遠距復健對長照機構腦中風患者身體功能及生活品質的影響

Abstract

研究背景：腦中風是國人十大死亡因素之一。然而腦中風生存者的後續醫療照顧，成為醫療照顧體系和患者本身的沉重負擔。關於腦中風研究大多著重於其死亡率與發病率，對居住在機構的腦中風住民的生活品質卻鮮有研究關心和探討。文獻回顧：從社區的研究發現，腦中風老人其身心健康、身體健康及自評健康程度都較同年齡的社區老人明顯來得低；而運動治療的介入是會改善患者的肌力、社會參與與生活品質等。至於遠距醫療的介入，發現可偵測居家或社區患者的身體狀況。目的：藉著使用遠距復健運動治療療程，來針對居住於機構的腦中風患者進行為期四週的治療，並探討療程對患者功能性活動能力與生活品質是否有產生明顯進步。方法：24位中風患者由3家長照機構通過篩選而參與本研究。由一位物理治療師進行隨機分組。實驗組(遠距組)及控制組(傳統組)分別由兩位不同之物理治療師進行每週三次為期四週的介入治療。在治療結束後，再由同一位物理治療師進行介入後評估後再進行統計分析。評估的項目包含中風動作復原評估量表精簡版(S-STREAM)、柏格氏平衡量表(BBS)、巴氏量表(BI)與中風衝擊量表(SIS)。結果：本研究主要發現: (1) 遠距組與傳統組都能明顯改善健康生活品質的中風衝擊量表的身體功能面向(p<0.05); (2) 遠距組與傳統組都能明顯改善身體功能，如S-STREAM, BBS與BI，(p<0.05); (3) 健康生活品質(中風衝擊量表)與日常生活功能、上肢能力及性別相關; (4) 遠距組不同於傳統組的是遠距組改善較多下肢活動功能而傳統組改善較多情緒問題。討論： 與先前研究比較，本文所徵召的參雨者有著中度到嚴重的身體功能缺陷。在介入的成效主要表現在於改善中風衝擊量表的身體功能面向部份，這樣的結果也與先前研究相近。遠距組在肌力與活動能力面向達到臨床上重要差異，而在日常生活功能面向方面也幾近達成。傳統組則在肌力與日常生活功能面向達到臨床上重要差異。結論：遠距與傳統治療組之治療效果相似，遠距復健應是可以被運用於長照機構的患者。

Background: Stroke has been one of leading causes of disability in Taiwan. However, the follow-up medical care of stroke survivors becomes a heavy burden on medical care system and the patients themselves. Most studies focused on mortality and morbidity of stroke, but there are only few studies related to the quality of life of residents with stroke living in long-term care facilities. Literature Review: Studies conducted to patients with stroke indicated that their physical performance, mental health, physical health, and the degree of self-rated health were lower than community elder. The intervention of therapeutic exercises would improve the muscle strength, emotional and social participation in physical function for quality of life in non-institution residents. Further, studies indicated that telemedicine could monitor the physical function of patients. Purpose: To investigate whether a four-week tele-rehabilitation program can result in significant improvements in physical function and quality of life for subjects with chronic stroke living in long-term care facilities. Methods: Twenty-four participants were recruited from three long-term care facilities. Participants were assigned into tele-rehabilitation (Tele group) and conventional Groups (Con group) randomly. Baseline and post-treatment physical function, daily activities and health-related quality of life (HRQOL) were assessed by Simplified-STREAM, Berge Balance scale (BBS), Barthel index (BI), and Stroke Impact Scale (SIS 3.0), respectively. Interventions were conducted to both groups by two different physical therapists with three sessions a week for four weeks of intervention. Results: The major findings in the study included as follows. (1) Both the Tele- and Con groups improved the physical components of SIS 3.0 significantly (p < 0.05). (2) Both the Tele- and Con groups improved the score of Simplified-STREAM-mobility, BBS, and BI significantly (p < 0.05). (3)SIS 3.0 was strong to very strong correlated with BI, upper limb function and gender. (4) Compared to conventional therapy, the different effects of Tele-group included improving lower limb function more than Con group, but improving the mood less than the Con group. Discussions: Compared with previous studies, the subjects we recruited had moderate to severe impairment of physical function. The improvements were mainly in the physical components of SIS which were similar with previous studies. The Tele group achieved the clinically important difference (CID) in strength and mobility domains, and the ADL/IADL domain was nearly achieved. The Con group achieved the CID in strength and ADL/IADL domains. Conclusions: Most the training effects of Tele and Con groups were similar. Tele-rehabilitation seems a feasible approach to deliver rehabilitation to those living in long-term care facilities.