臺灣博碩士論文加值系統

背景與目的
住院服務往往無法提供中風患者出院後社區生活的預後資訊。建立中風患者出院後長期參與的預後資訊是重要且缺乏研究探討的議題。本研究旨在探討出院時改良式Rankin量表(modified Rankin Scale, mRS)的分數是否可以預測不同功能次群體間長期的參與趨勢，並描述各組社區參與的長期趨勢和差異。

方法
本研究是回溯性的次級資料分析，資料來自兩個前瞻性觀察性研究，共納入645名首次中風的患者。資料蒐集時間點分別在出院時、出院後3個月和中風1年後。本研究根據出院時mRS分數，將中風患者進行三元的功能性分層，並比較長期參與趨勢。參與將透過社會參與量表（Participation Measure-3 Domains, 4 Dimensions, PM-3D4D）測量。本研究將採用混合效應回歸模型建立預測模型，並使用Scheffe's事後比較測驗識別不同時間各組的差異。

結果
出院時，日常生活活動獨立的中風患者（mRS 1-2）較日常生活部分需要協助的中風患者（mRS 3）參與更多社區和生產性活動，也在所有參與中經歷較少的困難。出院後一年，兩組的參與差異變得不再顯著（調整後p=0.116-0.903）。僅在社會參與頻率方面，日常生活活動獨立的中風患者（mRS 1-2）和日常生活部分需要協助的中風患者（mRS 3）在出院後一年內無顯著差異（調整後p=0.273-0.990）。出院時日常生活需要大量照顧的中風患者（mRS 4-5）整體參與情況最差，出院後參與最少活動，也面臨更大的參與挑戰。


結論
出院時的改良式Rankin量表（mRS）分數，可以作為預測出院後中風患者長期社區參與恢復趨勢的參考工具。本研究提出各功能分級中風患者出院後應關注的參與活動，並強調出院時日常生活需要大量照顧的中風患者（mRS 4-5）為需要額外介入措施以回歸社區的族群。

Background and aims
Inpatient services often provide limited insight into the post-discharge evolution of community life. Establishing prognostic evidence for long-term participation outcomes remains an essential yet underexplored issue. This study aims to investigate whether the modified Rankin Scale (mRS) score at discharge can predict long-term participation trends across different functional subgroups, and to describe the long-term community participation trends and differences among these groups.

Methods
This study conducted a secondary data analysis using information from two prospective observational studies, including a total of 645 first-ever stroke patients. Data were collected at three time points: at discharge, 3 months post-discharge, and 1 year post-stroke. Based on the mRS score at discharge, stroke patients were stratified into three functional subgroups to compare long-term community participation trends. Participation was measured using the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). Mixed-effect regression models were employed to establish predictive models, and Scheffe's post hoc test was used to identify differences among groups over time.

Results
At discharge, stroke patients who were independent in activities of daily living (ADL) (mRS 1-2) participated in more community and productive activities and experienced fewer difficulties compared to those who were partially dependent in ADL (mRS 3). One year after discharge, the differences in participation between the two groups were no longer significant (adjusted p=0.116-0.903). Only in social participation frequency, there was no significant difference between the independent group (mRS 1-2) and the partially dependent group (mRS 3) within the first year after discharge (adjusted p=0.273-0.990). Stroke patients who required substantial care in ADL (mRS 4-5) had the poorest overall participation, engaging in the fewest activities and facing the most significant challenges post-discharge.

Conclusions
The modified Rankin Scale (mRS) score at discharge serves as a valuable prognostic tool for predicting long-term community participation trends among stroke survivors. This study highlights the need for targeted interventions and personalized discharge plans for stroke patients with varying functional levels, particularly those who require extensive care (mRS 4-5) to support their reintegration into the community.

Table of contents

Introduction 1
1. Life after Stroke 1
2. Reduced Participation after Stroke 2
3. Variability in Participation Based on Functional Status 3
Methods 6
1. Study Design 6
2. Participants 6
3. Measures 7
3.1. Participation 7
3.2. Functional Status 7
3.3. Personal Factors 8
4. Statistical analysis 9
Results 11
1. Characteristics 13
2. Trends of participation in the first year after discharge 15
3. Group Comparisons of the participation score over time 22
Discussion 24
Strength and Limitations 26
Conclusion 28
Appendix 29
Reference 38

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