视力残疾人康复需求和康复服务发展状况Logistic回归分析研究

目的研究视力残疾人的康复需求特点和康复服务发展状况。方法研究样本为2018年度241865名视力残疾人省级康复需求与康复服务实名制数据,统计分析视力残疾人康复需求特征和康复服务发展状况及其相关因素。结果共有50882人报告康复需求(21.0%),从高至低依次为辅助器具56.5%、药物29.0%、护理24.6%、功能训练15.5%和手术4.2%。共有43492人报告获得康复服务(18.0%),从高至低依次为辅助器具55.0%、药物21.6%、护理20.8%、功能训练20.7%和手术2.3%。Logistic回归模型显示,残疾等级对视力残疾人报告康复需求和接受康复服务均有显著影响(P<0.001)。结论视力残疾人报告康复需求主要集中于视力辅助器具、药物和护理三个方面。获得的康复服务与其报告的康复需求结构一致。为视力残疾人提供信息无障碍环境支持是非常重要的康复服务,需要采用现代信息和通讯技术,提升视力残疾人获取信息的能力,以提升其社会参与水平。     

肢体残疾人康复需求与康复服务发展状况Logistic回归分析研究

目的研究肢体残疾人的康复需求特点和康复服务发展状况。方法以1512438名肢体残疾人康复需求和康复服务实名制数据为样本,对肢体残疾人康复需求特点、康复服务发展及其影响因素进行分析。结果在肢体残疾人报告的康复需求中,从高至低依次为辅助器具55.9%、护理27.0%、药物26.3%、功能训练23.9%和手术2.3%。在肢体残疾人报告获得的康复服务中,从高至低依次为辅助器具48.2%、护理26.4%、功能训练24.3%、药物19.5%和手术1.4%。Logistic回归结果发现年龄和残疾等级对肢体残疾人的康复需求与康复服务报告率有显著影响(P<0.001)。结论肢体残疾人的康复需求主要集中于辅助器具、护理、药物和康复训练领域。所获得的康复服务主要在辅助器具、护理和功能训练领域。提高肢体残疾的康复服务的可及性仍是未来发展的重点。根据ICF功能理论,推广个别化的精准康复服务是提升康复服务质量的重要措施。     

智力残疾人康复需求与康复服务发展状况Logistic回归分析研究

目的探讨智力残疾人的康复需求特点与康复服务发展状况及其影响因素。方法以250654名智力残疾人省级康复需求与康复服务实名制数据为样本数据,统计分析智力残疾人的康复需求特点和康复服务发展状况,Logistic回归分析其相关因素。结果在智力残疾人的康复需求报告中,报告率从高到低依次为护理47.8%、药物37.2%、功能训练26.1%、辅助器具19.8%和手术1.3%。智力残疾人报告获得的康复服务从高到低依次为护理43.5%、药物29.3%、功能训练27.2%、辅助器具19.6%和手术0.8%。根据Logistic回归模型发现,年龄和残疾等级对智力残疾人康复需求的报告与获得康复服务的概率存在显著影响(P<0.001)。结论智力残疾人康复需求主要表现为护理、药物和康复训练。接受的康复服务与康复需求具有相同的结构。由于智力残疾人功能的复杂性,重度或极重度残疾人更强调护理照料服务,轻度残疾人则需要功能训练。发展针对智力残疾人的康复服务,应该根据其智力功能和社会适应行为特点,开发康复服务项目,提供个别化的精准康复服务。     

成年残疾人康复需求与康复服务发展研究

目的研究成年残疾人的残疾状况、主要康复需求特征、康复服务发展状况及其影响因素。方法以2019年度省级2315498名成年残疾人实名制数据为样本,运用多重响应分析统计成年残疾人的残疾状况,分析其康复需求特征和康复服务发展状况;Logistic回归分析影响康复需求与康复服务的相关因素。结果省级成年残疾人的残疾分布从高到低分别为肢体残疾(62.2%)、视力残疾(9.9%)、智力残疾(8.4%)、精神残疾(7.3%)、听力残疾(6.9%)、多重残疾(2.8%)和言语残疾(2.5%)。成年残疾人报告康复需求从高到低分别为辅助器具需求(49.0%)、药物需求(33.3%)、护理需求(27.7%)、功能训练需求(20.2%)和手术需求(1.9%)。成年残疾人报告获得康复服务从高到低分别为辅助器具服务(44.1%)、护理服务(26.6%)、药物服务(25.9%)、功能训练服务(22.2%)和手术服务(1.3%)。Logistic回归显示残疾类别和残疾等级对成年残疾人报告康复需求和康复服务的概率有非常显著影响(P<0.001)。结论残疾人功能状态影响到其康复需求报告,康复需求与康复服务之间仍然存在结构性差异,为提升精准康复服水平,应根据ICF关于功能、残疾和健康分类的理论模式和方法,制定针对特定残疾类别的康复需求报告方法并开发精准的个别化的康复服务项目。     

极重度听力残疾人康复需求与康复服务发展状况结构方程模型

目的研究极重度听力残疾人的残疾状况、康复需求特点和康复服务发展状况及相关影响因素。方法选取90052名极重度听力残疾人数据为样本,采用多重响应交叉列联表分析康复需求特征和康复服务发展状况,构建康复需求与康复服务的结构方程模型,探讨他们之间的关系及影响因素。结果极重度听力残疾人报告的康复需求,按照需求程度从高到低在辅助器具需求(61.5%)、护理需求(24.1%)、药物需求(23.4%)、功能训练(17.6%)和手术需求(2.5%)。极重度听力残疾人接受过的康复服务主要集中在辅助器具服务(58.3%),其次是护理服务(24.4%)、药物服务(22.4%)、功能训练服务(22.0%)和手术服务(2.2%)。结构方程模型显示,接受康复服务程度越高,对人工耳蜗手术需求和言语治疗需求的程度越高(P<0.001);经济情况越好,人工耳蜗手术需求越高(P<0.001);年龄对人工耳蜗手术需求和言语治疗需求有显著影响(P<0.001)。结论极重度听力残疾人的康复需求与康复服务主要包括辅助器具、护理、药物和功能训练。接受过康复服务的极重度听力残疾人对康复的需求程度提高,说明提高极重度听力残疾人的康复服务的可及性仍是未来残疾服务发展的重点。根ICF功能理论,结合残疾人需求特征,推广精准康复服务是提升康复服务质量的重要措施。     

残疾儿童康复需求与康复服务发展研究

目的研究残疾儿童的残疾状况、康复需求特点和康复服务发展状况。方法以130290名残疾儿童康复需求与康复服务实名制数据为样本,对残疾儿童的残疾现状、康复需求特征和康复服务发展状况及其影响因素进行统计分析。结果残疾儿童占总残疾人口的5.33%。其中,男性60.4%,女性39.6%;0~6岁16.3%,7~18岁83.7%;农业户口88.4%,非农业户口11.6%。残疾程度由重度到轻度占比依次为28.3%、39.5%、17.7%、14.6%。在报告的康复需求中,从高至低依次为辅助器具40.3%、功能训练37.4%、护理32.2%、药物24.9%、手术5.7%。在报告获得的康复服务中,从高至低分别为辅助器具37.9%、功能训练33.7%、护理服务31.0%、药物19.7%、手术2.9%。根据Logistic回归结果显示,残疾等级对于报告康复需求和获得康复服务均存在非常显著的影响(P<0.001)。结论残疾儿童的功能特点直接影响到其服务需求,应该根据残疾儿童的康复需求特点布局康复服务发展规划,要根据不同类型残疾儿童的功能特点,开发个别化和结构化的康复服务项目,提升残疾儿童康复服务的可及性和质量。     

极重度和重度成年智力残疾人护理需求与护理服务结构方程模型

目的研究极重度和重度成年智力残疾人的残疾现状及护理需求和护理服务的特点及其相关影响因素。方法选取127547名极重度和重度成年智力残疾人为研究对象,采用描述性统计和多重响应分析对残疾状况、护理需求与护理服务特点进行分析,构建护理需求与护理服务的结构方程模型,探讨他们之间的关系及其影响因素。结果共26038名极重度和重度成年智力残疾人报告康复需求,从高到低分别为护理(52.5%)、药物(36.9%)、辅助器具(20.9%)、功能训练(19.7%)和手术(0.8%);共11640名极重度和重度成年智力残疾人报告接受康复服务,从高到低分别为护理(49.9%)、药物(36.8%)、功能训练(19.1%)、辅助器具(14.1%)和手术(1.0%)。结构方程模型显示,有无接受护理服务(总效应=0.646)、有无接受康复服务(总效应=0.014)、年龄(总效应=0.031)、户口性质(总效应=0.015)和受教育情况(总效应=-0.158)均对护理需求存在影响(P<0.001)。结论极重度和重度成年智力残疾人接受到的护理服务为其主要需求。应根据残疾人康复经历、年龄、家庭社会经济情况、功能状态和需求特点等,开发个性化护理服务项目,提供个别化精准康复。     

上海城区残疾人康复需求与服务现状分析

目的了解上海城区残疾人康复服务需求与服务现状。方法采用分层整群随机抽样法随机抽取上海市闸北区芷江街道,用问卷调查方式对该街道1074名持证残疾人的康复服务需求与服务利用现状进行调查。结果城区残疾人康复服务需求实现率为87.8%,90%的残疾人满意所获得的康复服务;33.3%-44.0%的残疾人其“辅助器具”服务需求得到实现;手术治疗、听力语言训练和视功能训练需求实现率分别为63.8%、82.2%和78.7%。结论应构建残疾人康复救助政策体系,加大辅助器具服务工作力度,加大对手术治疗、听力语言训练和视功能训练等服务的专业技术支撑。     

肢体残疾人康复需求调查

目的:了解成年肢体残疾人的康复需求状况,为制定相关政策提供依据。方法:67例残疾人采用结构式问卷调查表调查,主要内容包括残疾类别、致残时间、生活自理程度及对医疗康复、功能训练、辅助器具、教育培训、社会生活信息资讯等的需求。结果:67例残疾人中,截瘫偏瘫占调查类型的首位,致残时间1～3年及生活可部分自理的患者占大多数;67例患者以手术、药物治疗、运动功能训练、行动辅助器具、职业培训、家庭成员支持及残疾人相关优惠政策等的需求为主。结论:重视肢体残疾人的康复需求,针对康复需求的多样性,提供有针对性康复服务,是提高残疾人生活水平的重要措施之一。     

广东省残疾人社会参与状况与康复需求的关系

目的对广东省各类残疾人的社会参与状况与康复需求的调查数据进行分析,探讨各类残疾人不同程度社会参与状况与康复需求的关系,并提出相应的康复对策。 方法采用广东省第2次全国残疾人抽样调查中残疾人社会参与评定的分项目,以及个人主要需求的调查数据进行等级资料比较的统计处理。 结果听力、视力、肢体、智力残疾人不同社会参与状况在本人主要需求上的构成比差异有统计学意义,而言语、精神残疾人不同社会参与状况在本人主要需求的构成比差异无统计学意义。各类残疾人不同社会参与状况相对应的康复需求以医疗服务及救助、辅助器具配送和康复功能训练及服务为主。 结论各类残疾人不同社会参与状况与康复需求的差异不尽相同,主要集中在医疗服务及救助、辅助器具配送和康复功能训练及服务等基本医疗和社会的需求方面,可为采取相应的康复对策提供依据。     

A population approach to understanding children's access to assistive technology

Purpose.?To determine whether service delivery system factors, including having a quality medical home, access to therapeutic services, or enrolment in early intervention/special education services, are associated with meeting children's needs for assistive technology (AT).

Method.?Data were analysed for children 0–17 years of age participating in the 2001 US National Survey of Children with Special Health Care Needs who required AT services (N = 18,372) and a subgroup of children needing assistive devices typically provided by rehabilitation professionals (N = 4429). AT needs included vision or hearing aids or care, communication or mobility devices, or other medical equipment. Unmet need was defined as not receiving all needed services. Estimates were generated of the per cent of children needing and having unmet needs for services. Associations between the medical home, therapy and education variables and having an unmet need for AT were assessed using logistic regression.

Results.?An estimated 49% of children with special health care needs require AT services. Twelve per cent require AT services typically provided by rehabilitation professionals. Of the latter group, 14% had unmet needs. The likelihood of having unmet AT needs was greater for children lacking a quality medical home (a.O.R. = 3.27 [95% C.I. = 2.29–4.66]) and/or those not receiving needed therapy services (a.O.R. = 3.52 [95% C.I. = 2.25–5.48]) than for children whose medical home and therapy service expectations were met. Enrolment in early intervention/special education was not associated with having unmet needs for AT.

Conclusions.?Promoting quality care within a complex service delivery system is critical to meeting the AT needs of children and their families. Changes in the structure and processes of care, including facilitating access to a quality medical home and needed therapy services would likely increase access to needed AT.     

Secondary Health Conditions Among Middle-Aged Individuals with Chronic Physical Disabilities: Implications for Unmet Needs for Services

Data from the Aging with Disability (AwD) Study are used to examine variations in the types and frequency of secondary conditions experienced by 301 middle-aged individuals living with the effects of three disabling conditions: polio (n = 124), rheumatoid arthritis (RA) (n = 103), and stroke (n = 75). All respondents were randomly selected from a county rehabilitation hospital or a community-based subject pool. Secondary conditions are operationalized as (1) the number of new health problems diagnosed or treated since the onset of the primary disability and (2) the amount of change/decline in basic and instrumental daily activities since a previous reference period in the disability trajectory. Also analyzed are changes in use of assistive devices and unmet needs for services. Differences in secondary conditions are examined within the AwD sample by impairment group and between samples by comparing AwD rates to national estimates for the same cohort. Results reveal significant differences in the types of new health problems reported by persons living with polio, RA, and stroke and document marked disparities, or accelerated aging, between disabled and nondisabled adults. Findings are discussed in terms of the changing health care needs of persons aging with disability and the importance of improving access to preventive services, ongoing rehabilitation, and assistive technology.     

Assistive technology devices for the elderly at home

Using assistive technology (AT) to help the elderly and disabled overcome disabilities and attain their rehabilitation, learning, working and living potentials represents the mainstream trend in well-developed countries. According to data from Taiwan's Ministry of the Interior, Taiwan's senior citizen population exceeds two million. Proper application of AT can help achieve in Taiwan the goal of aging in place. Assistive technology devices can be divided into five categories, including barrier free environment (home modification), daily living aids, mobility aids, seating and positioning devices, and sensory aids. As of 2005, there were 16 senior care centers in Taiwan funded and administered by the Department of Health, all of which maintain interdisciplinary teams--comprising specialists in rehabilitation medicine, occupational therapy, physical therapy, speech therapy, nursing, education, social work and engineering--that provide service directly to persons with special needs and cooperate with manufactures to develop new assistive devices. Services provided by these centers include evaluation, design, customization, adaptation, maintenance, repair, therapy, training and technical assistance related to AT devices. The government has a legal responsibility to provide senior citizens in need with appropriate AT services. Service users, their families and professionals may contact centers directly for consultation.