中文摘要

健保局施行健保制度目前逐年虧損，要使健保的永續經營，改善醫療服務是為最有效益的方法。台灣已邁入高齡化社會，相關退化性關節疾病亦趨普遍，使得骨科與復健科就診的病患日趨益增，尤其是需要負擔全身重量的大關節：髖與膝關節。骨科手術通常伴隨著長期的復健治療，除了少數的院內復健，還包括有門診治療與居家復健治療，病人離開醫院後回診狀況很難掌控，無論在時間上、經濟上、心理層面上，居家復健佔較大的優勢。所以讓病患出院回家後仍可以獲得完善的復健治療，是最主要的關鍵。居家復健治療除了醫師或復健師給予病人運動處方外，包含居家照護與疾病相關的背景知識及注意事項、協助病患日常活動的方法等等。利用髖關節置換術後復健為例，作為呈現復健運動處方系統的前導說明，具體定義復健運動處方分階目標與方向。藉由電子復健運動處方系統的建立，將復健運動處方內容的數位化，讓資料得以永久保存、方便傳遞、重複使用，依照病患病狀做不同處方的搭配；使用多媒體呈現處方內容，讓復健運動更為有趣，提升復健治療效益，間接改善醫療資源浪費的情況。

Abstract

Sufficient rehabilitation after the surgical operation is necessary to ensure the patients’ recovery and to reduce the cost of medical resource. Taiwan has becoming a highly develop society, the osteoarthritis disease are increasing by the elderly, especially the hip and the knee, in orthopedics and rehabilitation department clinics. A long period of treatment is needed including clinical therapy in hospital, outpatient service and home rehabilitation program. The home rehabilitation therapy program (HRTP) is the most important practice of all from either economical or psychological point of view. In a HRTP, the content comes from not only the doctor or the Physical Therapists’ exercise prescription but also the precautions about diseases, the way of that assist patients in activity of daily living. This study uses the case study for hip replacement rehabilitation as an example to make a description of rehabilitative prescription scheme, and to define phasing goal of rehabilitation exercise program concretely. By building up the electronic prescription scheme digitize the rehabilitation exercise program. The data can be kept forever, sent conveniently, recycled, and in accordance with different conditions decide treatment prescription. It is more interesting to display the treatment by multimedia, that increases the benefit of rehabilitation, and improve the situation of wasting medical resources indirectly.

目錄
中文摘要 I
英文摘要 II
第壹章 緒論
第一節、研究背景與動機…………………………………………………… 01
第二節、研究目的…………………………………………………………… 04
第三節、研究範圍…………………………………………………………… 04
第貳章 文獻探討
第一節、復健醫學現今在醫療體系所處的地位…………………………… 05
第二節、運動治療的重要性與處方設計原則……………………………… 08
第三節、居家運動處方存在的必要性……………………………………… 14
第四節、相關髖關節居家運動復健處方的研究…………………………… 16
第叁章 問題分析
第一節、使用者需求分析…………………………………………………… 32
第二節、復健治療流程分析………………………………………………… 35
第三節、數位式居家運動復健處方內容分析……………………………… 36
第四節、病患使用居家復健運動處方資料流程分析………………… 37
第肆章 系統規劃與設計
第一節、系統規劃…………………………………………………………… 38
第二節、系統功能設計……………………………………………………… 39
第三節、系統資料表結構…………………………………………………… 42
第四節、分階復健計劃設計………………………………………………… 47
第五節、人機介面設計……………………………………………………… 55
第六節、系統評估計劃……………………………………………………… 56
第伍章 結論與建議………………………………………………………… 58
參考文獻
英文部分……………………………………………………………………… 59
中文部分……………………………………………………………………… 64
網站部份……………………………………………………………………… 65
參考附錄
附錄一、Harris量表………………………………………………………… 66
附錄二、生活品質量表SF36………………………………………………… 68
附錄三、術後一週運動紀錄表-範例………………………………………… 72
附錄四、返家後運動紀錄表（第一週）-範例……………………………… 75
附錄五、病歷紀錄-範例……………………………………………………… 76
附錄六、物理治療評估表-範例……………………………………………… 77
附錄七、生活品質問卷-範例………………………………………………… 78
附錄八、髖關節情況評估表 ………………………………………………… 80
附錄九、髖關節置換術病人復健活動觀察資料表 ………………………… 82
附錄十、訓練部位或肌群 …………………………………………………… 83

表目錄
表一 返家後的文獻居家復健內容…………………………………………… 24
表二 復健措施文獻比較……………………………………………………… 28
表三 病歷資料表……………………………………………………………… 42
表四 處方資料表……………………………………………………………… 44
表五 居家復健運動動作資料內容複式動作分類選單規劃………………… 46
表六 髖關節分階復健處方…………………………………………………… 48
表七 髖關節復健運動資料內容……………………………………………… 50
表八 居家復健運動處方系統規劃評估表…………………………………… 56

圖目錄
圖一 文獻探討架構圖………………………………………………………… 05
圖二 復健治療流程圖………………………………………………………… 35
圖三 居家復健運動處方系統功能…………………………………………… 38
圖四 居家復健運動處方系統使用流程……………………………………… 39
圖五 病歷資料檔案管理……………………………………………………… 39
圖六 處方資料管理…………………………………………………………… 40
圖七 運動處方建立…………………………………………………………… 40
圖八 居家復健運動操作回饋………………………………………………… 41
圖九 復健處方系統操作介面流程圖………………………………………… 55

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網站部份
全民健保的成就與困境公民會議基礎資料http://tsd.social.ntu.edu.tw/NHIachievementandlimit.pdf
行政院主計處(民國93年6月25日)：衛生統計台灣地區平均年齡。行政院主計處 摘自：http://www.dghas.gov.tw/dghas03/bs8/world/i_socec3
行政院主計處(民國93年6月25日)：衛生統計-行政院主計處。
http://www.dghas.gov.tw/dghas03/bs7/report/91/title91.htm
行政院衛生署：(民國92年10月5日)衛生統計台灣地區事故傷害死亡-因素年齡分別 http://www.doh.gov.tw/statistic/data/衛統計年表/衛生指標/表34.xls