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預測腦中風於急性照護出院後第一年之功能改善
Other Title
Predicting functional improvement during the first year after discharge from acute care in patients with stroke
Type
thesis
Date Issued
2023-01-06
Author(s)
潘文山
Advisor
張鳳航
Subjects
系所名稱：傷害防治學研究所碩士班
Description
學位別：碩士
語文別：英文
口試委員：林硯農 LIN, YEN-NUNG;康峻宏 KANG, JIUNN-HORNG;張鳳航 CHANG, FENG-HANG
授權範圍：開放校內, 開放日期為2023-02-01;校外, 開放日期為2028-01-19
語文別：英文
口試委員：林硯農 LIN, YEN-NUNG;康峻宏 KANG, JIUNN-HORNG;張鳳航 CHANG, FENG-HANG
授權範圍：開放校內, 開放日期為2023-02-01;校外, 開放日期為2028-01-19
Abstract
Background: Predicting patients’ functional outcomes, increasing the frequency and intensity of inpatient rehabilitation should be considered to improve results.
Objective. To describe functional changes among stroke patients and to identify predictors of improvement during the first year following discharge from acute care.
Methods: This was a longitudinal study. Outcomes were measured at rehabilitation discharge and 3, 6 and 12 months afterward. Results were measured as Outcomes were changes in activity limitations (basic mobility [BM], daily activity [DA], and applied cognition [AC]) by using the Mandarin version of The Activity Measure for Post- Acute Care (AM- PAC) short forms.
Results: We included 500 stroke patients at discharge. The mean score of cognitive function decreased over the period from discharge (DC) to 3 months (p<0.0001). For BM and DA, about 85.89% of the participants demonstrated improvement during DC-3 months. For AC, the proportion of the participants who demonstrated improvement over the time from DC to 12 months was between 21% and 29%. No predictor was correlated with BM score improvement during DC to 3 months. The BM discharge score was the only significant predictor of BM score improvement during 3-6 months and 6-12 months following discharge and of DA score improvement during DC to 3 months and 6-12 months following discharge. Moreover, the DA discharge score was a significant predictor of DA and AC score improvement during 3 to 6 months; AC discharge score was the significant predictor of AC score improvement during all three stages. The areas under the curve for the BM, DA, and AC discharge scores in predicting BM score improvement were 0.78~0.85.
Conclusion: Functional improvements were seen in BM and DA following discharge from acute care wards, but the improvements in AC were more evident during 3 to 12 months following discharge. The AM-PAC subscale scores at discharge were the most important predictors of functional improvements in each activity domain.
Keywords: Rehabilitation; stroke; functional outcomes; prediction.
Objective. To describe functional changes among stroke patients and to identify predictors of improvement during the first year following discharge from acute care.
Methods: This was a longitudinal study. Outcomes were measured at rehabilitation discharge and 3, 6 and 12 months afterward. Results were measured as Outcomes were changes in activity limitations (basic mobility [BM], daily activity [DA], and applied cognition [AC]) by using the Mandarin version of The Activity Measure for Post- Acute Care (AM- PAC) short forms.
Results: We included 500 stroke patients at discharge. The mean score of cognitive function decreased over the period from discharge (DC) to 3 months (p<0.0001). For BM and DA, about 85.89% of the participants demonstrated improvement during DC-3 months. For AC, the proportion of the participants who demonstrated improvement over the time from DC to 12 months was between 21% and 29%. No predictor was correlated with BM score improvement during DC to 3 months. The BM discharge score was the only significant predictor of BM score improvement during 3-6 months and 6-12 months following discharge and of DA score improvement during DC to 3 months and 6-12 months following discharge. Moreover, the DA discharge score was a significant predictor of DA and AC score improvement during 3 to 6 months; AC discharge score was the significant predictor of AC score improvement during all three stages. The areas under the curve for the BM, DA, and AC discharge scores in predicting BM score improvement were 0.78~0.85.
Conclusion: Functional improvements were seen in BM and DA following discharge from acute care wards, but the improvements in AC were more evident during 3 to 12 months following discharge. The AM-PAC subscale scores at discharge were the most important predictors of functional improvements in each activity domain.
Keywords: Rehabilitation; stroke; functional outcomes; prediction.