The Journal of the Korea Contents Association (한국콘텐츠학회논문지)

The Korea Contents Association (한국콘텐츠학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Community-based Rehabilitation on Patients with Brain Injury: Meta-analysis Based on the ICF Model

뇌손상 환자의 지역사회재활(CBR) 프로그램의 효과: ICF 모델에 근거한 메타분석

  • 차유진 (세명대학교 작업치료학과) ;
  • 김세연 (우석대학교 작업치료학과)
  • Received : 2013.12.18
  • Accepted : 2014.02.21
  • Published : 2014.03.28
Download PDF
⟨ Previous Next ⟩

Abstract

In this study, a meta-analysis was conducted to investigate the effect of community-based rehabilitation on patients with brain injury by ICF factor in previous studies and examine the application of recent community-based rehabilitation program. Total 15 articles that satisfied the selection criteria were divided by ICF factors to obtain the effect size. Homogeneity and publication bias were tested for those selected papers. As a result, the overall effect size of community-based rehabilitation was 0.22; the effect size by physical function and structure among the ICF factors came to be 0.21; and the effect size of activity and participation was 0.20, indicating a small effect size. The studies involved in a meta-analysis were considered as the absence of heterogeneity and publication bias, which indicates that the results of this study are subjectively reliable. These results well explained the level of change on ICF factors, especially physical function and structure, activity and participation, in other words, the intervention effect of community-based rehabilitation on patients with brain injury.

본 연구는 메타분석을 통해 뇌손상 환자를 대상으로 한 최근 연구들의 지역사회재활의 효과를 ICF 요소별로 알아보고, 최근 지역사회재활 프로그램 적용방법 등을 알아봄으로써 지역사회재활 프로그램의 개발 및 활성화를 위한 기초자료를 제시하고자 하였다. 선정기준에 적합한 논문은 총 15건을 ICF 요소별로 나누어 효과크기 값을 구하였으며 대상 논문들의 동질성 검정과 출판편견 검정을 실시하였다. 그 결과 지역사회 재활 프로그램의 전체 효과크기는 0.22였고, ICF 요소별 효과크기는 신체기능과 구조 0.21, 활동과 참여 0.20으로 작은(small) 효과크기를 보였다. 또한 메타분석에 포함된 연구들은 통계적 이질성이나 출판편견이 없는 것으로 간주되어 본 연구 결과는 객관적이고 신뢰할 수 있었다. 이러한 결과는 뇌손상 환자의 지역사회재활 프로그램이 ICF 요소들인 신체기능과 구조, 활동과 참여 요소에 대한 변화 정도 즉 개입 효과를 잘 설명해 주고 있음을 알 수 있었다.

Keywords

References

  1. J. M. S. Pearce, "Positive and negative cerebral symptoms: The roles of Russell Reynolds and Hughlings Jackson," Journal of Neurology, Neurosurgery & Psychiatry, Vol.75, No.8, pp.1141-1148, 2004. https://doi.org/10.1136/jnnp.2003.019943
  2. J. H. Carr and R. B. Shepherd, Stroke rehabilitation: Guidelines for exercise and training to optimize motor skill, Butterworth-Heinemann London, 2003.
  3. D. R. Kim, "The effect of somatosensory stimulation on recovery of the integrity of the somatosensory pathway after brain damage," Journal of Korean Academy of Nursing, Vol.34, No.7, pp.1255-1264, 2004. https://doi.org/10.4040/jkan.2004.34.7.1255
  4. H. S. Oh, Y. R. Kim, W. S. Seo, and Y. O. Seo, "Development of an integrative cognitive rehabilitation program for brain injured patients in the post-acute stage," Journal of Korean Academy of Nursing, Vol.35, No.2, pp.270-282, 2005. https://doi.org/10.4040/jkan.2005.35.2.270
  5. T. A. Burke, R. N. Burke, and R. N. Venketasubramanian, "The epidemiology of stroke in the East Asian region: A literature based review," International Journal of Stroke, Vol.1, No.4, pp.208-215, 2006. https://doi.org/10.1111/j.1747-4949.2006.00060.x
  6. M. A. Finlayson and S. H. Garner, Challenges in rehabilitation of individuals with acquired brain injury, Williams and Wilkins, 1994.
  7. 정한영, ICF의 재활의학적 적용, 국립재활원, 2005.
  8. 최원영, "외상성 뇌손상 장애인의 지역사회통합 수준 측정 및 관련 요인 연구", 대구대학교 특수교육재활과학연구소, 제43권, 제2호, pp.135-164, 2004.
  9. 정한용, "외상성 뇌 손상 환자의 신경정신과 영역 치료", 생물정신의학, 제5권, 제1호, pp.71-82, 1998.
  10. 원종임, "뇌졸중 환자에 대한 지역사회 재활시스템의 필요성", 한국콘텐츠학회논문지, 제8권, 제1호, pp.16-26, 2008. https://doi.org/10.5392/JKCA.2008.8.1.016
  11. 김영근, "보건소 지역사회중심 재활사업에서 작업치료 필요성 탐색-대구시 CBR 시범지역을 중심으로", 대한작업치료학회지, 제15권, 제3호, pp.13-24, 2007.
  12. V. A. Wood, "The prevention and management of stroke," Journal of Public Health, Vol.18, No.4, pp.423-431, 1996. https://doi.org/10.1093/oxfordjournals.pubmed.a024540
  13. 곽내화, 장기연, 안규환, 우희순, "ICF 기반 SPG 케이스 관리 틀 적용연구: 단일 척수손상환자를 중심으로", 대한작업치료학회지, 제20권, 제4호, pp.95-110, 2012.
  14. P. J. Doyle, "Measuring health outcomes in stroke survivors," Archives of Physical Medicine and Rehabilitation, Vol.83, No.12, pp.39-43, 2002. https://doi.org/10.1053/apmr.2002.36838
  15. E. Helander, The management of community-based rehabilitation, World Health Organization, 1983.
  16. 고효은, 오명화, 백지영, 이재신, "지역사회 노인들의 활동 및 참여수준과 신체기능과의 관계: ICF를 기반으로", 대한작업치료학회지, 제20권, 제4호, pp.15-28, 2012.
  17. 이경석, "한국형 장애평가기준을 위한 제언", 보건의료정책 방향, 제6권, 제4호, pp.75-80, 2008.
  18. 김지현, "뇌졸중 환자의 지역사회중심재활서비스: 사례연구", 대한지역사회작업치료학회지, 제1권, 제2호, pp.31-43, 2011.
  19. 이소연, 방요순, 김황용, 고영경, 손보영, "지역사회 작업치료 서비스 현황 및 만족도에 관한 조사 연구", 지역사회연구, 제19권, 제3호, pp.77-91, 2011.
  20. J. Portnow, T. Kline, M. A. Daly, S. M. Peltier, C. Chin, and J. R. Miller, "Multidisciplinary home rehabilitation. A practical model," Clinics in Geriatric Medicine, Vol.7, No.4, pp.695-706, 1991.
  21. H. Rodgers, J. Soutter, W. Kaiser, P. Pearson, R. Dobson, C. Skilbeck, and J. Bond, "Early supported hospital discharge following acute stroke: Pilot study results," Clinical Rehabilitation, Vol.11, No.4, pp.280-287, 1997. https://doi.org/10.1177/026921559701100403
  22. 박영주, 장문영, 김경미, "지역사회 재활이 외상성 뇌손상 환자에게 미치는 효과: 체계적 고찰", 대한지역사회작업치료학회지, 제2권, 제1호, pp.13-23, 2012.
  23. 송주민, 김진상, "외상성 뇌손상의 손상 기전과 신경 가소성에 대한 고찰", 대한물리치료 학회지, 제16권, 제2호, pp.283-289, 2004.
  24. L. Evans, "The efficacy of community-based rehabilitation programmes for adults with TBI," International Journal of Therapy and Rehabilitation, Vol.15, No.10, pp.446-458, 2008. https://doi.org/10.12968/ijtr.2008.15.10.31213
  25. S. Hillier and G. Inglis-Jassiem, "Rehabilitation for community-dwelling people with stroke: Home or centre based? A systematic review," International Journal of Stroke, Vol.5, No.3, pp.178-186, 2010. https://doi.org/10.1111/j.1747-4949.2010.00427.x
  26. L. Legg, "Rehabilitation therapy services for stroke patients living at home: Systematic review of randomised trials," Lancet, Vol.363, No.9406, pp.352-356, 2004. https://doi.org/10.1016/S0140-6736(04)15434-2
  27. 박정임, 이금진, "정신분열병을 가진 사람들을 위한 사회기술훈련의 효과에 관한 메타분석", 한국콘텐츠학회논문지, 제13권, 제12호, pp.309-320, 2013. https://doi.org/10.5392/JKCA.2013.13.12.309
  28. 이성대, 김선주, 염동문, "사회복지분야의 메타분석 논문에 대한 고찰과 제안", 한국콘텐츠학회논문지, 제14권, 제1호, pp.209-222, 2014. https://doi.org/10.5392/JKCA.2014.14.01.209
  29. M. Arbesman, J. Scheer, and D. Lieberman, "Using AOTA's critically appraised topic (CAT) and critically appraised paper (CAP) series to link evidence to practice," OT Practice, Vol.13, No.5, pp.18-22, 2008.
  30. 이준영, "메타분석", 대한내분비학회지, 제23권, 제6호, pp.361-378, 2008.
  31. R. Rosenthal and D. B. Rubin, "Comparing effect sizes of independent studies," Psychological Bulletin, Vol.92, No.2, pp.500-504, 1982. https://doi.org/10.1037/0033-2909.92.2.500
  32. 송혜향, 메타분석분석법, 자유아카데미, 1992.
  33. L. Hedges, "Distribution theory for Glass's estimator of effect size and related estimators," Journal of Educational and Behavioral Statistics, Vol.6, No.2, pp.107-128, 1981. https://doi.org/10.3102/10769986006002107
  34. J. Cohen, Statistical power analysis for the social sciences, Erlbaum, 1988.
  35. R. J. Simes, "Confronting publication bias: A cohort design for meta-analysis," Statistics in Medicine, Vol.6, No.1, pp.11-29, 1987. https://doi.org/10.1002/sim.4780060104
  36. 최영아, 서순림, 서부덕, "재가 뇌졸중 노인에게 적용한 고려수지요법을 포함한 재활프로그램의 효과", 기본간호학회지, 제11권, 제3호, pp.281-291, 2004.
  37. 홍명선, "재가 뇌졸중 환자를 위한 패턴화된 감각향상 (PSE) 상지운동 프로그램의 개발 및 효과", 지역사회간호학회지, 제22권, 제2호, pp.192-203, 2011. https://doi.org/10.12799/jkachn.2011.22.2.192
  38. I. M. Altman, S. Altman, D. Swick, J. F. Parrot, and J. F. Malec, "Effectiveness of communitybased rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged," Archives of Physical Medicine and Rehabilitation, Vol.91, No.11, pp.1697-1704, 2010. https://doi.org/10.1016/j.apmr.2010.08.001
  39. T. Askim, S. Morkved, A. Engen, K. Roos, T. Aas, and B. Indredavik, "Effects of a community- based intensive motor training program combined with early supported discharge after treatment in a comprehensive stroke unit a randomized, controlled trial," Stroke, Vol.41, No.8, pp.1697- 1703, 2010. https://doi.org/10.1161/STROKEAHA.110.584284
  40. G. J. Carnevale, "Changes in ratings of caregiver burden following a community-based behavior management program for persons with traumatic brain injury," Journal of Head Trauma Rehabilitation, Vol.17, No.2, p.83, 2002. https://doi.org/10.1097/00001199-200204000-00002
  41. G. J. Carnevale, V. Carnevale, M. V. Anselmi, K. Johnston, V. Busichio, and V. Walsh, "A natural setting behavior management program for persons with acquired brain injury: A randomized controlled trial," Archives of Physical Medicine and Rehabilitation, Vol.87, No.10, pp.1289-1297, 2006. https://doi.org/10.1016/j.apmr.2006.06.010
  42. L. Gilbertson, P. Langhorne, A. Walker, A. Allen, and G. D. Murray, "Domiciliary occupational therapy for patients with stroke discharged from hospital: Randomised controlled trial," British Medical Journal Vol.320, No.7235, pp.603-606, 2000. https://doi.org/10.1136/bmj.320.7235.603
  43. S. Lord, K. M. McPherson, H. K. McNaughton, L. Rochester, and M. Weatherall, "How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke," Clinical Rehabilitation, Vol.22, No.3, pp.215-225, 2008. https://doi.org/10.1177/0269215507081922
  44. P. A. Logan, J. R. F. Gladman, A. Avery, M. F. Walker, J. Dyas, and L. Groom, "Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke," British Medical Journal, Vol.329, No.7479, pp.1-4, 2004. https://doi.org/10.1136/bmj.329.7456.1
  45. C. J. Parker, J. R. F. Gladman, A. E. R. Drummond, M. E. Dewey, N. B. Lincoln, D. Barer, P. A. Logan, and K. A. Radford, "A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke," Clinical Rehabilitation, Vol.15, No.1, pp.42-52, 2001. https://doi.org/10.1191/026921501666968247
  46. J. Ponsford, H. Harrington, J. Olver, and M. Roper, "Evaluation of a community-based model of rehabilitation following traumatic brain injury," Neuropsychological Rehabilitation, Vol.16, No.3, pp.315-328, 2006. https://doi.org/10.1080/09602010500176534
  47. J. Powell, J. Heslin, and R. Greenwood, "Community based rehabilitation after severe traumatic brain injury: A randomised controlled trial," Journal of Neurology, Neurosurgery & Psychiatry, Vol.72, No.2, pp.193-202, 2002. https://doi.org/10.1136/jnnp.72.2.193
  48. M. J. Smith, F. L. Vaughan, L. J. Cox, H. McConville, M. Roberts, S. Stoddart, and A. R. Lew, "The impact of community rehabilitation for acquired brain injury on carer burden: An exploratory study," Journal of Head Trauma Rehabilitation, Vol.21, No.1, pp.76-81, 2006. https://doi.org/10.1097/00001199-200601000-00008
  49. C. D. A. Wolfe, K. Tilling, and A. G. Rudd, "The effectiveness of community-based rehabilitation for stroke patients who remain at home: A pilot randomized trial," Clinical Rehabilitation, Vol.14, No.6, pp.563-569, 2000. https://doi.org/10.1191/0269215500cr362oa
  50. J. J. Yu, Y. S. Hu, Y. Wu, W. H. Chen, Y. L. Zhu, X. Cui, W. B. Lu, Q. Qi, P. Y. Qu, and X. H. Shen, "The effects of community-based rehabilitation on stroke patients in China: A single-blind, randomized controlled multicentre trial," Clinical Rehabilitation, Vol.23, No.5, pp.408-417, 2009. https://doi.org/10.1177/0269215508091870
  51. 차유진, 박수현, "알코올 중독자를 대상으로 한 비약물적 치료프로그램 효과에 대한 메타분석", 대한작업치료학회지, 제19권, 제4호, pp.51-67, 2011.
  52. N. Jenkinson, T. Jenkinson, D. Ownsworth, and D. Shum, "Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitation," Brain Injury, Vol.21, No.12, pp.1283-1294, 2007. https://doi.org/10.1080/02699050701739531
  53. C. D. Fisher and R. Gitelson, "A meta-analysis of the correlates of role conflict and ambiguity," Journal of Applied Psychology, Vol.68, No.2, pp.320-333, 1983. https://doi.org/10.1037/0021-9010.68.2.320
  54. 문동규, "노인의 자살생각과 관련된 유발변인의 메타회귀분석", 노인복지연구, 제55권, 단일호, pp.133-157, 2012.
  55. D. B. Pettiti, Meta-analysis, decision analysis and cost-effectiveness analysis, Oxford University Press, 2000.