测量创伤后急性康复需求：康复复杂性量表的初步评估。
Measuring acute rehabilitation needs in trauma: preliminary evaluation of the Rehabilitation Complexity Scale.
机构信息
Trauma Clinical Academic Unit, Blizard Institute of Cell and Molecular Science, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
出版信息
Injury. 2013 Jan;44(1):104-9. doi: 10.1016/j.injury.2011.11.001. Epub 2011 Nov 29.
BACKGROUND
Injury severity, disability and care dependency are frequently used as surrogate measures for rehabilitation requirements following trauma. The true rehabilitation needs of patients may be different but there are no validated tools for the measurement of rehabilitation complexity in acute trauma care. The aim of the study was to evaluate the potential utility of the Rehabilitation Complexity Scale (RCS) version 2 in measuring acute rehabilitation needs in trauma patients.
METHODS
A prospective observation study of 103 patients with traumatic injuries in a Major Trauma Centre. Rehabilitation complexity was measured using the RCS and disability was measured using the Barthel Index. Demographic information and injury characteristics were obtained from the trauma database.
RESULTS
The RCS was closely correlated with injury severity (r=0.69, p<0.001) and the Barthel Index (r=0.91, p<0.001). However the Barthel was poor at discriminating between patients rehabilitation needs, especially for patients with higher injury severities. Of 58 patients classified as 'very dependent' by the Barthel, 21 (36%) had low or moderate rehabilitation complexity. The RCS correlated with acute hospital length of stay (r=0.64, p=<0.001) and patients with a low RCS were more likely to be discharged home. The Barthel which had a flooring effect (56% of patients classified as very dependent were discharged home) and lacked discrimination despite close statistical correlation.
CONCLUSION
The RCS outperformed the ISS and the Barthel in its ability to identify rehabilitation requirements in relation to injury severity, rehabilitation complexity, length of stay and discharge destination. The RCS is potentially a feasible and useful tool for the assessment of rehabilitation complexity in acute trauma care by providing specific measurement of patients' rehabilitation requirements. A larger longitudinal study is needed to evaluate the RCS in the assessment of patient need, service provision and trauma system performance.
背景
伤害严重程度、残疾和护理依赖通常被用作创伤后康复需求的替代指标。但患者的真实康复需求可能有所不同，目前还没有用于测量急性创伤护理中康复复杂性的经过验证的工具。本研究旨在评估康复复杂性量表（RCS）第 2 版在测量创伤患者急性康复需求方面的潜在效用。
方法
对一家大型创伤中心的 103 名创伤患者进行前瞻性观察研究。使用 RCS 测量康复复杂性，使用 Barthel 指数测量残疾程度。从创伤数据库中获取人口统计学信息和损伤特征。
结果
RCS 与损伤严重程度（r=0.69，p<0.001）和 Barthel 指数（r=0.91，p<0.001）密切相关。然而，Barthel 指数在区分患者的康复需求方面表现不佳，尤其是对于损伤严重程度较高的患者。在根据 Barthel 指数被归类为“非常依赖”的 58 名患者中，有 21 名（36%）的康复复杂性较低或中等。RCS 与急性住院时间长短呈正相关（r=0.64，p<0.001），且康复复杂性较低的患者更有可能出院回家。Barthel 指数虽然具有统计学相关性，但存在地板效应（56%被归类为非常依赖的患者出院回家），缺乏区分度。
结论
RCS 在识别与损伤严重程度、康复复杂性、住院时间和出院去向相关的康复需求方面优于 ISS 和 Barthel 指数。RCS 可能是一种可行且有用的工具，可用于评估急性创伤护理中的康复复杂性，提供患者康复需求的具体测量。需要进行更大的纵向研究来评估 RCS 在评估患者需求、服务提供和创伤系统性能方面的作用。
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