修正式制動療法與等量傳統復健於慢性中風個案之療效比較

Abstract

目的：比較修正式制動療法與等量控制傳統復健治療於慢性中風患者之動作缺陷、日常生活功能及生活品質之療效。 設計：實驗組與控制組，介入前後接受測驗，隨機控制試驗。 環境：三所醫院之復健科部。 介入：個案接受三週修正式制動療法或等量控制傳統復健介入，每天進行兩小時治療，並接受約三小時的額外健側手侷限。 成效評量：評量工具依國際功能、失能與健康分類架構組織，評估個案之動作缺陷、日常生活功能及生活品質。 結果：兩組個案接受等量治療，且接受治療以外時間的健側手侷限，相較於傳統復健組，修正式制動療法組於連續性動作表現、基本日常生活功能、社區行動能力，與生理相關層面之自覺生活品質呈現較佳結果。 結論：侷限健側手有助於若干面向之上肢動作與日常生活功能功能。修正式制動療法於動作復原、日常生活功能及回歸社區生活等面向之成效值得後續驗證。

Objective: To examine the effectiveness of modified constraint-induced therapy (mCIT) in comparison with placebo-controlled traditional rehabilitation (TR) on motor impairment, daily function and quality of life. Design: Two-group design, pre- and post-intervention measures, randomized controlled trial. Setting: 3 rehabilitation departments. Participants: Twenty-two chronic patients (at least 6 months post-onset) with unilateral stroke. Interventions: Patients received either mCIT or placebo-controlled traditional rehabilitation, with 2-hour treatment and restraint of the unaffected upper extremity (UE) for 3 weeks. Main Outcome Measures: Outcome measures included assessments in the body structure and function domain (the Fugl-Meyer Assessment, Graded Wolf Motor Function Test, and Action Research Arm Test and 9-hole Peg Test), the activity domain (FIM and Revised Nottingham Extended Activities of Daily Living Scale) and the participation domain (Stroke Impact Scale and Stroke Specific Quality of Life Scale) in the International Classification of Functioning, Disability and Health framework. Results: The average restraint time of the two groups was comparable, and the two groups had similar motor performance in affected extremity after intervention. However, the mCIT group exhibited greater recovery and sustained motor ability in affected UE. Participants in the mCIT group were more independent in basic ADL and mobility in community, and reported better quality of life after treatment especially in domains related to physical function. Conclusions: mCIT conferred therapeutic benefits on some aspects of motor performance, daily functioning, transition to community, and quality of life, even though both groups received constraint of equal intensity outside the therapy time.