髖關節骨折急性後期復健照護之長期成效

Long Term Effects of Post-Acute Care Program for Hip Fracture

丁睿宇(Rei-Yu Ding) ； 陳彥方(Yan-Fang Chen) ； 陳慧娟(Hui-Juan Chen) ； 黃冠樺(Guan-Hua Huang) ； 高木榮(Mu-Jung Kao)

《北市醫學雜誌》 16卷3期 (2019/09) Pp. 220-231

https://doi.org/10.6200/TCMJ.201909_16(3).0005

摘要

目的：此試驗的目的在於探討急性後期復健照護計畫對於髖關節骨折術後患者之功能性恢復有無正向之影響。二來研究影響患者術後功能恢復的相關因子，以協助將來制定計劃時能夠找出明顯影響預後之因子加以改善或排除。方法：此研究的設計為一前瞻性研究，將髖關節骨折的患者分為兩組，一組為有接受急性後期復健照護計畫（Post-acute care，PAC）的患者（試驗組），另一組屬於沒有接受急性後期復健照護計畫的患者（對照組）。以單因子變異數分析（ANOVA）來分析試驗組與對照組兩組的各次追蹤之巴氏量表分數有無差異，再以邏輯回歸分析（logistic regression）和線性分析（linear regression）來查看有哪些因子會影響髖關節骨折術後十二個月時的巴氏量表分數。結果：總共有222位受試者，其中189位為試驗組，另外有33位沒有為對照組。受試者的巴氏量表分數，在每一次的評估中試驗組與對照組皆有顯著性的差異。術後首次評估（BI1）時，對照組的平均巴氏量表分數為36.5分，試驗組為26.8分，對照組的分數顯著的比起試驗組來的高。除了上述的術後首次評估（BI1）以外，在術後兩周評估（BI2）、術後三個月評估（BI3）以及術後12個月評估（BI12）這三次皆為試驗組的巴氏量表分數顯著較高。試驗組的平均巴氏量表分數分別為55.7、80.9、86.8，對照組為47.0、65.2、67.2。針對試驗組以及對照組巴氏量表所進步的分數，試驗組平均進步59.4分，而對照組平均進步35.5分，兩者達到統計上顯著差異。患者年齡、照顧者類型、個案是否獨居、鼻胃管使用有無、出院後一年內有無發生重大疾病這五項因子會影響一年後的功能預後。結論：提供髖關節骨折的個案完整的急性後期照護計畫我們可以預期患者在一年的期間中會有更快速且幅度更大的功能恢復。

關鍵字

髖關節骨折 ； 急性後期照護計畫 ； 復健 ； 生活自理能力

並列摘要

Purpose: We planned to evaluate the effects of post-acute care program in patients with postoperative hip fracture and examine the determining factors of long-term outcomes. Methods: Patients were divided into two groups: one underwent PAC program and the other received routine postoperative care. Barthel index was measured in both groups at baseline, 2 weeks, 3 months and 12 months after operation. We conducted an ANOVA to examine the differences of Barthel Index between groups at each time point. Also, linear regression was performed to determine the factors affecting the Barthel Index 12 months after operation. Results: A total of 222 patients were enrolled in this study. The Barthel index scores showed significant changes as time progressed in both groups. At the baseline, the control group had higher Barthel index score compared with the test group (36.5 versus 26.8 points). The changes in Barthel index scores after one-year follow up were 59.4 in the experimental group and 35.5 in the control group, which was statistically significant. Also, age, solitary living or not, types of care provider, use of the nasogastric tube, and incidence of stroke or dementia were influencing factors to functional recovery. Conclusion: Post-acute care program provides faster functional recovery in postoperative hip fracture patients at one year period compared with usual care.

並列關鍵字

hip fracture ； post-acute care ； rehabilitation ； functional recovery