脑卒中患者社会参与影响因素的Meta分析及护理启示

doi:10.3761/j.issn.0254-1769.2026.11.016

摘要/Abstract

摘要：

目的系统评价脑卒中患者社会参与的影响因素，为临床制订针对性的护理干预方案提供循证依据。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Web of Science、PubMed、Cochrane Library、Embase数据库中关于脑卒中患者社会参与影响因素的研究。检索时限为建库至2025年10月17日。由2名研究者独立进行文献筛选、质量评价和数据提取，采用Stata 18.0软件进行Meta分析。结果共纳入19篇研究，提取20个影响因素。Meta分析结果显示，具有统计学意义的影响因素包括日常生活活动能力（OR=0.26）、女性（OR=1.82）、脑卒中既往史（OR=4.43）、年龄（OR=1.05）、美国国立卫生研究院脑卒中量表评分（OR=1.49）、改良Rankin量表评分（OR=2.16）、抑郁（OR=3.17）。结论脑卒中患者社会参与受到多种因素综合影响，护理人员应动态评估脑卒中患者的社会参与水平，重点关注高龄、女性、伴有负性情绪及躯体功能受损的人群，结合多学科协作模式，给予个体化、精准化的干预措施，促进患者顺利回归社会。

关键词: 脑卒中, 社会参与, 影响因素分析, Meta分析, 循证护理学

Abstract:

Objective To systematically evaluate the influencing factors of social participation in stroke patients，providing a basis for formulating targeted rehabilitation intervention programs in clinical practice. Methods Computerized searches were conducted in databases including CNKI，Wanfang Data，VIP，SinoMed，Web of Science，PubMed，Cochrane Library，and Embase to collect studies on factors influencing social participation in stroke patients from inception to October 2025. There were 2 researchers who independently performed literature screening，quality assessment，and data extraction. Meta-analysis was performed using Stata 18.0 software. Results A total of 19 studies were included，and 20 influencing factors were extracted. Meta-analysis revealed that the statistically significant factors included activities of daily living（OR=0.26），female sex（OR=1.82），history of stroke（OR=4.43），age（OR=1.05），NIHSS score（OR=1.49），MRS score（OR=2.16），and depression（OR=3.17）. Conclusion Social participation in stroke patients is influenced by multiple factors. Nursing staff should dynamically assess the level of social participation in stroke patients，focus on elderly individuals，females，and those with negative emotions or impaired physical function，and provide individualized and precise interventions in combination with a multidisciplinary model to promote patients’ successful return to society.

Key words: Stroke, Social Participation, Root Cause Analysis, Meta-Analysis, Evidence-Based Nursing

王妍, 袁雨秋, 汤露, 俞国红. 脑卒中患者社会参与影响因素的Meta分析及护理启示[J]. 中华护理杂志, 2026, 61(11): 1548-1555.

WANG Yan, YUAN Yuqiu, TANG Lu, YU Guohong. Meta-analysis of factors associated with social participation in stroke patients and nursing implications[J]. Chinese Journal of Nursing, 2026, 61(11): 1548-1555.

图/表 4

图1 文献筛选流程

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征及质量评价结果（n=19）

Table 1 The basic characteristics and quality evaluation results of the included literature（n=19）

表2 脑卒中患者社会参与影响因素的Meta分析结果

Table 2 Meta-analysis results of influencing factors for social participation in stroke patients

图2 年龄因素相关文献发表偏倚漏斗图

Figure 2 Funnel plot for publication bias of literature related to age factors

参考文献 30

[1]	谭雨婷, 张志霞, 许梦莉, 等. 中年脑卒中患者自主康复行为与相关症状关系的研究[J]. 中华护理杂志, 2025, 60(7):773-778.
	Tan YT, Zhang ZX, Xu ML, et al. Relationship between auto-nomous rehabilitation behavior and related symptoms of mid-dle-aged stroke patients[J]. Chin J Nurs, 2025, 60(7):773-778.
[2]	郭鑫, 石红英, 朱杉杉, 等. 脑卒中患者社会参与的纵向研究进展[J]. 护理学杂志, 2024, 39(11):126-129.
	Guo X, Shi HY, Zhu SS, et al. A review of longitudinal studies on social participation in stroke patients[J]. J Nurs Sci, 2024, 39(11):126-129.
[3]	王晓萱, 张振香, 林蓓蕾, 等. 脑卒中患者生活质量与复发风险感知的关系:社会参与的中介作用[J]. 军事护理, 2024, 41(3):47-51.
	Wang XX, Zhang ZX, Lin BL, et al. Mediating effect of social participation in the relationship between quality of life and recurrence risk perception in stroke patients[J]. Mil Nurs, 2024, 41(3):47-51.
[4]	Levasseur M, Lussier-Therrien M, Biron M L, et al. Scoping study of definitions of social participation:update and co-construction of an interdisciplinary consensual definition[J]. Age and Ageing, 2022, 51(2):afab215.
[5]	吕游, 周璇. 脑卒中患者社会参与影响因素研究的系统评价[J]. 护理与康复, 2025, 24(8):20-28.
	Lü Y, Zhou X. A systematic review of determinants of social participation in stroke patients[J]. J Nurs Rehabil, 2025, 24(8):20-28.
[6]	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. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9):710-715.
	Chinese Society of Neurology,Chinese Stroke Society. Diagno-stic criteria of cerebrovascular diseases in China(version 2019)[J]. Chin J Neurol, 2019, 52(9):710-715.
[7]	顾培培, 曾妃, 兰美娟, 等. 肺移植患者衰弱影响因素的Meta分析[J]. 中华护理杂志, 2024, 59(9):1122-1129.
	Gu PP, Zeng F, Lan MJ, et al. Influencing factors of frailty in lung transplant patients:a Meta-analysis[J]. Chin J Nurs, 2024, 59(9):1122-1129.
[8]	Fujita T, Sone T, Asao A, et al. Factors and prediction model associated with resumption of social outings in stroke survivors 6 months after onset:a multicenter prospective study[J]. Top Stroke Rehabil, 2025, 32(4):382-391.
[9]	Chen C, Reeves MJ, Lisabeth LD. Sex differences in participa-tion restriction in social activities among older stroke survi-vors:a nationwide study[J]. Stroke, 2025, 56(2):265-275.
[10]	彭莹, 黄晓娇, 闫凤侠. ICF视角下中青年脑卒中患者社会参与潜在剖面分析[J]. 中国现代医生, 2025, 63(13):46-51.
	Peng Y, Huang XJ, Yan FX. Potential profile analysis of social participation of young and middle-aged stroke patients from the perspective of ICF[J]. China Modern Doctor, 2025, 63(13):46-51.
[11]	Zhang HJ, Liu WP, Sun Y, et al. Multi-dimensional factors asso-ciated with adequate social participation among stroke survivors based on the social ecological model:a cross-sectional study on the gender and living place differences[J]. Geriatr Nurs, 2024,60:654-663.
[12]	Ozkan H, Ambler G, Banerjee G, et al. Prevalence,patterns,and predictors of patient-reported non-motor outcomes at 30 days after acute stroke:Prospective observational hospital cohort study[J]. Int J Stroke, 2024, 19(4):442-451.
[13]	Jadow B, Melmed KR, Lord A, et al. The impact of functiona-lity and psychological outcome on social engagement 3-months after intracerebral hemorrhage[J]. Clin Neurol Neurosurg, 2024, 246:108553.
[14]	文晓芬, 黄凡珊, 刘妍, 等. 中青年缺血性脑卒中患者社会参与水平现况及其影响因素的研究[J]. 医学理论与实践, 2024, 37(14):2482-2485.
	Wen XF, Huang FS, Liu Y, et al. Current status and influen-cing factors of social participation among young and middle-aged patients with ischemic stroke[J]. J Med Theory Pract, 2024, 37(14):2482-2485.
[15]	Flink M, Lindblom S, von Koch L, et al. Health literacy is associated with less depression symptoms,higher perceived recovery,higher perceived participation,and walking ability one year after stroke:a cross-sectional study[J]. Top Stroke Re-habil, 2023, 30(8):865-871.
[16]	Reeves MJ, Thetford C, McMahon N, et al. Life and leisure activities following stroke or transient ischaemic attack(TIA):an observational,multi-centre,6-month follow-up study[J]. Int J Environ Res Public Health, 2022, 19(21):13848.
[17]	吴笑君, 黄小琼, 陈秀兴. 脑卒中患者出院后的社会参与水平及其影响因素[J]. 中西医结合护理(中英文), 2021, 7(9):184-186.
	Wu XJ, Huang XQ, Chen XX. The level of social participation and its influencing factors in stroke patients after discharge[J]. J Clin Nurs Pract, 2021, 7(9):184-186.
[18]	Toglia J, Askin G, Gerber LM, et al. Participation in younger and older adults post-stroke:frequency,importance,and desira-bility of engagement in activities[J]. Front Neurol, 2019,10:1108.
[19]	Svensson JS, Westerlind E, Persson HC, et al. Occupational gaps 5 years after stroke[J]. Brain Behav, 2019, 9(3):e01234.
[20]	Palstam A, Sjödin A, Sunnerhagen KS. Participation and auto-nomy five years after stroke:a longitudinal observational study[J]. PLoS One, 2019, 14(7):e0219513.
[21]	Cai Y, Towne SD Jr, Bickel CS. Multi-level factors associated with social participation among stroke survivors:China’s health and retirement longitudinal study(2011-2015)[J]. Int J Environ Res Public Health, 2019, 16(24):5121.
[22]	Törnbom K, Hadartz K, Sunnerhagen KS. Self-perceived partici-pation and autonomy at 1-year post stroke:a part of the stroke arm longitudinal study at the university of Gothenburg(SALGOT study)[J]. J Stroke Cerebrovasc Dis, 2018, 27(4):1115-1122.
[23]	de Graaf JA, van Mierlo ML, Post MWM, et al. Long-term rest-rictions in participation in stroke survivors under and over 70 years of age[J]. Disabil Rehabil, 2018, 40(6):637-645.
[24]	Arwert HJ, Schults M, Meesters JJL, et al. Return to work 2-5 years after stroke:a cross sectional study in a hospital-based population[J]. J Occup Rehabil, 2017, 27(2):239-246.
[25]	Zhang LF, Yan TB, You LM, et al. Barriers to activity and participation for stroke survivors in rural China[J]. Arch Phys Med Rehabil, 2015, 96(7):1222-1228.
[26]	Singam A, Ytterberg C, Tham K, et al. Participation in comp-lex and social everyday activities six years after stroke:predictors for return to pre-stroke level[J]. PLoS One, 2015, 10(12):e0144344.
[27]	Wu S, 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.
[28]	鲍金雷, 杨庆爱, 张俊, 等. 脑卒中半失能老年患者复发恐惧的调查研究[J]. 中华护理杂志, 2021, 56(11):1661-1666.
	Bao JL, Yang QA, Zhang J, et al. Risk factors of stroke and fear of stroke recurrence in elderly stroke patients with semi disability[J]. Chin J Nurs, 2021, 56(11):1661-1666.
[29]	杨静, 陈馨, 白忠良, 等. 社区老年脑卒中患者的社会网络状况及影响因素研究[J]. 中国全科医学, 2019, 22(10):1243-1246, 1250.
	Yang J, Chen X, Bai ZL, et al. Social network status and influencing factors in community-dwelling elderly stroke patients[J]. Chin Gen Pract, 2019, 22(10):1243-1246,1250.
[30]	苏炫, 成巧梅, 李晓婉, 等. 急性期脑卒中患者卒中后抑郁的潜在类别及护理启示[J]. 中华护理杂志, 2025, 60(7):785-791.
	Su X, Cheng QM, Li XW, et al. Study on the latent classes of post-stroke depression in patients with acute stroke and nursing insights[J]. Chin J Nurs, 2025, 60(7):785-791.