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1. Rehabilitative Effects of Schroth Therapy with Bonesetting Massage for Adolescent Idiopathic Scoliosis
LU Yuelun, LUO Guogang, XIE Haifeng, DAI Ziyi
Chinese General Practice    2022, 25 (32): 4059-4064.   DOI: 10.12114/j.issn.1007-9572.2022.0386
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Background

Adolescent idiopathic scoliosis (AIS) is becoming increasingly common in clinical settings, imposing a heavy burden on the family and society. At present, few treatments are available with fair effects for AIS, and there is a lack of unified and effective treatment schemes for AIS.

Objective

To explore the effect of Schroth therapy with bonesetting massage in AIS.

Methods

Forty adolescent AIS patients treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to December 2020 were selected, and equally randomly divided into treatment group and control group, 20 cases in each group. Both groups received bone setting massage once a week, and the treatment group additionally received Schroth therapy, 90 minutes per time, 3 times per week. The treatment for both groups lasted for 6 months. Pre- and post-treatment Cobb angle and angle of trunk rotation (ATR) as well as clinical efficacy were compared between the two groups.

Results

The Cobb angle after treatment was smaller than that before treatment in both groups (P<0.05). And the treatment group had a smaller post-treatment Cobb angle than the control group (P<0.05). ATR decreased after treatment in both groups (P<0.05), and it decreased more obviously in the treatment group (P<0.05). The response rate for either control group or treatment group was 95.0% (19/20) but the marked response rate was higher in the treatment group〔85.0% (17/20) vs. 30.0% (6/20) 〕 (P<0.001) .

Conclusion

Compared with bonesetting massage alone, Schroth therapy with bonesetting massage had better effect on improving the Cobb angle and ATR in AIS patients, so the combination therapy is recommended for clinical use.

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2. Telemedicine Management in Stabilized Respiratory Rehabilitation of Elderly Patients with Moderate-to-severe Chronic Obstructive Pulmonary Disease: a Randomized Controlled Trial
YUAN Quan, LU Haiying, WANG Yi, LIU Yunxiao, YU Jiaqin, TIAN Fengzhao, LI Yao
Chinese General Practice    2024, 27 (06): 711-716.   DOI: 10.12114/j.issn.1007-9572.2023.0333
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Background

The number of chronic obstructive pulmonary disease (COPD) patients in China is huge, and respiratory rehabilitation training, as an important part of the management of COPD patients in the stabilization period, can effectively improve their lung function and quality of life, as well as reduce the burden on their families and society. Current data from Europe and the United States have shown that the implementation of respiratory rehabilitation under telemedicine management can improve the lung function and QOL of patients, however, there is a lack of relevant practice in China, especially in the west.

Objective

To assess the impact of respiratory rehabilitation training via telemedicine management in combination with conventional therapy on improving ventilatory capacity and lung function in elderly patients with moderate-to-severe COPD.

Methods

This study was a prospective randomized controlled study, enrolling consecutive COPD patients who attended the Fourth People's Hospital of Sichuan Province and five joint community clinics from June 2021 to June 2022. The included patients were randomly divided into the experimental group and control group by simple randomized grouping method using random number table. The control group received traditional long-term regular inhalation bronchodilator and oral medication, and the experimental group was guided by telemedicine on the basis of the treatment plan of the control group. A six-month study was conducted on two groups of patients, lung function, Borg score, 6MWT, and quality of life score (QOL score) were recorded at 1 month before and 1, 3, 6 months after intervention.

Results

The study subjects were divided into 72 cases in the control group and 73 cases in the experimental group, and there was no significant difference in gender, age and lung function at baseline [the forced expiratory volume in one second/predicted value ratio (FEV1%pred) , and the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV1/FVC) ] between the two groups (P>0.05) . There was an interaction between time and group for dyspnea and mood in FEV1%pred, FEV1/FVC, 6MWT level and QOL score (P<0.05) . After 1, 3, and 6 months of intervention, FEV1%pred, FEV1/FVC, 6MWT, Borg score, and QOL score of the experimental group were better than those of the control group (P<0.05) ; FEV1%pred, FEV1/FVC, Borg score, 6MWT, and QOL scores at 3 and 6 months post-intervention were better than those at 1 month post-intervention in the experimental group (P<0.05) .

Conclusion

The use of telemedicine technology for respiratory rehabilitation of elderly moderate-to-severe COPD patients in the stable stage can effectively improve the pulmonary function, quality of life and the quality of survival of this group of patients after 3, 6-months intervention.

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3. Integrating Physical Activity into Healthcare for the Prevention and Treatment of Diabetes: Insights from the U.S. Experience
Yuan GAO, Xianjuan KOU
Chinese General Practice    2022, 25 (25): 3089-3096.   DOI: 10.12114/j.issn.1007-9572.2022.0222
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The prevention and treatment of diabetes is booming driven by the integration of physical activity into healthcare. In China, the integration of physical activity into healthcare started late and still has many imperfections, the improvement of which relies crucially on measures explored according to the national conditions. The U.S. has formed a relatively comprehensive diabetes prevention and control system based on integrating physical activity into healthcare after years of exploratory practice, which may provide insights into the development of diabetes prevention and control in China. We introduced the development and implementation of the America's National Diabetes Prevention Program (DPP) , and summarized the wellness benefit system in health insurance for diabetes, innovative models of referral cooperation, interdisciplinary talent training programs, and the framework of integrating the data of health records and physical activities in the U.S. Then based on this, we put forward the following recommendations for integrating physical activity into healthcare to improve the current diabetic prevention and treatment (including solving problems) in China: speeding up the development of a China's national DPP, and popularizing the idea of integrating physical activity into healthcare; deepening the reform of the social security system, and resolving the conflicts between medical insurance regulations; promoting the innovation of the models of integrating physical activity into healthcare, and improving the operation of referral services; filling the gap in interdisciplinary talent training to develop a competitive heath workforce; bridging the data of health records and physical activities for information sharing with good management of the privacy and security of personal information.

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4. Efficacy of Virtual Reality Vestibular Rehabilitation Training in Patients with Sudden Deafness and Vertigo: a Randomized Controlled Trial
ZHAO Yanan, HAN Shifan, LI Ying, ZHOU Liyuan, YANG Jie, WU Jiaxin, CHEN Ganggang
Chinese General Practice    2024, 27 (14): 1672-1677.   DOI: 10.12114/j.issn.1007-9572.2023.0272
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Background

Due to its unique advantages, virtual reality rehabilitation (VR) training has been widely used in the field of rehabilitation therapy, but there is a lack of study on its application efficacy in patients with sudden deafness and vertigo.

Objective

To observe the efficacy of coventional vestibular rehabilitation training and vestibular rehabilitation training assisted by VR technology in patients with sudden deafness and vertigo.

Methods

From January 2022 to January 2023, 84 patients with sudden deafness and vertigo were selected from the Department of Otolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University and randomly divided into the two groups, with 42 cases in each group. The control group was given drug therapy combined with coventional vestibular rehabilitation training, while the observation group was given vestibular rehabilitation training assisted by VR technology on the basis of drug therapy. The Dizziness Disorder Scale (DHI) and Hospital Anxiety and Depression Scale (HADS) were respectively used to evaluate the two groups before intervention, 7 and 14 days after the intervention.

Results

Finally 81 patients completed the trial, including 41 patients in the observation group and 40 patients in the control group. Group and time had interaction effects on DHI-Function (F), DHI-Emotion (E) and DHI-Physical (P) scores and total DHI score (P<0.05). The main effects of group and time on DHI sub-scores and total score were significant (P<0.05). There was no significant difference between the two groups in DHI sub-scores and total score before intervention (P>0.05) ; DHI sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). DHI sub-scores and total score in the observation group were higher than the control group after 7 and 14 days of intervention (P<0.05). Group and time had interaction effects on HADS-Anxiety Scale (A), HADS-Depression Scale (D) scores and total HADS score (P<0.05). The main effect of group and time on HADS sub-scores and total score was significant (P<0.05). There was no significant difference in HADS sub-scores and total score between the two groups before intervention (P>0.05). HADS sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). After 7 and 14 days of intervention, there was no significant difference in HADS sub-scores and total score between the two groups (P>0.05) .

Conclusion

Vestibular rehabilitation training is effective for patients with sudden deafness and vertigo, and the vestibular rehabilitation training assisted by VR technology can obviously improve patients' balance disorders and quality of life.

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5. Efficacy of Remote Rehabilitation Combined with Outpatient Treatment in Mild Adolescent Idiopathic Scoliosis
DONG Jiaxing, WANG Liancheng, ZHANG Jinchai, WANG Shuai, ZHANG Yajie
Chinese General Practice    2022, 25 (32): 4065-4071.   DOI: 10.12114/j.issn.1007-9572.2022.0418
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Background

Scoliosis is a common abnormal curvature of the spine. Patients with mild scoliosis are usually treated with outpatient physiotherapy, but satisfactory efficacy is associated with appropriate treatment time and frequency. The efficacy of offline physiotherapy may be affected by limited medical resources and patients' treatment time and geographical location. Remote rehabilitation may save patients' treatment time and increase the geographical accessibility of physiotherapy, making the therapy more simple and convenient.

Objective

To explore the efficacy of remote rehabilitation combined with outpatient treatment in mild adolescent idiopathic scoliosis (AIS) .

Methods

Fifty-eight eligible mild AIS patients were selected from Department of Rehabilitation Medicine, Tianjin Hospital from September 2020 to September 2021, and divided into three groups according to patients and their parents' selection of treatment: online group (n=18), combined group (n=20) and offline group (n=20). The online group received WeChat- and Tencent Video-based physiotherapeutic scoliosis specific exercise (PSSE), the combined group received both outpatient and WeChat- and Tencent Video-based PSSE treatment, and the offline group received outpatient PSSE treatment. Data of three groups were collected, including the main curve Cobb angle, coronal balance (CB), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, sagittal vertical axis (SVA), angle of axial trunk rotation (ATR), parietal vertebra rotation (Raimondi), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), muscle activation rate (MAR) on both sides of paraspinal vertebrae, root mean square ratio (RMSR) of paraspinal muscles on both sides of paraspinal vertebrae, and the score of SRS-22 before and after treatment.

Results

The main curve Cobb angle, TK, SVA, ATR, Raimondi, SS, MAR on paraspinal vertebrae, RMSR on the concave side of the parietal vertebra and SRS-22 self-image and mental health domain scores were significantly different from those before treatment in all groups (P<0.05). Specifically, the combined group was superior to the other two groups in improved ATR and treatment satisfaction. The combined group had significantly improved main curve Cobb angle after treatment than the online group. The improvement of the concave MAR in either the combined group or offline group was significantly better than that in the online group (P<0.05) .

Conclusion

In mild AIS patients, remote rehabilitation combined with outpatient treatment could effectively slow down the progression of AIS curve, improve sagittal abnormality of spine, abnormal posture and vertebral rotation, increase the activation rate of paraspinal muscles on the concave side of paraspinal vertebra and improve the balance of paraspinal muscles on both sides of paraspinal vertebrae. Moreover, the combined therapy also improved the quality of life.

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6. Community Practice of the Integration of Sports and Medicine in China:Typical Models,Realistic Dilemmas and Development Paths 
WANG Yijie,WANG Shiqiang,LI Dan1,XU Zhihan,WANG Shaokun
Chinese General Practice    2021, 24 (18): 2260-2267.   DOI: 10.12114/j.issn.1007-9572.2021.00.512
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The integration of sports and medicine integrates the tangible and intangible resources of the health system and the sports system through policy guidance,uses the theories and methods of medicine and sports science to achieve the purpose of enhancing people's physical fitness and maintaining people's health.As a key part in the construction of sports medical integration,community is not only the foothold but also the focus of sports medical integration.This paper summarizes and analyzes the practice of community sports medical integration in China,analyzes the current difficulties of community sports medical integration service,and puts forward the further improvement path.At present,the integration of community sports and medicine in China has formed three types of service models based on government enterprise cooperation,community sports club and community fitness monitoring center.However,there are still some problems,such as insufficient awareness of the concept of sports and medicine integration,lack of long-term cooperation mechanisms,shortage of talents,lagging platform construction,and insufficient participation of social forces.In view of this,in order to further promote the deep integration of community sports and medicine,it is urgent to enhance the cognition of community sports and medicine integration,establish the system and mechanism of the collaborative governance of multiple entities in the community,strengthen the construction of sports and medicine professionals,build a big data service platform,and mobilize different social forces to participate in the construction of community sports and medicine integration,so as to speed up the process of community sports and medicine integration service and meet the health needs of the broad masses of people health needs.
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7. Effects of Aquatic Therapeutic Exercise in Stroke Rehabilitation: an Overview of Systematic Reviews
Nannan HU, Hong GUO, Keke LIN, Ao ZHANG, Shanshan CHEN
Chinese General Practice    2022, 25 (19): 2421-2428.   DOI: 10.12114/j.issn.1007-9572.2022.0249
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Background

Aquatic therapeutic exercise is an emerging physical therapy technique, which provides new ideas for improving the motor function and quality of life of patients with stroke. However, it is not clear that the rehabilitation benefits obtained by patients with stroke from aquatic therapeutic exercise, and the levels of methodological quality and evidence quality of relevant studies.

Objective

To overview the systematic reviews of aquatic therapeutic exercise in improving the rehabilitation in patients with stroke.

Methods

In June 2021, Systematic reviews assessing the effects of aquatic therapeutic exercise in stroke rehabilitation were searched in databases of PubMed, the Cochrane Library, EmBase, CINAHL, Web of Science, CNKI, WanFang Data, CQVIP and SinoMed from inception to June 15, 2021. Two researchers screened systematic reviews according to the inclusion and exclusion criteria and extracted data separately. The methodological quality was evaluated using AMSTAR 2. The reporting quality was evaluated using the PRISMA. The quality of evidence for major outcomes was evaluated using the GRADE system.

Results

A total of 9 reviews were included, 2 of which were in Chinese and 7 were in English. The analysis showed that the methodological quality of 1, 1, and 7 reviews were moderate, low, and extremely low, respectively. The reporting quality of 7 reviews were relatively complete, 1 review had some flaws, and 1 review had a serious information flaw. There were a total of 9 outcome indicators, and 49 bodies of evidence, and the quality of bodies of evidence was mostly low or very low. Aquatic therapeutic exercise improved the balance function, mobility and muscle strength of stroke patients to a certain extent. And the rehabilitation benefits had proven to be more when it was used in combination with dryland trainings.

Conclusion

Aquatic therapeutic exercise has proven to be effective in improving balance function, mobility and muscle strength in stroke patients with good safety. But the overall methodological quality and quality of evidence for major outcomes of included systematic reviews are unsatisfactory. It is suggested that future studies use a larger sample size and an improved design, which will provide evidence-based guidance for clinical management of stroke rehabilitation with aquatic therapeutic exercise.

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8. Development of a Community Health Promotion Model Based on Integrating Physical Activity and Medical Technologies 
WANG Shiqiang,LI Dan,SHENG Xiangmei,XIAO Gang,NIE Yingjun,WU Juhua
Chinese General Practice    2020, 23 (12): 1529-1534.   DOI: 10.12114/j.issn.1007-9572.2020.00.062
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The increasing incidence of aging and chronic diseases has become a major social challenge faced by China.The achievement of Healthy China goals urgently needs to change the previous health promotion models that overly depend on medical care,and to promote the formation of a disease management and health management services model by integrating physical activity and medical technologies.However,the integration of physical activity and medical technologies is in the theoretical exploration stage,and the practical pathway is not clear.Moreover,there is no available feasible model for reference or following.Therefore,on the basis of theoretical analysis and field investigation,this study puts forward a health promotion model of "medical institutions-sports institutions-community institutions" with medical institutions and sports institutions as the advantages of resources,and community as the basic environment.The organization structure,operation mechanism and implementation process of the model are described in detail and analyzed and demonstrated,aiming to provide a feasible path choice for the integration of physical activity and medical technologies,explore a set of replicable and popularizable community work model,and explore a new way for the integration of physical activity and medical technologies and non-medical health intervention.
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9. Intervention Effect of a Novel Core Stability Rehabilitation Training Program on Chronic Non-specific Low Back Pain
LIU Xiaolong, HE Mengxiao, YIN Yikun, YANG Yang, ZHANG Jingzhi
Chinese General Practice    2023, 26 (09): 1064-1074.   DOI: 10.12114/j.issn.1007-9572.2022.0608
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Background

The traditional core stability rehabilitation training has been proven to be effective in improving the rehabilitation in patients with chronic non-specific low back pain (CNSLBP) , but with poor long-term compliance. We independently developed a new core stabilization rehabilitation training program (NO.2021107165452) for CNSLBP patients, but the intervention effects of which are still unclear.

Objective

To explore the intervention effect of a novel core stabilization rehabilitation training program in CNSLBP patients.

Methods

Twenty-one male CNSLBP patients were recruited from Guangxi Normal University and Guilin College from December 2021 to January 2022, and randomly divided into an experimental group (n=11) and a control group (n=10) , receiving a six-week intervention using the core stabilization rehabilitation training program independently developed by our research group, and traditional core stability rehabilitation training, respectively. The visual analogue scale (VAS) was used to evaluate the pain level. The Oswestry Disability Index (ODI) was used to evaluate the status of lumbar dysfunction. The Hoggan MicroFET 2 was used to measure muscle force and muscle force signals of the flexor muscles, extensor muscles, and rotatores muscles of the low back. The Y-balance test (YBT) was used to assess the dynamic balance ability.

Results

The values of VAS and ODI were significantly reduced in both groups after the intervention (P<0.05) , and they were more lower in the experimental group (P<0.05) . The muscle strength of upper abdominal flexors, spinal extensors, spinal left rotators, and spinal right rotators increased significantly in both groups after the intervention (P<0.05) . The left and right YBT scores were increased notably in both groups after the intervention (P<0.05) , and they were more higher in the experimental group (P<0.05) .

Conclusion

Both kinds of intervention programs could improve the lumbar pain, lumbar dysfunction, the muscle strength of upper abdominal flexors, spinal extensors, and spinal rotators, and dynamic balance in CNSLBP patients, but our core stability rehabilitation training program was more effective in reducing lumbar pain, improving lumbar dysfunction, and enhancing dynamic balance, so this novel program is worth promoting.

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10. Effect of routine language therapy combined with acupoint massage on language function and intelligence in young children with developmental retardation
CUI Jing,DI Weihua,LI Yan,WANG Jinyan,BI Fengli,WANG Wansheng,WANG Deqiang,SHAO Cuijie
Chinese General Practice    2020, 23 (21): 2689-2692.   DOI: 10.12114/j.issn.1007-9572.2020.00.240
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Background Due to the influence of environmental factors,the number of children diagnosed with language delay has increased significantly,which has gradually attracted the attention of parents and medical workers.However,available rehabilitation programs for such patients are homogeneous with slow responses.Although acupuncture and moxibustion therapy,a traditional rehabilitation therapy,has been reported in many articles to be effective in improving language function and intelligence,it is difficult to be accepted by the children and their parents due to its invasion.In contrast,acupoint massage is an effective method without the shortcomings of acupuncture and moxibustion therapy.So we further studied its effect on language function and intelligence in such children.Objective To explore the effects of routine rehabilitation therapy combined with acupoint massage on language function and intelligence of young children with developmental retardation.Methods A total of 155 young children diagnosed with developmental retardation in Children's Rehabilitation Clinic,Binzhou Medical University Hospital between January 2018 and January 2019 were included in this study.Using generated random numbers,they were divided into the routine group(n=80) and the intervention group(n=75).Both groups received routine rehabilitation therapy(consisting of language training and brain circulation therapy with cerebral circulation function therapeutic apparatus),the intervention group additionally received acupoint massage.The Gesell Developmental Schedules were used to assess the mid-term and long-term therapeutic effects in both groups at the end of 3,and 6 courses of treatment,respectively.Results After 6 courses of treatment,the intervention group showed better language function and intelligence(P<0.05).Both treatment method and time produced significant main effects on the development quotient of language function and adaptive behavior(P<0.05).And there was an interaction between treatment method and time on the development quotient of language function and adaptive behavior(P<0.05).The general mid-term and long-term improvements in the development quotient of language and adaptive behavior in the intervention group were higher than those of the routine group(P<0.05).Conclusion For young children with developmental retardation,routine rehabilitation therapy combined with acupoint massage is effective in improving their language function and intelligence.
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11.

Effect of Vestibular Training with Regular Rehabilitation on the Overall Development of Children with Global Developmental Delay and Hypotonia: a Randomized Controlled Trial

WANG Yan, WUYUN Tana, XIANG Dongliang, ZHAO Mingyue, YUAN Yiming
Chinese General Practice    2022, 25 (07): 867-873.   DOI: 10.12114/j.issn.1007-9572.2021.00.310
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Background

The increase in the number of children with global developmental delay and hypotonia is a growing concern. However, clinical rehabilitation for these patients is often carried out using monotherapy approaches, and the period for achieving improvement is relatively long.

Objective

To observe the effect of vestibular training with regular rehabilitation on muscle tone and global developmental level in children with global developmental delay with hypotonia, providing evidence for improving treatment options for these children.

Methods

Sixty children with global developmental delay accompanied by hypotonia who received rehabilitation training in Department of Pediatric Rehabilitation, Rehabilitation Center, the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from April 2018 to January 2020 were selected, and equally randomized into a control group (regular rehabilitation) and an observation group (vestibular training with regular rehabilitation) . Both groups were treated once daily, 6 days per week, for consecutive 4 weeks. Changes in the normative percentages of Griffiths Mental Development Scales (GMDS) subscales and development quotient, and muscle tone grading of both groups were observed before and after treatment. The overall response rates of muscle tone improvement were compared between the groups.

Results

The values of normative percentages of GMDS subscales and development quotient were similar in both groups at baseline (P>0.05) , but they were more higher in the observation group after intervention (P<0.05) . The post-intervention level of muscle tone of the observation group was higher than that in the control group (P<0.05) although intergroup difference in baseline muscle tone level was insignificant (P>0.05) . The observation group had a much higher overall response rate of muscle tone improvement 〔86.7% (26/30) : 17 (56.7%) with significant responses, 9 (30.0%) with fair responses, 4 (13.3%) with no responses〕 than the control group〔56.7% (17/30) : 9 (30.0%) with significant responses, 8 (26.7%) with fair responses, 13 (43.3%) with no responses〕 (χ2=13.658, P<0.001) .

Conclusion

Vestibular training with regular rehabilitation could improve the muscle tone and developmental delay in children with global developmental delay and hypotonia, which was superior to regular rehabilitation.

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12.

Research Advances in Vestibular Rehabilitation Mechanism and Treatment

QI Xiaoyuan, SONG Ning, GU Ping, YANG Xu
Chinese General Practice    2022, 25 (11): 1399-1405.   DOI: 10.12114/j.issn.1007-9572.2021.01.104
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Recent years have seen rapid advances in clinical diagnosis and treatment of vestibular diseases, especially vestibular evaluation and rehabilitation technologies, greatly promoting the developments in individualization and precision of rehabilitation for peripheral and central vestibular diseases. The vestibular rehabilitation helps to correct inappropriate strategy of equilibrium and/or to accelerate a good but slow compensation phenomenon, effectively improve vestibular, visual, and proprioceptive inputs to balance coordination control ability, improve the compensatory function of central nervous system, so as to reduce or eliminate the symptoms of dizziness, vertigo, and balance instability, eventually restoring the normal vestibular status. Given this background, we reviewed the advances in mechanisms of rehabilitation, pre-rehabilitation evaluation, rehabilitation program formulation and treatment regarding vestibular diseases, offering insights into clinical implementation and research concerning vestibular rehabilitation in China.

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13. Research on the Construction of Adherence and Its Influencing Factors of Patients with Percutaneous Coronary Intervention in Phase Ⅰ Cardiac Rehabilitation
CHEN Yilin, LIN Ping, HAN Yongkui, WANG Yini
Chinese General Practice    2023, 26 (18): 2209-2216.   DOI: 10.12114/j.issn.1007-9572.2022.0790
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Background

The importance of phase Ⅰ cardiac rehabilitation after percutaneous coronary intervention (PCI) has been confirmed, but there is suboptimal adherence among patients. Therefore, investigating the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the influencing factors can provide a theoretical foundation for improving the adherence of patients.

Objective

To clarifythe influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the effect pathways by the structural equation model construction, in order to provide the oretical support for improving the adherence of PCI patients to phase Ⅰ cardiac rehabilitation.

Methods

Patients with PCI enrolled in the Cardiac Rehabilitation Center of the Second Hospital of Harbin Medical University from August to December in 2021 were selected as the research objects by convenience sampling. The general demographic information questionnaire, therapy adherence questionnaire, health belief of coronary heart disease questionnaire, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiexy Disorde-7 (GAD-7), Family Adaptability and Cohesion Evaluation Scale (FACES), Chronic Illness Resource Survey (CIRS), Gensini score were used to investigate the patients by the end of phaseⅠ cardiac rehabilitation. Spearman rank correlation analysis was used to verify the correlations between health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource utilization and cardiac rehabilitation adherence, respectively. Based on correlation analysis, the hypothetical model of the influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation was constructed combined with Anderson's model of health service utilization. Maximum likelihood method was used to fit and modify the model constantly. Structural equation model was used to analyze the relationship among influencing factors.

Results

A total of 443 questionnaires were distributed and 430 valid questionnaires were returned, with a valid return rate of 97.06%. The results of multiple linear regression analysis showed that health belief (β=0.427), depression (β=-0.057), anxiety (β=-0.130), family adaptability and cohesion (β=0.242), chronic illness resource (β=0.140) were independent factors of the adherence to phaseⅠcardiac rehabilitation of PCI patients (P<0.05). The results of the correlation analysis showed that cardiac rehabilitation adherence score of PCI patients was positively correlated with health beliefs, family adaptability and cohesion, chronic illness resource utilization (P<0.05) and negatively correlated with depression and anxiety (P<0.05). A structural equation model of the adherence of PCT patients to phaseⅠ cardiac rehabilitation was constructed using health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource and the model fits well: χ2/df=3.092<5, standardized root mean square residual (SRMR) =0.070<0.080, goodness of fit indices (GFI) =0.981, adjusted goodness of fitindices (AGFI) =0.936, comparative fit index (CFI) =0.992, normed fit indexes (NFI) =0.989, with all of them>0.9. The results of the intermediate effects test showed that health belief, family adaptability and cohesion, chronic illness resource had positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=0.395, 0.277, 0.152, P<0.01) ; health belief, family adaptability and cohesion had a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic disease resource utilization (β=0.057, 0.065, P<0.01). Depression and anxiety had a direct negative effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=-0.055, -0.116, P<0.05) .

Conclusion

The adherence of PCI patients to phaseⅠ cardiac rehabilitation is influenced by multiple factors. There are complex pathway relationships among the influencing factors. Health belief, family adaptability and cohesion, chronic illness resource have a positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; depression and anxiety have a negative direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; health beliefs, family adaptability and cohesion have a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic illness resource utilization, and have a negative indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through anxiety and depression.

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14. Effectiveness of Telerehabilitation Applied to Functional Recovery after Stroke: an Overview of Systematic Reviews
Qi LI, Ruiqing LI, Jing GAO, Kaiqi SU, Xiaodong FENG
Chinese General Practice    2022, 25 (13): 1659-1666.   DOI: 10.12114/j.issn.1007-9572.2022.0156
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Background

Telerehabilitation (TR) is an emerging model of rehabilitation service delivery based on communication technology, remote sensing and control technology, virtual reality technology and computer technology to to achieve cross-regional rehabilitation medical services. However, the effectiveness of TR in functional rehabilitation after stroke is still unclear, the methodological quality of related studies is uneven, and few researchers have systematically evaluated it.

Objective

To re-evaluate the systematic reviews/meta-analyses on the effectiveness of TR for functional rehabilitation after stroke.

Methods

In August 2021, PubMed, Web of science, the Cochrane Library, VIP, WanFang Data, CNKI and CBM were retrieved by computer for systematic reviews/meta-analyses on the effectiveness of TR applied to functional rehabilitation after stroke from the establishment of the database to August 2021. After the literature screen and data extract by two researchers independently, the methodological quality of the included literature was evaluated by AMSTAR 2 scale, and the evidence quality of the outcome index was graded by GRADE system. Descriptive analysis was used to analyze the effectiveness of TR in functional rehabilitation after stroke.

Results

A total of 10 systematic reviews/meta-analyses were included, and the results of the AMSTAR 2 review showed that 2 systematic reviews were of high quality, 3 were of low quality, and 5 were of very low quality. The main reasons for the low methodological quality were the failure to report the preliminary study protocol, the list and reasons for excluded studies, the publication bias of the original study and the funding sources. The GRADE evidence quality assessment resulted in 10 systematic reviews addressing seven outcome measures, 41 bodies of evidence, with eight grade graded as intermediate, 23 grade graded as low, and 10 grade graded as very low. TR promoted the improvement of activities of daily living, motor function, quality of life, depressive symptoms and speech function of stroke patients to a certain extent, and had the same curative effect as face-to-face rehabilitation therapy or routine treatment, and even some TR rehabilitation effects were better than traditional rehabilitation therapy.

Conclusion

TR can promote the functional rehabilitation of stroke patients, but considering that the methodological quality and reliability of outcome measures of current systematic reviews/meta-analyses on the effectiveness of TR applied to functional recovery after stroke are mostly low, strict, standardized and comprehensive high-quality randomized controlled trials are still needed to provide evidence support; The results of this study can provide reference for the topic selection, research design and results report of future TR research.

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15. Use of Information-motivation-behavioral Skills Model and Motivational Interviewing in Cardiac Rehabilitation for Patients with Coronary Heart Disease in the Community 
MENG Jia,DU Shaoying,WANG Yan,LOU Shining
Chinese General Practice    2021, 24 (31): 3990-3994.   DOI: 10.12114/j.issn.1007-9572.2021.00.256
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Background Cardiac rehabilitation is an important part of standardized rehabilitation for coronary heart disease(CHD),but 30%-40% of the patients will drop out of the program after 6 months and 50% will drop out after 1 year.  Objective To explore the effect of information-motivation-behavioral skills(IMB) model and motivational interviewing used in cardiac rehabilitation education for CHD patients in the community. Methods CHD patients recruited from a community health station during May to June 2019 were randomized into the experimental group(n=40) and control group(n=42),receiving a series of lectures on cardiac rehabilitation plus IMB model-based education and motivational interviewing,and a series of lectures on cardiac rehabilitation,respectively. The self-efficacy,self-management behaviors and exercise adherence of the two groups were compared before the intervention,and 3 and 6 months after the intervention. Results The number of patients who completed follow-up in the experimental group and the control group were 36 and 41 respectively. Analysis using a repeated measures ANOVA revealed that the improvement in self-efficacy differed significantly across the two groups(F=4.176,P<0.05). The interaction effect generated by intervention contents and duration on self-efficacy was statistically significant(F=5.173,P<0.05). There was a statistically significant intergroup difference in the improvement in self-management behaviors(F=4.436,P<0.05). The self-management behaviors differed significantly by intervention duration(F=50.573,P<0.05). The experimental group showed statistically higher exercise adherence than the control group either at three or six months after the intervention(P<0.05). Conclusion IMB model and motivational interviewing may contribute to the improvement of self-efficacy and self-management behaviors of patients with CHD.
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16. Recent Advances in Self-determined Motivation towards Rehabilitation Treatment in Schizophrenia Patients
Kai YU, Yu WANG, Weiliang WANG, Yuqiu ZHOU
Chinese General Practice    2022, 25 (21): 2675-2679.   DOI: 10.12114/j.issn.1007-9572.2022.0103
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Schizophrenia is a severe mental disorder that endangers patients and their families' lives as well as the society. Over 80% of patients cannot be cured completely, one contributor to which is patients' lack of self-determined motivation for treatment. There are few studies on self-determined motivation for treatment among patients with schizophrenia in China. Self-determined motivation facilitates the development of positive emotions, behaviors and cognition, which also plays a vital role in the promotion health-related behaviors. We reviewed the latest advances in self-determined motivation towards rehabilitation treatment in schizophrenia patients, and gave a summary of the features and measurement methods regarding self-determined motivation, as well as its roles in predicting the effect of cognitive remediation, physical therapy and other types of rehabilitation treatment, and in maintaining treatment adherence. After that, we made suggestions on the problems to be solved. To improve treatment adherence and cure rate in schizophrenia patients, future studies may focus on developing appropriate interventions in accordance with the self-determined motivation of the patients.

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17. Guidelines on Cardiac Rehabilitation in Patients with Coronary Heart Disease: a Systematic Review
LIU Jingtao, SU He, QIN Xiaojin, LAN Yunxia, ZHANG Jinzhi
Chinese General Practice    2023, 26 (19): 2323-2331.   DOI: 10.12114/j.issn.1007-9572.2022.0700
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Background

It has been a consensus that cardiac rehabilitation is an effective comprehensive intervention for patients with coronary heart disease (CHD), but the quality of relevant guidelines is still unclear, and recommendations from the guidelines need to be integrated.

Objective

To systematically review the guidelines on cardiac rehabilitation in patients with CHD, providing evidence to inform clinical practice.

Methods

In June 2022, guidelines on cardiac rehabilitation in patients with CHD were searched in electronic databases of the Cochrane Library, Web of Science, PubMed, CNKI, CQVIP and Wanfang Data, relevant guideline repositories and association websites from inception to 30 June 2022. Literature screening and data extraction were performed by two researchers separately according to the inclusion and exclusion criteria. The quality of included guidelines was assessed using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ), and recommendations from which were summarized.

Results

Ten guidelines (eight of them are foreign guidelines) with publication time ranging from 2011 to 2020 were eventually included. The average score of every AGREEⅡ domain was 71% for scope and purpose, 65% for stakeholder involvement, 58% for rigor of development, 80% for clarity of presentation, 64% for applicability, and 45% for editorial independence. Four guidelines were rated as grade A and the remaining six as grade B. Six aspects are involved in recommendations, including basic requirements of cardiac rehabilitation, heath education, risk factors control, psychological support, exercise training, and improvement of cardiac rehabilitation participation.

Conclusion

The quality of included guidelines is at a moderate to high level. More efforts are needed to improve the domains in stakeholder involvement, rigor of development, applicability, and editorial independence. Recommendations of the 10 guidelines tend to be consistent, but there are still insufficient recommendations on improving cardiac rehabilitation participation. There is a gap in the quality between domestic and foreign guidelines, so it is necessary to develop a high-quality guideline on cardiac rehabilitation for patients with CHD in China.

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18. Health Promotion by Integrating Sports and Medicine in Japan:Experience and Implications 
HUANG Jing,WANG Shiqiang,LIU Qing
Chinese General Practice    2021, 24 (18): 2268-2274.   DOI: 10.12114/j.issn.1007-9572.2021.00.511
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The integration of sports and medicine is an effective approach to alleviating accelerated aging and sustained high prevalence of chronic diseases in China. Japan has developed a set of standardized health promotion systems by integrating sports and medicine after years of exploration and practice. By further investigation,it has been found that Japan's delivery models for health promotion can be classified into welfare type,integrated medical care and commercial types. In the process of advancing the integration of sports and medicine,Japan has formed a multi-party collaborative health promotion system with clear determination of each party's duties and responsibilities,developed a deeply rooted health promotion concept of integrated sports and medicine,a continuous education program and a social security system for sports medicine professionals,and a sound sports medicine industry. To advance the integration of sports and medicine in China,in consideration of Japan's experience,we put forward the following recommendations: clearly defining the duties of the government,guiding the collaboration of multiple providers of sports medicine services,popularizing the health promotion concept of integrating sports and medicine during the basic education,modifying the training system for sports medicine professionals,establishing multidisciplinary and interdisciplinary teams,developing a consumer market of sports medicine services,and establishing various health promotion programs.
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19. Visualization Analysis of Hot Topics about Cardiac Rehabilitation in Studies in the Web of Science Database #br#
LI Cuigang,ZUO Anju,LI Tingting,GUO Yuan
Chinese General Practice    2021, 24 (25): 3263-3268.   DOI: 10.12114/j.issn.1007-9572.2021.00.134
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Background In China,there are a large number of cardiovascular disease patients,which highlights the important role of cardiac rehabilitation in improving patients' prognosis and reducing their treatment burden. To promote domestic development of cardiac rehabilitation,it is necessary to review the international research hotspots in this field regularly. Objective To understand the distribution of countries and institutions studying cardiac rehabilitation, and hot topics of cardiac rehabilitation research since 2000,providing scientific evidence for carrying out relevant research in China. Methods With "(cardiac or heart) and rehab*" as theme,studies regarding cardiac rehabilitation included in the Web of Science Core Collection from 2000 to 2020 were searched in August 1,2020. VOSviewer 1.6.14 and CiteSpace 5.6.R3 were used to perform visualization analyses of the trend of publication,countries of publication,author institutions,and research hotspots of the eligible studies. Results A total of 9 793 articles were included. The yearly number of publications was on the rise overall. The author institutions in developed countries have a long history of cardiac rehabilitation research and a great influence on this field. The topics in these studies mainly focused on:the exploration of new forms of cardiac rehabilitation,forms of exercise interventions,integrated health management and psychological interventions for cardiac rehabilitation. Conclusion Our analysis indicated that for exploring forms of cardiac rehabilitation suitable for Chinese cardiovascular disease patients,priority should be given to strengthening the idea of patient-centered rehabilitation,with enough consideration on current research hotspots,and the use of the emerging technologies and family- and community-related factors.
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20. Perceived Social Support in Stroke Survivors and Their Caregivers during Rehabilitation in the Community:a Qualitative Study 
CHEN Suyan,MEI Yongxia,ZHANG Zhenxiang
Chinese General Practice    2020, 23 (35): 4503-4507.   DOI: 10.12114/j.issn.1007-9572.2020.00.106
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Background As the second leading cause of death in the world,stroke kills 5.5 million people in 2016.It causes heavy burdens to patients,their families and the society.Social support can reduce the anxiety,depression and other psychological pain of patients and their caregivers during rehabilitation,but the level of social support obtained by them is low.At present,there are so many quantitative studies about the social support.However,it is difficult to thoroughly know the experience of patients and caregivers.Objective To investigate the perceived social support in stroke survivors and their caregivers during the rehabilitation in the community.Methods  From September to December 2018,by using both purposive and snowball sampling,9 stroke survivor-caregiver dyads were selected from Linshanzhai Community,Zhengzhou City.Semi- structured face-to-face interviews were conducted with them and the results were analyzed with Colaizzi's phenomenological method.Results  The interview results were classified into three themes:(1) Sources of perceived social support.From the perspective of stoke survivors,their social support came from the major family caregiver and other family members,friends and community healthcare workers.From the perspective of caregivers,their social support came from other family members,friends and neighbors.(2) Types of perceived social support.The types of social support obtained by stoke survivors included information,emotional and tool supports.The caregivers obtained emotional and information supports,and provided emotional and tool supports for stoke survivors.(3) Barriers to obtaining social support.From the perspective of stoke survivors,the barriers consisted of three internal factors(cognitive bias in seeking support,uncomprehended needs and depression),and two external factors(insufficient sources for support and lack of ways to access to support).From the perspective of caregivers,the barriers consisted of three internal factors(weak awareness of seeking help,insufficient time and strong character),and two external factors(insufficient sources for support and lack of ways to access to support).Conclusion  To better promote the rehabilitation of the stroke survivors,healthcare providers in the community should provide continuous,effective and dynamic family-focused social support for stroke survivors and their family caregivers during the rehabilitation based on the evaluation results of their education level,clear needs and perceptions.
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21. Dynamic Trajectory of Exercise Rehabilitation Adherence of Patients with Atrial Fibrillation after Radiofrequency Ablation in the Internet+ Home Cardiac Rehabilitation Mode 
WANG Jie,SUN Guozhen,YANG Gang,BAO Zhipeng,LIU Shenxinyu,WANG Lin
Chinese General Practice    2021, 24 (32): 4074-4079.   DOI: 10.12114/j.issn.1007-9572.2021.01.218
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Background Decreased exercise endurance still exists after atrial fibrillation radiofrequency ablation. A number of studies have proved that atrial fibrillation exercise rehabilitation is effective,and adherence is a key determinant of whether the patient continues to benefit from exercise therapy. Therefore,understanding the dynamic changes and influencing factors of patients' exercise adherence after atrial fibrillation radiofrequency ablation is of great significance to establish the mechanism of internalization of external dynamics in patients' home exercise rehabilitation. Objective To analyze the longitudinal follow-up data of home-based exercise rehabilitation in patients with atrial fibrillation after radiofrequency ablation,reveal the dynamic change of exercise adherence and explore its influencing factors,in order to provide theoretical basis for the formulation of targeted intervention strategies. Methods A total of 72 patients with atrial fibrillation after radiofrequency ablation who were selected by convenient sampling method from February 2019 to August 2020 in the First Affiliated Hospital of Nanjing Medical University,were treated with Internet+ home exercise rehabilitation intervention for 12 weeks,and followed up to 24 weeks. The average adherence rates in seven time periods of 0-1 week,2-4 weeks,5-8 weeks,9-12 weeks,13-16 weeks,17-20 weeks and 21-24 weeks were collected. A multi-stage latent growth curve model was constructed for exercise adherence,and robust maximum likelihood estimation(MLR)was used to estimate the mean,the variance and the covariance. Taking gender,education,working status,the existence of comorbidities and frequency adherence as covariates,the latent growth curve model was constructed for intensity-time adherence and the parameters were estimated by MLR method. Results Intensity-time adherence and frequency adherence both showed a second-stage curve increasing trend model,suggesting that there is a turning point in the development of adherence,in the 12th week of exercise. The first-stage of intensity-time adherence(from the beginning to 12th week)showed a curve increasing trend,and the increasing rate slowed down with time(Q1=-0.062,P<0.05);The second stage(from 12 weeks to 24 weeks of exercise)showed a linear downward trend(S2=-0.081,P<0.05),and the differences in the initial level and growth rate of individuals were statistically significant(P<0.05). Frequency adherence showed a quadratic growth trend in the first stage,reaching the peak at the 4th week of exercise,and then decreased slightly;The second stage showed a quadratic downward trend,and the rate of decline accelerated with time(Q2=0.003,P<0.05),and the differences between the individual's initial level and the acceleration of change were statistically significant(P<0.05). Among the time-constant covariates,only the existence of comorbidities had a significant impact on intensity-time adherence at the first week(P<0.05). Between the first week and the 24th week,frequency adherence had a positive impact on intensity-time adherence(P<0.05). Conclusions During the intervention period,the level of intensive-time adherence and frequency adherence are relatively low,both with a curve increasing trend and stabilizing at a higher level,while the adherence decreased gradually during the follow-up period. Patients with comorbidities had poor initial intensity-time adherence,while frequency adherence had a positive impact on intensity-time adherence.
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22. Incidence and Related Factors of Post-stroke Cognitive Impairment: a Multicenter Cross-sectional Study Based on Full-cycle Rehabilitation in Stroke
TU Shuting, LIN Jiaying, ZHUANG Jinyang, XIANG Jingnan, WEI Dongshuai, XIE Yong, JIA Jie
Chinese General Practice    2024, 27 (23): 2829-2837.   DOI: 10.12114/j.issn.1007-9572.2023.0784
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Background

Post-stroke cognitive impairment (PSCI) can significantly limit the recovery of stroke patients at all stages and lead to a decline in activity participation and quality of life.

Objective

Based on the concept of full-cycle rehabilitation in stroke, by investigating the incidence of PSCI, to analyzed the differences of PSCI in different age and disease period and its potential influencing factors.

Methods

Stroke patients were hospitalized in the rehabilitation departments of 27 hospitals in different regions of China from October 2022 to July 2023 using simple random sampling method for cross-sectional analysis. A total of 402 patients were finally included according to the study criteria, and categorized into the young and middle-aged group (18-64 years old, n=234) and the elderly group (≥65 years old, n=168) according to the criteria of the National Bureau of Statistics of China, and the patients were also categorized into the acute-phase group (1-7 d, n=25), subacute-phase group (8-180 d, n=338), and the chronic-phase group (>180 d, n=39) according to the International Stroke Rehabilitation Alliance. Baseline information on patients was collected through interviews, assessments, and an electronic case system. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and subscores and total scores were calculated for each cognitive domain. Using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Hospital Anxiety Scale (HADS-A), and the Hospital Depression Scale (HADS-D) were used to assess the disease conditions and physical functioning of the patients. Spearman's rank correlation analysis was used to investigate the correlation between cognitive function levels and other clinical indicators at different ages and different stages of disease.

Results

The prevalence of PSCI in stroke patients was 76.4% (307/402), including 81.0% (136/168) in elderly patients and 73.1% (171/234) in young and middle-aged patients; the prevalence of PSCI in stroke patients was 56.0% (14/25) in the acute phase, 78.4% (265/338) in the subacute phase, and 71.8% (28/39) in the chronic phase. The results of grouping by age and disease period showed that the elderly group had lower visuospatial and executive function, attention, numeracy, delayed recall scores and total MoCA scores than those in the young and middle-aged group (P<0.05). Patients in the subacute-phase group had lower visuospatial and executive function, language, delayed recall scores and total MoCA scores than those in the acute-phase group (P<0.05). Correlation analysis showed that the total MoCA score was positively correlated (P<0.001) with educational level (rs=0.314), stroke type (rs=0.114), FMA-UE (rs=0.245), FMA-LE (rs=0.242), BBS (rs=0.265), MBI (rs=0.293), and was negatively correlated (P<0.05) with gender (rs=-0.107), age (rs=-0.103), history of hypertension (rs=-0.112), hemiplegic side (rs=-0.139), disease duration (rs=-0.135), NIHSS (rs=-0.107), HADS-A (rs=-0.239), HADS-D (rs=-0.280). Further stratified analyses showed that the young and middle-aged and elderly groups were correlated with the total MoCA score in terms of the educational level, NIHSS and physical function indicators such as FMA-UE, FMA-LE, BBS, MBI, HADS-A, and HADS-D (P<0.05). In the acute-phase group, disease duration, FMA-UE, and HADS-A were related to total MoCA score (P<0.05). In the subacute-phase group, age, education level, hypertension, history of alcohol consumption, type of stroke, hemiplegic side, disease duration, NIHSS, and physical function indicators such as FMA-UE, FMA-LE, BBS, MBI, HADS-A, HADS-D were correlated with the total MoCA score (P<0.05), and only educational level, hypertension, and HADS-D were correlated with the total MoCA score in the chronic-phase group (P<0.05) .

Conclusion

PSCI is closely related to age, disease development period, education level, physical function, balance, activities of daily living, anxiety and depression levels in stroke patients, and individualised preventive strategies and interventions should be developed for patients based on different stratified cognitive potential influencing factors, as well as increased screening and attention to cognition in the early stages of the disease to the later stages of rehabilitation.

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23. Prevalence and Associated Factors of Very Early Cognitive Impairment in COVID-19 Convalescents: a Study Using Data from a Questionnaire Survey
HUA Qiaoli, LIU Huiling, XU Xiaohua, ZHENG Danwen, WANG Qian, LIU Yuntao, ZHOU Xin, YANG Rongyuan, DING Banghan, GUO Jianwen, ZHANG Zhongde
Chinese General Practice    2023, 26 (10): 1234-1240.   DOI: 10.12114/j.issn.1007-9572.2022.0870
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Background

COVID-19 may impair the central nervous system, but the prevalence and related factors of very early cognitive impairment in discharged COVID-19 convalescents are still unclear.

Objective

To assess the prevalence of very early cognitive impairment in discharged COVID-19 convalescents, and to identify its influencing factors.

Methods

This study included 574 COVID-19 convalescents from August 28 to September 30, 2020, including individuals who were discharged from designated hospitals for treating COVID-19 in Wuhan from December 2019 to April 2020 randomly selected from the hospital information system, and those with informed consent recruited through news media. According to the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) score, the subjects were divided into a very early cognitive impairment group (AD8≥2) and a non-very early cognitive impairment group (AD8<2). A questionnaire survey was conducted with the subjects by four investigators at Hubei Provincial Hospital of Traditional Chinese& Western Medicine, using the General Information Questionnaire to collect demographic information and past disease history of the patients (including gender, age, underlying disease, classification of COVID-19 on admission, interval between discharge and the current survey, and various symptoms present at the time of follow-up), using the Generalized Anxiety Disorder-7 (GAD-7), the PTSD Check List–Civilian Version (PCL-C), and the Short Form 36 Health Survey Questionnaire (SF-36) to assess patients' anxiety, post-traumatic stress disorder, and quality of life, respectively. Three hundred and eleven cases finally completed the cognitive function screening. Multiple Logistic regression was used to evaluate the effects of gender, age, underlying disease and admission classification of COVID-19 on very early cognitive impairment. A restricted cubic spline model was used to assess the quantitative relationship between anxiety level and very early cognitive impairment.

Results

311 (54.18%) who effectively responded to the survey was finally enrolled, including 170 (54.7%) with very early cognitive impairment and 141 (45.3%) without. 230 (23.9%) had residual symptoms after discharge. Comparisons of gender, age, insomnia, fatigue, chest tightness, shortness of breath, loss of appetite, generalized anxiety disorder, PTSD positive, and the score of each SF-36 entry among COVID-19 convalescents with and without very early cognitive impairment were statistically significant (P<0.05). Multivariate Logistic regression analysis suggested that females〔OR (95%CI) =2.658 (1.528, 4.625) 〕, advanced age〔OR (95%CI) =3.736 (1.083, 12.890) 〕, and having generalised anxiety disorder〔OR (95%CI) =5.081 (1.229, 21.008) 〕were influential factors in increasing very early cognitive impairment (P<0.05). Restricted cubic spline models indicated a linear quantitative relationship between anxiety level and very early cognitive impairment, with higher levels of anxiety associated with a greater likelihood of very early cognitive impairment (P for non-linear test =0.132) .

Conclusion

The incidence of very early cognitive impairment is high in COVID-19 convalescents, and it may be higher in those who are older, female, or have generalized anxiety symptoms. Timely interventions for psychiatric problems and alleviation of anxiety symptoms in COVID-19 convalescents, especially in older women, may help to improve their cognitive function and Alzheimer's disease.

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24. Rehabilitation Needs and Influencing Factors in Community-dwelling Schizophrenia Patients in Shanghai 
GE Congcong,ZHANG Weibo,YANG Li,ZHANG Qiong,CAI Jun
Chinese General Practice    2019, 22 (19): 2365-2369.   DOI: 10.12114/j.issn.1007-9572.2019.00.376
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Background Most patients with schizophrenia return to the community to continue to recover when the symptoms during an acute schizophrenic episode being relieved or improved.However,in China,the utilization rate of community mental health resources is not high,community-based rehabilitation services can not meet the growing rehabilitation needs of patients,and patients are dissatisfied with such services.Objective To investigate the rehabilitation needs and influencing factors among community-dwelling schizophrenic patients in Shanghai,providing a basis for theoretical research and implementation of mental health rehabilitation.Methods From December 2016 to July 2017,a survey was conducted in a multi-stage stratified cluster random sample of 2 285 registered schizophrenic patients receiving community-based mental health management from 249 residential(village)committees in 18 districts of Shanghai.Survey tools include self-developed General Personal Information Questionnaire,and Disease Characteristics and Treatment Questionnaire,and Wuxi version of the Rehabilitation Needs Questionnaire for People with Schizophrenia(PRNQ-S-WX).The total score of rehabilitation needs was compared by personal characteristics.Influencing factors of rehabilitation needs were analyzed by stepwise multiple linear regression.Results The mean total score of rehabilitation needs assessed by all the participants was(2.93±1.07).The top-ranked six factors in terms of mean evaluation score were social security(3.57±1.42),emotional management(3.50±1.42),treatment compliance(3.47±1.43),symptom management(3.39±1.39),mental health knowledge(3.33±1.34),psychosocial care(3.12±1.49).The total score of rehabilitation needs varied significantly by gender,place of residence(urban or suburban area),education level,living status(independent or not),main caregivers,employment status,financial support from family,mean monthly expenditure on schizophrenia,prevalence of having disability certificate,family history,schizophrenia,medication status,outpatient follow-up and psychiatric symptoms relief(P<0.05).The total score of rehabilitation needs was negatively correlated with age and duration of schizophrenia(r valuces were -0.230,0.139;P<0.05),but was positively correlated with the number of schizophrenia relapses,the number of rehabilitation services received and the score of service satisfaction(r valuces were 0.113,0.469,0.330;P<0.05).Stepwise multiple linear regression analysis showed that place of residence,employment status,financial support from family,mean monthly expenditure on schizophrenia,outpatient follow-up,age,number of schizophrenia relapses,number of rehabilitation services received,and satisfaction with rehabilitation services were associated with the rehabilitation needs in schizophrenia patients(P<0.05).Conclusion Schizophrenic patients in the community in Shanghai have many various domains of rehabilitation needs.Their rehabilitation needs are influenced by place of residence,employment status,financial support from family,monthly expenditure on schizophrenia,outpatient follow-up status,age,number of schizophrenia relapses,number of rehabilitation services received,and satisfaction level with rehabilitation services.In view of this,social and government departments should make full use of the existing resources to provide personalized and diversified services according to the patient's situation.
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25. Hospital-community-home Three-stage Rehabilitation Strategy for Elderly Patients after Total Hip Arthroplasty 
ZHANG Junhong,SHEN Gufeng,CUI Ting,MAO Yuanwen,WANG Lingling,YU Lei,ZHU Yueyue,LIU Jianlin
Chinese General Practice    2021, 24 (28): 3620-3628.   DOI: 10.12114/j.issn.1007-9572.2021.00.257
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Background It is difficult for the orthopedic department in general hospitals to manage increased workload associated with out-of-hospital rehabilitation for increasing elderly patients after total hip replacement(THR). As out-of-hospital rehabilitation may directly affect the surgical effect and functional rehabilitation outcome,it still needs to be studied to develop a feasible long-term management plan involving hospital-community-home collaboration with efforts ensuring its implementation,to improve patients' functional recovery and reduce medical expenses in the long term. Objective To develop a hospital-community-home three-stage rehabilitation scheme for elderly patients after THR by representative members from the community general practice team and representative family members of the patients led by the orthopedic team from general hospitals. Methods The development of hospital-community-home rehabilitation strategy was divided into 3 stages:1. theoretical stage:During August to October 2018,the initial scheme was developed using focus group discussion by 10 members of our research team. 2. clinical trial stage:a randomized controlled trial(RCT) involving totally 60 patients admitted to Shanghai Fourth People's Hospital,Tongji University from January to August 2019 and their family members or carers was conducted to compare video-feedback interventions and regular health interventions in two equal groups of patients randomly divided in terms of efficacy evaluated by Harris Hip Score and Barthel Index at discharge,1 and 3 months after discharge. 3. improving stage:During June to August 2020,our research group determined the contents and predicted the cost of community interventions using literature review,and then formulated the final version of hospital-community-home rehabilitation process for elderly patients after THR using focus group discussion. Results 1. Among the hospital-community-home rehabilitation process,the hospital acts as the "source of technologies and information",and shoulders the responsibility of efficiently providing professional skills and information for community- and home-based postoperative rehabilitation. The community acts as the "family doctor station",and shoulders the responsibility of providing post-discharge rehabilitation services including outpatient and inpatient care,home-based visits,in-home medical care,and management of other chronic diseases via integrating various community resources by the family doctor team. In terms of home-based rehabilitation,pre-discharge rehabilitation services could be provided by the orthopedic department of a general hospital or workers engaging in pre-discharge nursing and patient transferring,and other challenging and time-consuming services such as looking for rehabilitation resources and disease management could be provided by the family doctor team. 2. The RCT showed that patients receiving video-feedback interventions had statistically higher Harris Hip Score and Barthel Index at discharge,1 and 3 months after discharge(P<0.05),indicating that the video-feedback interventions were feasible and effective. 3. After once again clarifying the prerequisites for ensuring the sustainable participation of all parties in the collaboration process,specific calculations indicated that the hospital-community-home three-stage out-of-hospital rehabilitation strategy for elderly patients after THR could be implemented via organically integrating the resources of hospitals,communities,and families to satisfy the patients' needs. Among the services,important management services delivered by family doctors should be paid reasonably,such as pooling sources,coordination,consultation and follow-up,and the estimated cost during the rehabilitation period would not exceed 25.3 yuan per day. Conclusion This rehabilitation strategy has proved to be applicable in terms of both technology and process,and the preliminary exploration is expected to be implemented. Services delivered by family doctors are important and core component of the rehabilitation services,which should to be paid appropriately. As these services are not included in the current medical payment system,a proper payment system reducing the overall long-term cost should be established.
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26. Efficacy and Safety of Virtual Reality for Stroke Rehabilitation:an Overview of Systematic Reviews 
ZHANG Xingxing,DUAN Hongwei,ZHOU Chen,WANG Xiaoxiao,WANG Aihong
Chinese General Practice    2020, 23 (5): 566-572.   DOI: 10.12114/j.issn.1007-9572.2019.00.464
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Background Available surveys show that about 55% to 75% of stroke survivors worldwide have limb dysfunction,which directly affects the motor function and daily living activities,and brings great mental stress and physical pain.Functional rehabilitation after stroke is one method to effectively reduce the disability rate.Virtual reality technology(VR) is one of the most widely used rehabilitation methods in recent years,which is safe,effective and timely responsive.However,clinical evaluation of its effectiveness and safety is not the same.Objective To systematically overview the systematic reviews(SR)/meta-analyses of the effectiveness and safety of VR for stroke rehabilitation.Methods Databases of PubMed,EMBase,the Cochrane Library(2018,Issue 6),CNKI,Wanfang Data,CBM and VIP were searched as of June 2018 and the SR/meta analyses based on VR for stroke rehabilitation were collected.Literature screening and data extraction were performed by two reviewers independently.AMSTAR was used to evaluate the methodological quality of the included articles.The GRADE system was used to evaluate the quality of evidence for main outcome indicators reported in the articles.Results Finally,10 SR/meta analyses were included,involving 7 major outcome indicators.AMSTAR evaluation results showed that only two studies were of high quality and the other eight studies were of medium quality.The major problems of methodological quality assessment were lack of pre-design planning,omission of the status of publications of the included articles,lack of the list of excluded articles and the explaining of the conflicts of interest.Qualities of the evidence for indicators measuring 6 outcomes (the upper limb motor function,limb mobility,functional mobility,balance function,gait speed and the participation) were mainly graded as "medium",and those for indicators related to stride length were mainly graded as "low".Three studies showed good VR safety and no adverse reactions,and one study showed that a small number of studies reported pain,headache or dizziness,but no serious adverse reactions were found.Conclusion The methodological quality of included studies is unsatisfied,with a low grade of evidence.VR has good safety and can be used as a short-term clinical assistant rehabilitation for stroke patients.However,there are still some controversies about its long-term effectiveness.A large number of high-quality tests are needed to prove its long-term effectiveness and safety.Clinicians should be cautious when using the evidence for rehabilitation.
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27. Physicians and Nurses' Perspective of Barriers and Solutions to the Delivery of Home-based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease:a Qualitative Study 
FANG Hui,SHI Yan,LIU Xianliang,GUAN Jiabei
Chinese General Practice    2021, 24 (10): 1284-11288.   DOI: 10.12114/j.issn.1007-9572.2021.00.034
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Background The latest epidemiological survey shows that there are about 100 million patients with chronic obstructive pulmonary disease(COPD) in China,about 1 million people die of respiratory diseases each year,and more than 5 million people become disabled due to respiratory diseases. The effectiveness of home-based pulmonary rehabilitation is as good as hospital and community pulmonary rehabilitation in improving the quality of life and lung function of COPD patients. However,there are few studies showing the barriers to the delivery of home-based pulmonary rehabilitation from the perspective of physicians and nurses. Objective To investigate the barriers to the delivery of home-based pulmonary rehabilitation based on a survey of physicians and nurses blocking the quality of life and lung function of COPD. Methods From July to November 2019,in-depth semi-structural interviews regarding the barriers to the delivery of home-based pulmonary rehabilitation based on a self-developed framework were carried out in a purposive sample of 14 medical workers from respiratory and rehabilitation departments of a grade A tertiary hospital in Shanghai. Content analysis was performed to sort out and analyze the recorded interview results. Results Three themes with nine sub-themes(each including three sub-themes) were extracted:patients' negative health,cognitive,and psychological conditions(prevalence of multiple comorbidities and low motivation of receiving home-based pulmonary rehabilitation;insufficient knowledge of home-based pulmonary rehabilitation;distrust of the efficacy of home-based pulmonary rehabilitation and low exercise compliance). Physicians and nurses' insufficient knowledge and trainings and attentions regarding home-based pulmonary rehabilitation(insufficient related knowledge and feeling incompetent to carry out home-based pulmonary rehabilitation;insufficient related standard trainings;insufficient attentions paid to home-based pulmonary rehabilitation by hospitals and related departments ). Limited capacities at the organizational level for the delivery of home-based pulmonary rehabilitation(inadequate communication and cooperation among the hospital,community and family and imperfect follow-up monitoring system;insufficient medical professionals for delivering such services;lack of systematic rehabilitation training mode and simple and practical evaluation indicators). Conclusion There are many barriers to the delivery of home-based pulmonary rehabilitation. To address these barriers to make sure COPD patients can really benefit from home-based pulmonary rehabilitation,strengthened professional trainings for physicians and nurses to improve their knowledge,more attentions paid to the guidance on home-based pulmonary rehabilitation are needed,with the joint help of social supports as well.
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28. Reflections and Strategies for Full-cycle Stroke Rehabilitation
JIA Jie
Chinese General Practice    2025, 28 (02): 129-134.   DOI: 10.12114/j.issn.1007-9572.2024.0212
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Post-stroke patients are often left with different degrees of functional impairment, and in the process of returning from the medical institution to the community and home, it is necessary for medical institutions at all levels to cooperate and interact, so as to form a good full-cycle rehabilitation closed loop. At present, the application of full-cycle stroke rehabilitation is progressing, but some resistance still exists. This articel is based on the concept of full-cycle rehabilitation for stroke, combined with the current situation of the development of community-based rehabilitation, we also think about the development of the full-cycle rehabilitation and community-based rehabilitation link for stroke. The article emphasizes the importance of "community-based inflection-point rehabilitation" and the need to establish standards of community-based rehabilitation. Moreover, the article also mentions the need to emphasize the full-cycle stage of rehabilitation for stroke patients, explore the development strategy of community-based rehabilitation, and effectively improve the quality of life in community and family.

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29. Analysis and Reflection on Hospital-based Rehabilitation and Postdischarge Community-based Intelligent Cloud Rehabilitation Mode for Spinocerebellar Ataxia Type 2 in a Child 
QIAN Xue,ZHUANG Ren,HE Jun,YANG Ling
Chinese General Practice    2021, 24 (21): 2717-2720.   DOI: 10.12114/j.issn.1007-9572.2020.00.609
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Background Childhood onset of spinocerebellar ataxia type 2(SCA-2)is very rare.Currently,in addition to symptomatic drug treatment,active rehabilitation treatment is the key to possibly maintaining the self-care ability and improving quality of life in SCA-2 patients.Objective To analyze the hospital-based rehabilitation and postdischarge community-based intelligent cloud rehabilitation for a child with SCA-2,to provide a reference for the delivery of rehabilitation treatment for such patients.Methods Retrospective analysis was conducted on the clinical data,hospital-based rehabilitation treatment strategies and effect of postdischarge community-based intelligent cloud rehabilitation treatment for a child with SCA-2 who was admitted to the Rehabilitation Center of Changzhou Dean Hospital in 2018.Results After 30 days of in-hospital systematic rehabilitation treatment,the child showed significant improvement in coordination,balance,feeding ability and other functions,indicating that he could take care of himself basically.After 1 year of postdischarge community-based intelligent cloud rehabilitation treatment,the child’s memory and attention showed a declining trend,but there was no significant decline in his coordination,balance,transfer,feeding and walking abilities,and he was able to complete the indoor 10-meter walk,take care of himself basically,and manage to attend school normally.And family and social supports for him are continuing to improve.Conclusion This pediatric case of SCA-2 presented significant improvement in coordination,balance,eating and walking abilities and could basically take care of himself after in-hospital systematic rehabilitation treatment delivered based on precise assessment,and postdischarge community-based intelligent cloud rehabilitation treatment.Postdischarge community-based intelligent cloud rehabilitation mode may be as a new mode of continuing rehabilitation by community physicians to deliver home-based rehabilitation trainings and to deliver rehabilitation treatment for patients with lifelong diseases.
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30. Influence of Preoperative Frailty before Operation on Knee Function Rehabilitation in Elderly Patients after Unilateral Total Knee Arthroplasty 
FANG Wen,WANG Xiuhong,WANG Junhua,JIANG Zhiyue,DONG Lianghong,LI Jing
Chinese General Practice    2021, 24 (8): 968-976.   DOI: 10.12114/j.issn.1007-9572.2020.00.617
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Background Total knee arthroplasty(TKA) is an optimal method for advanced severe knee osteoarthritis(KOA).However,high prevalence of complications such as postoperative pain and joint stiffness,and postoperative knee dysfunction and other problems,seriously affecting the surgical effect and postoperative recovery process.Rapid development of geriatric surgery has revealed that preoperative physiological reserve state(for example,frailty) may be more closely associated with postoperative outcome of elderly patients than the surgery.Objective To explore the effect of preoperative frailty on knee function rehabilitation in elderly patients after unilateral total knee arthroplasty.Methods By use of purposive sampling,totally 230 elderly osteoarthritis inpatients with initial unilateral TKA were selected from the Affiliated Hospital of Guizhou Medical University,Guizhou Orthopedics Hospital and the Fourth People's Hospital of Guiyang during November 2018 to April 2019.They were divided into frail group(n=156) and non-frail group(n=74) according to FRAIL Scale score(scoring>2 points indicates frailty)before surgery.The time of the first postoperative ambulation,incidence of early postoperative complications and postoperative use time of walking AIDS were recorded to compared between two groups.On the 3rd,and 7th days,at the 2nd week,1 and 3 months after surgery,postoperative FPS-R score and knee flexion of two groups were evaluated.And postoperative AKS function score was evaluated at the 2nd week after surgery.Results Compared with non-frail group,frail group ambulated postoperatively much later,used walking AIDS longer postoperatively,and had higher incidence of early postoperative complications(P<0.05).There was an interaction between treatment time and frailty status on the FPS-R score(P<0.001).Both treatment time and frailty status exerted significant main effects on the FPS-R score(P<0.001).The FPS-R score of the frail group was higher than that of non-frail group at each time point after operation(P<0.001).There was an interaction between treatment time and frailty status on the knee flexion(P<0.001).Both treatment time and frailty status exerted significant main effects on the knee flexion(P<0.001).The knee flexion of the frail group was less than that of non-frail group at each time point after operation(P<0.001).There was an interaction between time and group on the knee function AKS score(P<0.001).Both treatment time and frailty status exerted significant main effects on the AKS function score(P<0.05).The AKS function score of the frail group was lower than that of non-frail group at each time point after operation(P<0.001).There was a positive correlation between preoperative FRAIL score and postoperative FPS-R score(P<0.001).And there was a negative correlation between preoperative FRAIL score and postoperative knee flexion or AKS function score(P<0.001).Conclusion Preoperative frailty may have negative influence on the recovery process of the joint function after TKA,which could enhance postoperative knee pain and delay the recovery of knee flexion function.At the same time,it may increase the risk of early postoperative complications,delay the time of first postoperative ambulation and prolongate the time of postoperative use of walking AIDS.
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31.

Status of Diagnosis and Expert Advice of Developmental Disorder Related to Childhood Rehabilitation

The Subspecialty Group of Rehabilitationthe Society of PediatricsChinese Medical Association

中华医学会儿科学分会康复学组
Chinese General Practice    2022, 25 (08): 899-904.   DOI: 10.12114/j.issn.1007-9572.2022.01.301
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In order to standardize the diagnosis and nomenclature of dvelopmental disorder in China, and ensure that clinical professionals can be able to diagnose and treat these diseases early and accurately, the Rehabilitation Group of Pediatrics Branch of Chinese Medical Association has organized relevant experts to discuss many times and formulated this recommendation based on the current actual situation in China. The paper mainly includes the diagnosis and naming status, evaluation and expert advice ofhigh-risk infants, developmental delay, global developmental delay, 1anguage disorder, mental retardation, autism spectrum disorder, developmental coordination disorder, the objective is to provide reference and guidance for clinical professionals in the diagnosis, evaluation and treatment of developmental disorderin children.

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32. Community General Practitioners' Perception of Community-based Cardiac Rehabilitation for Stable Coronary Artery Disease:a Survey in Beijing's Xicheng District 
DONG Yuming,YANG Ling,DONG Jianqin,DU Xueping
Chinese General Practice    2021, 24 (34): 4356-4363.   DOI: 10.12114/j.issn.1007-9572.2021.00.309
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Background The number of patients with coronary heart disease(CHD)is increasing year by year in China. As an important means of prevention and treatment,cardiac rehabilitation can improve the quality of life,reduce the readmission rate and mortality of CHD patients. However,community-based cardiac rehabilitation is less developed at present,and CHD patients have gained less merits from sleeping guidance,psychological counseling and cardiac risk assessment in exercise. Objective To explore community general practitioners'(GPs')perception of community-based cardiac rehabilitation for stable coronary artery disease(SCAD)providing a scientific basis for the development of community-based cardiac rehabilitation. Methods By use of cluster sampling,we selected frontline general practitioners(GPs)(n=212)from 5 community health centers(Yuetan,Guangwai,Zhanzhan Road,Taoranting,Desheng)in November 2020. Then we conducted a survey on wjx.cn(an online questionnaire survey platform)using a self-administered questionnaire(consisting of basic demographics,attitudes and perceptions regarding community-based cardiac rehabilitation for SCAD,essential knowledge and practice of cardiac rehabilitation)developed by us,and invited the GPs to anonymously complete the survey via scanning the WeChat QR code or printed QR code using a mobile phone or computer between November 26 and December 31,2020. The survey data were collected to input into a database,and analyzed for understanding GPs' perceptions of community-based cardiac rehabilitation for SCAD. Willingness of community GPs' to provide community-based cardiac rehabilitation services for patient swith SCAD and scores of GPs obtained by answering the questions about community-based cardiac rehabilitation for SCAD by demographic factors were compared. Binary Logistic regression was used to identify potential factors associated with community GPs' willingness to provide community-based cardiac rehabilitation services for SCAD patients. Results A survey response rate of 98.1%(208/212)was obtained. In accordance with the analysis,of the respondents,91.3%(190/208)thought that SCAD patients need community-based cardiac rehabilitation,90.4%(188/208)thought that community-based cardiac rehabilitation could be safely implemented without monitoring,74.0%(154/208)were willing to provide the services. Binary Logistic regression analysis showed that participating in cardiac rehabilitation training for CHD patients 〔OR(95%CI)=6.042(1.935,18.867),P<0.05〕,and perceptions of SCAD patients needing community-based cardiac rehabilitation〔OR(95%CI)=10.792(2.361,49.336),P<0.05〕 were associated with community GPs' willingness to provide community-based cardiac rehabilitation services for SCAD patients. The respondents obtained an average SCAD cardiac rehabilitation knowledge test score of(70.12±9.54),with a pass rate of 86.5%(180/208).  There is a statistically significant difference in SCAD cardiac rehabilitation knowledge test score among  professional title groups(P<0.001). The correct rates of the respondents answering "basic concept of cardiac rehabilitation" "selection of target population for intervening" "health education" "follow-up" and "psychological and sleep management" were 94.2%(196/208),90.4%(188/208),98.6%(205/208),92.8%(193/208),and 98.1%(204/208),respectively. But the correct rates of them answering "comprehensive cardiovascular evaluation" "cardiovascular risk control" "risk stratification of coronary heart disease" and "formulation of exercise prescription" were 1.9%(4/208),1.9%(4/208),3.4%(7/208),and 1.4%(3/208),respectively. Only 10.1%(21/208)of the respondents knew the 6-min walk test and often used it. Conclusion The GPs generally thought that community-based cardiac rehabilitation services for SCAD patients is necessary and feasible,and they were willing to provide such services with high enthusiasm,but their awareness rate of key contents of SCAD cardiac rehabilitation was low. To ensure the successful implementation of community-based cardiac rehabilitation,multi-party collaboration should be strengthened to improve GPs' community cardiac rehabilitation skills.
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33. A Follow-up Survey on Mental Health Status of COVID-19 Survivors 
WANG Xixin,CAO Jie,YANG Yanguo,XU Fei,XIA Lei,HU Xiaowen,LIU Huanzhong
Chinese General Practice    2021, 24 (26): 3343-3348.   DOI: 10.12114/j.issn.1007-9572.2021.01.303
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Background The "Work Plan for Psychological Counseling of Patients Under Normalization of Prevention and Control of New Coronary Pneumonia" in September 2020 pointed out that it is important to strengthen the follow-up of the psychological status of COVID-19 patients after recovery. At present,cross-sectional studies have found that patients have frequent mental health problems after recovery,but there is still a lack of dynamic follow-up studies. Objective A dynamic follow-up survey was conducted to investigate the mental health status and its influencing factors of COVID-19 patientstwo weeks and three months after recovery and discharge. Methods  COVID-19 patients diagnosed in two designated hospitals in Anhui Province from February to April 2020 were selected as the research objects,the thegeneral demographic data were collected,and the Streaming Depression Self-Rating Scale (CES-D),Insomnia Severity Index Scale (ISI),Somatization Symptom Self-rating Scale(SSS) and Post-Traumatic Stress Disorder Checklist(PCL) were used for mental health status evaluation. Results One hundred and twenty five questionnaires were distributed.The results showed that the incidences of depression,insomnia,PTSD and somatization symptoms in COVID-19 patients at 2 weeks after discharge were 9.92% (12/121),26.45%(32/121),1.65%(2/121) and 4.96%(6/121),respectively. The incidences of depression,insomnia,PTSD and somatization symptoms at 3 months were 36.47%(31/85),83.53%(71/85),8.24%(7/85) and 18.82%(16/85),respectively. There was no significant difference in gender,age,health status,family support,need for psychological assistance and acceptance of psychological assistance between 2 weeks and 3 months after discharge (P>0.05). There were significant differences in the economic status,physical and mental impairment and care about the views of the people around them at 2 weeks and 3 months after discharge(P<0.05). The total scores of CES-D,ISI,SSS and PCL at 3 months after discharge were higher than those at 2 weeks after discharge(P<0.05). In the Multivariate Logistic regression analysis with depression as the dependent variable,age and the need for psychological assistance were the risk factors of depression at 2 weeks after discharge(P<0.05). Physical and mental impairment was the risk factor of depression at 2 weeks and 3 months after discharge(P<0.05). The risk factor of depression at 3 months after discharge was caring about the views of the people around them. Patients who cared about the views of others were 3.997 times more likely to suffer from depressive symptoms than those who didn't〔OR (95%CI)=3.997(1.708,9.351),P=0.001〕. In the Multivariate Logistic regression with insomnia as the dependent variable,age,physical and mental impairment and the need for psychological assistance were the risk factors of insomnia at 2 weeks after discharge(P<0.05). The risk factor of insomnia at 3 months after discharge was caring about the views of the people around them or not. Patients who cared about the views of others were 10.255 times more likely to suffer from insomnia than those who didn't〔OR (95%CI)= 10.255 (2.796,37.611),P<0.001〕.Conclusion  After recovery and discharge,COVID-19 patients have obvious mental health problems such as depression,insomnia,post-traumatic stress disorder and somatization symptoms,and the longer the follow-up period,the higher the incidence of symptoms. Psychiatric professionals need to carry out psychological crisis intervention as soon as possible.
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34. Efficacy of Enhanced External Counterpulsation in Patients with Coronary Heart Disease Complicated with Cardiac Dysfunction during the Cardiac Rehabilitation Training 
LIU Miaomiao,FAN Junya,LIU Zhen,ZHANG Zhao,HUANG Xin,ZHANG Hui
Chinese General Practice    2020, 23 (18): 2270-2274.   DOI: 10.12114/j.issn.1007-9572.2020.00.248
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Background In recent years,a large number of studies at home and abroad on the enhanced external counterpulsation(EECP),a type of "passive" exercise,have shown that EECP can improve exercise tolerance and cardiac function in patients with stable and unstable angina pectoris and mild to moderate cardiac insufficiency.Yet few reports have covered whether additional gain can be achieved in EECP in combination with active exercises like cardiac rehabilitation training.Objective To explore the efficacy of EECP in cardiac rehabilitation for patients with coronary heart disease and cardiac dysfunction.Methods A total of 100 patients with coronary heart disease and cardiac insufficiency who were hospitalized in Cardiovascular Department,the Second Affiliated Hospital of Zhengzhou University from March 2018 to April 2019 were recruited voluntarily.They were randomly and equally divided into two groups,namely,the control group(receiving conventional medication+cardiac rehabilitation training)and the counterpulsation group(receiving conventional medication+cardiac rehabilitation training+EECP)with the adoption of random number tables.Then,the anaerobic threshold(AT),6-minute walking distance(6MWD),left ventricular ejection fraction(LVEF),and serum brain natriuretic peptide(BNP)before and after treatment in the two groups were measured and recorded.Results The counterpulsation group,after the treatment,had higher mean levels of AT,6MWD and LVEF,and lower mean level of BNP than the control group(P<0.05).Both groups had significantly increased mean levels of AT,6MWD,and LVEF,as well as significantly lowered mean level of BNP after treatment(P<0.05).Conclusion EECP may significantly enhance exercise tolerance,6MWD,heart pump function and heart failure related indices in patients with coronary heart disease and cardiac insufficiency and cardiac rehabilitation training.Its efficacy is better than that of medication treatment or cardiac rehabilitation training alone.Therefore,EECP is highly worthy of clinical promotion.
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35. Discussion on Community Rehabilitation Management Mode and Technology of Stroke 
TANG Long,ZHENG Zheng,RAO Amin,YAO Liqing
Chinese General Practice    2021, 24 (15): 1932-1937.   DOI: 10.12114/j.issn.1007-9572.2021.00.459
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Stroke is the main cause of threaten to the health of middle-aged and elderly people in China.Its high morbidity,mortality and disability rate has brought heavy economic burden to families and society.In recent years,evidence-based medicine has proved that community rehabilitation is an effective method to reduce the disability rate of stroke.However,the community-level rehabilitation technology in China is outdated and the management mode is chaotic now.Therefore,how to improve the community rehabilitation technology of stroke in China has gradually become a research hotspot.This paper briefly introduces the status of the management mode and the technology of community rehabilitation for stroke at home and abroad,puts forward some countermeasures for the development of community rehabilitation in China,so as to provide new ideas for the model of community rehabilitation for stroke in China.
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36. Progress in Study of Exercise Rehabilitation Management Strategy for Patients with Chronic Kidney Disease 
ZANG Li,WANG Shaoqing
Chinese General Practice    2020, 23 (1): 109-113.   DOI: 10.12114/j.issn.1007-9572.2019.00.544
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Patients with chronic kidney disease(CKD)generally have a problem of reduced physical exercise,while exercise has an irreplaceable role in improving malnutrition,cardiorespiratory endurance and quality of life in patients with CKD.This problem is often overlooked by many health care workers and patients.This article focuses on the management strategy and effect evaluation of exercise rehabilitation in patients with CKD,in order to improve the attention of medical workers to the exercise of patients with CKD,and provide some guidance for clinical management of patients with CKD.
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37. Construction and Application of a VR Platform Based on the Omaha System for Rehabilitation Management of Breast Cancer Patients 
JIN Ai-xiang,CHEN Xiao-min,ZHANG Xiao-fei,CHEN Jie
Chinese General Practice    2018, 21 (24): 2987-2993.   DOI: 10.12114/j.issn.1007-9572.2018.00.026
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Objective To build a virtual reality (VR) model for a breast cancer combined rehabilitation program based on breast cancer rehabilitation principles and the Omaha system,and to explore its clinical application.Methods According to the operation type and stage of postoperative recovery,combined with the natural language processing of the Omaha system and feedback from patient information,the core physical and psychological rehabilitation functions of the VR platform were developed and implemented.A total of 120 breast cancer patients treated in the Zhejiang Province People's Hospital between January 2016 and May 2017 were selected and divided into observation group (VR group,n=60) and control group(conventional rehabilitation group,n=60) with a random number table method.The scores of various dimensions and average scores of quality of life scales(SF-36) between the two groups were compared.Results A VR platform for postoperative rehabilitation of breast cancer patients based on the Omaha system was developed.After a 3-month application,the scores of various dimensions and average scores of SF-36 in the observation group were significantly higher than those in the control group(P<0.05).Conclusion The VR platform based on the Omaha system for rehabilitation management is easy to operate and apply.It is an effective physical and psychological postoperative rehabilitation model for breast cancer patients,and it provides a new option for personalized rehabilitation of breast cancer patients.
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38. Advantage Analysis of Chinese and Western Medicine Integration in Cardiac Rehabilitation 
ZHANG Jie,GUO Hangyuan,CHI Jufang
Chinese General Practice    2019, 22 (12): 1392-1395.   DOI: 10.12114/j.issn.1007-9572.2019.00.015
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Cardiovascular diseases have become the number one killer of human health.At present,although more attention has been paid on its treatment in clinical practice,little was paid on its rehabilitation and prevention.Thus,the research on accelerating cardiac rehabilitation is needed urgently.Currently,the guidelines for cardiac rehabilitation in China mostly refer to the ones in foreign countries,but the implementation of some foreign guidelines requires a great deal of equipment and professional guidance,sometimes with a huge investment,which is not suitable to real situation in our country.Therefore,the medical model of cardiac rehabilitation in our country must be fully considered the national conditions.We can utilize the advantage of traditional Chinese medical rehabilitation therapy,while drawing upon and integrating foreign advanced science and human civilization achievement,to finally form a Chinese-Western medical model with Chinese characteristics,and do a good job in cardiac rehabilitation.
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39. Clinical Application of Balance Disorder Rehabilitation-assisted Robot in Postoperative Rehabilitation of Elderly Patients with Fall-related Lower Limb Fractures 
FENG Yuning,LI Kainan,JIA Zishan
Chinese General Practice    2021, 24 (25): 3233-3237.   DOI: 10.12114/j.issn.1007-9572.2021.00.260
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Background According to the results of China's seventh national census,Chinese population aged 60 and above is 264.02 million,the proportion of which,compared with that of 2010,has increased by 5.44 percentage points. The accelerated population aging has aroused increased concerns about postoperative rehabilitation of elderly patients with lower limb fractures after fall. Given many unfavorable factors for postoperative rehabilitation,such as lack of rehabilitation physicians,few rehabilitation schemes,and nonuniform subjective judgment of rehabilitation physicians,robot-associated balance disorder rehabilitation might be a safer and more effective rehabilitation training choice. Objective To explore the clinical effect of balance disorder rehabilitation-assisted robot in postoperative rehabilitation of elderly patients with fall-related lower limb fractures. Methods One hundred elderly patients with lower limb fractures caused by fall were recruited from Orthopedic Ward,Affiliated Hospital of Chengdu University and Chinese PLA General Hospital from April to October 2020,and equally divided into case group and control group using a computer algorithm,receiving physical exercise therapy with robot-assisted balance disorder rehabilitation,physical exercise therapy with walking for weight loss,respectively. Major indicators for postoperative rehabilitation effect were stride time,speed of 3-meter straight walking and step size of 3-meter straight walking measured by the attitude sensor at the end of the 16th week of postoperative training,and the Berg Balance Scale score measured at the end of the 8th,12th and 16th weeks of postoperative training. Results All the participants were included for final analysis except 5 dropouts(3 in the case group,and 2 in the control group). Two groups showed no significant differences in gender ratio,and mean age and BMI(P>0.05). The mean course of fractures differed significantly between the groups(P<0.05). The case group had much shorter mean left and right stride time than the control group(P<0.05). The case group had quicker average speed of 3-meter straight walking and greater average step size of 3-meter straight walking(P<0.05). The interaction between training contents and time was statistically significant in both groups(F=53.116,P<0.001). The recovery degree of lower limb motor function was different between the two groups(F=3.675,P=0.013). The Berg Balance Scale scores for both groups differed significantly by measurement time(F=1 364.425,P<0.001). Conclusion For older adults with fall-related lower limb fractures,robot-assisted balance disorder rehabilitation may yield a better outcome concerning lower limb motor function recovery compared with walking for weight loss,but the speed of recovery may slow down with the extension of rehabilitation time.
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40. Application of Neural Regulation Therapy of Magnetic Stimulation in Rehabilitation of Core Muscle in Children with Cerebral Palsy
BAO Ke-xiu,YANG Zhong-xiu,LI Zhi-lin,LI Xin-jian,WANG Min,WU Ye,QIU Ai-zhen,WU Gai,WANG Ji-ping
Chinese General Practice    2018, 21 (26): 3246-3250.   DOI: 10.3969/j.issn.1007-9572.2018.00.096
Abstract646)      Save
Objective To investigate the effect of magnetic stimulation therapy on the stimulation of the nerve root of the thoracolumbar spinal cord and enhancing the stability of the core muscle group in the rehabilitation of children with cerebral palsy.Methods Fifty-nine children with cerebral palsy admitted from January 2016 to January 2017 in Xuzhou Children's Hospital were divided into treatment group(n=30) and control group(n=29) by random number table.The control group was treated with traditional rehabilitation method,the treatment group was treated with neural regulation therapy of magnetic stimulation combined with traditional way.After 2 months of treatment,the treatment parameters were adjusted in 18 cases of the treatment group.Before and after treatment,the Gross Motor Function Measure(GMFM),International Classification of Functions,Disability and Health for Children and Youth(ICF-CY) sitting posture holding capacity(d4153) score were used to evaluate the motor function of two groups.Results There was interaction between time of treatment and GMFM A score(Finteraction=3.999,Pinteraction<0.05).Time had significant main effect on the scores of GMFM A area,B area and ICF-CY(d4153)(Ftime=29.304,Ftime=6.328,Ftime=9.257,Ptime<0.05).Treatment had significant main effect on the scores of GMFM A area,B area and ICF-CY(d4153)(Ftreatment=5.158,Ftreatment=17.639,Ftreatment=10.670,Ptreatment<0.05).The scores of GMFM A area and B area in the treatment group were lower than those in the control group,and the scores of ICF-CY(d4153) in the treatment group were higher than those in the control group 1,2 months after treatment(P<0.05).After 3 months of treatment,the scores of GMFM A area and B area of 18 infants treated in the treatment group adjusted for treatment parameters were all higher than those of 2 months after treatment(tpair=10.168,tpair=6.230,P<0.001),the ICF-CY(d4153) score was not significantly different from 2 months after treatment(tpair=1.458,P=0.163).Conclusion Neural regulation therapy of magnetic stimulation plays a role in the rehabilitation of children with cerebral palsy,which can enhance the stability of the core muscle group and improve the motor function in children,and especially the effects of the first two months is obvious.
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