把握黃金復健時間提升中重度腦中風急性後期照護療效

The Optimal Rehabilitation Time Course for Moderate to Severe Stroke Patients in Post-acute Care

冼鴻曦(Hong-Hsi Hsien) ； 劉文欽(Wen-Chin Liou) ； 楊儀華(Yi-Hua Yang) ； 羅文聰(Wen-Tsung Lo)

《台灣老年醫學暨老年學會雜誌》 16卷4期 (2021/11) Pp. 278-289

https://doi.org/10.29461/TGGa.202111_16(4).0002

摘要

目的：探討腦中風患者經過不同時程的急性後期照護之後，是否各項功能有不同的改善程度，並分析急性後期照護最適當的復健治療時程。方法：收錄本院腦中風急性後期照護結案人數共655人為研究對象，以前瞻性世代研究法登錄每位病人的評估量表，比較於收案與結案時量表的分數差異與不同的復健時程分別為3週組、6週組及9週組進行統計分析。結果：住院週數與各變項進步分數的單因子變異數分析研究發現，住院3週組無論在巴氏量表、吞嚥功能、營養評估、健康相關生活品質、感覺與動作功能、認知功能、語言功能的進步分數都顯著差於6週組或9週組。巴氏量表的分數進步在9週與6週兩組之間無差異，可知巴氏量表在6週的復健之後已經可以達到最佳穩定的進步狀態。其他如營養、吞嚥、認知、感覺與動作和語言功能在6週之後仍然有進步的潛能。巴氏量表的進步與住院週數之迴歸模型顯示，6週組相較於3週組對於巴氏量表的進步有顯著的高勝算，9週組雖然不達顯著，但是相較於3週組對於巴氏量表的進步亦有較高的勝算趨勢。結論：腦中風急性後期照護的經驗顯示，在發病後黃金治療期間的積極復健可降低病患的失能程度進而能減輕家庭與社會的負擔。本研究發現復健6至9週的進步最佳，而3週的復健時程不足以達到較佳的功能進步。

關鍵字

腦中風 ； 急性後期照護 ； 日常生活功能 ； 復健治療時程

並列摘要

Objective: To assess the optimal rehabilitation time course of post-acute care (PAC) program on functional improvement for stroke patients. Methods: This prospective cohort study enrolled 655 patients of stroke from March 1, 2014 to June 30, 2020. Patients were divided into three groups each of which had its own rehabilitation time course (3-week, 6-week, and 9-week respectively). Functional improvement based on 14 measurement scales was assessed by examining the differences of each group during the hospitalization for post-acute care. Data were analyzed using descriptive statistics (correlation and one-way ANOVA) to examine the effects of the three different rehabilitation time courses on the probability of functional improvement. Binominal logistic regression was used to predict improvement in the activities of daily living (ADL) among the three different groups. Results: Of the three different groups by rehabilitation time course, the functional improvement of the 3-week group appeared to be inferior to that of 6-week and 9-week groups. The patients had reached their best ADL function (Barthel index score) within 6 weeks from the beginning of the PAC program, and there is no difference between the 6-week and 9-week groups. The recovery in terms of nutrition, swallowing, cognition, sensorimotor function and language remained in progress from the 6^(th) to the 9^(th) weeks. The results of binominal logistic regression analysis indicated that the 6-week group was significantly related to ADL improvement (OR=2.48, 95% CI 1.17-6.26). The 9-week group was also positively associated with ADL improvement (OR=2.16, 95% CI 0.69-6.76) as compared to the 3-week group. Conclusion: PAC program promotes functional recovery and decreases the severity of dependency for stroke patients. The optimal rehabilitation time course of a PAC program for stroke patients ranges 6 to 9 weeks. The program should be implemented to provide better care and reduce the severity of disability for stroke patients.

並列關鍵字

stroke ； post-acute care ； activities of daily living ； rehabilitation time course