Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, NL-1007 MB Amsterdam, The Netherlands. E-mail:
J Rehabil Med. 2014 Jun;46(6):527-31. doi: 10.2340/16501977-1797.
Despite beneficial effects on communication and process measures, client-centred practice has been shown to result in poor functional outcomes. To examine a potential explanation for poor functional outcomes, this paper aims to assess whether in client-centred therapy more time is spent on diagnostic consultation and less time on actual treatment compared to usual care.
A multicentre cluster randomised controlled trial was performed. Thirteen hospitals and rehabilitation centres, 29 therapists and 269 outpatients with multiple sclerosis participated. Measurements included an inventory of diagnostic and treatment goals, the number of sessions, therapy duration and therapy intensity.
In client-centred therapy, more sessions were used for diagnostic consultation (10.9% points difference, p = 0.030); the time needed to formulate the first treatment goal was longer (11.4 days difference, p = 0.041); there was a tendency towards more goals directed to diagnostic issues (0.69 goals difference, p = 0.056), spending more hours on indirect issues (1.16 h difference, p = 0.051) and towards a longer total therapy period (1.56 months difference, p = 0.058) than in usual care.
Client-centred therapy resulted in more intensive diagnostic evaluation and less intensive treatment. This suggests that client-centred therapy should be adjusted towards a more proportional distribution of time devoted to diagnostic evaluation versus actual treatment.
尽管以患者为中心的实践在沟通和流程措施方面具有有益效果，但已表明其导致功能结局较差。为了研究功能结局较差的潜在原因，本文旨在评估在以患者为中心的治疗中，与常规护理相比，是否在诊断咨询上花费更多时间，而在实际治疗上花费更少时间。
进行了一项多中心集群随机对照试验。共有 13 家医院和康复中心、29 名治疗师和 269 名多发性硬化症门诊患者参与了该试验。测量包括诊断和治疗目标清单、疗程、治疗持续时间和治疗强度。
在以患者为中心的治疗中，用于诊断咨询的疗程更多（差异为 10.9%，p=0.030）；制定第一个治疗目标所需的时间更长（差异为 11.4 天，p=0.041）；更多地针对诊断问题制定目标（差异为 0.69 个目标，p=0.056），在间接问题上花费更多时间（差异为 1.16 小时，p=0.051），以及总治疗时间更长（差异为 1.56 个月，p=0.058），与常规护理相比。
以患者为中心的治疗导致更密集的诊断评估和治疗强度降低。这表明，应该对以患者为中心的治疗进行调整，使其在诊断评估与实际治疗之间的时间分配更加均衡。
