脑卒中患者康复锻炼依从性发展轨迹及其潜在类别预测因素分析

doi:10.3761/j.issn.0254-1769.2023.17.008

摘要/Abstract

摘要：

目的探讨脑卒中患者康复锻炼依从性发展轨迹及其潜在类别的预测因素。方法采用便利抽样法，选取2020年9月—2021年5月大庆市2所三级甲等医院住院的252例脑卒中患者为调查对象。采用一般情况调查表、脑卒中患者功能锻炼依从性量表、疾病感知问卷简版、Herth希望指数、医院焦虑抑郁量表收集患者的基线资料，于脑卒中后第6、14、24周评估患者的康复锻炼依从性水平，应用潜变量增长混合模型识别依从性发展轨迹，并采用多元Logistic回归分析不同发展轨迹类别的预测因素。结果共识别出脑卒中患者4种康复锻炼依从性发展轨迹：低依从性-改善组（7.5%）、持续中依从性组（21.4%）、中依从性-下降组（46.5%）与低依从性-下降组（24.6%）。多元Logistic回归分析显示，脑卒中类型、脑卒中发作次数以及基线希望、焦虑、抑郁水平是脑卒中患者康复锻炼依从性不同发展轨迹类别的独立预测因素（P<0.05）。结论脑卒中患者发病24周内康复锻炼依从性发展轨迹存在显著群体异质性，仅少部分患者依从性持续处于中等水平或由低水平获得改善，约1/4患者持续处于低水平并有下降趋势。医护人员应依据预测因素早期识别低依从性-下降组患者，实施针对性、特异性与高效的康复锻炼依从性干预，以改善依从性的发展趋势。

关键词: 脑卒中, 康复锻炼, 依从性, 发展轨迹, 预测因素, 潜在类别, 护理

Abstract:

Objective To explore the development trajectory of rehabilitation exercise adherence and its potential classes predictors in stroke patients. Methods By the convenience sampling method，252 stroke patients who were hospitalized in 2 tertiary hospitals in Daqing from September 2020 to May 2021 were selected.The general situation questionnaire，questionnaire of exercise adherence for stroke patients，the brief illness perception questionnaire，Herth hope index，and hospital anxiety and depression scale were used to collect the baseline data of patients，and the rehabilitation exercise adherence was assessed at 6，14 and 24 weeks after stroke. Latent growth mixed model was used to identify the development trajectory of rehabilitation exercise adherence among stroke patients，and multivariate logistic regression analysis was used to explore the predictors of different latent trajectories classes. Results A total of 4 developmental trajectories of rehabilitation exercise adherence among stroke patients were identified：low adherence-improvement group（7.5%），sustained moderate adherence group（21.4%），moderate adhere-nce-decline group（46.5%）and low adherence-decline group（24.6%）. Multivariate Logistic regression analysis showed that stroke type，number of stroke attacks，baseline hope，anxiety and depression levels were independent predictors of different developmental trajectory of rehabilitation exercise adherence among stroke patients（P<0.05）. Conclusion There is significant group heterogeneity in the developmental trajectory of rehabilitation exercise adherence in stroke patients within 24 weeks of onset. Only a small number of patients’ adherence continued to be at a high level or improved from a low level，and about 1/4 of the patients continued to be at a low level and tending to decline. Medical staff should identify patients in the low adherence-decline group early on the basis of predictive factors，and implement targeted，specific and efficient adherence interventions to improve the development trend of adherence.

Key words: Stroke, Rehabilitation Exercise, Adherence, Developmental Trajectory, Predictors, Potential Classes, Nursing Care

吕雨梅, 郭玉成, 周郁秋. 脑卒中患者康复锻炼依从性发展轨迹及其潜在类别预测因素分析[J]. 中华护理杂志, 2023, 58(17): 2103-2111.

LÜ Yumei, GUO Yucheng, ZHOU Yuqiu. Research on the developmental trajectory of rehabilitation exercise adherence and its potential classes predictors in stroke patients[J]. Chinese Journal of Nursing, 2023, 58(17): 2103-2111.

图/表 7

表1 脑卒中患者的一般资料（n=252）

Table 1 Baseline data for stroke patients（n=252）

表2 康复锻炼依从性发展轨迹潜变量增长混合模型拟合指标（n=252）

Table 2 GMM fitting index of developmental trajectory of rehabilitation exercise adherence（n=252）

图1 脑卒中患者康复锻炼依从性潜变量增长混合模型发展轨迹注：T0为基线（康复锻炼1周后），T1、T2、T3分别为脑卒中后6、14、24周。

Figure 1 GMM developmental trajectory of rehabilitation exercise adherence among stroke patients

表3 脑卒中患者各时间点各轨迹类别康复锻炼依从指数简单效应分析结果

Table 3 The simple effect analysis of rehabilitation exercise compliance index of each classes of stroke patients at each time point and trajectory

表4 各轨迹类别患者一般人口学、疾病相关特征与基线心理学因素的单因素分析结果（n=252）

Table 4 Univariate analysis of general demographics, disease-related characteristics and baseline psychological factors between each trajectory class（n=252）

表5 分类自变量赋值情况

Table 5 Assignment of categorical variables

表6 脑卒中患者康复锻炼依从性发展轨迹类别的多元Logistic回归分析结果（n=252）

Table 6 Results of multivariate Logistic regression analysis of the classes of rehabilitation exercise adherence developmental trajectory（n=252）

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