Research report on treatment techniques, deadlines and institutional access conditions for early rehabilitation_West China Medical Journal

Authors：

XIE Wei ^1,2,3 , SU Jianhua ^1,2,3 , JI Qiaodan ^2,3 , LIU Sijia ^1,2,3 ,  HE Chengqi ^1,2,3

1. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HE Chengqi, Email: hxkfhcq@126.com

Keywords：

Early rehabilitation; Rehabilitation technology; Deadline; Institutional access conditions

DOI：

10.7507/1002-0179.201807028

Video：

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Objective To explore the common rehabilitation techniques involved in early rehabilitation, early rehabilitation period, and the access conditions of medical institutions for early rehabilitation on the basis of the early rehabilitation data of Chengdu, investigation on some domestic rehabilitation institutions, and expert consultation opinions, to provide a scientific basis for the early rehabilitation of relevant medical institutions. Methods We extracted the data of 130 medical insurance designated institutions in Chengdu for the whole year of 2014 (from January 1st to December 31st), and used the investigation method to study eight common types of clinical rehabilitation diseases (except stroke); went out to investigate the data of eight common types of clinical rehabilitation diseases (except burns) of five hospitals; using expert consultation method, collected 15 experts’ opinions on the early treatment of common clinical rehabilitation, intervention time, rehabilitation costs and so on. Results Common techniques for early rehabilitation included: rehabilitation assessment, acupuncture/electroacupuncture treatment, low-intermediate frequency pulse electrotherapy, pneumatic limb blood circulation promotion treatment, joint loosening training, other massage training, aerobic training, exercise therapy, and occupational therapy. In addition, each disease type also corresponded to special rehabilitation techniques. The early rehabilitation period was 13–14 days for persistent vegetative state (hypoxic ischemic encephalopathy), 11–18 days for fractures, 12–14 days for joint and soft tissue injury, 31–47 days for spinal cord injury, 11–18 days for brain injury, 14–19 days for burn (chemical, electric shock), 10–12 days for hand injury, 9–20 days for peripheral nerve injury, and 13–21 days for stroke. The access conditions for early rehabilitation included: general hospitals above the second level, with independent rehabilitation treatment rooms and rehabilitation wards, with early rehabilitation equipment, qualified full-time rehabilitation physicians and therapists. Conclusions In the common technical aspects of early rehabilitation, each disease has a common technology and also corresponds to special rehabilitation techniques. The early rehabilitation period for most diseases is 2–3 weeks. In order to ensure the quality and safety of early rehabilitation, it is recommended to include the hospital level and professional rehabilitation talent qualifications into the access conditions for early rehabilitation.

Citation： XIE Wei, SU Jianhua, JI Qiaodan, LIU Sijia, HE Chengqi. Research report on treatment techniques, deadlines and institutional access conditions for early rehabilitation. West China Medical Journal, 2018, 33(10): 1224-1231. doi: 10.7507/1002-0179.201807028 Copy

1.	Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pa. Arch Phys Med Rehabil, 2014, 95(5): 986-995.
2.	Stucki G, Stier JM, Grill E, et al. Rationale and principles of early rehabilitation care after an acute injury or illness. Disabil Rehabil, 2005, 27(7/8): 353-359.
3.	Stucki G, Ewert T, Cieza A. Value and application of the ICF in rehabilitation medicine. Disabil Rehabil, 2002, 24(17): 932-938.
4.	Sosnowski K, Lin F, Mitchell ML, et al. Early rehabilitation in the intensive care unit: an integrative literature review. Aust Crit Care, 2015, 28(4): 216-225.
5.	Ring PA. Treatment of trochanteric fractures of femur. Br Med J, 1963, 1(5331): 654-656.
6.	Johnston MV, Keister M. Early rehabilitation for stroke patients: a new look. Arch Phys Med Rehabil, 1984, 65(8): 437-441.
7.	Martínez-Velilla N, Cadore L, Casas-Herrero Á, et al. Physical activity and early rehabilitation in hospitalized elderly medical patients: systematic review of randomized clinical trials. J Nutr Health Aging, 2016, 20(7): 738-751.
8.	Leistner K, Stier-Jarmer M, Berleth B, et al. Early rehabilitation care in the hospital--definition and indication. Results of the expert group "Early Rehabilitation Care in the Hospital". Rehabilitation (Stuttg), 2005, 44(3): 165-175.
9.	Pack QR, Squires RW, Lopez-Jimenez F, et al. Participation rates, process monitoring, and quality improvement among cardiac rehabilitation programs in the United States: a National SURVEY. J Cardiopulm Rehabil Prev, 2015, 35(3): 173-180.
10.	Keener JD, Galatz LM, Stobbs-Cucchi GA, et al. Rehabilitation following arthroscopic rotator cuff repair a prospective randomized trial of immobilization compared with early motion. J Bone Joint Surg Am, 2014, 96A(1): 11-19.
11.	Hashem MD, Parker AM, Needham DM. Early mobilization and rehabilitation of patients who are critically ill. Chest, 2016, 150(3): 722-731.
12.	Lord RK, Mayhew CR, Korupolu R, et al. ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med, 2013, 41(3): 717-724.
13.	Tay-Teo K, Moodie M, Bernhardt J, et al. Economic evaluation alongside a phase Ⅱ, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT). Cerebrovasc Dis, 2008, 26(5): 475-481.
14.	Quack V, Ippendorf AV, Betsch M, et al. Multidisciplinary rehabilitation and fast-track rehabilitation after knee replacement: faster, better, cheaper? A survey and systematic review of literature. Rehabilitation, 2015, 54(4): 245-251.
15.	Varela E, Oral A, Ilieva E, et al. UEMS-PRM section professional practice committee. Musculoskeletal perioperative problems. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med, 2013, 49(5): 753-759.
16.	Schaller SJ, Anstey M, Blobner M, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet (London, England), 2016, 388(152): 1377-1388.
17.	Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke, 2016, 47(6): e98-e169.
18.	Hester JM, Guin PR, Danek GD, et al. The economic and clinical impact of sustained use of a progressive mobility program in a Neuro-ICU. Crit Care Med, 2017, 45(6): 1037-1044.
19.	Wakabayashi H, Maeda K, Shamoto H. Combined intervention of whey protein intake and rehabilitation in female patients with hip fracture in the early postoperative period. Clin Nutr, 2015, 34(6): 1278-1279.
20.	De Groot PE, Hjeltnes N, Heijboer AC, et al. Effect of training intensity on physical capacity, lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured individuals. Spinal Cord, 2003, 41(12): 673-679.
21.	Scivoletto G, Morganti B, Molinari M. Early versus delayed inpatient spinal cord injury rehabilitation: an Italian study. Arch Phys Med Rehabil, 2005, 86(3): 512-516.
22.	Formisano R, Azicnuda E, Sefid MK, et al. Early rehabilitation: benefits in patients with severe acquired brain injury. Neurol Sci, 2017, 38(1): 181-184.
23.	Frazzitta G, Zivi I, Valsecchi R, et al. Effectiveness of a very early stepping verticalization protocol in severe acquired brain injured patients: a randomized pilot study in ICU. PLoS One, 2016, 11(7): e0158030.
24.	Rammelt S, Dürr C, Schneiders W, et al. Minimally invasive fixation of calcaneal fractures. Oper Orthop Traumatol, 2012, 24(4/5): 383-395.
25.	石梦娜, 李娜, 王冰水, 等. 早期超短波联合序贯压力治疗对手深度烧伤后功能恢复的作用. 中华烧伤杂志, 2014, 30(6): 472-476.
26.	Giannicola G, Polimanti D, Bullitta G, et al. Critical time period for recovery of functional range of motion after surgical treatment of complex elbow instability: prospective study on 76 patients. Injury, 2014, 45(3): 540-545.
27.	Ozdemir HM, Biber E, Oğün T. The results of nerve repair in combined nerve-tendon injuries of the forearm. Ulus Travma Acil Cerrahi Derg, 2004, 10(1): 51-56.
28.	Hachem LD, Ahuja CS, Fehlings MG. Assessment and management of acute spinal cord injury: from point of injury to rehabilitation. J Spinal Cord Med, 2017, 40(6): 665-675.
29.	中华人民共和国卫生部. 卫生部关于印发《康复医院基本标准(2012 年版)》的通知. (2012-03-20)[2018-07-01]. http://www.nhfpc.gov.cn/mohyzs/s3578/201204/54557.shtml.

1. Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pa. Arch Phys Med Rehabil, 2014, 95(5): 986-995.
2. Stucki G, Stier JM, Grill E, et al. Rationale and principles of early rehabilitation care after an acute injury or illness. Disabil Rehabil, 2005, 27(7/8): 353-359.
3. Stucki G, Ewert T, Cieza A. Value and application of the ICF in rehabilitation medicine. Disabil Rehabil, 2002, 24(17): 932-938.
4. Sosnowski K, Lin F, Mitchell ML, et al. Early rehabilitation in the intensive care unit: an integrative literature review. Aust Crit Care, 2015, 28(4): 216-225.
5. Ring PA. Treatment of trochanteric fractures of femur. Br Med J, 1963, 1(5331): 654-656.
6. Johnston MV, Keister M. Early rehabilitation for stroke patients: a new look. Arch Phys Med Rehabil, 1984, 65(8): 437-441.
7. Martínez-Velilla N, Cadore L, Casas-Herrero Á, et al. Physical activity and early rehabilitation in hospitalized elderly medical patients: systematic review of randomized clinical trials. J Nutr Health Aging, 2016, 20(7): 738-751.
8. Leistner K, Stier-Jarmer M, Berleth B, et al. Early rehabilitation care in the hospital--definition and indication. Results of the expert group "Early Rehabilitation Care in the Hospital". Rehabilitation (Stuttg), 2005, 44(3): 165-175.
9. Pack QR, Squires RW, Lopez-Jimenez F, et al. Participation rates, process monitoring, and quality improvement among cardiac rehabilitation programs in the United States: a National SURVEY. J Cardiopulm Rehabil Prev, 2015, 35(3): 173-180.
10. Keener JD, Galatz LM, Stobbs-Cucchi GA, et al. Rehabilitation following arthroscopic rotator cuff repair a prospective randomized trial of immobilization compared with early motion. J Bone Joint Surg Am, 2014, 96A(1): 11-19.
11. Hashem MD, Parker AM, Needham DM. Early mobilization and rehabilitation of patients who are critically ill. Chest, 2016, 150(3): 722-731.
12. Lord RK, Mayhew CR, Korupolu R, et al. ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med, 2013, 41(3): 717-724.
13. Tay-Teo K, Moodie M, Bernhardt J, et al. Economic evaluation alongside a phase Ⅱ, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT). Cerebrovasc Dis, 2008, 26(5): 475-481.
14. Quack V, Ippendorf AV, Betsch M, et al. Multidisciplinary rehabilitation and fast-track rehabilitation after knee replacement: faster, better, cheaper? A survey and systematic review of literature. Rehabilitation, 2015, 54(4): 245-251.
15. Varela E, Oral A, Ilieva E, et al. UEMS-PRM section professional practice committee. Musculoskeletal perioperative problems. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med, 2013, 49(5): 753-759.
16. Schaller SJ, Anstey M, Blobner M, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet (London, England), 2016, 388(152): 1377-1388.
17. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke, 2016, 47(6): e98-e169.
18. Hester JM, Guin PR, Danek GD, et al. The economic and clinical impact of sustained use of a progressive mobility program in a Neuro-ICU. Crit Care Med, 2017, 45(6): 1037-1044.
19. Wakabayashi H, Maeda K, Shamoto H. Combined intervention of whey protein intake and rehabilitation in female patients with hip fracture in the early postoperative period. Clin Nutr, 2015, 34(6): 1278-1279.
20. De Groot PE, Hjeltnes N, Heijboer AC, et al. Effect of training intensity on physical capacity, lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured individuals. Spinal Cord, 2003, 41(12): 673-679.
21. Scivoletto G, Morganti B, Molinari M. Early versus delayed inpatient spinal cord injury rehabilitation: an Italian study. Arch Phys Med Rehabil, 2005, 86(3): 512-516.
22. Formisano R, Azicnuda E, Sefid MK, et al. Early rehabilitation: benefits in patients with severe acquired brain injury. Neurol Sci, 2017, 38(1): 181-184.
23. Frazzitta G, Zivi I, Valsecchi R, et al. Effectiveness of a very early stepping verticalization protocol in severe acquired brain injured patients: a randomized pilot study in ICU. PLoS One, 2016, 11(7): e0158030.
24. Rammelt S, Dürr C, Schneiders W, et al. Minimally invasive fixation of calcaneal fractures. Oper Orthop Traumatol, 2012, 24(4/5): 383-395.
25. 石梦娜, 李娜, 王冰水, 等. 早期超短波联合序贯压力治疗对手深度烧伤后功能恢复的作用. 中华烧伤杂志, 2014, 30(6): 472-476.
26. Giannicola G, Polimanti D, Bullitta G, et al. Critical time period for recovery of functional range of motion after surgical treatment of complex elbow instability: prospective study on 76 patients. Injury, 2014, 45(3): 540-545.
27. Ozdemir HM, Biber E, Oğün T. The results of nerve repair in combined nerve-tendon injuries of the forearm. Ulus Travma Acil Cerrahi Derg, 2004, 10(1): 51-56.
28. Hachem LD, Ahuja CS, Fehlings MG. Assessment and management of acute spinal cord injury: from point of injury to rehabilitation. J Spinal Cord Med, 2017, 40(6): 665-675.
29. 中华人民共和国卫生部. 卫生部关于印发《康复医院基本标准(2012 年版)》的通知. (2012-03-20)[2018-07-01]. http://www.nhfpc.gov.cn/mohyzs/s3578/201204/54557.shtml.

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