Landscape Design Elements in Rehabilitation Environment Founded on Evidence-based Design

The concept and development history of rehabilitation environment were summarized in this study,principles and techniques of applying evidence-based design in the design of rehabilitation environment were analyzed,classification and functions of landscape elements in rehabilitation environment were particularly discussed.

Clinical Practice of Evidence-Based PDCA Cycle Management Model in Accelerated Recovery of Lung Cancer Patients

Objective: To explore the nursing effect of evidence-based PDCA cycle management mode in accelerated rehabilitation of patients undergoing thoracoscopic lung cancer radical surgery. Methods: 104 patients who underwent thoracoscopic lung cancer radical surgery in our hospital from June 2022 to February 2023 were randomly divided into control group and intervention group, with 52 cases in each group. The control group implemented evidence-based ERAS clinical pathway management, while the intervention group implemented evidence-based PDCA cycle quality management. The postoperative recovery of the two groups of patients was compared. Results: The postoperative recovery of the intervention group was significantly better than that of the control group. The first time to get out of bed, the first time to eat, the duration of chest drainage tube placement, and the length of hospital stay were significantly shorter than those of the control group. The incidence of postoperative chest complications and hospitalization costs were significantly lower than those of the control group, and patient satisfaction was significantly higher than that of the control group (P Conclusion: Evidence-based PDCA cycle quality management mode can effectively improve the implementation quality of accelerated rehabilitation nursing for patients undergoing thoracoscopic lung cancer radical surgery, and it is worthy of clinical promotion.

The Effect of Home-Based Cardiac Rehabilitation on Functional Capacity,Behavior,and Risk Factors in Patients with Acute Coronary Syndrome in China

Aim:To investigate the effect of home-based cardiac rehabilitation on functional capacity,health behavior,and risk factors in patients with acute coronary syndrome in China.Methods:Eighty patients with acute coronary syndrome were enrolled in this prospective randomized controlled study.Patients in the cardiac rehabilitation group(n=52)received home-based cardiac rehabilitation with a heart manual and a home exercise video for 3 months and patients in the control group(n=28)received only routine secondary prevention.The 6-min walk distance,laboratory test results,healthy behavior(questionnaire),quality of life(12-item Short Form Health Survey),anxiety(7-item Generalized Anxiety Disorder Questionnaire),and depression(9-item Patient Health Questionnaire)were evaluated at the beginning and after treatment for 3 months.Results:Compared with baseline data,52 patients who participated in cardiac rehabilitation had longer 6-min walk distance(515.26±113.74 m vs 0.445.30±97.92 m,P<0.0002),higher proportions of“always exercise”(78.26% vs.28%,P<0.05),“always limit food with sugar”(65.22% vs 12%,P<0.05),“always eat fruits 200–400 g every day”(82.61% vs.4%,P<0.05).and“always eat vegetables 300–500 g every day”(21.74%vs.12%,P<0.06)after treatment for 3 months.The low-density lipoprotein cholesterol control rate(52.17% vs.28%,P<0.05)and the systolic blood pressure control rate(100%vs.68%,P<0.05)were also signifi cantly increased after treatment for 3 months in the cardiac rehabilitation group.No signifi cant increase was found in the control group after treatment for 3 months.No cardiac-event related to home exercise was reported in both groups.Conclusion:Home-based cardiac rehabilitation is a feasible and available cardiac rehabilitation mode in China.

An Evaluation Study of a Nature Based Rehabilitation in Sweden for Patients with Exhaustion Disorder

The aim of this study was to evaluate a Nature Based Rehabilitation (NBR) for a group of patients with Exhaustion Disorder (ED) in the southwest Sweden. A multidisciplinary team consisting of an occupational therapist, a physiotherapist, a medical doctor practising symbolic drama and a nurse with gardening experience provided NBR in an agricultural environment. Patients were offered 14 weeks of rehabilitation in a group of eight persons, three mornings per week. Seventeen patients participated in the study and 15 completed the study. A semi-structured interview was conducted at the beginning of the rehabilitation and at the end and a follow-up interview by telephone was done one year after completion of the rehabilitation. The interviews were recorded and transcribed. Assessment scales used included: Stress and Crisis Inventory (SCI-93), Coping Resources Inventory (CRI) and Visual Analogue Scale (VAS). Weekly notes from the staff members were reviewed and compared with the patient’s own experience. The interviews and the staff notes were analysed with semantic thematic analysis. Result showed that this kind of NBR with a multidisciplinary team promotes improved health and improved quality of life for patients with ED and may thus constitute a good alternative to treatment, provided the ED has not become chronic.

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.

Analysis of Activities of Adults with Aphasia at Community-Based Rehabilitation Training

Aphasia is a higher brain dysfunction that affects the production or comprehension of speech and the ability to read or write. The purpose of this research is to establish support guidelines based on a questionnaire survey and a language activity analysis of rehabilitation training so that volunteers can more easily assist disabled persons with aphasia. The focus of this study was the non-profit community-based intervention group Yokohama Aphasia Partner Group, which consists of members with aphasia, their families, speech-language-and-hearing therapists, psychiatric social workers, and volunteers. The following results were obtained. (1) Members with aphasia participate in the Partner Group because they can meet others with aphasia on a regular basis as well as participate in the aphasia rehabilitation program with the recovery of language functions. In addition to medical treatment, the community-based support, which improves the environment and other life contextual factors, is important for rehabilitation. (2) An individual with aphasia shows different language actions, and so an individually different support system in accordance with language activity is necessary.

Developing Skills in Intra-Workplace Rehabilitation Education: I

Japan has an advanced healthcare system, on par with any developed country;at the same time, it is challenged by a rapidly aging population. In line with other countries, medical and paramedical training differs from college or university to when the graduates start working in the hospital wards;it seems like a new career to freshmen. Rehabilitation draws together the most varied professional teams treating patients from a range of specialists, and physical therapists generally receive very little intra-workplace skills training. The aim of this paper is to develop the first of a two-part educational model that is useful for the professional development of therapists working in rehabilitation medicine, by incorporating, at least, Shared Decision-Making and Narrative-Based Medicine. The most productive systems of analysis are Bloom’s psychomotor taxonomy and the Japanese DIKW system. The Japanese DIKW model of “chishin”, which is based on Data, Information, Knowledge, and Wisdom, is similar to the professional attitude and rehabilitative mindset in the healthcare system, the convalescent rehabilitation wards. The individual, departmental, and hospital levels could all benefit from aspects of these systems. Rehabilitative medicine in Japanese terms is presented as a holistic medical care that heals the body and mind and restores dignity, such as personality and self-confidence, and it is also a place where unique Japanese cultural concepts such as “Ikigai” (reason to live) and “Omotenashi” (hospitality) can be nurtured as professional awareness.

Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains un- clear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The FugI-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sen- sorimotor cortex.

Assistive Technology Based on Robotics and Rise in China

The concept of assistive technology based on robotics,rehabilitation robot and intelligent assistive devices. Domestic intelligence assistive devices include intelligent prosthetics, intelligent orthotics, intelligent walker, assistive devices for smart home environment control, intelligent life assistive devices; Domestic intelligent rehabilitation robot include upper limb rehabilitation robot, hand rehabilitation robot, lower limb rehabilitation robot, robotic smart wheelchair, intelligent nursing bed, daily care robot,the development trend of intelligent assistive devices and rehabilitation robot.

Design and Evaluation of a Vision-Based UI for People with Large Cognitive-Motor Disabilities

Recovering from multiple traumatic brain injury (TBI) is a very difficult task, depending on the severity of the lesions, the affected parts of the brain and the level of damage (locomotor, cognitive or sensory). Although there are some software platforms to help these patients to recover part of the lost capacity, the variety of existing lesions and the different degree to which they affect the patient, do not allow the generalization of the appropriate treatments and tools in each case. The aim of this work is to design and evaluate a machine vision-based UI (User Interface) allowing patients with a high level of injury to interact with a computer. This UI will be a tool for the therapy they follow and a way to communicate with their environment. The interface provides a set of specific activities, developed in collaboration with the multidisciplinary team that is currently evaluating each patient, to be used as a part of the therapy they receive. The system has been successfully tested with two patients whose degree of disability prevents them from using other types of platforms.

Nature-Based Therapy for People Suffering from Post-Concussion Syndrome—A Pilot Study

Background: Approximately 10% - 15% of people diagnosed with a concussion develop post-concussion syndrome (PCS), in which mental fatigue is a dominating symptom. PCS has major consequences for the individuals diagnosed, and society as a whole. Objective: The objective of the pilot study was to investigate whether a nature-based therapeutic (NBT) intervention would be suitable for ameliorating the symptoms experienced by people with PCS, especially mental fatigue. Method: Eight participants diagnosed with PCS took part in a NBT programme, which consisted of weekly two-hour sessions over the course of eight weeks. The participants’ level of mental fatigue was measured on the Mental Fatigue Scale (MFS) before and after the intervention. An analogue scale inspired by the EuroQol-visual analogue scales (EQ-VAS) was used to measure immediate self-perceived feeling of health/ well-being before and after individual sessions. A semi-structured interview was held with each participant after the intervention. The interviews and logbooks were analysed through content analysis, which entails several steps in a spiral-like process, from reading and re-reading the transcripts to forming units of meaning, which were then grouped into sub-categories and categories for further analysis. Result: The MFS showed a significant decrease in mental fatigue and large effect size. The participants’ self-assessed health/ well-being on the analogue scale showed an increase from the beginning to the end of each session. The analysis of the interviews revealed that the participants experienced the sensory stimuli and exercises in the natural environment as motivating and meaningful, even when they were challenging. Further, they found the psycho-educational aspects transferable to everyday life. Conclusion: The results support that NBT can have potential in the rehabilitation of PCS, by lowering mental fatigue and improving health and well-being. The NBT was further found to be experienced as enjoyable and motivating with good transferability to everyday life.

心房颤动患者射频消融术后居家运动康复强度-时间依从性轨迹及预测因素的纵向研究

背景我国心房颤动(以下简称房颤)患病率逐年升高,患者的预后及生活质量亟需关注。现有研究证实运动康复是改善房颤射频消融术后患者预后及生活质量不佳的有效方式。依从性是衡量运动康复益处是否持续存在的关键指标,但其变化轨迹未知。目的基于前瞻性纵向观察的心房颤动患者射频消融术后居家运动康复强度-时间依从性5期追踪数据,考察发展轨迹及预测因素。方法采用便利抽样法,选取2020年5—11月就诊于南京医科大学第一附属医院心血管内科行射频消融术的246例房颤患者为研究对象进行随访。其中入组1周为基线调查,入组后3、6、9个月和12个月为追踪调查。收集患者的一般资料;本研究使用智能设备或运动日志对依从性进行监督和记录,从强度-时间依从性评估运动依从性;采用运动自我效能量表(SEE)、运动恐惧量表(Fact-CHF)、领悟社会支持量表(PSSS)、患者积极度量表(PAM13)分别评估患者的运动自我效能、运动恐惧水平、社会支持情况、积极度水平。利用Mplus工具构建潜类别增长模型(LCGM),取最优的拟合模型确定房颤患者射频消融术后居家运动康复强度-时间依从性的发展轨迹,采用Logistic回归分析识别轨迹类别的预测因素。结果44例患者失访,最终共202例纳入分析。基线、运动3个月、运动6个月、运动9个月、运动12个月患者例数分别为202、201、185、174例和159例,患者强度-时间依从性分别为(0.83±0.55)、(1.07±0.54)、(0.99±0.57)、(0.91±0.55)、(0.89±0.60)。LCGM结果显示,患者的运动康复强度-时间依从性变化过程具有群体异质性,分为3个潜类别轨迹组:缓慢下降-低水平组(n=69,34.2%)、快速上升-高水平组(n=14,6.9%)、持续依从组(n=119,58.9%)。无序多分类Logistic回归分析结果显示,以缓慢下降-低水平组为参照组,快速上升-高水平组和持续依从组男性患者的强度-时间依从性水平更高(P<0.001);快速上升-高水平组和持续依从组患者的年龄更大,运动自我效能水平更高(P<0.05);快速上升-高水平组患者的运动恐惧水平更低(P<0.05);持续依从组患者的积极度水平更高(P<0.05)。结论房颤患者射频消融术后居家运动康复强度-时间依从性呈多类别曲线增长的发展轨迹;未来可依据依从性的时变特点和因素定期进行强化干预,进而提高患者居家运动康复依从性水平且保持稳定。

“互联网+”辩证行为疗法干预模式在青少年非自杀性自伤干预中的应用研究

背景青少年非自杀性自伤已成为日益严重的精神卫生问题,其病程迁延,对患者、家庭、社会造成沉重负担。对青少年非自杀性自伤干预需要采用综合干预模式,我国线上干预管理实践尚处于起步阶段。目的探讨“互联网+”辩证行为疗法(DBT)干预模式对青少年非自杀性自伤患者自杀意念、认知情绪调节、缓解抑郁等方面的干预效果。方法选取2021年5月—2022年5月新乡医学院第二附属医院系统中出院的青少年非自杀性自伤患者120例为研究对象,采用随机对照单盲法,分为对照组(n=60)和干预组(n=60)。对照组进行药物干预、电话随访及心理咨询,干预组在对照组的基础上实施为期1年的“互联网+”DBT训练,分为4个模块,分别是正念训练、人际效能训练、情绪调节训练和忍受痛苦训练。在干预前及干预6、12个月后,分别采用青少年自杀意念自评量表(SIOSS)、认知情绪调节问卷(CERQ-C)、Montgomery-Asberg抑郁量表(MADRS)评价两组患者的自杀意念、认知情绪调节、抑郁状态。采用重复测量方差分析对不同时间点两组患者健康状态进行比较。结果最终对照组57例、干预组55例完成研究。组间与时间对SIOSS、CERQ-C、MADRS评分有交互作用(P<0.05);组间对SIOSS、CERQ-C、MADRS评分主效应显著(P<0.05),时间对SIOSS、CERQ-C、MADRS评分主效应显著(P<0.05)。其中干预组组内干预前后SIOSS、CERQ-C、MADRS评分比较,差异有统计学意义(P<0.001);对照组组内前后SIOSS评分、MADRS评分和CERQ-C评分中积极重新关注、重新关注计划、积极重新评价、理性分析、灾难化、责难他人维度比较,差异无统计学意义(P>0.001),对照组组内前后CERQ-C评分中自我责难、接受、沉思维度比较,差异有统计学意义(P<0.001)。结论“互联网+”DBT干预模式可以有效降低青少年非自杀性自伤患者的自杀意念,提高情绪控制水平,缓解抑郁状态,改善患者生存质量和社会功能。

急性心肌梗死患者心脏运动康复依从动机的质性研究

目的探究急性心肌梗死(acute myocardial infarction,AMI)行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者心脏运动康复的依从动机,为提升患者运动康复参与及行为改变提供建议和依据。方法采用描述性质性研究,通过目的抽样法选取2021年7月至2022年1月在上海某三级甲等医院复诊的29例AMI患者进行半结构式深度访谈,其中18例来源于心脏康复中心、11例来源于随访门诊。采用内容分析法整理访谈资料。结果共提炼3个主题和9个亚主题:患者的运动体验(康复获益感、风险感知),患者的心理状态(悲观、恐惧、积极心态)和社会支持(家庭依恋及支持、专业指导及支持、同伴交流及支持、物理资源及支持)。结论护理人员应重视AMI行PCI治疗患者的运动体验、心理状态及社会支持情况,以提高患者心脏运动康复依从动机。

中医适宜技术治疗脑卒中后偏瘫的循证临床实践指南

脑卒中是成年人死亡和残疾的主要原因之一。中医适宜技术在脑卒中后偏瘫的康复治疗中广泛应用,然而尚缺乏系统的、高质量的循证指南来指导这些实践。本指南根据《世界卫生组织指南制订手册》和《中西医结合诊疗指南制订手册》制定,遵循卫生保健实践指南的报告要求,并参照推荐分级的评估、制定与评价系统对证据质量及推荐强度进行分级。本指南组建了包括5个小组在内的跨学科工作团队,通过问卷、面对面专家会议和问题解构方法来选择指南中需要回答的关键临床问题。从25个关键问题中筛选出10个进行研究。基于系统评价的结果,考虑到证据的优缺点、干预成本、证据质量、患者偏好及价值观、多学科专家的反馈和共识,本指南提出了20条关于中医适宜技术在脑卒中后偏瘫康复治疗中应用的推荐意见。本指南主要面向中国各级医院和康复机构的医务工作者,专注于中医适宜技术在脑卒中后偏瘫康复治疗中的临床应用。

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。

案例学习法结合Seminar在物理治疗实践教学中的应用

目的 探讨Seminar结合案例学习法在物理治疗实践教学中的应用效果。方法 2021年7月至2022年6月,不定向招募在南京医科大学第一附属医院康复医学中心实习的康复治疗专业学生42例,随机分为对照组(n=21)和试验组(n=21)。试验组采用Seminar结合案例学习法,对照组采取单纯案例学习法,共3个月。观察两组理论和实践考核成绩,采用自行设计的满意度问卷进行调查。结果 试验组理论和实践考核成绩优于对照组(t> 2.421, P <0.05);试验组调动学习积极性、提高学习能力、培养临床推理思维、提高师生互动沟通能力、提高团队协作能力、提高自身整体能力以及教学7个方面满意度优于对照组(χ^(2)> 6.667, P <0.05)。结论 在案例学习法的基础上结合Seminar可提升物理治疗实践教学效果。

椎体压缩性骨折患者术后运动康复的循证护理实践

目的:检索、总结椎体压缩性骨折患者术后运动康复的证据,制定审查指标,实施并评价其临床应用效果。方法:以基于证据的持续质量改善模型为研究框架,于2022年12月至2023年3月通过证据获取、现状审查、证据引入,构建椎体压缩性骨折患者术后运动康复的循证方案;便利选取2023年3月—8月在青岛市某三级甲等医院脊柱外科行手术治疗的椎体压缩性骨折患者59名及科室护士20名为研究对象,比较应用运动康复循证实践证据前后2组患者的满意度、生存质量和功能障碍指数得分,同时比较循证实践证据应用前后运动康复相关审查指标的执行率及护士运动康复知识水平变化。结果:证据应用后,循证实践组患者满意度、生存质量得到提升(P<0.001)、功能障碍指数下降(P<0.001)、运动康复相关审查指标的执行率和护士康复知识水平得分均较应用前提高(t=-15.873,P<0.001),差异具有统计学意义(P<0.05)。结论:基于证据的椎体压缩性骨折患者术后运动康复方案临床应用切实可行,有效促进了护士专业知识的提升以及临床管理行为的落实,同时对于提高椎体压缩性骨折患者满意度、改善术后生存质量、降低功能障碍程度具有重要意义。

成人吸入性损伤肺康复管理最佳证据总结

目的检索、评价及汇总成人吸入性损伤肺康复相关证据。方法计算机检索BMJ Best Practice、UpToDate临床顾问、JBI图书馆、Cochrane图书馆、国际烧伤协会、欧洲烧伤协会、美国烧伤协会、日本皮肤病学协会、中国知网、万方数据库、中国生物医学数据库等网站中关于成人吸入性损伤相关的临床实践指南、专家共识、证据总结、系统评价及随机对照试验,检索时限为建库至2022年12月31日。进行文献质量评价后,根据主题对证据进行提取与汇总。结果根据纳入标准筛选出证据16篇,包括临床实践指南7篇、专家共识5篇、系统评价3篇、随机对照试验1篇。通过阅读、提取和归类,总结了对证据进行梳理,最终形成肺康复评估、肺康复模式、肺康复时机、肺康复时长、肺康复地点、肺康复方式、肺康复营养支持及效果评价8个维度,20条证据。结论本研究基于总结多个国家及地域成人吸入性损伤的肺康复管理证据,供医护人员根据临床实际情况选择证据进行干预。

椎体骨折病人术后运动康复的证据总结

目的:检索、评价并总结椎体骨折术后病人运动康复的最佳证据,为临床工作提供循证依据。方法:遵循“6S”证据模型,系统检索UpToDate、最佳临床实践、国际指南协作网、美国指南网、加拿大安大略注册护士协会网站、澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心数据库、the Cochrane Library、PubMed、EMbase、Web of Science、中国知网、万方数据库、中国生物医学文献数据库等临床决策支持系统、医脉通指南网站、梅斯医学及国际骨质疏松协会等网站中关于椎体骨折术后运动康复管理策略的文献,包括临床决策、指南、系统评价、证据总结和专家共识,对文献质量进行评价并提取、汇总证据。结果:共纳入16篇文献,包括临床决策3篇、指南7篇、系统评价1篇、专家共识5篇,汇总了包含运动康复团队、运动评估、运动计划、运动时机、运动方式、运动频率与强度、支具使用和运动注意事项8个方面的26条证据。结论:形成的椎体骨折术后病人运动康复管理的最佳证据可为骨科临床医护人员制订椎体骨折术后病人运动康复方案提供参考。