中年脑卒中患者康复锻炼生态瞬时评估影响因素的质性研究

doi:10.3761/j.issn.0254-1769.2024.21.009

摘要/Abstract

摘要：

目的探究对中年脑卒中患者康复锻炼实施生态瞬时评估（ecological momentary assessment，EMA）的影响因素，为脑卒中精准康复护理的决策和实践提供依据。方法采用描述性质性研究方法，通过目的抽样法于2024年1月2日—3月10日选取武汉市某三级甲等综合医院8名医护人员、4名信息技术人员、8例中年脑卒中患者及5名照顾者为研究对象，以创新扩散理论为框架进行半结构式访谈，运用定向内容分析法分析资料。结果提炼出相对优势因素（辅助医护人员精准动态评估患者康复行为及症状轨迹；增强患者自我管理意识，有效降低照顾负担），兼容性因素（新方法与现存认知相冲突；新方法与临床工作实践相契合），复杂性因素（评估频率影响康复追踪的准确性；肢体功能受限和社会支持不足增加用户使用负担），可试验性因素（试点与实时反馈可提高用户体验；经验总结与推广，强化实践验证导向），可观察性因素（移动医疗的成功案例，助力新方法普及；可视化呈现康复成效，丰富移动医疗实践）5个主题及10个亚主题。结论在中年脑卒中患者居家康复锻炼领域实施EMA存在一定促进及阻碍因素，未来需挖掘EMA在精准康复领域的潜力，确保其与临床实践相契合。

关键词: 中年, 脑卒中, 康复锻炼, 生态瞬时评估, 影响因素分析, 质性研究, 康复护理

Abstract:

Objective To explore the influencing factors of ecological momentary assessment（EMA） in the implementation of home rehabilitation exercise for middle-aged stroke patients，and to provide a basis for decision-making and practice of precision rehabilitation nursing for stroke. Methods This descriptive qualitative research utilized purposive sampling method to select 8 medical staff，4 information technicians，8 middle-aged stroke patients，and 5 caregivers from a tertiary A general hospital in Wuhan from January 2 to March 10，2024 as the research subjects. Semi-structured interview was conducted based on the framework of diffusion of innovations theory. The data were analyzed using directed content analysis. Results 5 themes and 10 sub-themes were extracted，including relative advantage factors（conducive to precise and dynamic evaluation of patient rehabilitation behavior and symptom trajectory by medical staff；enhancing patient self-management awareness，effectively reducing care burden），compatibility factors（new methods conflict with existing values；new methods are in line with clinical work practice），complexity factors（evaluation frequency affects the accuracy of rehabilitation tracking；limited limb function and social support increase user burden），experimental factors（pilot and real-time feedback improve user experience；experience summary and promotion，the strengthening of practical verification orientation），and observable factors（successful cases of mobile health help popularize new methods；visualization of new methods to enrich mobile health practice）. Conclusion There are certain promoting and hindering factors in the implementation of EMA in the field of home rehabilitation exercise for middle-aged stroke patients. In the future，it is necessary to explore the potential of EMA in the field of precision rehabilitation and ensure its compatibility with clinical practice.

Key words: Middle-Aged, Stroke, Rehabilitation Exercise, Ecological Momentary Assessment, Root Cause Analysis, Qualitative Study, Rehabilitation Nursing

谭雨婷, 张志霞, 杨振, 乔林茹, 程蓉, 陈秋霞, 陈兰姣, 肖琴, 姜芳. 中年脑卒中患者康复锻炼生态瞬时评估影响因素的质性研究[J]. 中华护理杂志, 2024, 59(21): 2620-2626.

TAN Yuting, ZHANG Zhixia, YANG Zhen, QIAO Linru, CHENG Rong, CHEN Qiuxia, CHEN Lanjiao, XIAO Qin, JIANG Fang. A qualitative study of the influencing factors of ecological momentary assessment of rehabilitation exercise in middle-aged stroke patients[J]. Chinese Journal of Nursing, 2024, 59(21): 2620-2626.

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参考文献 23

[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.
[2]	Bukhari S, Yaghi S, Bashir Z. Stroke in young adults[J]. J Clin Med, 2023, 12(15):4999.
[3]	刘晓, 朱郭婷, 蔡雲, 等. 脑卒中患者肢体功能锻炼的证据总结[J]. 中国护理管理, 2020, 20(11):1689-1694.
	Liu X, Zhu GT, Cai Y, et al. Synthesis of the evidence regarding functional exercise for stroke survivors[J]. Chin Nurs Manag, 2020, 20(11):1689-1694.
[4]	García-Cabo C, López-Cancio E. Exercise and stroke[J]. Adv Exp Med Biol, 2020, 1228:195-203. DOI PMID
[5]	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. DOI
	Lü YM, Guo YC, Zhou YQ. Research on the developmental trajectory of rehabilitation exercise adherence and its potential classes predictors in stroke patients[J]. Chin J Nurs, 2023, 58(17):2103-2111. DOI
[6]	徐妍, 黄馨睿, 徐敏. 移动医疗用于脑卒中患者居家康复的范围综述[J]. 护理学杂志, 2023, 38(17):121-125.
	Xu Y, Huang XR, Xu M. A scoping review on the application of mobile health in home rehabilitation for stroke patients[J]. J Nurs Sci, 2023, 38(17):121-125.
[7]	Shiffman S, Stone AA, Hufford MR. Ecological momentary asse-ssment[J]. Annu Rev Clin Psychol, 2008, 4:1-32.
[8]	桑玉还, 严忠婷, 袁媛, 等. 生态瞬时评估在脑卒中患者中应用的范围综述[J]. 中华护理杂志, 2023, 58(3):304-310. DOI
	Sang YH, Yan ZT, Yuan Y, et al. Ecological momentary asse-ssment in stroke patients:a scoping review[J]. Chin J Nurs, 2023, 58(3):304-310.
[9]	郭玉成, 吕雨梅, 闫蕊, 等. 基于生态瞬时评估脑卒中患者康复锻炼依从性及其影响因素分析[J]. 中国卫生统计, 2023, 40(6):917-920.
	Guo YC, Lü YM, Yan R, et al. Evaluation of compliance of rehabilitation exercise of stroke patients based on ecological momentary assessment and analysis of its influencing factors[J]. Chin J Health Stat, 2023, 40(6):917-920.
[10]	Rogers E. Diffusion of innovations[M]. 4th ed. New York: Free Press,1982.
[11]	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 Society of Neurology,Cerebrovascular Disease Group. Diagnostic criteria of cere-brovascular diseases in China(version 2019)[J]. Chin J Neurol, 2019, 52(9):710-715.
[12]	沈子祺, 谢文军, 刘晓平. 基于视频的自动Fugl-Meyer评估方法研究[J]. 电子测量与仪器学报, 2022, 36(2):1-11.
	Shen ZQ, Xie WJ, Liu XP. Automatic Fugl-Meyer assessment based on videos[J]. J Electron Meas Instrum, 2022, 36(2):1-11.
[13]	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9):1277-1288.
[14]	Demers M, Winstein CJ. A perspective on the use of ecolo-gical momentary assessment and intervention to promote stroke recovery and rehabilitation[J]. Top Stroke Rehabil, 2021, 28(8):594-605.
[15]	朱金凤, 张远星, 王芳, 等. 脑卒中患者远程康复运动管理有效性及安全性的系统评价再评价[J]. 中华护理杂志, 2022, 57(12):1447-1455. DOI
	Zhu JF, Zhang YX, Wang F, et al. The effectiveness and safety of telerehabilitation management in stroke patients:an overview of systematic reviews[J]. Chin J Nurs, 2022, 57(12):1447-1455.
[16]	Shekoni O, Iversen S, Diaz GJ, et al. Healthcare workers’ per-ceptions about the use of mobile health technologies in public health facilities in Lagos,Nigeria[J]. SAGE Open Med, 2024, 12:20503121231224568.
[17]	姚涵, 孟晓阳, 卢涛, 等. 智能化技术趋势下医院信息化建设研究[J]. 中国医院管理, 2023, 43(12):60-63.
	Yao H, Meng XY, Lu T, et al. Research on the construction of hospital informatization under the trend of intelligent technology[J]. Chin Hosp Manag, 2023, 43(12):60-63.
[18]	段春梅, 王媛媛, 王玲玲. 多模块康复护理模式在脑卒中患者智能化随访中的应用效果[J]. 中华护理杂志, 2023, 58(3):276-282. DOI
	Duan CM, Wang YY, Wang LL. Application effect of multi-module rehabilitation nursing model in intelligent follow-up of stroke patients[J]. Chin J Nurs, 2023, 58(3):276-282. DOI
[19]	Williams MT, Lewthwaite H, Fraysse F, et al. Compliance with mobile ecological momentary assessment of self-reported health-related behaviors and psychological constructs in adults:systematic review and meta-analysis[J]. J Med Internet Res, 2021,23(3):e17023.
[20]	Kalasin S, Surareungchai W. Challenges of emerging wearable sensors for remote monitoring toward telemedicine healthcare[J]. Anal Chem, 2023:1773-1784.
[21]	王文娜, 林蓓蕾, 张振香, 等. 脑卒中患者远程康复体验质性研究的Meta整合[J]. 中华护理杂志, 2021, 56(2):199-206. DOI
	Wang WN, Lin BL, Zhang ZX, et al. Meta-synthesis of qua-litative research on the real experience of telerehabilitation for stroke survivors[J]. Chin J Nurs, 2021, 56(2):199-206.
[22]	Devittori G, Dinacci D, Romiti D, et al. Unsupervised robot-assisted rehabilitation after stroke:feasibility,effect on therapy dose,and user experience[J]. J Neuroeng Rehabil, 2024, 21(1):52. DOI PMID
[23]	Lau SCL, Connor LT, King AA, et al. Multimodal ambulatory monitoring of daily activity and health-related symptoms in community-dwelling survivors of stroke:feasibility,acceptabi-lity,and validity[J]. Arch Phys Med Rehabil, 2022, 103(10):1992-2000.