اثربخشي آموزش مهارت استفاده از وسايل كمك حركتي بر عزت نفس و خودكارآمدي بيماران مبتلا به سكته مغزي

The Effect of Training Skills to Using the Mobility Assistive Devices on Self-Esteem and Self-Efficacy of Hospitalized Patients with Stroke

ﻣﻘﺪﻣﻪ: ﮐﺎﻫﺶ ﺧﻮدﮐﺎرآﻣﺪي و ﻋﺰت ﻧﻔﺲ از ﻋﻮارض ﺷﺎﯾﻊ ﺑﻌﺪ از ﺳﮑﺘﻪ ﻣﻐﺰي اﺳﺖ. ﺗﻮاﻧﺒﺨﺸﯽ ﺑﯿﻤﺎران ﭘﺲ از اﺑﺘﻼ ﺑﻪ ﺳﮑﺘﻪ ﻣﻐﺰي اﻣﺮي اﺟﺘﻨﺎب ﻧﺎﭘﺬﯾﺮ اﺳﺖ. آﻣﻮزش اﺳﺘﻔﺎده از وﺳﺎﯾﻞ ﮐﻤﮏ ﺣﺮﮐﺘﯽ ﺑﺎﻋﺚ اﻓﺰاﯾﺶ ﺳﻄﺢ ﻓﻌﺎﻟﯿﺖ و اﺳﺘﻘﻼل ﺑﯿﻤﺎران ﻣﯽﺷﻮد. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ ﺗﺄﺛﯿﺮ آﻣﻮزش ﻣﻬﺎرت اﺳﺘﻔﺎده از وﺳﺎﯾﻞ ﮐﻤﮏ ﺣﺮﮐﺘﯽ ﺑﺮ ﺧﻮدﮐﺎرآﻣﺪي و ﻋﺰت ﻧﻔﺲ ﺑﯿﻤﺎران ﺳﮑﺘﻪ ﻣﻐﺰي اﻧﺠﺎم ﺷﺪ. روش ﮐﺎر: اﯾﻦ ﻣﻄﺎﻟﻌﻪ از ﻧﻮع ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ ﺷﺎﻫﺪ دار اﺳﺖ ﮐﻪ ﺑﺮ روي 62 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﺳﮑﺘﻪ ﻣﻐﺰي در ﺳﺎل 1397 در ﺑﯿﻤﺎرﺳﺘﺎن ﮐﺎﺷﺎﻧﯽ ﺷﻬﺮﮐﺮد اﻧﺠﺎم ﺷﺪ. اﻓﺮاد ﻧﻤﻮﻧﻪ ﺑﻪ ﺷﯿﻮه ﻧﻤﻮﻧﻪ ﮔﯿﺮي آﺳﺎن اﻧﺘﺨﺎب و ﺑﺮ اﺳﺎس اﻋﺪاد ﺗﻮﻟﯿﺪ ﺷﺪه ﺗﻮﺳﻂ ﻧﺮم اﻓﺰار random allocation ﺑﻪ دو ﮔﺮوه آزﻣﻮن و ﺷﺎﻫﺪ ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ. ﻗﺒﻞ از ﺗﺮﺧﯿﺺ ﮔﺮوه ﻣﺪاﺧﻠﻪ آﻣﻮزش اﺳﺘﻔﺎده از وﺳﺎﯾﻞ ﮐﻤﮏ ﺣﺮﮐﺘﯽ را دﯾﺪﻧﺪ و ﮔﺮوه ﺷﺎﻫﺪ آﻣﻮزشﻫﺎ و درﻣﺎنﻫﺎي ﻣﻌﻤﻮل را درﯾﺎﻓﺖ ﮐﺮدﻧﺪ. در ﻣﺮاﺟﻌﻪ ﺑﻌﺪي ﺑﻪ ﭘﺰﺷﮏ ﻣﻌﺎﻟﺞ )ﺣﺪاﻗﻞ دو ﻫﻔﺘﻪ ﺑﻌﺪ( ﺧﻮدﮐﺎرآﻣﺪي و ﻋﺰت ﻧﻔﺲ آﻧﻬﺎ اﻧﺪازه ﮔﯿﺮي ﺷﺪ. دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار SPSS ﻧﺴﺨﻪ 18 و ﺑﻪ ﮐﻤﮏ آزﻣﻮنﻫﺎي آﻣﺎري ﺗﻮﺻﯿﻔﯽ و اﺳﺘﻨﺒﺎﻃﯽ ﺗﺤﻠﯿﻞ ﮔﺮدﯾﺪﻧﺪ ﺳﻄﺢ ﻣﻌﻨﯽ دار 0/05 در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﺑﯿﻤﺎران دو ﮔﺮوه ﻣﺪاﺧﻠﻪ و ﮐﻨﺘﺮل از ﻧﻈﺮ ﻣﺘﻐﯿﺮﻫﺎي ﺟﻤﻌﯿﺖ ﺷﻨﺎﺧﺘﯽ ﻫﻤﺴﺎن ﺑﻮدﻧﺪ. ﺑﺮرﺳﯽ ﻣﯿﺰان ﺧﻮدﮐﺎرآﻣﺪي و ﻋﺰت ﻧﻔﺲ ﻗﺒﻞ و ﺑﻌﺪ آﻣﻮزش در ﮔﺮوه ﺷﺎﻫﺪ، ﺳﻄﺢ ﻣﻌﻨﺎ داري وﺟﻮد ﻧﺪاﺷﺖ )ﺧﻮدﮐﺎرآﻣﺪي 0/221 = P، ﻋﺰت ﻧﻔﺲ 0/102 = P( ﺑﻮد. 0/05 ≥ P وﻟﯽ درﮔﺮوه ﻣﺪاﺧﻠﻪ ﺗﻔﺎوت ﻣﻌﻨﺎ دار داﺷﺖ و ﺑﻬﺒﻮد ﯾﺎﻓﺘﻪ ﺑﻮد. 0/05 ≤ P. ﺑﺮرﺳﯽ ﺧﻮدﮐﺎرآﻣﺪي و ﻋﺰت ﻧﻔﺲ ﮔﺮوه ﻣﺪاﺧﻠﻪ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﺷﺎﻫﺪ در آزﻣﻮن ﮐﻮارﯾﺎﻧﺲ )ﺧﻮدﮐﺎرآﻣﺪي 50/704 = f، ﻋﺰت ﻧﻔﺲ 59/62 = f ﻣﻌﻨﺎدار ﺑﻮد. ﻟﺬا ﺧﻮدﮐﺎرآﻣﺪي و ﻋﺰت ﻧﻔﺲ ﮔﺮوه ﻣﺪاﺧﻠﻪ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﺷﺎﻫﺪ ﺗﻔﺎوت ﻣﻌﻨﺎداري ﭘﯿﺪا ﮐﺮده ﺑﻮد. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: آﻣﻮزش وﺳﺎﯾﻞ ﮐﻤﮏ ﺣﺮﮐﺘﯽ ﺑﻪ ﺑﯿﻤﺎران ﺳﮑﺘﻪ ﻣﻐﺰي ﺳﺒﺐ ﺑﻬﺒﻮد ﻋﺰت ﻧﻔﺲ و ﺧﻮدﮐﺎرآﻣﺪي آﻧﺎن در ﮐﻨﺘﺮل ﻋﻮارض ﻣﺮﺑﻮط ﺑﻪ ﺑﯿﻤﺎري ﻣﯽﮔﺮدد. ﺑﻨﺎﺑﺮاﯾﻦ ﺗﻮﺻﯿﻪ ﻣﯽﺷﻮد آﻣﻮزش اﺳﺘﻔﺎده از اﯾﻦ وﺳﺎﯾﻞ ﺑﺮاي اﻓﺰاﯾﺶ ﻋﺰت ﻧﻔﺲ و ﺧﻮدﮐﺎرآﻣﺪي ﻣﺪ ﻧﻈﺮ ﺑﺎﺷﺪ. ﮐﻠﯿﺪواژهﻫﺎ: وﺳﺎﯾﻞ ﮐﻤﮏ ﺣﺮﮐﺘﯽ، ﺳﮑﺘﻪ ﻣﻐﺰي، ﺧﻮدﮐﺎرآﻣﺪي، ﻋﺰت ﻧﻔﺲ

Decreased self-efficacy and self-esteem are common complications after a stroke. Rehabilitation for patients after stroke is inevitable. The training of the use of mobility assistive devices helps to increase the level of activity and independence. This study aimed to determine the effect of movement assistive devices skills training on the self-efficacy and self-esteem of stroke patients. Methods: This study was a controlled clinical trial that was performed on 62 patients with stroke in Kashani Hospital Shahrekord in 2018. Samples were selected by simple sampling, and based on the numbers generated by random allocation software; they were assigned to the control and experimental groups. Before Patients discharge, the intervention group was trained in the use of assistive mobility devices, and the control group received conventional training and treatment. At the next visit to the doctor (at least two weeks later), self-esteem and self-efficacy of patients were measured. Data were analyzed by SPSS software version 18 using descriptive and inferential statistics. The significance level was considered (0.05). Results: Patients in both intervention and control groups were matched in terms of demographic variables. Self-efficacy and self-esteem before and after training were not significantly different in the control group (self-efficacy P = 0.221, self-esteem P = 0.102). P ≥ 0.05 But in the intervention group, the difference was significant and improved P ≤ 0.05. Self-efficacy and self-esteem in the intervention group compared to the control group in the covariance test (self-efficacy F = 50.704 self-esteem F = 59.69) Therefore, self-efficacy and self-esteem in the intervention group compared with the control group had a significant difference (sig = 0.000). Conclusions: The teaching of motor aid to stroke patients improves self-esteem and self-efficacy in controlling the complications of the disease. Therefore, it is recommended to use these tools to increase self-esteem and self-efficacy.