Investigation of burn rehabilitation development of China in 2014
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摘要: 目的 深入了解我国烧伤康复发展状况,以更好地促进我国烧伤康复事业的发展。 方法 2014年底,由中国康复医学会烧伤治疗与康复学专业委员会(以下简称专委会)发起,对我国65家专委会委员单位进行了烧伤康复治疗开展情况的问卷调查。共计26个问题,这些问题主要针对:(1)所在单位烧伤科的一般情况,包括编制床位数、年收治烧伤患者数、年收治特重度烧伤患者数、医师数、护士数、康复治疗师数、有无康复场地、有无康复床位等。(2)烧伤康复治疗开展情况,包括康复工作开展情况、康复治疗介入时间、ICU内康复治疗开展情况、康复治疗人员组成情况,以及康复治疗师的职称、专业背景、学历情况、职责分工等。(3)影响所在单位烧伤康复工作开展的主要问题。按年收治患者数对烧伤救治单位进行分组,统计各组单位编制床位数,患者收治及医疗人员、康复配置情况,床位与医师数比,床位与护士数比,床位与专职康复治疗人员数比。对数据行
t 检验、单因素方差分析、χ 2检验。 结果 (1)共发出调查问卷65份,回收45份(69.2%)。回复调查问卷的45家单位中,35家为烧伤救治单位。(2)按年收治患者数将35家烧伤救治单位分为500例以下组8家、501~1 000例组11家、1 001~1 500例组10家、1 500例以上组6家。1 001~1 500例组单位的编制床位数显著多于500例以下组(t =4.563,P <0.05),1 500例以上组单位的编制床位数显著多于其余3组(t 值为1.859~3.743,P 值均小于0.05)。501~1 000例组、1 001~1 500例组、1 500例以上组单位年收治患者数明显多于500例以下组(t 值为6.027~12.684,P 值均小于0.05),1 001~1 500例组、1 500例以上组单位年收治患者数明显多于501~1 000例组(t 值分别为7.408、6.980,P 值均小于0.05),1 500例以上组单位年收治患者数明显多于1 001~1 500例组(t =4.239,P <0.05)。4组单位年收治特重度烧伤患者数、有康复场地、有康复床位情况相近(F =0.820,χ 2值分别为5.266、2.848,P 值均大于0.05)。1 500例以上组单位医师数显著多于500例以下组(t =2.836,P <0.05)。1 001~1 500例组单位护士数显著多于500例以下组(t =2.837,P <0.05),1 500例以上组单位护士数、康复治疗师数显著多于其余3组(t 值为1.762~4.789,P 值均小于0.05)。(3)35家烧伤救治单位均能够为烧伤患者提供至少1项康复治疗,其中体位摆放、关节活动训练、红外线照射、水疗、功能训练、日常生活活动训练、瘢痕按摩、瘢痕内药物注射开展较好,而心理治疗、音乐治疗、职业康复、社会康复等多数未开展。(4)仅有9家(25.7%)烧伤救治单位在患者伤后3 d内介入康复治疗。(5)27家(77.1%)烧伤救治单位能够在ICU内开展体位摆放。(6)23家烧伤救治单位拥有专职康复治疗人员,按年收治患者数分为500例以下组1家、501~1 000例组8家、1 001~1 500例组9家、1 500例以上组5家。1 500例以上组单位床位数与医师数比显著高于501~1 000例组(t =2.810,P <0.05),1 001~1 500例组单位床位数与医师数比与501~1 000例组相近(t =1.506,P >0.05)。4组单位床位数与护士数比、床位数与专职康复治疗人员数比相近(F 值分别为0.783、0.434,P 值均大于0.05)。(7)20家烧伤救治单位有康复治疗相关专业背景的康复治疗师(共73人,占76.0%),其中康复治疗专业人员占80.8%(59/73),本科及以上学历人员占60.3%(44/73),初、中级职称人员占87.7%(64/73)。39.7%(29/73)的康复治疗师从事的是物理治疗师工作,12.3%(9/73)的康复治疗师从事作业治疗师工作,38.4%(28/73)的康复治疗师未明确具体职责。(8)35家烧伤救治单位的烧伤康复工作在开展过程中,普遍的困难反映在康复治疗相关人员的编制、专业技术水平以及开展康复治疗的场地、设备方面。烧伤外科医师与康复治疗师的配合及资金方面也存在不少问题。医院、科室领导的支持较好。 结论 通过几年的发展,我国烧伤救治单位一般情况及康复治疗开展情况均得到了一定的改善,烧伤康复介入时间提前,从业人员数量增加、专业性提高,烧伤康复工作得到了来自医院、科室的大力支持。Abstract: Objective To further study the development of burn rehabilitation in China, so as to promote the development of burn rehabilitation in China. Methods The questionnaire about the development of burn rehabilitation treatment was started by Specialized Committee of Burn Treatment and Rehabilitation Science of Chinese Association of Rehabilitation Medicine (hereinafter referred to as Specialized Committee) in the end of 2014, and 65 affiliations of Specialized Committee members participated in. There was a total of 26 questions, mainly focusing on problems as below: (1) General information of the burn department of the units, including the number of authorized beds, annual admitted burn patients, annual admitted patients with extremely severe burn, doctors, nurses, rehabilitation therapists, and the condition of rehabilitation area and rehabilitation beds, etc. (2) Development of burn rehabilitation treatment, including the development of rehabilitation treatment, the intervention time of rehabilitation treatment, the rehabilitation treatment carried out in intensive care unit (ICU), the composition of rehabilitation treating personnel, and the professional title and background, educational background, and division of responsibilities of rehabilitation therapists, etc. (3) Major problems affecting the development of burn rehabilitation treatment of the units. The burn treatment units were grouped according to the number of annual admitted patients. The units′ situation of authorized beds, admitted patients, allocation of medical personnel and rehabilitation, and the ratio of beds to doctors, beds to nurses, beds to full-time burn rehabilitation treating personnel were recorded. Data were processed witht test, one-way analysis of variance, and chi-square test. Results (1) A total of 65 questionnaires were sent, and 45 questionnaires (69.2%) were retrieved. Among the 45 units that replied the questionnaires, 35 units were burn treatment units. (2) The 35 burn treatment units were divided into less than 500 cases group (n =8), 501-1 000 cases group (n =11), 1 001-1 500 cases group (n =10), and more than 1 500 cases group (n =6) according to the number of annual admitted patients. The number of authorized beds of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group (t =4.563,P <0.05). The number of authorized beds of units in more than 1 500 cases group was significantly more than that in the other 3 groups, respectively (witht values from 1.859 to 3.743,P values below 0.05). The number of annual admitted patients of units in 501-1 000 cases group, 1 001-1 500 cases group, and more than 1 500 cases group was dramatically more than that in less than 500 cases group (witht values from 6.027 to 12.684,P values below 0.05). The number of annual admitted patients of units in 1 001-1 500 cases group and more than 1 500 cases group was significantly more than that in 501-1 000 cases group (witht values respectively 7.408 and 6.980,P values below 0.05). The number of annual admitted patients of units in more than 1 500 cases group was significantly more than that in 1 001-1 500 cases group (t =4.239,P <0.05). The number of annual admitted patients with extremely severe burn and the condition of rehabilitation area and rehabilitation beds of units in the 4 groups was similar (F =0.820, withχ 2 values respectively 5.266 and 2.848,P values above 0.05). The number of doctors of units in more than 1 500 cases group was significantly more than that in less than 500 cases group (t =2.836,P <0.05). The number of nurses of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group (t =2.837,P <0.05). The number of nurses and that of rehabilitation therapists of units in more than 1 500 cases group were significantly more than those in the other 3 groups (witht values from 1.762 to 4.789,P values below 0.05). (3) The 35 burn treatment units were able to provide at least one rehabilitation treatment for patients, among which body positioning, motion of joint exercise, infrared ray irradiation, hydrotherapy, function training, activities of daily life training, scar massage, and drug injection in scar were carried out well, while psychological therapy, music therapy, occupational rehabilitation, and social rehabilitation were mostly not carried out. (4) Only 9 (25.7%) burn treatment units started rehabilitation treatment for patients within 3 days after injury. (5) Twenty-seven (77.1%) burn treatment units could carry out body positioning in ICU. (6) Twenty-three burn treatment units had full-time rehabilitation treating personnel, and the units were divided into less than 500 cases group (n =1), 501-1 000 cases group (n =8), 1 001-1 500 cases group (n =9), and more than 1 500 cases group (n =5) according to the number of annual admitted patients. The ratio of beds to doctors of units in more than 1 500 cases group was significantly higher than that in 501-1 000 cases group (t =2.810,P <0.05) and the ratios of beds to doctors of units in 501-1 000 cases group and 1 001-1 500 cases group were similar (t =1.506,P >0.05). The ratios of beds to nurses and beds to full-time burn rehabilitation treating personnel in 4 groups were similar (withF values respectively 0.783 and 0.434,P values above 0.05). (7) Twenty burn treatment units had rehabilitation therapists with rehabilitation treatment related professional background (a total of 73 person, account for 76.0%), 80.8% (59/73) rehabilitation therapists with rehabilitation and therapeutic professions, 60.3% (44/73) with bachelor degree or above, and 87.7% (64/73) with primary and intermediate titles. Besides, 39.7% (29/73) rehabilitation therapists did physical therapy; 12.3% (9/73) rehabilitation therapists did occupational therapy; 38.4% (28/73) rehabilitation therapists did not have specific duties. (8) During the development of burn rehabilitation treatment of 35 burn treatment units, the common problems were reflected in the authorized strength and professional technology level of rehabilitation treatment relating personnel, and the area and equipment for rehabilitation. There were also many problems in cooperation between burn surgeons and rehabilitation therapists and fund. The supports from hospital and department leaders were good. Conclusions Through the development of several years, the general condition and the development of rehabilitation treatment of burn treatment units in China are improved; the beginning time of burn rehabilitation treatment is advanced; the number of rehabilitation treatment personnel is increased with their speciality improved; the burn rehabilitation work get great support from hospitals and departments.-
Key words:
- Burns /
- Rehabilitation /
- Questionnaires /
- Development
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