| Summary: | 博士 === 國立陽明大學 === 護理學系 === 101 === Background: The prevalence of unilateral neglect (UN) among stroke patients is up to 69%. It hinders their activities of daily living (ADL), reduces their health-related quality of life (HRQOL), increases their fall hazard ratio and caregiver’s burden, and increases the duration of rehabilitation in the hospital days. The vestibular rehabilitation (VR) bases on the transformation theory that describe behaviors of neglect were caused by vestibular system or sensory input impairment. The current study aims to investigate the effects of primary caregiver participation in VR on improving the measures of neglect, ADL, balance, falls, HRQOL, and family caregiver burden of UN patients.
Methods: This study is a single-blind randomized controlled trial. Subjects who were chosen from two medical centers located in central Taiwan. The wards of the same hospital were randomly assigned to the experimental or control group. Both experimental (n=24) and control groups (n=24) received conventional rehabilitation. The experimental group undertook VR for a month. During the first and second weeks, a registered nurse trained the experimental group in VR. The primary caregivers in the experimental group supervised and guided their patients in VR during the third and fourth weeks. Assessors, who were blind to the treatment, assessed the groups using the Rivermead Behavioral Inattentional Conventional Subtests (BITC), Catherine Bergego Scale (CBS), Functional Independent Measure (FIM®), Postural Scale for Stroke patients (PASS), number of falls, Stroke Specific Quality of Life Scale (SSQOL), and Caregiver Reaction Assessment (CRA). The outcome measure was conducted at three time points: Day0 (baseline), Day14, and Day28. The obtained data were analyzed using descriptive statistics, chi-square test, independent t-test, one-way repeated measure ANOVA, and generalized estimating equation models.
Results: The two groups of UN patients showed a significant improvement in BITC, CBS, FIM®, PASS over time. Based on the generalized estimating equations model, an interaction was observed between groups and times. Significant interactions were observed between the VR group at days 14 and 28 in the areas of BITC, CBS, FIM®, PASS. No significant difference was observed between the two groups in the number of falls, SSQOL, CRA of UN patients.
Conclusion: Neglect, ADL, and balance among UN patients with right hemispheric stroke can be improved through the participation of primary caregivers in VR. Trained informal caregivers were recommended to provide VR guidance and supervision to patients who suffer from UN.
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