BACKGROUND & AIMS: BACKGROUND AND PURPOSE:The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD:Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS:The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION:The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.

背景与目标：

BACKGROUND & AIMS: The present study was aimed at investigating the use of a treadmill for ambulation training of paraplegic subjects. To investigate the likely effectiveness of this modality of rehabilitation, six paraplegic patients (three male and three female) were studied, using new generation reciprocating gait orthoses (RGO and ARGO), in a treadmill training program. Oxygen consumption, heart rate, and pulmonary ventilation were measured when the subjects were walking at their most comfortable speed on the treadmill and on the open field. These measurements were carried out at the beginning of the study and after two and six months of treadmill training. The following findings were significantthe treadmill walking required 30% less energy than open field ambulation prior to training (P < 0.001) and 50% after training (P < 0.05). The most comfortable walking speed was faster on the treadmill than on the open field by 18% prior to training (P < 0.05) and 42% afterwards (P < 0.05). The energy cost was 50% less after 2 months training on the treadmill (P < 0.05) showing that treadmill training can improve the efficiency of over ground ambulation. It can be concluded that the treadmill training improves the RGO/ARGO walking capability, probably both the walking efficiency (short term adaptation) and physical fitness (long term adaptation).

背景与目标： 本研究旨在研究跑步机用于截瘫受试者的步行训练。为了研究这种康复方式的可能有效性，在跑步机训练计划中使用新一代往复式步态矫形器 (RGO和ARGO) 研究了六名截瘫患者 (三名男性和三名女性)。当受试者以最舒适的速度在跑步机和开阔的场地上行走时，测量耗氧量，心率和肺通气。这些测量是在研究开始时以及经过两到六个月的跑步机训练后进行的。以下发现是显着的跑步机步行所需的能量比训练前 (P < 0.001) 和训练后50% (P < 0.05) 的野外步行所需的能量少30%。在跑步机上，最舒适的步行速度比在露天场地上的速度快，在训练前18% (P <0.05)，之后42% (P <0.05)。在跑步机上进行2个月的训练后，能量消耗50% 较低 (P <0.05)，表明跑步机训练可以提高地面移动的效率。可以得出结论，跑步机训练提高了RGO/ARGO步行能力，可能同时提高了步行效率 (短期适应) 和身体素质 (长期适应)。

BACKGROUND & AIMS: :In older adults, physical activity (PA) is promoted for public health preventive effort. It is also a major target in the rehabilitation process. Existing assessment tools in the clinical routine do not include any aspects of PA or participation and are often prone to floor or ceiling effects. The aim of this study was to document the process of rehabilitation by activity monitoring without floor or ceiling effects. Ninety-two stroke patients of a geriatric rehabilitation unit (mean age 82 years, ±6.21 years, 61% women) were included in an observational study to assess physical capacity (balance, chair rise, gait speed) and PA at admission and two weeks thereafter. PA was measured through an ambulatory activity monitor based on accelerometers and gyroscopes and showed no floor or ceiling effects. Floor effects were however documented for measures of physical capacity (admission 5-11%; follow-up 2-9%) and ceiling effects were registered for the balance test (admission 17.4%; follow-up 22.8%). Improvements were documented for measures of physical capacity as well as for PA (all p < 0.001). We conclude that the assessment of PA by activity monitoring is a valuable measure to document objectively the process of rehabilitation without floor or ceiling effects.

背景与目标： : 在老年人中，体育锻炼 (PA) 被促进用于公共卫生预防工作。这也是康复过程中的主要目标。临床常规中现有的评估工具不包括PA或参与的任何方面，并且通常容易产生地板或天花板效应。这项研究的目的是通过活动监测来记录康复过程，而没有地板或天花板效应。老年康复病房的92名中风患者 (平均年龄82岁，± 6.21岁，61% 名女性) 被纳入一项观察性研究，以评估入院时及其后两周的身体能力 (平衡，椅子上升，步态速度) 和PA。PA是通过基于加速度计和陀螺仪的动态活动监测器测量的，没有地板或天花板效应。然而，记录了用于身体能力测量的地板效应 (入院5-11%; 随访2-9%)，并记录了平衡测试的天花板效应 (入院17.4%; 随访22.8%)。记录了物理容量和PA的改进 (所有p <0.001)。我们得出的结论是，通过活动监测对PA的评估是客观记录康复过程而没有地板或天花板效应的有价值的措施。

BACKGROUND & AIMS: OBJECTIVE:The aims of this study were to conduct an exploratory factor analysis on admission data, identify key variables that may predict discharge to home, and create and test a predictor model using confirmatory factor analysis and structured equation modeling. DESIGN:A secondary data analysis was conducted using a data set of 176,419 cases. Statistical analyses used included an exploratory factor analysis, confirmatory factor analysis, and structural equation modeling using variables collected upon admission. RESULTS:The hypothesis model included ten items that loaded on a latent factor of physical performance and five items that loaded on a latent factor of cognitive performance. The final predictor model resulted in three physical performance items (grooming, toileting, and chair transfers) and four cognitive performance items (comprehension, expression, problem solving, and memory) with results of χ(2) (df) of 44,708.630 (11), root mean square error of approximation of 0.152, and comparative fit index/Tucker-Lewis index of 0.957/0.918. CONCLUSIONS:Four factors (admit cognitive scores, admit physical scores, age, and diagnosis category) were identified and tested. The latent factors admit cognitive performance scores and admit physical performance scores were shown to be strong predictors for discharge to home, whereas diagnosis categories and age were weak predictors in this model.

背景与目标：

BACKGROUND & AIMS: AIM:The aim of this study was to investigate the long-term mortality, daily living activities, social activity, and symptoms of depression, in post-stroke patients discharged to their homes from a convalescent rehabilitation ward, and to determine the relationship between demographic variables and long-term outcome. METHODS:This study included 252 consecutive stroke patients (140 men; mean age, 72.4 ± 10.8 years) who had been admitted to a convalescent rehabilitation ward for inpatient rehabilitation. Follow-up assessment was made by postal questionnaire for up to >1 year after discharge, and included the modified Rankin scale, Frenchay activities index (FAI), and Geriatric Depression Scale. RESULTS:Of the 192 respondents (76.2%), 160 (83.3%) were living at home. Eighty-three (51.8%) were independent. Cumulative post-stroke mortality at 1 and 3 years was 3.7% and 19.4%, respectively.Mean total FAI score was 26.5 ± 10.9, suggesting that social inactivity was common. The estimated prevalence of depression was 21.6%. Coronary artery disease and motor functional independence measures were significantly associated with mortality, whereas age, recurrent stroke, severity of paralysis, and motor functional independence measures were significant predictors of independence. In the cross-sectional logistic model, depression symptoms were inversely associated with FAI score. CONCLUSIONS:The mortality rate of patients discharged to their home following inpatient rehabilitation is relatively low. Social inactivity and depression symptoms, however, remain common during the chronic phase, and the severity of depression and restriction of participation were interrelated.

背景与目标：

BACKGROUND & AIMS: PURPOSE:The Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) developed an outpatient low-vision programme for patients with macular diseases providing low-vision rehabilitation comparable to VA inpatient blind rehabilitation centres (BRCs). This programme targets veterans who do not need or chose not to participate in a comprehensive inpatient blind rehabilitation programme. We examined costs and consequences using veterans in LOVIT and comparable veterans in an inpatient BRC. METHODS:We compared costs and consequences between treatment patients who participated in LOVIT, a two-site randomized clinical trial, and a sample of comparable patients who received treatment at a VA inpatient BRC. We measured consequences as the change in functional visual ability from baseline to follow-up (LOVIT: 4 months after randomization; BRC: 3 months after discharge) using the VA Low Vision Visual Functioning Questionnaire (VA LV VFQ-48). RESULTS:There were 55 LOVIT and 121 BRC patients for our analyses. Average costs were $38,627.3 higher for BRC patients ($5,054.4 +/- $404.7 SD for LOVIT vs. $43,681.7 +/- $8,853.6 SD for BRC, p < 0.0001). Thus, the BRC cost $38,627.3 per patient more than the LOVIT programme (95% CI: $17,414 to $273,482). There was a greater improvement in overall visual ability, mobility, and visual motor skill scores for BRC patients; however, there was no significant difference in improvement in reading ability or visual information processing scores. CONCLUSIONS:As VA increases outpatient blind rehabilitation services, LOVIT provides a model for expanding outpatient low-vision rehabilitation services for veterans at substantially lower costs than current inpatient BRC services.

背景与目标：

BACKGROUND & AIMS: PURPOSE:To look critically at the present reality of AIS (Adolescent Idiopathic Scoliosis) treatment and verify the hypothesis that the current prevalence of a single medical specialty could be creating distortions in patient care and/or cure. METHOD:This is a multifaceted study comprising a review of the evidence on AIS, a bibliometric study of the general and orthopedic literature since Medline start, and two case reports. RESULTS:Evidence exists to support the efficacy of exercises, bracing and fusion (grade B, B and C recommendations, respectively), but in clinics exercises are generally ignored; braces are used with some criticism, while fusion is generally considered the only reliable treatment. The literature on AIS treatment prevails in journals of orthopedic surgery, and therapy papers focused on surgery have increased from 34 to 55% over the past two decades. The two clinical cases show how an incorrect psychological approach to the patient and family, as well as inappropriate conservative treatments can have disastrous consequences for patients. CONCLUSIONS:Our results seem to confirm the initial hypothesis: The interest of the AIS treatment community (composed almost exclusively by orthopedic surgeons) has shifted toward fusion whereas research has increased, while conservative treatment is suffering a decrease in professional interest (and diminished research). AIS requires expert, committed evidence-based care, but other specialists totally devoted to conservative treatment, particularly (but not exclusively) Physical and Rehabilitation Medicine specialists, should enter the field to create better treating teams.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Strengthening exercises for the scapular muscles are used in the treatment of scapulothoracic dysfunction related to shoulder injury. In view of the intermuscular and intramuscular imbalances often established in these patients, exercises promoting lower trapezius (LT), middle trapezius (MT), and serratus anterior (SA) activation with minimal activity in the upper trapezius (UT) are recommended. HYPOTHESIS:Of 12 commonly used trapezius strengthening exercises, a selection can be performed for muscle balance rehabilitation, based on a low UT/LT, UT/MT, or UT/SA muscle ratio. STUDY DESIGN:Controlled laboratory study. METHODS:Electromyographic activity of the 3 trapezius parts and the SA was measured in 45 healthy subjects performing 12 commonly described scapular exercises, using surface electromyography. RESULTS:For each intramuscular trapezius ratio (UT/LT, UT/MT), 3 exercises were selected for restoration of muscle balance. The exercises side-lying external rotation, side-lying forward flexion, prone horizontal abduction with external rotation, and prone extension were found to be the most appropriate for intramuscular trapezius muscle balance rehabilitation. For the UT/SA ratio, none of the exercises met the criteria for optimal intermuscular balance restoration. CONCLUSION:In cases of trapezius muscle imbalance, some exercises are preferable over others because of their low UT/LT and UT/MT ratios. CLINICAL RELEVANCE:In the selection of rehabilitation exercises, the clinician should have a preference for exercises with high activation of the LT and MT and low activity of the UT.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:International studies suggest almost half of all major coronary episodes annually occur in survivors of acute coronary syndrome (ACS). OBJECTIVE:A greater focus on medium- and long-term ACS management and adherence to proven therapies is essential if out-of-hospital reductions in mortality and morbidity are to be optimized. METHODS:A national panel of clinical and research opinion leaders in ACS care met for 2 days to set future priorities in health care delivery. RESULTS:Lifestyle, control of risk factors, and prescription of pharmacological therapies can improve the course of coronary heart disease (CHD) by reducing all-cause and cardiovascular mortality by 15% to 25%. All ACS patients stand to benefit from rehabilitation and systematic secondary prevention, however, underutilization and suboptimal adherence to rehabilitation and secondary prevention measures persist globally. RESULTS:A range of new initiatives in Australia and elsewhere indicate that time is ripe for change to improve the uptake of preventative treatments in patients after ACS. Key universal drivers of delivering best evidence practice for medium- to long-term care after ACS are economics and locality. CONCLUSIONS:Health-service redesign involving all stakeholders will be integral to increasing access, uptake, and adherence to lifestyle, control of risk factors, and pharmacologic therapies shown to improve cardiovascular outcomes.

背景与目标：

BACKGROUND & AIMS: :Cancer and cardiovascular diseases are globally the leading causes of mortality and morbidity. These conditions are closely related, beyond that of sharing many risk factors. The term bidirectional relationship indicates that cardiovascular diseases increase the likelihood of getting cancer and vice versa. The biological and biochemical pathways underlying this close relationship will be analyzed. In this new overlapping scenario, physical activity and exercise are proven protective behaviors against both cardiovascular diseases and cancer. Many observational studies link an increase in physical activity to a reduction in either the development or progression of cancer, as well as to a reduction in risk in cardiovascular diseases, a non-negligible cause of death for long-term cancer survivors. Exercise is an effective tool for improving cardio-respiratory fitness, quality of life, psychological wellbeing, reducing fatigue, anxiety and depression. Finally, it can counteract the toxic effects of cancer therapy. The protection obtained from physical activity and exercise will be discussed in the various stages of the cancer continuum, from diagnosis, to adjuvant therapy, and from the metastatic phase to long-term effects. Particular attention will be paid to the shelter against chemotherapy, radiotherapy, cardiovascular risk factors or new onset cardiovascular diseases. Cardio-Oncology Rehabilitation is an exercise-based multi-component intervention, starting from the model of Cardiac Rehabilitation, with few modifications, to improve care and the prognosis of a patient's cancer. The network of professionals dedicated to Cardiac Rehabilitation is a ready-to-use resource, for implementing Cardio-Oncology Rehabilitation.

背景与目标： : 癌症和心血管疾病是全球死亡和发病的主要原因。除了分担许多风险因素之外，这些条件密切相关。双向关系一词表明心血管疾病增加了患癌症的可能性，反之亦然。将分析这种密切关系的生物学和生化途径。在这种新的重叠场景中，体育锻炼和运动被证明是针对心血管疾病和癌症的保护行为。许多观察性研究将体力活动的增加与癌症发展或进展的减少以及心血管疾病风险的降低联系起来，心血管疾病是长期癌症幸存者不可忽略的死亡原因。锻炼是改善心肺功能，生活质量，心理健康，减轻乏力，焦虑和抑郁的有效工具。最后，它可以抵消癌症治疗的毒性作用。从身体活动和运动获得的保护将在癌症连续体的各个阶段进行讨论，从诊断到辅助治疗，从转移阶段到长期影响。将特别注意预防化学疗法，放射疗法，心血管危险因素或新发心血管疾病的庇护所。心脏肿瘤康复是一种基于运动的多成分干预措施，从心脏康复模型开始，很少进行修改，以改善护理和患者癌症的预后。致力于心脏康复的专业人员网络是一种随时可用的资源，用于实施心脏肿瘤康复。

BACKGROUND & AIMS: BACKGROUND:To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS:Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS:We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N = 2188) in post-TKR rehabilitation and 4 studies (N = 783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): - 0.25; 95% confidence interval (CI): - 0.48, - 0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: - 11.18, - 2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION:There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.

背景与目标：

BACKGROUND & AIMS: :Virtual rehabilitation has been used during decades to provide a more personalized, controlled, and enjoyable experience on upper-limb motor rehabilitation. Since novel virtual reality (VR) technologies are now accessible and highly immersive, the challenge for a wide dissemination of virtual rehabilitation in clinical scenarios has shifted from the hardware robustness to the software intelligence. A sophisticated technique that provides physiological intelligence to novel human-computer interaction (HCI) applications is biocybernetic adaptation. The concept emerges from the electrophysiological computing field, and it proposes using body signals to detect human states (e.g. workload or fatigue) and modulate the virtual activity accordingly. This paper evaluates the effects of using biocybernetic adaptation in a virtual rehabilitation game that aims to encourage users to exert at a desirable intensity level while interacting with the virtual environment. The system relies on surface-electromyography (sEMG) signals to detect fatigue levels in real-time and adapt the game challenge dynamically. Perceived fatigue levels, game user experience, and game performance parameters are assessed after playing the game, considering two different visualization modalities: non-immersive (conventional flat screen) and immersive (VR headset). Results revealed how the biocybernetic system in the immersive condition not only produced lower levels of perceived fatigue compared with the non-immersive, but also, created a more enjoyable and positive experience in a controlled experiment with 24 healthy subjects. Moreover, participants in the immersive condition showed a better performance in the virtual game and higher usability levels scored by users compared with the non-immersive condition. To conclude, we highlight the importance of combining novel immersive approaches with physiologically aware systems to enhance the benefits of virtual rehabilitation therapies.

背景与目标： : 虚拟康复在过去的几十年中一直被用来为上肢运动康复提供更加个性化，可控和愉快的体验。由于新颖的虚拟现实 (VR) 技术现在可以访问并且高度沉浸式，因此在临床场景中广泛传播虚拟康复的挑战已从硬件鲁棒性转向软件智能。生物细胞适应是一种为新型人机交互 (HCI) 应用提供生理智能的复杂技术。该概念来自电生理计算领域，它提出使用身体信号来检测人类状态 (例如工作量或乏力) 并相应地调节虚拟活动。本文评估了在虚拟康复游戏中使用生物细胞适应的效果，该游戏旨在鼓励用户在与虚拟环境交互的同时以理想的强度发挥作用。该系统依靠表面肌电图 (sEMG) 信号来实时检测乏力水平并动态适应游戏挑战。考虑两种不同的可视化方式: 非沉浸式 (常规平板屏幕) 和沉浸式 (VR耳机)，在玩游戏后评估感知乏力水平，游戏用户体验和游戏性能参数。结果表明，与非沉浸式相比，沉浸式生物细胞系统不仅产生了较低的感知乏力水平，而且在24位健康受试者的对照实验中创造了更愉快和积极的体验。此外，与非沉浸状态相比，沉浸状态的参与者在虚拟游戏中表现出更好的性能，并且用户获得了更高的可用性水平。最后，我们强调了将新颖的沉浸式方法与生理感知系统相结合以增强虚拟康复疗法的益处的重要性。

BACKGROUND & AIMS: BACKGROUND:Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined. METHODS:This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL). DISCUSSION:This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation. TRIAL REGISTRATION:Clinicaltrials.gov, NCT02631850 .

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:This study aims to test the hypothesis that the Revised Version of the Ability for Basic Movement Scale (ABMSII) can predict ambulation during rehabilitation in poststroke patients. SUBJECTS AND METHODS:The study included first-ever stroke patients who were admitted to the rehabilitation ward and were dependent in walking. ABMSII scores were assessed by physical therapists on admission to the hospital. Functional ambulation category (FAC) was assessed every 2 weeks during hospitalization. The primary outcome was independent ambulation, defined as 4 points or higher on the FAC. RESULTS:After setting the inclusion criteria, data of 374 stroke patients (mean age: 70 years, 153 women) were eligible for the analysis. Of these, 193 patients achieved independent ambulation during hospitalization. The ABMSII score was significantly higher in the patients who regained independent walking ability than in those who required assistance in walking. Based on receiver operating characteristic curve analysis, an ABMSII score of 16 points or higher had a sensitivity of 93% and a specificity of 71%. Kaplan-Meier curve analysis after log-rank test demonstrated a significantly higher event rate in patients with an ABMSII score of 16 or higher compared to those with an ABMSII score lower than 16. Univariate and multivariate Cox regression analyses identified the ABMSII score as a significant and independent predictor of ambulation during rehabilitation. CONCLUSION:Our results suggest that the ABMSII score is a potentially useful tool to predict ambulation during rehabilitation in poststroke patients.

背景与目标：

BACKGROUND & AIMS: :Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness.

背景与目标： : 认识到精神卫生服务中的族裔/种族差异并没有直接导致对文化有反应的心理社会干预措施的发展。仍然需要对与患有严重和持续精神疾病的文化多样性消费者的期望，需求和目标相关的社会文化问题进行评估。作者认为，将社会文化问题的评估纳入社会心理康复实践是设计与文化相关的经验支持实践的一步。它成为从业者可以检查其干预措施与日常实践中遇到的多样性的相关性的基础。本文概述了对文化和临床相关评估实践的需求，并断言通过改善对社会文化问题的评估，可以增强服务提供商的临床能力。作者提供了一个概念框架，用于将社会文化问题的临床评估与消费者的结果联系起来，并引入了一种评估工具，以促进社会心理康复环境中的过程。强调合格的临床评估技能将最终提供一种策略，以解决患有严重和持续性精神疾病的文化多样性消费者的研究不足人群的治疗结果差异。