居家物理治療改善日常生活活動功能之因素分析

Factors Associated With Activities of Daily Living Improvement in Disabled Community Dwellers Receiving Home-Based Physical Therapy

李宜玲(Yi-Ling Li) ； 李世代(Shyh-Dye Lee) ； 曹昭懿(Jau-Yih Tsauo) ； 胡名霞(Ming-Hsia Hu)

《物理治療》 43卷3期 (2018/09) Pp. 229-246

https://doi.org/10.6215/FJPT.201809_43(3).0004

摘要

背景和目的：本研究旨在探討十年長期照顧專案下，失能個案接受居家物理治療(home-based physical therapy, HPT)期間，改善日常生活活動功能之影響因素。方法：研究設計為次級資料分析。資料來源為臺北市與新北市HPT資料庫之717筆無記名居家失能個案，每一位個案皆於2012年1月至12月間接受2次以上之HPT服務。資料內容包括個案之社會人口學資料與健康功能狀況、收案與結案時之日常生活活動功能（巴氏量表[Barthel Index, BI]得分）及介入頻度等。本研究以描述性統計、單變項邏輯斯迴歸分析(univariate logistic regression)與多變項邏輯斯迴歸分析(multivariate logistic regression)等統計方法進行資料處理。結果：HPT介入後，約35%的個案BI得分有改善。顯著影響功能改善的變項包括：肌力2分以上(odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.43 ～ 4.54)、意願良好(OR = 1.91, 95% CI = 1.20 ～ 3.06)、短期失能(OR = 1.64, 95% CI= 1.10 ～ 2.54)與介入次數(OR = 1.23, 95% CI = 1.15 ～ 1.31)。結論：肌力較佳、意願較高、短期失能及使用較多介入次數的失能個案，在HPT介入後，日常生活活動功能改善的傾向較高。其結果可供政府規劃中之急性後期照護、長期照護HPT制度參考，在兼顧療效與經濟效益下，提供具改善潛能的失能個案適當的HPT服務資源。

關鍵字

失能 ； 居家物理治療 ； 服務利用 ； 療效 ； 居家健康照護

並列摘要

Background and Purposes: The aim of this study was to investigate the factors that affected the improvement of activities of daily living (ADLs) in clients who had received home-based physical therapy (HPT) under the Ten-year Plan for Long-Term Care project. Methods: This was a secondary data analysis. The data were obtained from the databases of HPT in Taipei and New Taipei City. The delinked data of 717 subjects were collected from January to December in 2012 and each subject had received HPT interventions for at least 2 sessions. The data included socio-demographic data, health functional status, intervention sessions, and Barthel Index (BI) scores. Descriptive statistics, univariate logistic regression, and multiple logistic regression analysis were used in the study. Results: Approximately 35.0% subjects showed improvement in ADLs for at least 5 points in BI after HPT intervention. Multiple logistic regression showed that better strength (odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.43-4.54), stronger willingness (OR = 1.91, 95% CI = 1.20-3.06), shorter-term disability (OR = 1.64, 95% CI = 1.10-2.54), and higher counts of intervention sessions (OR = 1.23, 95% CI = 1.15-1.31) were significantly associated with higher chance in improving ADLs. Conclusions: Muscle strength, personal factors (such as willingness, length of disability), as well as service providing policy (such as the number of intervention sessions) were important factors associated with better outcomes of HPT. The administrators and policy makers should consider these factors when designing the continuation of long-term care and post-acute care policies, in order to improve resource relocation and efficacy of HPT for homebound disabled clients.

並列關鍵字

Disability ； Home-based physical therapy (HPT) ； Utilization ； Effectiveness ； Home health care