Huang Hsing-Ching, Bih Liu-Ing, Tsai Ming-Miau, Chang Tzu-Ling, Liao Wan-Chun, Lai Chung-Liang
Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
Department of Occupational Therapy, Asia University, Taichung, Taiwan.
Int J Gen Med. 2023 May 4;16:1653-1659. doi: 10.2147/IJGM.S407532. eCollection 2023.
Traumatic brain injury (TBI) can result in functional impairments. Many patients with TBI require post-acute care to improve their functional skills and allow for greater self-independence and a better quality of life. Taiwan's National Health Insurance proposed a nationwide post-acute care program in 2017 for patients with traumatic brain injury. The program's goal was to maximize patients' functional recovery and make it possible for them to return to their homes and communities. This study aimed to explore the effectiveness of such programs in Taiwan.
This pilot study retrospectively evaluated a de-identified database that contained the scores of various assessments evaluated at admission and discharge. It used the data to determine the functional improvement of patients with traumatic brain injury after participating in post-acute care programs.
This study collected complete data from 27 patients. After an average of 45.11 days in the program, the patients showed significant improvement in the Barthel Activity Daily Living Index, the Lawton-Brody Instrumental Activity Daily Living Scale, the Mini Nutrition Assessment, the EuroQol Five Dimensions Questionnaire, the Berg Balance Scale, the Galveston Orientation and Amnesia Test, the Rancho Los Amigos Scale, the Concise Chinese Aphasia Test, and the Mini Mental State Examination. After discharge, 96% of the patients could return to their community.
This pilot study concluded that the program significantly promoted functional recovery for patients and could help patients with traumatic brain injury return to their communities and reduce the risk of institutionalization. Thus, patients with the potential for functional recovery could receive post-acute care in regional or community hospitals immediately after being discharged from acute wards. In the future randomized controlled trials are needed to further confirm the clinical impact of this program.
创伤性脑损伤（TBI）可导致功能障碍。许多TBI患者需要急性后期护理来提高其功能技能，实现更大程度的自理并改善生活质量。台湾地区的国民健康保险于2017年为创伤性脑损伤患者推出了一项全国性急性后期护理计划。该计划的目标是使患者的功能恢复最大化，并使其能够重返家庭和社区。本研究旨在探讨此类计划在台湾地区的有效性。
这项试点研究回顾性评估了一个经过去识别处理的数据库，该数据库包含入院和出院时各项评估的得分。研究利用这些数据来确定创伤性脑损伤患者参与急性后期护理计划后的功能改善情况。
本研究收集了27名患者的完整数据。在该计划中平均接受45.11天的护理后，患者在巴氏日常生活活动指数、洛顿-布罗迪工具性日常生活活动量表、简易营养评估、欧洲五维健康量表、伯格平衡量表、加尔维斯顿定向遗忘测试、兰乔斯阿米戈斯量表、汉语失语症简明测试和简易精神状态检查表方面均有显著改善。出院后，96%的患者能够回到社区。
这项试点研究得出结论，该计划显著促进了患者的功能恢复，并有助于创伤性脑损伤患者重返社区，降低机构化风险。因此，具有功能恢复潜力的患者在从急性病房出院后可立即在地区或社区医院接受急性后期护理。未来需要进行随机对照试验以进一步证实该计划的临床影响。
