多发性硬化的家庭运动康复

由于多发性硬化的复杂性、多变性、长期性、进展性和不可预知性,患者的管理具有一定的特殊性和挑战性。以患者为中心、家庭为基础,患者主动参与的个别化康复服务是当前较为有效的康复干预模式。家庭运动康复可以很好地改善患者的功能水平。     

Semi-Structured Interviewing in Practice-Close Research

Jennifer Baumbusch
Column Editor: Lauren Clark Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.     

临床康复医学研究的选题和实验设计方法

选题是临床康复医学研究的第一步和最重要的一步。本文论述了临床康复医学研究的实施步骤和方法，并对临床康复医学研究的选题、实验设计、数据收集和分析的基本原则进行了详细的论述。     

康复专业生理学课程的网络研究性学习模式

本文介绍了网络研究性学习模式的实施过程、特点及应用效果。网络环境下的研究性学习模式促进了生理学理论教学改革,提高了学生的自学能力、综合分析能力和创新能力。     

Secondary analysis of national survey datasets

Aim: This paper describes the methodological issues associated with secondary analysis of large national survey datasets. Methods: Issues about survey sampling, data collection, and non‐response and missing data in terms of methodological validity and reliability are discussed. Results: Although reanalyzing large national survey datasets is an expedient and cost‐efficient way of producing nursing knowledge, successful investigations require a methodological consideration of the intrinsic limitations of secondary survey analysis. Conclusions: Nursing researchers using existing national survey datasets should understand potential sources of error associated with survey sampling, data collection, and non‐response and missing data. Although it is impossible to eliminate all potential errors, researchers using existing national survey datasets must be aware of the possible influence of errors on the results of the analyses.     

脑卒中偏瘫患者6个月三级康复整体护理期间的成本效果分析

目的：对脑卒中偏瘫患者三级康复整体护理方案作成本-效果的经济学统计和分析,为能更有效恢复患者功能的同时节省治疗费等开支提供依据。方法：129例脑卒中患者随机分为A、B、C 3组各43例,均按内科常规治疗,同时A组执行脑血管病三级康复治疗方案：早期Bobath法,中期移乘、站立、重心转移及步行训练,出院后社区康复训练,并配合三级康复整体护理,包括协调康复团队工作,指导康复器具使用,将训练内容融合ADL中及每周访视等。B组仅接受三级康复治疗方案。C组完成常规治疗。治疗6个月末时采用美国国立卫生研究院脑卒中量表（NIHSS）、Fugl-Meyer运动功能评定量表（FMA）、改良Barthel指数（MBI）评定各组间的差值,并对治疗期间的各项费用作成本-效果的经济学统计。结果：3组所花费的总住院费,直接医疗费用比较差异无统计学意义,但间接费用、直接非医疗费用和总费用C组明显高于A组。B组的直接非医疗费用高于A组。A组FMA、MBI评分每提高1分、NIHSS评分降低1分,需要消耗的住院相关费用、直接医疗费和总的成本费用均明显低于B、C组,B组低于C组。结论：实施三级康复治疗及整体护理方案能明显减少医疗费用,是一种经济、有效的护理方案。     

康复治疗专业临床科研概论教学策略浅析

培养康复治疗专业人才是发展我国康复医学的当务之急。康复治疗学本科生教育是培养康复治疗专业人才的重要途径；康复治疗学专业应重视临床科研教学工作。临床科研概论的教学策略应该包括以下内容：激发学习兴趣、培养科研素质；掌握临床科研的基本步骤；鼓励学习新知识；关注循证康复医学；改革考试方式、注重能力培养。     

Practice guidelines for program evaluation in community-based rehabilitation

Purpose: This paper proposes practice guidelines to evaluate community-based rehabilitation (CBR) programs.

Method: These were developed through a rigorous three-phase research process including a literature review on good practices in CBR program evaluation, a field study during which a South Africa CBR program was evaluated, and a Delphi study to generate consensus among a highly credible panel of CBR experts from a wide range of backgrounds and geographical areas.

Results: The 10 guidelines developed are summarized into a practice model highlighting key features of sound CBR program evaluation. They strongly indicate that sound CBR evaluations are those that give a voice and as much control as possible to the most affected groups, embrace the challenge of diversity, and foster use of evaluation processes and findings through a rigorous, collaborative and empowering approach.

Conclusions: The practice guidelines should facilitate CBR evaluation decisions in respect to facilitating an evaluation process, using frameworks and designing methods.

• Implications for rehabilitation

• Ten practice guidelines provide guidance to facilitate sound community-based rehabilitation (CBR) program evaluation decisions. Key indications of good practice include:

• ??being as participatory and empowering as possible;

• ??ensuring that all, including the most affected, have a real opportunity to share their thoughts;

• ??highly considering mixed methods and participatory tools;

• ??adapting to fit evaluation context, local culture and language(s);

• ??defining evaluation questions and reporting findings using shared CBR language when possible, which the framework offered may facilitate.

     

Conceptual Models of Health Behavior: Research in the Emergency Care Settings

This article provides recommendations for incorporating conceptual models of health behavior change into research conducted in emergency care settings. The authors drafted a set of preliminary recommendations, which were reviewed and discussed by a panel of experienced investigators attending the 2009 Academic Emergency Medicine consensus conference. The original recommendations were expanded and refined based on their input. This article reports the final recommendations. Three recommendations were made: 1) research conducted in emergency care settings that focuses on health behaviors should be grounded in formal conceptual models, 2) investigators should clearly operationalize their outcomes of interest, and 3) expected relations between theoretical constructs and outcomes should be made explicit prior to initiating a study. A priori hypothesis generation grounded in conceptual models of health behavior, followed by empirical validation of these hypotheses, is needed to improve preventive and public health–related interventions in emergency care settings.     

An Innovative Strategy for Conducting Clinical Research: The Academic Associate Program

Performance of high-quality clinical research usually requires procurement of substantial funding to support and sustain the research infrastructure. The authors have developed a program to support a research infrastructure that minimizes financial start-up costs and maximizes productivity of clinical-educator faculty with limited protected time. The program integrates clinical research with undergraduate education. The authors report the experience with the academic associate program at two academic institutions. They describe the program, provide measures of program success, and discuss potential methods for other institutions to initiate similar programs. Similar programs can be developed in a variety of outpatient and inpatient settings allowing the performance of high-quality clinical research in a time-efficient and cost-effective manner.     

Analyzing variations in changes over time: development of the Pattern‐Oriented Longitudinal Analysis approach

Longitudinal qualitative research in nursing is rare but becoming more common. Data collection and analysis over time provide some intriguing possibilities to better understand processes, development, and change in illness experience, healthcare organizations, and self‐management. This paper aims to present a process for analyzing qualitative longitudinal data material, namely the Pattern‐Oriented Longitudinal Analysis approach (POLA). We developed this approach after synthesizing experiences from two longitudinal qualitative projects and comparing our procedures and reflections with the relevant literature. Using the POLA approach, researchers can describe complexity and variation in changes over time. During the analysis process, emphasis is put on visualizing and identifying change at both an individual and a group level. Ontological and epistemological assumptions for the approach are also described. The benefit of this approach is the possibility to describe complexity and diversity in processes over time, which is important for the development of nursing knowledge. The analysis approach can be further used and developed by researchers seeking to understand variance or contextual features in processes and changes over time.     

Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda

Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics—multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs.     

Potential Utility of a Miniature Electrocardiographic Device in the Medical Support of Law Enforcement Tactical Teams

Abstract

Objectives. To determine which mode of completing a survey yields the highest response rate among emergency medical services (EMS) providers, examine rural and urban differences, and determine the completeness of questions by mode of response. Methods. A random sample of EMS providers was mailed one of the following: 1) a paper survey, with instructions to return it via the enclosed self-addressed, stamped envelope; 2) a letter, with instructions to complete the survey at the provided URL (Web address); or 3) a paper survey with a self-addressed, stamped envelope and a URL, with the option of choosing the mode of response. We compared response rates based on the three different modes. We conducted analysis of the number of skipped multiple-choice and open-ended questions by mode and content analysis of the open-ended questions. Results. The paper-only option resulted in the highest response rate (40.4%, p = 0.003) compared with the response rates from Web-only and choice of mode. Overall, rural EMS providers responded at a higher rate than urban EMS providers (40.3% vs. 31.6%, respectively [p = 0.0002]). Web respondents were more likely to complete all the open-ended questions (p = 0.003). Almost a fourth (22.8%) of the paper respondents skipped multiple-choice questions. There was a pattern of more complete responses for open-ended questions among the Web-based participants, but this was not significant (p = 0.17). Conclusion. EMS providers seem to prefer a more traditional mode (paper) when responding to a survey. Rural providers are more likely to respond. Mode of response influences the number of skipped questions but does not impact the quality of open-ended answers.     

Quality of life in the care home: a qualitative study of the perspectives of residents with multiple sclerosis

Purpose: Care home residents with multiple sclerosis (MS) are more physically dependent than the average residents. However, little is known about their quality of life (QoL). We investigated the experiences of residents with MS using qualitative research methods and developed a conceptual model of QoL. Methods: Twenty-one people with MS (age range 43–80 years) residing in a range of care homes were interviewed. The interviews were transcribed verbatim and analyzed using the constant comparative method. Results: Four core model domains identified were as follows: (i) What the care home means to the residents, (ii) Self, (iii) Environmentand (iv) Relationships. Some residents reported that care homes can relieve the burden on family, address specific environmental issues regarding safety and act as a form of social support. However, some reported isolation and difficulties adjusting to life in the care home. Having access to rehabilitation strengthened the feelings of independence within the care home. Conclusions: QoL is a broad, multidimensional construct for residents with MS. QoL measures for residents with MS should incorporate broad domains, including environmental factors. The conceptual model highlighted several areas for improving QoL of residents with MS, including more involvement of family members, encouraging independence by providing access to rehabilitation and providing support in the transition process.

Implications for Rehabilitation

• Quality of life for people with multiple sclerosis in care homes is a multidimensional construct.

• Participants in this qualitative study differed in whether they were able to have access to rehabilitation in the care home.

• For those that did have access, this appeared to enhance their feelings of maintaining some degree of independence in the care home.

• This study demonstrated that rehabilitation, such as physiotherapy, is greatly valued by care home residents with disabilities and has an impact on their quality of life.

     

ICF理论框架在小儿脑性瘫痪社区家庭康复评估中的应用

目的探索以ICF 理论框架为基础的小儿脑瘫社区家庭康复评估的理论架构与方法。方法根据ICF 理论框架,综合多种评估工具和自编工作量表,开发评估系统。对50 例农村小儿脑瘫患儿进行社区家庭康复1 年。结果和结论ICF理论框架为小儿脑瘫社区家庭康复评估提供良好的架构,为评估工具的建立与体系化提供了参考依据;根据评估结果所制定的康复计划依从性较好,取得良好的康复效果。     

The Pros and Cons of Data Analysis Software for Qualitative Research

Purpose: To explore the use of computer-based qualitative data analysis software packages.
Scope: The advantages and capabilities of qualitative data analysis software are described and concerns about their effects on methods are discussed.
Findings: Advantages of using qualitative data analysis software include being freed from manual and clerical tasks, saving time, being able to deal with large amounts of qualitative data, having increased flexibility, and having improved validity and auditability of qualitative research. Concerns include increasingly deterministic and rigid processes, privileging of coding, and retrieval methods; reification of data, increased pressure on researchers to focus on volume and breadth rather than on depth and meaning, time and energy spent learning to use computer packages, increased commercialism, and distraction from the real work of analysis.
Conclusions: We recommend that researchers consider the capabilities of the package, their own computer literacy and knowledge of the package, or the time required to gain these skills, and the suitability of the package for their research. The intelligence and integrity that a researcher brings to the research process must also be brought to the choice and use of tools and analytical processes. Researchers should be as critical of the methodological approaches to using qualitative data analysis software as they are about the fit between research question, methods, and research design.