中風病人的治療動機與日常生活功能改善之關聯性研究

Abstract

研究背景與目的：病人的治療動機可能影響復健治療的成效，但國內仍未有相關研究探討。本研究藉由回顧病歷方法探討中風病人於結案時在職能治療的治療動機程度與復健住院期間日常生活功能改善之關聯。 方法：回顧2012年1月至2014年12月間臺大醫院復健病房住院病人之電子病歷，擷取內容完整登錄之中風病人職能治療病歷內容。以巴氏量表 (Barthel index, BI)評量分數代表病人日常生活活動 (Activities of Daily Living, ADL)的實際表現；以日常生活能力量表評量分數代表病人ADL的執行能力；以治療動機量表（佳、尚可、不佳）代表病人治療動機程度。再以簡短式心智功能檢核量表 (Mini Mental State Examination, MMSE)分數代表病人認知能力；以布朗斯壯動作恢復量表分數代表病人動作恢復程度；以姿勢控制量表分數代表病人姿勢控制能力。 本研究統計分析以共變數分析控制各項初始能力（ADL實際表現、ADL執行能力、認知能力、動作恢復程度、姿勢控制能力）為共變數下，檢視動機程度與治療後ADL執行能力及ADL實際表現改善（進步指數）之差異。 結果：利用161筆中風病歷資料，並排除各項初始能力對治療後ADL執行能力及實際表現的影響，研究分析顯示動機程度對復健治療後ADL執行能力及實際表現進步指數的影響效果檢定之F值分別為7.53與6.36，p≦0.05皆達到顯著水準，η2分別為0.05與0.04，表示ADL執行能力與ADL實際表現之進步指數因動機程度而有差異，但效果值小。 討論與結論：由臨床紀錄資料分析顯示，治療後ADL執行能力及ADL實際表現之改善均因治療動機程度而有差異，且治療動機佳者進步指數均顯著較高。本研究分析所獲得之初步結果，應可提供後續進一步研究及在臨床職能治療上加強病人治療動機提升以增進中風病人日常生活功能改善之參考。

Background and purposes: Patient’s treatment motivation might affect rehabilitation outcome, but no related studies have been done in Taiwan. The purpose of this study is to investigate the correlation between treatment motivation at discharge and activities of daily living (ADL) improvement during inpatient rehabilitation in patients with stroke through chart review. Methods: Electronic charts of stroke patients in National Taiwan University Hospital rehabilitation ward between January 2012 and December 2014 were reviewed, and data from Occupational Therapy note was abstracted. Barthel Index score was used to represent patient’s actual performance in ADL, Basic Activities of Daily Living Ability Scale score was used to represent patient’s ability in ADL, Motivation Level Scale was used to represent patient’s treatment motivation, Mini Mental State Examination score was used to represent patient’s cognitive ability, Brunnstrom Recovery Stage score was used to represent patient’s motor recovery, Postural Control Scale score was used to represent patient’s postural control ability. Analysis of covariate was used to test whether there is significance difference between treatment motivation and ADL improvement. Progress index of ADL actual performance and ADL ability using the formula (discharge score-initial score)/(total score-initial score) was used for ADL improvement. Initial ability such as ADL performance, ADL ability, cognitive ability, motor recovery, postural control ability was used as covariates. Results: 161 stroke patients’ data was included in this study. Analysis of covariance (using 5 different initial ability scores as covariates to control differences in initial ability between subjects with fair and good treatment motivation) revealed a significant difference for both ADL ability (F=7.53; p<0.05; η2=0.05 and ADL actual performance (F=6.36; p<0.05; η2=0.04) progress index between subjects with fair and good treatment motivation. The progress index for ADL ability and ADL performance is lower in patients with fair motivation. Discussion and Conclusion: According to data from clinical records, stroke patients with good treatment motivation had more improvements in both ADL ability and performance progress index, but with small clinical effect. Preliminary results from this study could provide information for further research and are important for clinical occupational therapists to enhance treatment motivation in order to improve stroke patient’s ADL improvement.