뇌졸중 환자의 재발방지를 위한 자기관리 중재: 체계적 고찰
Self-Management Interventions to Prevent Recurrence in Patients with Stroke: A Systematic Review
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초록
목적 : 본 연구의 목적은 문헌고찰을 통해 이차 뇌졸중 예방을 위한 자기관리 중재의 선행연구를 고찰하고 지역사회 및 임상환경에서 활용할 수 있는 근거를 제시하는 것이다. 연구방법 : 본 연구의 검색어는 “stroke” AND (“self management” OR “self care”) AND (“secondary prevention” OR “stroke prevention”) AND (“intervention” OR “education” OR “program” OR “rehabilitation”)를 사용하여 검색하였다. 문헌 선정은 PRISMA (Preffered Reporting Item for Systematic Reviews and Meta-Analyses)를 사용하여 본 연구에서 검색한 문헌을 분석하였고, MINORS (Methodological Index For Non-Randomized Studies)를 이용하여 비 무작위 연구논문의 질적 분석을 추가로 시행하였다. 결과 : 총 9개의 연구 중 7개의 연구의 근거 수준이 모두 1단계인 무작위 대조 실험 연구였으며 2개의 연구는 2단계인 두 그룹, 비무작위 실험 대조 연구였다. 자기관리 중재 연구 참여자는 간호사(n = 7), 작업치료사(n = 2), 물리치료사((n = 1)였다. 자기관리 중재는 당뇨, 혈압, 약물 순응도, 신체활동, 삶의 질 등에 유의한 차이를 보였다. 결론 : 뇌졸중 환자들은 이차 뇌졸중 예방을 위한 자기관리에 대한 인식 부족과 자기관리의 미흡으로 인해 이후의 삶을 영위하지 못하는 경우가 많다. 따라서 재활 분야의 전문 인력과 함께 협력하고 다학제적 접근을 통해 이차 뇌졸중 발병을 예방하기 위한 자기관리 중재 개발에 힘을 쓰는 것이 필요하다.
Abstract
Objective : This study aimed to review the literature on self-management interventions for secondary stroke prevention and provide evidence for their use in community and clinical settings. Methods : The search terms used were “stroke,” “self-management” or “self-care,” “secondary prevention” or “stroke prevention,” and “intervention,” “education,” “program,” or “rehabilitation.” The literature were analyzed using Preffered Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA), and non-randomized studies were qualitatively analyzed by Methodological Index For Non-Randomized Studies (MINORS). Results : Nine studies were extracted; seven randomized controlled trials and two two-group non-randomized experimental control studies. Self-management interventions resulted in significant differences in diabetes, blood pressure, medication adherence, self-efficacy, and quality of life (QoL). Conclusion : Lack of awareness and poor self-management to prevent secondary stroke often impair the QoL of patients with stroke. Therefore, it is important to collaborate with rehabilitation experts and adopt a multidisciplinary approach to develop self-management interventions to prevent secondary stroke.
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