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

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