The Journal of Korean society of community based occupational therapy (대한지역사회작업치료학회지)

Korean Society of Community Based Occupational Therapy Association (대한지역사회작업치료학회)
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Online Survey on Clinical Application of Constraint-Induced Movement Therapy in Children with Hemiplegic Cerebral Palsy in Korea

편마비 뇌성마비 환아에서 강제유도운동치료의 국내 임상적용에 대한 설문조사

  • Son, Ju-Hyun (Department of Rehabilitation Medicine, Pusan National University School of Medicine) ;
  • Shin, Yong-Beom (Department of Rehabilitation Medicine, Pusan National University School of Medicine) ;
  • Yun, Young-Ju (Department of Korean Medical Science, School of Korean Medicine, Pusan National University) ;
  • Kim, Bu-Young (Department of Physical Therapy, Graduate school, Silla University) ;
  • Moon, Jung-In (Department of Occupational Therapy, Pusan National University Yangsan Hospital) ;
  • Moon, Myung-Hoon (Department of Rehabilitation Medicine, Pusan National University School of Medicine) ;
  • Kim, Soo-Yeon (Department of Rehabilitation Medicine, Pusan National University School of Medicine)
  • 손주현 (부산대학교 의학전문대학원 재활의학교실) ;
  • 신용범 (부산대학교 의학전문대학원 재활의학교실) ;
  • 윤영주 (부산대학교 한의학전문대학원 동서협진의학) ;
  • 김부영 (신라대학교 대학원 물리치료학과) ;
  • 문정인 (양산부산대학교병원 작업치료실) ;
  • 문명훈 (부산대학교 의학전문대학원 재활의학교실) ;
  • 김수연 (부산대학교 의학전문대학원 재활의학교실)
  • Received : 2019.07.18
  • Accepted : 2019.08.26
  • Published : 2019.08.31
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Abstract

Objective : The aim of this study was to evaluate the current knowledge regarding constraint-induced movement therapy (CIMT) and its application in clinical practice by physiatrists and therapists in pediatric rehabilitation area in Korea. Methods : Online survey via E-mails was sent to a total of 510 members (204 physiatrists and 306 therapists) of the Korean Society of Pediatric Rehabilitation and Developmental Medicine (KSPRDM). Results : The response rate was 35.1% (179 of 510). A total of 179 questionnaires was completed by 39 physiatrists, 89 physiotherapists, 48 occupational therapists, and 3 speech therapists. 45.8% of responders had worked over 6 years in the pediatric rehabilitation setting and a total of 58.1% (n=104) of the sample had used CIMT. The main limitations of clinically applying CIMT included limited staff and inappropriate clinical setting (35.1%, n=61), lack of understanding (19.5%, n=34), and developmental issues of function on the unaffected side (13.8%, n=24). The cooperation of patients (77.6%, n=76), cognitive/behavioral factors (42.9%, n=42), and cooperation of caregivers (25.5%, n=25) were the 3 major concerns that could be limitations with CIMT. Conclusions : Although considerable evidence supports the use of CIMT, many of physiatrist and therapists do not apply this method in practice. The improvement of limitations is necessary for wide use of CIMT in clinical practice in Korea.

목적 : 이 연구는 국내 소아재활 분야에 종사하는 재활의학과의사 및 치료사를 대상으로 강제유도운동치료(constraint-induced movement therapy, CIMT)에 대한 지식과 임상적용 현황에 대해 조사하고자 하였다. 연구방법 : 대한소아재활발달의학회에 등록된 510명 (재활의학과의사 204명, 치료사 306명)을 대상으로 전자우편을 이용한 설문조사를 시행하였다. 결과 : 총 510명 중 179명이 설문에 응답하여 응답률은 35.1%였다. 응답한 179명 중 재활의학과 의사 39명, 물리치료사 89명, 작업치료사 48명, 언어치료사 3명이었다. 응답자 중 45.9%(82명)는 소아재활분야의 경험이 6년 이상인 전문가로 구성되어 있었고, 58.1%(104명)가 강제유도운동치료에 대한 경험이 있었다. 임상 진료에서 강제유도운동치료를 적용하는 경우는 환자의 순응도가 좋을 때 73.1%(76명), 보호자의 순응도가 좋을 때 48.1%(50명), 양손훈련(bimanual training)의 효과가 제한적이라고 판단될 때 39.4%(41명) 순으로 조사되었다. 임상적용에서 제한점으로 작용하는 요인은 치료인력 부족이나 가정내 환경 부적합 등과 같은 환경제한 35.1%(61명), 인식부족 19.5%(34명), 건측 제한으로 인한 건측 기능발달 저해에 대한 우려 13.8%(24명)으로 조사되었다. 강제유도운동치료를 중단한 이유로는 환자의 비협조 77.6%(76명), 인지/행동요인 42.9%(42명), 보호자의 비협조 25.5%(25명), 효과가 없다고 판단될 때(non-effectiveness) 11.2%(11명) 순으로 조사되었다. 결론 : 강제유도운동치료의 의학적 근거가 높게 보고되고 있지만 이 연구에서는 많은 수의 재활의학과 의사와 치료가사 실제 임상치료에서 적용하지 못하고 있음을 확인하였다. 국내 현황에서 제한점을 개선하여 향후 임상적용 확대를 위한 노력이 필요하겠다.

Keywords

References

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