针对多发伤患者的综合“快速通道”康复服务的效果：荷兰的一项非随机临床试验
Effects of an Integrated 'Fast Track' Rehabilitation Service for Multi-Trauma Patients: A Non-Randomized Clinical Trial in the Netherlands.
作者信息
Bouman Ans I E, Hemmen Bea, Evers Silvia M A A, van de Meent Henk, Ambergen Ton, Vos Pieter E, Brink Peter R G, Seelen Henk A M
机构信息
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Caphri, School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands.
出版信息
PLoS One. 2017 Jan 11;12(1):e0170047. doi: 10.1371/journal.pone.0170047. eCollection 2017.
OBJECTIVES
The effects on health related outcomes of a newly-developed rehabilitation program, called 'supported Fast Track multi-trauma rehabilitation service' (Fast Track), were evaluated in comparison with conventional trauma rehabilitation service (Care as Usual).
METHODS
Prospective, multi-center, non-randomized controlled study. Between 2009 and 2012, 132 adult multi-trauma patients were included: 65 Fast Track and 67 Care as Usual patients with an Injury Severity Score ≥16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures. The Fast Track program involved: integrated coordination between trauma surgeon and rehabilitation physician, shorter stay in hospital with faster transfer to a specialized trauma rehabilitation unit, earlier start of multidisciplinary treatment and 'non-weight bearing' mobilization. Primary outcomes were functional status (FIM) and quality of life (SF-36) measured through questionnaires at baseline, 3, 6, 9 and 12 months post-trauma. Outcomes were analyzed using a linear mixed-effects regression model.
RESULTS
The FIM scores significantly increased between 0 and 3 months (p<0.001) for both groups showing that they had improved overall, and continued to improve between 3 and 6 months for Fast Track (p = 0.04) and between 3 and 9 months for Care as Usual (p = 0.03). SF-36 scores significantly improved in both groups between 3 and 6 months (Fast Track, p<0.001; Care as Usual, p = 0.01). At 12 months, SF-36 scores were still below (self-reported) baseline measurements of patient health prior to the accident. However, the FIM and SF-36 scores differed little between the groups at any of the measured time points.
CONCLUSION
Both Fast Track and Care as Usual rehabilitation programs were effective in that multi-trauma patients improved their functional status and quality of life. A faster (maximum) recovery in functional status was observed for Fast Track at 6 months compared to 9 months for Care as Usual. At twelve months follow-up no differential effects between treatment conditions were found.
TRIAL REGISTRATION
ISRCTN68246661.
目的
评估一项名为“支持性快速多创伤康复服务”（快速通道）的新开发康复项目对健康相关结局的影响，并与传统创伤康复服务（常规护理）进行比较。
方法
前瞻性、多中心、非随机对照研究。2009年至2012年期间，纳入了132例成年多创伤患者：65例接受快速通道康复项目，67例接受常规护理，损伤严重程度评分≥16分，多部位复杂多发伤或复杂骨盆和/或髋臼骨折。快速通道康复项目包括：创伤外科医生与康复医生之间的综合协调、缩短住院时间并更快转至专业创伤康复单元、更早开始多学科治疗以及“不负重”活动。主要结局指标为创伤后基线、3个月、6个月、9个月和12个月时通过问卷调查测量的功能状态（FIM）和生活质量（SF-36）。采用线性混合效应回归模型分析结局指标。
结果
两组在0至3个月之间FIM评分均显著提高（p<0.001），表明总体有所改善；快速通道组在3至6个月之间持续改善（p = 0.04），常规护理组在3至9个月之间持续改善（p = 0.03）。两组在3至6个月之间SF-36评分均显著改善（快速通道组，p<0.001；常规护理组，p = 0.01）。在12个月时，SF-36评分仍低于事故前患者健康状况的（自我报告）基线测量值。然而，在任何测量时间点，两组之间的FIM和SF-36评分差异均不大。
结论
快速通道康复项目和常规护理康复项目均有效，多创伤患者的功能状态和生活质量均有所改善。与常规护理组9个月时相比，快速通道组在6个月时功能状态恢复更快（达到最大值）。在12个月随访时，未发现不同治疗条件之间存在差异效应。
试验注册
ISRCTN68246661
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