老年疗养院居民群体中与物理治疗服务相关的因素；一项横断面研究。
Factors associated with physiotherapy provision in a population of elderly nursing home residents; a cross sectional study.
作者信息
Leemrijse Chantal J, de Boer Marike E, van den Ende Cornelia H M, Ribbe Miel W, Dekker Joost
机构信息
NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
出版信息
BMC Geriatr. 2007 Apr 4;7:7. doi: 10.1186/1471-2318-7-7.
BACKGROUND
Although physiotherapy (PT) plays an important role in improving activities of daily living (ADL functioning) and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents.
METHODS
A random sample of 600 elderly residents was taken from a random sample of 15 nursing homes. Residents had to be admitted for rehabilitation or for long-term care. Data were collected through interviews with the nursing home physician and the physiotherapist. Multilevel analysis was used to define the variation in the provision of PT and the factors that are associated with the question whether a resident receives PT or not. Furthermore the amount of PT provided was analysed and the factors that are associated with this.
RESULTS
On average 69% of the residents received PT. The percentage of patients receiving treatment differed significantly across nursing homes, and especially the number of physiotherapists available, explained this difference between nursing homes. Residents admitted to a somatic ward for rehabilitation, and male residents in general, were most likely to receive PT. Residents who were treated by a physiotherapist received on average 55 minutes (sd 41) treatment a week. Residents admitted for rehabilitation received more PT a week, as were residents with a status after a total hip replacement.
CONCLUSION
PT is most likely to be provided to residents on a somatic ward, recently admitted for rehabilitation to a nursing home, which has a relatively large number of physiotherapists. This suggests a potential under-use of PT for long-term residents with cognitive problems. It is recommended that physiotherapists reconsider which residents may benefit from treatment. This may require a shift in the focus of physiotherapists from 'recovery and discharge' to 'quality of life and well-being'.
背景
尽管物理治疗（PT）在改善日常生活活动能力（ADL功能）和提高出院率方面发挥着重要作用，但尚不清楚有多少养老院居民接受了治疗。此外，对于影响治疗决策的决定因素缺乏了解。在本研究中，我们调查了有多少养老院居民接受了物理治疗。此外，我们分析了导致养老院之间以及居民之间物理治疗提供差异的因素。
方法
从15所养老院的随机样本中抽取600名老年居民的随机样本。居民必须因康复或长期护理而入院。通过与养老院医生和物理治疗师的访谈收集数据。采用多水平分析来确定物理治疗提供的差异以及与居民是否接受物理治疗这一问题相关的因素。此外，还分析了提供的物理治疗量及其相关因素。
结果
平均而言，69%的居民接受了物理治疗。接受治疗的患者百分比在不同养老院之间存在显著差异，尤其是可用物理治疗师的数量解释了养老院之间的这种差异。入住躯体病房进行康复治疗的居民以及一般男性居民最有可能接受物理治疗。接受物理治疗师治疗的居民平均每周接受55分钟（标准差为41）的治疗。因康复入院的居民每周接受的物理治疗更多，全髋关节置换术后的居民也是如此。
结论
最有可能接受物理治疗的是入住躯体病房、最近入住养老院进行康复治疗且有相对较多物理治疗师的居民。这表明认知问题的长期居民可能未充分利用物理治疗。建议物理治疗师重新考虑哪些居民可能从治疗中受益。这可能需要物理治疗师将重点从“康复和出院”转向“生活质量和幸福感”。
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