远程康复:印度三级护理中心儿科神经康复服务的替代服务交付模式

Telerehabilitation, Neurophysiotherapy, Disability., Covid
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摘要

背景:神经康复面临着独特的挑战,因为2019冠状病毒病疫情加剧了医疗保健服务的可及性和资源障碍;对残疾儿童护理的连续性造成了干扰。需要采取平权行动,以“包容残疾人”的方式应对2019冠状病毒病危机。因此,本研究旨在确定远程康复(TR)模式是否为儿童神经物理治疗的可行和有效的替代方案。方法:这是一项临床试验,对诊断为发育迟缓或神经系统疾病并在三级保健中心进行物理治疗的儿童进行研究。使用实时交互技术远程提供临床咨询。使用的结局指标为:1)及时接受物理治疗服务;2)患儿临床结局;3)家庭对TR提供的可接受性和满意度。结果:在可行性方面,TR过程中最常见的问题是技术性;缺少陪伴母亲的时间;儿童内科疾病等。儿童的临床结果显示出“获得发展技能”和“使用适当的功能行为来满足他们的需求”的改善。然而,家庭对TR服务表示满意,表示需要面对面的会议。结论:在目前的情况下,培训可以通过将残疾儿童与卫生保健提供者、资源和支持联系起来,提高家庭满足残疾儿童需求的能力;从而确保护理的连续性。虽然应对这一前所未有情况的准则仍在继续制定,但TR显示出作为一种替代康复战略的潜力,从而减轻社会距离对贫困儿童的影响。然而,一些社会心理因素阻碍了儿科人群TR的可行性。
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Telerehabilitation: An Alternative Service Delivery Model for Pediatric Neurorehabilitation Services at a Tertiary Care Center in India
Background: Neurorehabilitation is facing a unique challenge as COVID-19 circumstances magnify the access and resource barrier in healthcare provision; and are causing disruption in the continuity of care of children with disability. An affirmative action is required as a ‘Disability-inclusive response to the COVID-19 crisis.’ This study thus aimed to determine if Telerehabilitation (TR) model of service delivery is a feasible and effective alternative for pediatric neurophysiotherapy. Methodology: This is a clinical trial conducted on children diagnosed with developmental delay or neurological condition and referred for Physiotherapy at a tertiary care center. Clinical consultation was provided remotely with the use of real time interactive technology. Outcome indicators used were: 1)Timely receipt of physiotherapy services; 2) Child’s clinical outcomes; and 3) Familiy’s acceptability and satisfaction with the provision of TR. Results: With regards to feasibility, the most common issues faced during TR sessions were technical; lack of time with mother; child’s medical illness, etc. Children’s clinical outcomes showed improvement reported as ‘acquisition of developmental skills’ and ‘the use of appropriate functional behaviors to meet their needs’. Families showed satisfaction with TR services however, expressed the need for in-person sessions. Conclusion: In the current scenario, TR may enhance the capacity of families to meet the needs of their child with a disability by connecting them with health care providers, resources and supports; thus ensuring continuity of care. While guidelines to tackle this unprecedented situation continue to develop, TR demonstrates the potential as an alternative rehabilitation strategy thereby ameliorating the impact of social distancing on underprivileged children. However, some psychosocial factors act as barriers to feasibility of TR in pediatric population.
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