Development,Implementation, and Use of a Process to Promote Knowledge Translation in Rehabilitation

Objective

To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years.

世界卫生组织国际健康分类家族在康复中系统应用的方案与路线图

目的 研究世界卫生组织国际健康分类家族(WHO-FICs)在康复领域宏观层面的政策和理论架构、中观层面的治理与管理机制,以及微观层面的系统应用。方法 基于国际康复政策文件,主要是世界卫生组织《世界残疾报告》、《全球残疾行动计划》和《健康服务体系中的康复》等分析康复发展的政策理论架构;探讨WHO-FICs,包括《国际疾病分类》(ICD-11)、《国际功能、残疾和健康分类》(ICF)和《国际健康干预分类》(ICHIβ-2)三大参考分类在康复领域的系统应用。结果 基于WHO-FICs构建康复宏观政策和理论架构,明确现代康复服务的内涵和原则。康复服务是现代健康服务的重要组成部分,涉及6大要素,包括领导力与治理能力、筹资、健康人力资源、服务提供、医药技术和健康信息系统。要求在康复服务中依据ICD、ICF和ICHI的架构和知识体系,对康复领域的疾病、功能和干预的分类、命名规则、内涵、外延、术语体系和编码系统进行标准化,并完成康复相关的评估和统计。基于WHO-FICs构建康复治理与管理的中观机制。康复服务基于生物-心理-社会模式,坚持以人为本和功能定向原则;情景要素包括服务地点、服务设施和服务场景三个方面。在康复领域系统应用WHO-FICs推荐采用“评定(ICHI)–功能分类、评定、说明和编码(ICF)–疾病分类、诊断、编码(ICD-11)–康复干预(ICHI)”系统应用模式,遵循“评估(功能和需求)和诊断(疾病和功能)–确定康复目标和康复方案–实施康复干预–康复结局评价(功能评定)”的标准化流程。基于WHO-FICs构建康复的微观应用模式,明确康复涉及的主要疾病有28大类,主要功能障碍有7大类,康复干预有6大类。根据ICD-11和ICF推荐的整体功能评估工具有WHO残疾评定方案(WHODAS 2.0)、WHO示范残疾评估表简明版(MDS-B)和VB40通用功能领域(VB40),同时推荐ICF核心分类组合用于康复功能和康复结局的评估。WHO-FICs在康复病案管理和病案首页报告中的应用,可实现康复病案管理的标准化,基于康复病案首页的疾病、功能和干预编码以及康复绩效报告的标准化为康复付费和支付管理提供了工具。基于WHO-FICs构建标准康复数据集,建立标准化康复大数据,实现功能相关的诊断相关分类和case-mix统计。结论 将WHO-FICs分类系统应用于康复领域,在宏观层面构建康复理论和政策架构,在中观层面明确康复治理与管理的机制,在微观层面建立康复应用模式,可进一步提升康复服务的科学化、规范化、精细化和信息化水平,提升康复服务的治理水平和治理能力,提高康复服务的质量、安全性和覆盖率,提供科学有效的整体解决方案。     

系统康复护理干预对急诊冠状动脉内支架植入术患者身心康复的影响

目的 探讨系统性康复护理干预对急诊冠状动脉内支架植入术(PCI)患者身心康复的影响.方法 将120例急诊PCI患者随机分为干预组和对照组各60例,两组患者均给予常规护理,干预组在对照组基础上进行系统性康复护理干预,主要包括心理干预,健康教育和术后早期康复训练.干预后对两组患者心理状态、并发症、心功能、术后监护时间及住院时间进行比较.结果 干预组患者焦虑、抑郁发生率较对照组明显降低,并发症明显少于对照组,均P＜0.01,心功能较对照组明显改善P＜0.05,术后监护时间和住院时问较对照组明显缩短,P＜0.01,差异有统计学意义.结论 对急诊PCI患者实施系统康复护理干预,能缓解其焦虑、抑郁的心理状态,提高患者对疾病和康复训练的认知能力,改善不良行为,减少术后并发症发生,改善患者心功能,缩短术后监护时间和住院时间,降低住院费用,促进患者身心康复.     

Utilization of Rehabilitation Services in Stroke: A Study Utilizing the Health and Retirement Study With Linked Medicare Claims Data

ObjectivesTo describe Medicare fee-for-service beneficiaries who used poststroke rehabilitation services and identified the strongest predictors of utilization after the initial stroke care episode.DesignPooled, cross-sectional design using data from 1998 to 2010 from the Health and Retirement Study (HRS) with linked Medicare claims data.SettingNA.ParticipantsStroke survivors who were Medicare fee-for-service beneficiaries and participated in the HRS were included (N=515).Main Outcome MeasureUtilization of rehabilitation services up to 10 years poststroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors, and social support.ResultsRehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and <16% in years 2, 4, 6, 8, and 10, respectively. Age was the primary factor predicting use of rehabilitation in the first 10 years poststroke (odds ratio: 1.14; P=.001). Recurrent stroke (odds ratio: 1.64; P=.051) was also significantly associated with utilization, whereas unspecified incident stroke at incident trended toward significance (odds ratio: 2.17; P=.077). None of the other factors was a significant predictor of participation in rehabilitation services in this period.ConclusionA small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years poststroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.     

Looking at hospitalized persons throughout the prism of the handicap

Objective

To describe the disability status of non-selected hospitalized persons.

《世界残疾报告》及对我国残疾人康复服务的启示

介绍《世界残疾报告》的出台背景、理论架构和主要建议,分析评述“第四章康复”的表述;认为我国残疾人康复服务发展应更新残疾观念和重构模式,体现现代康复的内涵与价值,分析残疾人的康复障碍及其解决策略,倡导《国际功能、残疾与健康分类》理念并推进“残疾人权利国际公约”落实;提出我国发展残疾人康复服务行动策略：倡导康复服务理念变革,推行以社区为基础的康复服务,采纳多专业合作的康复服务模式,建设专业化的康复服务人才队伍。     

Systematic Review of Mobile Health Applications in Rehabilitation

Objective

To conduct systematic review to better define how medical mobile applications (apps) have been used in environments relevant to physical medicine and rehabilitation.

The Burden of Traumatic Spinal Cord Injury in the United States: Disability-Adjusted Life Years

Objective

To quantify the burden of traumatic spinal cord injury (SCI) as defined by nonfatal health loss and premature mortality among a large sample of participants over a 44-year period, and estimate the national burden of SCI in the United States for the year 2010.

Development and Psychometric Validation of Capacity Assessment of Prosthetic Performance for the Upper Limb (CAPPFUL)

Objectives

(1) To develop a performance-based measure for adult upper limb (UL) prosthetic functioning through broad (ie, overall performance) and functional domain-specific (eg, control skills) assessment of commonplace activities; (2) to conduct initial psychometric evaluation of the Capacity Assessment of Prosthetic Performance for the Upper Limb (CAPPFUL).

Urban-Rural Differences in Service Utilization and Costs of Care for Racial-Ethnic Groups Hospitalized With Poststroke Aphasia

Objective

Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs urban) and race-ethnicity on service utilization and cost of care among PWA.

Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

ObjectiveTo examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.DesignSecondary analysis of inpatient Medicare claims data using Standard Analytical Files.SettingAcute hospitals across the United States.ParticipantsFrom nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010.InterventionsHospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high.Main Outcome MeasuresAll-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics.ResultsIn fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission. For low PT (30 minutes), the odds ratio (OR) was 0.90 (95% confidence interval [CI], 0.83-0.96). For medium PT (>30 to ≤75 minutes), the OR was 0.89 (95% CI, 0.82-0.95). For high PT (>75 minutes), the OR was 0.86 (95% CI, 0.80-0.93).ConclusionHospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.     

Family Involvement in Traumatic Brain Injury Inpatient Rehabilitation: A Propensity Score Analysis of Effects on Outcomes During the First Year After Discharge

ObjectiveTo evaluate the effect of family attendance at inpatient rehabilitation therapy sessions on traumatic brain injury (TBI) patient outcomes at discharge and up to 9 months postdischarge.DesignPropensity score methods are applied to the TBI Practice-Based Evidence database, a database consisting of multisite, prospective, longitudinal, and observational data.SettingNine inpatient rehabilitation centers in the United States.ParticipantsPatients (N=1835) admitted for first inpatient rehabilitation after an index TBI.InterventionFamily attendance during therapy sessions.Main Outcome MeasuresParticipation Assessment for Recombined Tools-Objective-17 (Total scores and subdomain scores of Productivity, Out and About, and Social Relations), Functional Independence Measure, Satisfaction with Life Scale, and Patient Health Questionnaire-9.ResultsParticipants whose families were in attendance for at least 10% of the treatment time were more out and about in their communities at 3 and 9 months postdischarge than participants whose families attended treatment less than 10% of the time. Although findings varied by propensity score method, improved functional independence in the cognitive area at 9 months was also associated with increased family attendance.ConclusionsFamily involvement during inpatient rehabilitation may improve community participation and cognitive functioning up to 9 months after discharge. Rehabilitation teams should engage patients’ families in the rehabilitation process to maximize outcomes.     

Using the ICF to Identify Contextual Factors That Influence Participation of Persons With Deafblindness

ObjectiveTo identify and describe the contextual factors that influence the participation of people with deafblindness in India.DesignQualitative study, using directed content analysis approach and the International Classification of Functioning, Disability and Health (ICF) as a framework to analyze the data.SettingCommunity and social participation settings.ParticipantsCommunity-dwelling individuals with deafblindness (N=16). Age ranges from 18-45 years.InterventionsNot applicable.Main Outcome MeasuresPersonal and environmental factors that influence the participation of individuals with deafblindness using the ICF framework.ResultsResults indicate that the age of onset and nature of impairment (deafblindness) and willingness to explain the condition (functional consequences of deafblindness) emerged as important personal factors. Access to resources such as assistive technology, social support, and deafblind-specific services were found to be enablers of participation. Lack of services, systems, and policies specific to deafblindness along with negative societal attitude toward disability were highly perceived environmental barriers that influence participation of people with deafblindness in India.ConclusionsProfessionals must acknowledge aspects of the environment in conducting assessments and delivering interventions and understand the dynamic interactions between environment of the individual and his/her concurrent vision and hearing impairments. Approaches to enable participation require rehabilitation professionals to work with those with deafblindness to advocate for removal of environmental barriers and ensure provision of appropriate resources from the government to facilitate their participation. Social policy and government must ensure emphasis on awareness about deafblindness, access to deafblind-specific services, positive societal attitude, and opportunities for full participation for people with deafblindness in society.