• 期刊

【論文摘要】物理治療師投入輔助科技產業之決策歷程與工作經驗

背景與目的：我國於2018年邁入高齡社會，老年人口與失能人口的輔具需求隨之提升，同時也將帶起輔助科技產業的發展。目前已有物理治療師進入輔助科技產業任職，然針對物理治療師在工作與就業的研究非常有限，且無研究探討物理治療師在輔助科技產業之工作與就業。本研究目的為探討物理治療師投入輔助科技產業之決策歷程與工作經驗。方法：本研究採質性研究之紮根理論研究法，以理論性選樣，並用滾雪球方式進行取樣。研究樣本數以蒐集資料達飽和便停止收案。本研究共完成9位年齡介於25至49歲，且目前專職於輔助科技產業一年以上之物理治療師的訪談。研究以自行設計之半結構式訪談指引進行一對一深入訪談。於訪談結束後將錄音轉成逐字稿，並以持續比較分析法進行分析。收案時間為2018年12月至2019年6月。研究的嚴謹度依據Lincoln及Guba（1985）對質性研究所提出四方面評鑑標準，含確實性、可轉移性、可靠性及可驗證性。結果：本研究發現核心類屬為「追求獨立自主與創造性的職業生涯」，其引導物理治療師投入輔助科技產業的整個過程。「投入產業的拉力與推力」為此過程的先驅類屬，當物理治療師受興趣與外在環境等影響時，即進入「初手到入門」過程。此過程有以下六個互動行為類屬：「輔助科技產業前後的入門學習」、「產業內著手的工作範疇」、「現實與理想間的差距」、「充滿未知的迷茫」、「企業氛圍」及「進修與再學習」。物理治療師在產業工作過程中遇到挑戰與困境，便進入提升自我能力的情境中。最終的結果類屬為物理治療師在工作過程中得到「工作成就之樂趣」。結論：輔助科技在物理治療教育較不受重視，故有數位受訪者是經由投入輔助科技相關產業才得以深度認識輔助科技。而任職於輔助科技產業者，需加強不同專業的能力，包括輔具實作層面、商業層面、醫療器材與輔具補助法規層面。臨床意義：為了使物理治療科系之學生職涯發展擴及至輔助科技產業，建議各大專院校能加強輔助科技相關課程。而欲投入輔助科技產業之物理治療師，其自身應朝多面向專業努力精進，提升自我競爭力並建立獨特性，在產業中創造屬於自我的工作價值。

• 期刊

【論文摘要】Interview With Parents of School-Aged Taiwanese Children With Attention Deficit Hyperactivity Disorder: The Preliminary Findings

Background and Purpose: Attention deficit hyperactivity disorder (ADHD) affects 5% of children worldwide. Recent research has highlighted the importance of understanding the lifestyle of children with ADHD and the benefits of exercise for these children. Parents or caregivers are often looking for suitable exercise programs for their children with ADHD who are not necessarily motivated or engaged in physical activity. The present research used the qualitative design that research team has been translated from the same questions implied in Australia to identify specific needs and critical factors in promoting exercise programs for Taiwanese school-aged children with ADHD. Meanwhile, the in-depth interview with parents aimed to identify individual challenges and preferences in school-aged children with ADHD not only in the participation in exercise programs but in the typically daily life. Methods: The ongoing semi-structured interview study had completed two parent interviewees (mean age = 36.00 ± 2.83 years old) caring a 8 to 12 year-old child with ADHD. Content analysis was conducted to abstract themes and categories on children’s physical activity, management strategies, strength, and challenges in daily life with a coding system that was developed from the interview data. Results: In the preliminary interview findings, the coding achieved good inter-rater reliability (kappa = 0.78) while the number of meaning units in each interview ranged from 65 to 349 (Mean = 198.10 ± 72.72). In the inductive content analysis of the abstraction process, 57 categories under 10 themes emerged from 220 meaning units. According to the core theme, exercise was discussed in 50 meaning units. Both parents viewed exercise could bring benefits both in the physical and psychological effects. Furthermore, these interviewees shared their suggestions that a well-structured, small group, and the close supervision programs for exercise intervention for children with ADHD will be adequate for more children with ADHD to engage. Conclusion: In this preliminary report, parents that are raising school-aged children shared the benefits and challenges in the participation of physical activity program and related issues in caring children with ADHD. The current interview study will be an ongoing project will keep recruiting interviewees to meet the saturation level. Therefore, researchers could make the cross-cultural comparison to research findings that had been explored in Australia. Clinical Relevance: Attending to parents' voice and responses, the current interview study aimed to elaborate the perceived effects and challenges in promoting exercise programs for children with ADHD. Further implications for research and practice will be discussed in how to promote exercise as a daily routine in children with ADHD and the findings will adopt the cultural comparison between Taiwan and Australia.

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【論文摘要】Effect of Exercise Intervention on Cardiac Function and Exercise Capacity in Breast Cancer Patients Receiving Chemotherapy

Background and Purpose: Reviewed studies have shown, breast cancer patients were observed decreased in left ventricle function and increased the risks of heart failure and cardiovascular disease after receiving chemotherapy. Exercise capacity associated with peak VO_2 reduction were also found in breast cancer survivors and patients receiving chemotherapy that was significant related to prognosis and over-all mortality. Previous studies have shown exercise intervention was effective in improving cardiac function in heart failure patients and exercise capacity among breast cancer survivors to reduce risk of cardiovascular disease. However, most of the current study results of exercise intervention limited to breast cancer survivors. Studies of exercise training in breast cancer patient during chemotherapy were insufficient and inconsistent. In order to prevent subsequent cardiac side effects of chemotherapy, this study aimed to evaluate the effect of early exercise intervention on cardiac function, cardiac fitness, and exercise capacity in breast cancer patients during chemotherapy. Methods: This randomized control trial enrolled breast cancer patients to investigate the effect of exercise training during chemotherapy in subclinical cardiotoxicity and exercise capacity compared to usual cancer care. Participants were randomly assigned to either exercise training group (EX) with 24 sessions of program lasting for 3 months combined with aerobic, resistance and flexibility training, or control group (CTL) that was under usual cancer care. The primary outcome was left ventricular cardiac function examined by 2D and M-mode echocardiography before and 3 months after starting chemotherapy and the variables of cardiopulmonary exercise test that was test at baseline, 1.5 months and 3.0 months. The secondary outcomes were hemodynamic responses of 3-min-step test evaluated at baseline, 1.5 months and 3.0 months after starting chemotherapy. Results: A total of 16 breast cancer patient was involved in this study (EX: n = 10; CTL: n = 6). Left ventricle ejection fraction (LVEF) was significantly higher in EX (72.67%) in contrast with reduction in CTL (from baseline to 3.0 months: 70.22% to 63.95%). Peak VO_2 was significantly different between groups at 3.0 months after starting chemotherapy (EX vs. CTL: 14.0 vs. 11.8 mL/kg/min). The results of 3-min-step test were found no intragroup or intergroup difference. Conclusion: Exercise during chemotherapy prevents deterioration of LVEF and improve cardiac capacity in peak VO_2 in breast cancer patients. Clinical Relevance: The results suggested exercise intervention during chemotherapy prevents deterioration of cardiac function and improve cardiac capacity in breast cancer patients.

• 期刊

【論文摘要】以社區夥伴關係提供居家衰弱長者體能促進活動之成效初探：物理治療師、志工及學生之團隊協力模式

背景與目的：衰弱（frailty）容易發生失能、住院、死亡等負面結果。透過陽明大學社會責任（University Social Responsibility, USR）「培力社區發展在地安老整合型服務計畫」之推動，結合跨校系資源，透過在地社區夥伴關係建立，探討居家型式體能促進及預防延緩失能活動對於社區衰弱長者的介入成效。方法：本研究屬「類實驗型研究設計（quasi-experimental study design）」；從2019年2月開始自臺北市北投區及新北市三芝區招募符合收案標準，年齡≥ 65歲的居家衰弱長者，依據其配合意願與可行性分配為運動介入組與對照組。結合物理治療師、社區志工及高齡照顧系學生形成居家訪視小組，並開設培訓課程加強社區志工及學生簡要的運動介入要領。由物理治療師評估介入前長者之身體功能、環境障礙及生活照顧問題來形成個人化之運動計畫，由團隊執行每週2次、每次40～50分鐘、為期三個月之居家型體能促進及預防延緩失能活動介入。運動內容包含暖身運動、有氧運動、肌力運動、平衡與柔軟度運動。成效評量工具包括：基本生理資料（身高、體重、身體質量指數 [body mass index, BMI]）、體適能檢測（握力、2.44公尺起身繞行測驗、2 分鐘踏步測驗和單腳站平衡測試）、Fried衰弱指標、身體活動量量表（International Physical Activity Questionnaire, IPAQ）、de Morton Mobility Index （DEMMI）量表、簡短身體功能量表（Short Physical Performance Battery, SPPB）及修正式巴氏量表。結果：共有40位衰弱長者參與此項研究，介入組與對照組各20位；受試者之平均年齡為82.7歲，75%為女性。在經過12週的運動介入後，介入組相較於對照組在多數成效評量項目呈現明顯進步，兩組於前、後測變化達到組間顯著差異，包含：體重（p = 0.004）、BMI（p = 0.005）、收縮壓（p = 0.028）、握力（p ＜0.001）、3公尺行走速度（p ＜ 0.001）、2分鐘踏步測驗（p = 0.018）、身體活動量（p = 0.001）、DEMMI量表（p ＜ 0.001）、SPPB（p ＜ 0.001），及修正式巴氏量表（p ＜ 0.001）。結論：本研究針對衰弱長者進行12週的居家型體能促進與延緩失能活動，對衰弱長者在身體組成、身體適能、活動變化量、身體功能表現和日常生活功能均有顯著改善。臨床意義：未來仍需探討此種透過社區團隊協力的居家運動介入模式是否可以推廣到別的社區。

• 期刊

【論文摘要】復健治療對於老人髖部骨折術後三年內再住院與死亡風險之影響：以全民健保百萬人世代追蹤抽樣檔為基礎之縱貫性追蹤研究

背景與目的：髖關節骨折會導致失能、功能性活動能力下降，已被視為重要的老年醫學議題。本研究使用全民健保百萬人世代追蹤抽樣歸人檔（Longitudinal Health Insurance Database 2000, LHID2000）進行分析，研究目的為分析在全民健保醫療體系下：（1）臺灣初次髖關節骨折術後患者其復健治療的利用情形；（2）初次髖關節骨折術後患者其復健介入對於三年內再住院與死亡風險之影響；（3）檢驗上述影響是否對於不同手術類型、年齡層、性別、住院天數或共病症多寡呈現不同效應；（4）進行再住院原因分析，探討初次髖關節骨折術後的復健介入對於各種不同再住院原因之影響。方法：自全民健保抽樣歸人檔擷取2001至2008年間曾接受手術之首次髖關節骨折長者（年齡 ≥ 65歲），往後追蹤三年。並將復健介入分為三個模型進行分析，模型一：有／無復健介入；模型二：無介入／只做院內復健／只做門診復健／院內及門診復健皆有介入；模型三：無介入／介入1～3次／介入大於4次。以多變項存活迴歸模型（Cox proportional hazards model）檢驗復健介入對於三年內再住院與死亡風險之影響，繼而進行次族群分析。觀察事件包含：（1）事件一（Event1, E1）：三年內再住院或死亡；（2）事件二（Event2, E2）：三年內死亡。結果：共擷取4,522名個案中，其中有復健介入為1,947名（43.1%），無復健介入個案為2,575名（56.9%）。復健介入族群比起無復健介入族群，其E2風險顯著較低（HR = 0.76, 95% CI = 0.66 ～ 0.88）；其中又以「同時接受院內及門診復健」（HR = 0.64, 95% CI = 0.46 ～ 0.89）及「復健介入大於4次」（HR = 0.63, 95% CI =0.49 ～ 0.80）效益更為顯著。相對地，只執行門診復健者其E1風險反而提高；其他復健介入模式則對E1沒有顯著影響。就E2所作次族群分析顯示，「接受內固定手術」、「男性」以及「共病症分數較高」者於E2降低更為顯著。結論：復健介入對於髖關節骨折術後老年患者，能降低其三年內死亡風險；尤其同時接受門診及院內復健者其效益更為顯著。然而復健介入並未能降低，甚而還提高三年內之「再住院或死亡」風險；推測可能是因為出院後發現功能復原不理想，才前往接受門診復健介入所導致的「個案選擇性偏差」。臨床意義：本研究對於老年髖部骨折術後復健治療之介入效益提供不同面向以及較長期之實證研究資料，期能做為決策單位擬訂跨團隊復健照護模式與支付制度之參考。

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【論文摘要】Reliability and Validity of the Modified Figure of Eight Test in the Community-Dwelling Older Adults

Background and Purpose: To examine the relative reliability, absolute reliability and convergent validity of the modified figure of eight (MFE) test in two testing situations (natural-walk and tandem-walk) for community-dwelling older adults. Methods: A total of 52 community-dwelling older adults (9 male/43 female) participated in the study (age: 69.6 ± 3.8 years). The MFE test was administered twice, within 5–7 days. Intra-class correlation coefficient (ICC_(3,2)) was used as a relative reliability index. Absolute reliability indices, including the standard error of measurement (SEM), the minimal detectable change at the 95% confidence level (MDC_(95)), and the Bland- Altman method, were used to define the extent of measurement error. The one leg stance (OLS), timed up and go test (TUG), walking-speed test (WS), and functional gait assessment (FGA) were tested for convergent validity. Pearson's correlation coefficient (r) and Spearman's correlation coefficient (r_s) were used to determine the relationship among the MFE, OLS, TUG, WS, and FGA tests. Results: Test-retest agreements were moderate to high (ICC_(3,2): 0.73 ~ 0.93). The SEM of the MFE in natural-walk testing situation for times and oversteps were 2.34 sec and 0.42 steps, respectively; in tandem-walk testing situation for times and oversteps were 3.45 sec and 0.66 steps, respectively. The MDC_(95) of the MFE in natural-walk situation for times and oversteps were 6.48 sec and 1.16 steps, respectively; in tandem-walk testing situation for times and oversteps were 9.55 sec and 1.83 steps, respectively. The correlation coefficient between the natural/tandem walk testing situation and OLS and FGA showed a significant negative correlation (r = -0.47 ~ -0.58, p ＜ 0.05). Conclusion: The reliability and validity of the MFE in two testing situations were moderate to high for community-dwelling older adults, especially in the scoring method of oversteps. Clinical Relevance: These results indicate that the MFE are useful for clinicians and researchers for the evaluation of balance function/walking ability for community-dwelling older adults who had good physical performance.

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【論文摘要】醫學中心復健科運動治療室空氣品質與熱環境之改善策略

背景與目的：復健科運動治療室內的空氣品質與熱環境狀態會直接影響到正在執行復健任務的病人與專業醫療人員的身心狀態。本研究的目的是想瞭解平時運動治療室內的熱環境與空氣品質狀態，並試圖尋求改善方法以維護內部人員的身心健康。方法：（1）利用空氣品質監測儀，調查白天工作時運動治療室內各時段熱環境（溫、溼度）與空氣品質狀態（二氧化碳濃度、懸浮微粒PM2.5），並觀察與當時人流量的相關性及因素探討；（2）在室內熱環境與二氧化碳濃度超過安全狀態時，當下採取以人流疏散與情境控管為內容的「警示緩解策略」來進行環境改善，並觀察成效。結果：（1）根據連續兩個月共380筆環境監測數據及室內人數觀察結果發現，平時室內的平均二氧化碳濃度為766.8 ± 112.8 ppm，溫度為22.6 ± 1.4˚C，濕度為70.9 ± 6.2%，懸浮微粒PM2.5為11.9 ± 7.9 μ/m^3；平均觀察人數則依時段而有所不同，以上午9～10點與下午2～3點間人數顯著較多（前者27.9 ± 11.5人，後者26.4 ± 6.6人）。利用關聯性分析結果顯示：室內二氧化碳濃度與當下人數和溫度存在顯著正相關，前者呈現中到高度正相關（r=0.69, p＜0.05），後者呈現中度正相關（r=0.54, p＜0.05），與溼度和懸浮微粒PM2.5則無明顯相關（p＞0.05）。（2）經過10次「警示緩解策略」的執行結果顯示：在策略啟動後，室內人數與二氧化碳濃度有達統計上的緩減成效（p＜0.05），減少的人數（中位數）為9人，降低的二氧化碳濃度（中位數）為32 ppm。結論：本醫學中心復健科運動治療室內的平均二氧化碳濃度，在平時工作期間符合環保署規定的1,000 ppm以下的標準，但在每日高峰期間（上午9～11點與下午2～4點）仍存在超標風險；然而利用「警示緩解策略」的實施，對於當下較高的二氧化碳濃度與人流量確實能達到統計上的緩減效果。臨床意義：利用室內空氣品質監測儀配合「警示緩解策略」的實施，可以協助監控維護臨床的復健環境，以預防環境熱危害和缺氧風險的發生。

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【論文摘要】Effects of Kinesiology Taping With Exercise on Clinical Performance and Posture in Round Shoulder Subjects With Subacromial Pain Syndrome: A Single-Blinded Randomized Controlled Trial

Background and Purpose: Subacromial pain syndrome (SAPS) is a common diagnosis in shoulder region and round shoulder posture (RSP) is believed to be one of risk factors resulting in SAPS. Treatment strategy for subjects with SAPS has been focused on posture correction exercises. Despite moderate to large improvements in functional ability and pain with exercises, RSP remains in SAPS. Application of taping with exercise may have an additional effect on posture correction. The aim of this study was to compare the effects of exercise intervention with and without kinesiology taping in RSP subjects with SAPS. Methods: Subjects diagnosed with SAPS and RSP (acromial distance ≥ 2.6 cm) were recruited and randomly allocated to kinesiology taping or placebo taping group. Shoulder angle (SA), pain score, Taipei, Taiwan and self-reported Flexilevel Scale of shoulder function (FLEX-SF) were assessed before allocation. Kinesiology taping group received taping with 35–40% stretch while placebo taping group received taping without tension applied. Both groups underwent the same exercise protocols consisting of side-lying external rotation, prone horizontal abduction with external rotation, prone extension, and pectoralis minor stretching. Subjects received the intervention two times per week lasting for four weeks. Outcomes including pain, FLEX-SF, and SA were assessed at baseline, week 2 and week 4. Results: Thirty-six RSP subjects with SAPS participated and 2 subjects in placebo group dropped out. Only significant main effect of time (p = 0.027) was found in FLEX-SF. Greater decrease in pain level was correlated with improved functional performance in both groups (kinesiology group: r = -0.76, p ＜ 0.0005; placebo group: r = -0.67, p = 0.008). There is no significant interaction effect and main effect in SA. Significant correlation between posture and pain was found in kinesiology taping group (r = -0.60, p = 0.018). Conclusion: Significant improvement on functional performance was found in both groups after 4-week exercise intervention with or without kinesiology taping. Improvements in clinical symptoms were related to better posture. Clinical Relevance: Pain and function can be improved with exercise program in subject with SAPS and RSP However, taping treatment may not add an additional effect.

• 期刊

【論文摘要】物理治療師臨床教師教學能力評量結果及統計分析：以中部某區域教學醫院為例

背景與目的：依據本院師資培育暨評量辦法第六項評量辦法：教師應接受教學評量考核，透過學員評值教師、教師自評及主管評值教師，評量教師教學成效，教師教學評量未達平均分數3.5分要求時，應進行原因分析、檢討、輔導及協助教師改善，以瞭解教師教學困難，並定期檢討師資培育辦法及分析執行成效，適時修訂師資培育訓練計畫。以提升教師教學力及教學品質，使其成為優良教師。方法：教師教學評量項目包含學員評值教師、教師自評、主管評值教師等三種方式，參與評值教師學員有5位，受評值臨床教師有4位，資料收集期間為2018年1月至12月，依李克式量表（Likert scale）五分法計分：「很滿意」為5分、「滿意」為4分、「尚可」為3分、「不滿意」為2分、「很不滿意」為1分。針對教師三項評量結果以Excel 2007版本進行統計及分析。結果：（1）學員評值教師評量結果4.5分達4分滿意，其中學員對教師評量最滿意項目以「具備足夠的專業知識，能解答學員在課程上的疑問」、「能依據學員需求，提供指導，設計適合學員的教學活動」等二項之滿意度為4.6分為最高；（2）教師自評評量結果4.0分達4分滿意，其中教師評量最滿意項目以「提供適當的操作練習，使學員熟練學習內容」之滿意度皆為4.6分最高；（3）主管對教師評值評量結果為4.1分達4分滿意，其中主管對教師評量最滿意項目以「樂意與學員親近，保持良好的互動」、「運用正向溝通技巧，鼓勵學員表達」等二項之滿意度為4.3分最高。結論：學員評值教師評量分數為4.5分達4分滿意，發現教師教學依據學員需求，設計適合學員的教學活動及有效的運用各種教學方法，以符合學員的學習程度及清楚學習目標。教師教學評量結果被評量教師分數皆大於平均分數3.5分／年要求，醫學教育委員會會議依據師資培育辦法第七項：各科室排序前10%者遴選出年度最佳優良教學教師辦理，遴選本組1位優良教師，鼓勵教師教學認真、積極及盡職表現，院長並於員工座談會表揚。臨床意義：臨床教師教學能力評量是評估臨床教師教學成效，評量合格者教師表示具有教學專業能力，臨床教師運用各種教學方法教導學員專業知識及臨床技能，能提昇醫療品質及病人安全。

• 期刊

【論文摘要】The Balance Ability in Elderly With Heart Failure

Background and Purpose: Fall is one of the most important factor in causing hospital admission or death in older adults. Congestive heart failure (CHF) was common chronic disease in elderly. CHF patients have typical symptoms (e.g., breathlessness, ankle swelling, and fatigue) may be resulting poor balance ability and increasing fall risk. However, the past studies related to CHF in elderly focus on muscle strength, cardiopulmonary function and quality of life, there were no studies exploring the relationship about CHF and falls in elderly. The aims of this study were to assess the balance ability in the elderly with CHF using Berg Balance Scale (BBS), to realize balance skill and to prevent the fall risk in different stage with CHF in elderly. Methods: This study included 32 elderly patients with CHF in cardiology department in Cathay General Hospital. WHO Quality of Life- BREF (WHOQOL-BREF) was used to assess quality of life, BBS to assess balance status and falls risk. The relationship between BBS variables was analyzed by Mann-Whitney U test, Kruskal wallis test and Spearman’s correlation. Result: Lower BBS score significantly associated with older age (p = 0.033), advanced New York Heart Association (NYHA) class (p = 0.002), and hypertension (p = 0.014) in CHF patients. Significant positive bivariate correlation was found between BBS score and WHOQOL-BREF score (p = 0.002). No significant differences were observed in the heat rate, LVEF, and haemoglobin. Conclusion: This study concluded that the elderly CHF patients with more advanced NYHA class had lower BBS scores. Clinical Relevance: Our results provide important information that these patients have the higher risk of falling and worse quality of life. Suggesting that patients should be received early rehabilitation intervention and balance training to decrease the risk.