Enhance caregivers’ practice on motor rehabilitation care for stroke patients at Phu Tho Traditional medicine and Functional rehabilitation Hospital in Viet Nam

Nội dung text: Enhance caregivers’ practice on motor rehabilitation care for stroke patients at Phu Tho Traditional medicine and Functional rehabilitation Hospital in Viet Nam

1. RESEARCH ARTICLE ENHANCE CAREGIVERS’ PRACTICE ON MOTOR REHABILITATION CARE FOR STROKE PATIENTS AT PHU THO TRADITIONAL MEDICINE AND FUNCTIONAL REHABILITATION HOSPITAL IN VIET NAM Ngo Huy Hoang 1, Nguyen Thi Mai Huong2, Nguyen Thị Dung2 1Nam Dinh University of Nursing 2Phu Tho Medical College ABSTRACT Objective: To evaluate changes in practice right after the intervention and the caregivers’ practice on the motor before being discharged from hospital rehabilitation care for patients after stroke increased up to 12.78 ± 2.18 points then at Phu Tho Provincial Traditional Medicine continuously went up to 15.68 ± 3.04 points and Functional Rehabilitation Hospital after in comparison with 8.96 ± 2.30 points before the caregiver-training program in 2020. the intervention. The numbers of cagivers Method: The one group pre-test and post- who did appropriate practice on several test educational intervention regarding the items of taking care for motor rehabilitation practice on motor rehabilitation for patients of stroke patients were increased right after after stroke was conducted with a purposive the intervention and before the discharge sample of 50 caregivers who were main from hospital. Conclusion: The cargivers’ responsible for taking care of patients after practice on motor rehabilitation for patients stroke. Results: After the intervention, the after stroke was considerablely improved caregiver’s practice of motor rehabilitation after the training intervention of study. for stroke patients was significantly overall Keywords: motor rehabilitation, stroke improved. The mean scores of cargivers’ patients, caregivers, intervention 1. INTRODUCTION According to the World Health of sequelae after stroke depend a lot on Organization [1], stroke or cerebral vascular time and how patients are recognized, accident is currently the second most diagnosed and treated [2], [3]. Most studies common cause of deaths and will become on prevention and treatment of stroke had one of the leading causes of deaths been done in developed countries, but more worldwide in 2030. Among cardiovascular than 85% of strokes occur in developing causes, stroke is one of the leading causes countries [3]. of death and disability. Accompany with In developed countries, because of high the advancement of medicine, the death costs, many patients with stroke often de- rate from stroke has been decreasing, but pend on outpatient care for rehabilitation the number of disabled patients suffered after being discharged from hospitals [4]. from stroke tends to increase. The levels Home-based programs have emerged as an attractive alternative for stroke rehabil- itation. Numerous studies have shown that Cor. author: Ngo Huy Hoang home-based or caregiver-mediated rehabil- Email: ngohoang64@ndun.edu.vn itation programs can improve the mobility Received: Feb 17, 2021 and functional performance of patients with Revised: Feb 23, 2021 acute or subacute stroke and reduce health Accepted: Mar 05, 2021 care costs [5], [6]. 132 Journal of Nursing Science - Vol. 04 - No. 01
2. RESEARCH ARTICLE In Viet Nam, due to low economic con- conducted in order to “evaluate changes in dition, the resources of medical facilities the practice of motor functional rehabilitation in many local areas are limited, while the in family caregivers of patients after stroke mortality rate and motor sequelae of stroke at Phu Tho Provincial Traditional Medicine patients are still high [9], rehabilitation for and Functional Rehabilitation Hospital after stroke patients, especially for low-income the educational intervention in 2020.” families remains a difficulty. Patients after 2. RESEARCH METHOD a period of acute stroke in Viet Nam are of- The participants in this study were ten seen in various levels of function loss “regular caregivers” of stroke patients from mild to severe, and notably a deficit of with hemiplegia being hospitalized at Phu motor function. This make stroke patients Tho Provincial Traditional Medicine and to lose their independence in daily life and Functional Rehabilitation Hospital from to become dependent on their family or so- January to May 2020. ciety [7]. Therefore, motor rehabilitation for stroke patients become essential imporrt- The one group pre-test and post-test ant, not during the hospital stay but need to educational intervention regarding the be continued after the discharge from hos- practice on motor rehabilitation for patients pital to return home. after stroke was selected for this study design because of the most appropriate in Studies showed a range of 60-80% of terms of research method. disabled people were recovered their func- tion at home after discharge from hospi- Caregivers selected to the study training tal. However, rehabilitation in general and program included persons who were motor rehabilitation in particular for stroke confirmedly to take the main responsibility patients requires a patience and long-term for caring of their stroke patient, to spend after a hospitalized duration and therefore, the most time on caring for patient’s daily regular caregivers of stroke patients play an living activities such as hygiene, bathing, important role, s/he needs to be aware of feeding, assissting the patient’s movement the importance of rehabilitation and to be and mobility during the hospital stay as provided appropriate skills on care through well as after the patient discharges from a training program so that these caregivers hospital to return home. They have to can continue to perform motor rehabilitation consent to participate in the study and be for their stroke patients at home [8]. As rec- able to perceive and perform activities of ommended by the VietNamese Ministry of motor rehabilitation for the stroke patient. Health, caregivers need to be trained in the The study sample were not included specific care techniques appropriate to their any caregivers who attended a similar ability such as preventing pressure ulcers, educational program; caregivers who did placing therapeutic positions, moving the not participate fully in the activities of the patient from bed to chair, or assisting with study were not included in the analysis for activities such as walking [9]. results. Aiming to train the regular caregivers Convenience sampling method was of stroke patients on essential motor applied and all caregivers who met the rehabilitation skills during patients’ sampling criteria were selected. In fact, not hospitalization and caregivers are available all stroke patients have a regular caregiver in hospital so that these caregivers will as mentioned above and fully engaged continue to do motor rehabilitation for in the research activities, so the actual patients after the discharge, this study was sample of this study during the period of Journal of Nursing Science - Vol. 04 - No. 01 133
3. RESEARCH ARTICLE implementing educational program was 50 the day before discharge from hospital participants. (M3). Each motor care technique that the The training content for caregivers was caregiver performed appropriately for the based on the document “Rehabilitation after patient was scored 1 point, cases was a stroke” issued by the Ministry of Health of not performed; not appropriate enough or Viet Nam [8]. Techniques of patient’s motor performed incorrectly received no point. rehabilitation were illustrated with images Data from evaluations were cleaned, accompanied by specific instructions were entered independently two times and provided in advance to the caregiver, analyzed on SPSS 20.0 software. sample manipulations of care techniques for In addition to ethical aspects such as the stroke patient were performed in order the participant’s rights and confidentiality, to caregivers followed until s/he did well. the study proposal received the approval Aimed to train the participanted caregivers by the Scientific Board and the Ethical to perform appropriately the motor care of Council for Biomedical Research of Nam stroke patients and to become routine care, Dinh University of Nursing as well as the after the session of providing instructions permission of Phu Tho Provincial Traditional and evaluating participant’s performance, Medicine and Functional Rehabilitation the caregivers were daily encouraged to Hospital. deliver motor care for the patient away 3. RESULTS from patient’s meals under the supervision The mean age of 50 regular caregivers of research team and any inappropriate who participated in the study was 49.64 performance by caregivers would be ± 8.66 years old, the number of female instructed again and the result after the re- caregivers accounted for 72% and the instruction was not included in the analysis number of caregivers at the educational of the study results. level of high school was 64%. The caregiver’s implementation of The results of motor care practice motor rehabilitation techniques for the by participated caregivers based on the stroke patient was measured by direct training content at the time before the observations and using the same checklist training (M1), right after the training (M2) for three times included on the second and on the day before the discharge from day of hospital stay (M1 ), on the day after hospital (M3) were summarized in Tables 1 training of motor techniques (M2) and on to Table 4 as the following. Table 1. Care for lying postures of the patient Number of caregivers Caring items performed by caregivers M1 M2 M3 Placing the patient in his/her back Placing pillows under the paralyzed shoulder and hip 10 20 47 Keeping the patient’s knee to be in a slight folding position 30 34 46 Placing the paralyzed foot to be perpendicular to the leg 26 39 43 Placing the patient on the affected side Placing the paralyzed shoulder to be in a folding position 30 38 47 Stretching the paralyzed upper limb to be perpendicular to 28 39 44 the supine body with stretched paralyzed lower limb Folding the healthy lower limb at the groin and knee 18 33 38 134 Journal of Nursing Science - Vol. 04 - No. 01
4. RESEARCH ARTICLE Placing the patient on the healthy side Stretching the healthy lower limb, placing the patient body to 12 19 42 be perpendicular to the bed surface Supporting the paralyzed upper limb with a pillow to be 30 40 46 perpendicular to the body Supporting the paralyzed lower limb with a pillow and to be 16 21 46 folded in the hip and knee Table 2. Care for changing patient positions Number of caregivers Caring items performed by caregivers M1 M2 M3 Rolling the patient to the normal side Interlocking the normal hand to the paralyzed hand 29 31 43 Folding the paralyzed groin and knee 18 27 40 Pulling the paralyzed hand toward the healthy side with the 30 35 40 healthy hand Pushing the patient hip toward the healthy side 21 24 29 Rolling the patient to the affected side Lifting the patient’s healthy arm and leg 12 22 43 Bring the healthy arm and leg toward the paralyzed side 33 33 43 Turning the patient’s body toward the affected side 40 44 45 Supporting the patient to sit up from the supine position Sitting beside the stroke patient 31 37 39 Making the patient’s hands to cling on the cagiver’s arm 18 21 27 Having an arm to be around to support the patient’s shoulder 33 33 30 Lifting the patient slowly to sit up 40 42 48 Table 3. Supporting the patient in performing exercises to improve muscle strength Number of caregivers Caring items performed by caregivers M1 M2 M3 Doing movements of the patient’s hand joints 15 23 36 Doing movements of the patient’s wrist joints 34 44 44 Doing the patient’s elbows to be folded and stretched 36 46 45 Doing the patient’s shoulders to be folded and stretched 23 30 34 Doing the patient’s shoulders to be opened and closed 22 31 38 Doing the patient’s groin to be folded and stretched 18 29 38 Doing the patient’s groin to be opened and closed 22 21 27 Doing the patient’s knees to be folded and stretched 30 32 33 Doing the patient’s ankles to be folded and stretched 24 31 38 Helping the patient to put his/her weight on the paralyzed leg 4 19 23 Helping the patient to lift his/her hips off the bed 2 8 8 Journal of Nursing Science - Vol. 04 - No. 01 135
5. RESEARCH ARTICLE Table 4. Assisting the independence of patient in daily activities with support tools Number of caregivers Caring items performed by caregivers M1 M2 M3 Transfering the patient from bed to wheelchair and vice versa 40 43 48 Supporting the patient to stand up from sitting position 33 41 45 Supporting the patient to walk in the two parallel bars 12 31 33 Supporting the patient to use a shoulder pulley system 4 13 16 Applying an orthopedic brace to maintain correct posture 1 6 11 The results from observing the caregivers’ performance of care techniques regarding motor rehabilitation for stroke patient at the time of pre-training, summarized in Tables from 1 to 4, showed clearly that there were a certain number of caregivers implemented already four groups of motor rehabilitation on caring for their stroke patients. Notably, there were a number of items which were performed by 30 or more than caregivers of the total 50 study participants. Observing and re-evaluating at the times of post-training and the day before the patient’s discharge from the hospital all showed a general trend of increasing the number of caregivers performed appropriate techniques of motor rehabilitation. in all 4 groups included taking care of the lying position of the patient, of changing the position for the patient, of helping the patient to perform exercises that improve muscle strength and support the patient to establish daily living activities. The outcomes of care practice on motor rehabilitation for stroke patients performed by the caregivers participated in the study was overall evaluated based on the scores of all care techniques at different times as seen in Table 5. Table 5. Overall score of caregivers practice Times of measurement Scores M1 M2 M3 Minimum score 5 10 10 Maximum score 14 17 21 Mean score 8.96 ± 2.30 12.78 ± 2.18 15.68 ± 3.04 p(t-test) p(2-1) < 0.001 p(3-1) < 0.001 There was a significant increase in the mean score of motor rehabilitation practice immediately after the training course (M2) and continued to increase on the day before the discharge from hospital (M3), the mean scores respectively were 12.78 ± 2.18 points and 15.68 ± 3.04 points in comparision with 8.96 ± 2.30 points at the time of pre-training (M1). 4. DISCUSSION According to the overview report of Viet Nam dong per year. About 15,990 the health sector in 2014 by the Ministry stroke patients were paralyzed, disabled, of Health of Viet Nam [10], the incidence and unable to work due to stroke each of stroke in 2014 was 47.6 per 100,000 year. Common consequences of strokes persons and the direct cost for medical in people with stroke were weakness or treatment of this disease was 144 billion paralysis of one side of the body, leading to 136 Journal of Nursing Science - Vol. 04 - No. 01
6. RESEARCH ARTICLE difficultyin rolling over in bed while changing guidance and training from healthcare body positions. Weakness or paralysis of professionals. one side of the body also affected the ability After the training course and on the to balance, making difficult for the patient day before the patient’s discharge, the to sit up and sit steadily, to stand up and results showed a considerable increase in to move. In addition, the difficulty of moving the number of regular caregivers who did hands, feet and body also made difficult appropriate practice on motor rehabilitation for the patient to perform daily activities care in more items in all technical groups of including eating, washing face, brushing motor rehabilitation for their stroke patients. teeth, changing clothes, etc. [2 ], [11] Accompany with the same improvement Doing motor exercise not only helps resulted in the study of Nguyen Thi Lan’s the stroke patient to recover mobility and after the educational intervention [13], the gradually become independent in daily result of improving caregivers’ practice at activities, take care of and serve themselves, the times of post-intervention in our study reduce the burden on their family and the was again confirmed this. society, but also helps to reduce stroke The study had not yet achieved the recurrence [4], [6] and the role of caregivers ideal results that was to enable all regular who were trained on providing appropriate caregivers to properly and fully implement care and advocacy for stroke patients have motor rehabilitation care for their stroke been shown to contribute to solving these patients. The reasons could in particularly problems [12]. be the limited duration of the intervention. It Before the training, there was a certain was the period of hospital stay of a patient but uneven number of the caregivers who and the presence of his/her caregiver in the performed some items of care in all the hospital not long enough to be affected. motor rehabilitation technical groups for Moreover, a regular caregiver also needs stroke patients as seen in Tables 1 to 4. This time to create his/her habits in daily caring results in our study were also consistent practice. However, adding of a caregiver with the results from a similar educational to the team of caregivers who can provide intervention study by Nguyen Thi Lan in motor rehabilitation care for stroke patients 2017 in Quang Ninh that conducted in 54 after the intervention is likely to increase regular caregivers [13] in which there was the chances for stroke patients to be taken also a certain number of caregivers who care of and recovered motor function after were able to perform some of the care items discharge from hospital, and this means regarding motor care technical groups practical rather than statistical. before participated in the training program. As required, each of motor rehabilitation Stroke as mentioned is a common problem care techniques for stroke patients that and information on taking care of stroke caregivers performed properly and fully has been disseminated from a variety of could be scored and the results based on sources that could be the reason for this scores of practice. Table 5 illustrated an finding, but there is still no evidence from increased score of caregivers’ practice right the research itself to confirm. And this after the training course at 12.78 ± 2.18 is also one of the limitations of the study points and continued to increase on the when the instrument fof data collection did day before the discharge at 15.68 ± 3.04 not ask questions for this issue. However, points compared to 8.96 ± 2.30 points that it can be said that this is a positive signal caregivers gained at the time before the of caregivers’ willingness to receive official training course of the total 23 points of the Journal of Nursing Science - Vol. 04 - No. 01 137
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