Wade Derick
Clin Rehabil. 2016 Feb;30(2):109-18. doi: 10.1177/0269215515601177.
This editorial proposes changes in healthcare services that should greatly improve the health status of all patients with disability. The main premises are that: rehabilitation usually involves many actions delivered by many people from different organisations over a prolonged period; specific rehabilitation actions cover a wide range of professional activities, with face to face therapy only being one; and the primary patient activity that improves function is practice of personally relevant activities in a safe environment. This editorial argues that: rehabilitation should occur at all times and in all settings, in parallel with medical care in order to maximise recovery and to avoid loss of fitness, skills and confidence associated with rest and being cared for; hospitals and other healthcare settings should adapt the environment to encourage practice of activities at all times; and that measuring rehabilitation, whether in research or for re-imbursement, should not simply consider face-to-face 'therapy time' but must include: all the other important activities undertaken by the team; 'structures' such as the appropriateness of the environment; and a process measure of the time spent by patients undertaking activities.
本社论提议对医疗服务进行变革，这应能极大改善所有残疾患者的健康状况。主要前提如下：康复通常涉及众多人员从不同组织在较长时期内开展的诸多行动；特定的康复行动涵盖广泛的专业活动，面对面治疗只是其中之一；而改善功能的主要患者活动是在安全环境中进行与个人相关的活动实践。本社论认为：康复应在所有时间和所有场所进行，与医疗护理并行，以最大限度地促进康复，并避免与休息和接受护理相关的体能、技能及信心丧失；医院和其他医疗场所应调整环境，以鼓励患者随时进行活动实践；并且，无论是在研究中还是为了报销而衡量康复情况时，不应仅考虑面对面的“治疗时间”，还必须包括：团队开展的所有其他重要活动；诸如环境适宜性等“结构”因素；以及对患者进行活动所花费时间的过程性衡量。
