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研究生:徐子銘
研究生(外文):Syu Zih-Ming
論文名稱:追蹤急性後期腦中風患者之一年期成效-以樂生療養院為例
論文名稱(外文):One-year follow-up of the effectiveness of post-acute care among patients with stroke: A study of the Lo-Sheng Sanatorium and Hospital
指導教授:劉倩秀劉倩秀引用關係
指導教授(外文):Liu Chien-Hsiou
口試委員:江心瑜尤菀薈
口試委員(外文):Chiang Hsin-YuYu Wan-Hui
口試日期:2018-12-24
學位類別:碩士
校院名稱:輔仁大學
系所名稱:跨專業長期照護碩士學位學程在職專班
學門:醫藥衛生學門
學類:其他醫藥衛生學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:138
中文關鍵詞:急性後期高強度復健腦中風
外文關鍵詞:post acute careintensive rehabilitationstrokeCVA
相關次數:
  • 被引用被引用:1
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  • 下載下載:99
  • 收藏至我的研究室書目清單書目收藏:1
中文摘要
背景:
腦中風是導致失能的主因之一,2014年衛福部提出「急性後期照護計畫」(Post-Acute Care, PAC),以腦中風病人為試辦對象,施行至今短期成果顯著,但至目前為止尚無文獻指出PAC療效是否可以持續,也未比較PAC與一般復健模式是否有所差異。
目的:
本研究目的在於追蹤PAC患者在復健療程結束後,其動作與認知功能的恢復成效,並比較PAC與一般常規復健(GR)患者在病發後的第三個月至第十二個月,其動作與認知功能的恢復差異。
方法:
某地區醫院內有接受PAC與GR之中風病患為取樣對象,共有26位受試者完成本次研究,包括13位PAC組與13位GR組之腦中風病患。PAC組住院時間至少6周(最多12周),每周接受20次的復健療程;GR組住院時間24周,每周接受10次的復健療程。兩組在第3個月、第6個月、第9個月與第12個月,評估其平衡能力、心肺耐力、走路速度、認知能力、日常生活功能與生活品質。以Mann-Whitney U test檢定兩組的組間差異,Wilcoxon sign test檢定兩組的組內差異,並且計算PAC與GR組在第3到第6個月、第6到第9個月與第9至第12個月的改變量與效應值。
結果:
本研究PAC組在動作、認知與日常生活功能,每個量測時間點都有持續地進步。PAC組與GR組的比較,兩組在動作與認知功能的恢復程度,PAC組在動作功能的伯格式平衡、六分鐘心肺耐力,生活品質的身體功能、活力狀態、心理健康,日常生活功能的認知功能與總分功能的恢復,都比GR組好。
結論:
本研究一年期的追蹤結果顯示,PAC的模式對於有復健潛力與動機的腦中風病人,確實可以增加中風病人的動作與認知功能。



ABSTRACT
Background:
Stroke is the major cause of disability among adults. The Post-Acute Care (PAC) Program was implemented by the Taiwan Department of Health and Welfare in 2014 as a trial for patients with post-acute stroke. The short-term effects of the program were significant. However, no research has examined the long-term effects. Furthermore, it remains unclear whether differences exist in the effectiveness of general rehabilitation (GR) and PAC programs for stroke patients.
Purpose:
The study investigated the effects on physical and cognition functions among patients with stroke in a PAC group. Compared with a GR group in terms of functional recovery from the third month to twelfth month post onset.
Method:
A total of 26 patients with post-acute stroke at one hospital in Taiwan were recruited into either a PAC group (n = 13) or a GR group (n = 13) as control. The PAC program included 20 sessions per week for 6 (maximum 12) weeks, whereas the GR program was 10 sessions per week for 24 weeks. The outcome indicators included balance, cardiopulmonary function, walking speed, cognition, and quality of life. Data were collected at the third, sixth, ninth, and twelfth months after onset. The Mann–Whitney U test was employed to examine between-group improvements and the Wilcoxon signed-rank test was used to examine within-group improvements. Relative improvement analysis was also performed.

Result:
In the PAC group, physical functions, cognitive functions, and activity of daily life functions improved over time. Compared with the GR group, the PAC group scored higher on physical tests (Berg Balance Scale and Six Minute Walk Test for movement), quality of life tests (body function, energy level, and mental health), and activity of daily life tests (cognition and total score).
Conclusion:
For patients with potential and motivation after stroke, these results indicate that the PAC model can truly enhance their physical and cognitive functions and be maintained for one year.




目錄
書名頁 i
中文摘要 ii
英文摘要 iv
誌謝 vi
目錄 vii
表目錄 ix
圖目錄 x
第壹章 緒論 1
第一節 研究背景 1
第二節 研究目的 7
第三節 名詞定義 9
第貳章 文獻回顧 17
第一節 美國與台灣急性後期照護之實施現況及成效 17
第二節 PAC與一般常規復健介入之成效 24
第三節 臨床評估工具 35
第四節 評估時間點之影響 39
第五節 總結 41
第參章 研究方法 43
第一節 研究設計 43
第二節 研究對象 44
第三節 研究工具 45
第四節 統計方法 55
第肆章 結果 57
第一節 PAC與GR組之組間治療效果 58
第二節 PAC與GR組之組內治療效果 61
第三節 PAC與GR組之組內改變量 65
第伍章 討論 75
第一節 PAC組動作與認知成效 75
第二節 PAC與GR組成效之差異 78
第三節 治療強度與評估量表之差異 82
第四節 評估工具敏感度 87
第五節 總結 88
第陸章 結論 89
參考文獻 91
附錄一 圖表 99
附錄二 人體研究倫理委員會通過證明 111
附錄三 正式問卷 117

表目錄
表4 1 人口學特徵 99
表4 2 PAC組與GR組於動作功能平均值標準差Mean (SD)(N=26) 100
表4 3 PAC組與GR組於生活品質狀況平均值標準差Mean (SD)(N=26) 101
表4 4 PAC組與GR組於認知功能狀況平均值標準差Mean (SD)(N=26) 102
表4-5 PAC組與GR組於日常生活功能平均值標準差Mean (SD)(N=26) 104

圖目錄
圖3 1 PAC組復健期間與評估時間點 105
圖3 2 GR組復健期間與評估時間點 105
圖4 1收案流程圖 106
圖4 2 PAC與GR組於動作功能改變量 107
圖4 3 PAC與GR組於生活品質改變量 108
圖4 4 PAC與GR組於認知功能改變量 109
圖4 5 PAC與GR組於日常生活功能改變量 110

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