腦中風急性後期照護計畫－－職能治療介入之成效分析

Post-Acute Care Plan for Stroke : Analysis of Effects of Occupational Therapy Intervention

目的：本研究目的為探討某區域教學醫院承作急性後期照護計畫之腦中風患者，在接受職能治療介入前後之成效及相關影響因子。方法：採病歷回溯方式，針對75名急性後期照護計畫的腦中風患者，在治療期間給予包含傳統與現代療法的職能治療計畫，採用巴氏量表、工具性日常生活功能、傅格梅爾評估量表-感覺與動作、簡短智能測驗、動作活動日誌，包括使用量及使用品質等職能治療相關量表，以成對t檢定考驗治療前、後各項進展差異；再以單因子變異數分析改良式雷氏量表不同等級之患者族群間是否有進展差異。結果：本研究受試者在介入後，所有量表皆有顯著差異(p<0.05)。改良式雷氏量表四分之患者，在巴氏量表與傅格梅爾評估量表-動作量表顯著高於其他兩組；而三分組之患者則在動作活動日誌使用量與品質量表顯著高於其他組。動作活動日誌使用量及動作活動日誌品質皆與年齡呈現負相關(p值分別為0.025、0.01)；傅格梅爾評估量表-動作、動作活動日誌使用量，以及動作活動日誌品質的進展程度皆與入住急性後期病房天數有高度正相關(p值依序為0.025、0.009、0.008)。結論：接受急性後期照護計畫之腦中風患者經過職能治療介入後有效提升動作控制並改善日常生活功能，尤其以治療前功能較佳者、年齡較低以及入住急性後期病房天數較長者進展較多。本研究可提供職能治療臨床人員介入前後預期目標之參考。

Objectives. The purpose of this study was to describe the effects of occupational therapy for stroke patients and analyze factors related to outcome for patients under Post- Acute Care (PAC) in a regional teaching hospital in northern Taiwan.
Methods. Data were obtained by reviewing the medical charts and reports of 75 patients under PAC in which the patients received intervention plans that included both traditional and contemporary occupational therapy approaches and procedures. Outcomes included results from the following evaluative tools: the Barthel Index (BI), Lawton-Brody IADL Scale, Fugl-Meyer Assessment (FMA-sensation, FMA-motor), Mini-Mental State Examination (MMSE), Motor Activity Log (MAL-AOU, MAL-QOM). The paired t-test was used to analyze the effects of the occupational therapy intervention. Analysis of Covariance (ANCOVA) was used to analyze whether patients with different MRS levels had different outcomes.
Results. The scores for all subjects in this study improved significantly (p<0.05) after the occupational therapy intervention. Patients with four points on the MRS had higher outcomes in both BI and FMA-motor assessments. Patients with 3 points on MRS had higher scores in MAL-AOU and MAL-QOM assessments. Both MAL-AOU and MAL-QOM were negatively correlated with age (p=0.025, 0.01). Improved FMA-motor, MAL-AOU, and MAL-QOM results were highly positively correlated with the number of days in acute wards (p=0.025, 0.009, 0.008).
Conclusion. The patients receiving occupational therapy PAC plans had improved motor control and daily living activity. Patients with milder dysfunction and those who were younger, and those who had longer hospital stays had greater improvement. This study highlights the value of functional goal setting for clinical occupational therapists.