zhang a new institutional based rehab model after the sichuan eq in china crdr.disaster.symp.isprm11
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研究生:朱杰
导师 :励建安 教授
A new institutional based rehabilitation model after the Sichuan earthquake in China
Xia Zhang, MD, PhD candidateMentor: Jianan Li
Nanjing Medical University, Nanjing, ChinaCaring For Children Foundation, Hongkong, China
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M county•21 townships, 500,000 residents
•11,000 people died • 60 KM to the epicenter•Mountainous area
Baseline: on site investigation in M, S and J county in 2008
Follow-up: Re-evaluation in M, S and A county in 2010
IBR, CBR, surgery and training programs
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NHV Model
NGO(CFCF)
LocalHospital
Health Bureau
DisabledPerson’s
Federation
IBR
CBR
HandicapInternational
PhysiatricianPT/NurseRehab
equipmentEarthquake Survivors
Cooperation in NGOs, Health departments and rehabilitation Volunteers
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NGO(CFCF)
LocalHospital
Health Bureau
DisabledPerson’s
Federation
IBR
CBR
HandicapInternational
Local hospital
NHV Model
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NGO(CFCF)
LocalHospital
Health Bureau
DisabledPerson’s
Federation
IBR
CBR
HandicapInternational
Local hospitalHealth Bureau
NHV Model
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NGO(CFCF)
LocalHospital
Health Bureau
DisabledPerson’s
Federation
IBR
CBR
HandicapInternational
Local hospitalHealth BureauHandicap International
NHV Model
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NGO(CFCF)
LocalHospital
Health Bureau
DisabledPerson’s
Federation
IBR
CBR
HandicapInternational
Local hospitalHealth BureauHandicap InternationalDisabled Person’s Federation
NHV Model
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Demography data
Injury classification
Rehab needs
Physical function
Mental healthSocial
integration
2008Baseline
2010Follow-up
M county
NHV Model
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2008Baseline
2010Follow-up
M county
VS
A county S county
VS VS
NHV Model
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Medical outcome in M county—ADL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
I ndependent Dependent
Baseline
Follow-up
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Medical outcome in M county—ADL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
I ndependent Dependent
Baseline
Follow-up
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Functional recovery in SCIs
Diagnosis Outcome Baseline Follow-up
Paired
t test
P value
SCI
ADL 71.2±25.8 81.9±18.7 -3.37 0.002
WSCI II walking index
5.8±7.0 9.6±8.2 -5.01 0.000
WHOQOL 68.3±12 71.4±10.2 -1.66 0.011
PTSD 39.2±8.0 35.9±8.2 -2.18 0.039
CHART 322±87.0 344±80.8 -1.58 0.127
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Functional recovery in SCIs
Diagnosis Outcome Baseline Follow-up
Paired
t test
P value
SCI
ADL 71.2±25.8 81.9±18.7 -3.37 0.002
WSCI II walking index
5.8±7.0 9.6±8.2 -5.01 0.000
WHOQOL 68.3±12 71.4±10.2 -1.66 0.011
PTSD 39.2±8.0 35.9±8.2 -2.18 0.039
CHART 322±87.0 344±80.8 -1.58 0.127
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Comparison between M-S county and M-A county
M county S county A county
ADL 91.1±10.5 87.3±16.5 91.2±11.8
LSQ 55.7±16.5 33.6±9.80 50.0±9.86
SF-36 54.9±16.1 51.9±13.1 54.9±16.8
PCL-C 34.2±10.6 39.3±9.43 33.6±9.80
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Comparison in M-A county
Mianzhu Shifang Anxian P
ADL 91.1±10.5 42.1±46.3 93.3±14.2
LSQ 47.3±9.65 50.3±9.53 44.8±8.26
SF-36 54.9±16.1 51.9±13.1 54.9±16.8
PTSD 35.6±10.0 34.3±10.1 39.3±9.60
M county S county A county P
ADL 91.1±10.5 87.3±16.5 91.2±11.8 0.113
LSQ 55.7±16.5 33.6±9.80 50.0±9.86 0.068
SF-36 54.9±16.1 51.9±13.1 54.9±16.8 0.172
PCL-C 34.2±10.6 39.3±9.43 33.6±9.80 0.603
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Comparison in M-S county
Mianzhu Shifang Anxian P
ADL 91.1±10.5 42.1±46.3 93.3±14.2
LSQ 47.3±9.65 50.3±9.53 44.8±8.26
SF-36 54.9±16.1 51.9±13.1 54.9±16.8
PTSD 35.6±10.0 34.3±10.1 39.3±9.60
M county S county A county P
ADL 91.1±10.5 87.3±16.5 91.2±11.8 0.003
LSQ 55.7±16.5 33.6±9.80 50.0±9.86 0.002
SF-36 54.9±16.1 51.9±13.1 54.9±16.8 0.027
PTSD 34.2±10.6 39.3±9.43 33.6±9.80 0.000
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Site Inpatient Outpatient Surgery
M county 377 59 303
A county 97 3 226
B county 70
Z county 81 24
J county 92 35 67
D county 130
P county 132
647 191 858
Total 1696
Economic outcome-average cost
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Site Inpatient Outpatient Surgery
M county 377 59 303
A county 97 3 226
B county 70
Z county 81 24
J county 92 35 67
D county 130
P county 132
647 191 858
Total 1696
Economic outcome-average cost
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Site Inpatient Outpatient Surgery
M county 377 59 303
A county 97 3 226
B county 70
Z county 81 24
J county 92 35 67
D county 130
P county 132
647 191 858
Total 1696
Economic outcome-average cost
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Economic outcome
Total: ¥5.3 million
Administrative
management
5%
Volunteerteam 21%
Programoperation
4.8%
Equipments
13.5%
Rehabilitation
16.1%
Surgery38.6%
Homeadaption 1%
Average cost: 4,350 yuan
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Research outcome
地震伤员康复需求调查报告 2011-01-08
1.张霞,卞荣,励建安等;四川江油地震伤员康复状况分析;中国康复医学杂志; 2009,24 ( 1 ): 5-8.
2.刘守国,艾金飞,张霞,励建安等;四川省北川中学地震伤员康复状况调查分析;中国康复医学杂志; 2009,24( 8 ): 680-3.
3.肖明月,刘守国,张霞,励建安等;绵竹地震伤员职业需求康复现状的调查与分析 ;中华物理医学与康复杂志; 2010( 11 ): 657-658.
4.李勇强,励建安,张霞等;四川地震脊髓损伤康复医疗状况分析;中华物理医学与康复杂志; 2010 ( 10 ): 488-492.
1.肖明月,刘守国,励建安,张霞等;绵竹地震胫腓骨骨折伤员功能恢复的影响因素分析;中国康复医学杂志; 2011 年1 月发表
2.刘守国,励建安,王红星,张霞等;四川绵竹地震伤员社区康复需求调查;中华物理医学与康复杂志;已收稿;
3.陈思婧,张霞,励建安等;绵竹脊髓损伤地震伤员生存质量和抑郁状态分析;中华物理医学与康复;
4.李咏雪,张霞,励建安等;地震骨折伤员慢性疼痛的相关因素及与生存质量的关系;中华物理医学与康复,已收稿;
1.张霞,陈思婧,胡筱蓉,励建安等;医疗康复对四肢骨不连地震伤员生活质量的影响;中华物理医学与康复;已投稿;
2.胡筱蓉,张霞,励建安等;四川绵竹脊髓损伤伤员回归社区后功能变化;
3. Yongqiang Li, Yin Liu, Sijing Chen, Xia Zhang, Jianan Li; Outcome of medical rehabilitation for 51 Sichuan earthquake victims with SCI; Spinal;
4. Mingyue Xiao, Jianan Li, Xia Zhang; Factors affecting functional outcome of Sichuan earthquake survivors with tibial shaft fractures: a follow-up study; Journal of Rehabilitation Medicine.
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5 Physiatricians
6 Physical Therapists
6 Rehabilitation Nurses
50 Patient Wards
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Long term mechanism—cooperation in the future 3 years
No-fee rehabilitation treatments for earthquake survivors and low-income patients
Capacity building of MZ hospital CBR programs for MZ earthquake survivors
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Based on the earthquake survivors
government and non-government
IBR and CBR