探討急性後期整合照護（PAC）對急性腦中風病人之主要照顧者照顧負荷的影響

Impact of the Post-Acute Care Program on Primary Caregiver Burden After Acute Stroke

背景：腦中風為重要失能與死亡原因，臺灣自2014年起推動急性後期整合照護（post-acute care，PAC），對主要照顧者負荷欠缺實證成效。
目的：比較PAC組與非PAC組之急性腦中風病人主要照顧者在追蹤期間家庭功能與照顧者負荷隨時間變化趨勢是否不同（以組別×時間交互作用檢驗），並探索臨床需優先關注之照顧者特徵，作為後續研究之參考。
方法：採類實驗設計，收案北部某醫學中心100位照顧者，依病人是否接受PAC，分為PAC組與非PAC組各50人，於住院第10–14日、出院後1個月及3個月施測家庭功能評估表與主要照顧者負荷量表，並以卡方檢定、t檢定及二因子重複量數變異數分析進行資料分析。
結果：兩組基線人口學特性無顯著差異。二因子重複量數分析顯示，身體、時間與人生發展負荷隨時間顯著下降（時間主效果p < .01），惟組別×時間交互作用未達顯著，未觀察到PAC組與非PAC組在照顧者負荷隨時間變化趨勢上的顯著差異。另以全體樣本進行探索性分析，出院後三個月家庭功能在年齡與教育程度間呈差異；女性在情緒與人生發展負荷分數較高。介入效果之解釋仍需考量未測量混雜之可能。
結論：本研究結果顯示照顧者負荷隨時間下降，且在本研究設計與資料條件下，未觀察到PAC與非PAC兩組負荷變化趨勢之差異；研究重點在於兩組隨時間變化軌跡之比較，而非單一時間點分數高低之差異。探索性結果提示年長、教育程度較低及女性照顧者於部分指標較不理想，可供臨床優先關注與後續研究驗證，以發展更以家庭為中心之PAC支持策略。

Background: Stroke is a leading cause of disability and death. Taiwan has implemented a post-acute care (PAC) program for stroke since 2014. However, the impact of this program on primary caregiver burden remains inadequately investigated.
Purpose: This study was conducted to compare the trajectories of family functioning and caregiver burden over the follow-up period between primary caregivers of patients with acute stroke in PAC and non-PAC groups (as tested using group×time interaction). The caregiver characteristics that may warrant clinical prioritization were also explored as potential hypothesis-generating signals for future research.
Methods: A quasi-experimental design was adopted. One hundred primary caregivers from a medical center in northern Taiwan were enrolled and allocated to either the PAC or non-PAC group (n = 50 each) based on whether the patient had received PAC. Two instruments, including the Family APGAR and Caregiver Burden Inventory, were administered once on hospital days 10–14, and at 1 and 3 months after discharge. Chi-square tests, t tests, and two-way repeated-measures ANOVA were used for analysis.
Results: Baseline sociodemographic characteristics did not differ significantly between the PAC and non-PAC groups. Two-way repeated-measures ANOVA showed significant time effects, with caregiver physical, time, and developmental burdens decreasing over time (time main effect, p < .01). The Group×Time interaction was not significant. No significant between-group differences in trajectories were observed under the current design and data conditions. In the exploratory analysis of the overall sample, family function at 3 months post-discharge differed by age and educational level, and female participants reported higher emotional and developmental burden than their male counterparts. Interpretation of the intervention effect should consider the potential for unmeasured confounding variables.
Conclusions: Although caregiver burden declined over time, under the defined study design and data conditions, no significant difference in the trajectories of caregiver burden between the PAC and non-PAC groups was observed. The analytic focus in this study was on between-group differences in longitudinal change (trajectories) rather than cross-sectional differences at each time point. The findings of the exploratory analysis suggest associations between older age, lower educational attainment, and being female with less-favorable profiles on selected measures, warranting clinical prioritization as well as further validation in future studies to inform the development of more effective family-centered PAC support strategies.