Mills Jody-Anne, Marks Elanie, Reynolds Teri, Cieza Alarcos
The World Health Organization (WHO) has defined rehabilitation as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions, in interaction with their environment” (Nas and others 2015, 1). Rehabilitation interventions optimize well-being by addressing impairments, limitations, and restrictions in many areas (areas as disparate as mobility, vision, and cognition), as well as by considering personal and environmental factors (Nas and others 2015). Individuals with health conditions or injuries may require rehabilitation across the course of their lifespan. The timing and type of intervention that a rehabilitation provider selects depend greatly on several factors. These include the etiology and severity of the person’s health condition, the prognosis, the way in which the person’s condition affects the person’s ability to function in the environment, as well as the individual’s identified personal goals. Rehabilitation services may be delivered in any setting (including in hospitals and in communities), depending on individuals’ needs and situation. In hospitals, acute rehabilitation is particularly important in facilitating recovery, maximizing the effect of emergency and surgical services, preventing complications, and ensuring that the optimal functional outcome is achieved. Rehabilitation in the community similarly aims to optimize functioning in those who are not in the hospital system, to identify needs, and to provide services in a person’s typical environment. Community rehabilitation services frequently are accessed by those with chronic health conditions or sensory impairment, as well as by children with developmental conditions. The demand for community- and hospital-based rehabilitation services will continue to grow as the result of several factors. First is the significant epidemiological transition and demographic shift underway globally (Dalal and others 2015; Dias and others 2013; GBD 2015 Disease and Injury Incidence and Prevalence Collaborators 2016). Second, as access to care expands to universal health coverage, rehabilitation is essential for maximizing the effectiveness of a range of medical and surgical interventions. Finally, injuries (which remain an escalating public health concern in some countries) also contribute substantially to the demand for rehabilitation services (WHO 2014). These factors suggest that the positive health, social, and economic effects of rehabilitation will have a more profound influence on population health in coming years (WHO 2016a).
世界卫生组织（WHO）将康复定义为“旨在使健康状况有问题的个体在与环境的相互作用中，功能达到最佳并减少残疾的一系列干预措施”（纳斯等人，2015年，第1页）。康复干预措施通过解决许多领域（如行动能力、视力和认知等不同领域）的损伤、功能受限和活动受限问题，以及考虑个人和环境因素，来优化个体的健康状况（纳斯等人，2015年）。患有健康问题或受伤的个体在其一生中可能都需要康复治疗。康复服务提供者选择的干预时机和类型在很大程度上取决于几个因素。这些因素包括个体健康状况的病因和严重程度、预后、个体健康状况影响其在环境中功能的方式，以及个体确定的个人目标。康复服务可以在任何环境中提供（包括医院和社区），这取决于个体的需求和情况。在医院中，急性康复对于促进康复、使急诊和手术服务的效果最大化、预防并发症以及确保实现最佳功能结果尤为重要。社区康复同样旨在使未处于医院系统的个体功能达到最佳，识别需求，并在个体的典型环境中提供服务。患有慢性健康问题或感官障碍的个体，以及患有发育性疾病的儿童，经常会寻求社区康复服务。由于多种因素，对社区和医院康复服务的需求将持续增长。首先是全球正在发生的重大流行病学转变和人口结构变化（达拉尔等人，2015年；迪亚斯等人，2013年；2015年全球疾病负担疾病和损伤发病率及患病率协作组，2016年）。其次，随着医疗服务覆盖范围扩大到全民健康覆盖，康复对于使一系列医疗和外科干预措施的效果最大化至关重要。最后，损伤（在一些国家仍然是日益严重的公共卫生问题）也在很大程度上导致了对康复服务的需求（世界卫生组织，2014年）。这些因素表明，康复对健康、社会和经济的积极影响在未来几年将对人群健康产生更深远的影响（世界卫生组织，2016年a）。
