| Summary: | 碩士 === 國立臺灣大學 === 護理學研究所 === 107 === Background. Prolonged use of mechanical ventilation is a care mode involving high energy consumption and costs. In Taiwan, the number of patients requiring prolonged mechanical ventilation increases every year, leading to a rather high impact on families, the society, and medical resource allocations. Patients who are supported by mechanical ventilation have reduced physical activity and compromised muscle strength after staying in bed for a prolonged period, which impacts their daily activities. Rehabilitation exercises help increase physical activities, bringing improvements to the quality of life, physical functions, and psychological aspects of patients.
Objectives. This study aims to understand the effectiveness of the extremities activities program in relation to the weaning parameter, extremity muscle strength, activities of daily living functions, and psychological-emotional status of patients with prolonged use of mechanical ventilation.
Methods. The study subjects were patients from a medical center in Northern Taiwan relying on mechanical ventilators. A quasi-experimental with repeated measures design was developed and implemented with a study period ranging from January to December, 2017. The study applied purposive sampling, which was first carried out with a control group between January and June and then with an experimental group between July and December. After acquiring consent from patients, the study led the control group to continue their regular rehabilitation exercises and the experimental group to undergo regular rehabilitation exercises plus the extremities activity intervention. The intervention program consisting of active extremities exercises, upper-extremity rowing exercises, and lower-extremity biking exercises, was 5 to 20 minutes at a time and once a day. These were implemented for a total of 10 days. The outcome indicators, including the weaning parameter, extremity muscle strength, activities of daily living functions, and psychological-emotional status of the subjects of each study group, were collected at three time points: before the first day (T0), on day 11 (T1), and day 18 (T2) of starting the observation or implementing the intervention program. The data were analyzed by SPSS 22.0 software. Data were analyzed through descriptive statistics using Chi-square test and Independent t test. The effectiveness of each indicator was tested using generalized estimating equation (GEE) on the two groups at different time points.
Results. The study collected a total of 53 cases comprised of 25 from the control group and 28 from the experimental group. The results showed that (1) the study subjects were elderly (aged 68.96 years old on average) with many chronic conditions (3.40 on average); most had a high school education or less and their use of mechanical ventilation was long (29.43 days); (2) the basic characteristics of the subjects between the two groups were not significantly different; (3) the differences in the weaning parameter scores were all greater in the experimental group compared to those in the control group; yet, the difference between the two groups was not statistically significant; (4) the differences in the muscle strength scores were all greater in the experimental group compared to those in the control group; the difference between the two groups was statistically significant; (5) the differences in the activities of daily living functions (overall function, physical function, and cognitive function) scores were all greater in the experimental group compared to those in the control group; the difference between the two groups was statistically significant; (6) the outcomes of the two groups were significantly different, with the experimental group showing more cases in which subjects were able to sit up on the edge of the bed; (7) the differences in the psychological-emotional status scores were all greater in the experimental group compared to those in the control group; yet, the difference between the two groups was not statistically significant; and (8) the number of cases experiencing psychological-emotional changes was not significantly different between the experimental group and the control group.
Conclusion. In summary, 10 days of extremities activity intervention could increase patients’ extremity muscle strength, activities of daily living functions, and rehabilitation outcomes. The effects persisted one week after the end of the intervention program. However, no statistical differences were observed for the weaning parameter and psychological-emotional status. It is recommended that nurses include extremities activities as a regular nursing activity or invite family members to participate together with the patient during the activities, which, through body contact, not only facilitates psychological-emotional exchanges between the family member and patient but also offer substantial aid to the patient.
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