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博碩士論文 etd-0823114-180818 詳細資訊
Title page for etd-0823114-180818
論文名稱
Title
偏鄉地區居家長照物理治療介入之可行性
Efficacy of Home Physical Therapy for Chronic Care Patients in Rural Areas
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
65
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2014-10-22
繳交日期
Date of Submission
2014-12-28
關鍵字
Keywords
偏鄉地區、居家物理治療、長期照護
home physical therapy, rural areas, long-term care
統計
Statistics
本論文已被瀏覽 5660 次,被下載 1192
The thesis/dissertation has been browsed 5660 times, has been downloaded 1192 times.
中文摘要
研究背景:近年來我國人口老化趨勢快速成長。由於醫療技術的進步,大多數疾病都能在早期就獲得適當的治療,使死亡率大幅下降,但相對的也使慢性病和失能的人口比例攀升。若以進食、位移、室內行走、穿衣、洗澡、上廁所等六項日常生活為評估指標,2010年日常生活活動有障礙者達24萬人;預估2015年將攀升至30萬人。這些日常生活功能失能的個案不論對家庭或是社會都造成很大的負擔,尤其在醫療資源嚴重不足的偏鄉地區更顯嚴重,因此在適當的時機提供相關居家醫療服務,不但可以改善個案本身的功能,提高其自主性與生活品質,同時也能降低家庭負擔與社會成本彌補偏鄉醫療不足的缺憾。
研究目的:探討居家物理治療照護服務是否可以改善大旗山九個偏鄉地區失能者的健康狀況,依照不同的失能狀況與生活環境,提供之不同程度之照顧措施,使其盡量保有獨立性及一定的生活品質。
研究方法:本研究採前瞻式收案。收案其間為101 年1 月至101年12 月止;針對大旗山九區132位有長照需求的住民進行居家物理治療照護介入服務,以巴氏量表,簡易柏格式平衡量表,肌力評估量表(Motricity Index),5公尺行走測試進行前後測評估記錄,探討接受六次以上居家物理治療介入個案的之成效。
研究結果:接受居家物理治療介入服務為132位個案,當中至少接受6次以上居家物理治療有131位個案,男性為44人佔33.3%;女性為88人佔66.7%,平均年齡65歲以下為12人佔9.1%,65-74歲為37人佔28.0%,75-84歲為66人佔50.0%,85歲以上為17人佔12.9%。
比較所有個案治療介入前後都呈現顯著進步的正向結果:巴氏量表在腦中風P值為0.010,背痛、腰部關節疾病P值為0.014,關節置換P值為0.021;被動關節活動度測試接受治療前後,個案平均分數均有進步;簡易版伯格氏平衡量表關節置換P值為0.0001,心臟病P值為0.0001,外傷性骨折P值為0.0001,退化性關節疾病P值為0.0001;物理治療肌力評估量表(Motoricity Index)脊椎損傷P值為0.030,背痛、腰部關節疾病P值為0.023,5公尺行走測試,在接受治療前後時間與步數上也都有明顯進步。
結論:透過這次的居家長照計畫,證明居家物理治療對於改善個案日常生活功能和身體基本機能有明顯助益,未來應更加推廣偏鄉地區長期照護的相關服務以彌補偏遠地區醫療照護資源不足的窘境。
Abstract
Background: In recent years, the aging population has grown rapidly. Because medical technology has advanced, most patients receive effective treatment in the early stages of diseases, and mortality has dropped substantially; however, the proportion of the population with chronic diseases and disabilities has increased. According to evaluations of daily functioning based on 6 indicators (eating, displacement, indoor walking, dressing, bathing, and using the toilet), 240,000people had disabilities in 2010; by 2015, the disabled population is estimated to reach 300,000. Families of people with disabilities are frequently inconvenienced by the reduced functioning of disabled family members, as is society, particularly in rural areas where medical resources are insufficient. Thus, providing home health care services at the appropriate time can improve patient functioning, increasing autonomy and quality of life, and reducing inconveniences to families and society in areas where medical resources are inadequate.
Objective: This paper discusses whether home physical therapy can improve the health status of people with disabilities in nine rural areas. Various care measures designed according to disability status and living environment are proposed to enable patients to retain autonomy and to enhance quality of life.
Methods: In this study, 132 patients living in nine rural areas received home physical therapy intervention. The Barthal Index, Berg Balance Scale, Motricity Index and 5-Meter Walk Test were administered before and after intervention to determine the effectiveness of home physical therapy sessions.
Results: Among the 132 patients who received home physical therapy, 131 patients participated in a minimum of 6 therapy sessions. The percentage of men and women was 33.3% (44) and 66.7% (88), respectively. Patients than agedless 65, 65 to 74, 75 to 84, and 85 years and older accounted for 9.1%(12),28.0%(37),50.0%(66), and 12.9%(17), respectively, of the total sample.
The Barthal Index used to compare patients before and after intervention showed significantly positive progress. Patients with stroke (p=.010), lumbar joint pathologies (p=.014), and arthroplasty (p=.021) exhibited significant progress. In addition, the average passive range of motion improved. Functional balance, measured using a simplified Borg Balance Scale, improved in patients with stroke, heart disease, open fracture, and joint degeneration (p=.0001). The Motricity Index scores for muscle strength significantly improved in patients with spinal cord injuries (p=.030) and lumbar joint pathologies (p=.023). Progress in time and steps was determined using the 5-Meter Walk Test before and after intervention.
Conclusion: When long-term home care was administered, the daily and basic body functioning of patients undergoing home physical therapy were proved to have greatly improved. Long-term home care should be promoted in rural areas to compensate for insufficient medical resources.
目次 Table of Contents
目錄
論文審定書 I
誌謝 II
中文摘要 III
ABSTRACT V
目錄 VII
圖次 VIII
表次 IX
第一章緒論 1
第一節 研究背景及動機 2
第二節 研究目的 4
第二章 文獻探討 5
第一節 長期照護的定義 5
第二節 台灣長期照護體系 6
第三節 長期照護服務對象 9
第四節 長期照護健康功能評估 10
第五節長期照護之居家照護服務 13
第三章 研究方法 14
第一節 研究設計與架構 14
壹、 研究設計 14
貳、 研究流程 16
參、 研究架構 17
第二節 研究問題與假設 18
第三節 研究對象與個案收集程序 19
壹、 研究對象 19
第四節 研究變項之操作型定義 20
第五節 研究資料之處理與分析 21
第四章 研究分析與結果 22
第一節 描述性統計分析 22
第二節 推論性統計分析 27
第五章 討論與建議 38
第一節 居家物理治療介入對失能者改善健康狀況之成效 39
第二節 疾病嚴重程度與居家物理治療介入之影響 40
第三節 人口學變項之結論 41
第六章 研究建議 42
第一節研究限制 42
第二節研究建議 43
第三節研究貢獻 45
附件 46
文獻整理 53
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