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

Unmet Needs and Services Development of Rehabilitation for People with Extremely Severe Hearing Disability Using Structural Equation Analysis

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。

Objective To explore the characteristics and the influential factors of unmet needs and services development of rehabilitation for people with extremely severe hearing disability(PSHDs).Methods A total of 90052 PSHDs were included.Multiple response was used to analyze the characteristics of unmet needs and services of rehabilitation.The structural equation model of the received service and unmet needs of PSHDs was developed.Results The reporting rate of unmet needs of rehabilitation for PSHDs,from high to low,were assistive devices(61.5%),nursing care(24.1%),medicine(23.4%),functional training(17.6%)and surgery(2.5%).The reporting rate of received service for PSHDs,from high to low,were assistive devices(58.3%),nursing care(24.4%),medicine(22.4%),functional training(22.0%)and surgery(2.2%).Structural Equation Model showed that the more services received,the more needs for cochlear implantation surgery and speech therapy(P<0.001);the better family income situation,the more needs for cochlear implantation surgery(P<0.001);and age factor had significant effects on the unmet needs of cochlear implantation surgery and speech therapy(P<0.001).Conclusion PSHDs reported unmet needs and received services mainly included assistive devices,nursing care,medicine and functional rehabilitation training.Those PSHDs who had received services would report more demand of unmet needs,supposed that improving the accessibility and coverage of services should be emphasized in the development of rehabilitation services.According to ICF model,on the basis of the characteristics of the unmet needs of PSHDs,it proposed to take measures to implement precise rehabilitation services to improve the quality of services.