臺灣博碩士論文加值系統

研究目的
衛生福利部中央健康保險署2014年起，以腦中風為對象試推動急性後期照護試辦計畫(Post-Acute Care, PAC)，希望藉由垂直整合轉銜系統的建置與跨專業的整合照護團隊，提供腦中風病人高強度復健訓練，藉此協助病人延緩失能或恢復其身體功能狀態，以降低醫療機構與家庭負擔。因此，本研究探討工具性日常生活功能(Instrumental Activities of Daily Living, IADL) 對急性後期照護腦中風病人的生活品質是否具有中介之效果。
研究方法
本研究蒐集2014年3月1日至2021年3月1日，針對台灣南部兩家醫學中心、兩家區域醫院以及一家地區醫院的腦中風病人進行分析，共納入893位。於入院時及開始復健後第十二週、第一年，評估工具性日常生活功能(IADL)與生活品質(EQ-5D)相關聯性，運用結構方程模式(Structural Equation Modeling, SEM)進行相關研究，希望能找出影響工具性日常生活功能對急性後期照護腦中風病人之生活品質是否具有中介效果。本研究統計分析軟體使用Analysis of Moment Structure (AMOS)(v.21.0)以及Statistical Package for Social Science (SPSS 20)。

研究結果
急性後期照護對於剛入院時、接受照護第十二週時工具性日常生活功能(IADL)與生活品質皆有顯著差異(P<0.05)，此表示工具性日常生活功能(IADL)具中介作用；但持續復健一年之後，工具性日常生活功能(IADL)與急性後期照護對生活品質未有顯著差異。整體而言，工具性日常生活功能(IADL)在病人持續接受一年高強度復健時仍具有顯著差異，此表示工具性日常生活功能對急性後期照護腦中風病人之生活品質具有中介效果。
結論
接受急性後期照護試辦計畫之腦中風病人，在黃金治療時期接受密集且高強度的復健治療，對其功能恢復或延緩失能有重要的影響因素，其中工具性日常生活功能量表分數對其生活品質提升具有中介作用，因此建議腦中風病人應盡早接受PAC復健治療，以減少醫療機構與家庭負擔，期望透過此研究結果提供衛生主管單位作為未來持續推動之參考。

關鍵詞：急性後期照護、腦中風、工具性日常生活功能量表、生活品質

Purposes
Since 2014, the Central Health Insurance Agency, Ministry of Health and Welfare has tried to promote the post-acute care pilot program (Post-Acute Care, PAC) with the aim of cerebral apoplexy, hoping to establish a vertical integration transition system and inter-professional integration. The PAC team provides high-intensity rehabilitation training for stroke patients to help patients delay disability or restore their physical function in order to reduce the burden on medical institutions and families. This study purposed to investigate whether Instrumental Activities of Daily Living (IADL) has a mediating effect on the quality of life of stroke patients in PAC program.

Methods
This study collected and analyzed 893 stroke patients from two medical centers, two regional hospitals, and one regional hospital in southern Taiwan from March 1, 2014 to March 1, 2021. At the time of admission, the 12th week and 1st year after rehabilitation, the correlation between IADL and quality of life (EQ-5D) was assessed using Structural Equation Modeling (SEM). Relevant research hopes to find out whether the influence of instrumental daily life function has a mediating effect on the quality of life of stroke patients in PAC program. The statistical analysis software used in this study was Analysis of Moment Structure (AMOS) (v.21.0) and Statistical Package for Social Science (SPSS 20).

Results
There were significant differences in IADL and EQ-5D at the time of admission and at the 12th week after rehabilitation (P<0.05), indicating IADL had a mediating effect; However, after one year of continuous rehabilitation, there was no significant difference in EQ-5D between IADL and PAC program. Overall, IADL remained significantly different when stroke patients continued to receive intensive rehabilitation for one year, indicating that IADL still had a mediating effect on EQ-5D of stroke patients in PAC program.

Conclusion
Stroke patients who received PAC program with intensive and high-intensity rehabilitation therapy during the golden treatment period had important influence factors on their functional recovery or delay of disability. It has a mediating effect on the improvement of their quality of life, so it is suggested that stroke patients should receive PAC rehabilitation treatment as soon as possible to reduce the burden on medical institutions and families.
Keywords：Post-Acute Care, Stroke, Lawton-Brody IADL Scale, EuroQoL-5D (EQ-5D)

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 名詞解釋 5
第四節 預期貢獻 6
第二章 文獻探討 7
第一節 腦中風之簡介(Brain Stroke) 7
第二節 急性後期照護之簡介(Post-Acute Care, PAC) 10
第三節 結構方程模式之簡介 16
第四節工具性日常生活功能與生活品質量表相關性 24
第三章 研究方法 33
第一節 研究設計與研究樣本 33
第二節 研究架構與研究假說 37
第三節 研究工具 39
第四節 操作型定義 43
第五節 統計分析 46
第四章 研究結果 47
第一節 描述性統計 47
第二節 測量恆等性 52
第三節 工具性日常生活功能量表模式分析結果 54
第五章 討論與結論 63
第一節 研究目的、假說與討論 63
第二節 研究限制 67
第三節 研究建議 68
參考文獻 63
附錄 63

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