• 대한지역사회작업치료학회지
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• 제4권2호
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• pp.75-83
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• 2014

목적 : 본 연구는 강원도 태백지역에 거주하는 초기치매환자를 대상으로 실시한 방문 인지 작업치료 프로그램의 효과를 알아보고자 하였다. 연구방법 : 초기치매환자 30명을 대상으로 작업치료학과 학생 30명과 자원봉사자들이 주 1회 총 8회기의 가정방문 인지작업치료 중재를 실시하였다. 프로그램 전후의 대상자들의 인기기능의 변화를 알아보기 위해 MMSE-K를 사용하여 측정하였다. 또한 가정방문 인지작업치료에 대한 초기치매 환자들의 인식과 만족도를 확인하였다. 결과 : 초기 치매환자에게 가정방문 인지작업치료 적용한 결과 전반적인 인지기능의 향상이 나타났으며 특히 지남력, 기억회상, 주의집중력, 언어력의 경우 통계학적으로 유의한 향상이 나타났다. 결론 : 인지기능의 향상과 일상생활능력의 향상을 위한 가정방문 작업치료 프로그램이 치매환자의 중재에 있어 유용하게 적용될 것으로 사료되며 향후 가정방문 작업치료 서비스 도입을 위한 다양한 가정방문 작업치료 중재 프로그램 개발이 필요하다.

• 대한지역사회작업치료학회지
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• 제2권1호
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• pp.13-23
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• 2012

목적 : 외상성 뇌손상 환자의 지역사회 재활치료의 중재방법 및 중재효과를 알아보기 위하여 체계적 고찰을 하였다. 연구방법 : 자료는 데이터베이스인 Ovid와 PubMed를 통해 검색하였다. 사용된 검색어는 "community-based rehabilitation"와 "traumatic brain injury rehabilitation"이었다. 그 중 외상성 뇌손상 환자를 대상으로 지역사회 재활치료를 실시한 7편의 연구결과를 가지고 대상자, 평가도구, 중재방법과 중재결과를 분석하였다. 결과 : 연구 대상자의 수, 연령, 손상정도, 손상기간은 다양하였다. 연구 설계는 모두 실험연구의 형태로, 평가도구는 작업수행을 평가하는 영역이 5개(27.7%)로 가장 많았다. 중재방법은 작업치료사가 참여하는 전반적 재활프로그램, 인지치료, 인지행동치료, 가정방문 작업치료를 시행하였다. 중재효과는 결과측정 방법에 따라 작업수행, 참여, 예방, 그리고 작업 정의 영역에서 효과적이었고 적응, 건강과 안녕 영역에서 부분적으로 효과를 보였으며, 역할능력에서는 효과가 없었다. 결론 : 지역사회를 기초로 한 재활치료는 작업수행, 참여, 예방, 작업 정의에서 효과적이었으나 역할능력에서는 효과적이지 않았다. 앞으로 지역사회 재활에서 각 영역별 중재 프로그램 및 평가도구에 대한 연구가 지속적으로 필요하다.

• 가정간호학회지
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• 제8권1호
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• pp.25-37
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• 2001

Spinal cord injury patients need rehabilitation after the acute stage. They should be cared for at home to decrease hospitalization. Home care nurses play an important role in making spinal cord injury patients who have physical. and psychosocial problems do their best. For effective care, home care nurses need standardized nursing intervention protocols for spinal cord injury patients, but they are rarely developed. Therefore, this study was conducted to develop home care nursing protocols, based on NIC, that are applicable to spinal cord injury patients at home. Forty home care nursing charts of spinal cord injury patients registered in a home care nursing agency from July 1st, 1994 to August 31st, 1999 in S city were analyzed. Fifteen home care nurses participated in this study as a user validity validation group, The results of this study are as follows. 1. Fifteen nursing diagnoses were classified through the frequency analysis of home care nursing charts and previous literature for 40 spinal cord injury patients: altered urinary elimination, constipation, high risk for impaired skin integrity, chronic pain, impaired skin integrity, impaired social interaction, knowledge deficit, bowel incontinence, high risk for injury, altered role performance, care giver role strain, impaired physical mobility, sexual dysfunction, dysreflexia, and ineffective breathing pattern. 2. Based on validation by experts and user validities, 93 nursing interventions which were above ICV(Index of Content Validity) .80 were chosen. 3. Nursing intervention protocols which showed above ICV .80 were developed.

• Journal of Yeungnam Medical Science
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• 제38권4호
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• pp.361-365
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• 2021

Stroke patients have reduced aerobic capacity. Therefore, intensive structured exercise programs are needed. We report the case of a patient with stroke and cardiac disease who underwent early inpatient cardiac rehabilitation (CR). A 38-year-old male patient with atrial fibrillation, heart failure, and cerebral infarction underwent a symptom-limited exercise tolerance test (ETT) without any problems on day 45 after admission. He completed a 2-week inpatient program and an 8-week home-based CR program. Follow-up ETT showed increased exercise capacity. The present case might be the first to report a safely performed CR program in a patient with stroke and cardiac comorbidity in Korea. Systematic guidance is needed for post-stroke patients to receive safe and effective CR for the secondary prevention of stroke and cardiovascular risk.

• Healthcare Informatics Research
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• 제24권4호
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• pp.283-291
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• 2018

Objectives: To identify the current status of smartphone usage and to describe the needs for smartphone-based cardiac telerehabilitation of cardiac patients. Methods: In 2016, a questionnaire survey was conducted in a supervised ambulatory cardiac rehabilitation (CR) program in a university affiliated hospital with the participation of heart failure or heart transplantation patients who were smartphone users. The questionnaire included questions regarding smartphone usage, demands for smartphone-based disease education, and home health monitoring systems. Results were described and analyzed according to principal diagnosis. Results: Ninety-six patients (66% male; mean age, $5{\pm}11$ years), including 56 heart failure and 40 heart transplantation patients, completed the survey (completion rate, 95%). The median daily smartphone usage time was 120 minutes (interquartile range, 60-300), and the most frequently used smartphone function was text messaging (61.5%). Of the patients, 26% stated that they searched for health-related information using their smartphones more than 1 time per week. The major source of health-related information was Internet browsing (50.0%), and the least sought source was the hospital's website (3.1%). Patients with heart failure expressed significantly higher needs for disease education on treatment plan, home health monitoring of blood pressure, and body weight (${\chi}^2=5.79$, 6.27, 4.50, p < 0.05). Heart transplantation patients expressed a significant need for home health monitoring of body temperature (${\chi}^2=5.25$, p < 0.05). Conclusions: Heart failure and heart transplantation patients show high usage of and interest in mobile health technology. A smartphone-based cardiac telerehabilitation program should be developed based on high demand areas and modified to suit to each principal diagnosis.

• The Journal of Korean Physical Therapy
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• 제30권5호
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• pp.181-186
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• 2018

Purpose: This study investigated the effects of home-based exercise intensity on the aerobic capacity and 1 year re-hospitalization rate in patients with chronic heart failure (CHF). Methods: Forty seven patients with CHF (males 33, females 14, age $61.3{\pm}9.8years$) participated in this study. The patients were allocated randomly to 3 groups in accordance with home-based exercise intensity: no home based exercise (NHE, 40%, n=19), moderate intensity home-based exercise (MIHE, 43%, n=20), and high intensity home based exercise (HIHE, 17%, n=8). All patients completed the symptom-limited cardiopulmonary exercise (CPX) test safely at the cardiac rehabilitation hospital. Results: The NHE group significantly showed lower peak $VO_2$ and a higher $VE/VCO_2$ slope than the MIHE (p<0.05) and HIHE (p<0.01) groups. On the other hand, the NHE group did not show significant differences in the other hemodynamic responses, such as heart rate (HR) max, HR reserve, maximal systolic blood pressure (SBP), and SBP reserve. Nine out of 19 NHE patients (47%) were re-hospitalized related to heart disease and two out of 20 MIHE (10%) patients were re-hospitalized, but nobody in the HIHE group were re-hospitalized within 1 year from the CPX test. Conclusion: In patients with CHF, home-based self-exercise is one of the important factors for reducing the re-hospitalization rate. In addition, improved aerobic capacity is strongly associated with a lower re-hospitalization rate. In particular, re-hospitalized CHF patients showed significant differences in respiratory parameters and hemodynamic parameters compared to the non-re-hospitalized patients.

• 재활간호학회지
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• 제16권2호
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• pp.112-121
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• 2013

Purpose: This study aimed to describe Korean nursing home nurses' perceptions on dysphagia management and their working experiences of older adults with dysphagia. Methods: Using a purposive sampling design, 23 eligible nurses were interviewed as four focus groups from 4 facilities out of nursing homes. The qualitative data from focus group interviews were analyzed using thematic analysis to classify common themes into larger categories. Results: Two main themes on the attributes of caring nursing home residents with dysphagia were 'Need for nursing resources' and 'Need for support'. In addition, four subthemes emerged as a result of analysis: 'need for nursing protocols for assessing and managing dysphagia', 'need for emergency care skills of nurses and nurse assistants', 'need for prompt and accurate management by cooperation of physicians and therapists', and 'need for partnership upon comprehension of visiting family members concerning dysphagia'. Conclusion: Nursing home nurses fully recognized the importance of dysphagia management; however, they experienced substantial barriers due to lack of adequate nursing protocols or partnership with family caregivers, insufficient training for emergency care, and deficient support from medical staff. Development of nursing guidelines tailored to the nursing home context and based on partnership among medical experts and family caregivers is needed.

• 가정간호학회지
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• 제7권1호
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• pp.58-72
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• 2000

This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria, such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based intermediate facilities or home health care should be developed for rehabilitation services as a substitute for hospitalization in order to shorten the length of stay would be. A hospital based home health care nursing service. it would be available immediately to utilize by patients who want rehabilitation services as a substitute for hospitalization with the cooperation of car insurance companies.

• 한국산학기술학회논문지
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• 제13권7호
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• pp.3023-3029
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• 2012

본 연구의 목적은 만성 편마비 뇌졸중 환자를 대상으로 상지 운동기능 회복을 위하여 적용한 가상현실 가정운동프로그램의 가능성을 알아보기 위함이다. 만성 뇌졸중 환자 2명을 대상으로, 한 명의 참여자는 가상현실운동프로그램을 가정운동프로그램으로 처방하여 실행하였고, 다른 한 명의 참여자는 강제-유도운동치료를 가정운동프로그램으로 처방하여 실행하였다. 치료기간은 4주간으로 1주일에 총, 5회로 1회에 4시간씩 실시하였다. 평가는 뇌졸중 기능회복평가(Fugl-Meyer Assessment; FMA), 운동활동척도검사(Motor Activity Log, MAL), 그리고 울프운동기능검사(Wolf Motor Function Test; WMFT)를 이용하였다. 가상현실 운동프로그램을 가정운동프로그램으로 실시한 대상자가 모든 운동기능평가에서 상당한 기능적 회복을 보여주었다. 특히, FMA 점수는 가상현실프로그램을 사용한 대상자는 17% 향상된 반면, 강제유도운동치료를 가정운동프로그램으로 실시한 대상자는 5% 증가하였다. 또한, MAL 점수의 환측 상지를 이용하는 양(Amount of Use; AOU)와 움직임의 질(Quality of Movement; QOM)점수에서도 가정중심 가상현실 프로그램을 이용한 대상자가 각 40%, 20% 향상된 반면, 강제유도운동치료를 받은 대상자는 각각 0%, 20% 증가하였다. 가상현실 프로그램을 사용한 대상자와 강제유도운동치료를 받은 대상자의 WMFT 점수가 모두 20%증가하였다. 본 연구결과, 만성 편마비 뇌졸중 환자의 상지 운동 기능 향상을 목적으로 가정운동프로그램을 설계할 때 가상현실 운동프로그램이 강제-유도운동치료보다 더욱 효과적인 것으로 사료된다.

• The Journal of Korean Physical Therapy
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• 제34권1호
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• pp.26-37
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• 2022

Purpose: Japan established the convalescent rehabilitation wards, corresponding to Korea's rehabilitation medical institutions, in 2000 and developed it into the present system through continuous revisions. This study sought to analyze the issues and tasks faced by Japan segregated by the period of revision of convalescent rehabilitation ward-related medical fee regulations, through a literature review and further aimed to explore the direction of development of domestic rehabilitation medical institutions. Methods: Ten revisions of the medical fee regulations were classified into three stages based on quality evaluation: (1) the quantitative expansion stage (2000-2006); (2) quality evaluation introduction stage (2008-2014); and (3) quality evaluation maturity stage (2016-2020). Results: The following issues and tasks emerged: (1) For the quantitative expansion stage; insufficient rehabilitation within the ward, insufficient after-hour rehabilitation, insufficient connection with acute-stage hospitals and maintenance facilities, and the low ratio of specialists. (2) For the quality evaluation introduction stage; disparity in the manpower between institutions, the necessity of a 365-day rehabilitation system, avoidance of critical patients, and the problem that an increase in the amount of rehabilitation did not lead to a qualitative improvement. 3) For the quality evaluation maturity stage; cream-skimming issues in selecting patients, inappropriate evaluation of rehabilitation effects, and the necessity of follow-up measures after discharge. Conclusion: It is worth referring to the established regulations in Japan, and concurrently it is necessary to strengthen the evaluation of the structures, processes, and results when operating and evaluating rehabilitation medical institutions in Korea taking into account the side effects that could be identified in Japan.