Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Chongqing Key Lab for Disease Proteomics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Burns. 2013 Mar;39(2):269-78. doi: 10.1016/j.burns.2012.06.016. Epub 2012 Sep 13.
In China, there is a very long history of burn wound treatment, but the specialised burn care units were set up only from 1958. With more than 50 years of practice, great achievements have been made in burn wound care and operations in the country. However, in terms of burn rehabilitation, the development appears to be slow. In order to determine the current status of burn rehabilitation services in China, a survey was conducted to various burn centres in China.
A comprehensive survey was conducted as well as to collect data related to (1) the admissions and staffing of the burn centres; (2) availability of rehabilitation services, number and educational background of specialised personnel dedicated in burn rehabilitation therapy; and (3) the difficulties leading to the lag of the burn rehabilitation services. The survey was sent to the chiefs of 87 burn centres via e-mail and they were requested to fill out the survey questionnaire and to send it back. For those who did not respond within 1 month, a reminder was sent.
There are totally 39 (44.8%) burn centres responding to our survey. These centres were geographically distributed in nearly 70% of the administrative provinces in China; hence, the results could well represent the current burn care system. Most centres have recognised the importance of rehabilitation therapy and remarkable improvements of outcome in burn patients have been achieved. There are a very huge number of burn patients that need rehabilitation therapy, but most centres face the problems of shortage of rehabilitation therapists, which apparently could lead to the difficulties in delivering a quality rehabilitation programme for patients. Although the time of rehabilitation therapy is instituted far earlier than before, it is still not widely accepted in the acute burn care stage. There are more specialists joining the burn centre and becoming members of the professional burn team. However, professional education and training in the burn specialty appear to be sparse. There is room for improvement. Problems that impede the progress of rehabilitation therapy are: lack of rehabilitation knowledge in medical staff as well as the public, the shortage of specialised personnel and relatively low educational background of this team, lack of standard guidelines for rehabilitation treatment instructions and lack of funding from the government.
After 20 years of clinical practice, rehabilitation concepts are well accepted and many forms of rehabilitation techniques are carried out in most burn centres that responded to the survey. Yet, the results also indicate that there is a short history of rehabilitation practice among the burn centres. There is a burning need to enhance the development of rehabilitation services so as to meet the demands of management of severely burned patients in China. Some suggestions are made to improve the current burn rehabilitation services which would include: (1) provide rehabilitation education programmes for burn surgeons, therapists, nurses, as well as patients, families and the public; (2) set up standard guidelines for clinical instruction of rehabilitation therapy; (3) build an interdisciplinary burn team; (4) more investigation and research on the physical and psychological outcomes of burn patients; and (5) implement administrative measures in terms of staffing, funding and offering insurance to burn survivors.
在中国，烧伤创面的治疗历史悠久，但专门的烧伤治疗单位直到 1958 年才成立。经过 50 多年的实践，我国在烧伤创面治疗和手术方面取得了巨大成就。然而，在烧伤康复方面，发展似乎较为缓慢。为了确定中国烧伤康复服务的现状，对中国各烧伤中心进行了调查。
通过电子邮件向 87 家烧伤中心的主任发送了一份全面的调查问卷，以收集与（1）烧伤中心的入院人数和人员配置；（2）康复服务的可用性、专门从事烧伤康复治疗的人员数量和教育背景；以及（3）导致烧伤康复服务滞后的困难相关的数据。对于一个月内未回复的中心，我们会发送提醒。
共有 39 家（44.8%）烧伤中心对我们的调查做出了回应。这些中心在地理上分布在中国近 70%的行政省份，因此，调查结果能够很好地代表当前的烧伤治疗系统。大多数中心都认识到康复治疗的重要性，烧伤患者的治疗效果显著改善。有大量的烧伤患者需要康复治疗，但大多数中心都面临着康复治疗师短缺的问题，这显然会导致为患者提供高质量康复方案的困难。尽管康复治疗的时间比以前更早地开始，但在急性烧伤治疗阶段还没有被广泛接受。越来越多的专家加入烧伤中心，并成为专业烧伤团队的一员。然而，烧伤专业的专业教育和培训似乎还很匮乏。仍有改进的空间。阻碍康复治疗进展的问题有：医务人员和公众缺乏康复知识、专业人员短缺、该团队的教育背景相对较低、缺乏康复治疗指导的标准指南以及缺乏政府资金。
经过 20 年的临床实践，康复理念已被广泛接受，大多数参与调查的烧伤中心都开展了多种康复技术。然而，调查结果也表明，烧伤中心的康复实践历史较短。急需加强康复服务的发展，以满足中国严重烧伤患者的管理需求。我们提出了一些建议，以改善当前的烧伤康复服务，包括：（1）为烧伤外科医生、治疗师、护士以及患者、家属和公众提供康复教育计划；（2）制定康复治疗临床指导的标准指南；（3）建立跨学科烧伤团队；（4）对烧伤患者的身心结果进行更多的调查和研究；（5）在人员配置、资金和为烧伤幸存者提供保险方面实施管理措施。
