長照復能服務成效探討

Effectiveness of Long-term Care Reablement

「復能」是以個案為中心的全人照顧，目的是強化個案的生理和/或其他功能，以增加或維持個案在其居住的地方，從事有意義的生活活動，並減少長照服務需求。臺灣於2016年長照2.0導入復能服務，然目前有關其服務成效和指標探討之文獻仍不足。本文藉由國外多篇系統性文獻回顧及國內近期復能介入或照顧管理資料分析的整理，探討復能成效、成效測量指標建議及影響復能成效的因素等議題。結果顯示，成效指標中的照顧成本降低、個案後續使用居家照顧服務次數減少及不健康事件結果風險未提高等三個指標之研究結果較一致；然而，一般較常使用的個案身體或日常生活功能性能力改善情況及健康相關生活品質評估之成效，前人研究結果卻較未定論。回顧成效測量指標建議，以日常生活功能和身體行動能力為最常見指標，其餘有加拿大職能表現測量（COPM）、生活品質、心智健康狀態、和照顧者負擔狀況等為常見成效指標。影響復能成效的因素有來自於組織端、服務使用者端、工作團隊成員、介入方式、方案成效評估和個案及照顧者特質等。縱觀前人復能實證研究，可能由於各國對名詞的定義及介入方式內容尚未一致、研究設計、樣本來源、介入方式及期程、測量指標差異等等，使得復能成效尚未獲得學術一致性結果，值得再進一步研究。

Reablement is a case-centered holistic care with the aim of enhancing the physical and/or other functions of the cases, so as to increase or maintain the case in the place where they live, to engage in meaningful life activities, and to reduce the need for long-term care services. In 2016, Taiwan introduced long-term service 2.0, reablement is one of the services. However, there are still insufficient evidence of its effectiveness and consensus about its outcome measures. The current article compiled many systematic literature reviews as well as recent literature of reablement intervention or care management data in Taiwan. In addition, reablement effectiveness, recommendations for outcome measurement indicators, and factors affecting reablement effectiveness will be provided. The results show significant benefits of reablement services in the outcome indicators are the reduction of care costs, the reduction in the number of follow-up use of home care services and the risk of adverse events. However, the more commonly used outcome indicators as the physical function or ADL and the health-related quality of life are relatively inconclusive. Reviewing the recommendations for outcome measurement indicators, the most common indicators are the ADL and physical mobility, otherwise, the Canadian Occupational Performance Measure (COPM), quality of life, mental health status, and caregiver burden are other common outcome indicators. The factors that affect the effectiveness of reablement will be discussed from the organization, service users, staff, intervention, program effectiveness evaluation, and the characteristics of cases and caregivers. Looking at previous empirical studies on reablement, it may be due to differences in the definitions of terms and intervention methods in different countries, research designs, samples, intervention method and duration, and differences in measurement indicators, etc., so that the effectiveness of reablement has not yet achieved academic consistency. Therefore, it warrants further study.