脊髓损伤患者机构康复训练效果的影响因素分析

Factors influencing the outcomes of specialized institution-based rehabilitation in spinal cord injury

中文关键词:  脊髓损伤  机构康复  影响因素  因子分析

英文关键词:Spinal cord injury individuals  Specialized institution-based rehab training  Influencing factor  Factor analysis

中文摘要:

  【摘要】 目的：评价脊髓损伤患者机构康复训练效果并分析其影响因素。方法：收集2013年1月~2016年12月在上海市养志康复医院（上海市阳光康复中心）进行康复训练的脊髓损伤患者的档案，采集人口学和损伤基本特征指标，训练前后15个基本技能指标（包括进食、梳洗修饰、洗澡、穿裤子、穿上衣、上厕所、床/椅/轮椅转移、入厕和浴室转移、行走、上下楼梯和使用轮椅、人际沟通能力、解决问题能力和情绪处理能力指标）、3个家庭应用能力评估指标（个人卫生、家务劳动和休闲娱乐）以及5个社会生活应用能力评估指标（轮椅使用、交通工具使用、到达目的地的活动、沟通能力和任务完成情况）的评估结果。共有383例康复训练患者纳入本研究，患者入院时年龄为9~71岁（中位数45岁），受伤年龄0~69岁（中位数31岁），从受伤到参加康复训练间隔0~61年（平均11年，中位数5年）。外伤303例（79.3%）。应用因子分析考察数据变量间的内在结构，提取5个公因子，分别为基本生活技能、心理认知、行走和上下楼梯、家庭和社会生活应用。采用多元线性回归分析从受伤到参加机构训练的间隔时间、性别、教育水平、婚姻状况、受伤水平和受伤原因对5个因子的影响。结果：在康复训练45d后，患者的所有评估指标得分均显著性提高（P<0.01），提升最小的为进食（2.2%），最大的为轮椅实际使用（78.8%）；5个因子中家庭应用能力提升最大（54.3%，P<0.01），行走和上下楼梯提高幅度最小（10.5%，P<0.01）。在基本生活技能方面，参加训练间隔时间越长，相对提高越少（?茁＝-0.101，P<0.1）；与腰骶段损伤相比，颈段（?茁＝0.273，P<0.1）和胸段（?茁＝0.23，P<0.1）损伤的患者提高较多。在心理认知方面，大专及以上学历的患者比初中及以下患者提高相对更多（?茁＝0.122，P<0.1）。在家庭应用方面，训练间隔是负面影响因素（?茁＝-0.147，P<0.1），已婚比未婚康复效果更好（?茁＝0.11，P<0.1），外伤患者比非外伤患者改善效果差（?茁＝-0.141，P<0.1）。在社会应用方面，已婚和更早参加康复训练都是正面影响因素。结论：脊髓损伤患者短期参加机构康复训练可改善其日常生活自理能力和社会适应能力；康复效果与受伤到训练的间隔时间、损伤节段、学历、婚姻状况和教育背景有关。患者早期参加机构康复训练，关注患者的教育等多方面需求，有助于提升康复训练效果。

英文摘要:

  【Abstract】 Objectives: To evaluate the factors influencing the effects of rehabilitation training in spinal cord injury(SCI) individuals. Methods: Training documents of SCI individuals who had fulfilled rehabilitation training from 2013 to 2016 in Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center, SSRC) were reviewed, and general characteristics such as sex, date of birth, marital status, injury time, lesion level and etiology of injury were collected. Fifteen indicators of basic life skills(eating, grooming, bathing, upper limb dressing, lower limb dressing, toileting, bed/chair/wheelchair transfer, toilet transfer, bath transfer, walk, stairs, wheelchair, interpersonal communication, problem solving and emotion handling), 3 indicators of family life skills(personal hygiene, housework, entertainment), and 5 indicators of social life skills(wheelchair use, transportation use, destination arrival, task completion and communication skills) were compared between before and after the rehabilitation training. A total of 383 SCI individuals was included in this study, and the median age on admission was 45 years with a range of 9-71 years. They got injury at a median of 31 years old, and the oldest patient was 69 years old. There were 0-61 years(mean time, 11 years; median time, 5 years) from injury onset to rehab training. The SCI individuals with traumatic cause counted 303(79.3%). Factor analysis was used to explore the inner structure of the variables and resulted in 5 common factors(basic life skills, application in social life, cognition and emotion, application in family life, walk and stairs). Multivariate linear regression was conducted to explore the factors influencing the 5 common factors, and the independent variables included the time span from injury onset to rehab training, sex, education background, marital status, injury level and etiology. Results: The study found that the score of each indicator significantly increased, the lowest was eating(2.2%) and the highest was wheelchair use(78.8%); in the 5 factors, the application in family life improved highest(54.3%, P<0.01), and walk and stairs(locomotion) improved lowest(10.5%, P<0.01). The multivariate linear regression showed that the earlier to take part in rehab training, the greater improvement(P<0.1) in basic life skills obtained; the cases with cervical(P<0.1) and thoracic(P<0.1) cord injury had better rehabilitation outcomes in basic life skills than the cases with lumbosacral cord injury; the SCI individuals with junior or regular college education background showed more improvement in cognition and emotion than those with junior high school or below education background(P<0.1). Married SCI individuals had a positive influence on the application in family life(P<0.1), while the time span from injury onset to rehab training(P<0.1) and traumatic injury(P<0.1) had a negative influence. Married SCI individuals and earlier start of rehab training had a positive influence on applications in social life. Conclusions: The rehabilitation training outcomes are encouraging in SSRC, and the influencing factors may include the time span from injury onset to rehab training, education background, marital status, injury level and etiology. More attention should be paid on earlier rehab training and education et al, which are beneficial for rehab training outcomes.