影響物理治療對腦中風急性後期照護成效之因素

Factors Affecting Efficacy of Physical Therapy on Post-Acute Care of Cerebrovascular Diseases

陳慈吟(Tzu-Yin Chen) ； 蔡青芳(Ching-Fang Tsai) ； 石佳隴(Chia-Lung Shih)

《台灣醫學》 26卷1期 (2022/01) Pp. 1-9

https://doi.org/10.6320/FJM.202201_26(1).0001

摘要

衛生福利部於2014年推動腦中風急性後期照護計畫（Post-acute care-cerebrovascular diseases，PAC-CVD），提供腦中風病人住院早期高強度復健。本篇研究目的以嘉義某區域教學醫院為例，探討年齡、性別、病理型態、嚴重程度、PAC住院天數對物理治療介入PAC-CVD之成效的影響。採用病歷回溯設計方法，分析2018年1月至2020年12月160名腦中風病人。在接受PAC-CVD物理治療介入後，結果顯示改良式雷氏量表（modified Rankin scale, MRS）（3.92 vs. 3.18, p＜0.001）、巴氏量表（Barthel index, BI）（32.28 vs. 63.66, p＜0.001）、伯格氏量表（Berg balance scale, BBS）（17.44 vs 33.42, p＜0.001）、5公尺行走速度（5-meter walking speed）（0.10 vs 0.38, p＜0.001）、6分鐘行走測試（6-minute walking test, 6MWT）（31.79 vs. 113.24, p＜0.001）皆有顯著進步。相較於高齡組，非高齡組在BI（37.42 vs. 27.55, p＜0.001）、BBS（19.85 vs. 13.52, p=0.001）、5公尺行走速度（037 vs. 0 22, p=0.003）、6MWT（109.83 vs 63.49, p=0.01）有顯著進歩。腦出血病人相較於腦梗塞病人在BBS（14.71 vs. 19.02, p=0.043）有顯著進步。然而，腦中風嚴重程度並不會影響所有參數的改變量。相關性分析結果顯示，年齡與MRS改變量呈正相關（r=0.30, p＜0.001），但與BI（r=-0.31, p＜0.001）、BBS（r=-0.29, p＜0.001）、5公尺行走速度（r=-0.33, P＜0.001）、6MWT（r=-0.28, p＜0.001）改變量呈負相關；病理型態與BI（r=0.16, p=0.038）、BBS（r=0.16, p=0.044）改變量呈正相關；PAC住院天數與BI（r=0.28, p＜0.001）、BBS（r=0.19, p=0.017）改變量呈正相關。複迴歸分析結果顯示，非高齡組在BI（β=6.89, p=0.016）、BBS（β=4.84, p=0.021）、5公尺行走速度（β=0.14, p=0.013）、6MWT（β=43.94, p=0.019）之改變量，顯著的優於高齡組。本篇結論為接受PAC-CVD物理治療介入後對於腦中風病人的功能性恢復是有利的，尤其非高齡族群的成效更為顯著。

關鍵字

腦中風急性後期照護 ； 改良式雷氏量表 ； 巴氏量表 ； 平衡 ； 行走

並列摘要

In 2014, the Ministry of Health and Welfare lunched the post-acute care-cerebrovascular diseases (PACCVD) plan to provide hospital acute stage stroke patients with high intensity rehabilitation. The aim of this study was to investigate the effect of age, sex, stroke type, initial MRS and PAC hospital days on the efficacy of physical therapy for PAC-CVD in a Chiayi regional teaching hospital. A retrospective study was performed by medical chart review of 160 stroke patients from January 2018 to December 2020. After the intervention of PAC-CVD, there were significant improvements in modified Rankin scale (MRS) (3.92 vs. 3.18, p＜0.001), Barthel index (BI) (32.28 vs. 63.66, p＜0.001), Berg balance scale (BBS) (17.44 vs. 33.42, p＜0.001), 5-meter walking speed (0.10 vs. 0.38, p＜0.001) and 6-minute walking test (6MWT) (31.79 vs. 113.24, p＜0.001). Compared to the aged group (＞65 years), non-aged group (≤65 years) showed significant difference in the change of BI (37.42 vs. 27.55, p＜0.001), BBS (19.85 vs. 13.52, p=0.001), 5-meter walking speed (0.37 vs. 0.22, p=0.003), 6MWT (109.83 vs. 63.49, p=0.01). Patients with hemorrhagic stroke had better improvement in BBS than patients with ischemic stroke did (14.71 vs. 19.02, p=0.043). However, the initial degree of disability measured by the MRS did not affect other variables. In correlation analysis, age showed a positive correlation with the change of MRS (r=0.30, p＜0.001), but negative correlation with the change of BI (r=-0.31, p＜0.001), BBS (r=-0.29, p＜0.001), 5-meter walking speed (r=-0.33, p＜0.001) and 6MWT (r=-0.28, p＜0.001). The positive correlation was found between types of stroke and the change of BI (r=0.16, p=0.038), BBS (r=0.16, p =0.044), and between PAC hospital day and the change of BI (r=0.28, p＜0.001), BBS (r=0.19, p=0.017). Multiple regression analysis showed that the non-aged group had significant improvement in BI (β=6.89, p=0.016), BBS (β=4.84, p=0.021), 5-meter walking speed (β=0.14, p=0.013), 6MWT (β=43.94, p=0.019) compared to the aged group. In conclusion, the PAC-CVD program which provided early intervention with physical therapy demonstrated significant functional recovery in stroke patients, especially in the non-aged group.

並列關鍵字

post-acute care-cerebrovascular diseases ； modified Rankin scale ； Barthel index ； balance ； ambulation

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