Journal of the Korea Convergence Society (한국융합학회논문지)

Korea Convergence Society (한국융합학회)
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The Effect of a Convergence Approach of Home Environment Modification and Task-oriented Intervention on Fall Efficacy and Activity Level of Person with Stroke in the Community

가정환경 수정과 과제기반 중재의 융복합 접근이 지역사회 뇌졸중 환자의 낙상 효능감 및 활동 수준에 미치는 영향

  • Kim, Su-Kyoung (Department of Occupational Therapy, Konyang University)
  • 김수경 (건양대학교 작업치료학과)
  • Received : 2021.11.04
  • Accepted : 2022.02.20
  • Published : 2022.02.28
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Abstract

The purpose of this study is to determine the effect of a convergence approach, which applies both home environment modification applied with assistive technology and task-oriented intervention using a fall safety checklist, on the fall efficacy and activity level of stroke patients. 41 persons with stroke(21 experimental groups and 20 control groups) were divided into experimental and control groups. The experimental group was applied environmental modification and the task-oriented intervention using the fall safety checklist for 4 weeks. The control group was provided only the environmental modification. Before and after the intervention, the Korean Activity Card Sort (KACS) and the Korean Falls Efficacy Scale-Korean version (FES-K) were used for evaluation. There was no significant difference in fall efficacy and activity level change between the experimental group and the control group. Both the experimental group and the control group significantly improved the fall efficacy and activity level after the intervention. By applying the results of this study to the clinical field, it will be possible to support stroke patients to live safely and actively participate in the community.

본 연구의 목적은 보조공학 기술을 적용한 가정환경 수정과 낙상 안전 체크리스트를 이용한 과제기반 중재를 함께 적용하는 융복합 접근법이 뇌졸중 환자의 낙상 효능감과 활동 수준에 미치는 효과를 확인하는 것이다. 뇌졸중 환자 41명 대상자(실험군 21명, 대조군 20명)는 실험군과 대조군으로 나누어졌다. 실험군에는 환경수정과 낙상 안전 체크리스트를 활용한 과제기반 중재를 4주간 적용하였다. 대조군에는 가정환경 수정만 실시하였다. 중재 전과 후에 한국형 활동분류카드(Korean Activity Card Sort, KACS), 한국형 낙상효능감 측정도구(Falls Efficacy Scale-Korean version, FES-K)를 이용하여 평가하였다. 실험군과 대조군의 낙상효능감과 활동수준의 변화량은 유의한 차이가 없었다. 실험군과 대조군은 모두 중재 이후에 낙상효능감과 활동 수준이 유의하게 향상되었다. 이러한 연구의 결과를 임상 현장에 적용하여 뇌졸중 환자가 지역사회에서 안전하게 생활하고 적극적으로 참여하는 삶을 유지할 수 있도록 지원할 수 있을 것이다.

Keywords

References

  1. J. K. Tilson. S. S. Wu, S. Y. Cen. Q. Feng, D. Rose, A. L. Behrman, S. P. Azen & P. W. Duncan. (2012). Characterizing and identifying risk for falls in the LEAPS study: a randomized clinical trial of interventions to improve walking poststroke. Stroke, 43(2), 446-52. DOI : 10.1161/STROKEAHA.111.636258.
  2. L. M. Wagner, V. L. Phillips, A. E. Hunsake & P. G. Forducey. (2009). Falls among community-residing stroke survivors following inpatient rehabilitation: a descriptive analysis of longitudinal data. BMC Geriatry, 9, 46-50. DOI : 10.1186/1471-2318-9-46
  3. V. Weerdesteyn, M. de Niet, H. J. Duijnhoven & A. C. Geurts. (2008). Falls in individuals with stroke. Journal of Rehabilitation Research & Development, 45(8), 1195-1213. DOI: 10.1682/JRRD.2007.09.0145
  4. S. Pouwels, A. Lalmohamed, B. Leufkens, A. Boer, C. Cooper, T. Staa & F. de Vries. (2009). Risk of hip/femur fracture after stroke: a population-based case-control study. Stroke, 40(10), 3281-5. DOI : 10.1161/STROKEAHA.109.554055.
  5. L. A. Simpson, W. C. Miller & J. J. Eng. (2011). Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke. PLoS One, 6(4), e19431. DOI : 10.1371/journal.pone.0019431.
  6. T. Xu, L. Clemson, K. O'Loughlin, N. A. Lannin, C. Dean & G. Koh. (2018). Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 99(3), 563-573. DOI : 10.1016/j.apmr.2017.06.032.
  7. J. E. Harris, J. J. Eng, D. S. Marigold, C. D. Tokuno & C. L. Louis. (2005). Relationship of balance and mobility to fall incidence in people with chronic stroke. Physical Therapy, 85(2), 150-158. PMID: 15679466 https://doi.org/10.1093/ptj/85.2.150
  8. D. Hyndman, A. Ashburn & E. Stack. (2002). Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Archives of Physical Medicine and Rehabilitation, 83(2), 165-170. DOI : 10.1053/apmr.2002.28030
  9. B. Belgen, M. Beninato, P. E. Sullivan & K. Narielwalla. (2006). The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Archives of Physical Medicine and Rehabilitation, 87, 554-561. DOI : 10.1016/j.apmr.2005.12.027
  10. F. Soyuer & A. Ozturk. (2007). The effect of spasticity, sense and walking aids in falls of people after chronic stroke. Disability & Rehabilitation, 29(9), 679-87. DOI : 10.1080/09638280600925860
  11. B. Moreland, R. Kakara & A. Henry. (2020). Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years - United States, 2012-2018. Morbidity and Mortality Weekly Report, 69(27), 875-881. DOI : 10.15585/mmwr.mm6927a5
  12. W. Li, T. Keegan, B. Sternfeld, S. Sidney, C. P. Quesenberry & JL. Kelsey. (2006). Outdoor falls among middle-aged and older adults: A neglected public health problem. American Journal of Public Health, 96(7), 1192-1200. DOI : 10.2105/AJPH.2005.083055
  13. L. D. Gillespie, M. C. Robertson, W. J. Gillespie, C. Sherrington, S. Gates, LM. Clemson & SE. Lamb. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database System Review, 9. DOI : 10.1002/14651858.CD007146.pub3.
  14. J. K. Tilson, S. S. Wu, S. Y. Cen, Q. Feng, D. R. Rose, A. L. Behrman, S. P. Azen & W. Duncan. (2012). Characterizing and Identifying Risk for Falls in the LEAPS Study; A Randomized Clinical Trial of Interventions to Improve Walking Post stroke. Stroke, 43(2), 446-452. DOI : 10.1161/STROKEAHA.111.636258.
  15. S. Denissen, W. Staring, D. Kunkel, R. M. Pickering, S. Lennon, A. C. H Geurts, V. Weerdesteyn & G. SAF Verheyden. (2019). Interventions for preventing falls in people after stroke. Cochrane Database System Review, 10. DOI : 10.1002/14651858.CD008728.pub3.
  16. M. J. Kwon. (2008). The Fall Circumstance and Related Factors Associated with Fall in the Stroke Patients. The journal of Korean society of physical therapy, 20(3), 19-28.
  17. M. J. Lee. (2017). The Reviews of Occupation Based Intervention in Neurorehabilitation. Therapeutic Science for Neurorehabilitation, 6(2), 29-36. DOI : 10.22683/tsnr.2017.6.2.029
  18. L. Legg & P. Langhorne. (2004). Therapy-based rehabilitation for stroke patients living at home. Stroke, 35(4), 1022. DOI : 10.1161/01.STR.0000121043.21973.9F.
  19. J. Toglia, S. A. Rodger & H. J. Polatajko. (2012). Anatomy of cognitive strategies: a therapist's primer for enabling occupational performance. Canadian journal of occupational therapy, 79(4), 225-236. DOI : 10.2182/cjot.2012.79.4.4
  20. T. Heather. (2012). Occupation-Based Activity Analysis. Danvers, Thorofare, NJ: SLACK.
  21. B. P. Horowitz, T. Almonte & A. Vasil. (2016). Use of the Home Safety Self-Assessment Tool (HSSAT) within Community Health Education to Improve Home Safety. Occupational Therapy in Health Care. 30(4), 356-372. DOI : 10.1080/07380577.2016.1191695.
  22. S. K. Park, H. Kim, D. H. Yoo & T. H. Cha. (2017). Reliability and Validity of Korean-Translated Version of Home Safety Self-Assessment Tool(K-HSSAT). Korean Journal of Occupational Therapy, 25(3), 117-130. DOI : 10.14519/jksot.2017.25.3.09
  23. M. Tomita, S. Saharan, S. Rajendran, S. Nochajski & J. A. Schweitzer. (2014). Psychometrics of the Home Safety Self-Assessment Tool (HSSAT) to prevent falls in community-dwelling older adults. American Journal of Occupational Therapy, 68(6), 711-718. DOI : 10.5014/ajot.2014.010801
  24. B. P. Horowitz, S. M. Nochajski & J. A. Schweitzer. (2013). Occupational therapy community practice and home assessments: Use of the Home Safety Self-Assessment Tool(HSSAT) to support aging in place. Occupational Therapy in Health Care, 27(3), 216-227. DOI : 10.3109/07380577.2013.807450
  25. C. M. Baum & D. F. Edwards. (2001). Activity Card Sort(ACS): Test-Manual. St. Louis, Missouri: Washington University.
  26. S. H. An, H. H. Shin, H. Y. Cho & G. C. Lee. (2012). The Reliability and Validity of the Falls Efficacy Scale(Korean Version) in Stroke Patients. The Research Institute for Special Education & Rehabilitation Science, 51(3), 363-381.
  27. B. Hooper & W. Wood. (2019). The philosophy of occupational therapy. In Boyt Schell, B. A., & Gillen, G. (Eds.). Willard & Spackman's occupational therapy (13th ed., pp.43-55). Philadelphia, PA: Wolters Kluwer.
  28. J. Toglia & P. Chen. (2020). Spatial exploration strategy training for spatial neglect: A pilot study. Neuropsychological Rehabiitation, 20, 1-22. DOI : 10.1080/09602011.2020.1790394.
  29. K. Forsyth, R. R. Taylor, J. M. Kramer, S. Prior, L. Ritchie & J. Melton. (2019). The model of human occupation. In Boyt Schell, B. A., & Gillen, G. (Eds.). Willard & Spackman's occupational therapy (13th ed., pp.601-621). Philadelphia, PA: Wolters Kluwer.
  30. H. E. Jo & M. J Kim. (2017). Effects of a Fall Prevention Program on Physical Fitness Fall Efficacy and Fall Prevention Behavior among Community-dwelling Older Adults. The Korean Journal of Rehabilitation Nursing, 20(1), 22-32. DOI : 10.7587/kjrehn.2017.22
  31. H. C. Lee, K. C Chang, J. Y Tsauo & J. W. Hung. (2012). Effects of a Multifactorial Fall Prevention Program on Fall Incidence and Physical Function in Community-Dwelling Older Adults With Risk of Falls. Archives of Physical Medicine and Rehabilitation, 94(42), 606-615. DOI : 10.1016/j.apmr.2012.11.037.
  32. C. Ziebart, P. Bobos, R. Furtado, J.C. MacDermid, D. Bryant, M. Szekeres & N. Suh. (2020). The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis. Archives of rehabilitation research and clinical translation, 2(3), 100065. DOI : 10.1016/j.arrct.2020.100065
  33. Y. Huang, C. Wu, H. Peng, Q. Chen, X. Fan, L. Xiao, B. Song & L. Wan. (2020). The Correlation Between Fall Prevention Knowledge and Behavior in Stroke Outpatients. Journal of Neuroscience & Nurse, 52(2), 61-65. DOI : 10.1097/JNN.0000000000000494. PMID: 32032275