腦中風急性後期照護功能狀態之趨勢分析及影響因子：前瞻性世代研究

Factors influencing functional status in patients with stroke receiving postacute care: a prospective cohort study

目標：自2014年開始，衛生福利部開始試辦腦中風急性後期照護計劃，強調透過復健之介入，以改善腦中風病患之生活品質。本研究的目的為分析腦中風病患接受急性後期照護計畫後復建的成效。方法：本研究為前瞻性世代研究（prospective cohort study），於2021年1月1日至2023年3月31日間，針對整體功能狀態（MRS）2-4級之病患以問卷方式進行資料蒐集，納入台灣南部兩家醫學中心、兩家區域醫院及一家地區醫院之680位缺血性與151位出血性中風病患進行研究。追蹤時間點分別為入院時、入院後6週和入院後12週，三個時間點。研究工具採用廣義估計方程式（GEE）進行生活品質的趨勢分析。結果：復健後六周相較於入院時，PAC組相對Non-PAC組在BI（effect size, ES 0.19 vs. 0.20）、FOIS（ES 0.01 vs. 0.14）、IADL（ES 0.09 vs. 0.17）、BBS（ES 0.04 vs. 0.20）改善幅度皆顯著較差；然而，復健後12周相較於入院時，PAC組相對Non-PAC組在IADL（ES 0.47 vs. 0.18）、BBS（ES 0.67 vs. 0.17）、MMSE（ES 0.28 vs. 0.03）改善幅度皆顯著較佳。控制時間因素，年紀較輕男性教育程度較佳，身體質量指數（BMI）較高，急性住院天數較短、無30天再入院、無導尿管、無鼻胃管、無高血壓、無腦中風病史，復健前功能狀態較佳者，其復健後功能狀況皆有顯著改善（p<0.05）。結論：在腦中風病患的急性後期，3個月內是黃金治療期間，腦中風病患在急性後期最適合的復健治療時程為6至9週，這段時間進行高強度的復健治療能顯著改善病患的預後。

Objectives: Since 2014, Taiwan’s Ministry of Health and Welfare has implemented a postacute care (PAC) program for patients with stroke, emphasizing rehabilitation interventions for improving quality of life. This study analyzed rehabilitation outcomes in patients with stroke receiving a PAC intervention. Methods: For this prospective cohort study, data (January 1, 2021, to March 31, 2023) were collected from patients with stroke having a global functional status grade of 2–4. The study cohort comprised 680 patients with ischemic stroke and 151 patients with hemorrhagic stroke from two medical centers, two regional hospitals, and one district hospital in southern Taiwan. Patients receiving the PAC intervention constituted the PAC group, whereas those not receiving it constituted the control group. Follow-up assessments were performed at admission and 6 and 12 weeks after it. Generalized estimating equation models were used to analyze trends in quality of life. Results: After 6 weeks of rehabilitation, the PAC group exhibited less improvements (from baseline results) in the following parameters than did the Non-PAC group: the Barthel Index (effect size [ES]: 0.19 vs. 0.20), Functional Oral Intake Scale score (ES: 0.01 vs. 0.14), Instrumental Activities of Daily Living score (ES: 0.09 vs. 0.17), and Berg Balance Scale score (ES: 0.04 vs. 0.20). However, after 12-week rehabilitation, the PAC group exhibited significantly greater improvements in the following parameters than did the Non-PAC group: Instrumental Activities of Daily Living score (ES: 0.47 vs. 0.18), Berg Balance Scale score (ES: 0.67 vs. 0.17), and Mini-Mental State Examination score (ES: 0.28 vs. 0.03). Statistical models adjusted for time effects revealed that younger age, male sex, higher education level, high body mass index, shorter acute hospitalization duration, no 30-day readmission, no urinary catheter or nasogastric tube use, no previous hypertension or stroke, and better prerehabilitation functional status were significantly associated with greater postrehabilitation functional improvement (p < .05). Conclusions: For patients with acute stroke, the first 3 months after the event constitute the golden treatment period. A 6–9-week rehabilitation program during this phase can ensure optimal outcomes. High-intensity rehabilitation therapy during this period can markedly improve prognosis.