Hasenbein U, Kuss O, Bäumer M, Schert C, Schneider H, Wallesch C W
Institute of Neurological and Neurosurgical Rehabilitation, Magdeburg, Germany.
Disabil Rehabil. 2002 Dec 15;24(18):954-60. doi: 10.1080/0963828021000007888.
Analysis of medical decisions in the differential allocation of stroke rehabilitation programmes.
Medical specialists routinely involved in the treatment and rehabilitation of stroke patients from acute hospitals, rehabilitation centres, and the Medical Services of the Workers' Pension Funds of Sachsen-Anhalt and Mecklenburg-Vorpommern were included in a systematic survey, in which they had to give their opinions on the individually optimal rehabilitation setting and therapies and probable outcome on the basis of case vignettes. These specialists are crucial for decision-making in rehabilitation resource allocation.
Both allocation and prognosis did not depend only on patient but also on physician characteristics. Neurologists tended to prefer outpatient rehabilitation and expected a greater effect of rehabilitation upon ADL-function than specialists from other professions. Preferred rehabilitation setting did not influence the physicians' subjective prognosis. For patients who qualified both for in- and outpatient rehabilitation, the two settings, therapeutic potentials were considered to be equivalent.
Differences in setting and treatment preferences between experts concerning optimal treatment cannot be resolved on the basis of available evidence. Further data are required that allow to decide which type of rehabilitation is best suited for a given patient.
分析中风康复项目差异分配中的医疗决策。
对来自急性医院、康复中心以及萨克森 - 安哈尔特州和梅克伦堡 - 前波美拉尼亚州工人养老基金医疗服务部门、日常参与中风患者治疗与康复的医学专家进行系统调查，让他们根据病例 vignettes 就个体最佳康复环境、治疗方法及可能的结果发表意见。这些专家对于康复资源分配决策至关重要。
分配和预后不仅取决于患者，还取决于医生的特征。神经科医生倾向于选择门诊康复，并且预计康复对日常生活活动功能的影响比其他专业的专家更大。首选的康复环境并未影响医生的主观预后。对于符合住院和门诊康复条件的患者，两种环境下的治疗潜力被认为是相当的。
关于最佳治疗，专家之间在环境和治疗偏好上的差异无法根据现有证据得到解决。需要进一步的数据来确定哪种康复类型最适合特定患者。
