基于WHO-FICs的重症患者活动康复:Scoping综述

Rehabilitation of Mobility for Critically Ill Patients Based on World Health Organization Family International Classifications:A Scoping Review

目的基于世界卫生组织国际健康分类家族(WHO-FICs)架构,分析重症患者活动功能康复。方法采用Scoping综述方法对重症患者活动康复进行分析,检索建库至2021年2月28日Web of Science、PubMed、中国知网、万方数据库中重症领域中早期活动或康复的相关文献,对重症病区患者的疾病类型、活动功能障碍、康复干预、评价和环境等问题进行综述。结果基于WHO-FICs框架,本文从5个方面对纳入文献进行分析,涉及主要疾病包括呼吸系统疾病(MD10-MD6Y)、神经系统疾病(MB40-MB9Y)、心血管系统疾病(MC80-MC9Y)、外科术后(MD80-ME4Y、ME60-ME6Y、ME80-MF1Y)和其他(NA00-NF2Z、MA00-MA3Y、1G40-1G41);重症活动功能包含运动有关结构(s720-s760)、神经肌肉骨骼和运动有关功能(b710-b740)、活动(d4)、自理(d5)及就业(d850);康复干预方法则基于ICHIβ-3被分为治疗类、预防类和健康促进类三类;评价工具及指标涵盖关节活动度、肌力、肌张力、 de Morton活动指数(DEMMI)、重症监护(ICU)活动功能测试(FSS-ICU)、 6分钟步行试验(6MWT)、ICU住院时长等,运用ICF环境因素分类讨论了重症康复环境问题。结论本文基于WHO-FICs提出了重症患者活动功能康复的理论架构,重症患者的活动康复是针对呼吸系统、神经系统、心血管系统、外科术后等急重症疾病,以活动功能障碍为导向,应用治疗类、预防类和健康促进类的干预方法,使患者的活动功能最大化,预防并发症和继发性功能障碍发生,提高重症患者的整体健康水平。

Objective To analyze rehabilitation of functioning of mobility for critically ill patients based on the framework of the World Health Organization Family International Classifications(WHO-FICs).Methods A scoping review of rehabilitation of functioning of mobility for critically ill patients had been conducted.Literatures on early mobilization or rehabilitation in the field of critical illness from databases of Web of Science,PubMed,CNKI,and Wanfang up to February 28,2021 were retrieved.The diseases,functioning,rehabilitation intervention,functioning evaluation and environment of patients in critical ward had been reviewed.Results Based on WHO-FICs framework,this paper reviewed literatures in five dimensions:the type of diseases,functioning,rehabilitation intervention,functioning evaluation and environment factors.The diseases included respiratory system diseases(MD10-MD6Y),neurological system diseases(MB40-MB9Y),cardiovascular system diseases(MC80-MC9Y),post-surgical(MD80-ME4Y,ME60-ME6Y,ME80-MF1Y),and others(NA00-NF2Z,MA00-MA3Y,1G40-1G41).The functioning included movement-related structures(s720-s760),neuromusculo‐skeletal and movement-related functions(b710-b740),mobility(d4),self-care(d5),and remunerative employment(d850).The rehabilitation interventions were divided into three categories based on the International Classification of Health Interventions(ICHI)β-3:therapeutic,preventive,and health promotion interventions.The evaluation of functioning mainly involved joint mobility,muscle strength,muscle tone,de Morton Mobility Index,Functional Status Score for Intensive Care Unit(FSS-ICU),6-Minute Walking Test(6WMT),intensive care unit(ICU)length of stay and so on.The intensive care environment was also discussed using ICF environment factors.Conclusion This paper proposed a framework of rehabilitation of mobility for critically ill patients based on the WHOFICs.It focused on respiratory system disease,neurological system diseases,cardiovascular system diseases,post-surgical with mobility dysfunction.To implement interventions in therapeutic,preventive,and health promotion to optimize patients'function,and to prevent complications and secondary dysfunction,and improve their well-being.