EVALUATION OF MOTOR REHABILITATION RESULTS IN PATIENTS WITH STROKE SEQUELAE BY CONVENTIONAL ELECTRO-ACUPUNCTURE COMBINED WITH ACUPRESSURE MASSAGE

ABSTRACT

Vietnam is a country possessing a profound traditional medicine inherited from the world, which has become an important element in the current advanced medicine system. Over the years, many researches on rehabilitation after stroke with modern medicine and traditional medicine or a combination of modern medicine with traditional medicine have achieved quite good results (from 62 to 5 years old). 74.1%) [14]. With the above characteristics, we conduct research in this paper. Objectives: To determine factors related to the rehabilitation results by the methods of mirror therapy combined with movement therapy in patients with hemiplegia due to cerebral stroke. Methods: A controlled clinical experimental study was conducted on 104 stroke patients who were intervened by conventional electro-acupuncture combined with acupressure massage at Can Tho City General Hospital from February, 2020 to September, 2020. Results: Based on the Barthal scale, after 15 days of treatment, the recovery rate classified as “very good” and “good” in the study group accounted for 65.4%, significantly higher (p < 0.05) than the control group (26.9%). After the treatment, the proportion of patients recovering their motor function classified as “very good” and “good” in the study group was 76.9%, compared to only 42.3% in the control group. Factors such as age, sex, occupation, environment, and clinical characteristics did not have any relationship between the control group and the study group.

АННОТАЦИЯ

Вьетнам - страна, обладающая глубочайшими знаниями, собранными со всего мира, в области нетрадиционной медицины, которая играет важную роль в современной медицине. На протяжении многих лет большинство исследований по реабилитации после инсульта с использованием современной медицины и нетрадиционной медицины достигли довольно хороших результатов (у пациентов в возрасте от 5 до 62 лет). 74.1%) [14]. В данной статье проводится исследование с учетом вышеперечисленных характеристик. Цели: Определить факторы, связанные с результатами реабилитации с помощью методов зеркальной терапии в сочетании с лечебной гимнастикой у пациентов с гемиплегией вследствие инсульта головного мозга. Методы: Контролируемое клиническое экспериментальное исследование было проведено на 104 пациентах с инсультом, которым была проведена обычная электроакупунктура в сочетании с точечным массажем в городской многопрофильной больнице Кантхо с февраля по сентябрь 2020 года. Результаты: По шкале Бартела, после 15 дней лечения показатель выздоровления, оцениваемый как “очень хороший” и “хороший”, в основной группе составил 65,4%, что значительно выше (р < 0,05), чем в контрольной группе (26,9%). После лечения доля пациентов, восстановивших свои двигательные функции, также оцениваемые как “очень хорошие” и “хорошие” в основной группе, составила 76,9%, в контрольной группе -42,3%. Контрольная и основная группы не были связаны между собой такими факторами как возраст, пол, профессия, окружающая среда и клинические характеристики.

Keywords: stroke, electro-acupuncture, acupressure massage.

Ключевые слова: инсульт; электроакупунктура; точечный массаж.

1. Introduction

Cerebrovascular accident is one of the deadly diseases, being common in the elderly and the second-leading cause of death worldwide (AHA 2016) [1; 10]. About 15 million people around the world suffer from cerebrovascular accident every year, of which 6 million people decease and 5 million are permanently disabled [2]. In Vietnam, according to Le Van Thanh [2], yearly, about 200,000 people suffer from cerebrovascular accident and up to 50% of cases decease and 90% of cerebrovascular accident survivors have to live with neurological and motor sequelae. According to the World Health Organization, there are between 1/4 and 2/3 of cerebrovascular accident survivors having become permanently disabled, while Hirano et al., reported that 61% of cerebrovascular accident survivors remain sequelae, and 50% of patient must depend on others for daily activities [12, p.72]. Motor sequelae and impairments in hand and foot motor function make them dependent on others for daily activities and reduce their life quality and expectancy.

At Traditional Medicine – Physiotherapy and Rehabilitation Department, Can Tho City General Hospital, the number of patients with sequelae of cerebrovascular accident due to cerebral infarction and cerebral hemorrhage admitted to hospital for treatment in 2019 was 210 cases out of total 560 cases of inpatient treatment, accounting for 37.5%. Therefore, we conducted a study on the topic: “Evaluation of motor rehabilitation results in patients with stroke sequelae by conventional electro-acupuncture combined with acupressure massage at Traditional Medicine – Physiotherapy and Rehabilitation Department”.

2.  Research subjects and methodologies

2.1. Research subjects

Patients who are either stable after stroke emergency due to cerebrovascular accident or patients who are weak and hemiplegic arrived at Traditional Medicine Department of Can Tho City General Hospital for examination and treatment in 2020.

2.2. Inclusion criteria

Patients after stroke emergency diagnosed with cerebral infarction by computed tomography scan (diagnosis based on discharge diagnosis of stroke emergency department), arriving for treatment of sequelae with basic treatment in terms of internal medicine at Traditional Medicine Department of Can Tho City General Hospital in 2020 during the study period.

2.3. Exclusion criteria

Patients with traumatic brain injury, existing mental disorders, patients who do not agree to participate in the study; patients with contraindications to acupuncture / electro-acupuncture and acupressure massage; Patients with a history of heart failure or myocardial infarction.

2.4. Study period and place

The study was conducted from February, 2020 to September, 2020 at Traditional Medicine Department of Can Tho City General Hospital in 2020.

2.5. Study design

Clinical experiment with control group. The intervention group are patients meeting the inclusion criteria and were treated with conventional electro-acupuncture combined with acupressure massage; the control group also met the sampling criteria but only received conventional electro-acupuncture

2.6. Sample size and sampling method

- Use the sample size estimation formula to estimate 2 proportions. Substituting the values into the formula, we have n = 52, so the sample size in the study is 104 patients (the intervention group of 52 and the control group of 52).

- Sampling method: random sampling.

2.7. Research tool

Evaluating functional independence status of basic daily living activities in accordance with the Barthel scale (BI), including 10 basic functional activities in daily life such as eating, drinking, bathing, washing, cleaning, changing clothes, and moving. The total score is 100 points, divided into 3 levels:

Full independence: 90 – 100 points

With assistance: 50 – 85 points

- Full dependence: < 45 points

2.8. Data processing

Data processing using SPSS 20.0 software

3. Results

3.1. Socio-demographic characteristics

Table 3.1.

Research results by age group

* Comment: The average age of two groups was 62.2 (the control group of 62.13; the study group of 62.27). The patients in the 50-year-old-and-under group accounting for the highest proportion of 11.5% were in the study group; the patients in the over-50-year-old group accounting for the highest proportion of 89.4% were in the study group.

* Comment: More than half of research subjects in both groups were male, accounting for 57.5%.

* Comment: The morbidity rate for other occupational groups (retired officials and the elderly) in the two groups was higher than that of manual labor and mental labor groups.

Chart 3.2. Distributed by occupation

* Comment: The number of people suffering from the disease in rural areas accounted for a higher proportion than that in urban areas in both the control group (84.6%) and the study group (78.8%).

Comment: The proportion of patients with dysarthria in the control group accounted for 15.4% and that in the study group accounted for 21.2%.

Comorbidities:

Chart 3.2. The proportion of patients with hypertension

Comment: The proportion of people with hypertension in the control group accounted for 30.8% and that in the study group was 19.2%. This difference was not statistically significant (P > 0.05).

Comment: The proportion of people with ischemic heart disease in the control group accounted for 23.1%, and that in the study group was 26.9%. This difference was not statistically significant (P > 0.05).

2. Treatment evaluations based on the Barthel scale:

Table 3.3.

Evaluation of degree of paralysis in accordance with the Barthel scale on day N1, N15, N30

Comment: The average degree of analysis in the control group accounted for 50%, that in the study group was 36.5%; The “weak” rating in the control group accounted for 46.2%, that in the study group was 48,1%; The “poor” rating in the control group accounted for 3.8%, that in the study group was 15.4%. The difference in the two groups was not statistically significant (P > 0.05).

Comment: After 15 days of treatment, the “very good” and “good” recovery rate in the study group accounted for 65.4%, which in the control group accounted for 26.9%. This difference was statistically significantly (P < 0.05).

Comment: After the course of treatment, the proportion of patients recovering their motor function classified as “very good” and “good” in the study group was 76.9%, which in the control group is 42.3%. the proportion of patients recovering their motor function classified as “average” in the study group accounted for 23.1%, while this proportion in the control group was 57.7%.

Chart 3.3. Recovery results on day N30 in accordance with the Barthel scale

3. Discussions

3.1. Socio-demographic characteristics

The 50-year-old-and-under group accounted for 10.6%, and the over-50-year-old group accounted for 89.4%. This result is consistent with many studies by the authors Mai Tho Truyen (2012) [3], and Le Hoa (2015) [4].

The average age of two groups was 62.2 (the control group of 62.13; the study group of 62.27), the age of youngest patient was 35 years old, and that of eldest patient was 85 years old. It is similar in comparison with the study by Hoang Thanh Hien and Phan Quang Chi Hieu [11], the average age was 59.4 ± 11.7.

The proportion of men with the disease was higher than that of women with the disease (57.7% in men, 42.35% in women), which are similar to the studies by Mai Nhat Quang (55.275% in men, 44.73% in women) [13], by Nguyen Minh Duc (55.2% in men, 44.79% in women) [9] and also similar to the study by Luu Huu Dzuan and Nguyen Minh Duc (54.29% in men, and 45.71% in women).

The other labor group (retirees, the elderly) had the highest morbidity rate (54.8%) compared to the manual labor group (35.6%) and the mental labor group (9.6%).

This is consistent with the pathological characteristics of the elderly because atherosclerotic plaques can easily cause embolism [9].

People living in rural areas (the proportion of 81.7%) had a higher morbidity rate than those living in urban areas (the proportion of 18.3%). The reason is that people living in rural areas often live in accordance with customs, eat and drink comfortably, without abstaining, so they are prone to diseases.

Through our study, we found that the majority of people with cerebrovascular accident living in rural areas accounted for the highest proportion of 81.7%. Only 18.3% of patients live in urban areas. The results of this study are similar to those of the author Trinh Viet Thang (2012) [8] with the study on 308 patients with cerebrovascular accident in the residential community of Khanh Hoa Province, which showed that the patients were more rural than urban. We find this to be consistent with reality, because Can Tho City General Hospital is a first-class hospital, many seriously ill patients are gathered and transferred from lower-level hospitals [5; 7].

The proportion of people with dysarthria in the study accounted for 18.3% compared with the normal group accounting for 81.7%. These proportions, in accordance with the study group, depends very much on the sample size, so it should be researched further.

The proportion of people with hypertension in the study accounted for 25%, which is lower than that of the study by Nguyen Van Dung and Nguyen Thi Hung (the proportion of people with hypertension was 52.9%) [6] and that of the study by Mai Nhat Quang of 75.84% [13]. This difference is because the two studies above selected the same sample size for the group of people with cerebral haemorrhage and cerebral infarction who were admitted to the hospital on the first day. The patients therefore hardly had optimal blood pressure control.

The proportion of people with ischemic heart disease in the study accounted for 25%, which is lower than that in the study by Luu Huu Dzuan and Nguyen Minh Duc of 35.4%. This difference is due to the statistics of the authors Luu Huu Dzuan and Nguyen Minh Duc reckoning on cardiovascular disease, not on ischemic heart disease alone.

3.7. Motor rehabilitation results after treatment with the Barthel scale

- The proportion of patients recovering their motor function classified as “very “good” and “good” in the study group was 76.9%, which is higher than that in the study by Doàn Thi Nguyen and Phan Quang Chi Hieu (the “very good” recovery results reached 68.25%) [12], and higher than that in the study by Hoang Thanh Hien and Phan Quang Chi Hieu (the “very good” recovery results reached 67.2%) [11]. The reason is that the above two studies used the methods of acupuncture combined with physiotherapy. On the other hand, they only reckoned on the recovery results classified as “very good”, “average”, and “weak”, without “good” level.

- The motor rehabilitation rate is similar to that in the study by Trinh Thi Dieu Thuong (the “very good” and “good” recovery results reached 74.1%). The study of the author Trinh Thi Dieu Thuong is a multi-center study, taking samples at 3 medical examination and treatment facilities and using the methods of improved acupuncture combined with physiotherapy exercises with encouragement of brain to participate in other exercises, along with the intervention method of the study group at Traditional Medicine Department, Can Tho City General Hopsital.

4. Conclusions

4.1. Socio-demographic characteristics

- Age: The average incidence age of the two groups was 62.2. The age of youngest patient was 35 years old, and that of eldest patient was 85 years old.

- Sex: The proportion of men with disease was higher than that of women with disease (57.7% in men, 42.35% in women).

- Occupation: The other labor group (retired officials, the elderly) had the highest morbidity rate (54.8%) compared to the manual labor group (35.6%) and the mental labor group (9.6%).

- Residential area: People living in rural areas (the proportion of 81.7%) had a higher morbidity rate than those living in urban areas (the proportion of 18.3%).

- The proportion of people with dysarthria in the study accounted for 18.3% compared with the normal group accounting for 81.7%.

- Comorbidities: People with hypertension and ischemic heart disease accounted for 25%.

4.2. Motor rehabilitation results after treatment with the Barthel scale

After the course of treatment, the proportion of patients recovering their motor function classified as “very good” and “good” in accordance with the Barthel scale in the study was 76.9%, which was statistically significant with P < 0.05.

It is necessary to develop a care plan for patients with cerebrovascular accident before hospital discharge. Educate the patients on a home rehabilitation program to help them improve self-care.

References:

1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics-2016 Update: A Report from the American Heart Association // Circulation. 2016. No.133(4). Pp. e38-360.
2. Le Van Thanh. The launching ceremony of World Stroke Day held on October 14th in Ho Chi Minh City. Url: http://www.youtube.com/watch?v=6iODTOC A4bY.
3. Mai Tho Truyen, Ngo Dang Thuc. Evaluating the status of treatment and home care of stroke patients after hospital discharge in O Mon District – Can Tho City. The 3rd National Stroke Conference – Practical Medicine. 2012(811+812). Pp. 353-60.
4. Le Hoa. Survey on some common risk factors in stroke patients at Intensive Care – Anti-poison Department of Phu Yen Province General Hospital. Grassroots-level research project: Phu Yen Province General Hospital, 2015.
5. Pham Van Phu, Ngo Dang Thuc, Tran Trong Hai. Evaluation of independence in daily living activities after stroke in the community. Ho Chi Minh City Journal of Medicine. 2003. No.7(4). Pp. 69-72.
6. Dang Hoang Anh, Nguyen Van Chuong. Study on the recovery in patients after cerebrovascular accident with hypertension after 1 year and some related factors in 2009.
7. Tuan T. V., Research on some epidemiological characteristics of stroke in Thai Nguyen Province. Hanoi: Hanoi Medical University, 2007.
8. Trinh Viet Thang. Study on some epidemiological characteristics of cerebral stroke and effectiveness of rehabilitation exercises at home in Khanh Hoa Province. Hanoi: Vietnam Military Medical Academy, 2012.
9. Pei L., Zang X. Y., Wang Y., Chai Q. W., Wang J. Y., Sun C. Y., et al. Factors associated with activities of daily living among the disabled elders with stroke // International Journal of Nursing Sciences. 2016. No. 3(1). Pp. 29-34.
10. Egan M, Kubina L.A, Dubouloz C.J, Kessler D, Kristjansson E, Sawada M. Very low neighbourhood income limits participation post stroke: preliminary evidence from a cohort study. BMC Public Health. 2015. No.15. p. 528.
11. Cao Phi Phong, Tran Trung Thanh. Assessment of quality of life of patients after stroke // Ho Chi Minh City Journal of Medicine. 2013. No. 17(1). Pp. 152-157.
12. Doan Thi Nguyen, Phan Quan Chi Hieu. Investigate the influencing factors on the effectiveness of motor rehabilitation after stroke by improved acupuncture method in combination with physical therapy in Tra Vinh // Journal of Medicine of Ho Chi Minh City. 2012. Special issue specializing in Traditional Medicine. Volume 16. Supplement of volume 1. p.72.
13. Mai Nhat Quang. Frequency of risk factors and mortality rate of cerebrovascular accident at An Giang central general hospital // Journal of Medicine of Ho Chi Minh City. 2010. Volume 14, Supplement of No. 1. Pp.48-54.
14. Trinh Thi Dieu Thuong and Phan Quang Chi Hieu. Effectiveness of motor rehabilitation after stroke of improved acupuncture combined with active exercise // Journal of Medicine of Ho Chi Minh City. 2008. Special issue of traditional medicine. Supplement of volume 12. No. 4, p.18.