提升人工關節置換術後病人床邊復健運動之效益

Increasing Efficiency of Bedside Rehabilitation after Orthopedic Total Joint Arthroplasty

退化性關節炎病人藉由人工關節置換手術，改善疼痛症狀及增加關節活動力，術後持續復健運動，增強人工關節置換周圍肌肉力量及肌力平衡，有效使置入物達到最大穩定度及增加患肢關節最大活動度。由於住院天數短，病人未落實執行復健運動，致出院前肌力不足，對復健運動指導滿意度低，引發本專案改善動機。藉由整合人工關節置換病人，落實執行復健運動流程，增加出院前患肢肌力，提昇人工關節活動力。經團隊決策矩陣提出解決辦法：1.修正床邊復健運動標準化流程2.擬定執行復健運動工具「骨科人工關節置換術復健運動處方確認表」。結果病人復健運動執行頻率由27.3%增加87.0%，執行正確率由68.4%提升至92.3%，出院前肌力由3.20分提升至4.37分（5分量表），病人對床邊復健運動滿意度由83.9%提升92.9%，建立復健運動標準化流程及有效工具，除落實復健運動執行，持續性復健運動有助病人肌力恢復，提昇病人人工關節置換後的活動能力。The bedside rehabilitation by team work, the shortening of hospitalization period and the improvement of muscle power of the patients before being discharged were evaluated. The study aimed to evaluate and improve patients' persistence in bedside rehabilitation after total joint arthroplasty. We improved the standardization process by (1) drafting 'physical and exercise therapy confirmation sheet in orthopedic ward', and (2) designing the standardized process of bedside rehabilitation. The muscle power of the patients undergoing total arthroplasty increased from 3.20 to 4.37 before being discharged, with the frequency of rehabilitative exercise from 27.3% to 87.0% during Admission, Patients' satisfaction toward rehabilitation increased from 83.9% to 92.9%. The project is concluded with the improvement of the establishment of the standardized rehabilitation process, the drafting of 'physical and exercise therapy confirmation sheet in orthopedic ward', the frequency of rehabilitative exercise during admission, and the muscle power before being discharged.