Clinic Study On Rehabilitation Of Spinal Cord Injury

Objective: There are several aspects of rehabilitation of spinal cord injury to discuss in this study:①Activity of daily living measure scale(AMS) was established to suit the people cultural context and actual of China. The reliability and validity of AMS was analysed, in order to prove that the AMS can apply on clinic widely;②The rehabilitation involvement opportunity was conducted with the groups comparison, in order to clear further about the opportunity of early rehabilitation involvement as well as the influence of early rehabilitation on the function of patients with SCI;③Through the clinical comparison research, the vital role of the rehabilitation treatment which restores to function of patients with SCI was proved;④The influence of Rational-Emotive Therapy(RET) on the psychologic and functional condition of the patients with SCI.Object and method: 180 cases patients with spinal cord injury in orthopedics or rehabilitation department in hospital during September 2004 to September 2006 was involved in this study. The partial patients left the hospital still persist in the original rehabilitation program until this research is over. This research duration is 3 months.Study design: Doulbe-blinded, two groups randomized controlled trial, with pretreatment and posttreatment measures.Setting: Rehabilitation clinics.Measure contents: The follow measurement were taken in this study: Patient's general condition, damage plane, ASIA grade, Activities of daily living Measure Scale (AMS), Barthel index (BI), Functional independence measure(FIM), Hamilton depression rating scale(HAMD), Hamilton anxiety rating scale(HAMA), Beck depression inventory (BDI).Measure methods: All SCI patients integrated in this research were evaluated with above measures pre and post rehabilitation treatment. Rehabilitation assessmet were carried on by rehabilitation doctor, physical therapist (PT), psychological therapist (ST). The measure method and attention notes of rehabilitaion assessment was trained to guarantee the measure standard uniformity and the data reliability.The rehabilitation treatment program was carried on according to different clinical stage of patient; Rational-Emotive Therapy (RET) was taken in psychotherapy to the patients with SCI.Results:1,Reliability and validity analysis of the AMS: The reliability and validity of AMS was analysised by Pearson related analytic method of SPSS12.0 statistics software in 30 cases patients with SCI. The AMS scores is consist of movement score (AM), cognition score (AC), total score (AT).(1) Intergroup reliability: the AMS scores of two times measured by the identical observer within a week-long was analysis: The Pearson correlation coefficient between AM1 and AM2, AM1 and AT2, AC1 and AC2, AT1 and the AM2 is respective 0.999, 0.983, 0.982, 0.992, 0.992. It showed that the relation between the scores of two times measured by the identical observer is high. It demonstrated that AMS has good inter-group reliability.(2) Between-groups reliability: The AM,AC,AT scores measued by a observer(A) was compared with another observer(B) by Pearson relation. The Pearson correlation coefficient between AM(A) and AM(B), AM(A) and AT(B), AC(A) and AC(B), AT(A) and AM(B), AT(A) and AT(B) is respective 0.999, 0.991, 0.964, 0.992, 0.999. The results showed highly relations of the scores between two observers. It demonstrated that the AMS has good between-groups reliability.(3) Face validity: Expert's appraisal believed that the content and structure this measure scale are reasonable, the clause in the table can reflect the basic characteristic to SCI patient's functional condition. It shows that the AMS has the good face validity and the research of rehabilitation assessment on SCI measured by AMS can achieve the anticipated target.(4) Criteria validity: The correlation analysis AMS and FIM and BI was carried on pre and post treatment by pearson relation. The Pearson correlation coefficient of AM1 and FM1, AM1 and FT1, AM1 and BI1, AT1 and FM1, AT1 and FT1, AT1 and BI1 is respective 0.900, 0.880, 0.924, 0.880, 0.854, 0.903 pre treatment; The Pearson correlation coefficient of AM2 and FM2, AM2 and FT2, AM2 and BI2, AT2 and FM2, AT2 and FT2, AT2 and the BI2 is respective 0.825, 0.840, 0.788, 0.828, 0.846, 0.790 post treatment. It is showed that AMS is relative highly with FIM and the BI and has good criteria validity.(5) Sensitivity: The AMS scores(67.57±14.38) of post treatment is significant improved comparing with the scores(33±16.02) pre treatment (t=12.36, p=0.000). It shows that the sensitivity of AMS is good. Moreover the effect size statistics was used to evaluate the sensitivity of AMS. The effect size is 2.16 and shows that AMS has big effect. Thus the sensitivity of AMS is good.2,The results of involvement opportunity of rehabilitation treatment on SCI:According to the forecited grouping principle and the procedure, 80 cases patients with SCI were divided into two groups. 40 cases rehabilitation treatment involved within 1 month after the wound were divided into the treatmet group(TG). 40 cases rehabilitation treatment involved late to 1 month after the wound were devided into the control groupCG). AMS, BI, FIM were measured pre and post treatment. The AMS scorse pre treatment, post treatment, improved value is respective, TG38.23±17.88, 73.68±27.38, 35.45±18.13, CG42.93±18.75, 63.45±19.41, 20.53±12.56; BI scores is: TG 23.38±15.50, 53.13±28.46, 29.75±16.01, CG 25.50±17.28, 43.63±20.25, 18.13±11.80; FIM scores is: TG 55.98±16.76, 92.78±24.72, 36.80±14.97, CG 62.75±14.44, 84.50±17.85, 21.75±11.62.Statistics analysis: The AMS,BI,FIM scores pre treatment of each group is significant difference compared with post treatment(statistics: P=0.000). The AMS, BI, FIM scores pre treatment is non-statistics significance compared between two groups (P＞0.05); AMS, BI, FIM scores post treatment as well as their improved value is statistics significance compared between two groups(P=0.000). The results explanation that earlier rehabilitation involvement is more advantageous to function restoration on the SCI patients.3,rehabilitation treatment results:100 patients with SC1 included in this study were divided into two groups. 50 cases who has not been able to treated with rehabilitation treatment because of each kind of reason were divided into control group(CG). 50 cases who were provided rehabilitation treatment were divided into treatment group(TG). AMS, BI, FIM were measured pre and post treatment. The AMS scorse pre treatment, post treatment, improved value is respective: TG 35.14±16.77, 72.64±23.44, 37.50±20.81, CG 37.87±19.01, 44.92±20.36, 7.05±3.95; The BI score: TG 18.50±14.22, 56.80±26.45, 38.30±18.34, CG 22.40±15.79, 29.60±18.95, 7.20±4.54; The FIM score: TG 55.88±7.79, 94.50±19.75, 38.62±18.09, CG 58.24±9.83, 67.60±11.18, 9.36±3.70.Statistics analysis: AMS, BI, F1M score were compared between two groups by the independent sample t-test. The AMS, BI, FIM of pre treatment is non-statistics significance difference compared between TG and CG (t: -0.762, -1.298, -1.330; P 0.448, 0.197, 0.187). AMS, BI, FIM scores post treatment as well as their improved value is statistics significance difference compared between two groups(t=5.911～11.640; P=0.000). It explains rehabilitation treatment can improve the SCI patient movement function and ability of daily life (ADL) obviously.4,psychology treatment results:(1) SCI patient's psychology and correlation factors analysis:120 SCI patients were involved in this study. Depression was evaluated by HAMD, BDI and anxious condition was evaluated by HAMA. AMS, BI, FIM were evaluated to functional condition of SCI patients. In 120 cases, 112(93.33%) patients suffered the depression and 115(95.83%) patients suffered obvious anxious (＞21) and serious anxious (＞29). It explains that there is generally depression and anxious in the SCI patients.Correlation factors to depression: The Pearson correlation coefficient of HAMD score compared with the age, the sex, the course of illness, the damage section is respective -0.003, 0.008, 0.066, -0.046. HAMD score compared with ASIA, AMS, BI, FIM, The Pearson correlation coefficient is respective -0.780, -0.308, -0.540, -0.407. The Pearson correlation coefficient of BDI score compared with the age, the sex, the course of illness, the damage section is respective 0.014, -0.034, 0.160, -0.122. BDI score compared with ASIA, AMS, BI, FIM, the Pearson correlation coefficient is respective -0.673, -0.433, -0.548, -0.429. It explains that depression of SCI patients do not related with the age, the sex, the course of illness, the damage section and is closly relative with ASIA and patient's functional condition (AMS, BI, FIM).Correlation factors to anxious: The Pearson correlation coefficient of HAMA compared with the age, the sex, the course of illness is respective 0.010, -0.049, 0.146, HAMA compared with the damage section, ASIA,AMS,BI,FIM, the Pearson correlation coefficient is respective -0.887, -0.281, -0.524, -0.639, 0.559. It explains that the anxious of SCI patients do not related with the age, the sex, the course of illness and is relative with the damage section, ASIA and patient's functional condition(AMS, BI, FIM).(2) Influence of Rational-Emotive Therapy on psychology condition of SCI patients:120 SCI patients who were treated with rehabilitation program were divided into the control group(CG) 60 cases and treatment group(TG) 60 cases according to the grouping principle and procedure. The patients in treatment group was treated with RET while they were been suffering rehabilitation training. Psychology assessment was evaluated by HAMD, BDI, HAMA. The HAMD scores of pre and post treatment is: TG 35.53±8.83, 18.43±4.85, CG 36.43±8.90, 32.17±9.28; The BDI scores of pre and post treatment is: TG 21.77±5.35, 10.65±4.02, CG 23.63±4.97, 18.95±5.41; The HAMA scores of pre and post treatment is: TG 39.17±8.57, 20.90±6.35, CG 38.53±8.87, 34.17±9.04.Statistics analysis: The HAMD, BDI, HAMA scores were compared between two groups by the independent sample t-test. The HAMD, BDI, HAMA scores of pre treatment is non-statistics significance difference compared between two groups(t=-0.556, -1.979, 0.398, P=0.579, 0.055, 0.691). The HAMD, BDI, HAMA scores of post treatment and their improved value is statistics significance difference compared between two groups(t=-16.289～-8.439, P=0.000). It explains that Influence of Rational-Emotive Therapy on psychology condition of SCI patients is remarkable.(3) Influence of Rational-Emotive Therapy on movement function of SCI patients:AMS, BI, FIM were evaluated in the assessment of movement function and ADL of SCI patients in order to explore the influence of RET on the movement functional condition while psychology condition were improved. Results: The AMS scores of pre and post treatment is respective: TG 34.58±16.47, 72.65±23.52, CG 40.51±18.25,56.13±22.40; The BI scores of pre and post treatment is respective: TG 18.00±13.78, 58.50±26.99, CG 23.92±17.90, 42.08±22.20; The FIM scores of pre and post treatment is respective: TG 55.38±8.02, 95.23+20.04, CG 59.77±13.87, 78.73±15.65.Statistics analysis: AMS, BI, FIM scores of pre and post treatment were compared between two groups by the independent sample t-test. The AMS, BI, FIM scores of pre treatment is non-statistics significance difference compared between two groups(t=-1.867, -2.029,-0.119, P=0.064, 0.072, 0.076). The AMS, BI, FIM scores of post treatment is statistics significant difference compared between two groups(t=3.941, 3.639, 5.027, P=0.000). The improved value of AMS, BI, FIM is statistics significant difference compared between two groups(t=7.514, 7.300, 7.566, P=0.000). It is indicated that the RET can improve the movement function and ADL of SCI patients while psychology condition were improved.Conclusions:(1) There is the good validity and reliability in Activity of daily living measure scale(AMS). It can be widely applied in clinical to evaluate the movement function and ADL of patients with spinal cord injury.(2) The early rehabilitation involvement can promote the spinal cord injury function restoration, the rehabilitation to be supposed obviously to involve as far as possible within 1 month after the wound.(3) Rehabilitation treatment has the vital role to restore function of spinal cord injury.(4) There are depression and anxious generally in patients with spinal cord injury. The Rational-Emotive Therapy can improve psychology condition of the patients with spinal cord injury obviously, thus promotes the patient's function condition restoration.Innovation place of this study:1,It takes the lead that the Rational-Emotive Therapy(RET) was applied to the psychotherapy of patients with spinal cord injury. RET is a important method of psychotherapy. According to the psychology principle and the treatment idea of RET and analysed the psychology characteristic of SCI patients, RET truly has pointed as the psychotherapy to the SCI patient's psychological barrier. At present, although there are many research about the RET in domestic and foreign, but applied the RET to the disease clinical research are less, specially applied to the SCI psychotherapy has not seen the report.2,There is the good reliability and validity in Activity of daily living Measure Scale(AMS) and the widely appling in clinic to evaluate the movement function and ADL of patients with spinal cord injury. At present in domestic, there is not still a unification measure scale to evaluate ADL of SCI patients. It is very inconvenienced to the multi-central cooperation research as well as the academic exchange. Therefore, according to the international general measure scale related ADL, there is the vital significance to establish domestic unification scale of ADL for SCI patients linked to the domestic reality and the cultural context.3,Doulbe-blinded, randomized controlled trial is the authority clinical study design. Doulbe-blinded, randomized grouping controlled trial was first designed in this study on rehabilitation of patients with SCI in domestic. Rehabilitation treatment is vital significance to improve the function of patients with SCI. But domestic multitudinous research reported of SCI is all basical own around comparing and lacks the grouping randomized controlled comparison, specially not supposed blindly; The opportunity of early rehabilitation involvement lacks the unification standard. Therefore the findings persuasive power is not strong. Doulbe-blinded, randomized grouping controlled trial was first designed in this study on rehabilitation of patients with SCI in domestic. The results show that the influence of rehabilitation treatment on the function of patients with SC1 is important, specially for the early rehabilitation involvement. The early rehabilitation should involving within 1 month and has more advantageous to functional outcome of patients with SC1.