中青年出血性脑卒中患者康复运动依从性现状及其影响因素分析

doi:10.3761/j.issn.0254-1769.2023.05.010

摘要/Abstract

摘要：

目的多中心横断面调查中青年出血性脑卒中患者康复运动依从性现状并分析其影响因素。方法采用便利抽样法，多中心合作研究，于2021年7月—2022年1月选取中国中、东、北部3所三级甲等医院的397例中青年出血性脑卒中住院患者作为调查对象。依据健康行动过程取向（the health action process approach，HAPA）模型，采用一般资料调查量表、脑卒中功能锻炼依从性量表、运动自我效能量表、锻炼计划量表、脑卒中健康信念量表及Barthel指数量表进行横断面调查。结果中青年脑卒中患者功能锻炼依从性量表得分为（43.46±9.58）分，平均依从率为77.60%，康复运动依从性总体较高。多因素回归分析结果显示，运动自我效能、锻炼计划、感知到的易感性、感知到的严重性、感知到的益处、感知到的障碍、健康动力、自我效能是中青年脑卒中患者康复运动依从性的影响因素（P<0.05）。结论临床医护人员应依据HAPA模型，精准评估患者所处的康复运动阶段，根据患者的实际状况和各种可能的影响因素，制订和实施卒中康复运动策略，从而提高患者的康复运动依从性，改善其功能状态，进一步提高其生活质量。

关键词: 中青年, 脑卒中, 运动依从性, 影响因素分析, HAPA模型, 多中心研究, 横断面研究, 护理

Abstract:

Objective To investigate and analyze the current situation of rehabilitation exercise compliance and its influencing factors in young and middle-aged patients with hemorrhagic stroke. Methods By convenient sampling method，young and middle-aged patients with hemorrhagic stroke were selected from 3 hospitals in central，eastern and northern China from July 2021 to January 2022. According to the Health Action Process Approach（HAPA），a cross-sectional survey was conducted with the general information questionnaire，Exercise Adherence Questionnaire （EAQ），the Self-Efficacy for Exercise（SEE） Scale，exercise plan scale，stroke health belief scale and self-care ability scale. Results The total score of exercise adherence of young and middle-aged patients with stroke was 43.46±9.58，and the average compliance rate was 77.60%. Multivariate regression analysis showed that the total scores of exercise self-efficacy，exercise plan，perceived susceptibility，perceived severity，perceived benefits，perceived disorders，health motivation and self-efficacy were the influencing factors of exercise compliance in young and middle-aged stroke patients（P<0.05）. Conclusion Clinical medical staff should accurately evaluate the rehabilitation exercise stage of patients according to HAPA model，formulate and implement stroke rehabilitation exercise strategies according to patients’ actual conditions and various possible influencing factors，so as to improve patients’ exercise compliance，their functional status and further improve their quality of life.

Key words: Young and Middle-Aged, Stroke, Exercise Compliance, Root Cause Analysis, HAPA Model, Multicenter Study, Cross-Sectional Study, Nursing Care

朱金凤, 蔡卫新, 陶子荣, 季翠玲, 袁萍, 陈璐. 中青年出血性脑卒中患者康复运动依从性现状及其影响因素分析[J]. 中华护理杂志, 2023, 58(5): 580-586.

ZHU Jinfeng, CAI Weixin, TAO Zirong, JI Cuiling, YUAN Ping, CHEN Lu. Analysis of rehabilitation exercise compliance and its influencing factors in young and middle-aged patients with hemorrhagic stroke[J]. Chinese Journal of Nursing, 2023, 58(5): 580-586.

图/表 4

表1 中青年脑卒中患者功能锻炼依从性量表得分情况（n=397）

Table 1 Scores of Exercise Adherence Questionnaire in young and middle-aged patients with stroke（n=397）

表2 中青年脑卒中患者的一般资料及康复运动依从性单因素分析结果[例（百分比，%）]

Table 2 The general information of the young and middle-aged stroke patients and results of univarible analysis on the influcing factors of exercise adherence[case（percentage，%）]

表3 中青年脑卒中患者运动自我效能量表、锻炼计划量表、脑卒中健康信念量表得分情况及与脑卒中功能锻炼依从性量表得分的相关性分析结果（分，n=397）

Table 3 The scores of Exercise Adherence Questionnaire，the Self-Efficacy for Exercise Scale， Exercise Plan Scale，Stroke Health Belief Scale of the young and middle-aged stroke patients and correlation analysis with Exercise Adherence Questionnaire（score，n=397）

表4 中青年脑卒中患者康复运动依从性多因素分析结果

Table 4 Results of multivariate analysis of exercise compliance in young and middle-aged patients with stroke

参考文献 21

[1]	GBD Stroke Collaborators. Global,regional,and national burden of stroke and its risk factors,1990-2019:a systematic analysis for the global burden of disease study 2019[J]. Lancet Neurol, 2021, 20(10):795-820. DOI URL
[2]	Wu SM, Wu B, Liu M, et al. Stroke in China:advances and cha-llenges in epidemiology,prevention,and management[J]. Lancet Neurol, 2019, 18(4):394-405. DOI URL
[3]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12):994-1005.
	Chinese Society of Neurology,Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute intracerebral hemorrhage 2019[J]. Chin J Neurol, 2019, 52(12):994-1005.
[4]	弓少华, 孙超, 杨姮, 等. 中青年脑卒中患者疾病体验的Meta整合[J]. 中华护理杂志, 2021, 56(6):843-851. DOI
	Gong SH, Sun C, Yang H, et al. The real experience of stroke patients in young and middle-age adults:a qualitative meta-synthesis[J]. Chin J Nurs, 2021, 56(6):843-851.
[5]	Putaala J. Ischemic stroke in young adults[J]. Continuum (Minneap Minn), 2020, 26(2):386-414. DOI PMID
[6]	Lu XF, Niu XG, Shen C, et al. Development and validation of a Polygenic Risk Score for Stroke in the Chinese population[J]. Neurology, 2021, 97(6):e619-e628. DOI PMID
[7]	García-Cabo C, López-Cancio E. Exercise and stroke[J]. Adv Exp Med Biol, 2020, 1228:195-203. DOI PMID
[8]	练海娟, 姚梅琪, 陈金花, 等. 脑卒中患者家庭功能与康复锻炼依从性现状及其相关性分析[J]. 中华现代护理杂志, 2019, 25(27):3474-3479.
	Lian HJ, Yao MQ, Chen JH, et al. Status and correlation analysis of stroke patients’ family function and rehabilitation exercise compliance[J]. Chin J Mod Nurs, 2019, 25(27):3474-3479
[9]	Park JS, Lee G, Choi JB, et al. Game-based hand resistance exercise versus traditional manual hand exercises for improving hand strength,motor function,and compliance in stroke patients:a multi-center randomized controlled study[J]. NeuroRehabilitation, 2019, 45(2):221-227. DOI URL
[10]	Xu HY, Su C, Ji YY, et al. Predicting physical exercise changes in Chinese rural adolescents: the application of the health action process approach model[J]. Psychol Health Med, 2020, 25(5):639-651. DOI PMID
[11]	《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志, 2022, 19(2):136-144.
	Report on Stroke Prevention and Treatment in China Writing Group. Brief report on stroke prevention and treatment in China,2020[J]. Chin J Cerebrovasc Dis, 2022, 19(2):136-144.
[12]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[13]	林蓓蕾, 张振香, 孙玉梅, 等. 社区脑卒中患者功能锻炼依从性量表的编制及信效度检验[J]. 中国康复医学杂志, 2013, 28(6):574-578.
	Lin BL, Zhang ZX, Sun YM, et al. Development of Functional Exercise Compliance Scale for patients with stroke in community and its reliability and validity[J]. Chin J Rehabilita-tion Med, 2013, 28(6):574-578.
[14]	Resnick B, Jenkins LS. Testing the reliability and validity of the Self-Efficacy for Exercise Scale[J]. Nurs Res, 2000, 49(3):154-159. DOI PMID
[15]	Renner B, Schwarzer R. Risk and health behaviors: documentation of the scales of the research project “risk appraisal consequences in Korea”(RACK)[M]. 2nd ed. Berlin:International University of Bayreuth Press, 2006.
[16]	彭慧蛟, 万丽红, 黄月友, 等. 脑卒中患者健康信念与健康行为的调查研究[J]. 中华护理杂志, 2012, 47(1):10-13.
	Peng HJ, Wan LH, Huang YY, et al. Investigation on health beliefs and health behaviors of stroke patients[J]. Chin J Nurs, 2012, 47(1):10-13.
[17]	Mahoney FI, Barthel DW. Functional evaluation:the Barthel Index[J]. Md State Med J, 1965, 14:61-65.
[18]	李红霞, 孟凡梅, 董爱芹. 脑卒中患者康复运动现状及影响因素分析[J]. 华南预防医学, 2021, 47(3):374-377.
	Li HX, Meng FM, Dong AQ. Status and influencing factors of rehabilitation exercise in patients with stroke[J]. South China J Prev Med, 2021, 47(3):374-377.
[19]	曹莹, 张振香, 林蓓蕾, 等. 农村地区脑卒中患者院外康复锻炼依从性现状及对策分析[J]. 中国实用神经疾病杂志, 2020, 23(7):625-630.
	Cao Y, Zhang ZX, Lin BL, et al. The status of rehabilitation exercise adherence among rural stroke survivors and countermeasures in Henan Province[J]. Chin J Pract Nerv Dis, 2020, 23(7):625-630.
[20]	郭亚雯, 王永利, 梁莉莉, 等. 中青年脑卒中后重返工作研究现状及启示[J]. 护理研究, 2020, 34(9):1573-1577.
	Guo YW, Wang YL, Liang LL, et al. Research status quo on return-to-work in young and middle-aged people after stroke and its enlightenment[J]. Chin Nurs Res, 2020, 34(9):1573-1577.
[21]	盛晗, 邵圣文, 王惠琴, 等. 脑卒中患者康复锻炼依从性动态变化的研究[J]. 中华护理杂志, 2016, 51(6):712-715.
	Sheng H, Shao SW, Wang HQ, et al. A study on the rehabilitation exercise compliance curve in stroke patients[J]. Chin J Nurs, 2016, 51(6):712-715.