杭州市江干区人民医院 以人为本 求实求精

重点学科介绍康复理疗科成立于1982年，为了与国际接轨，2004年2月在浙江大学医学院附属邵逸夫医院康复医学科及神经内科的技术指导下扩大规模，将原有的康复理疗科更名为康复医学科(Departmentofrehabilitationmedicine，RM)，成为院内又一新型临床科室，该科具有良好素质并富有经验的康复医师、专业治疗师、护士组成医疗小组。在职医务人员10名，其中中高级技术职称以上专家4名，为目前杭城区级医院中规模最大、最具特色的重点学科。本科室分为病房和门诊两部分，有床位20张，门诊设有功能评定室、运动疗法室(PT室)、作业疗法室(OT室)…     

综合性医院护士承担康复训练的可行性研究

随着生活水平的提高 ,心脑血管疾病已成为严重危害人们健康的疾病之一 ,特别是脑血管疾病 ,使许多病人遗留有程度不等的功能障碍。为此 ,需要相应数量的康复医学专业人才 ,以帮助他们达到身心康复。但目前综合性医院拥有的康复专业人员为数不多 ,尤其是康复治疗专业的运动治疗师 (ＰＴ)、作业治疗师(ＯＴ)、语言治疗师 (ＳＴ)等更为缺乏。如何在康复专业人员缺乏的状况下 ,最大限度地为病人提供康复支持 ,成为综合性医院亟待解决的问题。我院是拥有 70 0多张床位的综合性医院 ,于1994年 11月创办康复医学科 ,共设病床 30张。在临床实践中对…     

上海市社区康复资源分析

目的 调查上海市社区卫生服务中心康复资源现状。方法 2018年12月,调查上海全市16个区所有社区卫生服务中心,共计247家。发放《医疗机构调查表》,内容包括康复人员数(康复医师数、康复治疗师数)、康复床位数等资源情况。结果 截至2017年底,上海市社区共有康复医师152人,康复治疗师597人。每千户籍人口康复医师、康复治疗师分别为0.01人、0.04人,每千户籍老年人口康复医师、康复治疗师分别为0.03人、0.12人。社区共有床位17 484张,其中康复床位1425张(8.15%)。上海市每千户籍人口、户籍老年人口的康复床位数分别为0.10张和0.30张。结论 上海社区康复发展不充分,资源较为缺乏,服务供给规模相对较小,供需不匹配。建议加强对社区康复工作的支持、增加社区康复资源供给。     

脑卒中社区家庭康复协作网护理有效性研究

目的 对城市脑卒中社区家庭康复协作网康复护理干预的有效性进行分析.方法 将出院到社区的80名脑卒中后遗症期患者,随机分为干预组和对照组,由社区护士、卒中护士、社区医生、神经内科医生、康复治疗师、营养师等组成的协作网按"小组教育加康复训练加文体疗法"方案实施干预,3个月时评价.结果 干预组患者运动功能部分恢复,日常生活活...     

分层管理模式对儿童康复病区物理治疗师职业倦怠的影响

正康复治疗师是儿童康复治疗工作的直接执行者,是康复效果的重要保障。物理治疗师在治疗师群体中占比高、地位关键,是康复机构的核心竞争力所在~([1])。传统管理模式是我国脑瘫康复机构主要的管理形式,在此管理模式下,物理治疗师职业倦怠严重,同时面临晋升门槛高~([2—3])、学历提升难~([4—6])、工资待遇低~([7])、心理压力大~([8—9])、工作负荷重且枯燥的窘境~([10]),自身价值难以体现~([7,11]),不仅导致专业队伍建设不稳定,而且还影响康复疗效。据文献报道,81.1%的治疗师有职业倦怠~([2]),25.6%的康复治疗师表示"未来考虑变换职业"~([12])。改变传统管理模式,降低物理治疗师的职业倦怠,提高患者满意度是康复机构管理者亟待解决的课题。     

上海市康复医疗资源与服务开展现状调查

目的了解上海市康复资源配置及服务提供情况,明确现状与问题,为上海市康复医疗服务体系规划提供依据。方法基于"结构-过程-结果"理论框架,围绕康复科室设置、人力、床位、设备、房屋、收支、转诊及服务提供等内容,对综合医院、康复医院、社区卫生服务中心进行问卷调查与现场考察。结果三类调查机构中康复医师321人,康复治疗师860人,康复护士666人;康复编制床位2199张,实有床位2573张。综合医院、康复医院、社区卫生服务中心康复服务开展率分别为94.79%、100.00%、75.56%,康复设备整体配备率分别为50.79%、71.15%、17.77%,康复诊疗项目门诊开展率分别为27.73%、30.00%、13.21%。结论上海市三级康复医疗服务体系架构初步形成,但是在康复功能落实方面还存在许多问题。康复医疗服务体系规划应将康复服务能力建设、人员队伍建设、康复资源配置、康复服务转诊作为建设重点。     

浙江省三级综合性医院康复医学科设置现状调查

目的:调查浙江省三级综合性医院康复医学科的医师、治疗师以及护士等人员配置、医疗资源现状的基本情况。方法:对浙江省内11个地区36家三级综合性医院的康复学科进行调查,采用问卷、实地走访和访谈的方式。结果:36家三级综合性医院中,康复医学科室以康复医学科命名的占76.19%,科室中心理治疗室设置率较低;康复学科共有在岗职工1222人,其中康复医师354人(28.97%),康复治疗师340人(27.82%),康复护士及其他工作人员528人(43.21%);康复人员学历和职称普遍偏低,尤其是康复治疗师和护士,高级和中级职称之和还不及50%。结论:浙江省三级综合性医院康复学科名称有待规范、康复从业人员以及康复医疗质量有待提高,康复医学人才的培养有待加强。     

医院结合家庭康复治疗对脑瘫患儿粗大运动功能的影响

目的:探讨医院结合家庭康复治疗对脑瘫患儿粗大运动功能的治疗效果。方法:将符合纳入标准的98例脑瘫患儿分为医院康复组和医院-家庭康复组,两组均接受医院康复治疗,医院-家庭康复组的家长接受康复培训,为患儿实施家庭康复,治疗师定期随访。患儿分别在治疗前、治疗3个月末和治疗6个月末采用粗大运动功能测试量表(GMFM-88)进行评估。结果:两组患儿在治疗前和治疗3个月末评估结果的差异无统计学意义,治疗6个月末评估结果差异有统计学意义,医院-家庭康复组的评估结果优于医院康复组。连续测量方差分析结果显示,不同治疗组评估结果的差异有统计学意义,医院-家庭康复组随治疗时间增加的上升变化更为明显。结论:医院结合家庭康复治疗可有效改善脑瘫患儿的粗大运动功能,值得推广。     

康复指导在痉挛型脑性瘫痪康复中的疗效观察

目的 探讨康复指导在痉挛型脑瘫患儿康复中的应用价值.方法 在医院进行综合康复的痉挛型脑性瘫痪患儿116例,能配合家庭康复训练的56例为治疗组,不能配合进行家庭康复训练的60例患儿为对照组,两组患儿均进行运动训练,针刺、低频电治疗、智力训练,治疗组还由治疗师或医师根据患儿病情指导家长进行康复指导;治疗前和治疗3个月后采用粗大运动功能测试量表(GMFM)进行测试.结果 两组患儿治疗前后GMFM各项得分和总分均有非常显著性差异(P<0.01).治疗后治疗组与对照组GMFM各项得分和总分比较均有显著性差异(P<0.05).结论 家庭康复训练能提高痉挛型脑性瘫痪患儿粗大运动功能.     

中国残疾人康复协会康复技术专业委员会成立暨第一届PT、OT培训班开学

中国残疾人康复协会康复技术专业委员会于1991年11月16日在北京中国康复研究中心正式成立。中国康复技术专业委员会为中国残疾人康复协会所属的二级分会,是由运动治疗师、作业治疗师、语言治疗师,物理治疗师和心理治疗师等组成的综合性学术团体。其宗旨是团结全国康复医学专业人员,共同研究和推广应用现代康复医学,探索具有中国特色的康复治疗技术,促进中国康复医学的发展。其主要任务是:研究各门康复医学治疗学的理论、方法,开展多种形式的康复治疗技术学术研究活动,为各层次     

Physical therapy management of patients undergoing total hip replacement.

Physical therapy management of patients who undergo total prosthetic replacement of the hip at St. Margaret Memorial Hospital is an integral aspect of a multidiscipline process of rehabilitation. Patients requiring total hip replacement have a variety of medical problems and, subsequently, have postoperative conditions which influence the physical therapy plan of care. The scope and pace of our physical therapy program are governed by criteria which emphasize the medical status, individual capability, and motivation of each patient. Arbitrary postoperative time intervals are not considered in the design of our physical therapy program. In addition, physical therapists have responsibility beyond the delivery of quality service which includes collaboration with other members of the rehabilitation team in the development and evaluation of the total surgical program.     

Differential diagnosis and management of a patient with peripheral vestibular and central nervous system disorders: a case study

Background

Clinical examination and management of patients with meningiomas is primarily dependent upon appropriate diagnosis of tumor type and surgical intervention. Physical therapists should be able to identify patients presenting with signs and symptoms suggestive of potential central nervous system (CNS) disorders and refer the patient appropriately.

Patient characteristics

In this case report, a 52-year-old female was referred to physical therapy after 18 months of unresolved dizziness.

Examination

Oculomotor examination revealed evidence of peripheral vestibular and potential CNS disorders. The physical therapist referred the patient to a physician who ordered magnetic resonance imaging (MRI).

Intervention

The patient received five physical therapy sessions while waiting for the MRI which revealed a meningioma. The meningioma was surgically removed and the patient was subsequently relieved of all symptoms.

Outcomes

Despite the presence of the meningioma, the patient reported improved stability during work-related activities and decreased dizziness as a result of physical therapy intervention pre-operatively.

Discussion

This case report emphasizes the importance of a physical therapists ability to perform and interpret an oculomotor examination in a patient presenting with signs consistent with peripheral vestibular and CNS disorders. It also demonstrates the role of physical therapy in collaboration with physicians in order to provide appropriate patient care management.     

Cardiac autonomic neuropathy and physical therapy: A case report

Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus, which imposes significant functional limitations and at times, sudden death. In an evolving healthcare landscape, physical therapists are assuming greater clinical responsibility and thus must be aware of this potential complication and tailor the plan of care appropriately. The purpose of this case report is to highlight the need for increased awareness of CAN among physical therapists in order to improve screening, diagnosis, and treatment. A 41-year-old Spanish-speaking male with uncontrolled type 2 diabetes arrived to the emergency department (ED) with dizziness and syncope leading to an inability to walk, work, or complete community service hours. After evaluation by the ED physical therapist, the patient was admitted for further work-up and diagnosed with CAN. After a short hospital course, the patient returned home symptomatic, fell, and was re-admitted the same day. Throughout the second hospital stay, the patient's symptoms improved with robust medical management allowing physical therapy treatment and functional independence for safe discharge home. Additionally, patient-specific goals were met with the help of social work and the medical team. Clinical knowledge of CAN for the non-cardiopulmonary specialist physical therapist is lacking. As physical therapists prepare to be advanced practice providers in a rapidly evolving healthcare landscape, increasing awareness has the potential to lead to improved screening, diagnosis, and treatment of persons with CAN, a severe complication of diabetes.     

Ultraviolet light treatment of a patient with pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease). A case report

The purpose of this case report is to detail the physical therapy of a patient with pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease), a condition usually not encountered by physical therapists. Prolonged exposure to ultraviolet light was the effective mode of treatment.     

Salary, education, and managerial-level differences of physical therapists in Maryland

The purpose of this study was to determine whether differences existed between a random sample of male and female physical therapists on selected factors. These factors included salary, managerial level, number of courses taken in management or administration, years of work experience in physical therapy, and years of seniority in an organization. A self-reported questionnaire was sent to 400 licensed physical therapists in Maryland who were also American Physical Therapy Association members. Data were analyzed on the 244 respondents using chi-square tests, t tests, and critical ratios. Results showed that female physical therapists, when employed full time in Maryland as department managers, on average, earned significantly less than their male counterparts. A significant difference existed between male and female department managers for full-time work experience in physical therapy. Neither the number of management courses taken nor seniority in an organization were significantly different for male and female physical therapists, regardless of managerial level. Conclusions were that differences existed on several factors between male and female physical therapy department managers and that schools preparing physical therapists for entry into the profession should assess the need for management preparation.     

Fire and smoke injuries

The successful management of burns and related injuries requires a comprehensive team approach at a designated burn center. This team should consist of burn surgeons, burn nurses, respiratory therapists, physical therapists, occupational therapists, clinical nutritionists, social workers, chaplains, and other clinical consultants. This article focuses specifically on the management of thermal burns and inhalational injuries, with an emphasis on assessment, resuscitation, and critical care management. It also discusses special considerations related to burned trauma patients.     

A grounded-theory investigation of patient education in physical therapy practice

Patient education is a critical component of physical therapy and is used frequently in practice. Research describing the practice of patient education in physical therapy is scarce, however. Qualitative research methods can be used to describe the practice of patient education in physical therapy and to identify supportive theory. This study describes the practice of patient education grounded in data obtained from nine physical therapists in three settings: outpatient, acute care, and inpatient rehabilitation. From the data common themes are reported. From the themes, supportive theory can be identified. Results show four primary themes regarding patient education in physical therapy. First, the physical therapists in this study were not able to easily differentiate patient education from primary interventions. Second, the purpose of patient education was to empower patients toward self-management and prevention. Third, therapists used a patient-centered approach to decide upon content. Finally, each therapist used function or demonstration to assess the outcome of patient education interventions. The results of this study can be used to inform current practitioners, for future research and to identify theoretical underpinnings to support the practice of patient education in physical therapy.     

A Pilot for Understanding Interdisciplinary Teams in Rehabilitation Practice

Interdisciplinary teams in rehabilitation are effective for positive patient outcomes. They require skills in team building and interprofessional collaboration. The Institute of Medicine has interdisciplinary teams as one of the five core competencies for healthcare workers. In reviewing the literature on teams, several themes were developed, such as communication, collaboration, understanding of roles, and educational levels of team members. Using these themes, a survey was developed to assess perceptions of teams by rehabilitation nurses, physical therapists, and occupational therapists. Significant findings came from questions on educational levels of team members between nurses and occupational therapists and also within the nursing groups. Open‐ended questions asked about barriers and facilitators for effective teams. We hope that these pilot results will lead to discussions on how to improve interdisciplinary teams and make them more effective for better patient outcomes.     

Reported practices related to,and capability to provide,first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists

BackgroundPhysical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy.ObjectivesDescribe Australian physical therapists’ awareness of guidelines; reported practices; and beliefs about capability, opportunity, motivation, and evidence.MethodsAn online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework.Results1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23–24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so.ConclusionAustralian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.