[[alternative]]A retrospective study on the correlation between post-acute care and changes in functional status in a group of stroke patients.

[[abstract]]摘要背景本研究比較一般住院復健病患和接受腦中風急性後期照護病患，兩者在急診、出院、出院之後一個月、三個月、六個月、和第十二個月等，六個時間點的失能程度(mRS)的差異，過去這類貫時性研究比較少見，少數研究僅能夠追蹤到出院後6個月，能夠針對受試者出院之後追蹤12個月的研究極少，本研究有助於彌補文獻上的空缺，研究結果可以做為臨床實務的參考。方法本研究是採回溯性縱貫性量化研究，由腦中風登錄資料庫回溯和編碼，其中包含人口統計學特性，失能危險因素，疾病嚴重度，復健類型，以病歷資料回溯的方式，探討接受急性後期照護計畫的病人與接受一般住院復健病人在整體活動功能的差異。共收了517位個案納入本研究對象，收案年份從2014年1月到2018年4月入住台灣北部某醫學中心，此次住院以電腦斷層及核磁共振確診為發病一個月內的急性腦中風個案，功能狀況具有中度到中重度功能障礙(mRS分數3-4分)，入院時由腦中風個管師訪視，出院後採電話追蹤病人失能程度，所用評估工具有NIHSS、mRS、BI，相關評估分數登錄於腦中風資料庫，收案至發病後滿一年，且完成急診、出院、發病後1、3、6、12個月共六次追蹤。基於重複量數的資料特質，本研究運用廣義估計方程式的方法進行統計分析結果六個時間點的測量結果顯示受試者的失能程度有逐漸改善的趨勢，接受急性後期照護的病患的改善情形顯著地勝過接受一般住院復健者，GEE分析的結果也顯示，在控制其他因子之下，時間點的增加與mRS評分的降低呈負相關（b = -0.44,95％CI = -0.51～-0.38），進一步印證接受急性後期照護者的失能改善情形比較佳的情形。研究結果也顯示年齡、急診時的 NIHSS、和中風時失能程度都和失能情形的變化有顯著相關。關鍵詞：急性腦中風、急性後期照護、失能，危險因子、疾病嚴重程度指數。[[abstract]]AbstactBackgroundThis study compared changes in disability status between patients receiving rehabilitation and those with post-acute care while in hospital due to stroke. Six points of mRS scores were obtained, including emergency care, in-hospital, discharge, and one month, three months, six months, and twelve months after discharge respectively. Few studies of post-stroke care were able to have a long follow-up up to 12 months while comparing patients with or without post-acute care while being hospitalized due to stroke.MethodThis study employed a retrospective and longitudinal research design. Data from a stroke registry were extracted for analysis with variables including patient demographic characteristics, life signs, diseases, disease severity, and disability status. Those who were hospitalized between January 1st 2014 and April 30th 2018 and received stroke diagnosis by computed tomography (CT) Nuclear Magnetic Resonance Imaging (MRI) within one month after hospitalization in a medical center in northern Taiwan. A total of 517 patients were included for analysis. Data were collected at six points as stated above by well-trained case managers via patients consents with standardized instruments, including NIHSS, mRS, and BI. Methods of data collection included face-to-face interviews in the hospital and telephone interviews with patients at home after discharge. A generalized estimating equation (GEE) method was used for analyzing data with repeated measures. Results review of six point measurements indicated a trend of improvement in disability status for all patients. Those receiving post-acute care improved significantly more than those receiving rehabilitation while in the hospital. The results from multivariate GEE analysis further confirmed this finding while controlling for other factors. This result showed the importance of providing post-acute care for those patients hospitalized after stroke. In addition, age, NIHSS in emergency room, and mRS score at stroke were found to be associated with changes in trend of disability status. Key Words: acute stroke, post-acute care, disability, risk factors, disease severit