王巧紅，張曉晴，郭靜，魏吉林，楊輝*

·科研綜述·

帕金森病病人居家康復(fù)運(yùn)動(dòng)影響因素及干預(yù)研究進(jìn)展

王巧紅1，2，張曉晴1，郭靜2，魏吉林2，楊輝1，2*

1.山西醫(yī)科大學(xué)護(hù)理學(xué)院，山西 030001；2.山西醫(yī)科大學(xué)第一醫(yī)院

總結(jié)帕金森病病人居家康復(fù)運(yùn)動(dòng)影響因素和干預(yù)策略的研究現(xiàn)狀，為我國(guó)臨床醫(yī)護(hù)人員制定帕金森病病人居家康復(fù)運(yùn)動(dòng)干預(yù)方案提供依據(jù)。

帕金森??；居家康復(fù)；康復(fù)運(yùn)動(dòng)；影響因素；干預(yù)；護(hù)理；綜述

帕金森病（Parkinson's disease,PD）是僅次于阿爾茨海默病的常見(jiàn)神經(jīng)退行性疾病，與多巴胺能神經(jīng)元的退行性變和隨之而來(lái)的神經(jīng)遞質(zhì)多巴胺的減少有關(guān)，導(dǎo)致運(yùn)動(dòng)和非運(yùn)動(dòng)的改變及病人日常生活能力和生活質(zhì)量的逐漸下降[1?2]。目前，尚無(wú)有效的藥物和技術(shù)可以停止或逆轉(zhuǎn)該病進(jìn)展[3?4]。帕金森病病人受益于持續(xù)不斷的運(yùn)動(dòng)，以改善和維持身體功能[5?6]，更好地管理疾病。但臨床實(shí)踐中仍然有許多病人久坐不動(dòng)，導(dǎo)致合并癥增加，給家庭和社會(huì)造成沉重的照顧負(fù)擔(dān)和經(jīng)濟(jì)負(fù)擔(dān)[7?8]。我國(guó)90%的帕金森病病人選擇居家康復(fù)，居家康復(fù)是醫(yī)院康復(fù)的有效替代方案。因此，建立基于社區(qū)和家庭的帕金森病病人康復(fù)運(yùn)動(dòng)長(zhǎng)效模式，保持病人長(zhǎng)期堅(jiān)持康復(fù)運(yùn)動(dòng)的動(dòng)力[9]是醫(yī)護(hù)人員面對(duì)的挑戰(zhàn)。

1 居家康復(fù)運(yùn)動(dòng)概述

1.1相關(guān)定義運(yùn)動(dòng)與體力活動(dòng)不同。體力活動(dòng)是指任何導(dǎo)致人體骨骼肌收縮所產(chǎn)生的能量消耗的身體運(yùn)動(dòng)，如種花、掃地和散步等日常活動(dòng)都包括在體力活動(dòng)范圍內(nèi)[10]。運(yùn)動(dòng)也稱鍛煉，被定義為身體活動(dòng)的一個(gè)子類別，包括有計(jì)劃、有組織、重復(fù)、有目的、旨在改善身體健康的一個(gè)或多個(gè)組成部分的體育活動(dòng)[8]。居家康復(fù)運(yùn)動(dòng)在本研究中是指在非醫(yī)療機(jī)構(gòu)場(chǎng)所，非專業(yè)醫(yī)護(hù)人員陪伴下，病人在家庭和社區(qū)進(jìn)行的運(yùn)動(dòng)或鍛煉，以期改善疾病癥狀，延緩疾病進(jìn)展，改善疾病結(jié)局。

1.2康復(fù)運(yùn)動(dòng)的重要性帕金森病發(fā)病機(jī)制復(fù)雜，現(xiàn)有研究顯示，可能是由于環(huán)境因素、年齡、老化、細(xì)胞凋亡、免疫異常、線粒體功能障礙和氧化應(yīng)激過(guò)度等諸多因素影響，導(dǎo)致中腦黑質(zhì)紋狀體多巴胺能神經(jīng)元變性、壞死，最終引起腦內(nèi)紋狀體多巴胺神經(jīng)遞質(zhì)減少而發(fā)病[11?12]。運(yùn)動(dòng)可能起到神經(jīng)保護(hù)作用，在動(dòng)物模型上的運(yùn)動(dòng)實(shí)驗(yàn)顯示，運(yùn)動(dòng)能夠增加多巴胺的釋放，通過(guò)下調(diào)多巴胺轉(zhuǎn)運(yùn)體的表達(dá)，增加細(xì)胞外的多巴胺，減少紋狀體的多巴胺丟失，保存部分中腦多巴胺能神經(jīng)元及修復(fù)多巴胺終端[13?14]，對(duì)帕金森病潛在的病理產(chǎn)生直接影響，從而減緩疾病的進(jìn)展。運(yùn)動(dòng)還與大腦中的許多結(jié)構(gòu)、血管和神經(jīng)分子變化有關(guān)，這些變化有助于改善老化大腦的身體、認(rèn)知和行為功能[15]。盡管運(yùn)動(dòng)對(duì)帕金森病病人益處的機(jī)制尚缺乏完整了解，但迅速積累的證據(jù)顯示鍛煉的帕金森病病人有更好的結(jié)局[16?17]。多種類型的康復(fù)訓(xùn)練能夠改善早中期帕金森病病人肌力、步態(tài)、運(yùn)動(dòng)功能和平衡功能，降低跌倒風(fēng)險(xiǎn)等[18?19]；不同類型和強(qiáng)度的運(yùn)動(dòng)還可以有效改善帕金森病病人睡眠障礙、抑郁和認(rèn)知功能等非運(yùn)動(dòng)癥狀[20]，運(yùn)動(dòng)能在一定程度上減少帕金森病病人對(duì)藥物依賴性的作用和藥物使用劑量[21]。

1.3帕金森病病人康復(fù)運(yùn)動(dòng)現(xiàn)狀帕金森病病人康復(fù)運(yùn)動(dòng)總體水平較低，即使是帕金森病Hoehn?Yahr 1期的病人活動(dòng)水平也非常低[22]，只有30%的人每天步行30 min，遠(yuǎn)遠(yuǎn)低于指南推薦水平[23]。而我國(guó)大部分帕金森病病人沒(méi)有進(jìn)行系統(tǒng)的康復(fù)訓(xùn)練[24]，應(yīng)在疾病所有階段進(jìn)行一系列的治療性運(yùn)動(dòng)，以保持長(zhǎng)期的運(yùn)動(dòng)依從性[9,25?28]。

2 帕金森病病人居家康復(fù)運(yùn)動(dòng)的影響因素

國(guó)內(nèi)李偉等[29]研究指出，相比同年齡組的健康人，帕金森病病人運(yùn)動(dòng)能力下降約1/3，其中24%的能力下降與疾病進(jìn)展、步行障礙和日?；顒?dòng)能力受限相關(guān)。精神障礙(如抑郁、孤獨(dú)和癡呆)、疲勞等個(gè)體因素以及由于跌倒恐懼而導(dǎo)致的戶外活動(dòng)減少等多種因素，都會(huì)引起帕金森病病人活動(dòng)能力降低。解璇等[30]研究指出，居家帕金森病病人康復(fù)鍛煉總依從率處于中等偏低水平，病情分期、康復(fù)鍛煉知識(shí)了解程度、是否身體疲勞、是否害怕跌倒、運(yùn)動(dòng)自我效能及社會(huì)支持是居家帕金森病病人康復(fù)鍛煉依從性的主要影響因素。陳志等[31]指出，環(huán)境影響帕金森癥病人的康復(fù)，主要涉及醫(yī)院、社會(huì)、家庭3個(gè)方面，如藥品和輔助器械等醫(yī)療設(shè)備以及與帕金森癥病人康復(fù)息息相關(guān)的服務(wù)及政策。吳曉[32]通過(guò)實(shí)施包括康復(fù)目標(biāo)、鼓勵(lì)病人、增強(qiáng)社會(huì)支持、滿足病人需求和利益等康復(fù)措施，提高帕金森病病人康復(fù)運(yùn)動(dòng)自我效能感，從而改善干預(yù)組病人的心理狀態(tài)，促進(jìn)病人功能康復(fù)。徐萍[33]也指出，自我效能與教育干預(yù)對(duì)帕金森病病人運(yùn)動(dòng)效能和平衡功能有顯著作用。李昊[34]研究顯示，醫(yī)護(hù)人員和家庭共同參與及督促對(duì)于維持帕金森病病人康復(fù)運(yùn)動(dòng)具有重要作用。

國(guó)外研究指出，帕金森病病人運(yùn)動(dòng)的障礙因素包括結(jié)果期望低、缺乏時(shí)間、害怕摔倒、自我效能低以及缺乏衛(wèi)生保健專業(yè)人員和組織的支持[9,35?36]。Khalil等[37]通過(guò)對(duì)帕金森病病人和康復(fù)治療師進(jìn)行質(zhì)性訪談，提出帕金森病病人運(yùn)動(dòng)的障礙因素和促進(jìn)因素，障礙因素包括缺乏疾病感知和參與運(yùn)動(dòng)的信息、疾病診斷困難、缺乏對(duì)物理治療的轉(zhuǎn)介、疾病特定問(wèn)題（僵硬和疲勞）、環(huán)境（中心鍛煉和家庭鍛煉、個(gè)人鍛煉和團(tuán)體鍛煉）及缺乏自我效能；促進(jìn)因素是啟動(dòng)和維持鍛煉計(jì)劃的動(dòng)機(jī)，包括結(jié)果預(yù)期和家庭支持。Afshari等[38]研究指出，得病前高運(yùn)動(dòng)量的病人在確診后更有可能開(kāi)始鍛煉，而低運(yùn)動(dòng)量的人更有可能減少運(yùn)動(dòng)量，運(yùn)動(dòng)量少的人需要更多的激勵(lì)因素，低運(yùn)動(dòng)量的人更常見(jiàn)的障礙是缺乏激勵(lì)、疲勞和抑郁。除此之外，Schootemeijer等[39]綜述了帕金森病病人運(yùn)動(dòng)的障礙和動(dòng)力因素，指出一般健康障礙(與帕金森病無(wú)關(guān))、害怕跌倒、鍛煉伙伴及病友影響、鍛煉地點(diǎn)交通不便、惡劣天氣、文化挑戰(zhàn)、鍛煉的經(jīng)濟(jì)負(fù)擔(dān)、擁擠的環(huán)境也是造成鍛煉依從性差的因素；運(yùn)動(dòng)改善癥狀、運(yùn)動(dòng)納入日常生活、相信體育運(yùn)動(dòng)對(duì)健康有益、希望保持獨(dú)立性、與能力和興趣相匹配的個(gè)性劃運(yùn)動(dòng)方案、個(gè)人目標(biāo)、高教育水平、家人或朋友的社會(huì)支持、專業(yè)支持、健康教育、社交活動(dòng)、病友鼓勵(lì)、掌握經(jīng)驗(yàn)、績(jī)效反饋與獎(jiǎng)勵(lì)是康復(fù)運(yùn)動(dòng)的促進(jìn)因素。

3 帕金森病病人居家康復(fù)運(yùn)動(dòng)干預(yù)研究現(xiàn)狀

3.1居家康復(fù)運(yùn)動(dòng)干預(yù)內(nèi)容《歐洲帕金森病物理治療指南》以國(guó)際功能、殘疾和健康分類(International Classification of Functioning,Disability and Health,ICF)為指導(dǎo)框架，確定帕金森病5個(gè)核心功能障礙，即體能、轉(zhuǎn)移、手活動(dòng)、平衡和步態(tài)[40]。帕金森病病人的康復(fù)運(yùn)動(dòng)干預(yù)圍繞改善核心功能障礙展開(kāi)。于洋[41]研究指出，帕金森病的康復(fù)干預(yù)是多學(xué)科全程管理中非常重要的部分，應(yīng)“貫穿于始終”，疾病不同時(shí)期側(cè)重點(diǎn)有所不同，治療方法設(shè)計(jì)應(yīng)基于日常生活活動(dòng)內(nèi)容，治療量應(yīng)遵循“循序漸進(jìn)”的原則。

國(guó)內(nèi)孫文玉[42]在常規(guī)康復(fù)運(yùn)動(dòng)治療方案的基礎(chǔ)上加入導(dǎo)引術(shù)，包括八段錦的前兩式和《養(yǎng)性延命錄》[43]記載的五禽戲中的鹿戲、鳥(niǎo)戲和熊戲，結(jié)果顯示提高了病人運(yùn)動(dòng)能力和生活質(zhì)量。吳夢(mèng)穎等[44]設(shè)計(jì)了互聯(lián)網(wǎng)模式下帕金森病病人延續(xù)性康復(fù)應(yīng)用軟件，其“運(yùn)動(dòng)療法”板塊主要是通過(guò)視頻指導(dǎo)病人進(jìn)行肌肉放松訓(xùn)練、步態(tài)訓(xùn)練、關(guān)節(jié)活動(dòng)度訓(xùn)練、緩慢下蹲式訓(xùn)練和低負(fù)荷運(yùn)動(dòng)訓(xùn)練等。劉燕平等[45]探討了基于移動(dòng)互聯(lián)網(wǎng)的帕金森病病人家庭康復(fù)訓(xùn)練效果，康復(fù)訓(xùn)練內(nèi)容包括步行、姿勢(shì)、站起、平衡、床上移動(dòng)、柔韌性等項(xiàng)目，每次30 min，每周4次，持續(xù)8周，結(jié)果顯示改善了帕金森病病人的運(yùn)動(dòng)功能和日常生活能力。楊新萍等[46]探討了家庭護(hù)理干預(yù)對(duì)帕金森病病人康復(fù)護(hù)理的效果，指出病人盡量多參與各種形式的活動(dòng)，如散步、打太極拳、保健操等。陳東霞[47]應(yīng)用長(zhǎng)期家庭治療中的緩慢下蹲式康復(fù)訓(xùn)練，結(jié)果顯示提高了帕金森病病人的下肢運(yùn)動(dòng)水平和關(guān)節(jié)運(yùn)動(dòng)水平，縮短了臨床癥狀改善時(shí)間，改善了病人生活質(zhì)量評(píng)分，提高了訓(xùn)練效果。

研究顯示，八段錦形式的氣功練習(xí)比其他形式的訓(xùn)練計(jì)劃更具優(yōu)勢(shì)，因?yàn)槠湓诩彝ノ锢砀深A(yù)的理想特征(成本效益高、簡(jiǎn)單、自我控制、安全、強(qiáng)度和持續(xù)時(shí)間低，不需要額外設(shè)備或大空間)和潛在的有益效果之間取得了積極的平衡[48?52]。八段錦已被證明可以改善帕金森病病人的非運(yùn)動(dòng)和運(yùn)動(dòng)相關(guān)的癥狀及其相關(guān)的功能結(jié)果[50,53?54]。Isernia等[55]探索了步行訓(xùn)練結(jié)合呼吸肌訓(xùn)練對(duì)帕金森病病人肺功能、呼吸肌力和功能運(yùn)動(dòng)能力的影響，結(jié)果表明步行訓(xùn)練可提高帕金森病病人的呼氣肌訓(xùn)練效果。Van Der Kolk等[56]研究表明，以自行車為基礎(chǔ)的高強(qiáng)度運(yùn)動(dòng)家庭鍛煉方案對(duì)帕金森病病人運(yùn)動(dòng)功能和最大攝氧量的改善是可行和有效的。Flynn等[57]系統(tǒng)綜述了基于家庭運(yùn)動(dòng)處方對(duì)帕金森病病人平衡、步態(tài)的效果，指出家庭運(yùn)動(dòng)處方一般涉及的運(yùn)動(dòng)干預(yù)為平衡、步態(tài)、暗示、力量、步行、日常活動(dòng)和跑步機(jī)運(yùn)動(dòng)，大強(qiáng)度（每周150 min，至少6周）鍛煉更為有效。Albani等[58]將探戈舞改編用于帕金森病病人家庭鍛煉，結(jié)果改善了病人的姿勢(shì)、步態(tài)、言語(yǔ)功能和生活質(zhì)量。

3.2居家康復(fù)運(yùn)動(dòng)干預(yù)形式目前，國(guó)內(nèi)外帕金森病病人居家康復(fù)干預(yù)并沒(méi)有統(tǒng)一方式。

3.2.1國(guó)內(nèi)帕金森病病人居家康復(fù)運(yùn)動(dòng)干預(yù)形式國(guó)內(nèi)學(xué)者對(duì)于帕金森病病人居家康復(fù)干預(yù)形式的研究較少，還處于初級(jí)探索階段，形式較單一。陳賽釵等[59]利用微信平臺(tái)在帕金森病病人出院后進(jìn)行延續(xù)康復(fù)護(hù)理，通過(guò)成立延續(xù)護(hù)理管理小組、建立病人信息檔案、建立微信群及微信公眾號(hào)，進(jìn)行知識(shí)、技能推送、答疑、實(shí)時(shí)反饋等，結(jié)果顯示有效改善了病人焦慮、抑郁的不良心理狀態(tài)，提高了居家運(yùn)動(dòng)依從性和日常生活活動(dòng)能力。劉燕平等[45]借助中文版“Parkinson Home Exercise”App協(xié)助帕金森病病人進(jìn)行家庭訓(xùn)練，改善了帕金森病病人的運(yùn)動(dòng)功能和日常生活能力。

3.2.2國(guó)外帕金森病病人居家康復(fù)運(yùn)動(dòng)干預(yù)形式國(guó)外學(xué)者一直致力于創(chuàng)新帕金森病病人居家康復(fù)運(yùn)動(dòng)干預(yù)形式，并引入現(xiàn)代化的電子信息技術(shù)，以提高病人居家康復(fù)運(yùn)動(dòng)的可行性、依從性、有效性和滿意度。

3.2.2.1遠(yuǎn)程醫(yī)療技術(shù)的進(jìn)步創(chuàng)造了管理和監(jiān)督家庭鍛煉計(jì)劃的替代渠道隨著人工智能和網(wǎng)絡(luò)通訊被大量應(yīng)用于醫(yī)療領(lǐng)域，病人和醫(yī)務(wù)人員之間通過(guò)網(wǎng)絡(luò)通訊技術(shù)和信息管理平臺(tái)，完成醫(yī)療服務(wù)的遠(yuǎn)程醫(yī)療模式應(yīng)運(yùn)而生。目前遠(yuǎn)程醫(yī)療被廣泛應(yīng)用于慢性病的隨訪管理等，如心臟起搏器植入術(shù)后、結(jié)腸癌、帕金森病、腦卒中等[60?65]。國(guó)際帕金森和運(yùn)動(dòng)障礙協(xié)會(huì)也發(fā)布了在運(yùn)動(dòng)障礙診所實(shí)施遠(yuǎn)程醫(yī)療的逐步指南[66]。Adams等[67]也指出，帕金森病病人的遠(yuǎn)程護(hù)理是可行、有效和有價(jià)值的。在虛擬環(huán)境中使用的統(tǒng)一帕金森病評(píng)分量表(UPDRS)的可靠性也得到了證實(shí)[68]。Kim等[69]使用定制的移動(dòng)應(yīng)用程序進(jìn)行帕金森病病人居家康復(fù)運(yùn)動(dòng)管理，結(jié)果證明移動(dòng)應(yīng)用程序可能有助于改善帕金森病病人的運(yùn)動(dòng)依從性、身體活動(dòng)水平、抑郁管理和生活質(zhì)量。Flynn等[70]為了比較中心鍛煉與家庭鍛煉的有效性，將以中心為基礎(chǔ)的鍛煉過(guò)渡到使用遠(yuǎn)程（反饋、監(jiān)測(cè)和支持）的家庭鍛煉計(jì)劃，結(jié)果表明帕金森病病人完成了更多的鍛煉課程，有更多的時(shí)間用于鍛煉，在改善平衡和步態(tài)方面與基于中心的鍛煉一樣有效。

3.2.2.2虛擬現(xiàn)實(shí)(VR)技術(shù)與傳統(tǒng)物理治療方法相比可能具有附加值VR干預(yù)定義為使用計(jì)算機(jī)軟件創(chuàng)建的視覺(jué)模擬應(yīng)用程序，實(shí)時(shí)模擬現(xiàn)實(shí)世界或可想象的環(huán)境、對(duì)象和事件，并通過(guò)用戶持續(xù)的行為反應(yīng)來(lái)要求交互性[71]，有可能在安全的環(huán)境中優(yōu)化運(yùn)動(dòng)學(xué)習(xí)，并且通過(guò)復(fù)制現(xiàn)實(shí)生活場(chǎng)景可以幫助改善日常生活的功能活動(dòng)。近年來(lái)，VR作為一種治療工具已成為神經(jīng)康復(fù)研究的新課題[72]。從運(yùn)動(dòng)學(xué)學(xué)習(xí)的角度看，VR為高強(qiáng)度、存在任務(wù)導(dǎo)向、多感官的反饋訓(xùn)練提供了可能，可以促進(jìn)病人的視覺(jué)、聽(tīng)覺(jué)和觸覺(jué)輸入，增加他們對(duì)康復(fù)過(guò)程的興趣。沉浸式或非沉浸式虛擬環(huán)境使病人的治療依從性得到有效提高[73?74]。研究表明，VR可以改善帕金森病病人的平衡功能和日常生活活動(dòng)[75]。Lei等[76]也指出，VR康復(fù)訓(xùn)練不僅可以達(dá)到與常規(guī)康復(fù)訓(xùn)練相同的效果，而且在帕金森病病人的步態(tài)和平衡方面有更好的表現(xiàn)?？傊?，VR沉浸式技術(shù)的最新進(jìn)展為開(kāi)發(fā)神經(jīng)康復(fù)的新穎和有前途的應(yīng)用提供了新的工具。

3.2.2.3可穿戴技術(shù)為家庭和社區(qū)環(huán)境中康復(fù)運(yùn)動(dòng)輔助和縱向監(jiān)控提供了可能性目前評(píng)估運(yùn)動(dòng)障礙和運(yùn)動(dòng)癥狀波動(dòng)的方法主要依靠臨床評(píng)分和病人日記。然而，這些方法捕捉縱向和真實(shí)世界的測(cè)量的能力有限[77]?？纱┐骷夹g(shù)中的慣性傳感器能夠長(zhǎng)時(shí)間收集數(shù)據(jù)，捕捉帕金森病病人日常生活中的運(yùn)動(dòng)功能數(shù)據(jù)，評(píng)估病人的狀態(tài)和疾病癥狀，監(jiān)測(cè)病人家庭康復(fù)運(yùn)動(dòng)，并通過(guò)客觀量化病人的狀況支持臨床醫(yī)生的決策過(guò)程[78]。Kawashima等[79]使用可穿戴步幅管理輔助設(shè)備(SMA)對(duì)中晚期帕金森病病人進(jìn)行家庭步態(tài)訓(xùn)練的療效研究，結(jié)果顯示SMA輔助下的步態(tài)訓(xùn)練可能會(huì)增加中度進(jìn)展期帕金森病病人的運(yùn)動(dòng)耐力。Raiano等[80]設(shè)計(jì)和驗(yàn)證了一種用于在家中評(píng)估帕金森病病人手腕僵硬程度的可穿戴機(jī)電設(shè)備，結(jié)果論證了該裝置在測(cè)量腕部硬度方面的可行性。Vergara?Diaz等[81]評(píng)估了可穿戴傳感器數(shù)據(jù)用于評(píng)估肢體特定癥狀嚴(yán)重程度的準(zhǔn)確性，結(jié)果證實(shí)可穿戴傳感器數(shù)據(jù)可以協(xié)助醫(yī)生進(jìn)行藥物劑量滴定和康復(fù)運(yùn)動(dòng)策略的制定?？傊纱┐骷夹g(shù)可能有助于克服帕金森病病人復(fù)診頻繁、醫(yī)療資源壓力大、癥狀動(dòng)態(tài)變化等挑戰(zhàn)[82]，可以在家中對(duì)病人進(jìn)行持續(xù)、客觀和有效的評(píng)估，幫助監(jiān)控個(gè)人對(duì)治療的反應(yīng)，優(yōu)化治療方案[83]。

3.2.2.4聲光刺激技術(shù)對(duì)于帕金森病病人居家康復(fù)運(yùn)動(dòng)的輔助效果Cock等[84]將智能手機(jī)應(yīng)用程序與可穿戴傳感器相結(jié)合，為家庭步態(tài)康復(fù)病人設(shè)計(jì)了一款音樂(lè)刺激程序（BeatWalk），結(jié)果顯示BeatWalk是一種易于使用、安全、愉快的音樂(lè)應(yīng)用程序，增加了帕金森病病人步行鍛煉持續(xù)時(shí)間，提高了步態(tài)康復(fù)的依從性。Thaut等[85]將節(jié)拍器嵌入音樂(lè)對(duì)帕金森病病人家庭步態(tài)訓(xùn)練進(jìn)行節(jié)律性聽(tīng)覺(jué)刺激(RAS)，結(jié)果顯示RAS可顯著減少帕金森病病人的跌倒次數(shù)，并改變了速度和步長(zhǎng)；視覺(jué)刺激方面，可在地板上畫(huà)類似斑馬線的彩色線條或者將光線打在地上，線條間距按成人的步長(zhǎng)設(shè)計(jì)，讓病人練習(xí)跨步，控制步長(zhǎng)和步速，避免小碎步和慌張步態(tài)。

4 小結(jié)與展望

康復(fù)運(yùn)動(dòng)是帕金森病病人關(guān)鍵的輔助治療方法，但臨床病人存在總體運(yùn)動(dòng)水平較低的現(xiàn)狀。居家康復(fù)運(yùn)動(dòng)是面對(duì)當(dāng)前醫(yī)療資源緊張狀況下最具有成本效益的長(zhǎng)效康復(fù)模式，但帕金森病病人居家康復(fù)運(yùn)動(dòng)的依從性受到眾多因素的影響，且國(guó)內(nèi)外學(xué)者也在致力于研究帕金森病病人居家康復(fù)干預(yù)策略。目前，國(guó)內(nèi)對(duì)于帕金森病病人康復(fù)運(yùn)動(dòng)研究多停留在院內(nèi)康復(fù)，對(duì)于居家康復(fù)運(yùn)動(dòng)的研究開(kāi)展較少；已有研究對(duì)于影響帕金森病病人居家康復(fù)運(yùn)動(dòng)意向和行為的影響因素及其路徑關(guān)系沒(méi)有深入系統(tǒng)的探討，缺乏評(píng)估、監(jiān)測(cè)、反饋和激勵(lì)的單一干預(yù)形式無(wú)法保障居家康復(fù)運(yùn)動(dòng)的效果。所以，臨床醫(yī)護(hù)人員可以從這些角度入手，找到干預(yù)措施準(zhǔn)確的干預(yù)環(huán)節(jié)和切入點(diǎn)，構(gòu)建和完善居家康復(fù)運(yùn)動(dòng)干預(yù)方案，提高病人長(zhǎng)期居家康復(fù)運(yùn)動(dòng)的動(dòng)力和依從性。

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Research progress on influencing factors and intervention of home rehabilitation exercise in patients with Parkinson's disease

WANGQiaohong, ZHANGXiaoqing, GUOJing, WEIJilin, YANGHui

Nursing College of Shanxi Medical University, Shanxi 030001 China

This study summarized the status quo of influencing factors and intervention strategies of home rehabilitation exercise in patients with Parkinson's disease，in order to provide basis for Chinese clinical medical staff to formulate the intervention scheme of home rehabilitation exercise for patients with Parkinson's disease.

Parkinson's disease； home rehabilitation； rehabilitation exercise； influencing factors； intervention； nursing； review

YANG Hui, E?mail: qyhui2020@163.com

10.12102/j.issn.1009-6493.2023.03.016

王巧紅，副主任護(hù)師，博士研究生在讀

楊輝，E?mail:qyhui2020@163.com

王巧紅,張曉晴,郭靜,等.帕金森病病人居家康復(fù)運(yùn)動(dòng)影響因素及干預(yù)研究進(jìn)展[J].護(hù)理研究,2023,37(3):471?477.

（收稿日期：2022-04-03；修回日期：2023-01-18）

（本文編輯 蘇琳）