Lugo Luz Helena, Salinas Fabio, García Héctor Iván
Physical Medicine and Rehabilitation, Rehabilitation on Health Group, University of Antioquia, Medellin, Colombia.
Disabil Rehabil. 2007;29(11-12):873-81. doi: 10.1080/09638280701455494.
The aim of this study was to evaluate an out-patient attention programme based on a short in-patient phase followed by an out-patient interdisciplinary rehabilitation programme.
A prospective quasi-experimental before-and-after study was carried out; a phase 2 trial. The study population consisted of 42 patients who met the inclusion criteria. The Functional Independence Measurement (FIM) was the main outcome, and the American Spinal Injury Association (ASIA) motor scores and morbidity the secondary ones. The intervention was a two-phase goal-based interdisciplinary programme which consisted of a hospital and an ambulatory phase. After an evaluation upon admission to hospital, follow-up was carried out 1, 3, 6, 12 and 18 months later.
Initially, 208 patients were evaluated and only 42 completed the study. The in-patient phase was short (average: 13.5 days) and the out-patient phase lasted 18 months. Motor FIM scores progressively increased from 25/91 up to 69/91 (p < 0.01). Some 25% of the patients had pressure sores at 1 month, and 11.9% still had them after 18 months. Pain was the most frequent complication, in 80% of patients by the third month. Urinary and fecal continence improved during follow-up (74% at 18 months and 81.1% at 12 months, respectively).
Good functional evolution of SCI patients and low morbidity can be obtained with a low-cost out-patient rehabilitation programme. Such a programme must emphasize patient and family education concerning self-care and possible SCI complications.
本研究旨在评估一项门诊关注计划，该计划基于短期住院阶段，随后是门诊多学科康复计划。
进行了一项前瞻性前后对照准实验研究；一项2期试验。研究人群包括42名符合纳入标准的患者。功能独立性测量（FIM）是主要结局指标，美国脊髓损伤协会（ASIA）运动评分和发病率是次要指标。干预措施是一个基于目标的两阶段多学科计划，包括住院阶段和门诊阶段。入院评估后，在1、3、6、12和18个月后进行随访。
最初评估了208名患者，只有42名完成了研究。住院阶段较短（平均：13.5天），门诊阶段持续18个月。运动FIM评分从25/91逐步提高到69/91（p<0.01）。约25%的患者在1个月时有压疮，18个月后仍有11.9%的患者有压疮。疼痛是最常见的并发症，到第三个月时80%的患者出现疼痛。随访期间尿失禁和大便失禁情况有所改善（18个月时分别为74%，12个月时为81.1%）。
通过低成本的门诊康复计划可以使脊髓损伤患者获得良好的功能进展且发病率较低。这样的计划必须强调对患者及其家属进行自我护理和可能的脊髓损伤并发症方面的教育。
