- 學位論文
腦中風病人接受早期活動之成效：系統性文獻回顧
Effectiveness of Early Mobilization in Patients with Stroke: A Systematic Review
摘要
研究背景：腦中風是致殘率極高的疾病。隨著存活率的上升，腦中風後因神經肌肉受損或治療需要導致病人產生制動，而制動帶來的合併症擴及生理及心理，會使病人的預後變差、生活品質下降，甚至死亡。文獻指出透過早期活動能減少制動的合併症、改善病人的功能結果、提高認知能力及心理健康。 研究目的：探討腦中風病人早期活動的型態及介入內容（開始時間、頻次），探討腦中風病人早期活動的生理及心理成效。 研究方法：本研究以系統性文獻回顧方式探討早期活動於腦中風病人之成效。搜尋PubMed、EBSCO、ProQuest、華藝線上圖書館及台灣碩博士論文網共5個資料庫，搜尋關鍵字包含含腦中風（stroke）、蜘蛛膜下腔出血（subarachnoid hemorrhage, SAH）、腦出血（cerebral Hemorrhage）、顱內出血（intracranial hemorrhage）、梗塞性腦中風（ischemic stroke）、出血性腦中風（hemorrhagic stroke）、腦血管意外（cerebrovascular accident, CVA）、梗塞（infarction）、早期活動（early ambulation; early mobilization; early mobility）、早期復健（early rehabilitation）、早期物理治療（early physiotherapy）。文獻的納入條件包含：（一）研究對象為住進加護病房或中風專科單位且年齡≧18歲之中風病人；（二）介入措施為早期活動且介入時間在腦中風後72小時內；（三）研究設計為隨機對照試驗；（四）發表語言為中文或英文；（五）研究目的為探討接受早期活動的成效；（六）發表時間無起始限制但截止至2019年3月6日。使用CASP評估工具進行文獻品質的評定。 研究結果：總共納入13篇文獻共8項研究，研究對象共2,881人次，平均年齡為67.58歲，以梗塞性腦中風為多數，佔81.4%（2,345人次），出血性腦中風佔18.6％（536人次）。建議早期活動的型態應為漸進式活動，自中風後24小時內先搖高床頭、翻身擺位，24小時至48小時進行坐、站、行走及生活功能訓練，活動頻率為每周5天，每天2次，每次30-60分鐘，活動期間依病人耐受性決定，持續至病人出院。早期活動能增加日常生活功能、減少合併症、增加存活率、減少住院天數、降低憂鬱及焦慮程度，但在認知功能則無顯著差異。 結論：中風病人入院後透過漸進式的早期活動對病人是有助益的，但本研究尚無法針對特定中風類型給予個別的活動內容以及每個活動階段應持續的時間給予建議，另外，有多個指標僅單一研究探討，無法進行比較。
並列摘要
Background: Stroke is a disease with high disability rate, with neuromuscular disability or treatment leading to a high probability of patient immobility. Immobilization has many complications including both physiological and psychological effects that worsen patient outcomes, decrease quality of life, or can lead to mortality. Early mobilization can reduce the complications of immobility, improve patients’ functional outcomes, cognitive ability, and mental health. Purpose: Firstly, to understand the intervention of early mobilization including start time, frequency, quantity, and type. Secondly, to confirm the physiological and psychological effectiveness of early mobilization and performance indicators in patients with stroke. Method: This study examines the effectiveness of early mobilization in patients with stroke by using a systematic review. We searched five databases including PubMed, EBSCO, ProQuest, Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan, and screened the relevant randomized controlled trials of patient with stroke who had accepted early mobilization. Keywords were used as follows: “stroke,” “subarachnoid hemorrhage,” “cerebral Hemorrhage,” “intracranial hemorrhage,” “ischemic stroke,” “hemorrhagic stroke,” “cerebrovascular accident,” “infarction,” “early ambulation,” “early mobilization,” “early mobility,” “early rehabilitation,” and “early physiotherapy.” Trials included: (1) population-based in patients with stroke admitted to the intensive care unit or stroke unit; (2) intervention-based for early mobilization within 72 hours post-stroke; (3) study design-based RCT; (4) publishing language-mode English or Chinese; (5) examination of the effectiveness of early mobilization; and (6) publishing time as a limitation before March 6, 2019. CASP was used to appraise the quality of each research. Result: A total of thirteen articles, with eight studies including 2,881 patients; average age of 67.58 years; 81.4% were ischemic stroke; and 18.6% were hemorrhagic stroke. We recommended the type of early mobilization should be progressive, with raised bedhead and changed position within 24 hours post-stroke, and sitting, standing, walking, and daily function training within 24-48 hours post-stroke. The time appended on activity was determined by the patient’s tolerance (30-60 minutes), and they all received mobilization twice a day, five days per week until discharge. Early mobilization was found to improve the daily function and survival rate, reduce complications, depression and anxiety, and decrease the length of stay. There were no significant differences in cognitive function. Conclusion: Progressive early mobilization was determined as being effective for stroke patients; however, this study is neither able to recommend early mobilization programs for specific stroke types nor the duration of each activity phase. Further evidence is required to determine the appropriate modalities. In addition, there were multiple effects from only single research studies that were examined, so valid comparisons are problematic.