背景:获得性脑损伤是成年期残疾的最常见原因之一。强化康复阶段对于康复至关重要。然而,在标准康复期后,缺乏进一步扩大治疗成功率的概念。此后,跨部门的特点,描述了多专业长期神经康复概念及其在不同ICF水平下对结局的影响。
方法:P.A.N.急性后神经康复中心将生活与教学人员的全天候支持以及现场门诊治疗和医疗护理相结合。对01.01.2015至09.04.2022之间完成P.A.N.治疗的所有患者的记录进行了二次数据分析。结果参数包括人口统计特征,诊断,Barthel指数(BI),德国量表“HilfebedarfvonMenschenmitBehinderungfürdenLebensbereichWohnen”(HMBW),加拿大职业绩效衡量标准(COPM)和出院后的目的地。对于BI和出院目的地,评估治疗成功的潜在决定因素。
结果:168例患者纳入分析。在BI中观察到显著改善(p<.001),中位数从55点增加到80点。HMBW显示,日常生活中对援助的需求显著下降(p<.001),个人基本护理(p<.001),塑造社会关系(p=0.003)和沟通(p<.001)。据报道,COPM总分在绩效(p<.001)和满意度(p<.001)方面有显着改善。72%的患者能够在社区生活安排中移动,并需要适度的支持。出院目的地的主要预测因素是初始认知缺陷。第三人称量表BI和HMBW与自我报告的COPM的比较表明,单独制定的患者目标仅在这些全球量表中没有充分反映。
结论:数据显示,P.A.N.追求的跨部门24/7面向目标的实践方法是可行和有效的。我们认为干预的成功是由于长时间提供的高强度治疗及其与现实世界实践的联系。为了全面分析康复成功,有必要记录和评估患者的个人目标,因为这些并不总是反映在常用的全球尺度上。
BACKGROUND: Acquired brain injuries are among the most common causes of disability in adulthood. An intensive rehabilitation phase is crucial for recovery. However, there is a lack of concepts to further expand the therapeutic success after the standard rehabilitation period. Hereafter, the characteristics of a transsectoral, multiprofessional long-term neurorehabilitation concept and its effects on outcome at different ICF levels are described.
METHODS: The P.A.N. Center for Post-Acute Neurorehabilitation combines living with 24/7 support of pedagogical staff with on-site outpatient therapy and medical care. A secondary data analysis was conducted on the records of all patients with completeted P.A.N. treatment between 01.01.2015 and 09.04.2022. Outcome parameters included demographic characteristics, diagnostics, Barthel Index (BI), the German scale \"Hilfebedarf von Menschen mit Behinderung für den Lebensbereich Wohnen \" (HMBW), the Canadian Occupational Performance Measure (COPM) and the destination after discharge. For BI and discharge destination, potential determinants of therapy success are evaluated.
RESULTS: 168 patients were enrolled in the analyses. Significant improvements were observed in the BI (p < .001), with median values increasing from 55 to 80 points. The HMBW showed a significant decrease in the need for assistance in everyday living (p < .001), individual basic care (p < .001), shaping social relationship (p = .003) and communication (p < .001). Significant improvements were reported in the COPM total score for performance (p < .001) and satisfaction (p < .001). 72% of the patients were able to move in a community living arrangement with moderate need for support. Main predictive factor for discharge destination was the initial cognitive deficit. The comparison of the third-person scales BI and HMBW with the self-reported COPM showed that individually formulated patient goals are only insufficiently reflected in these global scales.
CONCLUSIONS: The data show that a highly coordinated, trans-sectoral 24/7 approach of goal-oriented practice as pursued at P.A.N. is feasible and effective. We assume that the success of the intervention is due to the high intensity of therapies delivered over a long time and its interlink with real world practice. For a comprehensive analysis of rehabilitation success, it is necessary to record and evaluate individual patient goals, as these are not always reflected in the commonly used global scales.