(3.238.99.243) 您好!臺灣時間:2021/05/16 23:06
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:張慧慈
研究生(外文):Hui Tzu Chang
論文名稱:腦中風患者肩關節損傷對生活品質之衝擊
論文名稱(外文):Impact of Shoulder Impairments on Quality of Life after Stroke
指導教授:連恒裕
指導教授(外文):H. Y. Lien
學位類別:碩士
校院名稱:長庚大學
系所名稱:復健科學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
論文頁數:154
中文關鍵詞:腦中風生活品質肩關節損傷
外文關鍵詞:strokequality of lifeshoulderphysical impairments
相關次數:
  • 被引用被引用:1
  • 點閱點閱:480
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:3
慢性期之腦中風是導致成年人失能最主要的疾病,而中風衍生出的生理損傷及長期失能可能降低中風病患的生活品質。腦中風患者的肩關節問題常為臨床治療人員所重視,肩關節損傷不僅可能影響腦中風病人上肢的恢復,也會造成上肢日常生活活動的困難。由文獻中統整歸納出腦中風病患的肩關節損傷包含肩關節疼痛、肩關節半脫位、交感神經失養症、感覺機能缺損、肩關節肌肉無力、動作控制能力缺損、肩關節活動角度限制與痙攣等問題,其中肩關節疼痛會使中風存活者生活品質降低之效益已被初步證實。然而,整體肩關節損傷對於中風病患生活品質的影響以及與生活品質中各面向關係卻尚未被充分探討,因此,本研究著重於:(1)探討腦中風患者各種肩關節損傷之發生率(2)分析其與生活品質之間的相關性。(3)評估肩關節損傷對中風患者生活品質所造成之衝擊程度。研究方法:本實驗設計採橫斷面的相關性研究設計。在台灣北部醫院門診病患或中風病患支持團體中徵召慢性期之中風患者參與本實驗。中風病人的肩關節損傷以臨床評估工具測量,包括肩關節疼痛、肩半脫位評估、交感神經失養症、肩動作控制能力測試、肩感覺功能測試、肩關節活動角度測量、肩肌力測試及肌肉痙攣評估,而中風病人的生活品質由台灣版中風病人生活品質問卷(Stroke Specific Quality of Life Scale Taiwan Version, SSQOLTV)量測。結果:60位接受調查之腦中風病患,平均年齡為58.5±12.5歲,發病時間為半年至20年。在發生率以及相關分析中與中風患者整體生活品質達中度相關性的肩關節損傷類型分別為感覺功能(rs = .49, p<.05,發生率為61.7%)、肩關節疼痛(r = -.42, p<.05,發生率為43.3%)、肌力(r = .48, p<.05)、動作控制能力(r = .32, p<.05)及缺損發生率為76.7%,而活動角度受限之發生率最高卻未達顯著相關。在複迴歸分析中,肩關節感覺功能、肌力及疼痛等三個損傷類型為對整體生活品質影響最大(adjusted R2 = .38, F3,56 = 12.79, p<.001)。而感覺功能與肌力也是能有效影響生理面向之生活品質的肩關節損傷(adjusted R2 = .38, F2,57 = 19.15, p<.001)。能有效預測心理面向之生活品質的因子則為疼痛與肌力(adjusted R2 = .19, F2,57 = 8.0, p<.01)。結論:過去文獻已知肩關節疼痛可影響生活品質,而本研究卻也指出感覺功能與肩關節周邊肌力對中風患者的生活品質的影響更為明顯。臨床意義:本研究結果提供中風後各種肩關節損傷對其生活品質影響之資訊,在處理中風病患肩關節問題應特別著重於重建肩關節感覺功能與肌力,並降低肩關節疼痛的影響。
Background: Stroke is a major cause of morbidity in the adult population. Residual physical impairments and long-term disabilities following stroke usually lead to poor Quality of Life (QoL) of stroke survivors. Among abundant physical impairments associated with stroke, shoulder problems, have been identified as major burden of stroke which impede not only the functional recovery of upper extremity (U/E) but also the usage of U/E in daily activities. Efforts have been made to study the impacts of individual shoulder problems, especially shoulder pain, on rehabilitation outcomes of stroke survivors. However, the relationships and contributions of various shoulder problems on the QoL have not been fully explored. Therefore, the purposes of this study were: (1) To investigate the occurrence and severity of shoulder impairments in stroke patients. (2) To analyze the correlation between shoulder impairments and QoL (3) To examine the impact of shoulder impairments on QoL after stroke. Methods: This study adapt cross-sectional, correlational design scheme. Stroke survivors at their chronic stage were convenient sampled from out-patient department of hospital around northern Taiwan. Shoulder impairments were examined by clinical measures while the QoL of stroke survivors were measured by Stroke-Specific Quality of Life Taiwan Version. Results: Sixty stroke survivors enrolled in the study. Among 8 shoulder impairments, sensory function (rs = .49, p<.05), muscle strength (r = .48, p<.05), shoulder pain (r = -.42, p<.05) and motor control (r = .32, p<.05) correlated moderately to QoL. The stepwise regression analysis revealed that sensory function, muscle strength and shoulder pain (adjusted R2 = .38, F3,56 = 12.79, p<.001) were valid predictors of QoL. Sensations and muscle strength (adjusted R2 = .38, F2,57 = 19.15, p<.001) both hold predictive value on physical components of QoL while shoulder pain and muscle strength around shoulder affect mental components of QoL (adjusted R2 = .19, F2,57 = 8.0, p<.01). Discussion and Conclusions: The results support previous findings that shoulder pain have a significant impact on QoL. However, sensory function and muscle strength around stroke shoulder played over more important role on QoL after stroke. The findings may be partially explained by significant correlations between the impairments and the majority of physical subdomains of QoL measures. Clinical relevance: 1) To provide important information regarding the occurrences and severity of physical impairments around shoulder after stroke. 2) Clinicians should focus on restoring the sensory function and muscle strength around stroke shoulder and reducing shoulder pain to control their impact on QoL in stroke population.
目 錄
第一章 前言……………………………………………………… 1
1.1 研究背景與動機………………………………………….. 1
1.2 名詞解釋………………………………………………….. 6
1.3 研究問題………………………………………………….. 9
1.4 定義研究問題…………………………………………….. 10
第二章 文獻回顧………………………………………………… 12
2.1中風病患的肩關節問題………………………………....... 13
2.1.1 原發性肩關節損傷………………………………… 13
2.1.2 次發性肩關節損傷………………………………… 14
2.1.3 肌肉無力…………………………………………… 15
2.1.4 動作控制能力缺損………………………………… 17
2.1.5 痙攣………………………………………………… 19
2.1.6 感覺功能缺損……………………………………… 21
2.1.7 肩關節疼痛………………………………………… 24
2.1.8 肩關節半脫位……………………………………… 27
2.1.9 肩關節活動度限制………………………………… 30
2.1.10 交感神經失養症………………………………….. 33
2.2 肩關節損傷與中風病患之生活品質…………………….. 36
2.2.1中風病患生活品質概況與影響因子分析…………. 36
2.2.2 上肢功能與中風病患之生活品質………………… 40
2.2.3 中風病患生活品質之量測………………………… 42
2.2.3.1 世界衛生組織生活品質問卷…………… 42
2.2.3.2 簡短36健康量表……………………….. 44
2.2.3.3 中風衝擊量表…………………………… 45
2.2.3.4 中風病人生活品質問卷………………… 46
第三章 研究方法………………………………………………… 50
3.1 受試者取樣……………………………………………….. 50
3.2 測量工具………………………………………………….. 51
3.3 研究步驟………………………………………………….. 57
3.4 資料處理與分析………………………………………….. 58
第四章 結果……………………………………………………… 65
4.1 受測者基本資料………………………………………….. 65
4.2 中風患者之肩關節損傷綜合調查……………………….. 65
4.3 肩關節損傷與生活品質之相關程度…………………….. 67
4.4肩關節損傷類型與不同面向中各層次生活品質的相關
性………………………………………………………….. 69
4.5 肩關節損傷對生活品質之衝擊………………………….. 71
第五章 討論……………………………………………………… 83
5.1 中風患者之基本資料…………………………………….. 83
5.2 中風患者的各種肩關節損傷發生率概況……………….. 86
5.2.1 原發性肩關節損傷類型之發生率………………… 86
5.2.2 次發性肩關節損傷類型之發生率………………… 88
5.3 肩關節損傷類型與生活品質之間的相關性…………….. 90
5.3.1 肩關節損傷類型與整體生活品質間相關性……… 90
5.3.2 肩關節損傷類型與生活品質之生理面向間之相關
性…………………………………………………… 91
5.3.3 肩關節損傷類型與生活品質之心理面向間之相關
性…………………………………………………… 94
5.4 肩關節損傷類型對中風病患生活品質之衝擊………….. 96
5.4.1 肩關節損傷對中風病患整體生活品質之衝擊…… 96
5.4.2 肩關節損傷對中風病患生活品質中生理面向之衝
擊…………………………………………………… 99
5.4.3 肩關節損傷對中風病患生活品質中心理面向之衝
擊…………………………………………………… 100
5.5 肩關節疼痛對肩關節損傷情形及生活品質間之關係….. 102
5.6 臨床意義………………………………………………….. 104
5.7 研究限制………………………………………………….. 105
5.8 未來方向………………………………………………….. 106
第六章 結論……………………………………………………… 107
英文參考文獻……………………………………………………….. 110
中文參考文獻……………………………………………………….. 116
附錄一 Ritchie Articular index…………………………………....... 117
附錄二 量表面向架構圖…………………………………………… 118
附錄三 人體試驗倫理委員會同意證明書………………………… 119
附錄四 受試者同意書……………………………………………… 120
附錄五 傅格梅爾評估量表………………………………………… 122
附錄六 感覺測試量表……………………………………………… 123
附錄七 肌力測量表………………………………………………… 124
附錄八 單一施測者之重複測試信度……………………………… 125
附錄九 受試者基本資料表………………………………………… 128
附錄十 功能步行分級……………………………………………… 130
附錄十一 台灣版中風病人生活品質問卷………………………… 131
附錄十二 發病次數在肩關節損傷與生活品質之比較分析……… 135
附錄十三 發病時間長短在肩關節損傷與生活品質之比較分析… 136
附錄十四 偏癱側是否為慣用手在肩關節損傷與生活品質之比較
分析……………………………………………………… 137
附錄十五 各種肩關節損傷類型之間的相關性…………………… 138
附錄十六 有無肩關節感覺功能缺損在肩關節損傷與生活品質之
比較分析………………………………………………… 139
附錄十七 有無肩關節半脫位在肩關節損傷與生活品質之比較分
析………………………………………………………… 140
附錄十八 有無肩關節疼痛在肩關節損傷與生活品質之比較分析 141

表目錄
表 2-1 交感神經失養症的診斷……………………………………. 49
表 3-1 數據資料處理………………………………………………. 62
表 3-2 數據資料分析………………………………………………. 63
表 3-3 複迴歸分析資料處理………………………………………. 64
表 4-1 受測者基本資料……………………………………………. 74
表 4-2-1 中風患者肩關節損傷類型之發生率概況分析…………. 75
表 4-2-2 中風患者各種肩關節損傷類型之分類或嚴重程度分析. 76
表 4-3 肩關節損傷類型與生活品質相關表………………………. 77
表 4-4-1 肩關節損傷類型與生活品質中生理面向各層次之相關
性…………………………………………………………. 78
表 4-4-2 肩關節損傷類型與生活品質中心理面向各層次之相關
性…………………………………………………………. 79
表 4-5-1 肩節損傷於中風患者整體生活品質之逐步複迴歸分析
結果………………………………………………………. 80
表 4-5-2 肩節損傷於中風患者生活品質中生理面向之逐步複迴
歸分析結果………………………………………………. 81
表 4-5-3 肩節損傷於中風患者生活品質中心理面向之逐步複迴
歸分析結果………………………………………………. 82
英文參考文獻
1. Andrews AW, Bohannon RW. Decreased shoulder range of motion on paretic side after stroke. Phys Ther 1989;69:768-772.
2. American Heart Association : http://www.americanheart.org/presenter.jhtml?identifier=1200000
3. Andrews AW, Bohannon RW. Short-term recovery of limb muscle strength after acute stroke. Arch Phys Med Rehabil 2003;84:125-130.
4. Andrews AW, Bohannon RW. Discharge function and length of stay for patients with stroke are predicted by lower extremity strength on admission to rehabilitation. Neurorehabil Neural Repair 2001;15:83-87.
5. Andrews AW, Bohannon RW. Distribution of muscle strength impairments following stroke. Clin Rehabil 2000;14:79-87.
6. Aprile I, Piazzini DB, Bertolini C, Caliandro P, Pazzaglia C, Tonali P, Padua L. Predictive variables on disability and quality of life in stroke outpatients undergoing rehabilitation. Neurol Sci 2006;27:40-46.
7. Aras MD, Gokkaya NKO, Comert D, Kaya A, Cakci A. Shoulder pain in hemiplegia: Results from a national rehabilitation hospital in Turkey. Am J Phys Med Rehabil 2004;83:713–719.
8. Altug Z, Hoffman JL, Martin JL. Manual of clinical exercise testing, prescription, and rehabilitation. Norwalk, Conn.:Appletopn & Lange 1993
9. Andersen G, Vestergaard K, et al. Incidence of post-stroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale. Acta Psychiatry Scand 1994;90:190-195.
10. Bender L, McKenna K. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil 2001;23:698-705.
11. Boyd EA, Torrance GM. Clinical measures of shoulder subluxation: their reliability. Can J Public Health 1992;83:24–28.
12. Bohannon RW, LeFort A. Hemiplegic shoulder pain measured with the Ritchie Articular Index. Int J Rehabil Res 1986;9:379-381.
13. Bohannon RW& Andrews AW. Shoulder subluxation and pain in stroke patients. Am J Occup Ther 1990;44:507-509.
14. Boone DC, Azen SP, Lin C-M, Spence C, Baron C, Lee L. Reliability of goniometric measurements. Phys Ther 1978;58:1355-1360
15. Broeks JG., Lankhorst G.J, Rumping K, Prevo AJH. The long-term outcome of arm function after stroke: results of a follow-up. Disabil Rehabil 1999;21:357-364.
16. Bogousslavsky J, Van Melle G , F Regli. The Lausanne Stroke Registry: Analysis of 1,000 consecutive patients with first stroke. Stroke 1988;19:1083-1092
17. Carey LM. Somatosensory loss after stroke. Crit Rev Phys Rehabil Med 1995;7: 51-91.
18. Connell, Louise Anne. Sensory Impairment and recovery After Stroke. PhD thesis, University of Nottingham 2007;84-244
19. Chae J, Mascarenhas D, Yu DT, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Fang Z-P .Poststroke Shoulder Pain: Its Relationship to Motor Impairment, Activity Limitation, and Quality of Life. Arch of Phys Med Rehabil 2007;88:298-301.
20. Chang JJ, Sung YT, Lin YT.The relationship between early motor stage and hand function recovery six months after stroke. Kaohsiung J Med sci 1990;6:38-44.
21. Desrosiers J, Malouin F, Richards C, Bourbonnais D, Rochette A, Bravo G. Comparison of changes in upper and lower extremity impairments and disabilities after stroke. IJRRD 2003, 26:109–116.
22. De Jong LD, Nieuwboer A, Aufdemkampe G.. The hemiplegic arm: Interrater reliability and concurrent validity of passive range of motion measurements. Disabil Rehabil 2007;29:1442-1448.
23. Duncan PW, Propst M, Nelson SG.. Reliability of the Fugl-Meyer assessment of the sensorimotor recovery following cerebrovascular accident. Phys Ther 1983;63:1606-1610.
24. Duncan PW, Goldstein LB, Horner RD, Landsman PB, Samsa GP, Matchar DB.Similar motor recovery of upper and lower extremities after stroke. Stroke 1994;25:1181-1188.
25. Duncan PW, Wallace D, Lai SM, et al: The Stroke Impact Sale, Version 2.0.: evaluation of reliability, validity, and sensitivity to change. Stroke 1999;30:2131-2140.
26. Duncan PW, Bode RK, Min Lai S, Perera S; Glycine Antagonist in Neuroprotection Americans Investigators. Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. Arch Phys Med Rehabil. 2003;84:950-963
27. Dursun E, Dursun N, Ural CE, Cakci A. Glenohumeral Joint Subluxation and Reflex Sympathetic Dystrophy in Hemiplegic Patients. Arch Phys Med Rehabil 2000;81:944-956.
28. Dromerick AW, Lang CE, Birkenmeier R, Hahn MG, Sahrmann SA, Edwards DF. Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke. JRRD 2006;43:401-408
29. Desrosiers J, Malouin F, Bourbonnais D, Richards CL, Rochette A, Bravo G. Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap. Clin Rehabil 2003;17:666-673.
30. De Conno F, Caraceni A, Gamba A, Mariani L, Abbattista A, Brunelli C, La Mura A, Ventafridda V. Pain measurement in cancer patients: a comparison of six methods. Pain 1994;57:161-166
31. Daviet JC, Salle JY, Borie MJ, Munoz M, Rebeyrotte I, Dudognon P. Clinical factors associate with shoulder subluxation in stroke patients. Ann Readapt Med Phys 2002;45:505–509.
32. Fotiadis F, Grouios G, Ypsilanti A, Hatzinikolaou K . Hemiplegic shoulder syndrome: possible underlying neurophysiological mechanisms. Phys Ther Rev 2005;10:51-58.
33. Gallasch CH. Alexandre NM. The measurement of musculoskeletal pain intensity: a comparison of four methods. Rev Gaucha Enferm 2007;28:260-265.
34. Gladstone DJ, Danells CJ, Black SE.The Fugl-meyer assessment of motor recovery after stroke: A critical review of its measurement properties. Neurorehabil Neural Repair 2002;16:232-240.
35. Gregson JM, Leathley M, Moore AP, Sharma AK, Smith TL, Watkins CL. Reliability of the tone assessment scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil 1999;80:1013-1016.
36. Gould R, Barnes SS. Shoulder and Hemiplegia. [ eMedicine Specialties web site]. January 26, 2007. Available at : http://www.emedicine.com/pmr/topic132.htm .Accessed May 1, 2007.
37. Gamble GE, Barberan E, Bowsher D, Tyrrell PJ. Post stroke shoulder pain: More common than previously realized. EUJP 2000;4:313-315.
38. Gamble GE, Barberan E, Laasch H-U, Bowsher D, Tyrrell PJ, Jones AKP. Poststroke shoulder pain: A prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke. EUJP 2002;6:467–474
39. Harris JE, Eng JJ. Paretic upper-limb strength best explains arm activity in people with stroke. Phy Ther 2007;87:88-97.
40. Hall J, Dudgeon B, Guthrie M. Validity of clinical measures of shoulder subluxation in adults with post stroke hemiplegia. Am J Occup Ther 1995;49:526-533
41. Hakuno A, Sashika H, Ohkawa T, Itoh R. Arthrographic findings in hemiplegic shoulders. Arch Phys Med Rehabil 1984;65:706–711
42. Hanger HC, Whitewood P, Brown G, Ball MC, Harper J, Cox R, Sainsbury R. A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clin Rehabil 2000;14:370-380.
43. Ikai T, Tei K, Yoshida K, Miyano S, Yonemoto K. Evaluation and treatment of shoulder subluxation in hemiplegia: relationship between subluxation and pain. Am J Phys Med Rehabil 1998;77:421-426.
44. Ikai T, Yonemoto K, Miyano S, et al. Interval change of the shoulder subluxation in hemiplegic patients. Jpn J Rehabil Med 1992;29:569-575.
45. Jette DU, Latham NK, Smout RJ, Gassaway J, Slavin MD, Horn SD. Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities. Phys Ther 2005;85:238-248.
46. King RB.Quality of life after stroke. Stroke 1996;27:1467-1472
47. Kwok T, Lo RS, Wong E, Wai-Kwong T, Mok V, Kai-Sing W. Quality of life of stroke survivors: a 1-year follow-up study. Arch Phys Med Rehabil 2006;87:1177-1182.
48. Kemler MA and de Vet HCW. Health-Related Quality of Life in Chronic Refractory Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome Type I). J Pain Symptom Manage 2000;20:68–76.
49. Kong K-H, Neo J-J, Chua SG. A randomized controlled study of botulinum toxin A in the treatment of hemiplegic shoulder pain associated with spasticity. Clin Rehabil 2007;21:28-35.
50. Lindgren I, Jönsson A-C, Norrving B, Lindgren A. Shoulder Pain After Stroke: A Prospective Population-Based Study. Stroke 2007;38:343-348.
51. Lo SF, Chen SY, Lin HC, Jim YF, Meng NH, Kao MJ. Arthrographic and clinical findings in patients with hemiplegic shoulder pain. Arch Phys Med Rehabil 2003;84:1786-1791.
52. Lawrence ES, Coshall C, Dundas R et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke 2001;32: 1279-1284.
53. Mercier C ,Bourbonnais D. Relative shoulder flexor and handgrip strength is related to upper limb function after stroke. Clin Rehabil 2004;18:215–221..
54. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Compensation in recovery of upper extremity function after stroke: The Copenhagen stroke study. Arch Phys Med and Rehabil 1994;75:852-857.
55. Olsen TS. Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke 1990;21:247-251.
56. Paci M, Nannetti L, Rinaldi LA. Glenohumeral subluxation in hemiplegia:An overview. J Rehabil Research & Develop 2005;42:557–568.
57. Peszczynski M, Rardin TE . The incidence of painful shoulder in hemiplegia. Pol Med Sci Hist Bull 1965;29:21-23.
58. Portney LG, Watkins MP: Correlation. Foundations of clinical research: Applications to practice. 2nd ed. New Jersey: Prentice-Hall, 2000;491-508.
59. Poduri KR. Shoulder pain in stroke patients and its effect on rehabilitation. J Stroke Cerebrovascular Dis 1993;3:261-266.
60. Pomeroy VM, Frames C, Faragher EB, Hesketh A, Hill E, Watson P, Main CJ. Reliability of a measure of post-stroke shoulder pain in patients with and without aphasia and/or unilateral spatial neglect. Clin Rehabil 2000;14:584-591.
61. Sabari JS, Maltzev I, Lubarsky D, Liszkay E, Homel P. Goniometric assessment of shoulder range of motion: Comparison of testing in supine and sitting positions. Arch Phys Med and Rehabil 1998;79:647-651.
62. Smith DL, Akhtar AJ, Garraway WM. Proprioception and spatial neglect after stroke. Age Ageing 1983;12:63-69.
63. Sommerfeld DK, Eek EU-B, Svensson A-K, Holmqvist LW, Von Arbin MH. Spasticity after Stroke: Its Occurrence and Association with Motor Impairments and Activity Limitations. Stroke 2004;35:134-139.
64. Sommerfeld DK, von Arbin MH. The impact of somatosensory function on activity performance and length of hospital stay in geriatric patients with stroke. Clin Rehabil 2004;18:149-155.
65. Shah SK. Disturbances of muscle tone in the paralysed upper extremity following hemiplegia. Aust J Physiother 1979;25:243-249.
66. Suenkeler IH, Norwak M, Misselwitz B, Kugler C, Schreiber W, Oertel WH, Back T. Time course of health-related quality of life as determined 3, 6 and 12 months after stroke: relationship neurological deficit, disability and depression. J Neurol 2002;249:1160-1167.
67. Saladin LK. Measuring quality of life post-stroke. Neur Rep 2000;24:3
68. Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C. Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther 1993;73:447-454.
69. Sunderland A, Tinson D, Bradley L, Hewer RL. Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. J Neurol Neurosurg Psychiatry 1989;52:1267-1272.
70. Tepperman PS, Greyson ND, Hilbert L, Jimenez J, Williams JI. Reflex sympathetic dystrophy in hemiplegia. Arch Phys Med Rehabil 1984;65:442–447
71. Turner-Stokes L, Jackson D. Shoulder pain after stroke: A review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil 2002;16:276-298.
72. The WHOQOL Group. Development of the WHOQOL-BREF Quality of Life Assessment. Psycho Med 1998;28:551-558.
73. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1994;75:852-857.
74. Nichols-Larsen DS, Clark PC, Zeringue A, Greenspan A, Blanton S. Factors Influencing Stroke Survivors' Quality of Life During Subacute Recovery. Stroke 2005;36:1480-1484.
75. Renzenbrink GJ and IJzerman MJ. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin Rehabil 2004;18:359-365.
76. Wade DT, Langton-Hewer R, Skilbeck CE, David RM. Stroke, a Critical Approach to Diagnosis, Treatment and Management.London: Chapman and Hall, 1985.
77. Wade DT, Hewer RL, Wood VA, Skilbeck CE, Ismail HM. The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry 1983;46:521-524.
78. Wallesch CW, Maes E, Lecomte P, Bartels C. Feasibility study on pharmacoeconomics of botulinum toxin A (Botox) in spasticity following
troke. 3rd European Botulinum Toxin Symposium Abstracts 1997;1:4.
79. Williams LS, Weinberger M, Harris LE, Clark DO, Biller J. Development of a Stroke-Specific Quality of Life Scale. Stroke 1999;30;1362-1369.
80. Williams LS, Weinberger Morris, Harris LE, Biller J. Measuring quality of life in a way that is meaningful to stroke patients. Neurology 1999;53:1839-1843.
81. Wyller TB, Sveen U, Sedring KM, Pettersen AM, Bautz-Holter E. Subjective well-being one year after stroke. Clin Rehabil 1997;11:139-145.
82. WHO. ICF: International Classification of Functioning Disability and Health. Geneva, Switzerland: WHO: Classification, Assessment, Surveys and Terminology Team. 2001
83. Van Ouwenaller C, Laplace PM, Chantraine A: Painful shoulder in hemiplegia. Arch Phys Med Rehabil 1986;67:23-26.

中文參考文獻
1. 台灣行政院衛生署網站:取自http://www.doh.gov.tw/statistic/data/衛生統計叢書2/95/上冊/表10.xls
2. 姚開屏(2001)。台灣簡明版世界衛生組織活品質問卷之發展及使用手冊。台北:世界衛生組織生活品質問卷之發展及使用手冊。
3. 姚開屏(2002)。台灣版世界衛生組織生活品質問卷之發展與應用。臺灣醫學,6(3),193-200。
4. 游雯琇、連恒裕、王子綺、李言貞、蔡永裕(民93)。台灣版中風病人生活品質問卷建構效度與內在信度之調查。中華民國物理治療學會第四十八次學術研討會,2004/3/6。
5. 盧瑞芬、曾旭民、蔡益堅(民91)。國人生活品質評量(Ⅰ):SF-36台灣版的發展及心理計量特質分析。台灣衛誌,22(6),501-511。
6. 高瓊芳(民94)。門診中風患者生活品質及其相關因素之探討。長庚大學護理學研究所碩士論文。
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top