以质量求发展,以服务铸品牌

护理学报 ›› 2023, Vol. 30 ›› Issue (16): 41-46.doi: 10.16460/j.issn1008-9969.2023.16.041

• 文献研究 • 上一篇    下一篇

基于人-环境-作业模式的轮椅使用者跌倒干预研究进展

施雯1, 黄天翊1, 肖悦2, 徐艳文3   

  1. 1.南京医科大学 康复医学院,江苏 南京 211166;
    2.南京医科大学第一附属医院 康复医学科,江苏 南京 210029;
    3.无锡市第九人民医院,江苏 无锡 214062
  • 收稿日期:2023-03-01 出版日期:2023-08-25 发布日期:2023-09-08
  • 通讯作者: 肖悦(1994-),女,江苏南京人,硕士,康复治疗师。E-mail:xiaoyue00818@163.com
  • 作者简介:施雯(2000-),女,浙江杭州人,本科在读。
  • 基金资助:
    江苏省卫健委老年健康科研项目(LK2021034)

  • Received:2023-03-01 Online:2023-08-25 Published:2023-09-08

摘要: 目的 通过基于人-环境-作业模式的理论框架对轮椅使用者跌倒干预方法研究进展进行综述,为国内轮椅跌倒预防及相关护理提供参考。方法 通过检索国内外相关文献,从人-环境-作业模式角度对轮椅使用者跌倒的国内外临床干预现状及方法等方面进行总结归纳。结果 依据PEO模式框架,可将轮椅跌倒预防策略分成3个方面。(1)人的策略:增强身体平衡能力与肌肉力量、改善跌倒恐惧和抑郁心理;(2)环境的策略:辅助检测装置、轮椅适配、设施改造等物理环境干预和轮椅技能培训、系统化的防跌倒管理模式、社会政策支持等社会环境干预;(3)作业活动的策略:对执行的作业活动的危险预测能力、正确体位转移方法的掌握、作业活动改良等。结论 基于人、环境、作业因素制定以轮椅使用者为中心的干预策略对减少跌倒有一定的临床价值,应进一步完善轮椅使用者的康复护理体系。

关键词: 轮椅, 跌倒, 人-环境-作业模式, 干预策略

中图分类号: 

  • R472.4
[1] World Health Organization. Assistive technology[EB/OL].(2018-05-18)[2022-07-08]. https://www.who.int/news-room/fact-sheets/detail/assistive-technology.
[2] 罗椅民, 邹华. 我国轮椅发展的现状及建议[J]. 辅具情报研究, 2020,1(2): 1-3.
[3] Rice LA, Fliflet A, Frechette M, et al.Insights on an automated fall detection device designed for older adult wheelchair and scooter users: A qualitative study[J]. Disabil Health J, 2022, 15(1S): 101207.DOI: 10.1016/j.dhjo.2021.101207.
[4] Rubenstein LZ, Josephson KR.The epidemiology of falls and syncope[J]. Clin Geriatr Med, 2002, 18(2): 141-158.DOI: 10.1016/s0749-0690(02)00002-2.
[5] Sung J, Trace Y, Peterson EW, et al.Falls among full-time wheelchair users with spinal cord injury and multiple sclerosis: a comparison of characteristics of fallers and circumstances of falls[J]. Disabil Rehabil, 2019, 41(4):389-395.DOI: 10.1080/09638288.2017.1393111.
[6] Rice LA, Sung J, Peters J,et al.Perceptions of fall circumstances, injuries and recovery techniques among power wheelchair users:a qualitative study[J].Clin Rehabil, 2018, 32(7): 985-993.DOI: 10.1177/0269215518768385.
[7] Singh H,Scovil CY,Bostick G,et al.Perspectives of wheelchair users with spinal cord injury on fall circumstances and fall prevention: a mixed methods approach using photovoice[J]. Plos One,2020,15(8):e238116.DOI:10.1371/journal.pone.0238116.
[8] 周文庭,黄佩佩,周三连. 探讨护理程序在轮椅转移技术中的应用研究[J]. 中国保健营养,2020,30(25):220-220.
[9] Rice LA, Yarnot R, Peterson EW, et al.Fall prevention for people with multiple sclerosis who use wheelchairs and scooters[J]. Arch Phys Med Rehab, 2021, 102(4): 801-804.DOI: 10.1016/j.apmr.2020.10.107.
[10] Singh H, Scovil CY, Yoshida K, et al.Factors that influence the risk of falling after spinal cord injury:a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility[J]. Bmj Open, 2020, 10(2): e34279.DOI: 10.1136/bmjopen-2019-034279.
[11] Sosnoff JJ, Finlayson M, McAuley E, et al. Home-based exercise program and fall-risk reduction in older adults with multiple sclerosis: phase 1 randomized controlled trial[J].Clin Rehabil, 2013,28(3):254-263.DOI:10.1177/0269215513501092.
[12] Zwinkels M, Verschuren O, Janssen TW, et al.Exercise training programs to improve hand rim wheelchair propulsion capacity: a systematic review[J]. Clin Rehabil, 2014, 28(9): 847-861.DOI: 10.1177/0269215514525181.
[13] Diong J, Boswell-Ruys C.Exercise training programmes to improve hand-rim wheelchair propulsion capacity: PEDro systematic review update[J]. Brit J Sport Med, 2015, 49(19): 1284-1285.DOI: 10.1136/bjsports-2015-094583.
[14] 李一澜, 石雷, 杨润, 等. 精英轮椅冰壶运动员竞技能力特征及训练策略研究进展[J]. 中国体育科技, 2022, 58(3): 3-8.DOI: 10.16470/j.csst.2022010.
[15] Sol ME, Verschuren O, Horemans H, et al.The effects of wheelchair mobility skills and exercise training on physical activity, fitness, skills and confidence in youth using a manual wheelchair[J]. Disabil Rehabil, 2022, 44(16): 4398-4407.DOI: 10.1080/09638288.2021.1907456.
[16] 胡思学, 钱开林, 秦义婷, 等. 上肢和肩周肌力训练对脊髓损伤患者转移功能和日常生活活动能力的影响[J]. 中华物理医学与康复杂志, 2019, 41(10):748-751.DOI: 10.3760/cma.j.issn.0254-1424.2019.10.007.
[17] Wołoszyn N, Wiśniowska-Szurlej A, Grzegorczyk J,et al.The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes - a randomized control trial[J]. BMC Geriatr,2021,21(1):423. DOI: 10.1186/s12877-021-02368-7.
[18] Yeo SS, Kwon JW.Wheelchair skills training for functional activity in adults with cervical spinal cord injury[J]. Int J Sports Med, 2018, 39(12):924-928.DOI: 10.1055/a-0635-0941.
[19] Rice L, Kalron A, Berkowitz SH, et al.Fall prevalence in people with mult-iple sclerosis who use wheelchairs and scooters[J]. Medicine, 2017, 96(35): e7860.DOI: 10.1097/MD.0000000000007860.
[20] Kaneko K.Negative symptoms and cognitive impairments in schizophrenia : two key symptoms negatively influencing social functioning[J]. Yonago Acta Med, 2018, 61(2): 91-102.DOI: 10.33160/yam.2018.06.001.
[21] Piccoli A, Rossettini G, Cecchetto S, et al.Effect of attentional focus instructions on motor learning and performance of patients with central nervous system and musculoskeletal disorders: a systematic review[J]. J Funct Morphol Kinesiol, 2018, 3(3): 40.DOI: 10.3390/jfmk3030040.
[22] 王玉婷. “四维度”注意力训练对提高儿童注意力的有效性研究综述[C].第二十一届全国心理学学术会议摘要集,2018.
[23] 王超, 李芬芬. 体育锻炼对注意力影响的实验研究[J]. 湖北体育科技, 2015, 34(8):725-728.DOI:10.3969/j.issn.1003-983X.2015.08.021.
[24] Finlayson ML, Peterson EW, Cho CC.Risk factors for falling among people aged 45 to 90 years with multiple sclerosis[J]. Arch Phys Med Rehabil, 2006, 87(9):1274-1279.DOI: 10.1016/j.apmr.2006.06.002.
[25] Sung J, Shen S, Peterson EW, et al.Fear of falling, community participation, and quality of life among community-dwelling people who use wheelchairs full time[J]. Arch Phys Med Rehabil, 2021,102(6):1140-1146.DOI:10.1016/j.apmr.2020.11.013.
[26] Singh H, Scovil CY, Yoshida K, et al.Capturing the psychosocial impacts of falls from the perspectives of wheelchair users with spinal cord injury through photo-elicitation[J]. Disabil Rehabil, 2021, 43(19):2680-2689. DOI:10.1080/09638288.2019.1709911.
[27] Rice LA, Sung JH, Keane K, et al.A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: a pilot study[J]. J Spinal Cord Med, 2020, 43(5): 607-615.DOI: 10.1080/10790268.2019.1643070.
[28] Butler Forslund E, Jørgensen V, Skavberg Roaldsen K, et al.Predictors of falls in persons with spinal cord injury—a prospective study using the Downton fall risk index and a single question of previous falls[J]. Spinal Cord, 2019, 57(2): 91-99. DOI: 10.1038/s41393-018-0175-y.
[29] 廖国栋, 孙仁权, 蒙雪芳, 等. 行为激活疗法在抑郁症治疗中的研究进展[J]. 中国卫生标准管理, 2020, 11(7): 48-50. DOI: 10.3969/j.issn.1674-9316.2020.07.017.
[30] 汪春霞, 郭芳芳, 王平红, 等. 集束化安全标识管理在降低神经内科患者跌倒发生率中的应用[J].当代护士(下旬刊),2021, 28(5):187-189.DOI:10.19793/j.cnki.1006-6411.2021.15.074.
[31] Crawford A, Armstrong K, Loparo K, et al.Detecting destabilizing wheelchair conditions for maintaining seated posture[J]. Disabil Rehabil Assist Technol, 2018, 13(2): 178-185. DOI: 10.1080/17483107.2017.1300347.
[32] 吴磊. 面向智慧城市的行动不便人群智能感知与传输系统实现[D].武汉:武汉理工大学, 2014:1-75. DOI:10.7666/d.D617574.
[33] Frost S, Mines K, Noon J, et al.Wheelchair service training package - intermediate level[M]. World Health Organization, 2013: 1-60.
[34] World Health Organization.Assistive product specifications and how to use them[M]. Geneva: World Health Organization,2021: 130-146.
[35] Takada M, Wakimoto S, Oshikawa T, et al.Active cloth fabricated by a flat string machine and its application to a safe wheelchair system[J]. J Robot Mechatron, 2020, 32(5): 1010-1018.DOI: 10.20965/jrm.2020.p1010.
[36] Martorello L,Swanson E.Effectiveness of an automatic manual wheelchair braking system in the prevention of falls[J].Assist Technol, 2006, 18(2):166-169.DOI:10.1080/10400435.2006.10131915.
[37] Fukaya K, Uchida M.Protection against impact with the ground using wearable airbags[J]. Ind Health, 2008, 46(1): 59-65.DOI: 10.2486/indhealth.46.59.
[38] 武新涛, 廖生温, 刘畅, 等. 一种智能限速助起轮椅结构设计[J]. 南方农机, 2022,53(6).DOI: 10.3969/j.issn.1672-3872.2022.06.032.
[39] 刘悦. 老年人护理用多功能轮椅的研制[J]. 医学理论与实践,2022,35(19):3419-3420. DOI:10.19381/j.issn.1001-7585.2022.19.074.
[40] Miko ł ajewska E. Wheelchair-related falls-a review[J]. Int J Disabil Hum Dev, 2013, 12(3):259-266.DOI:10.1515/ijdhd-2012-0115.
[41] 任琳, 郎黎薇, 黄莺, 等. 住院神经系统疾病患者主要照顾者预防跌倒知识与行为及伤害处理知识的调查分析[J]. 现代临床护理, 2017, 16(2):4-8. DOI:10.3969/j.issn.1671-8283.2017.02.002.
[42] Lachance CC, Korall AMB, Russell CM, et al.Hand forces exerted by long-term care staff when pushing wheelchairs on compliant and non-compliant flooring[J]. Appl Ergon,2018,71:95-101. DOI: 10.1016/j.apergo.2018.04.009.
[43] Tanuwidjaja G, Marchelina J, Yosephine VL, et al.The low cost apartment for wheelchair user[J]. IPTEK J Proceed Ser, 2017,3:109-116. DOI:10.12962/j23546026.y2017i3.2442.
[44] Rice LA, Isaacs Z, Ousley C, et al.Investigation of the feasibility of an intervention to manage fall risk in wheeled mobility device users with multiple sclerosis[J]. Int J MS Care, 2018, 20(3):121-128.DOI:10.7224/1537-2073.2016-097.
[45] 王杨, 王海云, 邓小倩, 等.“工作坊式”轮椅技能训练对截瘫患者日常活动参与的影响[J].中国康复, 2021, 36(1): 31-33.DOI: 10.3870/zgkf.2021.01.007.
[46] Rice LA, Peterson EW, Backus D, et al.Validation of an individualized reduction of falls intervention program among wheelchair and scooter users with multiple sclerosis[J].Medicine,2019,98(19):e15418.DOI:10.1097/MD.0000000000015418.
[47] Tu CJ, Liu L, Wang W, et al.Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review[J].Clin Rehabil,2017, 31(12):1573-1582.DOI:10.1177/0269215517712043.
[48] 杨晓丽. 住院患者跌倒因素调查分析及应对方法[J]. 四川医学,2011,32(6):971-972.DOI:10.16252/j.cnki.issn1004-0501-2011.06.016.
[49] Greenhalgh M, Blaauw E, Deepak N, et al.Usability and task load comparison between a robotic assisted transfer device and a mechanical floor lift during caregiver assisted transfers on a care recipient[J]. Disabil Rehabil Assist Technol,2022,17(7):833-839.DOI:10.1080/17483107.2020.1818137.
[50] Redick EL.Applying FOCUS-PDCA to solve clinical problems[J]. Dimens Crit Care Nurs, 1999, 18(6): 30.
[51] 杨雪, 刘针, 袁霞, 等. 应用FOCUS-PDCA程序降低康复医学科偏瘫患者轮椅使用跌倒发生率[J]. 世界最新医学信息文摘(连续型电子期刊), 2020, 20(27): 184-185.DOI: 10.3969/j.issn.1671-3141.2020.27.087.
[52] Resar R, Griffin F, Haraden C, et al.Using care bundles to improve health care quality[M]. IHI innovation series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement, 2012.
[53] Tanner J, Padley W, Assadian O, et al.Do surgical care bundles reduce the risk of surgical site infections in?patients undergoing colorectal surgery? A systematic review and cohort Meta-analysis of 8,515 patients[J]. Surgery, 2015, 158(1): 66-77.DOI: 10.1016/j.surg.2015.03.009.
[54] 朱进, 罗群, 高燕, 等. AECOPD患者集束化管理策略下的中西医结合肺康复治疗临床研究[J]. 中国中医急症, 2019, 28(10): 1775-1777.DOI: 10.3969/j.issn.1004-745X.2019.10.020.
[55] 李景姗, 朱倩云, 吴言芬, 等. 集束化管理策略在重型颅脑损伤患者早期康复护理中的应用[J].护理实践与研究, 2021, 18(9):1278-1282.DOI:10.3969/j.issn.1672-9676.2021.09.004.
[56] 刘彬, 杨翠霞, 田涛. 适老化无障碍环境建设政策法规及完善对策[J]. 中国老年学杂志, 2022, 42(9): 2300-2303.DOI: 10.3969/j.issn.1005-9202.2022.09.071.
[57] 赵立志, 杨戈, 周庆, 等. 中外城市环境无障碍建设的比较与反思[J]. 城市发展研究, 2014, 21(4): 插4-插7.DOI: 10.3969/j.issn.1006-3862.2014.04.021.
[58] 余艳萍, 贾馨林. 我国家庭无障碍改造政策研究——基于五个省市的比较分析[J]. 残疾人研究, 2022(S1): 67-76.DOI: 10.3969/j.issn.2095-0810.2022.z1.014.
[59] 梅运彬, 张登成. 无障碍汽车发展的价值诉求与政策促进[J]. 残疾人研究, 2019(2):36-44. DOI:10.3969/j.issn.2095-0810.2019.02.005.
[60] Barbareschi G, Holloway C.An investigation of factors affecting the performance of wheelchair transfers[J]. Disabil Rehabil Assist Technol, 2019, 14(5):479-488.DOI:10.1080/17483107.2018.1463402.
[61] 赵东丽, 金肖, 高丽娟, 等. 脑卒中轮椅期不同护理方式84例康复比较[J]. 上海预防医学, 2011, 23(6):317-318.DOI:10.19428/j.cnki.sjpm.2011.06.030.
[62] Koyama S, Tanabe S, Saitoh E, et al.Comparison of two methods of bed-to/from-wheelchair transfer in patients with hemiparetic stroke[J]. Fujita Med J, 2020, 6(3):81-86.DOI: 10.20407/fmj.2019-016.
[63] Tsai CY, Boninger ML, Bass SR, et al.Upper-limb biomechanical analysis of wheelchair transfer techniques in two toilet configurations[J]. Clin Biomech, 2018,55:79-85.DOI: 10.1016/j.clinbiomech.2018.04.008.
[64] Goosey-Tolfrey V.Wheelchair sport: a complete guide for athletes, coaches, and teachers[M].Lllinois Champagne:Human Kinetics, 2010.
[65] Akbar M, Brunner M, Ewerbeck V, et al.Do overhead sports increase risk for rotator cuff tears in wheelchair users?[J]. Arch Phys Med Rehab, 2015, 96(3):484-488.DOI:10.1016/j.apmr.2014.09.032.
[66] Aytar A, Zeybek A, Pekyavas NO, et al.Scapular resting position, shoulder pain and function in disabled athletes[J]. Prosthet Orthot Int,2015,39(5):390-396.DOI:10.1177/0309364614534295.
[67] Dutton RA.Medical and musculoskeletal concerns for the wheelchair athlete: a review of preventative strategies[J]. Curr Sport Med Rep, 2019, 18(1):9-16.DOI:10.1249/JSR.0000000000000560.
[1] 许敏铮, 夏丽莉. 228例住院老年患者跌倒后生存状况及死亡危险因素的COX回归分析[J]. 护理学报, 2022, 29(7): 63-68.
[2] 李滢, 陈巧松, 白雅萍, 洪韵婷, 吴玉玲, 戴秋文. 对中高危跌倒患者应用护理专案管理的效果观察[J]. 护理学报, 2022, 29(5): 69-73.
[3] 郭雪琪, 谷奕樊, 杨娇, 胡惠菊, 李慧源, 武建辉, 唐启群. 养老机构睡眠障碍老人跌倒风险的危险因素研究[J]. 护理学报, 2022, 29(22): 11-14.
[4] 胡惠菊, 韩静, 唐启群, 成杰, 李慧源. Morse跌倒评估量表与STEADI跌倒风险自评量表在养老机构老年人中的应用比较[J]. 护理学报, 2021, 28(19): 8-12.
[5] 蔡莹莹, 张俊峰, 郑可欣, 张兰芳, 余璐萍, 曾文, 陈梦云, 黄琼珊. 老年肿瘤患者跌倒评估及管理最佳证据总结[J]. 护理学报, 2021, 28(18): 22-27.
[6] 苏晓慧, 陈文月, 魏敏. 235例单侧全髋关节置换术后患者社会疏离现状及影响因素分析[J]. 护理学报, 2021, 28(16): 37-41.
[7] 陈婉华, 麦剑欣, 叶君荣. 降低精神科住院患者跌倒发生率的品管圈实践[J]. 护理学报, 2020, 27(18): 29-32.
[8] 蒋丹, 刘伟, 宫宁, 赵佳琪, 李佳楠, 郑峰娟. 老年脑卒中患者跌倒效能与社会支持的相关性研究[J]. 护理学报, 2020, 27(18): 65-67.
[9] 张明凤. 基于“双精准”理念的轮椅使用短视频在脑卒中患者中的应用[J]. 护理学报, 2019, 26(7): 74-76.
[10] 王艾红, 谢莹莹, 尹安春, 殷慧慧. 抑郁症共病患者干预策略研究进展[J]. 护理学报, 2019, 26(2): 34-38.
[11] 王颖, 尹世玉, 郭晓贝, 汪晖. 住院患者预防跌倒安全屏障的建立与实践[J]. 护理学报, 2019, 26(15): 14-17.
[12] 王林, 杨粉英, 陈爱民, 咸康文. 4 R危机管理理论在精神科住院患者跌倒管理中的应用[J]. 护理学报, 2019, 26(12): 29-32.
[13] 余雪莲, 阳国兴, 李欢欢. 多功能防跌倒医用座椅的研制[J]. 护理学报, 2018, 25(22): 74-75.
[14] 杨梅,郗君梅,尚晓玲,董晓红,吕燕娜. 143名规范化培训护士跌倒预防知识、态度、行为的现状调查[J]. 护理学报, 2018, 25(2): 58-60.
[15] 孟凡嫣, 陈璇, 王艳, 吴颖. 基于现实环境的功能性步态训练对社区卒中后康复期老人步态特征及害怕跌倒的影响[J]. 护理学报, 2018, 25(19): 1-4.
Viewed
Full text


Abstract

Cited

  Shared   
[1] 黄伊, 李超凤, 陈丹, 孔祥麟, 范瑛瑛. 234名本科实习护生遭受护理教育欺凌现状及影响因素分析[J]. 护理学报, 2023, 30(14): 1 -6 .
[2] 张翠翠, 钟亚丽, 朱丽丽, 陈琳, 王瑶, 钟英, 龚喜燕, 廖常菊. 四川省1 320名三级甲等医院护士安全胜任力现状及影响因素分析[J]. 护理学报, 2023, 30(14): 7 -12 .
[3] 叶念思, 胡慧, 邓蓓. 重复性负性思维的研究进展[J]. 护理学报, 2023, 30(14): 32 -36 .
[4] 王若仙, 何斌, 王玉环, 刘柯汝, 唐雪婷, 赵淑华, 魏杉杉. 社区老年人骨质疏松性骨折风险感知偏差现况及影响因素分析[J]. 护理学报, 2023, 30(15): 1 -5 .
[5] 孙丽, 黄家丽, 胡成文, 顾道琴, 韦琦, 方敏, 刘群慧, 许宝惠. 基于文化敏感性框架肿瘤患儿安宁疗护方案的构建[J]. 护理学报, 2023, 30(15): 6 -10 .
[6] 蔡倩, 罗雯, 孙欣鑫, 陈荣, 宋慧子, 蔡业鹏, 张漪然, 廖月霞. 进食自我调节问卷的汉化及其在学龄前儿童中的信效度检验[J]. 护理学报, 2023, 30(15): 11 -15 .
[7] 彭仁梅, 钱荣, 李亚军, 段缓, 陈莲芳, 刘玉文. ICU转出患者睡眠障碍风险列线图预测模型的构建与验证[J]. 护理学报, 2023, 30(15): 16 -22 .
[8] 花芸, 王雯沁, 刘志梅, 冯国和, 杜沫晗. 癌症患者PICC置管支持性照护需求量表的编制及信效度检验[J]. 护理学报, 2023, 30(15): 23 -28 .
[9] 胡洁蔓, 缪雪怡, 蒋小曼, 唐楚蕾, 许勤. 社区肿瘤专科护士核心能力评价指标体系的构建[J]. 护理学报, 2023, 30(15): 29 -32 .
[10] 张索飞, 罗羽. 基于虚拟教研室的护理硕士研究生跨校课程建设的SWOT分析[J]. 护理学报, 2023, 30(15): 33 -37 .