基于《国际功能、残疾和健康分类》的居家脊髓损伤患者功能变化的纵向研究

关键词：脊髓损伤  国际功能、残疾和健康分类  纵向研究

Keywords:spinal cord injury  international classification of functioning  disability and health  longitudinal study

摘要：

      摘要 目的：以移动APP“脊髓损伤患者远程延续护理系统”中的《国际功能、残疾和健康分类》（ICF）相关随访指标为结局评定指标，纵向探讨脊髓损伤患者出院后功能状态的变化趋势。 方法：2018年6月—2019年9月，选取广州市、十堰市和成都市4家医院的6个临床科室的符合纳入排除标准的91例脊髓损伤患者，随访护士以APP中的32个随访指标（31个ICF类目和1个不能被ICF涵盖的指标“照顾者的能力”）为测量工具，分别在患者出院时、出院后3个月和出院后6个月使用APP评定患者的功能状态。 结果：75%（24个）ICF类目的适用率占90%以上，适用率最低的两个类目分别是性功能（29.67%）和生殖功能（14.29%）；在32个随访指标中，21个ICF类目（5个身体功能领域的类目，全部10个活动和参与领域的类目，6个背景性因素领域的类目）和1个不能被ICF涵盖的指标“照顾者的能力”在3个时点的评定结果之间的差异均有显著性意义，表明居家SCI患者的这些功能状态随时间发展有所好转。未呈现明显好转趋势的10个类目涉及生理功能障碍和常见并发症，均属于身体功能和身体结构成份。 结论：SCI患者出院后6个月内，大部分个体功能状态随着时间的推移逐渐好转。但部分生理功能障碍和并发症难以随着时间推移有明显改善，仍需要长期的康复和科学管理。

Abstract:

      Abstract Objective： Based on the follow-up ICF categories of mobile application (APP)， “Remote transitional care system for patients with spinal cord injury”， longitudinally exploring the changes in functional status of patients with spinal cord injury (SCI) after discharge. Method： From June 2018 to September 2019， 91 SCI patients who met the inclusion and exclusion criteria in 6 clinical departments of 4 hospitals in Guangzhou， Shiyan and Chengdu were selected. 32 follow-up indicators were engaged by follow-up nurses as the measurement tools，including 31 follow-up ICF categories in the APP and one category “ability of caregiver” not covered by ICF. The functional status of SCI patients were assessed by APP before discharge， 3 months after discharge and 6 months after discharge, respectively. Result： The application rate of 75% (24) ICF categories accounted for more than 90%. The two categories with the lowest application rates were sexual function (29.67%) and reproductive function (14.29%). In the 32 follow-up indicators，21 ICF category (five categories in the body function component， all 10 categories in the activities and participation component， six categories in the contextual factors component) and one category “ability of caregiver” not covered by ICF exhibited statistically significant difference between the evaluation results of three time points. This indicated that the functional status of SCI patients improved over time. Ten ICF categories that did not show a significant trend of improvement were related to physiological dysfunction and common complications， all of which belong to body function and body structure components. Conclusion： Within 6 months after discharge， most of functional status of SCI patients gradually improved as time going on. However，some of the physiological dysfunction and complications were difficult to improve significantly over time and still required long-term rehabilitation and scientific management.