病区或社区康复模式对脊髓损伤者生存质量及 并发症的影响

目的:比较病区和社区康复服务模式对脊髓损伤(SCI)患者生存质量及并发症发生率的影响。方法:采用真实世界研究方法将SCI患者126例分为对照组(76例)和观察组(50例)。对照组给予社区康复服务模式,观察组给予病区康复服务模式;均康复1个月。于康复前、后采用改良Barthel指数(mBI)评价患者日常生活能力,采用WHOQOL-BREF量表评价患者的生存质量,统计2组痉挛、异位骨化、下肢深静脉血栓等并发症的发生率。结果:康复治疗后,对照组WHOQOL-BREF量表的心理领域评分与治疗前差异无统计学意义(P0.05),2组的其他指标评分均高于同组治疗前(P0.05),且观察组高于对照组(P0.05)。康复过程中,对照组痉挛、异位骨化、下肢深静脉血栓、泌尿系统结石、压疮等并发症发生率均高于观察组(P0.05)。结论:病区康复服务模式,可显著提高SCI患者的日常生活能力及生存质量,减少SCI后并发症的发生。     

肺癌合并肺栓塞患者的康复护理

目的：探讨康复护理对肺癌合并肺栓塞出院患者的影响。方法：将我院收治的60例肺癌合并肺栓塞患者随机分成观察组和对照组各30例。2组均在出院前给予用药指导及健康教育,观察组另外实施康复护理。结果：出院后6个月,观察组日常生活能力、生活质量、幸福度评分均较出院时及对照组出院后6个月明显增加（P＜0.01,0.05）,对照组出院时及出院后差异无统计学意义。干预6个月后随访,观察组在正确服药、合理饮食、合理作息、避免诱发因素、定期复诊等方面的遵医依从性明显好于对照组（P＜0.05）。2组并发症发生率比较,观察组出血、肺栓塞复发发生率明显低于对照组,脑梗死及死亡发生率与对照组差异无统计学意义（P＜0.05）。结论：康复护理能提高肺癌合并肺栓塞患者的遵医依从性,提高日常生活能力及生活质量,降低患者抗凝治疗并发症的发生率。     

康复手册在胸腔镜下食道癌根治术患者中的应用

目的探讨康复手册在胸腔镜下食道癌根治术患者中的应用效果。方法将80例食道癌腔镜手术患者随机分对照组和观察组各40例,对照组采用传统的常规口头健康教育,观察组由责任护士应用康复手册进行全程健康教育,比较两组患者健康教育效果、护理服务满意度、术后肠功能恢复及并发症发生率。结果观察组患者健康教育知识和技能的掌握程度、护理服务满意度均高于对照组,差异有统计学意义(P0.001),术后肠功能恢复时间优于对照组,差异有统计学意义(P0.05)、术后并发症发生率低于对照组,差异有统计学意义(P0.01)。结论应用康复手册能提高胸腔镜下食道癌根治术患者的健康教育效果和护理服务满意度,促进术后肠功能恢复,降低术后并发症发生,值得在临床工作中推广应用。     

延续护理干预对老年糖尿病出院患者远期康复的影响

目的:探讨延续护理干预对老年糖尿病出院患者远期康复的影响.方法:将152例老年糖尿病出院患者随机分为观察组96例和对照组56例,对照组给予常规出院指导,观察组给予延续护理干预,比较两组干预6个月、12个月、18个月治疗依从性、血糖达标率及并发症发生率.结果:两组干预12个月治疗依从性中饮食控制、运动锻炼、自我管理及血糖达标率、并发症发生率比较差异有统计学意义(P<0.05);两组干预18个月治疗依从性、血糖达标率及并发症发生率比较差异均有统计学意义(P<0.05).结论:对老年糖尿病出院患者实施延续护理,能明显提高患者的自我管理能力,改善临床症状,减少并发症发生,提高生活质量,达到远期康复效果.     

快速康复外科理论对骨折患者术后训练依从性及康复效果的影响

目的探讨快速康复外科理论对骨折患者术后训练依从性及康复效果的影响。方法选取该院骨科2015年12月至2017年12月收治的120例骨折术后患者,按随机抽签分为观察组(60例)和对照组(60例),对照组按骨科常规护理,观察组应用快速康复外科护理,比较两组患者术后并发症总发生率、住院时间、住院费用、下床活动时间及伤口愈合时间,采用数字疼痛评估法(NRS)评估两组患者术后疼痛程度,采用康复训练依从性问卷评估两组患者的依从性。结果术前两组患者疼痛评分比较,差异无统计学意义(P0.05),观察组患者术后不同时间点疼痛评分及并发症总发生率显著低于对照组,术后康复训练的依从性明显高于对照组(P0.05),且住院时间、住院费用、下床活动时间及伤口愈合时间均明显少于对照组(P0.01)。结论采用快速康复外科理论对骨折术后患者进行护理,可以有效镇痛,提高患者进行康复训练的依从性,降低并发症发生率,从而缩短住院时间及恢复时间。     

健康教育路径对手足口病幼儿康复的影响

目的探讨健康教育路径对幼儿手足口病病情康复的影响。方法选取137例手足口病患儿为研究对象,其中80例采用健康教育路径,设为观察组,另57例采用随机健康教育,设为对照组,比较2组家长健康教育知识的掌握情况、患儿治疗依从性以及病情康复情况。结果观察组家长对手足口病发病原因、易感人群、传播途径、临床表现等健康知识的知晓率均高于对照组,差异有统计学意义(P0.05)。观察组的治疗依从性、总有效率高于对照组,高热、皮疹、神经内系统症状等消失时间、住院时间短于对照组,差异有统计学意义(P0.05)。结论健康教育路径能够有效提高手足口病家长对健康知识的知晓率,提高患儿治疗依从性,加快病情康复。     

微信健康教育在下肢骨折患者术后康复随访中的应用

目的探讨微信健康教育在下肢骨折患者术后康复随访中的应用效果。方法选取2014年2月至2016年12月在我院行下肢骨折内固定术术后患者76例为研究对象,入选患者按随机数字法分为观察组和对照组,各38例,对照组出院时采用术后常规教育,观察组在对照组的基础上实施微信健康教育。比较两组术后行走能力、并发症发生率及门诊复诊依从性。结果观察组术后行走能力明显优于对照组;术后并发症显著少于对照组;术后定期门诊复诊依从性明显高于对照组,差异有统计学意义(均P0.05)。结论微信健康教育能提高下肢骨折患者术后的行走能力,减少并发症的发生,促进患者术后功能康复,并能提高患者门诊复诊的依从性。     

快速康复护理在髋关节置换术患者术后康复中的应用

目的 探讨髋关节置换术围术期实施快速康复护理的临床价值.方法 选取2015年1月~2016年9月在该院接受髋关节置换手术治疗的患者40例,按随机数字表法分为观察组和对照组各20例.对照组行围术期常规护理,观察组在对照组的基础上实施快速康复护理.观察两组患者的髋关节功能恢复情况、疼痛情况、并发症发生率及护理满意度.结果 两组患者术前髋关节Harris评分、VAS评分比较差异均无统计学意义(均P>0.05);术后12周观察组VAS评分明显低于对照组,Harris评分明显高于对照组(均P<0.05);术后并发症结果显示,观察组仅出现1例,发生率为5.00%,对照组共6例,发生率为30.00%,差异有统计学意义(P<0.05);观察组的护理满意率为95.00%,显著高于对照组的65.00%,差异有统计学意义(P<0.05).结论 髋关节置换术治疗患者围术期行快速康复护理,能有效促进髋关节功能恢复、缓解疼痛、预防并发症发生,提高生活质量,值得推广.     

老年腹腔镜胆囊切除术的快速康复护理

目的探讨快速康复护理在老年腹腔镜胆囊切除患者中的应用价值。方法选取本院2012年1月~2015年12月收治的76例择期行腹腔镜胆囊切除的老年胆囊结石患者,患者按随机数字表法分为两组,观察组38例实施快速康复护理,对照组实施常规护理,比较两组患者术后肛门排气时间、并发症发生率与住院时间的差异。结果观察组与对照组肛门排气时间分别为(18.45±4.33)h与(27.04±3.88)h,两组间差异有统计学意义(P0.05);观察组与对照组术后并发症发生率分别为5.26%与10.5%,两组间差异有统计学意义(P0.05);观察组与对照组住院时间分别为(5.55±1.39)d与(8.50±2.03)d,两组间差异有统计学意义(P0.05)。结论老年腹腔镜胆囊切除患者实施快速康复护理,可以加快患者术后康复,缩短住院时间,降低术后并发症的发生率。     

亲属纳入健康教育路径在异位妊娠围术期的应用研究

目的探讨亲属纳入健康教育路径在异位妊娠女性围术期的临床价值。方法选取该院2009年6月至2013年6月进行治疗的200例异位妊娠女性,按照随机数表法分为观察组(100例)与对照组(100例)。对照组患者采取常规健康教育手段,观察组患者在对照组的基础上,对亲属实施健康教育路径。采用SCL-90量表观察比较2组患者术前不良情绪,比较2组患者术后并发症发生率,以及治疗依从性和术后生活质量评分。结果 2组患者的孤独、焦虑、担忧等术前不良情绪评分,观察组低于对照组(P0.05);术后并发症发生率也显著低于对照组,差异有统计学意义(P0.05)。问卷结果显示,观察组患者的治疗依从性和生活质量评分都低于对照组,差异有统计学意义(P0.05)。结论将亲属纳入健康教育路径有利于缓解患者术前不良情绪及术后并发症,提高患者治疗依从性和术后生活质量,促进患者治疗和恢复效果。     

A comparison of a hospital-based and two home-based rehabilitation programmes

Purpose.?This paper compares the service models of three different types of rehabilitation programmes provided in Victoria, Australia: One hospital-based and two types of rehabilitation in the home (RITH).

Method.?Nine focus group interviews were conducted with multidisciplinary staff working in rehabilitation teams in one hospital-based and eight RITH programmes. Additional data were collected for 164 clients and 75 carers from eight of these programmes at admission, discharge and three months post discharge. Interviews were conducted with 32 clients and 14 carers.

Results.?The criteria for admission and model of rehabilitation adopted in the three programmes were similar. There were differences in programme aims, characteristics of the clients admitted and the type and level of therapy clients received, both between hospital and home-based programmes and between the three programmes. In general, staff and clients saw the home as providing a relevant context that enabled individualized, goal directed therapy for medically stable rehabilitation clients. The hospital offered an opportunity to socialize with others and specialized equipment.

Conclusions.?Results of this study suggest clients and carers require a mix of hospital and home-based rehabilitation that is able to respond to their needs and preferences at each phase of the rehabilitation continuum.     

A comparison of a hospital-based and two home-based rehabilitation programmes

Purpose. This paper compares the service models of three different types of rehabilitation programmes provided in Victoria, Australia: One hospital-based and two types of rehabilitation in the home (RITH).

Method. Nine focus group interviews were conducted with multidisciplinary staff working in rehabilitation teams in one hospital-based and eight RITH programmes. Additional data were collected for 164 clients and 75 carers from eight of these programmes at admission, discharge and three months post discharge. Interviews were conducted with 32 clients and 14 carers.

Results. The criteria for admission and model of rehabilitation adopted in the three programmes were similar. There were differences in programme aims, characteristics of the clients admitted and the type and level of therapy clients received, both between hospital and home-based programmes and between the three programmes. In general, staff and clients saw the home as providing a relevant context that enabled individualized, goal directed therapy for medically stable rehabilitation clients. The hospital offered an opportunity to socialize with others and specialized equipment.

Conclusions. Results of this study suggest clients and carers require a mix of hospital and home-based rehabilitation that is able to respond to their needs and preferences at each phase of the rehabilitation continuum.     

An introduction to the Korean Employment Promotion Agency for the Disabled

Purpose. The main aim of this article is to provide an introduction to the Korean Employment Promotion Agency for the Disabled (KEPAD), and to provide comparative thought regarding government-based vocational rehabilitation service delivery between South Korea and the USA.

Method. Relevant literature is considered, and current issues and comparative discussion in practice are highlighted.

Results. Introductory information in terms of organization, eligibility, services and programmes are presented. In addition, practical problems associated with the KEPAD system and a cross-cultural analysis is elaborated, comparing the USA and South Korean vocational rehabilitation systems.

Conclusion. KEPAD has successfully derived public support and acknowledgement of its national responsibility in ensuring vocational rehabilitation services for persons with disabilities. The KEPAD system demonstrates a unique approach in implementing vocational rehabilitation services by providing various benefits for both employers and persons with disabilities. However, considerable cautiousness in terms of cross-cultural analyses is required for international application. Furthermore, successive research of rehabilitation infrastructure is warranted.     

An introduction to the Korean Employment Promotion Agency for the Disabled

Purpose. The main aim of this article is to provide an introduction to the Korean Employment Promotion Agency for the Disabled (KEPAD), and to provide comparative thought regarding government-based vocational rehabilitation service delivery between South Korea and the USA.

Method. Relevant literature is considered, and current issues and comparative discussion in practice are highlighted.

Results. Introductory information in terms of organization, eligibility, services and programmes are presented. In addition, practical problems associated with the KEPAD system and a cross-cultural analysis is elaborated, comparing the USA and South Korean vocational rehabilitation systems.

Conclusion. KEPAD has successfully derived public support and acknowledgement of its national responsibility in ensuring vocational rehabilitation services for persons with disabilities. The KEPAD system demonstrates a unique approach in implementing vocational rehabilitation services by providing various benefits for both employers and persons with disabilities. However, considerable cautiousness in terms of cross-cultural analyses is required for international application. Furthermore, successive research of rehabilitation infrastructure is warranted.     

From ancient Greece to the cognitive revolution: A comprehensive view of physical rehabilitation sciences

The development of rehabilitation has traditionally focused on measurements of motor disorders and measurements of the improvements produced during the therapeutic process; however, physical rehabilitation sciences have not focused on understanding the philosophical and scientific principles in clinical intervention and how they are interrelated. The main aim of this paper is to explain the foundation stones of the disciplines of physical therapy, occupational therapy, and speech/language therapy in recovery from motor disorder. To reach our goals, the mechanistic view and how it is integrated into physical rehabilitation will first be explained. Next, a classification into mechanistic therapy based on an old version (automaton model) and a technological version (cyborg model) will be shown. Then, it will be shown how physical rehabilitation sciences found a new perspective in motor recovery, which is based on functionalism, during the cognitive revolution in the 1960s. Through this cognitive theory, physical rehabilitation incorporated into motor recovery of those therapeutic strategies that solicit the activation of the brain and/or symbolic processing; aspects that were not taken into account in mechanistic therapy. In addition, a classification into functionalist rehabilitation based on a computational therapy and a brain therapy will be shown. At the end of the article, the methodological principles in physical rehabilitation sciences will be explained. It will allow us to go deeper into the differences and similarities between therapeutic mechanism and therapeutic functionalism.     

Rehabilitation in the home versus the hospital: The importance of context

Purpose: Stroke rehabilitation has received increased attention in the past decade. Recent trials with new alternatives such as home-based rehabilitation services are being conducted. The purpose of the study was to explore differences between a therapy session with a stroke patient in two different contexts, i.e. in the patient's home and in the hospital.

Methods: The research design was a qualitative case study. Three data collection methods were used; participant observations of therapy sessions in two different contexts, semi-structured interviews and documents.

Results: The data were examined and coded for common categories. Analysis of the data looking for similarities and differences in behaviour of two therapists and their patients during therapy sessions in the hospital and in the home was performed. The observations revealed that there was clearly a difference in behaviour; a different role-set used by the two therapists when working in the patient's home versus in the hospital. The major difference in patient behaviour was that the patient, observed in his home, took the initiative and expressed his goals, which was not the case with the patients observed in the hospital. The findings were confirmed in the interviews and the documents.

Conclusion: It is suggested that the context is a key component to be considered in the rehabilitation process of stroke patients.     

Developing a tool for evaluating community-based rehabilitation in Uganda

Purpose.?The overall purpose of this study is to use the conceptual criteria of the ‘Joint Position Statement (JPS)’ (see http://www.ilo.org/public/english/employment/skills/download/jointpaper.pdf)on Community-based rehabilitation (CBR), together with the data collected from a CBR programme in Uganda (Tororo) to generate a prototype CBR evaluation tool.

Method.?A case study approach is used to examine the Tororo CBR programme. Project documentation was examined to generate base line data which was used to inform sampling for interviews and focus group discussions. These were conducted with a wide range of stakeholders. The interview and focus group data are recorded, translated, transcribed and imported into a computer-assisted analysis programme, NVivo. The data was analysed in two stages: (i) data led development of themes (ii) allocation of the generated themes to the conceptual structure of the ‘JPS’. A third stage uses the data to generate an outcome measurement tool for evaluating CBR programmes.

Results.?Fifty different themes were identified during the analysis and used to construct a questionnaire framed around the concepts of the ‘JPS’. In addition, the questionnaire reflected the words and phrases used by participants. The outcome is a short and feasible tool for evaluating CBR programmes.

Conclusion.?The ‘JPS’ has been used as a framework for the analysis of qualitative data to generate the basis of a prototype evaluative questionnaire which can now be piloted, amended and then used for the evaluation of other CBR programmes.     

上海市康复医疗资源调查报告

目的:上海对本地区现有的康复医疗资源现状进行调研,为卫生行政部门启动康复医疗服务体系的试点工作提供科学循证的决策依据.方法:采用问卷和实地走访的方式调研,各单位在完成《上海市康复医疗资源调查表》填写后需加盖单位公章确认.结果:上海市共有463家医疗机构,其中180家(38.88％)设有康复医学科,31家(6.7％)设有康复病床,康复医师585人,康复治疗师754人.康复医师具有研究生及以上学历者占26.32％,康复治疗师具有研究生及以上学历者占3.71％.结论:目前上海康复从业人员数量和专业质量都未达到卫生部对康复医学科设置的基本标准,尤其康复人才匮乏凸显.多种形式多种渠道,规范培养康复人员非常紧迫.