探討影響長期照護機構腦中風住民復健治療與成效相關因素之研究

A study on the Related Factors For the Stroke Patients in Long-Term Care Organization Following Rehabilitation Therapy its Outcome

許擇良(Tse-Liang Shu)

指導教授 ： 李金德

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00005

摘要

本研究目的在探討長期照護機構之腦中風病患之日常生活活動功能之狀況，及其人口學因素、疾病因素、社會經濟因素、機構相關因素與每月復健次數之相關性。為探討中風住民對復健前後各項指標之改善程度，以結構式問卷收集資料，並使用簡易心智狀態問卷(SPMSQ)、中風評估量表(NIHSS)、工具性日常生活量表(IADLs)、巴氏量表(Barthel Score)等評估工具為成效測量指標，比較復健治療之成效與病患日常生活活動指數與複雜性日常活動之相關性。
研究結果發現，長期照護機構腦中風住民認知功能與宗教、管路置放及每月復健次數有顯著相關；腦中風嚴重程度與宗教、經濟來源、探視次數、疾病嚴重程度、併發症及每月復健次數有顯著相關；工具性日常生活活動能力與性別、經濟來源、探視次數、疾病嚴重度及每月復健次數有顯著相關；而執行日常生活活動能力評量結果與年齡、探視次數、併發症及每月復健次數有顯著相關。
人口學因素、疾病因素、疾病因素及機構相關因素評量結果研究顯示，信奉道教者之認知功能評估結果較佳，佛教信仰者腦中風程度評量結果最佳。而女性之工具性日常生活活動能力評估優於男性，65歲以下住民之日常生活活動能力評估成效最佳。而腦中風病況嚴重程度為中度者之腦中風程度評量結果優於重度與極重度者，輕度者之工具性日常生活活動能力優於病況較重者，其日常生活活動能力亦優於病況較重者。經濟來源為來自子女者之腦中風程度評量結果較優，其工具性日常生活活動能力表現也更好；每月探視次數1到5者之工具性日常生活活動能力以及日常生活功能均較佳。放置鼻胃管者之認知功能優於進行氣切與導尿管者，無院內併發症者之腦中風程度評量結果較優。無院內併發症者之日常生活活動表現優，有併發症者之中以肺炎併發症者之日常生活活動能力較佳。
腦中風病患最大的困難為面對日常生活功能的改變，本研究結果可協助增進中風病患發揮存餘的身體活動功能，設立合適的復健治療目標，另外，也能提供政府規劃社會醫療福利措施及後續照護資源等政策上之參考。

關鍵字

長期照護機構 ； 腦中風 ； 簡易心智狀態問卷(SPMSQ) ； 中風評估量表(NIHSS) ； 工具性日常生活量表(IADLs) ； 巴氏量表(Barthel Score)

並列摘要

This study aims to evaluate the daily living activity function of patient with stroke of the long-term care organization, and the relationship between the number of rehabilitation conducted per month and relevant factors of demographic, disease, social economic, and the long-term care organization. Study tools include the collection of secondary materials and survey via questionnaire. After the construction of the study structure, the following 4 indexes, including the SPMSQ, NIHSS, IADLs and Barthel Score, were conducted to evaluate the curative effect after the rehabilitation treatment. A structural questionnaire were conducted with the study target to compare the effect, patient's daily life activity index and relevance of the daily activity of complexity after the rehabilitation treatment.

The study result indicated that the cognitive function was significantlly related to the religious belief, pipeline put and number of rehabilitation treatment per month of stroke patients of long-term care organizations. The degree of stroke was significantlly related to the religious belief, economic source, visit frequency by relatives and friends, disease severity and number of rehabilitation treatment per month. The tool daily life circulation was significanylly related to the sex, economic source, times of visit by relatives and friends, disease severity and number of rehabilitation treatment per month. The carry out daily life circulation was significanylly related to the age, times of visit by relatives and friends, complication and number of rehabilitation treatment per month.
The result of the study of the factors of demographic, disease, social economic, and the long-term care organization, showed that patient with Taoism belief had a better evaluation result. The patients with Buddhism belief had higher scores. Female patient got better scores on tool daily life circulation than male. Patient under age 65 showed better evaluation result of daily life activity. The middle condition severity of strokeal are superior to severe and the extremely severe ones on study of the disease factor reveals. The same results showed in the evaluation of tool daily life circulation and daily life circulation. Patients with economic source from their children were superior to social welfare subsidy patients on social economic factor evaluation. An average 1-5 times of visited by relevansts and friends per month result in better tool daily life circulation and daily life function evaluation. The cognitive function of the patients who puts nasogastric tube is superior to cutting angrily with the catheter person. Petients who doesn't have complication in courtyard displays were superior to have for daily life function evaluation. Patients who have complications, the daily life circulations with pneumonia complication person are relatively good in the person who has other complications.
The stroke patients’ greatest difficulty faced is the change of the daily life function. Result of this is study will be a reference to set up the appropriate index for rehabilitation and to help the stroke patient to extend their body’s function. In addition, this study was expected to offer the government a reference when planning the policy on social medical welfare and long-term healthcare resource allocation.

並列關鍵字

Long-term care organization ； patient with stroke ； Short Portable Mental Status Questionnaire (SPMSQ) ； National institute of Health Stroke Scale (NIHSS) ； Instrumental Activities of Daily Living Scale (IADLs) ； Barthel Index ； BI/activities of daily living (ADL)

參考文獻

一、中文參考資料

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王慧儀、張志仲、宋雲通、林永哲（1991）．中風一年後功能恢復的程度與有關因素之關係．高雄醫學科學雜誌，7，136-142。

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