Heinemann Allen W, Wilson Catherine S, Huston Toby, Koval Jill, Gordon Samuel, Gassaway Julie, Kreider Scott E D, Whiteneck Gale
Rehabilitation Institute of Chicago, Chicago, IL, USA.
J Spinal Cord Med. 2012 Nov;35(6):578-92. doi: 10.1179/2045772312Y.0000000059.
To evaluate the effects of psychological interventions on rehabilitation outcomes, including residence and functional status at discharge, and residence, school attendance, or employment, and physical, social, occupational, and mobility aspects of participation 1 year after spinal cord injury (SCI).
Prospective observational cohort study.
Six inpatient rehabilitation facilities in the United States.
Inpatients with SCI 12 years of age and older.
Usual rehabilitation care.
Functional Independence Measure at rehabilitation discharge and 1-year injury anniversary; discharge destination and residence at 1-year anniversary; Craig Handicap Assessment and Reporting Technique, Diener Satisfaction with Life Scale, Patient Health Questionnaire, employment or school attendance, rehospitalization, and occurrence of a pressure ulcer at 1-year anniversary.
More time in psycho-educational interventions was associated with better function, discharge to home, home residence at 1 year, and the absence of pressure ulcers at 1 year. More psychotherapeutic sessions focusing on processing emotions and/or locus of control were associated with poorer function at discharge and 1 year, less physical independence and community mobility, lower satisfaction with life, and the presence of pressure sores at 1 year.
Psychological services are an important component of comprehensive medical rehabilitation and tailored to patient needs and readiness to benefit from rehabilitation. Services focused on remediating deficits tend to be associated with negative outcomes, while services intended to foster adjustment and growth tend to be associated with favorable outcomes. Further research is needed to determine the optimal type and timing of psychological services during inpatient rehabilitation based on individuals' strengths and vulnerabilities. Note: This is the sixth in this third series of SCIRehab articles.
评估心理干预对康复结局的影响，包括出院时的居住情况和功能状态，以及脊髓损伤（SCI）1年后的居住情况、上学或就业情况，以及参与的身体、社会、职业和活动方面。
前瞻性观察队列研究。
美国的六家住院康复机构。
12岁及以上的SCI住院患者。
常规康复护理。
康复出院时及受伤1周年时的功能独立性测量；1周年时的出院目的地和居住情况；克雷格障碍评估与报告技术、迪纳生活满意度量表、患者健康问卷、就业或上学情况、再次住院情况，以及1周年时压疮的发生情况。
接受心理教育干预的时间越长，功能恢复越好、出院回家的可能性越大、1年后居家居住的可能性越大，且1年后发生压疮的可能性越小。更多聚焦于情绪处理和/或控制点的心理治疗疗程与出院时及1年后较差的功能、较低的身体独立性和社区活动能力、较低的生活满意度以及1年后存在压疮有关。
心理服务是综合医学康复的重要组成部分，应根据患者需求和从康复中获益的准备情况进行调整。侧重于弥补缺陷的服务往往与负面结果相关，而旨在促进适应和成长的服务往往与良好结果相关。需要进一步研究以根据个体的优势和弱点确定住院康复期间心理服务的最佳类型和时机。注：这是SCIRehab系列文章第三辑中的第六篇。
