INTRODUCTION
Stroke is a clinical syndrome characterized by the
rapid development of focal disturbances, loss of cerebral function with no
other cause except vascular disorders (WHO). The cause of stroke as stated by Smeltzer and Bare (2002), is caused by one
of four events: thrombosis, cerebral embolism, ischemia, and cerebral
hemorrhage. Other causes of stroke are less common, such as congenital defects
in blood vessel walls or abnormalities in the blood clotting system (Mulyatsih, 2008). Stroke is a
clinical syndrome due to brain blood vessel disorders, arises suddenly and
usually affects patients aged 45-80 years (Rasyid & Soertidewi, 2007).
The 2008 International Stroke Conference held in
Vienna, Austria, revealed that the number of stroke cases in the Asian region
continues to increase (Rachmat et al., 2018). In addition, the
number of stroke sufferers worldwide under the age of 45 continues to increase.
At the international conference of neurologists in the UK it was reported that
there were more than 1000 stroke survivors aged less than 30 years. The world
health agency predicts that deaths from stroke will increase along with deaths from heart disease and cancer from approximately 6
million in 2010 to 8 million in 2030 (Winstein et al., 2016). According to Kemenkes (2013), the prevalence of
stroke in Indonesia for stroke based on interviews increased from 8.3 per 1000
population (2007) to 12.1 per 1000 population.
The problem of stroke in Indonesia is
becoming increasingly important and urgent, because now the number of stroke
sufferers in Indonesia is the largest in Asia. The number of stroke sufferers
with an average age of 60 years and over is the second largest in Asia, while
those aged 15-59 years are the fifth largest in Asia (Indonesian Stroke
Foundation, 2010). Based on data from medical records of stroke patients who
visited the Pasar Minggu District Health
Center for the period from January to August 2021, there were 123 cases. The
number of cases is a fairly high number with the majority of patients aged over
60 years.
The goal of rehabilitation in stroke patients is to
reach the optimal stage in terms of independence and productivity. Stroke
sufferers require a complex and time-consuming rehabilitation process, with the
progress and level of progress of patients being varied and unique (Hatem et al., 2016). The scope of
rehabilitation for stroke patients includes 3 main things, namely functional
capacity, psychological status, and social status (Tsouna-Hadjis et al., 2000). The purpose of
rehabilitation according to Lui and Nguyen (2018)
is to increase and strengthen natural healing mechanisms. When tissue ischemia
occurs, repair mechanisms are immediately initiated, including resolution of
post-stroke edema, variations in function, and the reverse of the diachisis
process (disruption of neuronal communication), called Vicariasis which refers
to the area of the surrounding tissue affected by
trauma will take over the function of neuronal activity (Dancause, 2006).
According to WHO, all actions aimed at reducing the
impact of disability conditions and increasing the ability of people with
disabilities to social interaction are called medical rehabilitation. Range of
Motion (ROM) exercise is one form of exercise in the medical rehabilitation
process which is still considered effective enough to prevent disability in
stroke patients (Hosseini et al., 2019). This exercise is
a form of fundamental intervention for nurses that can be done for the success
of therapeutic regimens for patients and in an effort to prevent the occurrence
of permanent disability conditions in post-acute stroke patients in hospital so
as to reduce the level of dependence of patients on their families.
In the elderly, the collagen structure is less able to
absorb energy, causing muscle mass and the healing process to be slower (Smeltzer & Bare, 2001). Process The loss
of a number of muscle fibers due to myiofibril atrophy and replacement of
fibrous tissue begins in the 40s as the initial impact of the degeneration
process. The impact of the degeneration process can be reduced by maintaining
the body in a healthy and fit condition. Strength and flexibility of muscles
and joints that are well maintained, accompanied by ROM exercises can increase
the ability to maintain muscle and joint condition (Stanley & Beare, 2006).
Research on family support for post-stroke
rehabilitation, especially ROM exercises will be able to provide benefits in
improving the quality of life of stroke patients and their families. Based on
the literature study conducted.
Improving the implementation of regular education with
a better structure, especially by using a variety of media such as the use of
booklets on the implementation of ROM so that the awareness of patients and
families to be willing and able to perform Range Of Motion (ROM) exercises will
increase (Rahayu, 2015). This study aims
to be expected to provide an overview of the impact of family assistance to
care for elderly patients after stroke with hemiplegia
METHOD
This study is a quasi-experimental study
carried out with a quantitative approach based on medical record data of stroke
patients who came for control to the Pasar Minggu District Health Center in
2021. The population in this study were elderly post-stroke patients who had
their first attack treated by their families at home, and were control
patients. to the Pasar Minggu District Health Center. The sample to be taken is
from the entire object under study or is considered to represent the entire
population with the inclusion criteria being the characteristics of the sample
that can be included or deserves to be studied (Notoatmodjo, 2012).
Formula:
Note:
N
: total population
n
: total sample
P
: Population Proportion Estimate
Q
: 1-P : 1-0.5��� = 0.5
Z
: Alpha dependent normal curve value: 0.05 (1- 0.95)
���� 5% deviation: 0.05����������
Data Analysis
1. Descriptive
analysis
Univariate analysis of numerical/interval
data was carried out to determine the distribution of normality, mean, median,
and standard deviation of the variable factors that influence family care
measures for stroke patients.
2. Differential
Test Analysis
The analysis was carried out to identify
the implementation of discharge planning, the ability of the family to carry
out health tasks, and the readiness of the patient & family to discharge
before and after the intervention using dependent t-test (Mann-whitney �
if the data is not normally distributed), and to identify differences in the
effect of the intervention group. and the control group using independent t-test.
3. Multivariate
analysis: used to see the simultaneous relationship between the factors of the
personal system, interpersonal system, and social system with the
implementation of discharge planning.
RESULTS AND DISCUSSION
A. Results
This research was conducted on 60 respondents of
post-acute stroke patients consisting of 30 control patients and 30 patients
who were treated at home by their own families, the treatment was in the form
of health education about care for stroke patients at home accompanied by
assistance for 1 month. This study aims to be able to provide an overview of
the impact of family assistance in caring for elderly patients after stroke
with hemiplegia. The mentoring process carried out for the family in the form
of providing stroke patient care training includes providing knowledge about
aspects that affect the physical condition of the elderly after stroke,
including nutritional status, medication discipline, ROM exercise routines,
psychological support and motivation, cognitive training and exposure (Cannon,
2011). about the risks that can arise in the patient's
condition while being treated at home. The specific objectives of this study
were to identify the characteristics of families caring for elderly post-stroke
patients, to identify the characteristics of post-stroke elderly patients who
were cared for at home by their family members, to provide an overview of the
effect of providing training on stroke patient care at home on the motivation
and ability of families to perform care at home. home, as well as its impact on
increasing muscle strength in elderly patients after stroke.
1. Univariate
analysis
Table
1
Characteristics
of families caring for patients by gender, education, and occupation
|
Variable
|
Groups
|
Total
|
|
Intervention
|
Control
|
|
N
|
%
|
N
|
%
|
N
|
%
|
|
Gender
|
|
|
|
|
|
|
|
Male
|
12
|
40,0
|
7
|
22,6
|
19
|
31,1
|
|
Female
|
18
|
60,0
|
24
|
77,4
|
42
|
68,9
|
|
Education
|
|
|
|
|
|
|
|
High Schools
|
17
|
58,6
|
15
|
48,4
|
32
|
53,3
|
|
D3/S1
|
5
|
17,2
|
4
|
12,9
|
9
|
15,0
|
|
S2
|
0
|
0,0
|
1
|
3,2
|
1
|
1,7
|
|
Others
|
8
|
24,1
|
10
|
35,5
|
18
|
30,0
|
|
Occupation
|
|
|
|
|
|
|
|
Unemployment
|
20
|
66,7
|
22
|
74,2
|
42
|
70,5
|
|
Honorary employee
|
1
|
3,3
|
1
|
3,2
|
2
|
3,3
|
|
Private company employee
|
7
|
23,3
|
6
|
19,4
|
13
|
21,3
|
|
Civil service employee
|
2
|
6,7
|
1
|
3,2
|
3
|
4,9
|
|
Total
|
30
|
100,0
|
30
|
100,0
|
60
|
100,0
|
In
table 1, it can be seen that gender is dominated by women in both the
intervention group (60.0%) and the control group (77.4%). Furthermore, the
Education variable was dominated by respondents with a high school education
level, both in the intervention group (58.6%) and in the control group
(48.44%). Furthermore, in the employment variable, it is known that respondents
are dominated by those who do not work both in the intervention group (66.7%)
and the control group (74.2%), followed by private workers in the intervention
group (23.3%) and the control group (19. 4%).
Table
2
Characteristics
of Respondents based on age of the family caring for the patient and the length
of time the patient had a stroke (in months)
|
Variable
|
Mean
|
Median
|
SD
|
Min
|
Max
|
|
Age of the
family caring for the patient
|
|
|
|
|
|
|
Intervention
Groups
|
45,30
|
44,50
|
14,160
|
15
|
66
|
|
Control Groups
|
42,76
|
43,00
|
16,681
|
14
|
74
|
|
|
|
|
|
|
|
|
The length of time the patient had
a stroke (in months)
|
|
|
|
|
|
|
Intervention
Groups
|
53,71
|
54,000
|
37,3284
|
0,5
|
144,0
|
|
Control
Groups
|
45,53
|
24,000
|
43,6520
|
0,5
|
156,0
|
In
table 2, it can be seen that the average age of family members who care for
patients in the intervention group is 45 years with the youngest age being 15
years and the oldest age being 66 years, while in the control group it can be
seen that the average age of family members caring for patients is 42 years.
with the youngest age 14 years and the oldest age 74 years. Furthermore, the
average length of time patients suffered from stroke in the intervention group
was 53 months with the duration of the stroke being at least 2 weeks and the
longest being 144 months (12 years), while in the control group the average
length of stroke was 45 months with a duration of stroke. a minimum of 2 weeks
and a maximum of 156 months (13 years).
Table
3
Frequency
Distribution of ROM exercise in the intervention and control groups
|
Variable
|
Groups
|
Total
|
|
Intervention
|
Control
|
|
N
|
%
|
N
|
%
|
N
|
%
|
|
|
Family ability to do ROM exercises
|
|
|
|
|
|
|
|
|
Unfollowing SOP
|
7
|
23,3
|
10
|
33,33
|
17
|
28.33
|
|
|
Following SOP
|
23
|
76,7
|
20
|
66,67
|
43
|
71.67
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
30
|
100
|
30
|
100
|
60
|
100
|
|
In table 3 it can
be seen that the ability of the family to do ROM exercises according to the SOP
in the intervention group (76.7%) was higher than the control group (66.67%).
2.
Bivariate Analysis
Analysis for
factors related to changes in the status of stroke patients who were treated at
home after mentoring, including family motivation in carrying out treatment, knowledge
of ROM exercise treatments and procedures (SOP) as well as family care actions
for stroke patients at home.
Table 4 shows the
results of statistical tests on motivation, knowledge and action variables,
which obtained a significant p value (0.000) in the intervention group. This
shows a significant difference in the scores of the three variables in the pre
and post intervention measurements.
Table 4
Distribution of Respondents in the Intervention Group Based on the
Average Score on before and after treatment
|
Variable
|
Mean
|
SD
|
SE
|
P value
|
N
|
|
Motivation klg
Pre
Post
|
3,30
4,47
|
0,429
0,539
|
0,078
0,098
|
0,000
|
30
|
|
Knowledge klg
Pre
Post
|
3,45
4,37
|
0,458
0,505
|
0,083
0,092
|
0,000
|
30
|
|
Treatment
Pre
Post
|
3,19
4,07
|
0,438
0,467
|
0,080
0,085
|
0,000
|
30
|
Based one the Wilcoxon test, obtained a significance value of
0.000 (p < 0.05), then H0 is rejected, thus it is concluded "there is a
significant difference in motivation between before and after treatment."
Table 5 shows the results of statistical tests on motivation,
knowledge and action variables, which obtained a significant p value (0.000) in
the control group. This shows a significant difference in the scores of the
three variables in the measurements before and after treatment.
Table 5
Distribution of Control Group Respondents
Based on the Average Score on Measurements before and after treatment
|
Variable
|
Mean
|
SD
|
SE
|
P value
|
N
|
|
Motivation
Pre
Post
|
3,37
4,00
|
0,61
0,38
|
0,117
0,701
|
0,000
|
30
|
|
Knowledge
Pre
Post
|
3,74
3,89
|
0,25
0,43
|
0,467
0,798
|
0,000
|
30
|
|
Treatment
Pre
Post
|
3,36
3,66
|
0,286
0,315
|
0,057
0,093
|
0,000
|
30
|
Table 6
Distribution of
Respondents in the Control Intervention Group Based on the Average Score on
Measurements before and after treatment
|
Variable
|
Score
|
Intervention
|
Control
|
|
Pre
|
Post
|
Pre
|
Post
|
|
Motivation
|
Mean
|
3,30
|
4,47
|
3,37
|
4,00
|
|
SD
|
0,429
|
0,098
|
0,61
|
0,38
|
|
P value
|
0,001
|
0,001
|
|
Knowledge
|
Mean
|
3,46
|
4,37
|
3,74
|
3.89
|
|
SD
|
0,465
|
0,502
|
0,25
|
0,43
|
|
P value
|
0,000
|
|
|
Treatment
|
Mean
|
3,14
|
3,98
|
3,36
|
3.66
|
|
SD
|
0,438
|
0,467
|
0,286
|
0,315
|
|
P value
|
0,000
|
0,001
|
1. Based on Mann-Whitney test, obtained a significant number of
0.148, because the p value> 0.05, then H0 failed to be rejected (accepted),
it can be concluded that "There is no significant difference between
motivation scores before treatment in the control group and the intervention
group".
2. If the BMI of the control group is not different from the
intervention group, then the chance factor alone can explain 14.8% to obtain a
score obtained > 5%, then this result is considered not significant.
3. Based on Mann-Whitney test, obtained a significance number of
0.001, because the p value <0.05, then H0 is rejected, it can be concluded
that "There is a significant difference between the post-treatment
motivation scores in the control group and the intervention group"
4. Based on Mann-Whitney test, obtained a significant number of
0.011, because the p value <0.05, it can be concluded that "There is a
significant difference between the knowledge scores before treatment in the
control group and the intervention group".
5. Based on Mann-Whitney test, obtained a significant number of
0.003, because the p value <0.05, then H0 is rejected, it can be concluded
that "There is a significant difference between the post-treatment
knowledge scores in the control group and the intervention group".
6. Based on Mann-Whitney test, obtained a significant number of
0.048, because the p value <0.05, then H0 is rejected, it can be concluded
that "There is a significant difference between the scores of treatment
actions before treatment in the control group and the intervention group".
7. Based on Mann-Whitney test, obtained a significant number of
0.006, because the p value <0.05, then H0 is rejected, it can be concluded
that "There is a significant difference between the scores of
post-treatment care actions in the control group and the intervention
group"
8. Based on Wilcoxon test, the control group obtained a significance
value of 0.000 (p < 0.05), then H0 was rejected, thus it was concluded
"there is a significant difference in motivation between before and after
health education to families."
Based on Wilcoxon
test, obtained a significancy value of 0.078 (p > 0.05), then H0 failed to
be rejected (accepted), thus concluded "there is no significant difference
in knowledge between before and after counseling." Based on Wilcoxon test,
a significance value of 0.001 (p <0.05) was obtained, then H0 was rejected,
thus it was concluded "there is a significant difference in action between
before and after health education treatment and monitoring.
3. Muscle
Strength Analysis
Table 7
Distribution of muscle
strength of stroke patients in the intervention group based on the average
score on measurements before and after exercise ROM
|
Variable
|
Mean
|
SD
|
SE
|
P value
|
N
|
|
Hand
Pre
Post
|
3,09
3,32
|
1,19
1,15
|
0,218
0,210
|
0,059
|
30
|
|
Leg
Pre
Post
|
3,75
3,95
|
1,06
0,91
|
0,19
0,16
|
0,074
|
30
|
Table 7 shows the average
score on the measurement before the ROM exercise is 3.09 with a standard
deviation of 1.19 while the ROM exercise after the average score is 3.32 with a
standard deviation of 1.15. The average difference in hand muscle strength
scores before and after ROM training was 0.23 with a standard deviation of
0.649. The results of the statistical test showed that the p value was not significant
(0.059) possibly because the length of the intervention was too short, the time
period was 1 month.
On leg strength, the average
score on the measurement before ROM exercise was 3.75 with a standard deviation
of 1.06, while the measurement after ROM exercise was 3.95 with a standard
deviation of 0.91. The average difference in muscle strength scores before and
after ROM training was 0.19 with a standard deviation of 0.567. The results of
statistical tests showed that the p value was not significant (0.074), possibly
because the intervention was too short for a period of about 1 month.
Table
8
Distribution
of muscle strength of stroke patients in the control group based on the average
score on measurements before and after ROM exercise
|
Variable
|
Mean
|
SD
|
SE
|
P value
|
N
|
|
Hand
Pre
Post
|
3.06
3.26
|
1.17
0.93
|
0.21
0.17
|
0,277
|
30
|
|
Leg
Pre
Post
|
3,50
3,66
|
1,04
0,88
|
0,19
0,16
|
0,294
|
30
|
Table 8 shows the
average score on the measurement before ROM exercise is 3.06 with a standard
deviation of 1.17 while the measurement after ROM exercise is 3.26 with a
standard deviation of 0.93. The difference in the mean score of muscle strength
measurements before and after ROM exercise of hand strength was 0.20 with a
standard deviation of 0.987. Statistical test results obtained p value which is
not significant (0.277).
On leg strength,
the average score before ROM exercise was 3.50 with a standard deviation of
1.04, while the measurement after ROM exercise was 3.66 with a standard
deviation of 0.88. The difference in the mean score of muscle strength in the
measurements before and after is 0.16 with a standard deviation of 0.854.
Statistical test results obtained p value that is not significant (0.294).
Table 9
Distribution of muscle strength in stroke patients in the
intervention and control groups based on the average score on measurements
before and after ROM exercise
|
Variabele
|
Score
|
Intervention
|
Control
|
|
Pre
|
Post
|
Pre
|
Post
|
|
Hand Strength
|
Mean
|
3,09
|
3,32
|
3,06
|
3,26
|
|
SD
|
1,19
|
1,15
|
1,17
|
0,93
|
|
P
value
|
0,059
|
0,277
|
|
Leg Strength
|
Mean
|
3,75
|
3,95
|
3,50
|
3,66
|
|
SD
|
1,06
|
0,91
|
1,04
|
0,88
|
|
P value
|
0,074
|
0,294
|
There is a difference in the
average score of muscle strength in the intervention group and the control
group given after the treatment did not show a significant difference.
Table
10
The
relationship of motivation to treat stroke patients� muscle strength before and
after intervention
|
Variable
|
N
|
Mean
|
Score
|
Std. Deviation
|
p-value
|
|
Pre-intervention hand
muscle strength
|
|
|
|
|
|
|
Not getting motivated
|
25
|
12.24
|
3.06
|
4.968
|
0,855
|
|
Get motivated
|
35
|
12.41
|
3.10
|
4.519
|
|
|
|
|
|
|
|
|
|
Post intervention hand
muscle strength
|
|
|
|
|
|
|
Not getting motivated
|
25
|
14.28
|
3.57
|
4.596
|
0,786
|
|
Get motivated
|
35
|
14.67
|
3,66
|
3.921
|
|
|
|
|
|
|
|
|
|
Pre-intervention leg muscle
strength
|
|
|
|
|
|
|
Not getting motivated
|
25
|
13.08
|
3,27
|
4.812
|
0,950
|
|
Get motivated
|
35
|
13.33
|
3.33
|
3.672
|
|
|
|
|
|
|
|
|
|
Post intervention leg
muscle strength
|
|
|
|
|
|
|
�No
|
25
|
14.80
|
3.70
|
3.464
|
0,209
|
|
�Yes
|
35
|
15.89
|
3.97
|
3.511
|
|
|
|
|
|
|
|
|
In table 10, it can be seen the
relationship between motivation to care for stroke patients on the strength of
the muscles of the hands and feet, whether motivated or not, before and after
the intervention. The average value of hand muscle strength in patients who are
not motivated is 12.24 with a standard deviation of 4.968 and the average value
of hand muscle strength who is motivated is 12.41 with a standard deviation of
4.519. The results of the statistical test obtained a p-value of 0.855 (>
0.05), which means that there is no difference in the average hand muscle
strength in respondents who are motivated or not motivated before the
intervention.
Furthermore, the average value of
hand muscle strength in patients who are not motivated is 14.28 with a standard
deviation of 4.596 and the average value of hand muscle strength who is motivated
is 14.67 with a standard deviation of 3.921. The results of the statistical
test obtained a p-value of 0.786 (> 0.05), which means that there is no
difference in the average hand muscle strength in respondents who are motivated
or not motivated after the intervention.
Furthermore, the average value of leg
muscle strength in patients who are not motivated is 13.08 with a standard
deviation of 4.812 and the average value of leg muscle strength who is
motivated is 13.33 with a standard deviation of 3.672. The results of the
statistical test obtained a p-value of 0.950 (> 0.05), which means that
there is no difference in the average leg muscle strength in respondents who
are motivated or not motivated before the intervention.
Finally, the average value of leg
muscle strength in patients who are not motivated is 14.80 with a standard
deviation of 3.464 and the average value of leg muscle strength who is
motivated is 15.89 with a standard deviation of 3.511. Statistical test results
obtained a p-value of 0.209 (> 0.05), which means that there is no
difference in the average leg muscle strength in respondents who are motivated
or not motivated after the intervention.
4. The
Influence of Age to Muscle Strength
Table 11
Frequency Distribution of Patient Age
|
Variable
|
N
|
%
|
|
Age
|
|
|
|
<60 Years old
|
21
|
35.0
|
|
≥60 Years old
|
39
|
65.0
|
|
Total
|
60
|
100,0
|
In table 11, it can be seen the
distribution of the patient age variable, where there were 22 (36.1%) age less
than 60 years and the remaining 39 (63.9%).
Table
12
Age
distribution of patients in the intervention and control groups
|
Variable
|
Group
|
Total
|
|
Intervention
|
Control
|
|
N
|
%
|
N
|
%
|
N
|
%
|
|
Age
|
|
|
|
|
|
|
|
<60 Years old
|
9
|
30,0
|
12
|
40.0
|
21
|
35.0
|
|
≥60 Years old
|
21
|
70,0
|
18
|
60.0
|
39
|
65.0
|
|
Total
|
30
|
100
|
30
|
100
|
60
|
100
|
In table 12, it can be seen that the
age of patients aged more than 60 years in the intervention group was higher
than in the control group.
Table 13
Relationship of Age to muscle strength before and after
intervention
|
Variable
|
N
|
Mean
|
Score
|
Std. Deviation
|
p-value
|
|
Pre-intervention hand
muscle strength
|
|
|
|
|
|
|
<60 Years old
|
22
|
11.27
|
2.81
|
4.255
|
0,181
|
|
≥60 Years old
|
38
|
12.94
|
3.23
|
4.833
|
|
|
|
|
|
|
|
|
|
Post intervention hand
muscle strength
|
|
|
|
|
|
|
<60 Years old
|
22
|
13.59
|
3.39
|
3.936
|
0,726
|
|
≥60 Years old
|
38
|
15.03
|
3.75
|
4.270
|
|
|
|
|
|
|
|
|
|
Pre-intervention leg muscle
strength
|
|
|
|
|
|
|
<60 Years old
|
22
|
12.91
|
3.22
|
3.890
|
0,134
|
|
≥60 Years old
|
38
|
13.41
|
3.35
|
4.315
|
|
|
|
|
|
|
|
|
|
Post intervention leg
muscle strength
|
|
|
|
|
|
|
<60 Years old
|
22
|
14.91
|
3.72
|
3.308
|
0,235
|
|
≥60 Years old
|
38
|
15.74
|
3.93
|
3.618
|
|
In table 13, it can be seen the
relationship between the age of stroke patients and the strength of the muscles
of the hands and feet, before and after the intervention. The average value of
hand muscle strength in patients aged under 60 years is 2.81 with a standard
deviation of 4.255 and the average value of hand muscle strength in patients aged
60 years and over is 3.23 with a standard deviation of 4.833. Statistical test
results obtained a p-value of 0.181 (> 0.05), which means that there is no
difference in the average hand muscle strength in respondents aged under 60
years and aged 60 years and over before the intervention.
The average value of hand muscle
strength in patients aged under 60 years is 3.39 with a standard deviation of
3.936 and the average value of hand muscle strength in patients aged 60 years
and over is 3.75 with a standard deviation of 4.270. Statistical test results
obtained a p-value of 0.726 (> 0.05) which means that there is no difference
in the average hand muscle strength in respondents aged under 60 years and aged
over 60 years after the intervention.
The average value of leg muscle
strength in patients aged under 60 years is 3.22 with a standard deviation of
3.890 and the average value of leg muscle strength in patients aged 60 years
and over is 3.28 with a standard deviation of 4.315. Statistical test results
obtained p-value 0.134 (> 0.05) which means that there is no difference in
the average leg muscle strength in respondents under 60 years of age or over 60
years of age before the intervention.
The average value of leg muscle
strength in patients aged under 60 years is 3.72 with a standard deviation of
3.308 and the average value of leg muscle strength in patients aged 60 years
and over is 3.93 with a standard deviation of 3.618. Statistical test results
obtained p-value 0.235 (> 0.05) which means that there is no difference in
the average leg muscle strength in respondents aged under 60 years and aged 60
years after the intervention.
5.
Multivariate analysis
Table
14
Multivariate
Analysis of Factors Affecting Change Hand Muscle Strength
|
Variable
|
Coefficient
|
95% CI
|
P-value
|
|
Lower
|
Upper
|
|
ROM
Exercise
|
0,143
|
-0,151
|
0,438
|
0,335
|
|
Motivation
from Family
|
-0,028
|
-0,257
|
0,201
|
0,808
|
|
Patient�s
age
|
-0,043
|
-0,116
|
0,030
|
0,240
|
The results of multivariate analysis of changes in leg muscle
strength, obtained p-values of all > 0.05. This means that
there are no variables that affect changes in hand muscle strength.
Table 15
Multivariate Analysis of Factors
Affecting Changes in Leg Muscle Strength
|
Variable
|
Coefficient
|
95% CI
|
P-value
|
|
Lower
|
Upper
|
|
ROM
Exercise
|
-0,076
|
-0,450
|
0,298
|
0,685
|
|
Motivation
from Family
|
0,012
|
-0,279
|
0,302
|
0,936
|
|
Patient�s
age
|
-0,001
|
-0,094
|
0,092
|
0,984
|
The results
of multivariate analysis of changes in leg muscle strength, obtained p-values
of all > 0.05. This means that there are no variables that
affect changes in leg muscle strength.
DISCUSSION
The results of Univariate analysis of 60 respondents' data
showed that 68.9% were female, this is not in accordance with the literature
which is known that stroke sufferers are dominated by men, 53.3% education
level is high school, job data obtained 70.5% already Doesn't work. The age of
the patients is 65% over 60 years, the family caring for the average age is 44
years. Based on the length of stay, it is known that the intervention group
patients had an average of 53 months while the control group had an average
length of stay of 45 months, meaning that the intervention group consisted of
patients who suffered from stroke longer than the control group. Statistical
data shows that of all respondents as much as 71.67% did ROM according to the
SOP, this shows that the health education carried out on the patient is
effective.
The family is the basic system in which health and care
behaviors are managed, implemented and maintained (Friedman, 2012). Assistance
for families of stroke survivors is something that is needed considering the
impact that occurs on the family when there is a sick family member, the focus
of attention, resources and support systems in the family will experience
changes to be more focused on caring for sick family members. Family assistance
in the care of post-acute stroke patients at home includes training through
health education, monitoring the health status of elderly patients who are
treated at home and providing consultation to families regarding the care of
post-acute stroke patients at home.
Health education provided to families as a stroke
patient system includes several aspects that need to be considered in order to
facilitate the factors needed in the healing process or improvement of the
condition of post-acute stroke patients. The aspects that are needed include
increasing mobilization exercises, improving nutrition, maintaining
communication, motivation, cognitive training, continuing treatment and
physical therapy in the form of ROM (Range of Motion) exercises. The ROM
exercises that are taught to the family are focused on passive exercises on the
part experiencing hemiplegia to increase the patient's muscle strength. These
aspects are interventions given to families of stroke patients, both the
control group and the intervention group. The difference in the treatment given
was that the intervention group was assisted through home visits once a week
for 1 month.
There is a significant difference in the average score
of motivation, knowledge and action variables in the two groups (intervention
and control) (p value 0.000). These results indicate that although the control
group received different treatment from the intervention group, the results
showed significant differences. These results can be explained because the
treatment in the control group was carried out by providing health education to
families of stroke patients regarding the necessary actions in caring for
stroke patients at home, while in the intervention group the treatment was
given in the form of health education plus 2 times monitoring during the span
of 1 month. This is done because it pays attention to the ethical aspects of
research with the consideration that control patients are still being treated
and there is no neglected action, the second possibility is that patients in
the control group and the intervention group are not divided based on the
length of suffering from stroke and based on the length of stroke so the
possibility old patients in the group had received health education or exposure
to the family from other health workers.
Maintenance
of muscle strength and joint flexibility with ROM exercises can increase and
maintain muscle strength and joint flexibility Kozier (2004),
based on this belief, the researchers wanted to prove the impact of ROM exercises
on elderly stroke patients. Based on the results of research by Lindberg et al. (2004), it was found that active and
passive ROM exercises on the nervous system have an impact on reactivation of
nerve connections in stroke patients.
CONCLUSION
Characteristics
of respondents in this study were post-acute stroke patients (survivor) aged 55
to 84 years, female 68.9%, male 31.1%, type of work stating that they are not
working 70.5% , 53.3% of the highest education levels are high school
graduates.
There
is a significant difference in the family's ability on the aspect of motivation
in the control and intervention groups with a significance level of 0.001 (p
value: 0.05), knowledge aspects with a significance level of 0.011 (p value:
0.05) and the ability of family actions to carry out home care by focusing ROM
exercise has a significance level of 0.006 (p value: 0.05).
There is a difference in muscle strength scores between
the intervention and control groups after being given treatment, indicating
that the ROM exercise intervention carried out by the family is effective even
though it does not show a statistically significant difference, so it is
necessary to consider extending the period of observation and monitoring in
stroke survivor to ROM exercises after more than 1 month.
Statistical test results obtained a p-value of 0.726 (>
0.05), which means that there is no difference in the average muscle strength
of respondents under 60 years of age or over 60 years of age after the
intervention.
Multivariate analysis did not show any influence of
motivation, knowledge and action variables on patient care on muscle strength
of treated patients.
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|
Copyright holder:
Mumpuni, Ani Nuraeni,
Maidawilis, Uun Nurulhuda (2022)
|
|
First publication right:
Journal of Social Science
This article is licensed under:
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THE EFFECTIVITY� OF FAMILY ACCOMPANIMENT FOR ROM EXERCISE UPON ELDERLY POST
STROKE PATIENT WITH HEMIPLEGIA