒中發(fā)病率致殘率高,康復(fù)的介入對于患者的功能恢復(fù)乃至生活質(zhì)量的影響至關(guān)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(fù)而反復(fù)發(fā)作,影響功能恢復(fù)的現(xiàn)狀,本課題通過對寶山社區(qū)“四站式”康復(fù)服務(wù)方案的設(shè)計(jì)與研究,并利用信息管理數(shù)據(jù)庫在寶山社區(qū)實(shí)現(xiàn)了病房、門診、站點(diǎn)以及家庭的社區(qū)全程管理,促進(jìn)了腦卒中后遺癥患者的康復(fù)認(rèn)知水平,建立了較為行之有效的康復(fù)方案,為更好地開展社區(qū)康復(fù)服務(wù)提供了理論和實(shí)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(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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本文編號：1964645