康复治疗师教育体制的探讨

我国现有人口１２．９５３３亿，按照国际标准，每１０万人口需要１５名以上的物理治疗师，８－１０名作业治疗师，应有物理治疗师近２０万名、作业治疗师约１０万名，目前我国的康复治疗师在数量上存在着严重的不足。由于缺乏受过正规化教育的高水平的专业师资、科学而合理的教学计划、符合国情的全国统一的教材，使得已培养的康复治疗人员又出现了水平参差不齐、质量不高的局面。在新的世纪，如何尽快解决上述问题，缩小我国与发达国家在此领域中的巨大差距，使我国的康复治疗师队伍早日融入国际大家庭确是当前迫在眉睫的任务。作者曾从事…     

偏瘫肩痛治疗的调查

<正> 偏瘫肩痛是脑卒中后的常见现象,发生率在16%～84%。目前临床治疗偏瘫肩痛有多种方法,但哪种效果最好尚不清楚。本调查旨在了解物理治疗师、作业治疗师、康复医师、疗养所医师、神经科医师治疗偏瘫肩痛的方法,以及他们对局部注射曲安奈德疗效的评价。 方法以邮寄问卷的形式调查了不同医疗机构的物理治疗师、康复医师、作业治疗师、疗养所医师、神经科医师各100名。被调查者均为在荷兰从事脑     

物理治疗学本科教学中学生的实践和创新能力的培养

目前国内外康复治疗学、物理治疗学专业的学历教育分布在综合性大学、医科、体育、高职高专等院校。在康复医疗团队中，康复治疗师起着中坚的、基础的地位。康复治疗师、物理治疗师的综合能力的培养至关重要。为适应社会的发展和职业的需要，我校在原有的康复医学和物理治疗学教育基础上，     

我国康复治疗技术教育改革与发展若干问题的分析

1我国康复治疗人才培养的现状我国自 2 0世纪 80年代初引进现代康复医学以来 ,康复医疗事业发展迅速 ,新建的康复中心、康复医院以及综合医院的康复医学科如雨后春笋 ,纷纷涌现 ,同时也培养了一批康复治疗人员走上新的岗位 ,以应急需。但由于我国康复治疗专业教育滞后 ,难以持续向康复医疗市场提供数量足够训练有素的康复治疗师 ,以致在康复治疗师队伍里存在以下的问题 :人员新旧并存 :康复治疗人员有经国内或日本、加拿大、澳大利亚、香港等国家和地区的大学正规学历教育的新型康复治疗师 ,这类人为数不多 ,多数是原来从事物理因子治疗的人…     

我国康复治疗技术岗位需求预测研究

目的：进行我国康复治疗技术岗位需求的预测，为制定康复治疗技术人才的培养规划提供依据。方法：①采用文献检索法了解我们与国外康复治疗人员配置的差距。②用动态数列法和趋势分析法计算我国2005年和2010年的床位数，采用床位数／康复治疗师比值法，预测2005年和2010年所需的康复治疗师人数。③专家咨询法：选取全国康复医学专家52名，收集各医院康复医学科康复治疗师目前的人数和2005年、2010年治疗师配置情况的预测。据此计算2005年和2010年所需的康复治疗师人数；另参考广东省康复医学专家对未来10年我国各级医院康复治疗师配置和需求总量提出的预测意见。结果：①我国康复治疗师总数现在约为0.4/10万人口，北京市二级医院康复医学科康复治疗师存在较大人员缺口，社区康复治疗师配置尤为薄弱。②2005年需要康复治疗师43700-47000名，2010年需要康复治疗师68910-74000名；③广东部分专家的预测：2005年和2010年全国需要的康复治疗师人数为约1．5万人和3．5万人。结论：2005年我国需要康复治疗师的保守估计是1．5万人，乐观估计是4．5万人。2010年我国需要康复治疗师的人数保守估计是3.5万人，乐观估计是6．9万人。2005年PT：OT=2．51：1,2010年PT：OT=2．48：1。     

我国康复治疗师队伍目前存在的问题及其对策

康复治疗是康复医学的基本内容之一，治疗师是医疗康复专业人员的重要组成部分．是康复治疗计划和训练措施的直接操作。一个治疗师的职业道德和技术水平的高低直接关系到患的康复治疗效果，对患的预后起着至关重要的作用。目前在康复医学发达的国家．其治疗师分工较细，如有物理治疗师、作业治疗师、言语治疗师、心理治疗师、音乐治疗师、舞蹈治疗师等，他们利用不同的手段为患服务．有很强的目的性，从而有着较好的治疗效果。与国外相比，我国在绝大多数综台医院的康复医学科．仅有专门的物理治疗师(包括体疗师和理疗师)，部分有作业治疗师，少数才有言语治疗师、音乐治疗师、心理治疗师．且大多水平不高。     

世界物理治疗联盟国际课程认证对我国物理治疗专业教育的启示

正康复治疗师可细分为物理治疗师(Physical Therapist,PT)、作业治疗师(Occupational Therapist,OT)、假肢矫形师(Prosthetist and Orthotist,PO)等。在世界康复专业发展较好的美国、日本等发达国家和我国香港地区,康复治疗专业人才培养模式已很成熟,并有独立的PT学院和OT学院[1]。而国内因     

《心肺系统疾病物理治疗》课程教学模式探析

正临床医学水平的提高使许多疾病的生存期延长,各种疾病的恢复期需进一步康复治疗,以恢复功能和提高生活质量。目前社会对康复治疗专业人才的需求缺口大,尤其是不同专科人才,如物理治疗师、作业治疗师等[1—3]。由于我国康复教育起步晚,缺乏办学经验,在培养计划、课程设置等方面没有成型的标准,其中心肺系统疾病物理治疗课程尤为如此,无法达到世界物理治疗联盟的最低教育标准[4—5]。笔者曾在香港理工大学康复科学系进修学习,本文就香港理工大     

上海市康复人力资源发展现状

目的 调研上海市康复人力资源现状。方法 基于世界卫生组织《健康服务体系中的康复：行动指南》“康复现状系统评估配套工具 康复信息收集模板”,按照上海市康复治疗质量控制中心要求,上海市康复医学会实施上海市康复相关从业人员数量及其知识结构调查。结果 调研医疗机构311家,开设康复医学科254家(82.47%);康复从业医师1414名,注册康复医师528名(37.34%),其中高级、中级、初级职称分别为142名(26.89%)、262名(49.62%)、124名(23.48%);具有康复资质治疗师共2668名,其中高级、中级、初级职称分别为11名(0.41%)、461名(17.28%)、2196名(82.31%);康复护师共1614名,其中高级、中级、初级职称分别为13名(0.81%)、476名(29.49%)、1125名(69.70%)。每10万人口中康复医师、康复治疗师、康复护师分别为2.17人、11.11人、6.65人,仅为国际平均水平的1/5;无康复执业医师机构121家,多点康复执业机构40家。结论上海市的康复医师、治疗师和护师存在较大缺口。基于当前物理治疗师、作业治疗师、言语治疗师等专业的职业系列和资质认证尚未完善的现状,建议多渠道、多形式进行针对性岗位培训,尤其须加强康复从业人员规范化岗位培训和康复转型培训;推进康复住院医师和专科医师规范化培养,快出人才,出好人才,以满足临床康复工作需求。     

广西康复医学科现状调查

目的调查广西壮族自治区康复医学发展现况。方法 2015年3~7月,采用广西康复医学科人力资源统计表和广西康复医学科专科情况调查表,以电子邮件方式,通过各地市卫计委,调查全区县、乡综合医院,康复专科医院,中医医院287家。结果全区共有康复医学医疗机构125家,医护治人员2146人;平均每床配备0.20名治疗师;康复医师与治疗师人数比为1∶0.725;医师职称高、中、初级比为1∶1.92∶3.14,治疗师职称高、中、初级比为1∶8∶63,护士职称高、中、初级比为1∶5.6∶18.9;91.3%康复医学科集中在三级医院;能开展物理治疗、作业治疗、言语治疗、吞咽康复、认知康复、心理治疗和康复工程等工作。结论全区康复医学科机构、人力、服务能力比2009年有所提高,但存在康复医学科医疗机构分布不合理、人力资源分布不均衡的情况。     

Critical Care Functional Rehabilitation Outcome Measure: developing a validated measure

Abstract

Introduction: In 2009, the National Institute for Health and Clinical Excellence (NICE) developed guidelines, which recognized that rehabilitation plays a vital role in recovery from illness and in returning patients to their previous activity levels. NICE recommended the use of valid and reliable “outcome measures” as an evaluation tool. Aim: To develop and evaluate the validity and reliability of a new Critical Care Functional Rehabilitation Outcome Measure (CcFROM). Method: The CcFROM was developed by physiotherapists working within the authors' institution and was based on an evaluation of current measures. Face and content validity were investigated using a questionnaire posted to 21 physiotherapists. Same-day and between-day intra-rater reliability and inter-rater reliability were investigated by three physiotherapists viewing 20 physiotherapy rehabilitation sessions and completing the CcFROM. Data were analysed for relative and absolute reliability. Results: The questionnaire demonstrated very high face validity and moderate content validity. 43% of the physiotherapists also suggested including an upper limb activity. Clinically acceptable same-day and between-day intra-rater reliability was demonstrated with ICCs of 0.985 (CI, 0.968–0.993) and 0.985 (CI, 0.871–0.972), respectively. Inter-rater reliability was recorded with an ICC of 0.906 (CI: 0.816–0.959). Conclusion: This study has shown that the CcFROM is a valid and reliable outcome measure for use in Critical Care.     

Teaching medical students rehabilitation medicine

Purpose.?The principles of rehabilitation medicine will become ever more important across many medical and surgical specialties in view of the rising prevalence of chronic and disabling conditions. Yet rehabilitation medicine has traditionally been unpopular with medical students. This article aims to review the existing evidence of problems in teaching medical undergraduates in rehabilitation medicine and provide published recommendations and practical approaches from our own experience.

Method.?A literature review was carried out to search for publications relating to teaching rehabilitation medicine to undergraduates in order to identify problems that potentially affect undergraduate education in rehabilitation medicine and its future as a medical speciality.

Conclusion.?The lack of consistent undergraduate curriculum, knowledge of rehabilitation medicine and academic opportunities contribute to the inadequate perception of the speciality to the undergraduates. The attitude of medical students towards rehabilitation medicine is important for its future development as a specialty. Further standardisation of teaching rehabilitation medicine at a national level, promoting research activity in this area and increasing the profile of rehabilitation medicine are warranted.     

Promoting physical activity for people with neurological disability: perspectives and experiences of physiotherapists

Both New Zealand and Sweden have health and disability policies that promote recreational exercise within society for people with disability. Despite these policies, levels of physical activity by people with disability in these countries are low. Physiotherapists are equipped to assist people with disabling conditions into physical activity. This qualitative study explored the perspectives and experiences of physiotherapists in New Zealand and Sweden toward promoting physically active recreation for adults with chronic neurological conditions. Nine physiotherapists who worked with adults with neurological disability in a range of long-term rehabilitation and community (home) health services were interviewed and the data analysed for themes. The physiotherapists described innovative and resourceful expertise to assist patients to be physically active. However, they perceived a lack of support for their work from within the health system and a lack of knowledge of disability issues within the recreational arena, both of which they perceived hindered their promotion of physical activity for people with neurological disability. Physiotherapists feel unable to fully support health and disability policies for the promotion of physically active recreation for people with neurological conditions, because of perceived constraints from within the recreational arena and their own health systems. If these constraints were addressed, then physiotherapists could be better agents to promote physical activity for people with neurological conditions.     

Expanding roles in orthopaedic care: a comparison of physiotherapist and orthopaedic surgeon recommendations for triage

Rationale, aims and objectives Innovative service delivery models are emerging using physiotherapists in the assessment and management of patients referred for orthopaedic consultation. The primary objective of this study was to compare the clinical recommendations of specially trained physiotherapists with those of an orthopaedic surgeon on: (1) appropriateness to be seen by an orthopaedic surgeon; and (2) candidacy and willingness to undergo total joint replacement (TJR) for patients with hip or knee problems. A secondary objective was to examine their recommendations for non‐surgical management and agreement on clinical diagnosis. Methods Physiotherapists and orthopaedic surgeons independently assessed patients with hip and knee problems referred for consideration for TJR and completed a standardized form on treatment recommendations. Agreement between providers was determined using the kappa coefficient and per cent agreement. Results Two physiotherapists and three orthopaedic surgeons participated in the study that included 45 and 17 patients with knee and hip problems respectively. In 91.8% (56/61) of cases, physiotherapists and orthopaedic surgeons agreed on the recommendation of appropriateness for the patient to see a surgeon (kappa 0.69). In discordant cases, the physiotherapists tended to refer for consultation. There was 85.5% (53/62) agreement on whether a patient was a candidate and willing to have TJR (kappa 0.70). The physiotherapists commonly recommended exercise and education for non‐surgical patients. Orthopaedic surgeons most commonly referred patients to rehabilitation services. Conclusions Patients with hip or knee pain referred to orthopaedic surgeons can be appropriately referred for orthopaedic consultation by physiotherapists working in extended roles. Further research is required to evaluate the value‐added and the most appropriate use of extended role physiotherapists.     

Rehabilitation research in China and Japan.

OBJECTIVE: Despite recent developments in global communication networks in medicine, researchers whose first language is not English are confronted by a dilemma; international demand to publish their works in English as the de facto common language and domestic needs to maintain a high level of research activity. To facilitate more contributions by non-English speaking researchers we reviewed rehabilitation research in China and Japan. DESIGN AND METHODS: The review was conducted by investigating 4 Chinese journals and the Japanese journal on rehabilitation medicine (1997/1999-2001), financial information from the proceedings of the Annual Congress of the Chinese Society (2000-02) and government grants given for research in Japan (1998-2000). RESULTS: In China, half of the articles focused on the effects of physical modality and therapeutic exercise on normal subjects. Most funds came from a Natural Science Foundation run by the central government. The Japanese journal contained a small number of clinical trials and many experimental studies. The number of applications for government grants increased. CONCLUSION: Though rehabilitation research is a relatively young branch of medical science, research in both China and Japan has been increasing. In the future we should organize clinical research to satisfy the needs of specific socioeconomic backgrounds and overcome the dilemma between global and domestic activities.     

Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists

Abstract

Purpose: To gain an understanding of physiotherapy practice in relation to executive dysfunction (ED) post-stroke. Method: Three focus groups were conducted using semi-structured interview schedules to highlight how ED post-stroke was understood by 12 physiotherapists with greater than 1 year of experience working in the area of stroke care. The focus group data were analysed using qualitative data analysis. Results: The themes extracted from the data on physiotherapists’ self-reported knowledge of ED post-stroke were: physiotherapists’ lack of knowledge of ED post-stroke; current physiotherapy practice regarding ED post-stroke; the negative impact of ED on physiotherapy rehabilitation post-stroke and the future learning needs of physiotherapists regarding ED post-stroke. Conclusions: Current results demonstrate that ED has negative implications for physiotherapy rehabilitation post-stroke. Although further interdisciplinary research is warranted, the present results suggest that physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.

• Implications for Rehabilitation

• Physiotherapists report a lack of knowledge of ED post-stroke and a requirement for future learning and training regarding the optimal management of people with ED undergoing physiotherapy rehabilitation post-stroke.

• ED has negative implications for physiotherapy rehabilitation post-stroke and physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.

     

A comparison of the predictions made by orthopaedic surgeons, nurses and physiotherapists about the rehabilitation problems of fracture patients

Health service staff sometimes are not aware of the psychological and social aspects of patients' rehabilitation problems. This paper compares the accuracy of predictions made by orthopaedic surgeons, nurses and physiotherapists about the rehabilitation problems of a series of fracture patients. Predictions were obtained in the acute orthopaedic trauma wards of one hospital, from members of all three professions, about 26 patients selected as likely to have rehabilitation problems. Follow-up data were obtained from interviews with the patients during the six months after their injury and from the orthopaedic case notes. The orthopaedic surgeons accurately predicted 48 per cent of the problems that occurred, the nurses 26 per cent and the physiotherapists 20 per cent. In their predictions the surgeons discriminated more accurately than the nurses or physiotherapists between the occasions on which problems did and did not occur in the follow-up period. The surgeons were better predictors than the other professions about medical and orthopaedic, work and personal and social problems. Fifty-five per cent of the problems that occurred were predicted by members of one or more professions. If it is desired to base early decisions about treatment or referral in rehabilitation on predictions about patients' likely problems, there is a need to increase the proportion of problems that are accurately predicted, and to increase the ability of predictors to discriminate between the occasions on which problems are and are not likely to occur.