有效提升中風患者的日常生活功能－急性後期照護之成效分析

Post-acute Care Improves Daily Activity Functions of Stroke Patients: An Effectiveness Analysis

冼鴻曦(Hong-Hsi Hsien) ； 劉文欽(Wen-Chin Liou) ； 楊儀華(Yi-Hua Yang)

《台灣老年醫學暨老年學雜誌》 10卷3期 (2015/08) Pp. 159-171

https://doi.org/10.29461/TGG.201508_10(3).0003

摘要

目的：探討急性後期照護對於腦中風患者日常生活功能改善的程度，並分析影響日常生活功能進步差異的因素。方法：收錄本院腦中風急性後期照護結案人數共107人為研究對象，以前瞻性世代研究法登錄每位病人的評估量表，比較於收案與結案時量表的分數差異進行統計分析。結果：比較收案與結案時巴氏量表分數的差異發現86人(80.4%)日常生活功能有進步，分數不變或退步者有21人(19.6%)。以單因子變異數分析發現日常生活功能的進步程度與腦中風的分類(梗塞或出血)、迷你營養評估等級，語言功能評估等級，以及是否有鼻胃管等變項有顯著的差異。以相關性分析發現巴氏量表的分數差異與住院時的吞嚥功能初評分數呈正相關。以多變項迴歸分析發現對日常生活功能的進步具有顯著預測力者有腦中風的類別、營養障礙的等級與吞嚥功能的初評分數等三個變項。結論：腦中風急性後期照護試辦計劃的經驗顯示，腦中風發病後黃金治療期間的積極復健可降低病患的失能程度及減輕家庭與社會的負擔。建議急性後期照護未來可擴大服務對象包括其他不同疾病合併有功能障礙的患者，使得急性後期照護的成功治療模式能夠擴展延伸，更多的患者能因此而受惠。

關鍵字

腦中風 ； 急性後期照護 ； 日常生活功能

並列摘要

Objective: To assess the effectiveness of post-acute care on functional improvement of daily activities (ADL) for stroke patients. Methods: This prospective cohort study enrolled 107 cases of stroke from March 1, 2014 to June 30, 2015. ADL functional improvement was evaluated by examining the differences in the Barthel ADL index scores during the hospitalization of post-acute care. Data were analyzed using descriptive statistics (correlation and one way ANOVA) to examine the effects of patients’ characteristics on the probability of ADL improvement. Multiple linear regression was used to study the predictors of ADL improvement. Results: Of the 107 patients, 86 (80.4%) reported ADL improvement, 21 (19.6%) showed either no improvement or deterioration. The type of stroke, the use of nasogastric tube, the level of mini-nutritional assessment (MNA) and concise Chinese aphasia test score emerged from One way ANOVA to be significantly associated with the degree of ADL improvement. Correlation analysis found functional oral intake score (FOIS) positively correlated to ADL improvement. Multiple linear regression identified the type of stroke, the level of MNA and FOIS as the significant predictors of ADL functional improvement. Conclusion: The PAC program promoted functional recovery and decreased the severity of dependency for stroke patients. This program should be implemented to provide better care for patients suffering stroke or other diseases associated with disability.

並列關鍵字

stroke ； post-acute care ； daily activity function