遵從性增強技巧對於中風個案居家物理治療運動遵從性及功能恢復之成效研究

Effects of Adherence Enhanced Intervention on Home Program Exercise Adherence and Functional Recovery in Stroke Patients

李庭蓁(Ting-Chen Lee) ； 林沂(Yi Lin) ； 胡名霞(Ming-Hsia Hu)

《物理治療》 38卷4期 (2013/12) Pp. 264-278

https://doi.org/10.6215/JFPT.PTS1381286463

摘要

Purpose: The 5A (Ask, Advise, Assist, Arrange and Agree) protocol is a behavior counseling technique which may improve patients' adherence to health promoting behavior. This study aimed to investigate the effects of utilizing the 5A protocol on the adherence of home rehabilitation program and on motor function recovery in stroke patients. Method: This was a randomized, controlled, double-blind clinical trial. Eighteen subacute stroke in-patients (average age: 60.8 y/o; male/female=13/5) were recruited and randomly assigned into the Adherence Enhancement (AE) group or the Conventional Home Program (CHP) group. Both groups received home exercise instructions and demonstrative sheets before discharge from the rehabilitation ward. Only the AE group instructed based on the 5A Behavior Intervention Protocol and used self-reports of daily activity diary and pedometer while walking as enhancers for 4 weeks. The outcome measurements included the 10-meter walking test (10MWT), the Functional Ambulation Category (FAC), the Berg Balance Scale (BBS), the daily activity diary, and the Specific Home Exercise Checklist between the two groups at the end of the 4th week post discharge. Follow-up was scheduled during the 12th week post discharge. Results: There were no significant differences on the parameters of basic data, except the hemiplegic side. The AE group subjects exhibited better adherence in some of self-reported of daily activity diary such as flexibility exercise (AE=211%; CHP=90%) and balance exercise (AE=38%; CHP=15%) at 4th week, but not at 12th week after discharge. Both groups improved significantly on 10MWT and BBS (p＜0.001) at both 4th and 12th weeks after discharge. The AE group subjects exhibited better performance in the 10MWT and FAC than the CHP group subjects (p＜0.05) at follow up. However, the groups did not differ significantly on the BBS, Physical Activity Scale for Individuals with Physical Disability, and Specific Home Exercise checklist. Conclusion: Stroke patients with enhanced intervention program on the adherence of home rehabilitation program exhibited better adherence in some of the home program exercise, and better performance in gait speed and community walking ability than the patients who did not receive the intervention program. Therefore, we can conclude that there are some effects of an enhanced intervention program on the adherence of home rehabilitation program in stroke patients. It is suggested that the 5A protocol be adopted by physical therapists for home exercise instructions of stroke patients.

關鍵字

居家運動 ； 5A行為介入協議 ； 遵從度 ； 中風 ； 功能恢復

並列摘要

Purpose: The 5A (Ask, Advise, Assist, Arrange and Agree) protocol is a behavior counseling technique which may improve patients' adherence to health promoting behavior. This study aimed to investigate the effects of utilizing the 5A protocol on the adherence of home rehabilitation program and on motor function recovery in stroke patients. Method: This was a randomized, controlled, double-blind clinical trial. Eighteen subacute stroke in-patients (average age: 60.8 y/o; male/female=13/5) were recruited and randomly assigned into the Adherence Enhancement (AE) group or the Conventional Home Program (CHP) group. Both groups received home exercise instructions and demonstrative sheets before discharge from the rehabilitation ward. Only the AE group instructed based on the 5A Behavior Intervention Protocol and used self-reports of daily activity diary and pedometer while walking as enhancers for 4 weeks. The outcome measurements included the 10-meter walking test (10MWT), the Functional Ambulation Category (FAC), the Berg Balance Scale (BBS), the daily activity diary, and the Specific Home Exercise Checklist between the two groups at the end of the 4th week post discharge. Follow-up was scheduled during the 12th week post discharge. Results: There were no significant differences on the parameters of basic data, except the hemiplegic side. The AE group subjects exhibited better adherence in some of self-reported of daily activity diary such as flexibility exercise (AE=211%; CHP=90%) and balance exercise (AE=38%; CHP=15%) at 4th week, but not at 12th week after discharge. Both groups improved significantly on 10MWT and BBS (p＜0.001) at both 4th and 12th weeks after discharge. The AE group subjects exhibited better performance in the 10MWT and FAC than the CHP group subjects (p＜0.05) at follow up. However, the groups did not differ significantly on the BBS, Physical Activity Scale for Individuals with Physical Disability, and Specific Home Exercise checklist. Conclusion: Stroke patients with enhanced intervention program on the adherence of home rehabilitation program exhibited better adherence in some of the home program exercise, and better performance in gait speed and community walking ability than the patients who did not receive the intervention program. Therefore, we can conclude that there are some effects of an enhanced intervention program on the adherence of home rehabilitation program in stroke patients. It is suggested that the 5A protocol be adopted by physical therapists for home exercise instructions of stroke patients.

並列關鍵字

Home program exercise ； 5A's Behavioral Intervention Protocol ； Adherence ； Stroke ； Functional recovery

參考文獻

Duncan P, Richards L, Wallace D, Stoker-Yates J, Pohl P, Luchies C, et al. A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke 1998;29:2055-60.

Duncan P, Studenski S, Richards L, Gollub S, Lai SM, Reker D, et al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke 2003;34:2173-80.

Choi-Kwon S, Kwon SU, Kim JS. Compliance with risk factor modification: Early-onset versus late-onset stroke patients. Eur Neurol 2005;54:204-11.

McAuley E, Motl RW, Morris KS, Hu L, Doerksen SE, Elavsky S, et al. Enhancing physical activity adherence and well-being in multiple sclerosis: A randomised controlled trial. Mult Scler 2007;13:652-9.

van der Ploeg HP, Streppel KR, van der Beek AJ, van der Woude LH, Vollenbroek-Hutten MM, van Harten WH, et al. Counselling increases physical activity behaviour nine weeks after rehabilitation. Br J Sports Med 2006;40:223-9.