Pachalska M, Talar J, Frańczuk B, Grochmal-Bach B, Krasuski M, Tomaszewski W
Oddział Rehabilitacji Medycznej, Krakowskie Centrum Rehabilitacji, Kraków.
Ortop Traumatol Rehabil. 2001 Jan-Mar;3(1):89-99.
Background. This article presents an evaluation of the strategic approach to managing rehabilitation for patients with high spinal cord injuries. The strategic approach is founded on the assumption that particular rehabilitation procedures should be applied in accordance with a strategic plan, which is developed in terms of the overarching goal of rehabilitation, understood as enabling the appropriate mechanism of adaptation and compensation. Consistent pursuit of this goal, instead of merely reacting to successive crises and problem situations as they arise, enables the patient to achieve greater independence, and thus a better quality of life. In order to adjust the strategic plan to the individual needs of the patient, it is developed in a series of steps: 1) comprehensive analysis of the patient's current status and situation; 2) establishment by negotiation of a target situation (overarching goal); 3) selection of subordinate goals leading systematically to the realization of the overarching goal; 4) establishment of a schedule for the realization of subordinate goals; 5) regular monitoring of goal performance and performobility.
Material and methods. The effectiveness of the strategic approach was evaluated in a clinical experiment involving 68 patients wit tetraplegia, who underwent surgery subsequent to spinal cord injury (SCI) at the level of the cervical vertebrae (C2-C7), and were treated in the centers represented by the authors. The patients were divided by matching for age and sex into two groups: a control group (K) of 34 patients whose rehabilitation was conducted without reference to a strategic plan, and an experimental group (E)of 34 patients who had such a plan. The methods used to measure the outcomes obtained by the patients in rehabilitation included clinical observation, the Polish version of the standard Functional Independence Measure (FIM), and a Self-Evaluating Scale of Progress in Rehabilitation. The patients were tested twice, once before beginning rehabilitation, and again 6 months later.
Analysis of results. In both group similar progress was recorded in certain parameters of the FIM scale, which points up the effectiveness of the therapeutic procedures used in comprehensive rehabilitation; in group E, however, much greaterprogress was noted in terms of functional independence and psycho-social functioning. The patients from group E were much more content with the results they had achieved in rehabilitation.
Conclusions. The results reported here justify the assertion that the strategic approach to the rehabilitation of patients with high cervical SCI makes the most of the benefits provided by the procedures applied, without the necessity to make fundamental changes in procedures or employ additional personel, acquire new equipment, etc. The strategic approach helps the patient attain better results in becoming independent, and gives grounds for greater satisfaction with the results obtained in rehabilitation, which in run increases motivation to take an active part in exercises and other procerdures. It also assures the patient the basic right to make fundamentally important decisions in the course of his own treatment, which is consistent with the Patient Bill of Rights and the requirements of 21st-century medicine.
背景。本文对高位脊髓损伤患者康复管理的战略方法进行了评估。该战略方法基于这样一种假设，即应根据战略计划应用特定的康复程序，该计划是根据康复的总体目标制定的，康复的总体目标被理解为实现适当的适应和补偿机制。持续追求这一目标，而不是仅仅对相继出现的危机和问题情况做出反应，能使患者获得更大的独立性，从而提高生活质量。为了使战略计划符合患者的个体需求，需分一系列步骤制定：1）对患者当前状况和情况进行全面分析；2）通过协商确定目标状况（总体目标）；3）选择有助于系统实现总体目标的从属目标；4）制定实现从属目标的时间表；5）定期监测目标完成情况和执行能力。
材料与方法。在一项临床实验中评估了该战略方法的有效性，该实验涉及68例四肢瘫痪患者，他们在颈椎（C2 - C7）水平脊髓损伤（SCI）后接受了手术，并在作者所在的中心接受治疗。根据年龄和性别匹配将患者分为两组：34例患者组成的对照组（K），其康复治疗未参照战略计划；34例患者组成的实验组（E），其有这样的计划。用于衡量患者康复治疗结果的方法包括临床观察、波兰语版标准功能独立性测量（FIM）以及康复进展自我评估量表。患者在康复开始前和6个月后各测试一次。
结果分析。在FIM量表的某些参数方面，两组都记录了相似的进展，这表明综合康复中所采用治疗程序的有效性；然而，在实验组（E）中，在功能独立性和心理 - 社会功能方面取得了更大的进展。实验组（E）的患者对他们在康复中取得的结果更满意。
结论。此处报告的结果证明了这样一种观点，即高位颈髓损伤患者康复的战略方法充分利用了所应用程序带来的益处，而无需对程序进行根本性改变或增加人员、购置新设备等。该战略方法有助于患者在实现独立方面取得更好的结果，并使患者有理由对康复结果更满意，这进而增加了患者积极参与锻炼和其他程序的动力。它还确保患者在其自身治疗过程中有做出至关重要决策的基本权利，这符合患者权利法案和21世纪医学的要求。
