加拿大作业表现量表结合作业活动分析在手部损伤患者中的应用

doi:10.3969/j.issn.1006-9771.2023.01.013

摘要/Abstract

摘要：

目的探讨手部损伤患者的作业需求以及基于活动分析的作业干预的效果。

方法选取2021年1月至2022年6月期间因腕手部损伤于南京医科大学第一附属医院康复医学中心进行作业治疗的患者212例，使用加拿大作业表现量表(COPM)进行面谈，收集患者“想做”“需要做”“被期望去做”但目前因损伤无法完成的作业需求，由2名高年资作业治疗师对作业需求进行活动分析，找出影响作业需求的作业成分，设计针对性的干预方案。干预前后采用COPM对表现和满意度进行评价。

结果累计收集到84项作业需求，涉及工作、基本日常生活活动、工具性日常生活活动、休闲娱乐和睡眠5大领域，累及率较高的作业活动是使用电脑(8.28%)、用筷子吃饭(6.42%)、拧毛巾(6.25%)、骑行交通工具出行(4.90%)和提重物(4.73%)等。治疗后，COPM表现分和满意度显著提高(t > 16.572, P < 0.001)。

结论手部损伤患者作业需求具有当地文化特点；采用基于活动分析的作业干预能有效满足患者的作业需求。

关键词: 手部损伤, 加拿大作业表现量表, 功能性评估, 作业需求

Abstract:

Objective To explore the occupational needs of hand injury patients and the effects of activity-based analysis and occupation-based interventions.

Methods From January, 2021 to June, 2022, 212 patients who accepted occupational therapy for wrist-hand injury in Rehabilitation Center of the First Affiliated Hospital of Nanjing Medical University were interviewed using Canadian Occupational Performance Measure (COPM) to collect the activities that they wanted to do, needed to do, were expected to do, but unable to do. Two senior occupational therapists conducted the activity analysis of the summarized needs, identified occupational components, designed a purposeful occupation-based intervention program, and evaluated the performance and satisfaction using COPM.

Results A cumulative total of 84 occupational needs were proposed, covering five major domains: work, basic activities of daily living, instrumental activities of daily living, leisure and sleep. The activities mostly impaired involved using computer (8.28%), using chopsticks (6.42%), wringing towels (6.25%), travelling on transport (4.90%) and lifting heavy objects (4.73%). The performance and satisfaction improved after treatment (t > 16.572, P < 0.001).

Conclusion The occupational needs are culturally specific for local hand injury patients; the use of an activity-based analysis and occupation-based intervention is effective on meeting the occupational needs.

Key words: hand injury, Canadian Occupational Performance Measure, functional assessment, occupational needs

中图分类号:

伊文超, 高秋野, 范亚蓓, 丁薇, 陈欣, 赵小龙, 曹蓉. 加拿大作业表现量表结合作业活动分析在手部损伤患者中的应用[J]. 《中国康复理论与实践》, 2023, 29(1): 88-92.

YI Wenchao, GAO Qiuye, FAN Yabei, DING Wei, CHEN Xin, ZHAO Xiaolong, CAO Rong. Application of Canadian Occupational Performance Measure combined with activity analysis in clients with hand injuries[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(1): 88-92.

图/表 4

表1

表2

表3

表4

治疗前后COPM表现和满意度比较"

时间	n	重要性	表现分	满意度
治疗前	52	8.49±1.53	3.63 $± 1.81$	3.15 $± 1.64$
治疗后	52	8.49±1.53	8.35 $± 1.76$	8.60 $± 1.76$
t值			16.572	19.411
P值			< 0.001	< 0.001

表4

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手功能	受影响的活动	占比/%
握不同粗细及质量的物品	拧毛巾、骑行交通工具(电动车、自行车、摩托车)、端锅炒菜、切菜、握水壶、拖地/拧拖把、握持工具(电焊、电锯、切割工具、塑料管接驳、方向盘、手刹、扳手、螺丝刀、球拍、球杆、健身器材等)、洗小件衣服抱小孩、抱材料/重物/桌子、托举物品、拎提重物(箱子、超市购物袋等) 握手、握爬梯	40.65
指力	抓拿小物品、修饰/化妆、叠衣服、用电脑、夹镊子、穿脱衣服袜子/拉拉链/扣扣子/系皮带、握笔写字、剥豆子/橘子等、提裤子、洗碗、晒衣服、系鞋带、剪指甲、便后清洁、打胰岛素、拧钥匙、抠耳朵、便后冲厕、洗头、刷牙、弹琴/吉他、捏网线/焊丝、打篮球、跳舞、游泳、翻书	35.37
前臂旋转	洗后背/对侧身体、洗脸、拿手机、梳头/扎辫子	12.93
灵活性	整理文件、做手术、贴票据、缝纫、用筷子吃饭、头模制作、画画、织毛衣、做手工	8.67
腕桡尺偏	打方向灯、拧盖子	1.70