| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 90 === Purpose：The purposes of this study are to assess the effect of home-care physical therapy for postoperative hip fracture patients in impairment and function and quality of life, and to find out the factors which affect the outcome. Patients were allocated to exercise group or control group randomly, 19 in exercise group and 15 in control group. We dropped out 4 patients from exercise group whose exercise compliance were poor and date of 15 patients left to be analyzed. Patients in exercise group were visited and treated 7 times, at the first, second, third, fourth, sixth, eighth and twelfth week after discharge. At first , fourth and twelfth weeks after discharge, both groups were all visited for evaluation. The evaluations included impairment（musclestrength, range of motion）, walking speed, Harris functional score （including Harris pain and Harris total-pain）and WHOQOL-BREF questionnaire (Taiwan version)（including general quality of life, general health satisfaction and physical capacity, psychological, social and environmental domains）. At the first time evaluation of QOL(the quality of life), the patients were asked to recall the QOL before fracture to compare the change.
Result: Both groups showed some improvement in strength and range of motion in the three month interval, however, there was no difference between the two groups.
IN walking speed, patients in both groups had significant improvement (p<0.05) (Exercise group from 8.8 m/minè18.8 m/min, 3.3 sec/strikeè2.21 sec/strike; control group from 9.9 m/minè20.0 m/min, 3.2 sec/strikeè2.26 sec/strike), but no significant difference between the two groups. The result of repeated measure showed there were significant difference in Harrispain both within group and between groups. The main progression occurred during the first month after discharge.In the measure of Harristotal-pain , the result showed there were no significant between-subject difference. Besides, there were interaction in groups and time, which mean home-care physical therapy will affect the progression.The exercise group progressed from 58.6 to 90.1 and control from 54.6 to 77.4. In Harristotal score , it showed significant improvement within group significant difference between groups(p<0.05). Exercise group was better than control group both on the first month or the third month after discharge.
There were no differences between both groups at each evaluation in general quality of life, general health satisfaction and social domain of QOL measurement. In the physical domain, the result of repeated measure showed there were significant improvement in both groups and significant difference between the two groups(p<0.05). The score of patients in exercise group was better than that of control group at three month but both groups didn’t recover to pre-fracture status. In the psychological domain, the score of patients in exercise group was better than that of control group at the first or third month after disharge. In the environment domain, both groups showed significant improvement but no difference between the two groups.
The result of multiple regression analysis showed home-care physical therapy is the main significant factor which affect the outcome of patients’ function and quality of life at the third month after discharge. Conclusion. Home-care physical therapy can significantly improve the function and quality of life of postoperative hip fracture patients, it maybe an important care model in the future.
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