Notice on the issuance of the principles of early rehabilitation treatment of nine common diseases (surgery) such as fractures of the extremities Ministry of Health of the People’s Republic of China www.moh.gov.cn
Health Office of Medical Policy [2013] No. 25 Henan Provincial People’s Hospital, Department of Rehabilitation Medicine Zhuang Health
Provinces, autonomous regions, municipalities directly under the Central Health Bureau, Xinjiang Production and Construction Corps Health Bureau.
In order to give full play to the role of early rehabilitation diagnosis and treatment in the Department of Rehabilitation Medicine in general hospitals, promote close cooperation between the Department of Rehabilitation Medicine and other clinical departments, improve the effectiveness of disease diagnosis and treatment and the efficiency of general hospitals, I have organized experts to prepare the “principles of early rehabilitation diagnosis and treatment of nine common diseases (surgery) such as fractures of the limbs”, which is hereby issued to you. Health administrative departments at all levels, medical institutions and relevant academic groups should organize medical personnel of rehabilitation medicine and related clinical disciplines to study carefully and refer to the implementation in the treatment activities.
General Office of the National Health and Family Planning Commission
April 2, 2013
Fractures of the extremities and other 9 common diseases (surgery)
Early rehabilitation treatment principles
Basic Principles
Standardized rehabilitation treatment in the early stage of the disease can effectively avoid or reduce the functional impairment of patients, improve self-care ability and quality of life, and reduce the burden on families and society. Early rehabilitation treatment should follow the following basic principles.
First, the principle of patient safety. To ensure patient safety is the core requirement for early rehabilitation treatment.
The core requirement of early rehabilitation treatment. Rehabilitation treatment activities should be carried out by rehabilitation physicians and qualified rehabilitation therapists. During the rehabilitation treatment process, the patient’s reaction should be closely observed and the treatment effect should be understood in a timely manner to avoid aggravation, adverse reactions and new injuries.
Second, the principle of gradual and orderly progress. The method, intensity, time and frequency of rehabilitation treatment
Dose parameters should be small to large, reasonable increment.
Third, the principle of individualized treatment. A comprehensive understanding of the patient’s basic information, condition and specialty treatment, the scope and degree of functional impairment, etc., should be used to develop an individualized rehabilitation treatment plan.
4. Principle of multidisciplinary cooperation. Rehabilitation professionals and other clinical specialists should fully communicate and establish teamwork.
The rehabilitation professionals and other clinical specialists should fully communicate, establish a team work mode, integrate the advantages of the specialties, and jointly develop and implement rehabilitation treatment plans to improve the overall treatment effect of patients.
Early rehabilitation treatment principles for limb fractures
I. First treatment time
Within 24 hours after the completion of clinical treatment in orthopedics.
II. Rehabilitation assessment content
(A) General condition of the patient. Including basic conditions such as consciousness, vital signs, sleep, urination and defecation. Understand the overall treatment situation of the patient.
(B) Rehabilitation specialist assessment. Assess the pain and swelling of the fracture site, the nerve function and circulation function of the limb, the joint mobility and muscle strength without affecting the stability of the fracture, etc. Assess the patient’s transfer, standing and walking functions as well as the ability of daily living activities according to the condition.
Rehabilitation treatment
According to the assessment results and the condition, the following rehabilitation treatments will be carried out as appropriate.
(1) Positioning and treatment.
(2) Prevention and control of complications, especially deep vein thrombosis, joint adhesions, muscle atrophy, tendon atrophy and ossifying myositis, etc.
(iii) Local treatment of fracture. Reduce swelling, relieve pain, and promote healing of the fracture site. According to the fracture site and fixation method, implement isometric contraction movement of the fracture site and active or passive movement of the adjacent joints.
(4) According to the patient’s condition, carry out transfer, weight-bearing and walking training at the appropriate time, and provide guidance on the use of assistive devices when necessary.
IV. Precautions
(1) Develop a schedule of weight-bearing time for the affected limb according to the fracture fixation mode.
(2) The rehabilitation treatment should not cause significant pain to the patient and the amount of exercise should be gradual.
(3) Rehabilitation treatment should be adjusted or suspended when the patient has the following conditions or complications: unstable vital signs, fever, pulmonary embolism, deep vein thrombosis of lower limbs, unstable fracture fixation, diseases that are not suitable for rehabilitation treatment, and uncooperative patients.
Early rehabilitation treatment principles for sports trauma
I. First treatment time
Within 24 hours after the completion of clinical specialist treatment.
II. Rehabilitation assessment content
(A) General condition of the patient. Including basic conditions such as consciousness, vital signs, sleep, urination and defecation. Understand the overall treatment situation of the patient.
(B) rehabilitation specialist assessment. Assess the pain and swelling of the injury site, joint mobility and muscle strength, neurological function, etc. Assess the patient’s motor ability and ability to perform daily living activities according to the condition.
Rehabilitation treatment
According to the assessment results and combined with the condition, the following rehabilitation treatments will be carried out as appropriate.
(1) Positioning and treatment.
(2) Prevention and control of complications, especially deep vein thrombosis, joint adhesions, muscle atrophy, tendon atrophy and ossifying myositis, etc.
(iii) Local treatment. Reduce swelling, relieve pain, and promote the healing of the injury site. According to the injury site and fixation method, implement muscle strength training and active or passive joint movement.
(D) According to the patient’s condition, conduct training of motor ability, proprioception, weight-bearing and activities of daily living. Configure assistive devices when necessary.
IV. Precautions
(1) Conduct rehabilitation treatment according to the tissue damage and healing, and accurately grasp the range of joint movement and stretching intensity to avoid secondary injury.
(2) Rehabilitation treatment should not cause obvious pain to the patient, and the amount of exercise should be gradual.
Early rehabilitation treatment principles for hip/knee joint replacement
I. Time of first treatment
Within 24 hours after joint replacement surgery. Encourage appropriate rehabilitation treatment and education before surgery according to the condition.
Rehabilitation assessment content
(1) General condition of the patient. Including basic conditions such as consciousness, vital signs, sleep, urination and defecation. Understand the overall treatment situation of the patient.
(2) Rehabilitation specialist assessment. Assess the pain and swelling of the surgical site, the nerve function and circulatory function of the limb, and the joint mobility and muscle strength without affecting the stability of the joint. Assess the patient’s transfer, standing and walking functions as well as the ability of daily living activities according to the condition.
III. Rehabilitation treatment
According to the assessment results and combined with the condition, the following rehabilitation treatments will be carried out as appropriate.
(1) Positioning and treatment.
(2) Prevention and control of complications, especially prevention of prosthesis loosening and lower limb deep vein thrombosis.
(iii) Surgical site treatment. Reduce swelling, relieve pain, and promote wound healing. Implement muscle training and active or passive joint exercises according to the surgical procedure and prosthesis type.
(D) According to the patient’s condition, carry out transfer, weight-bearing and walking training at the appropriate time, and provide guidance on the use of assistive devices when necessary.
IV. Precautions
(1) In the early postoperative period after hip arthroplasty, the operated joint should be kept mildly abducted and positions and movements that may cause dislocation of the prosthesis should be avoided. In the early postoperative period after knee replacement, the operated joint should be kept straight and no pillow should be placed behind the knee.
(b) Determine the weight-bearing schedule of the affected limb according to the surgical procedure and the type of prosthesis.
(c) Rehabilitation should not cause significant pain and the amount of exercise should be gradual.
(4) The following conditions should be adjusted or suspended: unstable vital signs, fever, pulmonary embolism, deep vein thrombosis of the lower extremity, prosthesis loosening or dislocation, diseases that are not suitable for rehabilitation treatment, and uncooperative patients.
Hand trauma early rehabilitation treatment principles
I. First treatment time
Within 24 hours after the completion of clinical treatment.
II. Rehabilitation assessment content
(A) General condition of the patient. Including basic conditions such as consciousness, vital signs, sleep, urination and defecation. Understand the overall treatment situation of the patient.
(B) Rehabilitation specialist assessment. Assess the pain and swelling of the injured hand, nerve function and circulation function, joint mobility and muscle strength without affecting tissue healing.
Rehabilitation treatment
According to the assessment results and combined with the condition, the following rehabilitation treatment will be carried out as appropriate.
(1) Keep the injured hand in a functional position or a position conducive to tissue healing.
(2) Local treatment. Reduce swelling, relieve pain and promote tissue healing. According to the type of injury, location and treatment modality, implement muscle training, active or passive joint exercises to maintain joint mobility and prevent tendon adhesions and joint stiffness.
(c) According to the patient’s condition, carry out hand function training and sensory training when appropriate. Configure assistive devices when necessary.
Precautions
(1) Conduct rehabilitation treatment according to the tendon healing condition, accurately grasp the range of joint movement and stretching intensity, and focus on active movement to avoid tendon rupture.
(2) Rehabilitation treatment should not cause obvious pain, and the amount of exercise should be gradual.
Peripheral nerve injury early rehabilitation treatment principles
I. First treatment time
Within 24 hours after the completion of clinical treatment.
B. Rehabilitation assessment content
(A) the patient’s general condition. Including consciousness, vital signs, sleep, urination and defecation and other basic conditions. Understand the overall treatment situation of the patient.
(B) Rehabilitation specialist assessment. Assessment of limb sensory function, motor function and circulatory function, reflex examination, and neurophysiological assessment if necessary.
(3) Rehabilitation treatment
According to the assessment results and combined with the condition, the following rehabilitation treatments will be carried out as appropriate.
(1) Keep the limb in a position that is conducive to tissue healing.
(2) Local treatment. Reduce swelling, relieve pain, and promote nerve repair. Depending on the type of injury, location and treatment modality, physical factor therapy and active or passive joint exercises are implemented to promote nerve function recovery and maintain joint mobility.
(c) According to the patient’s condition, carry out muscle strength training and sensory training when appropriate. Configure assistive devices when necessary.
IV. Precautions
During the early rehabilitation of peripheral nerve injury, compensatory movements should be avoided to prevent skin damage. Avoid excessive stretching movements and excessive fatigue.
Early rehabilitation of spinal cord injury treatment principles
I. First treatment time
Within 48 hours after the completion of clinical specialist treatment.
Second, the rehabilitation assessment content
(A) General condition of the patient. Including consciousness, vital signs, sleep, stool and urine and other basic conditions. Understand the overall treatment situation of the patient.
(B) rehabilitation specialist assessment. Use the International Standard for Neurological Classification of Spinal Cord Injury to assess the level and degree of spinal shock and neurological injury. Assess the ability of daily living activities according to the patient’s condition.
Rehabilitation treatment
According to the assessment results and combined with the condition, the following rehabilitation treatments will be carried out as appropriate.
(1) Positioning and management.
(2) Prevention and control of complications, especially pressure sores, urinary tract infections, bladder and kidney damage due to neurogenic bladder, deep vein thrombosis, crushing pneumonia, injury to joints or muscle tendons, muscle atrophy and tendon atrophy, postural hypotension, etc.
(iii) Active or passive joint movement and muscle strength training, early sitting and standing training, breathing and sputum evacuation training, neurogenic bladder and rectal management, pain management according to the patient’s condition.
(d) Conduct daily living ability training according to the patient’s condition at an appropriate time. Configure assistive devices when necessary.
(E) Early psychological support.
Precautions
(a) Select appropriate assistive devices to protect and support the spine according to the level of injury during early sitting and standing training.
(2) In the process of rehabilitation, pay special attention to the prevention and treatment of complications, such as pressure sores, pulmonary infection, urinary tract infection, deep vein thrombosis, postural hypotension, etc.
(c) Patients with high spinal cord injury should be closely observed for respiratory conditions.
Traumatic brain injury, postoperative cerebral hemorrhage and stroke
Early rehabilitation treatment principles
I. First treatment time
Within 48 hours after the patient’s vital signs are stable and the symptoms of neurological deficits are stabilized.
II. Rehabilitation assessment
(a) General condition. Include basic conditions such as vital signs, sleep, urination and defecation, etc. Pay attention to the assessment of the patient’s state of consciousness. Understand the overall treatment situation of the patient.
(2) Rehabilitation assessment. Assess cognitive function, mental behavior, motor function, speech function, swallowing function, sensory function, etc. Assess the patient’s transfer, standing and walking functions as well as the ability to perform activities of daily living according to the condition.
Rehabilitation treatment
According to the assessment results and the condition, the following rehabilitation treatments will be carried out as appropriate.
(1) Positioning and treatment.
(2) Prevention and control of complications, especially aspiration, pulmonary infection, deep vein thrombosis of the lower extremities and pressure sores.
(iii) Wake-promoting treatment. Comatose patients should be started as early as possible to promote awakening treatment, including various sensory input stimulation.
(iv) Swallowing therapy. After the patient regains consciousness, carry out oropharyngeal swallowing function training as soon as possible to improve swallowing function.
(E) Cognitive and speech therapy.
(vi) Psycho-behavioral therapy.
(vii) Improve the function of the limbs, and use assistive devices if necessary.
(H) Daily living activities training.
IV. Precautions
Patients with mental behavior abnormalities should pay attention to rehabilitation treatment to strengthen protection and ensure patient safety. Vital signs should be closely observed and comorbidities should be paid attention to during the rehabilitation treatment. If the patient’s condition worsens, consult with the relevant departments.