功能独立性评定和生活质量评定在康复临床中的结合应用(英文)

Combinative application of functional independence measure and quality of life assessment in clinical rehabilitation

背景:随着社会的发展和进步,生活质量越来越得到重视,在功能独立性评定的基础上,增加对生活质量的评定是必然的趋势。目的:探讨功能独立性评定和生活质量评定在康复临床中的结合应用。设计:病例分析。单位:复旦大学中山医院。对象:选择2003-01/12中山医院康复科病房住院患者83例,其中男45例,女38例。根据疾病分为以下4组:①骨关节康复组42例。②脑卒中康复组17例。③内科康复组15例。④肿瘤康复组9例。患者均自愿参加本实验。方法:每例患者在出入院24h内进行功能独立性和生活质量的评定,功能独立性量表采用功能独立性问卷评定(包括13项运动方面内容,5项认知方面内容。运动类活动总分最低为13分,最高为91分;认识类活动总分最低为5分,最高为35分;功能独立性问卷总分最低为18分,最高为126分),生活质量采用功能活动问卷进行评定(包括打电话、自理经济、购物、使用交通工具、做家务、工作、参加娱乐性活动等,总分100分),每份问卷均由作者亲自填写。主要观察指标:各组患者在出入院时功能独立性评分和功能活动问卷评分。结果:83例患者均进入结果分析。①脑卒中组的平均年龄和住院时间明显高于其他组(P<0.01)。②脑卒中组出院时功能独立性运动分、认知分明显高于入院时(5.276,3.624分;6.200,5.941分,P<0.01)。功能活动问卷评分明显低于入院时(1.253,1.547分,P<0.01)。③骨关节组出入院功能独立性认知分基本一致,出院时运动分明显高于入院时(6.220,5.388分,P<0.01)。功能活动问卷评分明显低于入院时(0.610,0.912分,P<0.01)。④肿瘤组只有能活动问卷评分明显低于入院时(0.722,0.989分,P<0.05)。⑤内科组的所有项目出入院评分基本一致(P>0.05)。结论:在康复临床中功能活动问卷评分比功能独立性评分更敏感,但并不能取代功能独立性评分,应该结合使用。

BACKGROUND： With the development of China, quality of life （QOL） is getting more and more attention, however, there are few studies on QOL, especially in China's Mainland. OBJECTIVE： To observe the situation of combinative application of Functional Independence Measure （FIM） and QOL assessment in rehabilitation clinical practice. DESIGN： Case analysis. SETTING： Zhongshan Hospital of Fudan University. PARTICIPANTS： Totally 83 rehabilitation patients selected from Shanghai Zhongshan Hospital from January to December 2003,consenting to take part in the study, were divided into 4 groups： bone ＆ joint rehabilitation （n=42）, stroke rehabilitation （n=17）, internal medicine （n=15）, and cancer rehabilitation （n=9）. METHODS： Every patient carried out functional independence assessment and quality of life measurement within 24 hour~ of admission. FIM was adopted for functional independence assessment which included 13 items of motor （ranged from 13 to 91 points） and 5 items of cognition （ranged from 5 to 35 points）, and FAQ for quality of life included making telephone call, self-care economy, shopping, using vehicle, housework, jobs, entertainment, etc. with 100 in total. The author performed all the assessment. MAIN OUTCOME MEASURES： Every patient carried out FIM and FAQ assessment after admission and discharge. RESULTS： All data of totally 83 patients entered the final analysis. ① The average age and length of hospital stay in stroke group were higher than those in other groups （P 〈 0.01）. ② FIM motor and cognitive scores in stroke group were higher at discharge than those at admission （5.276, 3.624;6.200,5.941,P 〈 0.01）, but scores of functional activity were lower at discharge than those at admission （1.253, 1.547, P 〈 0.01）. ③ In bone joint group, the FIM cognitive scores were coincidence in general, while motor scores were higher at discharge than those at admission （6.220, 5.388, P 〈 0.01）, but scores of functional activity were lower at discharge than those at admission （0.610, 0.912, P 〈 0.01）. ④ Only scores of functional activity in tumor group were lower at discharge than those at admission （0.722, 0.989, P 〈 0.05）. ⑤ All items in internal medicine group were coincidence in general （P 〉 0.05）. CONCLUSION： FAQ is more sensitive than FIM in rehabilitation practice, but cannot replace FIM, and should be used with FIM.