探討腦中風居家模式急性後期照護之成效及預測因子

前言：腦中風是造成成年人失能的主要原因，台灣中央健康保險署自2014年開始以住院模式提供急性後期照護服務，後續亦有實證證實此模式確實能改善整體功能狀態，2017年開始提供腦中風患者居家模式之急性後期照護，卻無研究探討居家模式急性後期照護的成效，因此本研究欲探討以居家模式提供六週急性後期照護所帶來的功能性恢復，並探討影響生活功能進步程度的因素。材料與方法：本研究納入2019年至2021年某地區醫院改良式雷氏中風量表（MRS）3-4級的腦中風個案，進行六週居家模式急性後期照護，在療程前、療程三週時、與六週結案時評估巴氏量表、工具型日常生活量表、功能性經口進食量表、健康相關生活品質量表，並進行統計分析。結果：本研究共納入102位個案，比較療程前、療程三週時與六週結案時各項量表的差異，結果發現六週的居家模式急性後期照護後，巴氏量表、工具型日常生活功能量表、功能性經口進食量表、健康相關生活品質量表的分數皆顯著提升，且六週結案時對比三週各項指標都有顯著、持續性的功能進步（p＜0.05）。包含性別、腦中風種類、腦中風次數、年齡、共病性、營養不良、吞嚥障礙、治療前功能障礙程度的多變項迴歸分析發現營養不良為影響日常生活功能進步的獨立預測因子（p＜0.05）。結論：對於一個月內中度至中重度功能缺損的腦中風病患，六週的居家模式急性後期照護能顯著提升病患的日常生活功能、工具型日常生活功能、吞嚥功能與生活品質，可作為腦中風病患急性後期復健黃金期的治療模式選擇。

關鍵字

腦中風（stroke）；急性後期照護（postacute care）；居家模式急性後期照護（postacute care at home）；日常生活功能（activity of daily living）；巴氏量表（Barthel index）

並列摘要

Introduction: Stroke is the leading cause of disability in adults. In 2014, Taiwan's National Health Insurance Administration started to provide inpatient postacute care, and the results indicated that this model improves the overall functional status of patients with stroke. In 2017, home-based postacute stroke care was initiated; however, no study has evaluated its effectiveness. Therefore, we explored the functional recovery of patients with stroke after 6 weeks of postacute care at home and the factors that influenced their functional improvement. Method: We recruited patients with stroke who received a score of 3 or 4 on the modified Rankin Scale between 2019 and 2021 from a district hospital and underwent 6 weeks of postacute care at home. Their scores on the Barthel Index (BI), Instrumental Activities of Daily Living (IADL), Functional Oral Intake Scale (FOIS) and EuroQol-5 Dimensions (EQ5D) at pretreatment, after 3 weeks of treatment, and after 6 weeks of treatment (i.e., end of treatment) were statistically analyzed. Result: We recruited 102 patients with stroke and compared the differences in their scores on the aforementioned scales at pretreatment, after 3 weeks of treatment, and after 6 weeks of treatment (i.e., end of treatment). The results revealed that after 6 weeks of postacute care at home, the patients' scores on the Barthel index, instrumental activities of daily living scale, functional oral intake scale, and health-related quality of life scale all increased significantly. Furthermore, the scores acquired after 6 weeks of treatment indicated a significant and continual functional progress relative to those acquired after 3 weeks of treatment (P ＜ 0.05). A multivariable regression revealed that malnutrition was the independent predictor that affected the patients' improvement in their activities of daily living (P ＜ 0.05). Conclusion: For patients who experienced a moderate to severe level of functional impairment within 1 month after a stroke, a 6-week home-based postacute care program can significantly improve their activities of daily living, instrumental activities of daily living scale, swallowing function, and quality of life. The treatment can serve as an option for patients with stroke during a crucial period of their postacute rehabilitation.

並列關鍵字

stroke ； postacute care ； postacute care at home ； activity of daily living ； Barthel index

參考文獻

Lee HC, Chang KC, Lan CF, et al. Factors associated with prolonged hospital stay for acute stroke in Taiwan. Acta Neurol Taiwan 2008;17:17-25.

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Peng LN, Lu WH, Liang CK, et al. Functional outcomes, subsequent healthcare utilization, and mortality of stroke postacute care patients in Taiwan: a Nationwide Propensity Score-matched Study. J Am Med Dir Assoc 2017;18:990.e7-12.

Huang HC, Tsai JY, Liu TC, et al. Functional recovery of stroke patients with postacute care: a retrospective study in a northern medical center. J Chin Med Assoc 2019;82:424-7.

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