成都肢体残疾人未满足辅助技术需求及其相关因素

doi:10.3969/j.issn.1006-9771.2024.05.015

摘要/Abstract

摘要：

目的调查成都市肢体残疾人未满足辅助技术需求，并分析其影响因素。

方法 2023年11月至2024年3月，对四川省“量体裁衣”服务平台登记的成都市肢体残疾人，采用世界卫生组织快速辅助技术评估问卷进行调查。

结果共发放问卷558份，回收有效问卷527例。26.8%的残疾人有未满足辅助技术需求，移动辅具需求最高(66.0%)。缺少支持(54.9%)、价格昂贵(26.3%)和不了解辅助器具(20.3%)是未获得所需辅具的主要原因。丧偶(OR = 3.615)、严重移动障碍(OR > 2.926)、严重自我护理障碍(OR > 2.781)是辅具需求未满足的风险因素(P < 0.05)。

结论应加大对辅具政策和辅具产品的宣传，关注不同障碍残疾人群的个性化辅具适配，增强辅具服务体系建设，以满足残疾人辅具需求。

关键词: 残疾人, 辅助技术, 卫生服务需求, 影响因素

Abstract:

Objective To investigate the unmet needs for assistive technology for people with physical disabilities in Chengdu, and analyze the related factors.

Methods From November, 2023 to March, 2024, the persons with physical disabilities in Chengdu were selected from Sichuan Individuation service platform, and investigated using World Health Organization rapid Assistive Technology Assessment.

Results A total of 558 questionnaires were set up, and 527 effective questionnaires retured. 26.8% of them reported unmet needs for aids, with the highest need for mobility aids (66.0%). Lack of support (54.9%), high price (26.3%) and lack of knowledge about aids (20.3%) were the main reasons for not obtaining the aids they needed. Loss of spouse (OR = 3.615), serious mobility impairment (OR > 2.926) and serious self-care impairment (OR > 2.781) were the risks of unmet needs for aids.

Conclusion It is important to popularize policies and products of aids, pay attention to personal adaptation for people with different barriers, and strengthen the service system, to meet the needs of people with disabilities.

Key words: people with disabilities, assistive technology, health services needs and demand, related factors

中图分类号:

R496

陈盼盼, 王炳龙, 董理权, 刘夕东, 杨幼平, 李佳玥. 成都肢体残疾人未满足辅助技术需求及其相关因素[J]. 《中国康复理论与实践》, 2024, 30(5): 598-605.

CHEN Panpan, WANG Binglong, DONG Liquan, LIU Xidong, YANG Youping, LI Jiayue. Unmet needs for assistive technology and its related factors for persons with physical disabilities in Chengdu, China[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 598-605.

图/表 3

表1

表2

未满足辅助技术需求影响因素单因素χ2分析"

变量	无未满足需求 (n = 386)	有未满足需求 (n = 141)	χ²值	P值	变量	无未满足需求 (n = 386)	有未满足需求 (n = 141)	χ²值	P值
性别			4.724	0.030	移动障碍等级			79.480	< 0.001
男	256	79			没有困难	127	12
女	130	62			有些困难	156	33
年龄/岁			7.616	0.179	非常困难	57	59
≤ 18	14	9			无法完成	46	37
19~44	46	12			自我护理障碍等级			69.622	< 0.001
45~59	134	36			没有困难	202	27
60~74	134	57			有些困难	106	36
75~89	52	24			非常困难	42	45
≥ 90	6	3			无法完成	36	33
残疾等级			22.023	< 0.001	最重要辅具获得距离/km			5.553	0.352
未评级	4	1			< 5	167	107
一级	26	15			5~< 25	9	3
二级	73	48			25~< 50	1	0
三级	107	40			50~< 100	3	0
四级	176	37			≥ 100	3	0
致残原因			9.516	0.049	不清楚	3	1
其他	57	27			最重要辅具支付者			3.843	0.698
意外	141	32			政府	67	48
遗传	25	9			非政府组织/慈善机构	1	0
疾病	157	71			保险	1	0
地震	6	2			自付	100	55
户口类型			0.338	0.561	家人/朋友	14	7
农业	238	83			其他	1	1
非农业	148	58			不清楚	2	0
婚姻状况			9.491	0.023	最重要辅具来源			7.120	0.310
未婚	56	19			公共部门	77	48
已婚有配偶	288	96			非营利性组织	1	2
丧偶	13	14			私营部门	58	33
离异	29	12			朋友/家人	22	6
受教育程度			9.294	0.054	自制	17	13
未上学	28	6			其他	9	9
小学	150	70			不清楚	2	0
初中	150	40			过去12个月辅具支付金额/元			8.703	0.003
高中(含中专)	42	15			0	364	122
大学及以上	16	10			> 0	22	19
重度残疾人护理补贴			11.091	0.001	是否使用辅具			39.783	< 0.001
否	290	85			没使用	200	30
是	96	56			使用	186	111
家庭医生签订情况			0.042	0.838	使用辅具种类			45.766	< 0.001
否	77	27			0	200	29
是	309	114			1	85	47
就业情况			1.766	0.184	2	72	39
未就业	276	109			3	25	22
就业	110	32			4	4	3
					5	0	1

表2

表3

参考文献 29

[1]	ZHANG W, EIDE A H, PRYOR W, et al. Measuring self-reported access to assistive technology using the WHO rapid Assistive Technology Assessment (rATA) questionnaire: protocol for a multi-country study[J]. Int J Environ Res Public Health, 2021, 18(24): 13336.
[2]	KHASNABIS C, MIRZA Z, MACLACHLAN M. Opening the GATE to inclusion for people with disabilities[J]. Lancet, 2015, 386(10010): 2229-2230. doi: 10.1016/S0140-6736(15)01093-4 pmid: 26681277
[3]	郭超, 郭帅, 丁若溪, 等. 改革开放40年来中国残疾统计体系的发展与未来建设[J]. 残疾人研究, 2019(2): 77-84.
	GUO C, GUO S, DING R X, et al. Development of China's Disability Statistics System during the past 40 years since Reform and Opening-up and its future construction[J]. Disabil Res, 2019(2): 77-84.
[4]	李艳萍, 王媛, 纪之琳, 等. 中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性[J]. 中华疾病控制杂志, 2024, 28(1): 26-31.
	LI Y P, WANG Y, JI Z L, et al. Association of multimorbidity patterns with activity of daily living and instrumental activity of daily living disability among ≥ 45 years middle-aged and elderly population in China[J]. Chin J Dis Control Prev, 2024, 28(1): 26-31.
[5]	闫媚, 江华, 董理权, 等. 中国辅助技术的需求、供给和满意度研究:基于快速辅助技术评估数据[J]. 中国康复理论与实践, 2023, 29(4): 373-380. doi: 10.3969/j.issn.1006-9771.2023.04.001
	YAN M, JIANG H, DONG L Q, et al. Demand, supply and satisfaction of assistive technology in China based on rapid Assistive Technology Assessment data[J]. Chin J Rehabil Theory Pract, 2023, 29(4): 373-380.
[6]	DESIDERI L, MAGNI R, ZHANG W, et al. Adapting the World Health Organization rapid Assistive Technology Assessment (rATA) to the Italian context: implementation of a TRAPD-based approach[J]. Ann Ist Super Sanita, 2022, 58(2): 118-123. doi: 10.4415/ANN_22_02_07 pmid: 35722798
[7]	杨亚茹, 杨剑, 邱卓英, 等. 深圳市中轻度残疾人社区康复健身活动及其健康效益研究[J]. 中国康复理论与实践, 2024, 30(2): 189-194. doi: 10.3969/j.issn.1006-9771.2024.02.008
	YANG Y R, YANG J, QIU Z Y, et al. Research on community-based rehabilitation exercise and physical activity and its benefits for people with mild and moderate disability in Shenzhen, Guangdong, China[J]. Chin J Rehabil Theory Pract, 2024, 30(2): 189-194.
[8]	杜本峰, 王翾, 周丽金, 等. 困境家庭儿童卫生服务利用特征与影响因素:基于安德森健康行为模型的实证研究[J]. 中国卫生政策研究, 2020, 13(10): 54-61.
	DU B F, WANG X, ZHOU L J, et al. Characteristics and influencing factors of child health service utilization in dilemma families: an empirical research based on Anderson health behavior model[J]. Chin J Health Polic, 2020, 13(10): 54-61.
[9]	田红梅, 邱卓英, 李欣, 等. 肢体残疾人康复需求与康复服务发展状况Logistic回归分析研究[J]. 中国康复理论与实践, 2020, 26(5): 508-512. doi: 10.3969/j.issn.1006-9771.2020.05.003
	TIAN H M, QIU Z Y, LI X, et al. Unmet needs and services of rehabilitation for people with physical disabilities using logistic regression analysis[J]. Chin J Rehabil Theory Pract, 2020, 26(5): 508-512.
[10]	柏若男, 王俊, 饶千宜, 等. 养老机构老年人智能辅具使用意愿的描述性质性研究[J]. 军事护理, 2023, 40(3): 1-4.
	BAI R N, WANG J, RAO Q Y, et al. Usage intention of intelligent assistive devices among the elderly institution residents: a descriptive qualitative study[J]. Military Nurs, 2023, 40(3): 1-4.
[11]	董海颖, 梁笑笑, 何燕. 基于Logistic回归与决策树模型的老年多重慢病及影响因素分析[J]. 中国卫生事业管理, 2024, 41(2): 208-211.
	DONG H Y, LIANG X X, HE Y. Analyzing the multiple chronic diseases of the elderly and its influencing factors based on logistic regression and decision tree model[J]. Chin Health Service Manag, 2024, 41(2): 208-211.
[12]	龙思宇, 姜雨婷, 丁福. 跨理论模型联合意外、死亡、伤害工具包在出院老年人跌倒防范中的应用研究[J]. 中国康复医学杂志, 2023, 38(9): 1233-1238.
	LONG S Y, JIANG Y T, DING F. Application of trans-theoretical and STEADl in prevention falls of elderly after discharged from hospital[J]. Chin J Rehabil Med, 2023, 38(9): 1233-1238.
[13]	王振, 曾智. 我国丧偶老人共病模式与灾难性卫生支出的关系研究[J]. 现代预防医学, 2023, 50(22): 4136-4142.
	WANG Z, ZENG Z. Associations between comorbidity patterns and catastrophic health expenditures among widowed older adults in China[J]. Mod Prev Med, 2023, 50(22): 4136-4142.
[14]	许金鹏, 郝晓宁, 孙佳乐, 等. 残疾老人辅具使用和配套服务利用对其照顾者压力的影响[J]. 中国卫生事业管理, 2023, 40(12): 951-956.
	XU J P, HAO X N, SUN J L, et al. Study on the impact of assistive device use and complementary service utilization in the elderly with disabilities on caregiver stress[J]. Chin Health Service Manag, 2023, 40(12): 951-956.
[15]	郝晓宁, 许金鹏, 郑研辉. 残疾老人辅助器具支付意愿的影响机制分析:基于Logit-ISM模型[J]. 卫生经济研究, 2022, 39(12): 17-21, 25.
	HAO X N, XU J P, ZHENG Y H. Analysis of the mechanisms influencing the willingness to pay for assistive devices for the elderly with disabilities-based on Logit-lSM model[J]. Health Econ Res, 2022, 39(12): 17-21, 25.
[16]	罗椅民. 我国适老辅具与残疾人辅具需求分析[J]. 标准科学, 2019(6): 57-61.
	LUO Y M. Analysis of the demand of the assistive aids for the elderly and the disabled in China[J]. Standard Sci, 2019(6): 57-61.
[17]	吴建贤, 金欠欠, 邓璐, 等. 安徽省5市残疾人残疾类型及辅具适配现状[J]. 安徽医科大学学报, 2018, 53(5): 774-777.
	WU J X, JIN Q Q, DENG L, et al. Adult disability types and assistive device demands in five cities of Anhui Province[J]. Acta Univ Med Anhui, 2018, 53(5): 774-777.
[18]	胡诚, 王蕾, 邸洋, 等. 新媒体时代下科普短视频在医院宣传报道中的创新应用[J]. 中国医院, 2024, 28(1): 81-83.
	HU C, WANG L, DI Y, et al. Innovative application of science short video in hospital publicity reporting in the new media era[J]. Chin Hospitals, 2024, 28(1): 81-83.
[19]	洪玮, 韩晔, 胡洋, 等. 2022年北京健康科普专家现状及其开展健康科普媒体宣传影响因素分析[J]. 中国健康教育, 2023, 39(6): 504-508.
	HONG W, HAN Y, HU Y, et al. The current situation of health science popularization experts and the influencing factors of their health science popularization activities in Beijing, 2022[J]. Chin J Health Educ, 2023, 39(6): 504-508.
[20]	杨立雄, 李晞, 董理权, 等. 全国辅助器具服务网络建设研究[J]. 残疾人研究, 2020(1): 61-71.
	YANG L X, LI X, DONG L Q, et al. Research on the construction of national assistive technology service network[J]. Disabil Res, 2020(1): 61-71.
[21]	初佃辉, 吴军, 刘志中, 等. 智能化医养融合服务平台关键技术及应用研究[J]. 智能系统学报, 2021, 16(5): 972-988.
	CHU D H, WU J, LIU Z Z, et al. Research on key technologies and applications of intelligent medical and care integration service platform[J]. CAAI Trans Intell Syst, 2021, 16(5): 972-988.
[22]	李高峰, 魏晨婧, 赖卿, 等. 我国轮椅服务存在的问题及对策[J]. 中国康复理论与实践, 2014, 20(2): 188-191.
	LI G F, WEI C J, LAI Q, et al. Problems and solutions of wheelchair service provision in China[J]. Chin J Rehabil Theory Pract, 2014, 20(2): 188-191.
[23]	刘夕东. 康复工程学[M]. 北京: 人民卫生出版社, 2018: 13.
	LIU X D. Rehabilitation engineering[M]. Beijing: People's Health Publishing House, 2018: 13.
[24]	刘晓静, 罗椅民. 深度老龄化背景下我国适老辅具技术:应用、适配评估与发展研究[J]. 中国软科学, 2021(2): 57-64.
	LIU X J, LUO Y M. China's age-appropriate assistive device technology in the context of deep aging: research on application, adaptation evaluation and development[J]. China Soft Sci, 2021(2): 57-64.
[25]	张洪峰, 焦永亮, 李博, 等. 人工智能在康复辅助技术中的应用研究进展与趋势[J]. 科学技术与工程, 2022, 22(27): 11751-11760.
	ZHANG H F, JIAO Y L, LI B, et al. Research progress and trend of artificial intelligence in rehabilitation assistive technology[J]. Sci Technol Eng, 2022, 22(27): 11751-11760.
[26]	赖卿, 李高峰, 方新, 等. ICF视野下康复辅助器具技术专业人才培养体系建设[J]. 中国康复理论与实践, 2018, 24(3): 367-372. doi: 10.3969/j.issn.1006-9771.2018.03.022
	LAI Q, LI G F, FANG X, et al. Construction of professional training system of assistive technology: in perspective of lCF[J]. Chin J Rehabil Theory Pract, 2018, 24(3): 367-372.
[27]	董理权, 吴小高, 任伟华, 等. 我国落实世卫组织«增进获得辅助技术决议»的基础与路径[J]. 残疾人研究, 2019(2): 45-49.
	DONG L Q, WU X G, REN W H, et al. The foundation and path of implementing the Resolution on Improving Access to Assistive Technology in China[J]. Disabil Res, 2019(2): 45-49.
[28]	范雨轩, 韩淑艳, ANTONIOJEVIC D, 等. 工业4.0时代我国康复辅具产业园发展模式探究[J]. 广州体育学院学报, 2019, 39(3): 62-67.
	FAN Y X, HAN S Y, ANTONIOJEVIC D, et al. Research on the development model of China's rehabilitation aids industrial park in the age of Industry 4.0[J]. J Guangzhou Sport Univ, 2019, 39(3): 62-67.
[29]	杨思创, 汤修齐, 邱服冰, 等. 国际辅助技术服务的政策架构、核心内容和发展研究[J]. 中国康复理论与实践, 2021, 27(9): 1006-1016. doi: 10.3969/j.issn.1006-9771.2021.09.003
	YANG S C, TANG X Q, QIU F B, et al. Framework and core content of international policy on service of assistive technology[J]. Chin J Rehabil Theory Pract, 2021, 27(9): 1006-1016.

变量	B	Wald	P值	OR	95%CI	变量	B	Wald	P值	OR	95%CI
性别 (参照女)						移动障碍等级 (参照无困难)
男	-0.117	0.240	0.624	0.889	0.557~1.421	有些困难	0.581	1.953	0.162	1.788	0.792~4.038
残疾程度 (参照四级)						非常困难	1.741	13.969	< 0.001	5.701	2.288~14.202
三级	0.574	3.800	0.051	1.775	0.997~3.162	无法完成	1.074	4.107	0.043	2.926	1.036~8.263
二级	0.330	0.433	0.511	1.392	0.520~3.724	自我护理障碍等级(参照无困难)
一级	0.313	0.239	0.625	1.368	0.389~4.809	有些困难	0.431	1.692	0.193	1.539	0.804~2.946
未评级	0.643	0.200	0.655	1.903	0.113~31.933	非常困难	1.023	7.233	0.007	2.781	1.320~5.861
致残原因 (参照疾病)						无法完成	1.182	6.655	0.010	3.261	1.328~8.006
其他	0.312	0.043	0.837	1.366	0.070~26.569	是否使用辅具 (参照不使用)
意外	-0.213	0.601	0.438	0.808	0.471~1.385	使用辅具	-1.671	1.224	0.268	0.188	0.010~3.629
遗传	0.138	0.085	0.770	1.147	0.456~2.888	使用辅具种类 (参照0件)
地震	0.057	0.004	0.837	1.366	0.070~6.010	1件	2.032	1.837	0.175	7.628	0.404~144.007
婚姻状况 (参照未婚)						2件	1.794	1.380	0.240	6.012	0.301~119.942
已婚有配偶	0.348	0.940	0.332	1.417	0.700~2.866	3件	1.853	1.437	0.231	6.381	0.308~132.065
丧偶	1.285	5.251	0.022	3.615	1.204~10.850	4件	2.188	1.625	0.202	8.916	0.308~257.684
离异	0.676	1.658	0.198	1.966	0.703~5.501	5件	23.068	< 0.001	1.000	< 0.001	< 0.001
重度残疾人护理补贴情况 (参照无补贴)						过去12个月辅具支付金额 (参照0元)
有补贴	-0.141	0.091	0.763	0.869	0.348~2.168	> 0元	0.262	0.456	0.500	1.300	0.607~2.781