臺灣博碩士論文加值系統

一、研究背景
腦中風多年來是國人十大死因之一，腦中風所導致的功能限制問題包含肢體癱瘓、行動限制、吞嚥以及語言障礙等問題等，而在康復期間最常見的心理問題即憂鬱症狀，不但會影響到復健成效，嚴重者甚至會造成二次中風危及到生命。過去文獻指出，憂鬱症狀可能是影響腦中風後功能變化的重要因素，但仍有研究持不同的看法。然而目前關於急性期患者憂鬱症狀對功能變化影響的相關資訊並不充分。因此，能否在關鍵時間內察覺患者中風後的精神與心理狀態變化，了解其對功能改變的影響對於早期治療相當重要。
二、研究目的
本研究的主要目的為針對急性中風患者住院期間憂鬱症狀及功能的改變進行分析與觀察，探討憂鬱症狀程度與功能變化的相關性。
三、研究方法
本研究為探索性研究，從計畫主持人張鳳航(本研究之指導教授)於2015年著手進行的研究「急性後期照護評估：評估工具發展」中進行二手資料分析，本研究從母研究於2015年11月12日至2018年02月13日於北醫三院所招募之620位剛入院的成年急性神經疾病患者中，篩選出456位急性期腦中風住院患者，使用其入院復健第一週（前測）與出院復健前一週（後測）兩次之評量資料進行分析。
本研究共有289位急性中風患者(平均年齡59.9 ± 11.8；女性佔35.6%)完成入院復健第一週（前測）與出院復健前一週（後測）兩次評估，使用中文版AM-PAC™住院病人短式量表(功能評估類別包含基本移動、日常活動、應用認知)與憂鬱量表CES-D進行測量，並使用相關性分析及多元迴歸分析進行AM-PAC與CES-D分數變化之間的關係。使用SPSS 19.0統計軟體進行雙變項分析及多元迴歸分析。
四、研究結果
研究結果顯示AM-PAC的基本移動與日常活動與CES-D的變化有顯著相關(r= -0.143以及-0.150，p< 0.05)。但AM-PAC的應用認知與憂鬱量表無顯著關係。在調整人口學與臨床變項後，結果仍顯示AM-PAC的基本移動與日常生活活動與CES-D的變化有顯著相關。
五、結論
研究發現基本移動功能、日常活動功能與憂鬱症狀呈現附相關。而應用認知功能與憂鬱症狀的變化並無相關性。本研究的結果可為未來急性期中風復健進行介入治療提供相關訊息。

Background
Stroke has been one of the 10 major causes of death in Taiwan for many years. The functional limitations caused by stroke have problems such as physical paralysis, movement restrictions, swallowing, language barriers and so on. The most commonly observed psychological problems during the recovery of stroke are depressive symptoms, which may have a great impact on the effectiveness of rehabilitation. In the past, literature has pointed out that depressive symptoms may be an important factor affecting the functional changes after stroke, but there are still studies with different opinions. However, little is known about how depressive symptoms affect functional outcomes among stroke survivors at the acute stage.
Therefore, it is very important to detect the changes of mental and psychological state of patients after stroke within a critical time, and understand its impact on functional changes for early treatment.
Purposes
The purpose of this study was to describe the changes of depressive symptoms and functions during hospitalization in patients with acute stroke, and to examine the correlation between the changes of depressive symptoms and the changes of functional performance.
Methods
This study is exploratory study that analyze secondary data from the “Acute Care Assessment: Development of Assessment Tools” in the primary study. The researchers screened out 456 acute stroke hospitalized patients from 620 newly admitted adults with acute neurological disease enrolled in three hospitals from Taipei Medical University from November 12, 2015 to February 13, 2018. First week rehabilitation after admission (pre-test) and the last week rehabilitation before discharge (post-test), assessments were analyzed twice.
A total of 289 acute stroke patients (mean age: 59.9 ± 11.8; 35.6% female) completed baseline assessment on admission to acute rehabilitation and completed post-test assessment at discharge. The primary outcome measures included the Mandarin version Activity Measure for Post-acute Care (AM-PAC) "6 Clicks" (measuring three functional domains: basic mobility, daily activity, and applied cognition) and the Center for Epidemiological Studies Depression Scale (CES-D) (measuring depressive symptoms). Correlation analysis and multiple regression analysis were used to examine the associations between the change scores of the AM-PAC and the CES-D. SPSS 19.0 statistical software was used to perform bivariate analysis and multivariate regression analysis.
Results
The change of the CES-D score was significantly correlated with the change of the AM-PAC Basic mobility and Daily activity subscale scores (r = -0.143 and -0.150, p <0.05), but not correlated with the AM-PAC Applied cognition subscale score. After adjusting for demographic and clinical variables, the change of the CES-D score still demonstrated correlations with the change of the AM-PAC Basic mobility and Daily activity subscale scores.
Conclusions
Changes of depressive symptoms was found negatively correlated with changes of basic mobility and daily activity functions among patients with stroke in acute care settings. However, changes of depressive symptoms was not significantly associated with changes of applied cognition. Findings of this study may be used to inform the development of interventions for acute rehabilitation services.

目錄
第一章、緒論
第一節 研究起源 1
第二節 研究目的 2
第三節 研究假設 2
第四節 名詞解釋 2
第二章、文獻回顧
第一節 腦中風的分類、結果與復健 6
第二節 急性腦中風後功能之變化 10
第三節 影響腦中風患者功能變化的因素 14
第四節 腦中風後憂鬱的情況 22
第三章、研究重要性 25
第四章、研究方法
第一節 研究設計 26
第二節 研究架構 26
第三節 研究對象與樣本 28
第四節 研究程序 29
第五節 研究工具 31
第六節 研究操作型定義與變項 35
第七節 統計分析 36
第五章、研究結果
第一節 描述性統計結果 38
第二節 AM-PAC住院病人短式量表與憂鬱量表的相關性分析 42
第三節 AM-PAC住院病人短式量表與憂鬱量表的多元迴歸分析 49
第六章、討論
第一節 基本移動、日常生活活動與應用認知之功能變化 51
第二節 憂鬱症狀與功能變化的相關性 55
研究限制 58
第七章、結論與建議 60
參考資料 63
附錄一、IRB審查通過證明 85
附錄二、社會人口學問卷 87
附錄三、憂鬱量表 88

Abanto, C., et al. (2013). Predictors of Functional Outcome Among Stroke Patients in Lima, Peru. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 22(7), 1156-1162. doi:10.1016/j.jstrokecerebrovasdis.2012.11.021
Alan Jette, P., PhD, et al. (2015). AM-PAC Short Forms™ for Inpatient and Outpatient Settings Instruction Manual. AM-PAC Short Form Manual, 9(AM-PAC Inpatient Short Forms ‘6 Clicks’), 87.
Alghwiri, A. A. (2016). The Correlation between Depression, Balance, and Physical Functioning Post Stroke. J Stroke Cerebrovasc Dis, 25(2), 475-479. doi:10.1016/j.jstrokecerebrovasdis.2015.10.022
Amaricai, E., & Poenaru, D. V. (2016). The post-stroke depression and its impact on functioning in young and adult stroke patients of a rehabilitation unit. J Ment Health, 25(2), 137-141. doi:10.3109/09638237.2015.1022251
Angeleri, F., et al. (1993). The influence of depression, social activity, and family stress on functional outcome after stroke. Stroke, 24(10), 1478-1483.
Appelros, P., & Viitanen, M. (2004). Prevalence and predictors of depression at one year in a Swedish population-based cohort with first-ever stroke. J Stroke Cerebrovasc Dis, 13(2), 52-57. doi:10.1016/j.jstrokecerebrovasdis.2004.02.005
Arsic, S., et al. (2016). Correlation between demographic characteristics, cognitive functioning and functional independence in stroke patients. Srp Arh Celok Lek, 144(1-2), 31-37.
Association, A. P. (2013). Diagnostic and Statistical Manual of Mental Disorders DSM-5™. 5, 970.
Astrom, M., et al. (1993). Major depression in stroke patients. A 3-year longitudinal study. Stroke, 24(7), 976-982.
Berezuk, C., et al. (2017). Functional Reserve: Experience Participating in Instrumental Activities of Daily Living is Associated with Gender and Functional Independence in Mild Cognitive Impairment. J Alzheimers Dis, 58(2), 425-434. doi:10.3233/jad-161227
Bindawas, S. M., et al. (2017). Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia. Clinical Interventions in Aging, 12, 1791-1797. doi:10.2147/CIA.S145402
Bindawas, S. M., et al. (2018). Length of Stay and Functional Outcomes Among Patients with Stroke Discharged from an Inpatient Rehabilitation Facility in Saudi Arabia. Med Sci Monit, 24, 207-214.
Bode, R. K., et al. (2004). Relative importance of rehabilitation therapy characteristics on functional outcomes for persons with stroke. Stroke, 35(11), 2537-2542. doi:10.1161/01.STR.0000145200.02380.a3
Bots, M. L., et al. (1996). Prevalence of Stroke in the General Population The Rotterdam Study.
Cataldo, M. C., et al. (2012). Association of total serum cholesterol with functional outcome following home care rehabilitation in Italian patients with stroke. Disabil Health J, 5(2), 111-116. doi:10.1016/j.dhjo.2011.11.003
Chan, L., et al. (2013). Does postacute care site matter? A longitudinal study assessing functional recovery after a stroke. Arch Phys Med Rehabil, 94(4), 622-629. doi:10.1016/j.apmr.2012.09.033
Chang, F.-H., et al. (2017). Adaptation of the Activity Measure Post-Acute Care (AM-PAC) from English to Mandarin using the dual-panel translation approach. Disabil Rehabil, 1-6. doi:10.1080/09638288.2017.1339210
Chang, F. H., et al. (2018). Adaptation of the Activity Measure Post-Acute Care (AM-PAC) from English to Mandarin using the dual-panel translation approach. Disabil Rehabil, 40(21), 2571-2576. doi:10.1080/09638288.2017.1339210
Chang, F. H., et al. (2018). Cultural and semantic equivalence of the activity measure post-acute care (AM-PAC) after its translation into Mandarin Chinese. Disabil Rehabil, 1-6. doi:10.1080/09638288.2018.1453874
Chang, W. H., et al. (2015). Characteristics of Inpatient Care and Rehabilitation for Acute First-Ever Stroke Patients. Yonsei Medical Journal, 56(1), 262-270. doi:10.3349/ymj.2015.56.1.262
Chen, et al. (2007). Outcome of large hemispheric infarcts: an experience of 50 patients in Taiwan. Surg Neurol, 68 Suppl 1, S68-73; discussion S74. doi:10.1016/j.surneu.2007.07.086
Chen, C.-F., et al. (2017). A multiparameter model predicting in-hospital mortality in malignant cerebral infarction. Medicine, 96(28), e7443. doi:10.1097/MD.0000000000007443
Chen, C.-M., et al. (2015). Potential predictors for health-related quality of life in stroke patients undergoing inpatient rehabilitation. Health and Quality of Life Outcomes, 13, 118. doi:10.1186/s12955-015-0314-5
Chodosh, et al. (2010). Depressive Symptoms, Chronic Diseases, and Physical Disabilities as Predictors of Cognitive Functioning Trajectories in Older Americans. J Am Geriatr Soc, 58(12), 2350-2357. doi:10.1111/j.1532-5415.2010.03171.x
Colsch, R., & Lindseth, G. (2018). Unique Stroke Symptoms in Women: A Review. J Neurosci Nurs. doi:10.1097/jnn.0000000000000402
de Man-van Ginkel, J. M., et al. (2015). Clinical Manifestation of Depression after Stroke: Is It Different from Depression in Other Patient Populations? PLoS One, 10(12), e0144450. doi:10.1371/journal.pone.0144450
del Ser, T., et al. (2005). Evolution of cognitive impairment after stroke and risk factors for delayed progression. Stroke, 36(12), 2670-2675. doi:10.1161/01.str.0000189626.71033.35
Deutsch, A., et al. (2006). Poststroke rehabilitation: outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs. Stroke, 37(6), 1477-1482. doi:10.1161/01.STR.0000221172.99375.5a
Dong, L., et al. (2018). Ethnic Differences in Prevalence of Post-stroke Depression. Circ Cardiovasc Qual Outcomes, 11(2), e004222. doi:10.1161/circoutcomes.117.004222
Fang, Y., et al. (2017). Patient and Family Member Factors Influencing Outcomes of Poststroke Inpatient Rehabilitation. Arch Phys Med Rehabil, 98(2), 249-255.e242. doi:10.1016/j.apmr.2016.07.005
Feigenson, J. S., et al. (1977). Factors influencing outcome and length of stay in a stroke rehabilitation unit. Part 2. Comparison of 318 screened and 248 unscreened patients. Stroke, 8(6), 657-662.
Feigenson, J. S., et al. (1977). Factors influencing outcome and length of stay in a stroke rehabilitation unit. Part 1. Analysis of 248 unscreened patients--medical and functional prognostic indicators. Stroke, 8(6), 651-656.
Fleming, M. K., et al. (2014). Self-perceived utilization of the paretic arm in chronic stroke requires high upper limb functional ability. Arch Phys Med Rehabil, 95(5), 918-924. doi:10.1016/j.apmr.2014.01.009
Franck, J. A., et al. (2017). Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation. PLoS One, 12(6), e0179453. doi:10.1371/journal.pone.0179453
Fu, J., et al. (2017). Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients. Medicine, 96(42), e8080. doi:10.1097/MD.0000000000008080
Gainotti, G., et al. (2001). Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry, 71(2), 258-261.
Gallo, J. J., et al. (1997). Depression without sadness: functional outcomes of nondysphoric depression in later life. J Am Geriatr Soc, 45(5), 570-578.
Gandolfi, M., et al. (2017). Feasibility and safety of early lower limb robot-assisted training in sub-acute stroke patients: a pilot study. Eur J Phys Rehabil Med, 53(6), 870-882. doi:10.23736/s1973-9087.17.04468-9
Geelen, S. J. G., et al. (2018). Construct validity and inter-rater reliability of the Dutch activity measure for post-acute care "6-clicks" basic mobility form to assess the mobility of hospitalized patients. Disabil Rehabil, 1-7. doi:10.1080/09638288.2018.1471525
Geng, H.-H., et al. (2017). Early neurological deterioration during the acute phase as a predictor of long-term outcome after first-ever ischemic stroke. Medicine, 96(51), e9068. doi:10.1097/MD.0000000000009068
Guo, X. X., et al. (2018). Effectiveness of neuromuscular electrical stimulation for wrist rehabilitation after acute ischemic stroke. Medicine (Baltimore), 97(38), e12299. doi:10.1097/md.0000000000012299
Hörnsten, C., et al. (2016). The prevalence of stroke and depression and factors associated with depression in elderly people with and without stroke. BMC Geriatrics, 16, 174. doi:10.1186/s12877-016-0347-6
Hackett, M. L., & Anderson, C. S. (2005). Predictors of depression after stroke: a systematic review of observational studies. Stroke, 36(10), 2296-2301. doi:10.1161/01.STR.0000183622.75135.a4
Haley, S. M., et al. (2004). Short-form activity measure for post-acute care. Arch Phys Med Rehabil, 85(4), 649-660.
Harris, G. M., et al. (2017). Depression and functional status among African American stroke survivors in inpatient rehabilitation. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 26(1), 116-124. doi:10.1016/j.jstrokecerebrovasdis.2016.08.039
Hatem, S. M., et al. (2016). Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery. Front Hum Neurosci, 10, 442. doi:10.3389/fnhum.2016.00442
Hernandez, R., et al. (2018). The Association Between Depressive Symptoms and Cognitive Functioning in Older Hispanic/Latino Adults Enrolled in an Exercise Intervention: Results From the " inverted exclamation markCaminemos!" Study. J Aging Health, 30(6), 843-862. doi:10.1177/0898264317696776
Hong, I., et al. (2018). Equating activities of daily living outcome measures: the Functional Independence Measure and the Korean version of Modified Barthel Index. Disabil Rehabil, 40(2), 217-224. doi:10.1080/09638288.2016.1247468
Hou WH, C., HY, Chang, FH (2018). Validation of the Mandarin Version Activity Measure Post-Acute Care (AM-PAC) "6-Clicks" in Acute Rehabilitation Patients. . American Journal of Occupational Therapy, in press., 74(3).
Huang, H. C., et al. (2009). The impact of timing and dose of rehabilitation delivery on functional recovery of stroke patients. J Chin Med Assoc, 72(5), 257-264. doi:10.1016/s1726-4901(09)70066-8
Huang, Y. J., et al. (2018). Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients. Arch Phys Med Rehabil, 99(3), 529-533. doi:10.1016/j.apmr.2017.08.472
Hybels, C. F., et al. (2009). The complex relationship between depressive symptoms and functional limitations in community-dwelling older adults: the impact of subthreshold depression. Psychol Med, 39(10), 1677-1688. doi:10.1017/S0033291709005650
Inness, E. L., et al. (2014). Impaired reactive stepping among patients ready for discharge from inpatient stroke rehabilitation. Phys Ther, 94(12), 1755-1764. doi:10.2522/ptj.20130603
Jette, A., et al. (2015). AM-PAC Short Forms™ for Inpatient and Outpatient Settings Instruction Manual. 9, 87.
Jette, A. M., et al. (2012). Evaluation of patient and proxy responses on the activity measure for postacute care. Stroke, 43(3), 824-829. doi:10.1161/strokeaha.111.619643
Jette, D. U., et al. (2014). Validity of the AM-PAC "6-Clicks" inpatient daily activity and basic mobility short forms. Phys Ther, 94(3), 379-391. doi:10.2522/ptj.20130199
Joseph, C., & Rhoda, A. (2013). Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape. African Health Sciences, 13(3), 646-654. doi:10.4314/ahs.v13i3.18
Kalaria, R. N., et al. (2016). Stroke injury, cognitive impairment and vascular dementia(). Biochimica et Biophysica Acta, 1862(5), 915-925. doi:10.1016/j.bbadis.2016.01.015
Kapoor, A., et al. (2017). "Good Outcome" Isn''t Good Enough: Cognitive Impairment, Depressive Symptoms, and Social Restrictions in Physically Recovered Stroke Patients. Stroke, 48(6), 1688-1690. doi:10.1161/strokeaha.117.016728
Karaahmet, O. Z., et al. (2017). Poststroke depression: risk factors and potential effects on functional recovery. Int J Rehabil Res, 40(1), 71-75. doi:10.1097/mrr.0000000000000210
Khatri, P., et al. (2012). Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke. Stroke, 43(2), 560-562. doi:10.1161/strokeaha.110.593897
Kim, B. R., et al. (2017). Risk Factors and Functional Impact of Medical Complications in Stroke. Ann Rehabil Med, 41(5), 753-760. doi:10.5535/arm.2017.41.5.753
Kim, G. W., et al. (2018). Effects of newly developed compact robot-aided upper extremity training system (Neuro-X(R)) in patients with stroke: A pilot study. J Rehabil Med, 50(7), 607-612. doi:10.2340/16501977-2361
Kostanjsek, N. (2011). Use of The International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems. BMC Public Health, 11(Suppl 4), S3-S3. doi:10.1186/1471-2458-11-S4-S3
Kringle, E. A., et al. (2018). Clinical Predictors of Engagement in Inpatient Rehabilitation Among Stroke Survivors With Cognitive Deficits: An Exploratory Study. J Int Neuropsychol Soc, 24(6), 572-583. doi:10.1017/s1355617718000085
Kutlubaev, M. A., & Hackett, M. L. (2014). Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies. Int J Stroke, 9(8), 1026-1036. doi:10.1111/ijs.12356
Lai, C.-L., et al. (2017). Post-acute care for stroke – a retrospective cohort study in Taiwan. Patient preference and adherence, 11, 1309-1315. doi:10.2147/PPA.S136041
Langhammer, B., et al. (2017). Factors enhancing activities of daily living after stroke in specialized rehabilitation: an observational multicenter study within the Sunnaas International Network. Eur J Phys Rehabil Med, 53(5), 725-734. doi:10.23736/s1973-9087.17.04489-6
Langhammer, B., et al. (2018). Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study. Brain Behav, 8(8), e01055. doi:10.1002/brb3.1055
Langhorne, P., et al. (2009). Motor recovery after stroke: a systematic review. Lancet Neurol, 8(8), 741-754. doi:10.1016/s1474-4422(09)70150-4
Lee, K. B., et al. (2015). Six-month functional recovery of stroke patients: a multi-time-point study. International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation, 38(2), 173-180. doi:10.1097/MRR.0000000000000108
Lees, R., et al. (2012). Cognitive and mood assessment in stroke research: focused review of contemporary studies. Stroke, 43(6), 1678-1680. doi:10.1161/strokeaha.112.653303
Lisabeth, L. D., et al. (2015). Factors Influencing Sex Differences in Post-stroke Functional Outcome. Stroke; a journal of cerebral circulation, 46(3), 860-863. doi:10.1161/STROKEAHA.114.007985
Liu, K. P., & Chan, C. C. (2014). Pilot randomized controlled trial of self-regulation in promoting function in acute poststroke patients. Arch Phys Med Rehabil, 95(7), 1262-1267. doi:10.1016/j.apmr.2014.03.018
Lopez-Espuela, F., et al. (2016). Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study. Am J Crit Care, 25(2), 144-151. doi:10.4037/ajcc2016215
Loubinoux, I., et al. (2012). Post-stroke depression: mechanisms, translation and therapy. Journal of Cellular and Molecular Medicine, 16(9), 1961-1969. doi:10.1111/j.1582-4934.2012.01555.x
Loubinoux, I., et al. (2012). Post-stroke depression: mechanisms, translation and therapy. J Cell Mol Med, 16(9), 1961-1969. doi:10.1111/j.1582-4934.2012.01555.x
MacIntosh, B. J., et al. (2017). Post-stroke Fatigue and Depressive Symptoms Are Differentially Related to Mobility and Cognitive Performance. Front Aging Neurosci, 9, 343. doi:10.3389/fnagi.2017.00343
MacIntosh, B. J., et al. (2017). Post-stroke Fatigue and Depressive Symptoms Are Differentially Related to Mobility and Cognitive Performance. Front Aging Neurosci, 9, 343. doi:10.3389/fnagi.2017.00343
Mahdi, S., et al. (2017). An international qualitative study of functioning in autism spectrum disorder using the World Health Organization international classification of functioning, disability and health framework. Autism Res. doi:10.1002/aur.1905
Mao, Y. R., et al. (2015). The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke. Biomed Res Int, 2015, 175719. doi:10.1155/2015/175719
Mayo, N. E., et al. (2002). Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil, 83(8), 1035-1042.
Mazure, C. M., et al. (2014). Gender and stress in predicting depressive symptoms following stroke. Cerebrovasc Dis, 38(4), 240-246. doi:10.1159/000365838
Mellon, L., et al. (2015). Cognitive impairment six months after ischaemic stroke: a profile from the ASPIRE-S study. BMC Neurology, 15, 31. doi:10.1186/s12883-015-0288-2
Memis, D., et al. (2016). Assessment of demographic and clinical characteristics on functional status and disability of patients with stroke. Neurosciences (Riyadh), 21(4), 352-357. doi:10.17712/nsj.2016.4.20160212
Mijajlovic, M. D., et al. (2017). Post-stroke dementia - a comprehensive review. BMC Med, 15(1), 11. doi:10.1186/s12916-017-0779-7
Miller, E. L., et al. (2010). Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke, 41(10), 2402-2448. doi:10.1161/STR.0b013e3181e7512b
Mirkowski, M., et al. (2018). Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation. Disabil Rehabil, 40(4), 457-461. doi:10.1080/09638288.2016.1260652
Mutai, H., et al. (2018). Functional outcomes of inpatient rehabilitation in very elderly patients with stroke: differences across three age groups. Top Stroke Rehabil, 25(4), 269-275. doi:10.1080/10749357.2018.1437936
Ng, Y. S., et al. (2016). Predictors of Acute, Rehabilitation and Total Length of Stay in Acute Stroke: A Prospective Cohort Study. Ann Acad Med Singapore, 45(9), 394-403.
Oh, H., et al. (2018). A 2-year prospective follow-up study of temporal changes associated with post-stroke cognitive impairment. Int J Nurs Pract, 24(2), e12618. doi:10.1111/ijn.12618
Ong, C.-T., et al. (2017). Sex-related differences in the risk factors for in-hospital mortality and outcomes of ischemic stroke patients in rural areas of Taiwan. PLoS One, 12(9), e0185361. doi:10.1371/journal.pone.0185361
Organization, W. H. (2001). International classification of functioning, disability and health : ICF., 303.
---. (2017). World health organization the top 10 causes of death.
Ostir, G. V., et al. (2008). Positive emotion following a stroke. J Rehabil Med, 40(6), 477-481. doi:10.2340/16501977-0193
Ouyang, F., et al. (2018). Association between socioeconomic status and post-stroke functional outcome in deprived rural southern China: a population-based study. BMC Neurol, 18(1), 12. doi:10.1186/s12883-018-1017-4
Pappadis, M. R., et al. (2018). Lived experiences of chronic cognitive and mood symptoms among community-dwelling adults following stroke: a mixed-methods analysis. Aging Ment Health, 1-7. doi:10.1080/13607863.2018.1481927
Pedrelli, P., et al. (2010). Relationship between residual symptoms of depression and self-reported cognitive impairment. CNS Spectr, 15(1), 46-51.
Pendlebury, S. T., & Rothwell, P. M. (2009). Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol, 8(11), 1006-1018. doi:10.1016/s1474-4422(09)70236-4
Phan, H. T., et al. (2018). Factors contributing to sex differences in functional outcomes and participation after stroke. Neurology, 90(22), e1945-e1953. doi:10.1212/wnl.0000000000005602
Radloff, L. S. (1977). The CES-D Scale:A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3), 385-401. doi:10.1177/014662167700100306
Reeves, M. J., et al. (2008). Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet neurology, 7(10), 915-926. doi:10.1016/S1474-4422(08)70193-5
Renoux, C., et al. (2017). Confounding by Pre-Morbid Functional Status in Studies of Apparent Sex Differences in Severity and Outcome of Stroke. Stroke, 48(10), 2731-2738. doi:10.1161/strokeaha.117.018187
Rippon, I., & Steptoe, A. (2018). Is the relationship between subjective age, depressive symptoms and activities of daily living bidirectional? Soc Sci Med, 214, 41-48. doi:10.1016/j.socscimed.2018.08.013
Robinson, R. G., & Spalletta, G. (2010). Poststroke depression: a review. Can J Psychiatry, 55(6), 341-349. doi:10.1177/070674371005500602
Roy-O''Reilly, M., & McCullough, L. D. (2018). Age and Sex Are Critical Factors in Ischemic Stroke Pathology. Endocrinology, 159(8), 3120-3131. doi:10.1210/en.2018-00465
Salinas, J., et al. (2017). Factors Associated With New‐Onset Depression Following Ischemic Stroke: The Women''s Health Initiative. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(2), e003828. doi:10.1161/JAHA.116.003828
Sandel, M. E., et al. (2013). Designing and implementing a system for tracking functional status after stroke: a feasibility study. Pm r, 5(6), 481-490; quiz 490. doi:10.1016/j.pmrj.2012.09.579
Satink, T., et al. (2018). The perspectives of spouses of stroke survivors on self-management - a focus group study. Disabil Rehabil, 40(2), 176-184. doi:10.1080/09638288.2016.1247920
Saxena, S. K., et al. (2008). Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation. Acta Neurol Scand, 117(2), 133-140. doi:10.1111/j.1600-0404.2007.00922.x
Schepers, V., et al. (2009). Prediction of depressive symptoms up to three years post-stroke. J Rehabil Med, 41(11), 930-935. doi:10.2340/16501977-0446
Schuster-Amft, C., et al. (2018). Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial. PLoS One, 13(10), e0204455. doi:10.1371/journal.pone.0204455
Scrutinio, D., et al. (2015). Functional Gain After Inpatient Stroke Rehabilitation: Correlates and Impact on Long-Term Survival. Stroke, 46(10), 2976-2980. doi:10.1161/strokeaha.115.010440
Seale, G. S., et al. (2010). Change in positive emotion and recovery of functional status following stroke. Rehabil Psychol, 55(1), 33-39. doi:10.1037/a0018744
Sharrief, A. Z., et al. (2017). The Impact of Pre-Stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke. J Stroke Cerebrovasc Dis, 26(11), 2686-2691. doi:10.1016/j.jstrokecerebrovasdis.2017.06.039
Shinar, D., et al. (1986). Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale. Stroke, 17(2), 241-245.
Singam, A., et al. (2015). Participation in Complex and Social Everyday Activities Six Years after Stroke: Predictors for Return to Pre-Stroke Level. PLoS One, 10(12), e0144344. doi:10.1371/journal.pone.0144344
Song, T., et al. (2017). Is there a correlation between socioeconomic disparity and functional outcome after acute ischemic stroke? PLoS One, 12(7), e0181196. doi:10.1371/journal.pone.0181196
Subramanian, S. K., et al. (2015). Depressive symptoms influence use of feedback for motor learning and recovery in chronic stroke. Restor Neurol Neurosci, 33(5), 727-740. doi:10.3233/rnn-150508
Sun, J.-H., et al. (2014). Post-stroke cognitive impairment: epidemiology, mechanisms and management. Annals of Translational Medicine, 2(8), 80. doi:10.3978/j.issn.2305-5839.2014.08.05
Svestkova, O., et al. (2016). Application of International Classification of Functioning, Disability and Health (ICF), Functional Health and Disability. Cent Eur J Public Health, 24(1), 83-85. doi:10.21101/cejph.a4140
Tang, E. Y., et al. (2018). Longitudinal Effect of Stroke on Cognition: A Systematic Review. J Am Heart Assoc, 7(2). doi:10.1161/jaha.117.006443
Tang, W. K., et al. (2015). Apathy and suicide-related ideation 3 months after stroke: a cross-sectional study. BMC Neurology, 15, 60. doi:10.1186/s12883-015-0323-3
Taveggia, G., et al. (2016). Efficacy of robot-assisted rehabilitation for the functional recovery of the upper limb in post-stroke patients: a randomized controlled study. Eur J Phys Rehabil Med, 52(6), 767-773.
Toglia, J., et al. (2017). Association Between 2 Measures of Cognitive Instrumental Activities of Daily Living and Their Relation to the Montreal Cognitive Assessment in Persons With Stroke. Arch Phys Med Rehabil, 98(11), 2280-2287. doi:10.1016/j.apmr.2017.04.007
Tse, T., et al. (2017). Reduction in retained activity participation is associated with depressive symptoms 3 months after mild stroke: An observational cohort study. J Rehabil Med, 49(2), 120-127. doi:10.2340/16501977-2184
Tyson, S., et al. (2015). Phase II Pragmatic Randomized Controlled Trial of Patient-Led Therapies (Mirror Therapy and Lower-Limb Exercises) During Inpatient Stroke Rehabilitation. Neurorehabil Neural Repair, 29(9), 818-826. doi:10.1177/1545968314565513
Tyson, S. F., et al. (2016). The effect of a structured programme to increase patient activity during inpatient stroke rehabilitation: a Phase I cohort study. Clin Rehabil, 30(2), 191-198. doi:10.1177/0269215515575335
van de Port, I. G., et al. (2006). Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study. Stroke, 37(1), 167-171. doi:10.1161/01.STR.0000195180.69904.f2
Verbrugge, L. M., & Jette, A. M. (1994). The disablement process. Soc Sci Med, 38(1), 1-14.
Vojtikiv-Samoilovska, D., & Arsovska, A. (2018). Prevalence and Predictors of Depression after Stroke - Results from a Prospective Study. Open Access Maced J Med Sci, 6(5), 824-828. doi:10.3889/oamjms.2018.182
Vulser, H., et al. (2018). Depression, Cognitive Functions, and Impaired Functioning in Middle-Aged Adults From the CONSTANCES Cohort. J Clin Psychiatry, 79(6). doi:10.4088/JCP.17m12003
Wang, Q., et al. (2018). Stroke Patients'' Acceptance of a Smart Garment for Supporting Upper Extremity Rehabilitation. IEEE J Transl Eng Health Med, 6, 2101009. doi:10.1109/jtehm.2018.2853549
Wang, S., et al. (2018). The Association Between Post-stroke Depression, Aphasia, and Physical Independence in Stroke Patients at 3-Month Follow-Up. Front Psychiatry, 9, 374. doi:10.3389/fpsyt.2018.00374
Wei, T.-S., et al. (2017). Gait asymmetry, ankle spasticity, and depression as independent predictors of falls in ambulatory stroke patients. PLoS One, 12(5), e0177136. doi:10.1371/journal.pone.0177136
West, T., & Bernhardt, J. (2012). Physical activity in hospitalised stroke patients. Stroke Res Treat, 2012, 813765. doi:10.1155/2012/813765
Willers, C., et al. (2018). Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study. Biol Sex Differ, 9(1), 11. doi:10.1186/s13293-018-0170-1
Wondergem, R., et al. (2017). The Course of Activities in Daily Living: Who Is at Risk for Decline after First Ever Stroke? Cerebrovasc Dis, 43(1-2), 1-8. doi:10.1159/000451034
Wong, J. S., et al. (2016). The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation. J Stroke Cerebrovasc Dis, 25(7), 1613-1621. doi:10.1016/j.jstrokecerebrovasdis.2016.03.017
Wong, R., et al. (2013). Progesterone and cerebral ischaemia: the relevance of ageing. J Neuroendocrinol, 25(11), 1088-1094. doi:10.1111/jne.12042
Wright, Z. E., et al. (2017). Genetic and environmental influences on Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) maladaptive personality traits and their connections with normative personality traits. J Abnorm Psychol, 126(4), 416-428. doi:10.1037/abn0000260
Yang, S. Y., & Kong, K. H. (2013). Level and predictors of participation in patients with stroke undergoing inpatient rehabilitation. Singapore Med J, 54(10), 564-568.
Yang, Y., et al. (2016). The Disability Rate of 5-Year Post-Stroke and Its Correlation Factors: A National Survey in China. PLoS One, 11(11), e0165341. doi:10.1371/journal.pone.0165341
Yelnik, A. P., et al. (2017). AMOBES (Active Mobility Very Early After Stroke): A Randomized Controlled Trial. Stroke, 48(2), 400-405. doi:10.1161/strokeaha.116.014803
Yetisgin, A. (2017). Clinical characteristics affecting motor recovery and ambulation in stroke patients. J Phys Ther Sci, 29(2), 216-220. doi:10.1589/jpts.29.216
Young, M. E., et al. (2014). A comprehensive assessment of family caregivers of stroke survivors during inpatient rehabilitation. Disabil Rehabil, 36(22), 1892-1902. doi:10.3109/09638288.2014.881565
Zahodne, L. B., et al. (2017). Comparing variability, severity, and persistence of depressive symptoms as predictors of future stroke risk. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 25(2), 120-128. doi:10.1016/j.jagp.2016.10.009
Zhang, H., et al. (2018). The effect of age, sex and strains on the performance and outcome in animal models of stroke. Neurochem Int. doi:10.1016/j.neuint.2018.10.005
余民寧, et al. (2011). 「台灣憂鬱症量表」心理計量特質分析報告. [The Development and Psychometric Study of Taiwan Depression Scale]. 測驗學刊, 58(3), 479-500. doi:10.7108/pt.201109.0479
余麗樺, et al. (2001). 認知教育對腦中風患者身體功能及疾病知識影響之縱貫性研究. [The Effects of Cognitive Intervention on the Physical Function and Stroke Knowledge of Stroke Patients: A Longitudinal Study]. 榮總護理, 18(1), 38-52. doi:10.6142/vghn.18.1.38
吳心怡. (2017). 臺灣腦中風急性後期照護品質之復健治療照護效益分析. [Assessment on the Stroke Rehabilitation Benefit of the Post-acute Care in Taiwan]. 物理治療, 42(4), 352-352. doi:10.6215/fjpt.2017.74.p20
冼鴻曦, et al. (2015). 有效提升中風患者的日常生活功能－急性後期照護之成效分析. [Post-acute Care Improves Daily Activity Functions of Stroke Patients: An Effectiveness Analysis]. 台灣老年醫學暨老年學雜誌, 10(3), 159-171.
胡名霞, et al. (2006). 腦中風患者復健治療時程與出院及長期功能結果之關聯性. [Correlation between Duration of Rehabilitation and Functional Outcome at Discharge and at Follow-up in Stroke Patients]. 台灣醫學, 10(2), 248-255. doi:10.6320/fjm.2006.10(2).14
張仁和, et al. (2011). 中文版「止觀覺察注意量表」之信效度分析. [Psychometric Properties of the Chinese Translation of Mindful Attention Awareness Scale (CMAAS)]. 測驗學刊, 58, 235-260. doi:10.7108/pt.201104.0090
張育儒, 胡., 姜義彬, 莊曜嘉, 郭芷霖. (2014). 缺血性腦中風病人住院期間所接受的復健治療量與殘障和死亡風險之關係. [Association between the Amount of Inpatient Rehabilitation Therapy and the Risk of Disability and Mortality in Patients with Ischemic Stroke]. 台灣復健醫學雜誌, 42(4), 191-198. doi:10.6315/2014.42(4)02
張虹雯, & 陳金燕. (2010). 憂鬱情緒當事人之求助歷程及影響因子研究. [Help-Seeking Process and Influential Factors among Clients with Depressed Mood]. 中華輔導與諮商學報(27), 1-38.
曹汶龍. (2006). 缺血性腦中風的症狀與診斷. 慈濟醫學雜誌, 18(5_S), 1-3. doi:10.6440/tzucmj.200610.0001
陳建甫, 藍., 許錦田, 賴秋蓮, 戴志達. (2005). Cognitive Dysfunction after Acute Lacunar Infarct. [急性陷窩型腦梗塞的認知功能障礙]. The Kaohsiung Journal of Medical Sciences, 21(6), 267-271.
廖麗君, et al. (1999). 缺血性腦中風患者功能預後之影響因素. [Factors Influencing Functional Outcomes in Ischemic Stroke Patients]. 中華民國物理治療學會雜誌, 24(6), 408-419.
衛生福利部統計處. (2018). 衛生福利部十大死因統計.
鄭建興. (2003). 認識腦中風. 健康世界(214), 49-52. doi:10.6454/hw.200310.0049
韓德生, et al. (2016). 臺灣腦中風復健治療指引. [Taiwan Guideline for Stroke Rehabilitation]. 台灣復健醫學雜誌, 44(1), 1-9. doi:10.6315/2016.44(1)01