Evaluation of the intervention of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Objective:Chronic obstructive pulmonary disease(COPD)can be prevented and treated,although presenting with persistent airflow restriction;the airflow restriction caused by COPD is mostly progressive.In recent years,more attention has been paid to the home-based pulmonary rehabilitation(PR)and its influence on COPD.Exercise training is the basic constituent of PR.However,it is not clear which exercise trainings are the ideal ways to deliver home-based PR.Methods:In this review,we focus on the effect of home-based exercise training on patients with COPD.We searched literature,which was necessarily required to be randomized controlled trails(RCTs)from the establishment of the four respective databases(Medline,PubMed,Web of Science,and China National Knowledge Infrastructure)from January 2008 to January 2018.We used the Cochrane collaborative“risk of bias”tool to assess the quality of evidence.A total of 21 trials(1694 participants)were included.Through the analysis of the literature,we find that a simple,low-cost,and low-intensity family-based lung-rehabilitation plan to adapt to the real life may lead to the improvement of the ability to exercise,the reduction of the difficulty in breathing,and the improvement of carrying out daily activities.Results:In the exercise training of home-based PR,lower limb exercise(LLE)training demonstrated a more perceptible effect in improving the quality of life of patients with COPD.At the same time,the combination of LLE training,breathing training,and upper limb exercise training is more obvious than the simple LLE training.In addition,home-based low-intensity aerobic training may sometimes be no less than the outpatient or center intervention to improve dyspnea,health status,and exercise tolerance.In conclusion,the simple and easy home-based PR exercise program is useful.Long-term home-based PR may require an enhanced need for maintenance.Conclusions:A simple,low-cost,and low-intensity high blood pressure response(HBPR)plan to adapt to the real life may lead to an augmentation in the ability to exercise,a reduction of the difficulty in breathing,and an improvement in carrying out day-to-day activities.HBPR strategies can benefit patients(elderly patients with COPD at home)in the long term.

The Need and Its Influence Factors for Community-based Rehabilitation Services for Disabled Persons in One District in Beijing

Purpose To explore the needs for basic community-based rehabilitation services for disabled persons in Xuanwu District, Beijing, China, and to identify factors which influence disabled persons to accept rehabilitation services. Method One hundred and eight disabled persons were selected by systematic sampling and simple random sampling to assess their needs for community-based rehabilitation services. Results Of the interviewees, 57A% needed the community-based rehabilitation services, but only 13.9% took advantage of it. The main factors influencing the interviewees to accept these services were cost （P〈0.05）, knowledge about rehabilitation medicine （P〈0.05）; and the belief in the therapeutic benefit of the community-based rehabilitation service （P〈0.05）. Conclusion A considerable gap exists between the supply of community-based rehabilitation services in Beijing and the needs for these services by disabled residents underscoring the need for improved availability, and for additional research.

Self-management A concept analysis of self-management for cancer patients’ home-based rehabilitation

Objective： To explore and clarify the concept of self-management in the context of cancer patients’ home-basedrehabilitation. This concept analysis will provide a theoretical lens for nurses to help cancer patients to developself-management strategies and enables them to improve their ability in symptom self-management of home-basedrehabilitation. Method： Walker and Avant’s framework （2011） was used to analyse the concept of self-management.Results： Self-management is defined as a dynamic process that involves perception of one’s needs, resource utilisation,problem solving and active participation. Antecedents of self-management include self-efficacy, disease knowledge andsocial support. Improving cancer patients’ ability in symptom self-management can improve their health outcomes andquality of life and reduce healthcare expenditures. Although Strategy and Effectiveness of Symptom Self-Managementscale is perceived as an ideal instrument to measure self-management and thus it is used worldwide, whether thisinstrument fits to measure this concept for cancer patients in Chinese context has still not yet been verified and thusfurther research is needed. Conclusion： According to the concept analysis, nurses should encourage cancer patients toinvolve actively in making a home-based rehabilitation plan and promote their ability in symptom self-management ofhome-based rehabilitation so as to improve their health outcomes and reduce healthcare expenditures.

Functional outcomes after home-based rehabilitation for heroin-induced spongiform leukoencephalopathy

A 22-year-old man with a 2-year history of heroin vapor inhalation developed spongiform leukoencephalopathy and underwent clinical and home-based rehabilitative treatments. Activities of daily living were measured using the Functional Independence Measure at discharge and at 6, 12, and 24 months after discharge. His neurological symptoms gradually disappeared with rehabilitative treatment, and the functional scale scores increased from 55 on admission to 105 at 24 months after discharge. These results suggest that home-based rehabilitation was effective in ameliorating the pathology and improving activities of daily living in this patient with heroin-induced spongiform leukoencephalopathy.

Experience of Drug Abusers Participating in Community-Based Drug Rehabilitation Services Provided by the Counselling Centres for Psychotropic Substance Abusers (CCPSAs) in Hong Kong

Despite the official statistics showing that the number of drug users has been declining, the problem of drug abuse remains serious in Hong Kong. This problem is evidenced by the trend of hidden and prolonged drug abuse. The recovery of drug abusers is an important process, because the misuse of drugs can cause many bio-psycho-social complications. Therefore, 11 Counselling Centres for Psychotropic Substance Abusers (CCPSAs) in different districts in Hong Kong play an important role on those drug abusers [1]. As a core community-based drug rehabilitation service in Hong Kong, studies about CCPSAs are limited. This study uses a descriptive qualitative approach to explore the experience of drug abusers participating in community-based drug rehabilitation services provided by CCPSAs. Five CCPSA users, who utilized the services for more than two months, participated in the semi-structured face-to-face interviews. Data collected were then analysed by thematic analysis, and five themes were generated: 1) receiving supportive counselling service in CCPSAs, 2) revealing variance towards nonmandatory services in CCPSAs, 3) encountering intrapersonal conflicts when participating in CCPSAs, 4) expanding social network through integration in group activities and 5) wishing to be a companion to other drug abusers. Findings of this study provide valuable insights towards services modification and the enhancement of drug rehabilitation and drug abusers’ wellbeing over the collaboration of healthcare workers, services providers and the media. However, this study has some limitations, and it presents suggestions for future research.

Assessing Basic Rehabilitation Services for Elders with Mobility Impairment

The current research seeks to examine the basic rehabilitation services for elders with mobility impairment. The research relied upon a quantitative approach and primary data which was gathered through the Drop-Off and Pick-Up (DOPU) method. The targeted respondents of this study were made up of healthcare workers, such as nurses and doctors from a group of hospitals in Zimbabwe. Therapy, assistive technologies, rehabilitation medicine, community-delivered rehabilitation were identified as the basic rehabilitation services for elders with mobility impairment. To assess the effectiveness of these services, the strength of these services had to be tested on the successful implementation of rehabilitation programs using a Structural Equation Model. In addition, these services were regarded as the independent variables of this study;while the successful implementation of the rehabilitation program was treated as a dependent variable. Based on the findings of this study, therapy, assistive technologies, rehabilitation medicine, community-delivered rehabilitation have a positive effect on the successful implementation of a rehabilitation program. The study recommends that to preserve the function and mobility among elderly and ageing individuals, the healthcare practitioners should promote strategies such as maximizing function by decreasing pain, improving the ability to self-propel and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise.

Effect of the pandemic on rehabilitation healthcare services in India:Breaking barriers

We would like to highlight the rehabilitation medicine perspective from India.Difficulties are impacted by the pandemic during this time,especially for people with disabilities.Awareness building among the public regarding the need for rehabilitation along with improvement in infrastructure is the key unmet need.

HOME-BASED MEDICAL SERVICES GET POPULAR IN LHASA

Whenever anybody feels uncomfortable,a doctor,once called,will immediately come to provide his or her services.As part of the new wave of doctors providing their services to smaller communities,"homebased doctors"are gradually being introduced to common civilian homes.At present,Lhasa City has been positively promoted the home-

Improvement in Patient Mobility Following Short-Term Rehabilitation in Skilled Nursing Facilities

Background: Mobility in older adults can be impaired after acute illness or hospitalization, and the level of severity can be used as a predictor of one’s ability to return to independent living. Patients are often referred to skilled nursing facilities in hopes of improving their mobility. We wanted to prove that rehabilitative services at Skilled Nursing Facilities improve overall outcomes. Methods: We conducted a retrospective analysis of data from 4612 patients admitted for short-term rehabilitation in a large nursing home chain in California. Our aim was to determine whether patients’ mobility scores, as measured by rehabilitative staff, significantly improved by time of discharge compared to their scores at admission. Mobility scores were rated from 1 to 6, with 1 being the most dependent on aid and 6 being the most independent, over a variety of tasks at admission and compared to scores at discharge. Pearson’s correlations were performed to determine if there were significant relationships in the data: the Pearson’s correlation coefficient was used to describe the relationships between patient admission to a skilled nursing facility and medical improvement upon discharge. Results: The study demonstrated a statistically significant improvement in patients’ mobility scores upon discharge, with Medicare insured patients showing on average 57% improvement and Managed Care insured patients showing on average 59% improvement. Additionally, admission scores appeared to be predictive of the patient’s outcome at discharge. Conclusions: The values and consistency of improvement support the use of acute rehabilitative services in skilled nursing facilities. An equation can be formulated that evaluates patients’ estimated mobility statuses upon discharge from facilities based on their conditions on their arrivals. With this, new interventions can be studied and compared to the current standard of care by using these measurements. They can determine if further improvements can be made to increase patient outcomes.

Analysis of the Effect of Extended Rehabilitation Care at Home on the Psychological Condition and Adherence to Medical Compliance Behavior of Patients with Coronary Heart Disease Combined with Heart Failure

Objective:To analyze the effects of providing extended rehabilitation nursing services at home to patients with coronary heart disease(CHD)combined with heart failure(CHF)on psychological improvement and adherence to medical compliance behavior.Methods:79 patients with CHD with CHF admitted to Sijia Town Central Health Hospital,Haimen District,Nantong City,Jiangsu Province,between June 2021 and June 2023 were selected and grouped according to the randomized numerical table method.The control group(39 cases)was provided with conventional nursing care and extended rehabilitation nursing care at home was provided to the observation group(40 cases).The psychological status,adherence to medical behaviors,cardiac function,and complications between both groups were compared.Results:The scores of anxieties and depression self-assessment scales(SAS,SDS)of patients in the observation group were lower than those of the control group(t=2.954,3.212;P<0.05);the compliance of patients in the observation group was higher than that of the control group(P<0.05).The levels of left ventricular ejection fraction,end-systolic and end-diastolic internal diameters(LVEF,LVESD,LVEDD)of patients in the observation group at 58.02±5.34%,44.49±5.16 mm,and 49.16±5.76 mm respectively were better than those of the control group after nursing care(t=3.205,3.288,2.633;P<0.05);the complication rate of the observation group was lower than that of the control group(P<0.05).Conclusion:Extended rehabilitation nursing at home exhibited a psychological regulation effect on CHD with CHF patients,improved their medical compliance,improved cardiac function,reduced the incidence of complications,and had significant application value.

Inter-organizational cooperation: A rehabilitation project based on cooperation between health care and three social service agencies

Purpose: Cooperation between organizations is an often-suggested remedy for handling unsolved borderland problems. However, actual projects aiming at cooperation are seldom very successful. The purpose here is to highlight obstacles related to cooperation between different organizations based on a case study of a rehabilitation project where health care and several social service organizations (social insurance, social welfare, and the local employment agency) were involved. Data were gathered through participation and interviews. Findings: It seems that efficient cooperation requires an understanding of the participating organizations’ differences in work logic as well as work practices. Furthermore, only certain fairly standardized “normal” problems may be handled through organized cooperation while non-routine exceptional problem requires a more fully integrated work organization. Implications: Obstacles to cooperation are highlighted and ways to improve the possibilities of cooperation between organizations are suggested although such possibilities are generally hampered by differences in work logic.

Quality-Oriented Climate and Service Quality Among Healthcare Providers： Evidence From a Rehabilitation Center in Italy

The importance of quality in service provision is widely recognized in health service research. However, a limited number of studies have investigated antecedents of quality in healthcare service provision. This article tries to shed further light on this under-researched field. Specifically, the aim of this study is to verify the relationship between the quality-oriented climate and service quality as perceived by employees. The study was conducted in a private non-profit Rehabilitation Centre in Italy using a questionnaire administered to all healthcare workers. The questions focused on perceptions of quality-oriented climate （priorization of quality care, social cooperation, and exchange）, four different connotations of the quality in healthcare provision （provision of high quality service, adequacy of time spent with patients, freedom in clinical decisions, and continuing relationships with patients）, as well as on respondents＇ background. Of the 248 healthcare workers, 183 completed the questionnaire. Hierarchical regression analysis was used to study the relationship between quality-oriented climate and outcome variables （quality in healthcare provision）. The results suggest that a quality-oriented climate does explain service quality in Healthcare settings： When an organization has implemented a quality-oriented climate, the service care provided by healtheare workers can determine an increase for three of the four investigated aspects of quality service provision （quality of care, freedom to make clinical decisions to meet patients＇ needs, and continuing relationships with patients）. The paper demonstrates that the offer of quality services involves in a different way the various healthcare professionals and/or management staff. This research provides interesting findings for healthcare manager in Health Service settings regarding the management of a quality-oriented process of service provision.

Home versus centre-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background: To evaluate the effects of home versus centre-based pulmonary rehabilitation on exercise capacity, quality of life, and dyspnoea scores in patients with chronic obstructive pulmonary disease by meta-analysis. Methods: We searched the Cochrane library, Embase, PubMed and CINAHL (EBSCO) up to April 2020 without language restriction to collect randomized controlled trials of home versus centre-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease. Literatures screening, risk of bias assessment and data extraction for the included studies were conducted by two reviewers independently. The data analysis was carried out by RevMan 5.3 software. Results: A total of 9 studies, which comprised a total of 859 participants were included in the meta-analysis. Centre and home-based pulmonary rehabilitation were equally effective at improving exercise capacity (MD = 2.30, 95% CI: 12.02 to 7.42, P > 0.05) and dyspnoea scores (MD = 0.15, 95% CI: 0.46 to 0.17, P > 0.05). They were also equally effective at improving health-related quality of life on the chronic respiratory questionnaire (dyspnea: MD = 0.08, 95% CI: 0.30 to 0.13, P > 0.05;fatigue: MD = 0.19, 95% CI: 0.45 to 0.07, P > 0.05;emotional function: MD = 0.18, 95% CI, 0.40 to 0.40, P > 0.05 and mastery: MD = 0.13, 95% CI: 0.38 to 0.11, P > 0.05), and on the St George's respiratory questionnaire (MD = 1.77, 95% CI: 4.54 to 0.99, P > 0.05). Conclusion: Home and centre-based pulmonary rehabilitation has similar effects on exercise capacity, quality of life, and dyspnoea scores in individuals with chronic obstructive pulmonary disease. Home-based pulmonary rehabilitation has the potential to be an alternative to centre-based pulmonary rehabilitation.

An Exploratory Study on the Meaning of Using Community Psychiatric Rehabilitation among Persons with Psychiatric Disabilities

This study explores the meaning of the use of community psychiatric rehabilitation(CPR)services to gain knowledge to improve services and shed more light on how to facilitate recovery.The topics explored included:the motivation for participation,perception and expectation towards CPR,the interactions with professionals in the CPR Center,and the feelings towards activities.A qualitative approach was adopted,and 30 consumers were interviewed face-to-face by using semi-structured interview guide.Data were analyzed using the open coding method of grounded theory.The consumer accounts provided information on the eight aspects of CPR services.The findings revealed that the CPR Center created a lifeworld,a friendly place similar to home with structure and activities.Professional relationship was the key change agent for rehabilitation.Most professionals adopted recovery-oriented approach to empower participants by giving opportunities and choices.The essential ingredients of this lifeworld covered rehabilitation goals,physical exercises,psychological impact,social interactions,learning,and economic gains.The services were venues for interpersonal interactions and provided structure for daily life,which helped consumers reach their rehabilitation goals and brought existential meaning to their lives.Yet,the accounts also revealed negative phenomena in the CPR center.Suggestions were made to improve services.

Motion-Sensing Based Management System for Smart Context-Awareness Rehabilitation Healthcare

In this paper, a motion-sensing based management system for smart context-awareness rehabilitation healthcare including various balance exercise is built by the integration of the physiological sensing and feedback coaching. The home-end system can not only provide the exercise coaching instruction, the balance stability analysis, and the motion similarity analysis in real-time, but also simultaneously transmit the user image, exercise skeleton streaming, center of pressure (COP), center of gravity (COG) and physiological information to the telecare-end center. According to the combination of the home-end and the telecare-end as well as the real-time care management of one-to-multiple personal balance exercise monitor, this system can provide user various personalized balance exercise prescription and cardiac rehabilitation coaching in an effectiveness rehabilitation exercise environment. Therefore, via this tele-system, the spinocerebellar ataxia (SCA) patients in balance rehabilitation stage not only can be monitored execution status of the rehabilitation exercise prescription, but also can be long-term monitored and evaluated the predicted goal of the rehabilitation exercise balance stability in order to improve patient’s compliance.

2022年度国家康复医疗服务与质量安全报告

目的 从医疗机构康复医疗服务结构、环节和结局质量等方面,分析2021年全国综合医院康复医学科和康复医院的医疗服务和质量安全情况。方法 本报告数据来源于国家医疗质量管理与控制信息系统。2022年度调查共纳入全国9 328家医疗机构的康复医疗质量相关数据,涵盖全部二级以上综合医院、康复医院,也包含中医和中西医结合综合医院。数据清洗后实际纳入2 513家配置康复医学科病房的医院数据,对其进行康复医疗服务质量分析。结果 在2022年度纳入调查的9 328家综合医院中,仅2 713家设置有康复医学科病房。综合医院中,56.77%医院的平均每床配置医师数、80.36%医院的平均每床配置康复治疗师数、53.53%医院的平均每床配置护士数未达到国家要求,且各地区康复医学科每床平均配置康复医务人员数差距较大。综合医院骨科、神经内科和重症医学科病房早期康复介入率分别为13.45%、20.67%和29.74%。综合医院康复医学科出院患者平均日常生活活动能力改善率为77.87%,康复医院为69.01%。结论 2021年我国康复医疗服务和质量安全整体稳中有升,但全国多数综合医院仍未配置康复医学科病房,且康复医务人员总量未满足要求,康复早期介入仍有较大提升空间,重点评定和治疗项目开展存在欠缺,康复治疗效果尚有提升空间。需持续推动康复医疗服务能力建设,进一步提升康复医疗质量。

基于ICF的听力障碍儿童言语与语言康复服务:理论架构与服务体系

目的 基于《国际功能、残疾和健康分类》(ICF)的生物-心理-社会功能和健康模式,系统分析世界卫生组织(WHO)康复相关的政策文件,探讨听力障碍儿童言语与语言康复的理论与政策原则、服务体系以及优先发展领域、主要政策和技术措施。方法 采用文献研究和政策研究法,系统梳理ICF的功能和健康架构、WHO康复相关政策报告和美国语言听力协会技术文件,结合我国听障儿童康复服务的现状和需求,提出构建基于ICF的听障儿童言语与语言康复服务体系的理论框架、优先领域和主要政策与技术措施。结果 发展听障儿童言语与语言康复需要遵循八大原则:以儿童为中心、尊重个体差异;全生命周期支持和促进持续发展;开展循证实践,确保干预的科学性和有效性;多学科团队合作并提供全面支持;构建家庭参与的支持网络;促进儿童的融合教育与社会参与;关注文化敏感性;技术赋能康复创新。听障儿童言语与语言康复要构建五大服务体系:早期筛查、诊断与干预综合体系;家庭和社会支持体系;多学科团队服务体系;全方位、多层次的听障儿童言语与语言康复服务体系;数字赋能服务构建新的康复服务模式。并讨论了优先发展领域以及主要政策和技术措施。结论 基于ICF的生物-心理-社会的功能和健康架构,通过加强政策支持、完善服务体系、构建多学科团队服务、推广数字赋能技术、加强社会支持等措施,可以为听障儿童提供全方位、个性化、持续性的高质量、全覆盖康复服务,促进儿童的全面发展和社会参与,提高儿童的生活质量。

以价值为导向的住院康复服务价值调节因子构建研究

目的:本研究旨在建立实现康复治疗效果可比的价值调节因子,为将康复服务价值作为医保支付依据、基于现行医保制度建立按价值付费机制提供可行思路。方法:课题组于2022年1月1日—2023年3月31日收集样本医院脑损伤住院患者功能相关信息,并与样本地区医保结算清单数据库关联。采用神经网络模型拟合康复结果与康复效果影响因素之间的函数关系,根据康复结果实际值与预测值差值的分布区间判断康复服务价值。结果:共计878例脑损伤患者的住院康复病案与医保结算清单资料纳入分析;根据预测精度评价指标及其标准,选取了最优模型,并根据其预测结果对康复治疗效果进行了评价,确定了包含四个档次的价值调节因子。结论:本研究构建的价值调节因子,不仅为评价住院康复服务治疗效果、实现康复效果可比提供了重要工具,也为进一步推动医保对住院康复服务实施按价值付费提供了可行方向。

重庆市北碚区康复医学人才队伍建设现状及对策研究

目的调查了解重庆市北碚区康复医学人才队伍建设现状及存在的问题,并分析其原因,从而为重庆市北碚区康复医学人才队伍建设提供参考依据。方法从2023年12月—2024年1月开展调研,共调研了24家开展了康复医学工作的机构,其中访谈了20家。收回有效问卷143份,应用SPSS 23.0进行数据处理与分析。结果143位调查对象中康复科医师67人、康复治疗师37人、康复科护士39人。年龄段以31~44岁为主,占50.3%。文化程度以本科为主,占60.8%,研究生及以上占13.3%。月收入5000元以下占51.7%,10000元以上仅占4.9%。正高级职称占2.1%,副高级职称占7.7%。从事康复医学工作的年限以1~5年为主,占36.4%,而工作年限为21年及以上的仅占6.3%。康复科医师第一专业名称中占比较多的2个专业是针灸推拿学和中医学,分别占41.8%(28/67)和37.3%(25/67),而康复医学仅占4.5%(3/67);执业方向中有康复医学的占41.8%(28/67),执业方向中有中医学的占70.1%(47/67)。康复治疗师第一专业以康复治疗类为主,占91.9%(34/37)。所有康复科护士第一专业都是护理学,从事的康复护理方向大多数是现代康复和中国传统康复护理,占66.7%。调查对象所在机构基本上是公立医疗机构,占95.1%(136/143)。康复治疗师主要在公立医疗机构,所在机构为三级医院的占40.6%(15/37)。康复科护士所在单位全部为公立医疗机构。结论目前重庆市北碚区康复医学人才队伍建设尚存在一定问题。建议培养或引进具有高技术水平、高管理能力的康复医学学科带头人;适时安排专人进修学习,提高其现代康复医学服务能力;打造人才队伍,激发人才积极性;完善康复医疗服务网络,提高康复医学人才数字化素养。