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中期考核

中期考核. A comprehensive rehabilitation service improves functioning and quality of life in spinal cord injured earthquake victims. 研究生：朱杰 导师 ：励建安 教授. Xia Zhang, MD, PhD First affiliated hospital Nanjing Medical University China. Mianzhu county 11,000 people died 60 KM to the epicenter

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中期考核

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  1. 中期考核 A comprehensive rehabilitation service improves functioning and quality of life in spinal cord injured earthquake victims 研究生：朱杰 导师 ：励建安 教授 Xia Zhang, MD, PhD First affiliated hospital Nanjing Medical University China

  2. Mianzhu county • 11,000 people died • 60 KM to the epicenter • Mountainous area 11th CSPMR Congress

  3. NHV Model NGOs, Health departments and rehabilitation Volunteers Handicap International Disabled Person’s Federation Health Bureau Local Hospital CBR Rehab equipment IBR Earthquake Survivors Physiatrician PT/Nurse NGO(CFCF)

  4. Functioning status Quality of life Socialparticipation Aims Discharge from hospital (2009) 1 year after (2010) 3 years after (2012) Risk factors +

  5. Subjects 29 SCIs from Mianzhu County Hospital Eligibility criteria: (i) SCI deduced by EQ (ii) 18 years and older (iii) got rehabilitation therapy in Mianzhu People’s Hospital Exclusion criteria: (i) SCI with TBI and/or fractures of the extremities; (ii) inability to complete the questionnaires, medical examinations and clinical assessment instruments. 2 Non earthquake SCIs 1 survivors ≤18 YO

  6. Data Collection General information Injury level and severity Physical examination Physical Function Mental Function Questionnaires Social Function

  7. Data Collection General information Injury level and severity Gender/ Age/ Marriage/ Education/ Employment Physical examination Physical Function Mental Function Questionnaires Social Function

  8. Data Collection General information Injury level and severity Physical examination American Spinal Injury Association Impairment Scale, AIS Physical Function Mental Function Questionnaires Social Function • 美国脊柱损伤协会,ASIA国际脊髓学会,ISCoS,等.脊髓损伤神经学分类国际标准(第6版).中国康复理论与实践,2007;13(1):963-972

  9. Data Collection General information Injury level and severity Physical examination Physical Function Modified Barthel Index, MBI Visual Analogue Scale,VAS Mental Function Questionnaires Social Function • Shah S, Muncer S. Sensitivity of Shah, Vanclay and Cooper's modified Barthel Index. Clin Rehabil.2000; 14(5):551-552. • Taylor J, Huelbes S, Albu S, et al. Neuropathic pain intensity, unpleasantness, coping strategies, and psychosocial factors after spinal cord injury: an exploratory longitudinal study during the first year. Pain Med. 2012;13(11):1457-68.

  10. Data Collection General information Injury level and severity Physical examination Physical Function Patient Health Questionnaire,PHQ-9 Mental Function Questionnaires Social Function • akakibara BM, Miller WC, Orenczuk SG, et al. A systematic review of depression and anxiety measures used with individuals with spinal cord injury. Spinal Cord, 2009;47(12):841-51.

  11. Data Collection General information Craig Hospital Handicap Assessment and Reporting Technique,CHART • Physical independence • Cognitive independence • Mobility • Occupation • Social integration • Economy Injury level and severity Physical examination Physical Function Mental Function Questionnaires Social Function • Noonan VK, Miller WC, Noreau L. A review of instruments assessing participation in persons with spinal cord injury. Spinal Cord. 2009;47(6):435-446.

  12. Data Analysis • Dependent variables • MBI • VAS • PHQ-9 • Quality of life • Social Integration • Mixed effects model • Longitudinal Tobit regression • linear mixed model • Independent variables • Gender • Age • Injury level • AIS • Injury time

  13. SCI data Abbr: CCS is central cord syndrome, CMS is conus medullaris syndrome

  14. SCI data • Male 12, Female 14 • Age 52.6±15.8 • Married 21, single1, widow4 Abbr: CCS is central cord syndrome, CMS is conus medullaris syndrome

  15. Physical functioning-MBI #Analyse with 2009 data, P<0.05 *Analyse with 2010 data,P<0.05

  16. Physical functioning-VAS

  17. Physical function • Pain • Aggravating factors • Cold, Body posture • Alleviating factors • Distracting activities, rest, medication • No significant change • 8 years after Tangshan Earthquake, 26.4% of SCIs suffered from pain * 李建军, 周红俊, 刘根林, 刘松怀, 赵超男, 宓忠祥等. 唐山地震26年后幸存脊髓损伤患者的社会调查. 中国康复理论与实践, 2005;11:110–112. * 李红, 沈彤. 脊髓损伤患者住院康复后社区生存质量的调查. 按摩与康复医学, 2010;23:114-116. Wen HC,  Reinhardt JD, Gosney J, Baumberger M, Zhang X, & Li J (2013). Spinal cord injuryrelated chronic pain in victims of the 2008 Sichuan earthquake: a prospective cohort study. Spinal Cord.  Jul 2. doi: 10.1038/sc.2013.59. [Epubahead of print] • Rintala D, Hart KA, Priebe MM. Predicting consistency of pain over a 10-year period in persons with spinalcord injury. [J] Rehabil Res Dev, 2004; 41:75–88. • Widerstrom-Noga E,Cruz-Almeida Y,Felix ER,etal.Relationshipbetween pain characteristics and pain adaptation type in persons with SCI. [J] Rehabil Res Dev, 2009;46:43–56.

  18. Psychological function #Analyse with 2009 data, P<0.05;

  19. Psychological function • Depression was prevalent. • The incidence of depression after Taiwan earthquake is also prevalent. • Our work • SCI self help group • Hung-Chi Wu, Pesus Chou, Frank Huang-Chih Chou, et al. Survey of quality of life and related risk factors for a Taiwanese village population 3 years post-earthquake. Aust N Z J Psychiatry,2006;40(4):355-61. • Sakakibara BM, Miller WC, Orenczuk SG, et al. A systematic review of depression and anxiety measures used with individuals with spinal cord injury. Spinal Cord,2009;47(12):841-851.

  20. Quality of life Social relationships Physical health Mental health Environment #Analyse with 2009 data, P<0.05; *Analyse with 2010 data, P<0.05.

  21. Quality of life • Quality of life improved • Relationship between injury level, AIS and quality of life • Aim to increase environment area score. • Motor ability effects quality of life • Home adaption • Gosney J, Reinhardt JD, Haig AJ, et al. Developing Post-disaster physical rehabilitation:role of the World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine. J Rehabil Med.2011;43:965–968. • Anson C, Stanwyck DJ, Krause JS. Social support and health status in spinal cord injury. Paraplegia, 1993; 31: 632–638. • Post MW, de Witte LP, van Asbeck FW, et al. Predictors of health status and life satisfaction in spinal cord injury. Arch Phys Med Rehabil,1998;79(4):395–401.

  22. Social integration Social integration Physical independence Cognitive independence Mobility Occupation #Analyse with 2009 data, P<0.05; *Analyse with 2010 data, P<0.05.

  23. Social integration • Determinants of social integration • Gender, age, AIS, anxiety,depression, pain, health condition, social support and coping ability • Social integration • Cognitive independence improved • Geyh S, Nick E, Stirnimann D, et al. Self-efficacy and self-esteem as predictors of participation in spinal cord injury-an ICF-based study. Spinal Cord, 2012;50(9):699-706. • Samuelkamaleshkumar S, Radhika S, Cherian B, et al. Community reintegration in rehabilitated South Indian persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation,2010;91(7):1117-1121.

  24. Conclusions • NHV improved ADL, psychological condition, QoL and social integration in SCI patients 3 years after the earthquake. • Important preditors of QoL and social integration: Injury level and severity.

  25. Analysis of functional status, quality of life and community integration in earthquake survivors with spinal cord injury at hospital discharge and one year in the community. Journal of Rehabilitation Medicine 2012, 44, 200-205. • Factors affecting functional outcome of Sichuan earthquake survivors with tibial shaft fractures: a follow-up study. Journal of Rehabilitation Medicine 2011, 43: 515-520. • Functional outcomes of physical rehabilitation and medical complications of spinal cord injury victims of the Sichuan earthquake. Journal of Rehabilitation Medicine (in press). • 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: 680-683. • Wen HC,  Reinhardt JD, Gosney J, Baumberger M, Zhang X, & Li J (2013). Spinal cord injuryrelated chronic pain in victims of the 2008 Sichuan earthquake: a prospective cohort study. Spinal Cord.  Jul 2. doi: 10.1038/sc.2013.59. [Epubahead of print] • 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. • 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: 5-8. • 张霞，励建安，陈思婧等。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杂志, 2011, 11: 872-875. • Xia Zhang, Xiaorong Hu, Jianan Li, et al. Functional outcomes and health related quality of life in fracture victims 27 months after the Sichuan earthquake. Journal of Rehabilitation Medicine 2012, 44, 206-209. • Xia Zhang, Jan D. Reinhardt, Jianan Li, et al. Effectiveness of the NHV rehabilitation services programme on long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi-experimental study. (Submit in process) • 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, 2011, 1: 59-61. • 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, 2: 156-159. • 四川地震51例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. • 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杂志, 2011, 9: 673-677. • 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杂志, 2012, 已接收. NHVmodel - Scientific research in rehab disaster relief

  26. One Foundation—Best Civil Disaster Relief （2012） China Charity Award- Best Influential Project (2012)

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