| 摘要: | 一、研究背景
腦中風多年來是國人十大死因之一，腦中風所導致的功能限制問題包含肢體癱瘓、行動限制、吞嚥以及語言障礙等問題等，而在康復期間最常見的心理問題即憂鬱症狀，不但會影響到復健成效，嚴重者甚至會造成二次中風危及到生命。過去文獻指出，憂鬱症狀可能是影響腦中風後功能變化的重要因素，但仍有研究持不同的看法。然而目前關於急性期患者憂鬱症狀對功能變化影響的相關資訊並不充分。因此，能否在關鍵時間內察覺患者中風後的精神與心理狀態變化，了解其對功能改變的影響對於早期治療相當重要。
二、研究目的
本研究的主要目的為針對急性中風患者住院期間憂鬱症狀及功能的改變進行分析與觀察，探討憂鬱症狀程度與功能變化的相關性。
三、研究方法
本研究為探索性研究，從計畫主持人張鳳航(本研究之指導教授)於2015年著手進行的研究「急性後期照護評估：評估工具發展」中進行二手資料分析，本研究從母研究於2015年11月12日至2018年02月13日於北醫三院所招募之620位剛入院的成年急性神經疾病患者中，篩選出456位急性期腦中風住院患者，使用其入院復健第一週（前測）與出院復健前一週（後測）兩次之評量資料進行分析。
本研究共有289位急性中風患者(平均年齡59.9 ± 11.8；女性佔35.6%)完成入院復健第一週（前測）與出院復健前一週（後測）兩次評估，使用中文版AM-PAC™住院病人短式量表(功能評估類別包含基本移動、日常活動、應用認知)與憂鬱量表CES-D進行測量，並使用相關性分析及多元迴歸分析進行AM-PAC與CES-D分數變化之間的關係。使用SPSS 19.0統計軟體進行雙變項分析及多元迴歸分析。
四、研究結果
研究結果顯示AM-PAC的基本移動與日常活動與CES-D的變化有顯著相關(r= -0.143以及-0.150，p< 0.05)。但AM-PAC的應用認知與憂鬱量表無顯著關係。在調整人口學與臨床變項後，結果仍顯示AM-PAC的基本移動與日常生活活動與CES-D的變化有顯著相關。
五、結論
研究發現基本移動功能、日常活動功能與憂鬱症狀呈現附相關。而應用認知功能與憂鬱症狀的變化並無相關性。本研究的結果可為未來急性期中風復健進行介入治療提供相關訊息。
Background
Stroke has been one of the 10 major causes of death in Taiwan for many years. The functional limitations caused by stroke have problems such as physical paralysis, movement restrictions, swallowing, language barriers and so on. The most commonly observed psychological problems during the recovery of stroke are depressive symptoms, which may have a great impact on the effectiveness of rehabilitation. In the past, literature has pointed out that depressive symptoms may be an important factor affecting the functional changes after stroke, but there are still studies with different opinions. However, little is known about how depressive symptoms affect functional outcomes among stroke survivors at the acute stage.
Therefore, it is very important to detect the changes of mental and psychological state of patients after stroke within a critical time, and understand its impact on functional changes for early treatment.
Purposes
The purpose of this study was to describe the changes of depressive symptoms and functions during hospitalization in patients with acute stroke, and to examine the correlation between the changes of depressive symptoms and the changes of functional performance.
Methods
This study is exploratory study that analyze secondary data from the “Acute Care Assessment: Development of Assessment Tools” in the primary study. The researchers screened out 456 acute stroke hospitalized patients from 620 newly admitted adults with acute neurological disease enrolled in three hospitals from Taipei Medical University from November 12, 2015 to February 13, 2018. First week rehabilitation after admission (pre-test) and the last week rehabilitation before discharge (post-test), assessments were analyzed twice.
A total of 289 acute stroke patients (mean age: 59.9 ± 11.8; 35.6% female) completed baseline assessment on admission to acute rehabilitation and completed post-test assessment at discharge. The primary outcome measures included the Mandarin version Activity Measure for Post-acute Care (AM-PAC) "6 Clicks" (measuring three functional domains: basic mobility, daily activity, and applied cognition) and the Center for Epidemiological Studies Depression Scale (CES-D) (measuring depressive symptoms). Correlation analysis and multiple regression analysis were used to examine the associations between the change scores of the AM-PAC and the CES-D. SPSS 19.0 statistical software was used to perform bivariate analysis and multivariate regression analysis.
Results
The change of the CES-D score was significantly correlated with the change of the AM-PAC Basic mobility and Daily activity subscale scores (r = -0.143 and -0.150, p <0.05), but not correlated with the AM-PAC Applied cognition subscale score. After adjusting for demographic and clinical variables, the change of the CES-D score still demonstrated correlations with the change of the AM-PAC Basic mobility and Daily activity subscale scores.
Conclusions
Changes of depressive symptoms was found negatively correlated with changes of basic mobility and daily activity functions among patients with stroke in acute care settings. However, changes of depressive symptoms was not significantly associated with changes of applied cognition. Findings of this study may be used to inform the development of interventions for acute rehabilitation services. |
