基于IP-SDM模式对脑卒中患者出院后康复结局及生活质量的随机对照研究-现代医学

基于IP-SDM模式对脑卒中患者出院后康复结局及生活质量的随机对照研究

单位：南京市江宁医院神经内科, 江苏南京 211100

分类号：R743.3

出版年·卷·期（页码）：2026·54·第七期（1071-1080）

摘要：

目的：探讨跨专业共同决策模式(IP-SDM模式)对脑卒中患者出院后康复结局及生活质量的影响。方法：采用随机对照试验设计，选取2024年1月至6月神经内科收治的脑卒中患者156例，按随机数字表法分为观察组和对照组各78例。对照组给予常规出院指导及随访，观察组在此基础上实施为期12周IP-SDM模式干预。分别于出院时及出院后4、8、12周评估两组患者的改良Barthel指数(MBI)、Fugl-Meyer运动功能评定量表(FMA)、脑卒中专用生活质量量表(SS-QOL)、一般自我效能感量表(GSES)及医院焦虑抑郁量表(HADS)得分。主要分析集为依从方案集(PP)，并以全分析集(FAS)进行敏感性分析。组间比较采用重复测量方差分析，多重比较采用Bonferroni法校正，并报告Cohen's d及95%置信区间(CI)。结果：PP分析共纳入148例(观察组75例，对照组73例)，敏感性分析结果与PP分析一致。干预12周后，观察组MBI评分[(72.35±12.48)分 vs.(61.28±14.35)分]、FMA评分[(68.92±15.63)分vs.(57.24±17.82)分]、SS-QOL评分[(186.45±28.76)分vs.(162.38±32.45)分]、GSES评分[(32.18±4.52)分vs.(27.65±5.38)分]均显著高于对照组，组间差值分别为11.07分(Cohen's d=0.82，95%CI：6.32~15.82)、11.68分(Cohen's d=0.70,95%CI：5.93~17.43)、24.07分(Cohen's d=0.78,95%CI：13.28~34.86)、4.53分(Cohen's d=0.91,95%CI：2.87~6.19)。观察组HADS焦虑[(6.82±2.45)分vs.(9.35±3.12)分]和抑郁[(7.15±2.68) 分 vs.(10.28±3.45)分]评分显著低于对照组，组间差值分别为2.53分(Cohen's d=0.89，95%CI：1.48~3.58)和3.13分(Cohen's d=1.00,95%CI：2.04~4.22)，上述差异均有统计学意义。结论：IP-SDM模式能够有效促进脑卒中患者出院后的功能康复，提高生活质量和自我效能感，改善焦虑和抑郁情绪，值得临床推广应用。

Objective: To investigate the effects of interprofessional shared decision-making(IP-SDM) model on rehabilitation outcomes and quality of life in stroke patients after discharge. Methods: A randomized controlled trial was conducted with 156 stroke patients admitted to the Department of Neurology from January to June 2024. Patients were randomly assigned to an observation group(n=78) or a control group(n=78). The control group received routine discharge guidance and follow-up, while the observation group received additional IP-SDM intervention over a 12-week period. Assessments were performed at discharge and at 4, 8, and 12 weeks post-discharge using the Modified Barthel Index(MBI), Fugl-Meyer Assessment(FMA), Stroke-Specific Quality of Life Scale(SS-QOL), General Self-Efficacy Scale(GSES), and Hospital Anxiety and Depression Scale(HADS). The primary analysis was conducted on the per-protocol(PP) set, with the full analysis set(FAS) used for intention-to-treat(ITT) sensitivity analysis. Between-group comparisons were performed using repeated-measures analysis of variance, with multiple comparisons adjusted by Bonferroni correction. Effect sizes were reported as Cohen's d with 95% confidence intervals(CI). Results: A total of 148 patients(75 in the observation group, 73 in the control group) were included in the PP analysis, and the ITT sensitivity analysis yielded results consistent with those of the PP analysis. At 12 weeks post-intervention, the observation group demonstrated significantly higher scores than the control group on the MBI [(72.35±12.48) points vs.(61.28±14.35) points], FMA [(68.92±15.63) points vs.(57.24±17.82) points], SS-QOL [(186.45±28.76) points vs.(162.38±32.45) points], and GSES [(32.18±4.52) points vs.(27.65±5.38) points], with between-group differences of 11.07 points(Cohen's d=0.82，95%CI：6.32-15.82), 11.68 points(Cohen's d=0.70,95%CI:5.93-17.43), 24.07 points(Cohen's d=0.78,95%CI:13.28-34.86), and 4.53 points(Cohen's d=0.91,95%CI:2.87-6.19), respectively. The observation group also exhibited significantly lower HADS anxiety [(6.82±2.45) points vs. (9.35±3.12) points]and depression [(7.15±2.68) points vs.(10.28±3.45) points] scores than the control group, with between-group differences of 2.53 points(Cohen's d=0.89,95%CI:1.48-3.58) and 3.13 points(Cohen's d=1.00,95%CI:2.04-4.22), respectively. All differences were statistically significant. Conclusion: The IP-SDM model effectively promotes functional recovery, enhances quality of life and self-efficacy, and significantly alleviates anxiety and depression in stroke patients after discharge, demonstrating substantial value for clinical dissemination and application.

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