Follow-up Rehabilitation Research Articles

The impact of an inpatient hospital admission on patients’ physical functioning and quality of life in the oncology setting

Objective : Cancer can affect an individual’s level of physical function and health related quality of life (HRQoL). Those requiring hospital admission may be at risk of further decline during hospitalisation. The aim of this study was to investigate physical functioning and HRQoL of cancer patients on admission and over the course of their hospital admission. Methods : A prospective observational study was undertaken on the inpatient wards of a specialist oncology hospital. Assessment measures were taken bi-weekly until discharge from hospital or if they became too unwell to continue. Functional outcome measures included timed-up and go test (TUG), 30 second sit to stand test (30SST), 30 second arm curl test and isometric muscle strength (30ACT). HRQoL was assessed via the EORTC-C30 and SF-8 and distress was measured using the Distress Thermometer. Results : Fifty-five patients (28 males), mean age 64 years ± 10.8, with an average length of stay of 19 days participated in the study. Primary reasons for hospital admission included; symptom management (36%) or delivery of cancer treatment (35%). On hospital admission, the majority of patients scored worse than normative levels on the EORTC-C30 and SF-8. Similarly, 65%, 69% and 35% recorded below age norms for TUG, 30SST and 30ACT. Most measures showed a trend towards worsening during hospitalisation with up to 59% of patients experiencing ± 10% worsening over time. However, only role and social functioning ( p < .05), as well as financial difficulty showed statistically significant worsening ( p < .05) during hospitalisation. Conclusions : Participants demonstrated substantially reduced HRQoL and physical functioning at time of hospital admission which tended to worsen during hospitalisation. Despite this low level of function, very few received rehabilitation follow-up. Screening programs using HRQoL and functional assessment measures could be useful in identifying patients who are deconditioned or at risk of deconditioning and require specialised therapy to prevent declines in function and hospital re-admissions.

Rehabilitation of patients with acid-base and fluid balance disorders with short bowel syndrome after ileostomies

Patients with ileostomies regularly suffer from short bowel syndrome or high volume output associated with loss of absorptive surface and subsequent impairment of absorption for drugs and different nutrients resulting in electrolyte and fluid balance disorders as well as renal insufficiency. Adaptation of these fundamental functions of the gut with adequate fluid uptake, absorption of sufficient different nutrients and vitamins represents a major challenge to rehabilitate these patients shortly after surgery. Patients with ileostomy often develop metabolic acidosis with normal anion gap. In our retrospective study we would like to draw attention to these metabolic disorders in patients with ileostomy in comparison to patients with colostomy and patients undergoing gastrectomy for gastric cancer. In the period from 2005 to 2012 we examined 164 patients with ileostomy in our rehabilitation clinic, 109 patients with colostomy and 193 patients after surgery for gastric cancer of the possible presence of metabolic acidosis by using capillary blood gas analysis (metabolic acidosis was anticipated, if base excess was ≤- 3,0 mmol/l). Patients are treated as inpatients both in early stage and for follow-up rehabilitation. The length of time in our rehabilitation clinic lies in between 24-28 days. On the basis of random samples we tested blood samples in 19 patients with ileostomy in succession for ferritin, folic acid, zinc, selenium and vitamin B12. Statistical analysis comprised the classical intervals (mean and standard deviation, range and T-test for dependent and independent samples). In total we tested 164 inpatients with ileostomy in our rehabilitation clinic (median age 67.4 years, range 19-79 years). Surgery for ileostomy took place about 1.4 months on average ago (range ¼-56 months). 60 (36.5%) inpatients suffered from metabolic acidosis often combined with renal insufficiency. Supportive therapy intravenously administered in 10 patients and sodium bicarbonate given by mouth in 40 patients significantly improved metabolic acid (base excess improved on average from -7.2 to -3.2 mmol/l, p<0.00138) and renal function calculated on the basis of serum creatinine (serum creatinine decreased from 1.49 on average to 1.34 mg/dl, p<0.04039). Body weight remained constant over the whole period on average with 74 kg. Diuretics did not show any influence on the base excess. In 19 patients with ileostomy who did not take any kind of supplements, among the parameters tested were a high percentage of zinc (9 of 19 patients, 47%) and selenium deficiency (13 of 19 patients, 68%). 50 patients with ileostomy were younger than 65 years of age and thus in the working age population. In the group of patients after gastrectomy because of gastric cancer (n=193, median age 69.1 years, range 36-82 years), surgery for gastrectomy took place about 1.8 months on average ago and in this group only 14 patients (7%) showed metabolic acidosis. In the group of patients with colostomy (n=109, median age 69.5 years, range 39-82 years), surgery for colostomy took place about 2.1 months on average ago and in this group only 6 patients (5.5%) suffered from metabolic acidosis. Medical rehabilitation is indicated for patients with enterostoma. Acceptance of the enterostoma by the patient himself, psychological stabilization, achievement of self-sufficiency in stoma care, improvement of physical abilities and finally being fit for full or limited employment are the most important objectives in rehabilitation medicine. Metabolic acidosis was often found in patients with ileostomy and was an important clinical appearance. Blood gas analysis is recommended to verify metabolic acidosis and if confirmed sodium bicarbonate and in cases of high volume output salt-depleting ileostomy additionally intravenous fluid support should be offered controlling body weight in the follow-up. As could be shown by our analysis patients with ileostomy should also be tested for zinc and selenium deficiency.

Spinal cord Injury management: current procedures and the future

Background: The term ‘spinal cord injury’ refers to damage to the spinal cord from trauma, disease, or degeneration. Estimated annual global incidences are 40 to 80 cases per million population; and in Asia are between 6.7 and 246 per million population. In Iran, the prevalence is 4.4 per 10,000 and annual incidences are 98 per million men and 47 per million women. The average age at injury is 42.6 years. In many records, 80% of cases are men. Causes are motor vehicle accidents (36–48%), violence (5–29%), falls (17–21%), and recreational activities (7–16%). While 56.5% of injuries are complete and 43% are incomplete, usually in developing countries cervical spine damage and quadriplegia is common. In developed countries, 58.7% are paraplegic because of thoracolumbar events. After the initial trauma, the spinal cord undergoes chronological pathologic changes. Primary injury mechanical and secondary injury (cellular and molecular) develop vascular abnormalities, free radicals, lipid peroxidation, excitotoxicity, and electrolyte imbalances, necrotic and apoptotic cell death, and inflammatory/immunologic responses. Objectives: For managing a disease, at first it is necessary to know all available and possible methods, their pros and cons, and knowledge gaps. We sought to review treatment of spinal injuries. Materials and Methods: We downloaded and reviewed more than 170 full textbooks and articles in English from the literature PubMed, and Google scholar websites. Results: There is different in vivo and in vitro managements. The primary approach is to stop injury with surgery or molecular therapeutic interventions. Other procedures are removal of inhibition, compensation for demyelization, promotion of axonal regeneration, enhancing conduction, creation of bridges, rehabilitation and long-term follow-up, and replacement of cells, among others. Conclusions: Available data implies that restorative therapies should focus on multiple targets and different intervals after injury. Yet, if we understand the key and basic origin of the injury, we may develop effective, complete, safe, and continual procedures.

A Long Term Follow up of Rehabilitation and Survivorship of Spinal Cord Injury Patients -an Observational Study

A Long Term Follow up of Rehabilitation and Survivorship of Spinal Cord Injury Patients -an Observational Study

A 4-year follow-up of rehabilitation of atrophied edentulous mandible with implant-supported overdenture

Conventional complete dentures primarily rely on residual alveolar ridge and mucosa for support and retention. Patients with poor mandibular ridge foundation usually suffer from inadequate denture retention and stability. In such cases, implant-supported overdenture treatment provides improved prosthesis retention and support and thus greatly increasing patient's acceptance toward prosthesis as when compared to conventional dentures. The present case report describes a successful rehabilitation of resorbed mandibular ridge with an overdenture supported by two implants.

Enhancing Community-Based Rehabilitation for Stroke Survivors: Creating a Discharge Link

Background and Objective: Intensive poststroke rehabilitation is critical to maximizing outcomes, improving inpatient flow, and decreasing long-term costs. This regional initiative investigated the impact of improving access to timely intensive home-based stroke rehabilitation follow-up care on hospital length of stay (LOS) and readmission rates. The enhanced service was made available across the region’s rural geography to new stroke survivors transitioning home who were unable to access outpatient care. Methods: All new stroke survivors with ongoing rehabilitation needs being discharged from the hospital and eligible for home care received timely enhanced intensity of home-based rehabilitation services from existing community rehabilitation providers for 2 months after discharge. Five hundred twenty-four stroke survivors received this service over a 3-year period. The service priority rating was increased to reduce wait times to less than 5 days. Collaborative planning across sectors occurred through discharge link meetings. Comparative analysis was used to investigate health system measures before and after service implementation. Results: A 15.7-day decrease in hospital LOS and decreased hospital readmission rates were observed after enhanced service implementation. Functional Independence Measure (FIM) efficiency improved for those discharged from inpatient rehabilitation. Average wait time for community rehabilitation services decreased from 44 days to 4.4 days. The mean total number of community therapy visits more than doubled to an average of 12 per client. Conclusion: The provision of timely more intensive home-based rehabilitation services for new stroke survivors transitioning home and unable to access outpatient care was associated with decreased hospital LOS and decreased readmission rates.

An adapted adult day centre for older adults with sensory impairment

The MAB-Mackay Rehabilitation Centre runs a Day Centre Programme whose objectives are to maintain or improve the seniors’ biological, psychological, and social health while delaying or avoiding institutionalization. Activities include walking groups, language courses, and memory games, supervised by an interdisciplinary team. Services include rehabilitation follow-up and referrals to community resources. The present study reports on the impact of the Day Centre on the holistic health of older adults with visual impairment. Between September 2011 and October 2012, 30 newly referred clients (age = 71–98 years, M = 85, visual acuity [VA] 20/50 to no-light-perception [NLP], M = 20/126) were evaluated at intake, and after 6 and 12 months, including the Visual Function Questionnaire-14, Hearing Handicap Inventory for the Elderly, Geriatric Depression Scale, Friendship Scale, Timed Up and Go Test, and Montreal Cognitive Assessment (MoCA). In all, 19 participants completed the 1-year follow-up and continued to live independently in the community 12 months after entering the Day Centre. Only one person was transferred into long-term care. Comorbid conditions included high blood pressure, asthma, cardiac problems, diabetes, stroke, arthritis, and osteoporosis. Participants reported statistically unchanged scores on all the measures, except for improved MoCA scores, p &lt; .05. Considering the vulnerability of this population, the data indicate that the Day Centre contributes to prevent decline in its clients’ general well-being. The increase in cognitive scores is possibly linked to practice effects and reduced test anxiety. Participation in adapted Day Centre activities, as an integrated part of rehabilitation services, may support independent living in older adults with vision loss.

Reproducibility and responsiveness of heart rate indexes to assess wheeling efficiency in patients with spinal cord injuries.

Cross-sectional study. To measure the reproducibility and responsiveness of heart rate indexes in measuring energy expenditure during wheelchair locomotion of adults with spinal cord injury (SCI). SARAH Rehabilitation Hospital Network-Brasilia, Brazil. The study consecutively enrolled 35 individuals with SCI. Volunteers propelled their wheelchairs at a self-selected and comfortable velocity around a circular track. The first assessment day was a responsiveness study, in which three tests were performed, with the wheelchair weight increased randomly during the last two tests. On the second assessment day, the test was conducted without extra weight (that is, baseline conditions) for reproducibility analyses. All indexes demonstrated reproducibility on all statistical analyses. The Propulsion Cardiac Cost Index (PCCI) had a lower variation coefficient than the Physiological Cost Index (PCI; 8.5%, 95% confidence interval (CI) 5.8-11.2 vs 24.2%, 95% CI 16.0-32.4) and lower effect size than the Total Heart Beat Index (THBI; 0.16 vs 0.26). The PCCI also had the best responsiveness results on all statistical tests. The PCCI correlation was the largest (r=0.63, P<0.01, 95% CI 0.43-0.83, followed by PCI (r=0.53, P<0.01, 95% CI 0.34-0.72) and then the THBI (r=0.50, P<0.01, 95% CI 0.29-0.71). All three indexes were reproducible and responsive. However, the PCCI gave better statistical results. This index may be useful in functional diagnosis and follow-up of rehabilitation.

Rehabilitation needs change with time after orthopaedic major trauma

Background: To comply with the Best Practice Tariff for Major Trauma, rehabilitation prescriptions are completed for patients with an Injury Severity Score above 8, which covers a broader, previously-undefined population. This project uses the rehabilitation prescription to define the characteristics and rehabilitation needs of the orthopaedic major trauma population. Methods: A total of 336 patients with orthopaedic major trauma had an initial rehabilitation prescription completed in 1 year. Over a 7-month period, 143 of these patients were clinically assessed by a trauma rehabilitation specialist physiotherapist. Demographic data and rehabilitation needs identified from initial and follow-up rehabilitation prescriptions were recorded and analysed. Results: Orthopaedic injuries affect the largest number of major trauma patients (n=336/692). Falls (30%) and road accidents (29%) are the most common mechanisms of trauma for patients of all ages (mean 55.6 years). At initial assessment, mobility (97%), pain (95%), and independence with activities of daily living (IADL) (79%) were the most prevalent rehabilitation needs identified. Five months after injury, patients had a reduced rehabilitation need for mobility (60%), IADL (30%), and pain (27%). The need for psychological support increased from 2% to 22%, while vocational needs remained stable (initial 29%, review 26%). Difficulties with mood were first identified at the review stage in 94% of cases. Of patients who were reassessed, 48% had unmet rehabilitation needs requiring referral to physiotherapy (25%), health psychology (13%), and orthopaedic review (6%). Conclusions: Rehabilitation from orthopaedic major trauma continues beyond the acute hospital admission. Mobility, pain and IADL are most affected by injury, and mobility problems can persist for many months after injury. Rehabilitation needs can change, with difficulties managing emotions developing over time. Physiotherapists play a lead role in addressing the most frequent rehabilitation needs, but patients need multidisciplinary support, including health psychology and pain specialists, to meet their ongoing rehabilitation needs. Implications: Orthopaedic major trauma patients require access to specialist multidisciplinary rehabilitation throughout their recovery journey. Reassessment of the rehabilitation prescription is necessary to evaluate an individual's changing rehabilitation needs and improve access to appropriate professionals.

Evaluation of a structured goal planning and tailored follow-up programme in rehabilitation for patients with rheumatic diseases: protocol for a pragmatic, stepped-wedge cluster randomized trial.

BackgroundComprehensive rehabilitation, involving health professionals from various disciplines, is widely used as an adjunct to pharmacological and surgical treatment in people with rheumatic diseases. However, the evidence for the clinical- and cost-effectiveness of such interventions is limited, and the majority of those who receive rehabilitation are back to their initial health status six to 12 months after discharge.Methods/designTo evaluate the goal attainment, health effects and cost-effectiveness of a new rehabilitation programme compared to current traditional rehabilitation programmes for people with rheumatic diseases, a stepped-wedge cluster randomized trial will be performed. Patients admitted for rehabilitation at six centres in the south-eastern part of Norway will be invited to participate. In the trial, six participating centres will switch from a control (current rehabilitation programme) to an intervention phase (the new rehabilitation programme) in a randomized order. Supported by recent research, the new programme will be a supplement to the existing programme at each centre, and will comprise four elements designed to enhance and support lifestyle changes introduced in the rehabilitation period: structured goal-planning, motivational interviewing, a self-help booklet and four follow-up telephone calls during the first five months following discharge. The primary outcome will be health-related quality of life and goal attainment, as measured by the Patient Generated Index directly before and after the rehabilitation stay, as well as after six and 12 months. Secondary outcomes will include self-reported pain, fatigue, a global assessment of disease activity and motivation for change (measured on 11-point numeric ratings scales), health-related quality of life as measured by the Short Form 36 Health Survey (SF-36) and utility assessed by the SF6D utility index.The main analysis will be on an intention to treat basis and will assess the clinical- and cost-effectiveness of the structured goal planning and tailored follow-up rehabilitation programme for patients with rheumatic diseases.DiscussionThe findings will constitute an important contribution to more cost-effective- and evidence-based rehabilitation services for people with rheumatic diseases.Trial registrationISRCTN91433175.

Therapeutic patient education for stroke survivors: The SOFMER working group

TPE itself is a goal in physical medicine and rehabilitation (PMR) and it is generally part of the missions of follow-up care and rehabilitation facilities. The French Physical and Rehabilitation Medicine Society (Sofmer) established a working group to devise methodological guides for implementing TPE programs based on analyses of practices and the literature. These guides are available in French on the Sofmer website (www.sofmer.com). This working group only addressed the after-effects of strokes. Secondary prevention and cardiovascular risk factor control, will be discussed in a specific working group. We will present the results of this work and update on the current practice in France by showing examples of programmes implemented with these guides.

Characteristics of anxiety and psychological well-being in chronic post-stroke patients

Background and purposeAnxiety and depression are common psychological conditions in post-stroke patients. In the present study, their relation with perceived quality of life and psychophysical well-being was investigated. MethodsIn the present cross-sectional study, chronic post-stroke patients (n=81; average years from stroke=4±4.6) were assessed with the Hospital Anxiety and Depression Scale (HADS), the 36-item Short-Form Healthy Survey (SF-36) and the Psychological General Well-Being Index (PGWBI), as well as a brief neuropsychological assessment focused on the thinking ability and executive functions. ResultsHigher levels of anxiety compared to depressive symptoms were found. Hierarchical multiple regressions indicated that SF-36 predicts neither anxiety nor depression, and PGWBI subscales only partially. ConclusionPost-stroke anxiety can be a largely observed psychological distress in chronic patients: this pattern would be interpreted in relation to patients' expectations about their health status during a rehabilitation follow-up. SF-36 and PGWBI questionnaires did not provide satisfactory and reliable indexes: the relation between anxiety and both quality of life and psychological well-being needs further exploration.

Study Protocol: Nutritional Support in a Cross-sector Model for the Rehabilitation of Geriatric Patients: A Randomized Controlled Trial

Background: Hospital stays are generally getting shorter which leaves limited time to improve a poor nutritional status for geriatric patients. Therefore, it seems necessary to integrate nutritional support also in the period after discharge. Furthermore, improving cross-sector cooperation in the transition of geriatric patients between hospital and home-care institutions is essential to ensure follow-up and completion of hospital (nutritional) treatment and rehabilitation of patients. In spite of many issues, i.e. the multi-morbidity, the reduced level of functioning and the excessive use of medication, which have a negative impact of appetite and food intake, little research, has been done to address these problems by investigating the effect of a more comprehensive systematic nutritional approach. Method: A twelve-week randomised controlled trial comparing discharge standard Follow-home Team vs. discharge Follow-home Team in cooperation with a Registered Dietician. Patients are eligible for this study when they are 70+ years old and at nutritional risk. The registered Dietician will perform three home visits. The first visit will take place at the day of discharge together with the Follow-home Team, while the remaining visits will take place approximately three and eight weeks after discharge and will be performed by the RD alone. The information gathered by the Follow-home Team i.e. regarding the medical treatment, the patient’s functional abilities and ability to cope with activities of daily living, and the need for change in social services, will be taken into consideration. The primary outcome parameter will be muscle strength measured as handgrip strength. Secondary outcomes will be nutritional status, dietary intake, physical performance, mobility, Activities of Daily Living, quality of life, use of social services, re-admissions and mortality. Discussion: This project is the first to combine individualized nutritional intervention with intervention from an established Follow-home Team. The results will hopefully help to ensure the cross-sector quality of nutritional support to geriatric patients. This may ultimately lead to reduced health care costs, and improvement in mobility, independence and quality of life for geriatric patients at nutritional risk. Trial registration: Clinical Trials.gov NCT01776762.

Modellflug: Eine nicht zu unterschätzende Quelle für komplexe Verletzungen

With the incidence of work-related injuries decreasing, we continue to observe an unchanged trend in leisure-related accidents. As in any other hobby, model flying devices bear the risk for accidents among builders and flyers ranging from skin lacerations to complicated and even life-threatening injuries. The fast-moving razor-sharp propeller blades predominantly cause trauma to the hands and fingers resulting in typical multiple parallel skin injuries also affecting structures deep to the dermis (e. g., tendons, vessels and nerves). The resultant clinical management involves complex reconstructive surgical procedures and prolonged rehabilitative follow-up. Improving the legal framework (e. g., warnings by the manufacturer) on the one hand, providing informative action and sensitising those affected on the other, should form a basis for an altered prevention strategy to reduce model flying device-related injuries in the future.

The Association of Education Level on Outcome after Distal Radius Fracture

Socioeconomic factors have been found to be predictors of outcome for other ailments. The purpose of this study was to evaluate the association of patient education level on pain and disability after distal radius fracture. A series of patients with distal radius fractures (n = 335) were enrolled into a prospective research registry. Standard demographic information was obtained from patients, including a five-value categorical education variable. After treatment with closed reduction, external fixation, or internal fixation patients were evaluated for pain, function (Disability of the Arm, Shoulder, and Hand score [DASH]), range of motion (ROM), and grip strength at standard intervals until 12months post-injury. A series of linear mixed effects models were developed to evaluate the relationship between time from injury and education level with each of the outcomes measured. Complete demographic and 12-month follow-up data were available on 227 patients (75%). There were neither group differences in mode of injury, severity, nor treatment modality after stratification by education level. Mixed effects model analyses revealed a significant linear association between level of education and measured outcomes at each follow-up point. Overall, each increase in education level demonstrated a doubling of improvement in pain, ROM, grip strength, and DASH score. Outcome of distal radius fracture depends on acute care and follow-up rehabilitation; however, patient-related factors indicative of socioeconomic status are becoming increasingly relevant as predictors of outcome and should be considered by the orthopaedist.

Financing external consultations in SSR (follow-up of rehabilitation) included in the annual operation endowment (DAF) and animation of the healthcare channels: What is the logic and what are the pernicious side-effects?

Financing external consultations in SSR (follow-up of rehabilitation) included in the annual operation endowment (DAF) and animation of the healthcare channels: What is the logic and what are the pernicious side-effects?

Two-year follow-up of osseointegration and rehabilitation in a patient with oral and maxillofacial arteriovenous malformations

The case of a patient with high-flow arteriovenous malformations (AVMs) affecting the mandible and lower face is presented. The patient had undergone surgical resection, sclerotherapy, and transcatheter embolization over the course of 16 years. As a result, all teeth except for the lower left third molar were missing, and a mass of arteriovenous malformed soft tissue covered the residual alveolar ridge. Implant placement surgery was performed in his mandible after treatment of the AVMs. Osseointegration of the implants placed in the mandible affected by the AVMs was evaluated. Rehabilitation in the absence of the alveolar ridge or keratinized gingiva was also evaluated. The implant stability quotient (ISQ) was measured before fabricating the restoration. An implant-supported partial denture was placed 4 months postoperatively. No implant failure was found; no bleeding on probing was present. The occlusion and masticatory function were satisfactory at 2-year follow-up. Osseointegration was safely achieved in the bone affected by the intraosseous AVMs that had been embolized. The success of an implant support prosthesis depends not only on the condition of the bony tissue but also on the surrounding soft tissue.

Repeatability of Static Posturography on the Follow-up of Vestibular Rehabilitation

We undertook this study to estimate the limits of agreement of repeated measures of static posturography on healthy adults and to assess the use of those limits on the interpretation of variations observed during vestibular rehabilitation of patients with chronic, peripheral vestibular disease. Twenty healthy adults and 30 vestibular patients accepted to participate. At baseline and at weeks 4, 6 and 8 of follow-up, posturography was performed with the eyes open or closed, while adding or not a layer of foam rubber to the base of support. The Dizziness Handicap Inventory was administered to patients prior to rehabilitation and at week 8. At baseline, a difference between groups was observed on the sway area (p < 0.05). Healthy subjects showed no statistical difference among the four recordings (repeatability of measurements from 85-100%). Vestibular patients showed differences among the four recordings on the area and the length/average speed of sway (p <0.05); individual differences from baseline exceeding the limits of agreement were observed on the sway area. A decrease on the Dizziness Handicap Inventory (≥18 points) was observed on 19 patients, from whom 12 (63, 95% CI 53-73%) showed a change on the sway area (eyes closed) that was larger than the limits of agreement. In healthy subjects, intra-subject repeated recordings of the area and the length/average speed of sway may be reliable at intervals of 4, 6 and 8 weeks. The sway area (without vision) may be a useful sway component, among others, to follow-up vestibular patients with chronic, peripheral disease during rehabilitation.

Sudden persistent fetal bradycardia after spinal analgesia for labor pain

Sudden persistent fetal bradycardia after spinal analgesia for labor pain

Application of the potential development of premature children by medication treatment joint early nursing intervention

Objective To explore the usage of Shi Jie Yin (Monosialotetrahexosylganglioside) with early comprehensive nursing intervention on the potential development of premature children.Methods 320 cases of premature children were randomly divided into intervention group and control group.The intervention group with 160 cases was given Shi Jie Yin with early rich environment intervention and comprehensive rehabilitation functional training in addition to conventional treatment.Control group only received conventional treatment,parental guidance and assessments.After discharging,children in both groups were followed up till 5 years old according to the 0 ～3 years outline of intellectual development in children and education programs.Results Scores of intervention group were significantly higher than the control group in behavioral and general condition according to NBNA [ (9.32 ± 0.33) and (5.94 ± 0.83 ) for intervention group,(6.35 ± 1.35 ) and (4.39 ± 0.42) for the control group; t =9.573,3.590,respectively; P ＜ 0.0 1 ].In the month with completed neurological and psychological developments,children in control group showed significantly less raising head at the supine position,upright of head,turn over,conscious pronouncing and laughing,grabbing toys with fingers,sitting steady with free hands and crawling than those of the intervention group (t =3.29,4.27,3.62,2.98,4.62,4.52,4.51,respectively ;P ＜0.01 ).The CDCC scale monitoring of the two groups included development index (MDI) and physical development index (PDI).Intervention group had higher scores in both indexes than the control group[ (95.46 ± 12.35 ) and ( 98.87 ± 12.20) vs ( 79.12 ± 1 4.71 ) and ( 84.03 ± 1 3.37 ) ; t =5.761,6.832,respectively;P ＜ 0.01 ].Comparing two groups of the development of intelligent energy region and the total developmental quotient,the intervention group was significantly higher than the control group ( P ＜0.01 ).For retardation and the incidence of complications,the intervention group was significantly lower than the control group ( P ＜ 0.05 ).Conclusions Application of Shi Jie Yin with early comprehensive nursing intervention in the potential development of premature children,together with comprehensive system of rehabilitation functional training,adequate treatment and follow-up treatment could reduce the incidence of cerebral palsy and mental retardation and complications,promote the overall development potential of premature children,and improve the quality of survival of premature children and population quality. Key words: Medication treatment; Early nursing intervention; Premature children; Potential development