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1、Rehazentrum Bad Eilsen 巴特艾尔森 康复中心 Rehabilitation of musculoskeletal conditions 肌肉骨骼疾病的康复,General information about task and infra-structure of Rehazentrum Bad Eilsen 巴特埃尔森康复中心职能和基础设施的基本情况 Example for ICF-based approach in rehabilitation (patients with Rheumatoid Arthritis) 以 ICF为基础的康复路径举例（患有类风湿性关节炎的
2、病人） Illustration of therapeutic interventions:各种治疗介入的实例: Kinesitherapy 运动治疗 Psychoeducation 心理教育 Job related therapy 根据患者职业针对性的治疗 Psychosocial therapy心理社会治疗,2,Presentation 报告,Centre for rehabilitation of musculoskeletal conditions and interdisciplinary concomitant diseases 肌肉骨骼疾病及其伴发疾病康复中心 Part of r
3、ehabilitation-center-group of Deutsche Rentenversicherung Braunschweig-Hannover (regional pension insurance)附属于德国布伦瑞克-汉诺威养老保险康复中心集团（地区性的养老保险公司） 365 in- and 20 out-patients 365位住院病人和20位门诊病人 6000 medical rehabilitation treatments per year每年有超过6000次医学康复治疗 Average age of patients: 51 years (60% male, 40
4、% female)患者平均年龄：51岁（60%为男性，40%为女性） Treatment is financed by the pension insurance(in contrast to acute treatment in hospital) 治疗费用由养老保险金提供 （不同于院内急诊治疗）,Rehazentrum Bad Eilsen 巴特埃尔森康复中心,Rehazentrum Bad Eilsen 巴特艾尔森 康复中心 Priorities 康复方案优先顺序,Muscoloskeletal diseases肌肉骨骼疾病,5,Range of indications in rehab
5、ilitation in Germany 德国各个康复适应症所占比例，肌肉骨骼系统疾病所占比例最大,Physicians 医生 Psychologists and social workers 心理治疗师和社工 Nurses and medical assistants 护士和医师助手 Physiotherapists and sports therapists 理疗师和运动理疗师 Masseurs and medical bath helpers按摩师和医疗浴师 Ergotherapists 职能治疗者 Nutritionists and diet conusultants 营养师和饮食顾问
6、,Rehazentrum Bad Eilsen 巴特埃尔森康复中心 Interdisciplinary rehabilitation-team 多学科康复团队,International Classification of Functioning, Disability and Health (ICF) der WHO WHO的国际健康功能与身心障碍分类系统（ICF）,Fundamental approach in planning therapeutic interventions 规划治疗干预计划的基本方法,Detailed medical anamnesis and profound p
7、hysical examination详细的医疗病历和全面的体格检查 Consideration of current technical findings 参考现代诊断技术(i.e. x-ray, MRI, ultrasound, laboratory blood tests)（如X光、核磁共振、超声、实验室血液检查） In addition use of screening- and assessment-instruments (also for course assessment)辅以筛选和评估工具 (也可用于病程的评估),8,Example: Rheumatoid Arthritis
8、例：类风湿性关节炎,9,System disease with main manifestation in musculoskeletal disorders主要表现在肌肉骨骼的系统性疾病 Progressive chronic recurring course渐进的慢性复发过程,10,Joint swelling and stiffness关节肿胀和僵硬 Mobility restrictions and joint destruction行动受限和关节损害 General symptoms: fatigue, fever, loss of wheigt一般症状：疲乏、发热、体重降低 Man
9、ifestations in other organs: 其他器官的临床表现 Skin, eyes, lung, heart, central and peripheral nervous system 皮肤、眼睛、肺、心脏、中枢和外周神经系统 Pain is a central symptom疼痛是最主要的症状,ICF-model: Rheumatoid Arthritis类风湿性关节炎ICF模型,Body Functions and Structures:身体结构和功能：,Mobility of joints: neutral zero method 关节活动性：中间零度法 Pain:疼痛
10、 Visual analog scale (VAS) 0-10 视觉模拟评分法 0 = no pain, 10 = unbearable pain 0=没有疼痛，10=难以忍受的疼痛 Disease activity:疾病活动度： Disease activity score (DAS-28)疾病活动评分(DAS-28) Number of swollen joints肿胀关节的数量 Number of tender joints脆弱关节的数量 ESR (erythrocyte sedimentation rate)红细胞沉降率 Self estimation of disease activ
11、ity疾病活动自我评估,12,ICF-model: Rheumatoid Arthritis类风湿性关节炎ICF模型,14,Activities活动,Health Assessment Qustionre健康评估问卷调查,FFBH汉诺威问卷调查表,Activities活动,Evaluation of impairment of activities of daily life is conducted mainly by ergotherapists 日常活动的损伤主要由运动治疗师评估,15,Hand grip (and strength)手柄（力量） Precision grips 精密度手
12、柄,Handdynamometer握力计,ICF-model: Rheumatoid Arthritis类风湿性关节炎ICF模型,Participation 参与 graphic representation of SF 36 SF36图示法 (Questionnaire of health associated quality of life, short form)健康相关生活质量问卷，简易格式）,17,Participation参与,Generic instruments (mainly used in scientific studies) 通用量表（主要运用在科学研究中）i.e. S
13、F 36 (Bullinger, Hogrefe, 1998) 例如 SF 36 Comparability with other diagnosis groups 与其他诊断组的可比较性 In daily routine with practical restrictions 日常生活中的实用限制 increasingly replaced by screening instruments 逐渐被筛选量表替代,18,Wrzburger Screening 维尔茨堡筛选问卷,Hinweise auf Besondere Berufliche Problemlage: 特殊职业困境的提示Arbe
14、itslosigkeit oder Zeitrente 失业或短暂期退休,Schlechte Subjektive Erwerbsprognose 主观性工作预后较差,Ggf. Hohe Berufliche Belastung 高工作压力,1,2,3,4,5,1,2,3,4,5,1,2,3,4,5,Professional problems:职业问题 Unemployment失业 Pension request 津贴需求 Subjective job prognosis主观职业预后,Subjective professional burden 主观职业负担 Restriction of pr
15、ofessional performance职业表现受限 Professional influence on health健康对职业的影响 Professional stress burden职业压力负担,Professional Participation职业参与,ICF-model: Rheumatoid Arthritis类风湿性关节炎ICF模型,Psychic stress精神应急,Pain and burden of disease 疼痛和疾病负担,Family burden家庭负担,Occupational stress职业压力,Environment and personal f
16、actors环境和个人因素,Example UKS (Ultrakurzscreening in der Rehabilitation) 超简易筛选,35% of our patients show tripel or fourfold burden:我们35%的病人显示有3-4倍的压力 Psychic comorbidity伴随心理疾病 Pain疼痛 Family burden家庭负担 Occupational burden职业负担,Profound diagnostics are performed in cases of positive screenig for severe psyc
17、hosocial burden 如果筛选出严重的社会心理负担,应当做进一步的诊断,Exploration of occupational situation 职业情形探究 Psychological individual interview社会心理学的个人谈话 Possibly with other specific Assessments可能结合其他的评估 i.e.HADS (Hospital Anxiety and Depression Scale) 如医院焦虑和抑郁量表Anxiety and Depression have severe impact on disease course and employment reintegration焦虑和抑郁严重影响疾病过程和重返社会就业 and are seldom discoverd in first contact with the physican并且很少能在 第一次与医师接触时发现,
