| Summary: | 碩士 === 亞洲大學 === 健康產業管理學系長期照護組 在職專班 === 97 === Introduction：Owing to the improvement of healthcare, the number and rate of death in stroke patients had been decreased in recent years, from 13,680 strokes in 1994 (64.8 per hundred thousand people) to 10,663 in 2008 (46.4 per hundred thousand). Nevertheless, the prevalence is not correspondingly reduced due to fast aging of population which results huge needs of service in medical and long-term care.
Purpose：The aims of this study were (1) to evaluate the impairments, functional ability, and psycho-social status in stroke patients with onset-of-lesion within 6 months; (2) to investigate predictors of functional independence, depression, fall incidence and impacts of care-giver. The result could be a valuable reference for government blue-print of medical service and health-policy making.
Method：The research data were retrieved from Stroke-care network of the bureau of public health in Changhua County. Variables assessed included (1) Impairments: National Institute of Health Stroke Scale (NIHSS), Motor function (Fugl-Meyer Score, FMS), Muscle tone (Modified Ashworth Scale, MAS). (2) Functional ability: Timed Up and Go Test (TUGT), posture (Postural Assessment Scale for Stroke Patient, PASS), balance & gait (Tinetti assessment tool : balance & gait), Fall Efficacy scale (FES), Functional Independence Measurement (FIM), and (3) psycho-social status: mental (Mini Mental Scale Examination, MMSE), depression (Geriatric Depression Scale, GDS), impacts of caregiver (Caregiver Strain Index, CSI). Parameters with a higer score indicated more severe impairments or disability in NIHSS, MAS, TUGT, and GDS.
Result: A total of 116 subjects were collected with mean age 71.3 10.4. Bivariate analysis showed (1) FIM had a highly positive correlation with PASS, Tinetti score and FES (r 0.8), but highly negative correlation with NIHSS (r -0.8). (2) PASS had a moderately positive correlation with FMS, MMSE and CSI (r = 0.6 ~ 0.8), but moderately negative correlated with NIHSS, Tinetti score, FES, FMS and CSI (r = -0.6 ~ -0.8). (3) Age was low correlated with PASS, Tinetti score, FES, NIHSS, MMSE, and FMS, whereas body height was not correlated with any other variables. In multivariate logistic regression analysis, functional independence, depression, impact of care-giver and falls were set as independent (outcome) variables. We found that (1) Tinetti score and NIHSS were independent predictors for FIM and NIHSS with adjusted odd’s ratio (AOR) of 1.17 (1.01~1.34) and 0.76 (0.58~0.99), respectively. Every increase in Tinetti score had the chance of 17% increase in functional independence and in NIHSS had a 25% decrease in functional independence. (2) The higher PASS, the lower chance of patient’s depression with an AOR of 0.38 (0.03~0.41). (3) FMS and FIM were significantly correlated with care-giver strain. An increment of 1SD (FMS=16, FIM=26), AOR of CSI were 1.12 (1.04~1.21) and 5.66 (1.39~23.09), respectively. (4) Falls could be predicted by NIHSS and GDS with AOR 1.64 (1.20~2.25) in NIHSS and 1.23 (1.01~1.49) in GDS.
Conclusion: The results show that continous care of disablement in stroke patients is a critical issue which indicates domiciliary rehabilitation program provided by Changhua health bureau is crucial and urgent for the community-dwelling strokes. Furthermore, the 10 years domiciliary-rehabilitation project and long-term care program directed by government are heading in right way and worthy to be fully supported.
Key words: cerebrovascular accident, rehabilitation care, Functional Independence
Measure, Geriatric Depression Scale, Caregiver Strain Index, accidental falls
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