专科获得性脑损伤社区外展服务——一项用于促进实践发展与改进的服务评估队列

文献信息

中文摘要

背景： 在英国及国际上，获得区域专科服务以支持社区中复杂管理需求（包括痉挛状态）的可及性往往存在差异。由于病情严重程度，服务获取存在障碍，导致服务提供不公平。
方法： 从一家提供专科社区外展服务的区域服务机构（英国伦敦及周边郡）的临床数据库中提取了覆盖六年期间（2019-2025年）的服务数据。对该队列逐年计算了病例量、临床活动和活动时间。统计并分类了服务提供方式：面对面、电话或虚拟，以及每年的评估或复查类型。
结果： 在6年期间活动量翻倍（n=360（2019-20年），n=728（2024-25年）。转诊的主要原因包括痉挛状态管理（n=2821）和/或复杂躯体管理（n=2393）。处理的其他问题包括夹板或矫形器、持续性意识障碍的再评估、压疮管理、沟通与吞咽、轮椅和体位管理。
结论： 在社区中，针对卒中和其他获得性脑损伤患者，为支持和管理严重复杂残疾而开展的服务利用正在扩大，尤其是针对痉挛状态和挛缩管理。专科服务与当地康复服务或团队之间的服务提供伙伴关系，可能是提供更无缝照护的关键。

英文摘要

BackgroundAccess to regional specialist services to support complex management needs (including spasticity) in the community is often variable in the UK and internationally. There are barriers to service access due to condition severity, resulting in inequity of provision.MethodsService data covering a six-year period were extracted from a clinical database (2019-2025) from a regional service offering specialised community outreach (London and surrounding counties, UK). Yearly caseload, clinical activity and activity time were all calculated for the cohort. Method of delivery: face-to-face, telephone or virtual and type of assessment or review per year were counted and classified.ResultsActivity doubled during the 6-year period (n = 360 (2019-20), n = 728 (2024-25). The primary reasons for referral were spasticity management (n = 2821), and/or complex physical management (n = 2393). Other issues addressed were splinting or orthotics, re-assessment of Prolonged Disorders of Consciousness, management of pressure sores, communication and swallowing, wheelchairs and postural management.ConclusionsThere is expanding utilisation to support and manage severe and complex disability for those with stroke and other acquired brain injury in the community, particularly for spasticity and contracture management. Service delivery partnership between specialised services and local rehabilitation services or teams, is likely to be key to providing more seamless care.