| Summary: | 碩士 === 國立臺北護理健康大學 === 護理研究所 === 106 === Abstract
Background
Chronic diseases has been the leading causes of death in 2015 to 2017 based on the National database. In particular, cerebrovascular disease was the third in 2015, the fourth in 2016 and 2017. In the Statistical Office of the Ministry of Health and Welfare (2016, 2017,2018). Previous studies have suggested that nearly 30% of the stroke victims present with signs of depression within the first 5 years of illness. Since post-stroke depression significantly affects the patient both physically and psychologically, the emotional disturbances impede the progress and effectiveness of rehabilitation. Regarding the non-pharmacological treatment of melancholia, the phototherapy has been used to treat psychological, behavioral or emotional disorders with satisfactory outcomes.Furthermore, many studies has suggested that artificial light should mimic natural sunlight to reach optimal effect. The benefit of sunlight in human wellbeing has been well documented, therefore we intend to utilize sunlight therapy for stroke patients in order to improve their physical and mental health.
Purpose
To utilize sunlight therapy in post-stroke patients in order to improve the depression and active daily function.
Method
This study is an experimental interventional study for two groups with pretest and posttest analysis. The subjects of the study met the inclusion criteria and were recruited by intention sampling method. They were randomly assigned to the experimental group and the control groups. This is a single-blind study with sunlight exposure as intervention. Appropriate clothing, skin protection measures were given. The calf portion of feet, forearms and hands were exposed to sunlight for at least 30 minutes per day, at least 14 days of exposure with intensity at least 10000lux over duration of 4 weeks. A total of 46 patients were recruited and 4 have lost follow up. 21 patients from each group have completed the study. The research tools include: depression status (TDS scale), physical activity function (Barthel Index), the severity of cognitive function (MMSE) and severity of stroke (NIHSS). Each patient was evaluated 3 times during the study: on the day of enrollment (pre-test), 2 to 4 weeks since enrollment (1st post-test) and 6-8 weeks after enrollment (2nd post-test). Statistical analysis was performed with the following variables: depression, cognitive function (MMSE), severity of stroke (NIHSS) and the Barthel Index for daily function.
Result
The statistically significant attributes of the subject to the state of depression are age, sex, time of stroke and rehabilitation. After analyzing with the generalized estimating equation (GEE), significant improvement was noted among the experimental ground in 2nd post-test depression score (p = .032), daily function ( p = .045 ; p = .033) after the first and second interventions , in terms of disease severity. the first time in the post-test after the intervention in the experimental group at 4 weeks after a stroke that is a significant difference (p = .013), but to no cognitive function of the difference statistically, then GEE model for analysis and found that depression improvement is statistically significant for the following variables: duration after stroke, age, gender, and frequency of rehabilitation.
Conclusion
This study confirms that sunlight therapy improves the mental health of post-stroke patients with depressed mood. It also enhances daily activity and facilitates the recovery to a health state. The results are significant and the intervention is nearly cost-free. It also increases the level of vitamin D in the blood and reduces bone mass (Sato, Metoki , Iwamoto, & Satoh, 2003) .This non-invasive intervention can be widely applied to nursing care to improve the quality of life and promote mental health.
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