소아 가정방문 물리치료의 인식도와 수요도에 관한 설문조사

최선영 ( Sun Young Choi ),윤장원 ( Jang Whon Yoon ) 한국전문물리치료학회 2013 한국전문물리치료학회지 Vol.20 No.3

본 연구는 소아 가정방문 물리치료에 관한 인식도와 수요도, 견해를 알아보기 위해 전국의 인구분포도에 대비하여 소아 물리치료사와 보호자, 의사를 대상으로 설문조사를 실시하였고 다음과 같은 결과를 얻었다. 첫째, 모든 집단이 소아 가정방문 물리치료에 대해인식도는 낮았으나 각 집단 모두 빠른 시일 내에 필요하다는 의견을 보였다. 둘째, 소아 가정방문 물리치료의 참여·이용에 대한 의사여부에서 모든 집단이 높은 참여·이용률을 보였다. 셋째, 운영방안에 대해서는 모든 집단이 의사의 처방이 필요하다고 하였고, 소아 가정방문 물리치료를 시행할 소아 물리치료사로 6∼10년의 임상자격조건을 원하였다. 치료비용에서는 물리치료사는 현재 치료비보다 2배를, 보호자는 현재 치료비와 동일하게를, 의사는 현재 치료비보다 1.5배에 많은 분포를 보였다. 물리치료사, 보호자, 의사 모두 현재와 동일한치료횟수와 1시간의 치료 소요시간을 선호하였다. 이상을 종합해보아 소아 가정방문 물리치료에 대한 인식도는 낮으나 수요도와 참여·이용률이 높음을 알 수있었다. 이렇게 높은 수요도와 참여·이용률을 보이는 소아 가정방문 물리치료를 제도적으로 정립하기 위해서는 실효성을 검증할 수 있는 일정기간의 시범사업을 통해 많은 연구와 조사가 필요하며, 먼저 소아 가정방문 물리치료와 관련된 관계자들의 의견을 충분히 수렴하고 이를 반영하여 소아 가정방문 물리치료 제도 정립을 위해 현재 의료 시스템의 정비가 이루어져야 할 것이다. Pediatric home-based physical therapy (PHBPT) provides professional rehabilitation programs at the patient`s home, where the activities of daily life are actually performed. PHBPT also allows to avoid the difficulties of transporting children with disabilities to the clinic. Despite these advantages, PHBPT is not yet widely practiced in Korea. There is little objective information regarding the opinions of the main stakeholders on PHBPT. To investigate the awareness and demand of PHBPT among the main stakeholders, 41 pediatric physical therapists (PT) (of 60 contacted) were recruited from different regions of Korea on the basis of the regional population distribution. The recruited PTs completed their questionnaires and also participated in collecting questionnaires from 35 medical doctors (MD) with whom they worked and from randomly selected 201 parents of children with disabilities recruited. The overall response rate was 85.5%. The awareness of PHBPT differed between PTs (95.1%) and parents (67.2%) (p<.001). The survey showed that 82.9% of MDs had at least heard about PHBPT. Significantly more parents (83.5%) than MDs (57.1%), and 70.0% of PTs, wanted to start PHBPT service immediately (p<.001). Significantly more parents (90.0%) than PTs (73.2%) were willing to participate in PHBPT (p<.001). Opinions on the details of policies and procedures (i.e., necessity for prescription, treatment cost, and treatment frequency) differed among the respondent groups, but all favored a minimal qualification of 6∼10 years of pediatric experience and a treatment session duration of 1 hour. These findings provide objective information to support health service administrators to understand the current demand and develop feasible policies and procedures of PHBPT in Korea.

류마티스관절염 환자를 위한 물리치료

원종임 한국전문물리치료학회 1994 한국전문물리치료학회지 Vol.1 No.1

An Application of Constraint-Induced Therapy in Patients With Chronic Hemiparesis After Brain Injury

Park, Ji-won,Kim, Jong-man,Kim, Yun-hee 한국전문물리치료학회 2001 한국전문물리치료학회지 Vol.8 No.4

뇌 손상 후 급성기에 기능의 자발적인 회복이 일어나지만 환자들은 환측의 상지를 잘 사용하지 못하게 된다. 그 결과 원하는 움직임을 억제하는 상황을 발생시키는데 이것을 학습 무사용 증후군(learned nonuse syndrome)이라 한다. 이러한 학습 무사용 증후군을 치료하기 위해 억제-유도 치료(constraint-induced therapy)가 고안되었다. 억제-유도 치료는 연속되는 몇 주간에 걸쳐 매일 많은 시간 동안 건측의 상지를 묶어두고 환측 상지를 사용하게 하여 기능을 반복 학습하게 함으로써 기능을 증진시키는 방법이다. 이미 여러 연구자들이 경두개 자기자극(transcranial magnetic stimulation), 움직임 관련 피질전위(movement-related cortical potential), 기능적 자기공명 영상기법(functional magnetic resonance imaging) 등을 통하여 억제-유도 치료 후 운동피질영역에서의 재조직화를 보고함으로써 기능 증진과 관련된 회복 기전을 뒷받침하고 있다. 억제-유도 치료의 영역은 확대되어 뇌졸중, 척수손상, 고관절 치환술 후로 하지에서의 기능증진을 위하여 연구가 진행되고 있으며 특히 뇌졸중 후 실어증 환자에서 새로운 방법으로 제시되고 있다. 따라서, 억제-유도 치료는 신경학적인 손상 후 움직임의 재활에 있어서 치료-유도를 통한 중추신경계의 회복에 효과적으로 작용할 수 있다.

심근경색후 물리치료

이정원 한국전문물리치료학회 1994 한국전문물리치료학회지 Vol.1 No.1

Effect of Breathing Exercise on Improvement of Pulmonary Function in Patient With Amyotrophic Lateral Sclerosis : Case Study

Jung, Young-jong 한국전문물리치료학회 2001 한국전문물리치료학회지 Vol.8 No.4

근위축성 측색 경화증(amyotrophic lateral sclerosis: ALS) 환자에게 있어 호흡기능 장애는 죽음에 이르게 하는 주요 원인 중 하나이다. 본 연구는 근위축성 측색 경화증이 있으며 호흡기능이 약화되어 있는 51세의 여성 환자를 대상으로 호흡운동 치료를 시행한 후 폐기능(pulmonary function)이 증진되었는지를 알아보자 실시하였다. 연구 대상자는 6주간의 호흡운동 치료 프로그램에 참여하였다. 호흡운동 치료 프로그램은 횡경막 호흡(diaphragmatic breathing), 복부근육강화(abdominal muscles strengthening), 지갑입술 호흡(pursed lip breathing), 그리고 동기 유발성 흡기폐활량계(incentive spirometer)를 이용한 흡기운동 등으로 구성되었다. 폐기능 검사는 이동식 호흡측정기(spirometer: MICROSPIROHI-198)를 이용해서 시행하였다. 또한 하지 에르고미터(cycle-ergometer)를 이용해 운동 시간을 측정함으로써 폐기능의 증진 여부를 알아보았다. 연구 대상자는 6주간의 호흡운동 치료 기간 동안 노력성 폐활량(forced vital capacity: FVC)과 정상 예측치에 대한 노력성 폐활량의 비율(percentage of the predicted forced vital capacity: %FVC), 그리고 하지 에르고미터의 운동 시간에 있어 현저한 증가를 보였다. 그러나 노력성 폐활량에 대한 1초간 노력성 폐활량 비(FEV1/FVC)에 있어서는 약간의 감소를 보였다. 근위축성 측색 경화증 환자에게 6주간의 호흡운동 치료를 실시한 결과, 폐기능의 증진에 효과적임을 알 수 있었으며, 앞으로 더 많은 연구 대상자에게 그 효과를 알아보는 연구가 필요할 것이다.

21세기 우리나라 적정 물리치료사 인력 수급계획에 관한 연구1)

권혁철,이충휘 한국전문물리치료학회 1998 한국전문물리치료학회지 Vol.5 No.1

Concordance Rate Between the Ratings of Clinician and Self Ratings of Worker on a Functional Capacity Evaluation

Bong-sam Choi 한국전문물리치료학회 2016 한국전문물리치료학회지 Vol.23 No.4

Background: Functional capacity evaluations (FCEs) are designed to systematically assess the capacity to perform work-related tasks and to determine worker’s ability to return to the previous job following work-related injuries. These evaluations may be rated either by clinician or worker. There has been a lack of consensus between the two scoring methods. Objects: This study aimed: 1) to confirm if the data are fit to the Rasch rating scale model and 2) to investigate the item-level concordance rate between the ratings of clinician and injured worker of the FCE. Methods: A cross-sectional study was conducted with a sample (n=124) of a rehabilitation program with the Occupational Rehabilitation Data Base for workers with low back pain. The functional capacity evaluation at admission and discharge was administered to clinicians and workers. The data were analyzed using both classical test theory-based Pearson’s r and intra-class coefficient followed by item-level analysis with Rasch rating scale model. Results: All items of the FCE, except sitting items rated by clinician at admission and handling items rated by both clinician and worker throughout admission and discharge, were acceptable fit statistics with minor out of ranges for a misfit criterion. This may indicate that the items of the FCE overall fit to the Rasch rating scale model. Few problematic items responding differently to clinician and worker both at admission and discharge were detected with the differential item functioning analysis despite the excellent concordance rate using the two conventional statistics-sitting and handling items at admission and handling item at discharge. Conclusion: The item-level speculations using Rasch analysis of the FCE demonstrate that the ratings of clinician and self ratings of worker were psychometrically acceptable though there was an apparent discrepancy between the raters both at admission and discharge.

비특이성 만성요통 유무에 따른 무산소성 역치수준 비교

성준혁 ( Jun Hyuk Seong ),권오윤 ( Oh Yun Kwon ),이충휘 ( Chung Hwi Lee ),신헌석 ( Heon Seock Cynn ),조영기 ( Young Ki Cho ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.1

The purpose of this study was to compare the anaerobic threshold (AT) between subjects with and without non-specific chronic low back pain (NCLBP). The patient group included 15 women with NCLBP. The normal group included 15 women without NCLBP who were age-, height-, weight-, and activity level-matched. The subjects performed a Balke treadmill protocol which was symptom-limited progressive loading test. Their heart rate (HR), ventilatory gas and metabolic equivalents (METs) were measured using the automatic breath gas analyzing system After the test, each subjects` ratings of perceived exertion (RPE) were evaluated. The visual analog scale (VAS) was assessed pre- and post-test. The independent t-test and Wilcoxon`s signed-rank test were used for analysis of the data. Time, HR, the volume of oxygen consumption (VO2), relative VO2, and METs at the AT level of the patient group were significantly lower than those of the healthy group (p<.05). However, there were no significant differences in RPE, VAS, and breathing frequency at the AT level (p>.05). The findings of this study indicate that patients with NCLBP had a lower aerobic fitness than healthy subjects. Thus, implementation of rehabilitation program to increase aerobic fitness may be considered in patietns with NCLBP, and further studies are required to determine the etiological factors of decreased aerobic fitness.

뇌졸중 환자에 대한 기능적 보행평가의 신뢰도

원종임 ( Jong Im Won ),유경훈 ( Kyung Hoon Yu ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.1

After stroke, many people have problems with balance during movement. Balance is essential for the optimal functioning of the locomotor system and the performance of many activities of daily living. The Functional Gait Assessment (FGA) is a clinical tool for evaluating balance ability during walking. The test consists of ten tasks, seven tasks of the Dynamic Gait Index and three additional tasks. The purpose of this study was to evaluate the reliability and internal consistency of data obtained with the Korean version of the FGA when used with people after suffering a stroke. One-hundred participants, at least three months poststroke and able to walk at least six meters with or without a walking aid, participated in the study (age range 30~83 years; mean±SD=58.8±10.9). Two physical therapists and two physical therapy students rated the FGA. Intrarater and interrater reliability of the FGA were assessed using kappa statistic and intraclass correlation coefficients (2,1). The internal consistency of the FGA was assessed using the Cronbach alpha. The Cronbach alpha was good (α=.86~.93). The intrarater (intraclass correlation coefficient=.92~.95) and interrater reliability (intraclass correlation coefficient=.91, .95) of the total scores administered by the therapists and students were good, whereas the reliability for single item scores when administered by the physical therapists was moderate to good (kapa value=.42~.97). This study found that intrarater and interrater reliability for total FGA scores and internal consistency were good. Therefore, the Korean version of the FGA can be used as a reliable tool to assess the functional gait performance of patients after stroke.

도수 촉진과 막대를 이용한 몸통의 전방 굴곡 운동에 따른 요추와 고관절 굴곡 각도의 변화

정성대 ( Sung Dae Choung ),박규남 ( Kyue Nam Park ),홍지아 ( Ji A Hong ),조민수 ( Min Sue Cho ),손동휘 ( Dong Hwi Son ),신헌석 ( Heon Seock Cynn ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.1

The purpose of this study was to identify the effects of manual facilitation and a stick on lumbar and hip joint flexion angles in subject with lumbar flexion syndrome during forward bending from a sitting position. Fifteen subjects with lumbar flexion syndrome were recruited for this study. As a pretest, all subjects performed three repetitions of bending the trunk forward until the tips of their fingers touched the target bar. After this pretest, the subjects practiced the forward bending of the trunk 10 times, using either manual facilitation or a stick. Then, as a posttest, all subjects repeated the pretest procedure. The flexion angles of lumbar spine and hip joint during forward bending in a sitting position were measured using a three-dimensional motion analysis system. A paired t-test was used to determine the statistical differences between pre-test and post-test flexion angles and pre- and post-test flexion angle differences between forward bending with manual facilitation and forward bending with a stick. The level of statistical significance was set at p=.05. The results of the study showed that the angle of the lumbar flexion decreased significantly and the bilateral hip flexion angle increased significantly when performing forward bending with stick and manual facilitation. Furthermore, the angle of lumbar flexion decreased significantly and the angle of bilateral hip flexion increased significantly in forward bending with a stick compared to forward bending with manual facilitation. The findings of this study indicate that both forward bending with manual facilitation and sticks could be used to prevent excessive lumbar flexion and increase hip flexion, and that forward bending with a stick is more effective than forward bending with manual facilitation for inducing lumbar spine and hip joint angle changes.