| 邱梓瑜,黄茹,何文珊,蔡东星,高潮铨,冯兰芳.广州轻中型颅脑损伤患者复工影响因素及职业康复策略研究[J].中国康复,2025,40(11):699-704 |
| 广州轻中型颅脑损伤患者复工影响因素及职业康复策略研究 |
| Influencing factors of return-to-work and vocational rehabilitation strategies for patients with mild-to-moderate traumatic brain injury in Guangzhou |
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| DOI：10.3870/zgkf.2025.11.011 |
| 中文关键词: 轻中型颅脑损伤 职业康复 重返工作 |
| 英文关键词: mild-to-moderate traumatic brain injury vocational rehabilitation return-to-work |
| 基金项目:广东省医学科学技术研究基金（B2024215） |
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| 中文摘要: |
| 目的：探讨广州地区轻中型颅脑损伤患者的复工影响因素，以及职业康复策略对其职业能力恢复的影响。方法：采用回顾性分析方法，收集2020年1月~2023年12月间在我院职业康复科治疗的87例轻中型颅脑损伤患者数据，包括临床资料、职业能力指标、家庭社会支持情况及职业康复方案，同时结合检索文献综合分析。结果：复工结局与病程、受伤侧显著相关（P<0.05），与年龄、性别无显著相关；身体功能（如Brunnstrom分期、上下肢肌力、上肢灵活性等）对复工结局无显著影响；职业属性、文化程度和后遗症状显著影响复工（P<0.05）；雇主态度和就业意愿显著影响复工（P<0.05，0.01），家庭支持对复工无显著影响；现场工作分析评估、工作模拟训练和社区工作安置技术对复工结局有显著影响（P<0.05），而就业意愿干预无显著影响。纳入文献结果显示：最关键的促进因素为教育水平、家庭及社会支持、职业相关干预，最主要的阻碍因素为康复时长、头痛等后遗症、心理问题。结论：轻中型颅脑损伤患者的复工结局主要受病程、受伤侧、职业属性、文化水平、后遗症状、雇主态度及就业意愿影响，而年龄、性别、身体功能、家庭支持和就业意愿干预的影响较小。职业康复策略中，现场工作分析评估、工作模拟训练和社区工作安置技术等干预技术可提升患者与岗位的匹配度，促进其重返工作岗位，提示可采用多学科协作模式（医生、心理师、职业治疗师、雇主）并结合患者社会文化背景制定的个性化干预方案，提升患者重返工作的成功率。 |
| 英文摘要: |
| Objective: To investigate the influencing factors of return-to-work (RTW) in patients with mild-to-moderate traumatic brain injury (TBI) in Guangzhou, and the effects of vocational rehabilitation strategies on their work capacity recovery. Methods: A retrospective analysis was conducted on 87 patients with mild-to-moderate TBI treated in Vocational Rehabilitation Department of our hospital between 2020-2023. Data included clinical records, work capacity index, family/social support status, and vocational rehabilitation protocols. Meanwhile, we searched literature and qualitatively analyzed the results of the included studies. Results: The outcome of RTW was significantly correlated with the course of the disease and the injured side (P<0.05), but not significantly correlated with age and gender. Physical function (such as Brunnstrom stages, the muscle strength and flexibility of upper and lower extremities, etc.) had no significant effect on the outcome of RTW. Occupational classification, educational level, and residual symptoms significantly affected the outcome of RTW (P<0.05). Employer attitudes and the patients’ willingness to RTW significantly affected the outcome (P<0.05，0.01), while family support had no significant impact; On-site job analysis/evaluation, job simulation training and community job placement had a significant impact on the outcome of RTW (P<0.05，0.01), while the intervention of the patients’ willingness to RTW had no significant impact. The qualitative description of the included literature showed that the most critical promoting fac-tors included: education level, family and social support, occupational related interventions. The main obstacles were as follows: duration of rehabilitation, sequelae such as headaches, psychological problems. Conclusion: The RTW outcome of patients with mild-to-moderate TBI is mainly affected by the course of the disease, injured side, occupation, educational level, residual symptoms, employer attitudes and the patients’ willingness to RTW, while the age, gender, physical function and fam-ily support have little effect. Among the vocational rehabilitation strategies, on-site job analysis/evaluation, job simulation training and community job placement can improve the matching degree between the patients and the jobs, thus facilitate the patients to RTW. A multidisciplinary collaboration model (doctors, psychologists, vocational therapists, employers) combined with personalized plans developed based on the patient’s social and cultural background can significantly improve the rate of RTW. |
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