研究背景及目的: 腦中風是造成老年人身心功能障礙的主要原因之一。持續進行居家復健運動，除了能有助於扭轉腦中風後的長期減少活動的不良影響、增進體能、防治腦中風再發以外， 亦是因應保險給付緊縮之重要對策。本研究的目的為探討依據5A’s行為介入諮詢(Five A’s Behavior Intervention Protocol)的遵從性增強策略是否可增進中風患者居家計畫運動之遵從性及動作功能之恢復。方法: 隨機控制雙盲試驗。18位即將出院回家之亞急性單側中風患者，分層隨機分為遵從性增強組及一般居家運動組，於出院前2週開始教導其居家復健運動。遵從性增強組多加了依據5A’s 行為介入諮詢，並使用填寫運動日誌及計步器當成增強物、以及出院後第2週打電話一次討論居家運動執行狀況。出院後第4週結束及第12週時追蹤評估以比較兩組在10公尺行走測試、功能性行走分類、柏格式平衡量表、日常活動日誌、身體失能者身體活動量表、居家復健運動核對清單之間的差異，以評估居家復健運動遵行性之促進介入的效果。並分析遵從性增強組內計步器記錄一日步數隨著時間變化之差異。以SPSS 13.0的電腦軟體做數據分析。結果：兩組受試者除了偏癱側有顯著差異外，其它參數在前測值均無顯著差異。遵從性增強組在出院後第4週時對於日常活動日誌中部分運動項目如柔軟度、平衡運動，具有較佳的遵從度，但無長期的效果。兩組隨著時間變化在10公尺行走測驗、柏格式平衡量表皆有顯著的進步(p＜0.001)，且遵從性增強組在10公尺行走測驗表現上顯著優於一般居家運動組(p＜0.05)。遵從性增強組在出院後第12週時功能性行走分類平均分數是5，表現顯著優於一般居家運動組(p＜0.05)。然而在柏格式平衡量表及身體失能者身體活動量表、居家復健運動核對清單和對運動觀感的表現上，未達組間差異。結論：中風病患於出院前開始接受依據5A''s行為介入諮詢的遵從性增強策略或許仍有些許效益。遵從性增強策略使出院後的中風病患在出院後第4週有部分較佳的居家復健運動的遵從度，尤其是在柔軟運動與平衡運動的執行方面。在功能活動測試方面，有接受遵從性增強策略的中風病患在行走速度及社區行走功能的表現上優於沒有接受此種諮詢的中風病患。雖然在本實驗中，遵從性增強策略的介入無法使遵性增強組的中風病患在平衡及參與度方面的表現和對運動的觀感上，顯著優於沒有接受此種諮詢的中風病患。然而檢討本研究設計發現，一般居家復健運動組有可能也接受了足夠的可增強遵從度的介入，如治療師一對一的教導病患及家屬符合病患個別能力的居家復健運動、預防不良事件發生之方法、給予附有圖片的運動單張以協助記住運動動作、記錄3次評估測試分數的小卡…. 等，因而減少了兩組間的差異。此外，受試者人數不足及評估量表的反應性或許均限制了研究結果。目前有關遵從性增強策略的介入對於中風病人功能性活動的影響，使用物理治療師臨床上常用於評估中風病患功能性表現的評估量表做為功能性預後的研究仍相當有限。未來希望能有更多的相關研究，以瞭解遵從性增強策略的介入對於中風病人功能性活動的影響。

Background and Purpose: Stroke is one of the main leading causes of physical disability in the elderly. The maintenance of home rehabilitation program, i.e., patient adherence, reduces side-effects from declined physical activity, improves fitness, prevents recurrent stroke and is an important strategy in response to gradually limited insurance coverage. The purpose of this study is to investigate the effects of an enhanced intervention program (based on Five A’s Behavior Intervention Protocol) on the adherence of home rehabilitation program in stroke patients. Method: This was a randomized, controlled, double-blind clinical trial. Neither the subjects nor the assessing therapist were informed of the assignment of groups. Sixteen subacute stroke in-patients were recruited. The subjects were randomly assigned into the Adherence Enhancement (AE) group or the Conventional Home Program (CHP) group. Both groups received home exercise instructions before discharge, however, only the AE group instructed based on the 5A’s (address the issue, address the patient, advise the patient, assist the patient, arrange follow-up and assess adherence) Behavior Intervention Protocol. At the baseline test, the subjects evaluated with 10-meter walking test, functional ambulation category, and the Berg Balance Scale. These data were recorded within the last two weeks prior to discharge from the hospital. The AE group subjects used self-reports of daily activity diary and pedometer throughout the 4 weeks after discharge from the hospital as enhancers. One telephone follow up was scheduled on the 2nd week to encourage exercise at home and evaluated the progression of home exercise for each AE group subject. The outcome measurements included the 10-meter walking test, the Functional Ambulation Category, the Berg Balance Scale, the daily activity diary, and the Specific Home Exercise Checklist between the two groups at the end of the 4th week post discharge. Follow up was scheduled during the 12th week post discharge. Results: There were no significant difference on the parameters of basic data, except the hemiplegic side. The AE group subjects exhibited better adherence in some of self-reported of daily activity diary such as flexibility exercise and balance exercise at 4th week, but not at 12th week after discharge. Both groups improved significantly on 10MWT and BBS (p <0.001) at both 4th and 12th weeks after discharge. The AE group subjects exhibited better performance in the 10MWT than the CHP group subjects ( p <0.05) at follow up. All subjects in the AE group reached FAC5 at 12th week, which was significantly better than the CHP group subjects ( p <0.05). However, the groups did not differ significantly on the BBS, PASIPD (Physical Activity Scale for Individuals with Physical Disability, and Specific Home Exercise Cheek list and perceptions of home program exercise. Conclusion: The Five A’s Behavior Intervention Protocol, along with other interventions such as pedometer and telephone follow up possibly reinforced the adherence of some of the home program exercises, particularly in the flexibility exercise and balance exercise. In the functional performance tests, stroke patients who received the adherence enhanced intervention program had better performance in gait speed and community walking ability than the patients who did not receive the intervention program. Though the AE group subjects did not demonstrate better balance performance nor on participation or perceptions of exercise than the CHP group, it is possible that the CHP group subjects might have received enough interventions for enhancing their adherence, thus minizing the between group difference. The CHP group received an exercise booklet with action picture to help remember the movement, one-to-one instructions by the same intervening physiotherapist on how to perform the home program exercise as well as some tips to prevent adverse events, a diary card to record the three test scores, and so on. These were all methods that may help enhancing adherence in the CHP group, thus reducing the differences between the two groups. In addition, the insufficient number of subjects and insufficient responsiveness of evaluating scales might have limited the findings of significance between groups. Thus far, the researches about the effects of the adherence enhanced intervention for functional recovery in stroke patients are limited. It is suggested that further studies in the field of adherence enhancement strategy interventions for functional recovery in stroke patients may help enhance and prolong the effects of physical therapy after the patients are dischaged.

第一章、 前言 1
第一節、 研究背景 1
第二節、 研究問題 3
第三節、 研究目的 3
第四節、 研究假說 3
第五節、 名詞及操作型定義 4
第六節、 研究重要性 5
第二章、 文獻回顧 6
第一節、 復健運動對於中風病患之效果 6
第二節、 行為諮詢(Behavior counseling)對於增加身體活動量的效果 6
第三節、 成人學習理論 7
第四節、 5A’s行為介入協議 8
第五節、 計步器對於增進動機的效果 9
第六節、 出院準備的介入 9
第七節、 結果評量之心理計量特性 11
第三章、 研究方法及實驗步驟 14
第一節、 研究設計 14
第二節、 受試者來源 14
第三節、 實驗步驟及流程 15
第四節、 研究工具 16
第五節、 實驗介入模式 18
第六節、 研究變項 20
第七節、 資料處理與統計分析 20
第四章、 研究結果 22
第一節、 受試者資料 22
第二節、 居家復健運動遵從性參數的變化 22
第三節、 功能性活動參數的變化 23
第四節、 參與度及其他問卷相關參數 24
第五章、 討論 27
第一節、 遵從性增強策略對居家復健運動遵從性的效果 27
第二節、 遵從性增強策略對功能活動的影響 29
第三節、 遵從性增強策略對中風患者社會參與度方面的效果 30
第四節、 居家復健運動記憶及執行的表現 30
第五節、 居家復健運動的觀感與障礙(Perception and Barriers) 31
第六章、 結論 34
參考文獻 35

1. Adams AS, Soumerai SB, Lomas J, Ross-Degnan D. Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care 1999;11(3):187-92.
2. Ahmed S, Mayo NE, Higgins J, Salbach NM, Finch L, Wood-Dauphinee SL et al. The Stroke Rehabilitation Assessment of Movement (STREAM): a comparison with other measures used to evaluate effects of stroke and rehabilitation. Phys Ther 2003;83(7):617-30.
3.Allison R, Evans PH, Kilbride C, Campbell JL, Allison R, Evans PH et al. Secondary prevention of stroke: using the experiences of patients and carers to inform the development of an educational resource. Fam Pract 2008;25(5):355-61.
4.Bandura A, Bandura A. Health promotion by social cognitive means. Health Educ Behav 2004;31(2):143-64.
5.Bassett SF, Prapavessis H, Bassett SF, Prapavessis H. Home-based physical therapy intervention with adherence-enhancing strategies versus clinic-based management for patients with ankle sprains. Phys Ther 2007;87(9):1132-43.
6.Beling J, Roller M, Beling J, Roller M. Multifactorial intervention with balance training as a core component among fall-prone older adults. J Geriatr Phys Ther 2009;32(3):125-33.
7.Blum L, Korner-Bitensky N, Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 2008;88(5):559-66.
8.Bohannon RW, Bohannon RW. Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis. Phys Ther 2007;87(12):1642-50.
9.Boysen G, Krarup LH, Zeng X, Oskedra A, Korv J, Andersen G et al. ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial. BMJ 2009;339:b2810.
10.Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298(19):2296-304.
11.Brown CA, Brown CA. The application of complex adaptive systems theory to clinical practice in rehabilitation. Disabil Rehabil 2006;28(9):587-93.
12.Brown CA, Brown CA. The role of paradoxical beliefs in chronic pain: a complex adaptive systems perspective. Scand J Caring Sci 2007;21(2):207-13.
13.Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med 1996;25(3):225-33.
14.Choi-Kwon S, Kwon SU, Kim JS, Choi-Kwon S, Kwon SU, Kim JS. Compliance with risk factor modification: early-onset versus late-onset stroke patients. Eur Neurol 2005;54(4):204-11..
15.Costanzo C, Walker SN, Yates BC, McCabe B, Berg K, Costanzo C et al. Physical activity counseling for older women. West J Nurs Res 2006;28(7):786-801; discussion 2-10.
16. Cyarto EV, Myers AM, Tudor-Locke C, Cyarto EV, Myers AM, Tudor-Locke C. Pedometer accuracy in nursing home and community-dwelling older adults. Med Sci Sports Exerc 2004;36(2):205-9.
17. Daley K, Mayo N, Wood-Dauphinee S. Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure. Phys Ther 1999;79(1):8-19; quiz 20-3.
18. de Blok BM, de Greef MH, ten Hacken NH, Sprenger SR, Postema K, Wempe JB et al. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study. Patient Educ Couns 2006;61(1):48-55.
19.Dean E, Dean E. Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother 2009;25(5-6):330-53.
20.Dean E, Dean E. Physical therapy in the 21st century (Part II): evidence-based practice within the context of evidence-informed practice. Physiother 2009;25(5-6):354-68.
21.Dubbert PM, Morey MC, Kirchner KA, Meydrech EF, Grothe K. Counseling for home-based walking and strength exercise in older primary care patients. Archives of Internal Medicine 2008;168(9):979-86.
22.Duncan KA, Pozehl B, Duncan KA, Pozehl B. Staying on course: the effects of an adherence facilitation intervention on home exercise participation. Prog Cardiovasc Nurs 2002;17(2):59-65.
23.Duncan P, Richards L, Wallace D, Stoker-Yates J, Pohl P, Luchies C et al. A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke 1998;29(10):2055-60.
24.Duncan P, Studenski S, Richards L, Gollub S, Lai SM, Reker D et al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke 2003;34(9):2173-80.
25.Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD et al. Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke 2005;36(9):e100-43.
26.Eng JJ, Chu KS, Dawson AS, Kim CM, Hepburn KE, Eng JJ et al. Functional walk tests in individuals with stroke: relation to perceived exertion and myocardial exertion. Stroke 2002;33(3):756-61.
27.Estabrooks PA, Glasgow RE, Dzewaltowski DA, Estabrooks PA, Glasgow RE, Dzewaltowski DA. Physical activity promotion through primary care. JAMA 2003;289(22):2913-6.
28.Fitzsimons CF, Baker G, Wright A, Nimmo MA, Ward Thompson C, Lowry R et al. The ''Walking for Wellbeing in the West'' randomised controlled trial of a pedometer-based walking programme in combination with physical activity consultation with 12 month follow-up: rationale and study design. BMC Public Health 2008;8:259.
29.Forkan R, Pumper B, Smyth N, Wirkkala H, Ciol MA, Shumway-Cook A et al. Exercise adherence following physical therapy intervention in older adults with impaired balance. Phys Ther 2006;86(3):401-10.
30.Friedrich M, Gittler G, Arendasy M, Friedrich KM, Friedrich M, Gittler G et al. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine 2005;30(9):995-1000.
31.Galvin R, Cusack T, Stokes E, Galvin R, Cusack T, Stokes E. A randomised controlled trial evaluating family mediated exercise (FAME) therapy following stroke. BMC Neurol 2008;8:22.
32.Glasgow RE, Emont S, Miller DC, Glasgow RE, Emont S, Miller DC. Assessing delivery of the five ''As'' for patient-centered counseling. Health Promot Internation 2006;21(3):245-55.
33.Glasgow RE, Goldstein MG, Ockene JK, Pronk NP, Glasgow RE, Goldstein MG et al. Translating what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care. Am J Prev Med 2004;27(2 Suppl):88-101.
34.Goldstein MG, Whitlock EP, DePue J, Planning Committee of the Addressing Multiple Behavioral Risk Factors in Primary Care P, Goldstein MG, Whitlock EP et al. Multiple behavioral risk factor interventions in primary care. Summary of research evidence. Am J Prev Med 2004;27(2 Suppl):61-79.
35.Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ et al. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Circulation 2004;109(16):2031-41.
36.Green J, Forster A, Young J, Green J, Forster A, Young J. Reliability of gait speed measured by a timed walking test in patients one year after stroke. Clin Rehabil 2002;16(3):306-14.
37.Haeuber E, Shaughnessy M, Forrester LW, Coleman KL, Macko RF, Haeuber E et al. Accelerometer monitoring of home- and community-based ambulatory activity after stroke. Arch Phys Med Rehabil 2004;85(12):1997-2001.
38.Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008(2):CD000011.
39.Ivey FM, Hafer-Macko CE, Macko RF, Ivey FM, Hafer-Macko CE, Macko RF. Exercise training for cardiometabolic adaptation after stroke. J Mol Signal 2008;28(1):2-11.
40.Jones F, Jones F. Strategies to enhance chronic disease self-management: how can we apply this to stroke? Disabil Rehabil 2006;28(13-14):841-7.
41. Kollen B, Kwakkel G, Lindeman E, Kollen B, Kwakkel G, Lindeman E. Time dependency of walking classification in stroke. Phys Ther 2006;86(5):618-25.
42.Krist AH, Woolf SH, Frazier CO, Johnson RE, Rothemich SF, Wilson DB et al. An electronic linkage system for health behavior counseling effect on delivery of the 5A''s. Am J Prev Med 2008;35(5 Suppl):S350-8.
43. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A et al. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke 2004;35(11):2529-39.
44. Langhammer B, Lindmark B, Stanghelle JK, Langhammer B, Lindmark B, Stanghelle JK. Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation. Clin Rehabil 2007;21(6):495-510.
45.Latham NK, Jette DU, Slavin M, Richards LG, Procino A, Smout RJ et al. Physical therapy during stroke rehabilitation for people with different walking abilities. Arch Phys Med Rehabil 2005;86(12 Suppl 2):S41-S50.
46.Laufer Y, Sivan D, Schwarzmann R, Sprecher E, Laufer Y, Sivan D et al. Standing balance and functional recovery of patients with right and left hemiparesis in the early stages of rehabilitation. Neurorehabil Neural Repair 2003;17(4):207-13.
47.Lawrence M, McVey C, Kerr S, Lawrence M, McVey C, Kerr S. What is the evidence for using family based interventions to prevent stroke recurrence? Nurs Times 2010;106(11):22-5.
48.Lee HC, Chang KC, Lan CF, Hong CT, Huang YC, Chang ML et al. Factors associated with prolonged hospital stay for acute stroke in Taiwan. Acta neurol 2008;17(1):17-25.
49.Lee HK, Scudds RJ, Lee HKM, Scudds RJ. Comparison of balance in older people with and without visual impairment. Age Ageing 2003;32(6):643-9.
50.Lee LL, Avis M, Arthur A, Lee L-L, Avis M, Arthur A. The role of self-efficacy in older people''s decisions to initiate and maintain regular walking as exercise -- Findings from a qualitative study. Prev Med 2007;45(1):62-5.
51.Leroux A, Leroux A. Exercise training to improve motor performance in chronic stroke: effects of a community-based exercise program. Int J Rehabil Res 2005;28(1):17-23.
52.Lewis SC, Dennis MS, O''Rourke SJ, Sharpe M. Negative attitudes among short-term stroke survivors predict worse long-term survival. Stroke 2001;32(7):1640-5.
53.Lyden P, Claesson L, Havstad S, Ashwood T, Lu M, Lyden P et al. Factor analysis of the National Institutes of Health Stroke Scale in patients with large strokes. Arch Neurol 2004;61(11):1677-80.
54. Macciocchi SN, Diamond PT, Alves WM, Mertz T. Ischemic stroke: relation of age, lesion location, and initial neurologic deficit to functional outcome. Arch Phys Med Rehabil 1998;79(10):1255-7.
55.Macko RF, Haeuber E, Shaughnessy M, Coleman KL, Boone DA, Smith GV et al. Microprocessor-based ambulatory activity monitoring in stroke patients. Med Sci Sports Exerc 2002;34(3):394-9.
56. Matthews CE, Freedson PS. Field trial of a three-dimensional activity monitor: comparison with self report. Med Sci Sports Exerc 1995;27(7):1071-8.
57. McAuley E, Motl RW, Morris KS, Hu L, Doerksen SE, Elavsky S et al. Enhancing physical activity adherence and well-being in multiple sclerosis: a randomised controlled trial. Mult Scler 2007;13(5):652-9.
58.Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M, Mehrholz J et al. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil 2007;88(10):1314-9.
59.Merom D, Rissel C, Phongsavan P, Smith BJ, Van Kemenade C, Brown WJ et al. Promoting walking with pedometers in the community: the step-by-step trial. Am J Prev Med 2007;32(4):290-7.
60.Michael K, Macko RF, Michael K, Macko RF. Ambulatory activity intensity profiles, fitness, and fatigue in chronic stroke. Top Stroke Rehabil 2007;14(2):5-12.
61.Moore JL, Roth EJ, Killian C, Hornby TG, Moore JL, Roth EJ et al. Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a "plateau" in recovery. Stroke 2010;41(1):129-35.
62.Moseley GL, Moseley GL. Do training diaries affect and reflect adherence to home programs? Arthritis Rheum 2006;55(4):662-4.
63.Mudge S, Barber PA, Stott NS. Circuit-Based Rehabilitation Improves Gait Endurance but Not Usual Walking Activity in Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2009;90(12):1989-96.
64.Olney SJ, Nymark J, Brouwer B, Culham E, Day A, Heard J et al. A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Stroke 2006;37(2):476-81.
65.O’Sullivan SB. Stroke .In Physical Rehabilitation : Assessment and Treatment.4th.New York;2002 ;519-581.
66.Ouellette MM, LeBrasseur NK, Bean JF, Phillips E, Stein J, Frontera WR et al. High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke 2004;35(6):1404-9.
67.Ovbiagele B, Saver JL, Fredieu A, Suzuki S, Selco S, Rajajee V et al. In-hospital initiation of secondary stroke prevention therapies yields high rates of adherence at follow-up. Stroke 2004;35(12):2879-83.
68.Pang MY, Eng JJ, Dawson AS, Gylfadottir S, Pang MYC, Eng JJ et al. The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clin Rehabil 2006;20(2):97-111.
69.Patterson SL, Forrester LW, Rodgers MM, Ryan AS, Ivey FM, Sorkin JD et al. Determinants of walking function after stroke: differences by deficit severity. Arch Phys Med Rehabil 2007;88(1):115-9.
70.Paula Caleffi Segura A, Veloso Fontes S, Maiumi Fukujima M, de Andrade Matas SL, Paula Caleffi Segura A, Veloso Fontes S et al. The impact evaluation of physical therapy on the quality of life of cerebrovascular stroke patients. Int J Rehabil Res 2006;29(3):243-6.
71.Ramas J, Courbon A, Roche F, Bethoux F, Calmels P. Effect of training programs and exercise in adult stroke patients: literature review. Ann Readapt Med Phys 2007;50(6):438-44.
72.Resnick B, Michael K, Shaughnessy M, Nahm ES, Kobunek S, Sorkin J et al. Inflated perceptions of physical activity after stroke: pairing self-report with physiologic measures. J Phys Act Health 2008;5(2):308-18.
73.Resnick B, Nigg C, Resnick B, Nigg C. Testing a theoretical model of exercise behavior for older adults. Nurs Res 2003;52(2):80-8.
74.Rimmer JH, Riley B, Creviston T, Nicola T. Exercise training in a predominantly African-American group of stroke survivors. Med Sci Sports Exerc 2000;32(12):1990-6.
75.Robiner WN, Robiner WN. Enhancing adherence in clinical research. Contemp Clin Trials 2005;26(1):59-77.
76.Ross JS, Halm EA, Bravata DM, Ross JS, Halm EA, Bravata DM. Use of stroke secondary prevention services: are there disparities in care? Stroke 2009;40(5):1811-9.
77.Schmid AA, Butterbaugh L, Egolf C, Richards V, Williams L, Schmid AA et al. Prevention of secondary stroke in VA: role of occupational therapists and physical therapists. J Rehabil Res Dev 2008;45(7):1019-26.
78.Schutzer KA, Graves BS, Schutzer KA, Graves BS. Barriers and motivations to exercise in older adults. Prev Med 2004;39(5):1056-61.
79.Shaughnessy M, Resnick BM, Macko RF, Shaughnessy M, Resnick BM, Macko RF. Testing a model of post-stroke exercise behavior. Rehabil Nurs 2006;31(1):15-21
80.Shepard KF. Understanding and Influencing Patient Receptivity to Change: The Patient-Practitioner Collaborative Model .In Handbook of Teaching for Physical Therapists.2nd.Boston; 2002.p.323-385
81. Sluijs EM, Kok GJ, van der Zee J. Correlates of exercise compliance in physical therapy. Phys Ther 1993;73(11):771-82; discussion 83-6.
82.Smith PS, Hembree JA, Thompson ME, Smith PS, Hembree JA, Thompson ME. Berg Balance Scale and Functional Reach: determining the best clinical tool for individuals post acute stroke. Clin Rehabil 2004;18(7):811-8.
83.Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J et al. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Arch Phys Med Rehabil 2008;89(3):404-12.
84.Stevenson TJ. Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother 2001;47(1):29-38.
85.Studenski S, Duncan PW, Perera S, Reker D, Lai SM, Richards L et al. Daily functioning and quality of life in a randomized controlled trial of therapeutic exercise for subacute stroke survivors. Stroke 2005;36(8):1764-70.
86.Sugden JA, Sniehotta FF, Donnan PT, Boyle P, Johnston DW, McMurdo ME et al. The feasibility of using pedometers and brief advice to increase activity in sedentary older women--a pilot study. BMC Health Serv Res 2008;8:169.
87.Talbot LA, Gaines JM, Huynh TN, Metter EJ, Talbot LA, Gaines JM et al. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc 2003;51(3):387-92.
88.Talvitie U, Pyoria O, Talvitie U, Pyoria O. Discourse analytic study of counseling sessions in stroke physiotherapy. Health Commun 2006;20(2):187-96.
89.Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil 1999;80(10):1211-8.
90.Tsouna-Hadjis E, Vemmos KN, Zakopoulos N, Stamatelopoulos S. First-stroke recovery process: the role of family social support. Arch Phys Med Rehabil 2000;81(7):881-7.
91.van der Ploeg HP, Streppel KR, van der Beek AJ, van der Woude LH, van Harten WH, van Mechelen W et al. Underlying mechanisms of improving physical activity behavior after rehabilitation. Int J Behav Med 2008;15(2):101-8.
92. van der Ploeg HP, Streppel KR, van der Beek AJ, van der Woude LH, Vollenbroek-Hutten M, van Mechelen W et al. The Physical Activity Scale for Individuals with Physical Disabilities: test-retest reliability and comparison with an accelerometer. J Phys Act Health 2007;4(1):96-100.
93.van der Ploeg HP, Streppel KR, van der Beek AJ, van der Woude LH, Vollenbroek-Hutten MM, van Harten WH et al. Counselling increases physical activity behaviour nine weeks after rehabilitation. BJSM online 2006;40(3):223-9.
94.van der Ploeg HP, Streppel KR, van der Beek AJ, van der Woude LH, Vollenbroek-Hutten MM, van Harten WH et al. Successfully improving physical activity behavior after rehabilitation. Am J Health Promot 2007;21(3):153-9.
95.Visser-Meily A, Post M, Gorter JW, Berlekom SB, Van Den Bos T, Lindeman E et al. Rehabilitation of stroke patients needs a family-centred approach. Disabil Rehabil 2006;28(24):1557-61.
96.Wang CH, Hsieh CL, Dai MH, Chen CH, Lai YF, Wang C-H et al. Inter-rater reliability and validity of the stroke rehabilitation assessment of movement (stream) instrument. J Rehabil Med 2002;34(1):20-4.
97.Washburn RA, Zhu W, McAuley E, Frogley M, Figoni SF, Washburn RA et al. The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil 2002;83(2):193-200.
98.Waters RL, Mulroy S. The energy expenditure of normal and pathologic gait. Gait Posture 1999;9(3):207-31.
99.Whitlock EP, Orleans CT, Pender N, Allan J, Whitlock EP, Orleans CT et al. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002;22(4):267-84.
100. Yavuzer G, Kucukdeveci A, Arasil T, Elhan A. Rehabilitation of stroke patients: clinical profile and functional outcome. Am J Phys Med Rehabil 2001;80(4):250-5.
101. Merriam SB, Wiley J, editors. Learning in Adulthood: A Comprehensive Guide, 2nd. NewYork:Chichester;1999.楊惠君譯。終身學習全書:成人教育總論。台北:商周出版;2004:283-303.
102.黃富順。成人學習。一版。台北：五南圖書出版股份有限公司；2004：355 -386。
103. 蔡培村。老人學習與生涯發展。出版。高雄:麗文文化事業股份有限公司；1996:35-49。
104.洪珍瑜、詹美華。人工髖關節置換術後居家復健運動之效果。國立台灣大學醫院物理治療學研究所。1999；碩士論文