The 1+N+N team model with family physicians as the core for rehabilitation of community-dwelling stroke patients / 中华全科医师杂志

ABSTRACT

Objective:To explore the effectiveness of 1+N+N team model with family physician as the core for rehabilitation of community-dwelling stroke patients.Methods:Convalescent stroke patients in Fenglin Community of Shanghai Xuhui District, who were followed up and registered from January 2019 to October 2021, were continuously enrolled in this intervention study. The 1+N+N care team consisted of a family doctor as the core (“1”) with the professional and technical team of the community health service center (“N”) and specialists in second or third hospitals (“N”). Patients were randomly divided into 1+N+N intervention group and control group. The control group was treated with traditional stroke management scheme, while the intervention group was treated by the 1+N+N team model. The activities of daily living (ADL), motor function and psychological status scores were evaluated at baseline and 12 months after intervention. Multivariate linear regression model was used to analyze the association of intervention methods with the improvement of ADL score, motor function score and psychological status score of patients.Results:A total of 120 patients were enrolled (60 in each group), including 59 males and 61 females with a mean age of (71.5±6.8) years. Compared with the control group, the age of patients in the intervention group was younger ( P=0.013), and the proportion of patients with coronary heart disease was lower ( P=0.003). There was no significant differences in other variables between the two groups ( P>0.05). After 12 months of intervention, the scores of ADL, motor function and psychological status were significantly improved compared with those before intervention in both groups ( P<0.01). There was no significant difference in motor function scores between the intervention group and the control group before intervention ( P>0.05), but the scores of ADL and psychological status in the intervention group were higher than those in the control group ( P<0.001). After intervention, the above scores in the intervention group were higher than those in the control group ( P<0.01). After adjusting for confounding factors, multivariate linear regression showed that the 1+N+N team model had no significant correlation with ADL score ( t=0.27, P=0.799), but had a positive correlation with motor function score ( t=15.64, P<0.01) and psychological status score ( t=13.70, P<0.01). Conclusion:The 1+N+N team model can effectively improve the daily living ability, motor function and psychological status of stroke patients in the convalescent period, and the intervention effect on the latter two is better than that of the traditional rehabilitation mode.