Program development and its Evaluation of Effectiveness to Support Stroke Patients and their Families by Nursing Intervention

在日本，中风患者约占所有家庭护理患者的70%。防止居家患者陷入卧床状态的护理是提高患者生活质量的最重要、最基本的护理。虽然已有大量关于站立平衡和/或行走能力的研究报道，但关于“从仰卧位起身，在床边保持坐位”的体位运动的研究却很少。此外，传统上使用的相对较大的分析设备难以应用于家庭护理的实际现场。本研究旨在定量评估护理干预在家庭护理场所预防患者卧床状态的效果，并验证其在护理场所的实用性。本研究分为两个阶段：1)研制出一种可用于家庭护理现场的测量体位变化的装置。为了验证该装置的可靠性和有效性，在正常受试者和模拟患者之间进行了以下两种运动（测试运动）的测量和比较。A)保持在床边的坐姿，b)从坐在轮椅上站起来。2)在脑卒中中心的两个点（间隔约一个月）测量测试运动。1)由压电振动陀螺仪、放大器和PC组成的位置变化测量装置的可靠性和有效性：测量了两名女性受试者的角度、角速度和功率的变化，结果表明，与正常受试者相比，角度、平均角速度、功率和运动时间存在显著差异。2)测量了12例脑卒中患者的测试运动，确定了每个病例的角度和角速度的纵向变化，揭示了脑血管疾病特有的体位变化。基础实验和临床实验的结果表明，本研究开发的测量装置可以定量和直观地确定位置的变化。本研究还指出，将训练效果应用于居家照护现场，可将训练效果直观地呈现给脑卒中患者、其家人及照护者，可作为激励患者及为照护者设定照护目标的指标。少

In Japan, stroke patients account for about 70% of all patients at home care setting. Nursing care to prevent patients at home from falling into a bedridden state is the most important and essential care for the improvement of QOL of patients. Though a large number of studies on standing balance and/or walking ability have been reported, they are few studies on a positional motion of "getting up from supine position and maintaining sitting position on the edge of the bed". Moreover, relatively large analytical devices used traditionally were difficult to apply to the practical site of home care. We conducted this study to develop a quantitative method to evaluated the efficacy of nursing intervention to prevent patients from falling into a bedridden state at home care site, and to verify its usefulness at care setting.The study had two stage:1) A device to measure the change in position that can be used at the site of homecare was developed. In order to verify the reliability and valid … More ity of this device experiment was performed where the following two motions(test motions) were measured and compared between normal subjects and mimic patients who emulated hemialgia.a) to maintain sitting position on the edge of the bed, and b) to stand up from sitting position on a wheelchair. 2) The test motions were measured at two points (in the interval of about one month) in stroke center.1) Reliability and validity of a device to measure the change in position consisted of a piezoelectric vibrating gyro, amplifier and PC: Changes in the angle, angular speed and power were measured in two female subjects, and the results revealed significant differences in the angle, mean angular speed, power and motion time as compared with those in normal subjects. 2) The test motions were measured in 12 stroke patients, and longitudinal changes in the angle and angular speed in each case were determined, which revealed changes in position specific for cerebrovascular disease.Results of the basic and clinical experiments demonstrated that the measuring device developed in this study was effective for quantitative and visual determination of changes in position. It was also indicated that its applicability in the site of home care would allow visual presentation of the effect of training to stroke patients, their family and care providers at home, which may serve as the indicator for motivating the patients and setting the target of care for care providers. Less