湘西民族地区脑卒中患者社区康复现状及影响因素分析

目的:了解湘西民族地区脑卒中患者社区康复现状及影响因素。方法:通过分层整群抽样,对湘西民族地区脑卒中患者进行问卷调查,共收回有效问卷206份;运用EPIDATA3.1制作数据库录入数据,用SPSS 17.0统计软件对所得数据进行统计学分析。结果:①25.7%的患者接受过社区康复,46.6%的患者没听说过社区康复,仅有6.3%的患者居住的社区有康复站。②患病时间、脑卒中次数、对社区康复的认知、是否定期进行康复治疗或锻炼等因素是湘西民族地区脑卒中患者接受社区康复现状的主要影响因素。结论:湘西民族地区脑卒中患者对社区康复的知晓率低,接受社区康复情况不理想且影响因素较多,社区康复服务的覆盖面有限,需要加大该地区脑卒中患者康复知识的宣传力度。     

社区康复护理3年效果观察

目的 探讨开展社区康复护理的康复效果.方法 对北京市西城区德胜社区卫生服务中心启动的社区康复护理服务进行评估.结果 开展社区康复护理3年前后调查比较:残疾人康复知识知晓率、残疾人自觉保持良好心理状态、残疾人主动与他人交流、主动参与训练、接受康复指导、参与社区活动、独立参与家务活动、日常生活活动能力各项均有改善.结论 社区康复护理是开展以家庭为基础、社区为依托的社区综合康复服务内容之一,能有效提高残疾人与慢性病功能障碍者生活质量.     

北京市肢体残疾人康复需求分析

目的 考察北京市肢体残疾人的康复需求情况.方法 以3006年全国残疾人抽样调查中北京市2390名肢体残疾人为研究对象,调查其康复现状与需求.结果 在康复形式上,54.85%的残疾人需要机构康复.38.20%的残疾人需要社区和家庭康复,6.95%的残疾人需要延伸服务(上门服务);康复内容方面.41.06%的残疾人需要医疗服务,30.70%的残疾人需要康复训练与服务,28.24%的残疾人需要辅助器具.结论 北京市肢体残疾人的康复需求多,需要采取多种措施解决.     

社区残疾人康复服务的影响因素与对策

目的:了解我社区残疾人康复服务的需求现状,探讨影响其接受康复服务的因素。方法:对我区426例残疾居民进行3个月干预治疗和随访观察,由调查员上门对残疾人本人或/和监护人进行问卷调查。结果:有针对性的干预治疗可以使残疾人在活动能力、日常生活、健康感受、生活感受明显改善,有效地减轻了患者焦虑、抑郁程度。多因素Logistic回归分析显示,文化程度、残疾年限、对康复服务的了解程度、对改善自身残疾状况的态度、康复锻炼方便程度和收费合理情况对残疾居民接受康复服务影响较大。结论:针对影响社区残疾人接受康复服务的因素进行措施改进,完成社区发展规划,整合资源,可推进残疾人社区康复,使更多的残疾人享受康复服务。     

北京市崇文区脑卒中康复现状调查分析

目的：了解当前北京市脑卒中患者及家属康复知识知晓情况和康复开展情况，为进一步普及脑卒中的社区康复提供参考。方法：采用随机抽样的方法，对北京市崇文区的216名社区脑卒中患者和197名患者家属进行问卷调查。结果：分别有5.1%的患者和8.6%的家属表示对康复知识很了解或比较了解；68.0%的患者和家属表示愿意在社区接受康复服务；25.0%的患者在住院期间接受过康复治疗，23.1%的患者回到社区后在社区接受康复治疗。结论：北京市崇文区脑卒中患者及其家属对脑卒中康复的知晓率和开展率仍然较低，需加大康复知识教育力度和进一步发展社区康复。     

社区残疾人康复服务需求的影响因素研究

目的:了解我区社区残疾人康复服务的需求现状,探讨影响其接受康复服务的因素.方法:采用单纯随机抽样方法,选择我区450名残疾居民作为研究对象,由调查员上门对残疾人本人或/和监护人进行面访问卷调查,采用SPSS13.0对实验数据进行统计分析,单因素分析采用χ2检验,多因素分析采用多因素Logistic回归分析.结果:在所收回的433份调查问卷中男性231例,女性202例;选择公立医院进行康复服务占51.0%,选择社康中心康复占24.0%,选择在家的占14.8%,选择私立机构的占6.9%.总康复需求率为98.4%.其中医疗服务需求占52.0%,训练指导需求占41.3%,用品用具需求占32.8%,知识宣传需求占19.2%,心理辅导需求占15.0%,转介服务需求占9.7%.单因素分析显示,是否距离近就医方便、是否医生水平高、是否付费合理、是否公费医疗/基本医疗保险定点医疗单位、残疾年限、对康复服务的了解程度、对改善自身残疾状况的态度、是否相信接受康复服务能改善残疾及是否愿意接受康复服务等因素,在最近3个月内是否接受康复服务上的构成比的差异有统计学意义(P<0.05).多因素Logistic回归分析显示,收费合理、相信经过接受康复服务能改善残疾、对医疗费用的承受程度、残疾年限、对康复服务的了解程度及对改善自身残疾状况的态度对残疾居民接受康复服务影响较大.结论:公立医院和社康中心是提供康复服务的主要单位,应尽快加快适宜康复技术;针对影响社区残疾人接受康复服务的因素改善措施,使更多的残疾人享受康复服务.     

湖北省视力残疾人的康复现状和需求调查分析

目的:了解湖北省视力残疾人接受康复的情况及康复需求.方法:对湖北省地区符合残疾评定标准的1142例视力残疾患者进行康复现状调查,内容包括①接受康复的项目:医疗服务与救助、辅助器具、康复训练与服务;②康复需求:机构康复,延伸服务、社区和家庭服务等.结果:1142例视力残疾患者中接受过一种或以上康复服务469例(41.1%);对康复形式的需求中机构康复760例(66.6%),延伸服务53例(4.6%),社区和家庭服务329例(28.8%).对康复内容的需求中医疗服务与救助898例(78.6%),辅助器具276例(24.2%),康复训练与服务120例(10.5%).结论:对视力残疾患者应根据不同年龄、不同地区、残疾程度和不同康复需求,在医疗机构和社区内提供相应的康复服务,满足视力残疾患者的康复需求.     

北京市智力残疾人康复需求分析

目的 调查北京市智力残疾人的康复需求情况.方法 以第二次全国残疾人抽样调查中北京市738名智力残疾人为研究对象,调查其康复现状与需求.结果 63.69%的智力残疾人需要社区和家庭服务,73.31%需要康复训练与服务;智力残疾人的医疗服务需求能基本得到满足,但康复训练需求远高于得到的服务,辅助器具需求很低,就业安置需求较高.结论 应建立智力残疾人个案管理系统,多途径地满足不同年龄和残疾程度智力残疾人的康复需求.     

重庆市智力残疾人康复情况分析

目的：了解重庆市智力残疾人的康复状况及其主要需求。方法：以重庆市第二次全国残疾人抽样调查确定的401例智力残疾人为研究对象,按智力残疾的分级进行评定,包括残疾人基本情况、致残原因、康复形式、康复内容、曾接受服务及主要需求等。结果：智力残疾人主要康复形式为社区和家庭服务,主要康复内容为康复训练与服务;主要需求是贫困救助与扶持。结论：加强社区医疗机构建设,提高社区医疗机构的医疗质量及康复训练与服务,是改善智力残疾人生存质量、减少残疾人数的重要手段。     

无锡市残疾人康复需求调查

目的探讨无锡市残疾人康复和社区康复网络建设的关系。方法采用问卷调查的方法对无锡地区74387名持证残疾人的类别、康复需求和现有康复服务进行调查。结果实际调查的74387名残疾人。不同类别的残疾人的康复需求有差异;残疾人的康复服务需求对社区康复网络的建设有指导意义。结论应充分利用政府资源建立一个包括上级医院、社区康复指导中心、社区康复站、家庭康复站在内的社区康复网络,以提供不同残疾人所需的康复服务。     

Access to postacute rehabilitation

Buntin MB. Access to postacute rehabilitation.Each year, more than 10 million Medicare beneficiaries are discharged from acute care hospitals into postacute care (PAC) settings, including inpatient rehabilitation facilities, skilled nursing facilities, and homes with services from home health agencies. These beneficiaries include very frail and vulnerable elders, many of whom have suffered from an acute event such as a stroke or a fall resulting in hip fracture, all of whom are judged unable to return to their homes without further care. Whether beneficiaries receive PAC and the type and intensity of care they receive is influenced not only by clinical factors, but by nonclinical factors including provider supply and financing, especially Medicare’s methods of payment. This article provides a definition of PAC and discusses the wide cross-sectional variation in the use of postacute rehabilitation. It then discusses recent changes to PAC provider payment that have raised concerns about access to postacute rehabilitation, trends in the use of PAC, and what these trends imply about the appropriateness of PAC as it is now delivered. It concludes by identifying issues about the policy and research implications of recent developments and the PAC literature reviewed.     

Interruptions to amputee rehabilitation

OBJECTIVES: To determine the frequency of interruptions to inpatient amputee rehabilitation, and to identify the causes, risk factors, and consequences of these interruptions. DESIGN: Retrospective cohort study. SETTING: Inpatient amputee rehabilitation service. PATIENTS: A total of 254 consecutive patients admitted within 90 days of amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient age, gender, comorbid medical conditions, amputation type(s), days from amputation to admission, admission Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) score, rehabilitation length of stay (LOS), whether a prosthesis was fabricated, discharge destination, discharge Houghton Scale score, discharge 2-minute walk test, and discharge SF-36 score. RESULTS: Interruptions occurred in 76 patients (30%). Impaired stump healing caused 46 (18%) interruptions and acute medical illness caused 26 (10%); 4 (2%) interruptions were because of other causes. Higher incidence of interruption was associated with female gender, peripheral vascular disease, and decreased days from amputation to rehabilitation. The majority of patients with interruptions (60/76, 79%) returned to complete rehabilitation. Patients with interruptions had significantly longer rehabilitation LOS (48.5 vs 37.0d, P<.001), but functional outcome measures at rehabilitation discharge were similar between those patients who returned to complete rehabilitation after interruption and those patients without interruption. CONCLUSIONS: Interruptions to amputee rehabilitation are common and result in longer rehabilitation LOS but do not adversely affect rehabilitation outcomes in those who are able to return to complete rehabilitation. No subgroup of patients with exceptionally high incidence of interruption could be identified.     

A team approach to rehabilitation

Through assessment, goal setting, planning, implementation, evaluation, and modification of goals and plans, members of the rehabilitation team individualize the meaning of "rehabilitation" for a client and establish a coordinated plan of action.     

Automatic referral to cardiac rehabilitation

OBJECTIVES: Cardiac rehabilitation (CR) remains underused and inconsistently accessed, particularly for women and minorities. This study examined the factors associated with CR enrollment within the context of an automatic referral system through a retrospective chart review plus survey. Through the Behavioral Model of Health Services Utilization, it was postulated that enabling and perceived need factors, but not predisposing factors, would significantly predict patient enrollment. SUBJECTS: A random sample of all atherosclerotic heart disease (AHD) patients treated at a tertiary care center (Trillium Health Centre, Ontario, Canada) from April 2001 to May 2002 (n = 501) were mailed a survey using a modified Dillman method (71% response rate). MEASURES: Predisposing measures consisted of sociodemographics such as age, sex, ethnocultural background, work status, level of education, and income. Enabling factors consisted of barriers and facilitators to CR attendance, exercise benefits and barriers (EBBS), and social support (MOS). Perceived need factors consisted of illness perceptions (IPQ) and body mass index. RESULTS: Of the 272 participants, 199 (73.2%) attended a CR assessment. Lower denial/minimization, fewer logistical barriers to CR (eg, distance, cost), and lower perceptions of AHD as cyclical or episodic reliably predicted CR enrollment among cardiac patients who were automatically referred. CONCLUSION: Because none of the predisposing factors were significant in the final model, this suggests that factors associated with CR enrollment within the context of an automatic referral model relate to enabling factors and perceived need. A prospective controlled evaluation of automatic referral is warranted.     

心脏康复相关研究

M aintenance of exercise capacity andphysical activity patterns2years aftercardiac rehabilitation.Journal of Car-diopulm onary Rehabilitation2005;25(1):14-21心脏康复两年后运动能力和运动方式的坚持情况Know ledge of heart attack sym ptom s inolder m en and w om en atrisk for acutem yocardialinfarction.JournalofCardiopul-m onaryRehabilitation2005;25(1):33-9有急性心肌梗塞危险的老年患者对心脏梗塞发作症状的了解Prevalence of depressive disorders inm en and w om en enrolled in cardiac re-habilita…     

Oral rehabilitation to maintain independence

A child born with missing or deformed upper extremities must learn to develop alternatives for the activities of daily living (ADL). To assure an independent existence, substitutes for nonfunctioning arms and hands must be developed. Teeth can replace hands for all activities that require pinch and grasp, as well as to support adaptive devices for turning pages, typing, drawing and painting. However, without carefully planned dental care, teeth, particularly incisors and canines, will show excessive wear if used for hands over the years. Loss of teeth threatens independence in self-care and in ADL, and loss of self-esteem. Oral health can be restored and retained to maintain function, independence, and esthetics. This case presentation illustrates a challenge and obligation of dentistry in rehabilitation.