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系統識別號 U0026-1008201613551500
論文名稱(中文) 建構中風復健患者手功能與整體生活獨立度之預測關聯性
論文名稱(英文) Prediction construction between hand function and comprehensive daily independence in stroke rehabilitation
校院名稱 成功大學
系所名稱(中) 職能治療學系
系所名稱(英) Department of Occupational Therapy
學年度 104
學期 2
出版年 105
研究生(中文) 康鈞雅
研究生(英文) Chun-Ya Kang
學號 T76031018
學位類別 碩士
語文別 中文
論文頁數 93頁
口試委員 指導教授-張哲豪
口試委員-官大紳
口試委員-陳志弘
口試委員-周偉倪
中文關鍵字 中風  手功能  日常生活功能  生活品質 
英文關鍵字 Stroke  bilateral hand function  activity of daily living  quality of life 
學科別分類
中文摘要 背景與目的:中風患者多數會遭遇不同程度的半側偏癱問題,也常因上肢功能復原不佳而致無法有效使用雙手執行日常生活活動,造成患者依賴性增加、生活品質下降。本研究之主要目的為:(1) 探索中風患者發病後半年內之兩側手功能、雙手共同操作能力以及日常生活獨立性之相關性 (2) 建構中風患者兩側手功能與日常生活活動獨立性、生活品質之預測關聯性。

方法:本研究為縱貫型研究設計,分別於中風患者發病後一個月內、第三個月、第六個月進行追蹤評估。研究使用富格梅爾動作評估(FMA)、簡易上肢機能評估(STEF)、Chedoke Arm and Hand Activity Inventory (CAHAI)以測量患者患側手功能、兩側手功能及雙手共同操作能力。日常生活功能獨立性及生活品質則分別採用中風患者電腦化適性測驗及世界衛生組織生活品質問卷台灣簡明版進行評測。最後使用階層迴歸及線性混合模式進行數據分析。

結果:中風患者兩側手功能表現於發病後三個月內有顯著提升,而後達平原期。日常生活功能則在發病後三至六個月間具顯著提升。患者半年來整體日常生活獨立性之重要預測因子則為年齡及患側手功能。而生活品質預測因子,則以同時考量兩側手動作功能恢復為佳。

結論:臨床治療師除針對中風患者患側手進行動作訓練外,應同時考慮其健側手動作功能及雙手共同操作能力之訓練,以期協助患者取得良好生活品質。
英文摘要 SUMMARY

Most stroke patients suffered from motor impairment not only in their contralateral hand but ipsilateral hand, and usually were not able to use both hands in activities of daily living (ADL) effectively, which could lead to poor quality of life (QOL). However, few studies have focused on discussing the relationship between bilateral hand function, independence of ADL and QOL in stroke patients. In this longitudinal study, subjects were evaluated three times during their first half year of onset, to collect patients’ demographic and performance ability information. After data collection, the linear mix model (LMM) was used to analyse the change in trends of patients’ capacity, and Person’s correlation coefficient was used to detect the relationship between bilateral hand function, ADL independence and QOL. Then using multiple hierarchical regression and LMM to find out whether prediction relationship existed. The results showed that: (1) both of the contralateral and ipsilateral hand function in stroke patients would improve during their first three months of onset. (2) Stroke patient’s age and contralateral hand function can be used to predict their ADL. (3) Besides stroke patient’s age, bilateral hand function is also an important factor to predict their QOL. This study points out the importance of bilateral hand function in stroke patients’ QOL, and can give occupational therapists a reference to set a reasonable rehabilitation goal for patients with stroke.
論文目次 摘要 I
英文摘要 II
誌謝 V
目錄 VI
表目錄 IX
圖目錄 XI
第一章、 緒論 1
第一節、 研究動機與重要性 1
第二節、 研究目的與假設 3
第三節、 名詞定義 4
第貳章、文獻回顧 5
第一節、中風患者日常生活功能及手功能關連性及其他功能性預測因子 5
第二節、中風患者手功能及日常生活功能恢復 7
壹、上肢動作功能自發性恢復 7
貳、日常生活功能時序性回復 8
參、中風患者生活品質變化與影響因子 9
第三節、中風相關研究常用評估工具 10
壹、 手功能評估工具 10
貳、 日常生活功能評估工具 13
參、 生活品質評估工具 16
第四節、研究參考架構 18
第三章、研究方法 19
第一節、研究對象 19
第二節、研究工具 20
第三節、研究架構與步驟 21
第四節、資料收集與分析 22
第四章、結果 24
第一節、全體研究對象基本描述 24
壹、基本背景資料概述 24
貳、功能表現概述 24
第二節、手功能、生活品質及日常生活獨立性於各時間點之變化 27
第三節、手功能表現、生活品質與日常生活獨立性之關係 28
第四節、生活品質與日常生活獨立性之預測因子 32
第伍章、討論 40
第一節、 中風患者發病後半年內手功能、生活品質及日常生活功能獨立性之變化 40
壹、手功能與日常生活功能獨立性之變化之比較 40
貳、生活品質各範疇於發病後半年變化之討論 41
第二節、 不同時間點日常生活獨立性及生活品質預測因子之討論 44
壹、性別是否可作為中風患者生活品質及日常生活獨立性之預測因子 44
貳、尋求其他社會醫療資源之患者將具有較低生活品質之可能因素 45
參、以子女為主要照護者具有較差社會關係相關生活品質可能因素 46
肆、環境範疇生活品質解釋力不良之因素探討 47
第三節、 中風患者日常生活功能及生活品質整體最佳預測模式 48
壹、日常生活獨立性最佳預測模式 48
貳、生活品質各範疇最佳預測模式 48
第陸章、結論 50
第一節、總結 50
第二節、研究特色與限制 52
參考文獻 54
附件一 91
附件二 人體試驗委員會人體研究同意證明書 92
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