失能老人長期照護物理治療服務之相關因素探討

Study on physical therapy of long term care for the disabled elders

陳昆鴻(Kun-Hong Chen)

指導教授 ： 楊東震

共同指導教授 ： 葉兆輝(Chao-Hui Yeh)

義守大學/管理學院/管理碩博士班/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00103

摘要

物理治療是一種預防、治療，以及處理因疾病或其他因素造成傷害問題的醫療專業。一位優秀的居家物理治療師在治療病患的過程中，必須為病患提供較長時間的居家日常生活動作訓練、坐姿與站姿的平衡訓練，以及每位失能老人都衷心期待的行走步態訓練。因此，本研究透過社團法人高雄市物理治療公會2014年長期照護服務共406人資料，探討接受服務之失能老人，以及提供長照服務之居家物理治療師，透過兩者本身諸多因素探討，試圖找出影響治療成效之重要因素。研究採取量化的研究方法，資料分析方面，使用描述性統計、獨立樣本ｔ檢定、成對樣本ｔ檢定，以及單因子變異數分析等統計方法對變項進行分析。
研究結果顯示在個案年齡群組方面，巴氏量表結評與簡易柏格式平衡量表初評有顯著影響；在個案身分別與個案居住區域方面，巴氏量表初評有顯著影響。在個案治療次數方面，巴氏量表結評有顯著影響。在居家物理治療復健服務需求方面則無顯著影響。在達到結案目標方面，3公尺行走初評有顯著影響。在所屬治療師居住區域方面，巴氏量表初結評、簡易柏格氏平衡量表初結評、3公尺行走量表初結評有顯著影響。在居家物理治療師專業學歷方面則無顯著影響。在治療師執業場所方面，巴氏量表結評、簡易柏格式平衡量表初評、3公尺行走量表初結評有顯著影響。在臨床工作時間方面，簡易柏格式平衡量表初評、3公尺行走結評有顯著影響。在長照臨床時間方面，巴氏量表初結評、簡易柏格式平衡量表結評、3公尺行走初評有顯著影響。在導致失能主要疾病方面，在巴氏量表初結評、簡易柏格式平衡量表初結評與有3公尺行走初結評顯著影響。
高雄市長期照護居家物理治療復健服務目前所面臨與亟待解決的問題，須先了解接受服務之失能老人、提供長照服務之居家物理治療師，透過兩者本身諸多因素探討，試圖找出影響治療成效之重要因素，以調整日後提供服務之參考。另外制度面則包含了長期照護整體財務的規劃、急性後期照護與長期照護的無縫接軌問題、跨專業醫護團隊合作模式問題、申請長期照護資源便利性的問題、居家物理治療師的人力與專業能力的問題、長期照護個案的預防保健及如何宣導居家物理治療復健服務等相關建議改善。

關鍵字

物理治療 ； 長期照顧 ； 巴氏量表 ； 簡易柏格氏平衡量表 ； 3公尺行走量表

並列摘要

Physical therapy is a kind of medical profession to prevent, treat, and deal with injuries caused by illness or other problem. And, it is necessary for the good long-term care home based physical therapists to provide those individuals with necessary training of daily-life movements, sitting and standing balance, and appropriate gait, which is the most wonder training for every disabled elderly and their families. Therefore, this research study on the Kaohsiung disabled elderly and their long-term care home based physical therapists to investigate the critical factors of improving their treatment. these data derived from Society of Kaohsiung Physical Therapist which was excecutive for the long-term care management center in Kaohsiung Kaohsiung referral Corp. from January 1, 2014 to December 31, 2014. There were 406 individuals enrolled in this research, and all of them were living in Kaohsiung City when they accepted the long-term care home based physical therapy. Mining quantitative research methods were used to analysis these data, such as, descriptive statistical analysis, independent t-test, paired t-test, one-way ANOVA, and post-Hoc analysis.
The results revealed that in the case, regarding of age groups- Barthel Index Scale Evaluation and short form Berg Balance Scale initial evaluation formula has significant influence; in case there are significant aspects of the body are pasteurized scale impact- the initial evaluation; a residential area in case aspect- Pakistan Scale's initial evaluation has significant influence. In terms of the number of cases treatment- pasteurization scale knot comment has significant influence. In home physical therapy rehabilitation services demand- had no significant effect. Closed in achieving the target to 3 meters walk initial evaluation has significant influence. In regard to your therapist living area- First Barthel Index scale knot assessment scale, short form Berg Balance Scale early knot comment has significant influence knot early assessmenttimed 3-meter walking test. Physical therapistspecializing in home education aspect- no significant impact. In places of therapistspracticing knot - Barthel Index scale assessment, a short form Berg Balance Scale initial evaluation, we have significant influence Junction 3 meters walk early assessment scale. In clinical working hours ~ short form Berg Balance Scale initial evaluation, 3 meters walk knot comment has significant influence. In terms of long-term care clinical time scale ~ Barthel Index scale comment early knot, short form Berg Balance Scale knot assessment, 3 meters walk initial evaluation has significant influence. In the cause disability in major diseases - early knot Barthel Index scalescale assessment, evaluation and a 3-knot meter walk early significant impact junction type commentaryshort form Berg Balance Scale simple beginning.
Kaohsiunglong-termcarehome based physicaltherapyservice are urged to find the key factors of improving treatment by means of study on the disabled eldly and theirlong-termcarehome based physicaltherapists.In addition to current long-termcarehome based physicaltherapy institution, we hope to find better ways to solve its problem of financial expenditure, gap btween post-emergent and long-term care, multi-professional coopration, convenience of application, and the quality of the service providers.

並列關鍵字

physical therapy ； long-term care ； Barthel Index scale ； short form Berg Balance Scale ； timed 3-meter walking test

參考文獻

林金立(2005)。老人居家服務方案之評估研究--以雲林縣為例。國立中正大學社會福利研究所碩士論文，未出版，嘉義市。

楊惠珍、鄭讚源、林四海、方志琳 (2011)，不同照護場所之中風失能老人復健照護利用及其長期照護政策意涵。健康管理學刊，9(1)，1 - 16。

黃源協 (2005)。社區長期照護體系的建構。國家政策季刊，4(4)，41-68。

戴玉慈、張媚、呂寶靜、吳淑瓊 (2004)。社區式照顧管理模式的設立與初步評價。臺灣公共衛生雜誌，23(3)，197-208。

王瑞瑤(1997)。台灣地區物理治療在機構式長期照護之現況。中華物療誌，22(3)，161-166