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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

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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。
A qualitative study of the influencing factors of ecological momentary assessment of rehabilitation exercise in middle-aged stroke patients
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.

Middle-AgedStrokeRehabilitation ExerciseEcological Momentary AssessmentRoot Cause AnalysisQualitative StudyRehabilitation Nursing

谭雨婷、张志霞、杨振、乔林茹、程蓉、陈秋霞、陈兰姣、肖琴、姜芳

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430064 武汉市 武汉科技大学附属天佑医院护理部

430064 武汉市 武汉科技大学附属天佑医院康复医学科

武汉科技大学医学部

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

2024

中华护理杂志
中华护理学会

中华护理杂志

CSTPCD北大核心
影响因子:5.365
ISSN:0254-1769
年,卷(期):2024.59(21)