職能與物理治療之評估共識：以中風病人「動作恢復」與「平衡」為例

The Evaluation Consensus between Occupational and Physical Therapy: Motor Recovery and Balance in Patients with Stroke

陳明輝(Ming-Hui Chen) ； 宋貞儀(Chen-Yi Song) ； 黃欽聖(Huang-Cin Sheng) ； 黃千瑀(Chien-Yu Huang)

《職能治療學會雜誌》 32卷2期 (2014/12) Pp. 247-268

https://doi.org/10.6594/JTOTA.2014.32(2).03

摘要

職能治療（OT）與物理治療（PT）對中風病人之評估是否一致（評估共識）為跨專業間復健治療計畫擬定之重要影響因素。本研究欲探討中風病人之「動作恢復功能」與「平衡能力」二評量項目於OT與PT之評分一致性與相關性。本研究使用一家醫院OT與PT部門之電子病歷資料庫，篩選民國100年10月到103年5月中風病人之布朗斯壯上肢動作恢復層級（動作恢復功能）與靜動態坐站姿平衡（平衡能力）病歷資料。加權（weighted）Kappa值、評分完全一致百分比（agreement percentage）用來檢驗OT與PT之評分一致性，斯皮爾曼相關係數（Spearman correlation coefficient, ρ）用來檢驗二專業評分之相關性。本研究共有293名中風病人，包括185名男性（63.1%），平均年齡為63.1歲（標準差13.2）。OT與PT於布朗斯壯上肢動作恢復層級有高度評分一致性與相關性（weighted Kappa ≥ 0.75, ρ=0.71-0.72），但評分完全一致比例較低（42.0-42.2%）；靜動態坐站姿平衡有中度評分一致性與相關性（weighted Kappa=0.45-0.63, ρ=0.45-0.62），而評分完全一致比例較高（58.7-71.6%）。OT與PT評分之一致性與相關性尚可接受，但有顯著的進步空間。OT與PT於布朗斯壯上肢動作恢復各層級可共同擬定具體、詳細之評分標準，於靜動態坐站姿平衡可選用相同之標準化評估工具、或選定相同的評分標準。「動作恢復功能」與「平衡能力」二評量項目經修正過後，可做為治療師評估訓練之參考。

關鍵字

中風 ； 評分一致性

並列摘要

The consensus on the evaluation of occupational therapy (OT) and physical therapy (PT) in patients with stroke is important when making the inter-disciplinary intervention plan. Therefore, the aim of the study is to investigate the rating consistency and correlations of Brunnstrom recovery stages (BRS) of the upper limb and static/dynamic sitting/standing balances between OT and PT. The electronic medical records from departments of OT and PT in a local hospital were used. Weighted Kappa, agreement percentages and Spearman correlation coefficients (ρ) were used to examine the rating consistency and correlations of BRS and static/dynamic sitting/standing balances between OT and PT. There were 293 patients with stroke recruited in the study, with 63.1% males (n=185). The average age was 63.1 years (SD 13.2). There were high rating consistencies and correlations of the BRS between OT and PT (weighted Kappa ≥ 0.75, ρ=0.71-0.72), but the agreement percentages were only 42.0 to 42.2%. There were moderate rating consistencies and correlations of static/dynamic sitting/standing balances between OT and PT (weighted Kappa=0.45-0.63), but the agreement percentages were high, ranging from 58.7-71.6%. The rating consistency and correlations of the BRS and static/dynamic sitting/standing balances were acceptable, but had much improvement. Therefore, more concrete content and rating criteria of the BRS should be discussed in OT and PT. In addition, a standard evaluation tool was suggested for measuring balance. The two modified evaluation assessments could be references for therapists' evaluation training in order to achieve high evaluation consensus between OT and PT.

並列關鍵字

Stroke ； Rating consistency