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題名：運用多元評估量表探討 長照2.0居家復能專業服務之成效
作者：許靜儀
作者(外文)：HSU, CHINGYI
校院名稱：亞洲大學
系所名稱：健康產業管理學系健康管理組
指導教授：廖宏恩
學位類別：博士
出版日期：2021
主題關鍵詞：長期照顧；失能；居家復健；居家復能；Long-term care；Disability；Home-based Rehabilitation；Home-based Reablement
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背景：
衛生福利部於2017年起全面推動長照2.0，其中重大的變革之一就是將長照1.0的「居家復健」轉型為「居家復能專業服務」並重新建立「居家復能專業服務」模式。然而長照 2.0「居家復能專業服務」，在推動期間公部門透過滾動式修正以尋求適合台灣且符合現行高齡社會需求的「居家復能專業服務」模式。目前最新的挪威研究與過去歐美的相關研究皆顯示居家復能的成本較一般醫療照護成本為低，在居家復能的成效大多指出對於被照顧者(服務使用者)的健康生活品質、日常生活功能的提昇有所幫助且能有助於降低醫療照護與長照服務的利用，其他的成效則尚未有定論，並缺乏外推性，因此本研究以國內長照2.0制度下大台中地區「居家復能專業服務」為基礎，期望能對於臺灣地區「專業復能」成效有所貢獻。
目的:
運用多元化量表探討長照2.0失能個案在接受「居家復能專業服務」之復能成效。希望其研究結果，能作為日後長照 2.0「居家復能專業服務」政策推動之參考。
研究方法：
本研究設計屬單組前後測設計，資料來源為社團法人台中市物理治療師公會長照2.0居家復能資料庫，原始試驗收案期間自108年9月16日至110年5月15日，並已經過去識別化處理。我們擷取193位接受12次(3個月) 「居家復能專業服務」介入的樣本將其納入本研究，並以SPSS 27.0版內的配對T檢定(paired t-test)和單因子變異數分析(Analysis of variance，簡稱ANOVA)來分析個案在接受「居家復能專業服務」的介入後，是否達統計上的顯著性差異。
結果:
研究有效樣本為193人，運用多元評估量表進行評估，就其居家復能專業服務介入後所呈現出具有前後測差異值並達統計上顯著性，包含：日常生活活動功能量表(ADL)平均數 9.82 ± 14.28標準差分(95% CI=7.79,11.85; t=9.55, p<0.001）、工具性日常生活活動能力量表(IADL) 平均數1 ± 2.12 標準差分(95%CI=0.70,1.30; t=6.54, p<0.001)、健康生活品質測量問卷(EQ-5D)平均數 -1.33 ± 2.06 標準差分 (95%CI=-1.62,-1.03; t=-8.93, p<0.001)、行動功能評估量表(DEMMI) 平均數1.78 ± 3.25 標準差分(95%CI=1.32,2.24; t=7.62, p<0.001)、照顧者負荷平均數 -1.33 ± 4.31標準差分(95%CI=-1.95,-0.72; t=-4.28, p<0.001)、個案復能潛力之學習能力(知識)平均數0.23 ± 1.22標準差分(95%CI=0.06,0.41; t=2.65, p<0.05)、個案復能潛力之復能動機(態度)平均數0.28 ± 1.56 標準差分(95%CI=0.06,0.50; t=2.49, p<0.05)。整體而言:被照顧者在日常生活活動、工具性日常生活活動與行動功能有顯著性進步，其生活品質同步獲得改善，且主要照顧者在照顧負荷上亦有減輕，統計資料顯示個案的復能潛力在知識、態度與行為上均有所提升尤其在知識、態度達統計上的顯著性差異。
結論與建議:
本研究以準實驗設計證實長照2.0「居家復能專業服務」可以改善失能個案的日常生活功能、行動功能及生活品質，也有助於減輕照顧者的負荷。個案在復能的學習能力(知識)及動機(態度)有所提升，但在配合度(行為)則未達統計上的顯著效益，可能代表須更長的時間介入或必須採用其他更有利的策略，以利於將復能精神落實於每日生活中，防止專業人員退場後個案的復能成效隨之下降或無法維持好的健康行為。
Background:
The Ministry of Health and Welfare has comprehensively promoted long-term care 2.0 since 2017. One of the major changes is to transform the “Home-based Rehabilitation" in long-term care 1.0 into “home-based reablement professional services" and re-establish the “home-based reablement professional services" model.The public sector workers amend" home-based reablement professional services " of the long-term care 2.0along with the promotion to find a model suitable for Taiwan and meets the needs of the current elderly society. The latest Norwegian research and past research in Europe and the United States both showed that the cost of home reablement was lower than the cost of general medical care.The results of home rehabilitation mostly point out that the quality of life of the caregivers (service users) can be improved and the cost of medical care can be reduced. Other results have not been determined and lack of extrapolation.. Therefore, this study uses the domestic long-term care 2.0 system in the Greater Taichung area to “home-based reablement Professional Services", it is expected to contribute to the promotionprofessional reablement in Taiwan.
Purpose:
To explore the reablement effect of long-term care 2.0 disabled patients after receiving "home reablement professional services" by using the diversity scale. It is hoped that the research results can be used as a reference for the policy promotion of "home reablement professional services" in the future.
Method and Materials:
The study design is a one-group pre-test design. The data source were from Home reablement Database version 2.0 of the Taichung City Physiotherapist Association from September 16to May 15, 2021, and the identification process has passed. We collected 193 samples who completely received 12 interventions (3 months) of "Home reablement Professional Services" and included them in this study, and used the paired t-test and single factor variance in SPSS version 27.0. One-way analysis of variance (ANOVA) is used to analyze whether there was a statistically significant difference of effectiveness after receiving the intervention of "Home reablement Professional Services".
Results:
This study used a multiple-dimension assessment scale tofind the statistical significance differences of effectiveness between the pre- and post-tests including the function of daily living function scale (95% CI=7.79,11.85; t test 9.55, p<0.001), instrumental activities of daily living Scale (95%CI=0.70, 1.30; t test 6.54, p<0.001), healthy life quality measurement questionnaire (95%CI=-1.62, -1.03; t test -8.93, p<0.001), action function evaluation Table (95%CI=1.32, 2.24; t-test 7.62, p<0.001), loadings of caregiver (95%CI=-1.95, -0.72; t-test -4.28, p<0.001), learning ability of individual resuscitation potential (Knowledge) (95%CI=0.06,0.41; t-test 2.65, p<0.05), the motivation of the case's rehabilitative potential (attitude) (95%CI=0.06,0.50; t-test 2.49, p<0.05). On the whole: The care-recipients had made significant progress in activities of daily living, instrumental activities of daily living, and movement functions. The quality of life among care-recipients has been improved simultaneously, and the care burden of main caregivers has also reduced.. The results also demonstrated that the care-recipients has improved the knowledge, attitude and behavior of ability potential, especially statistically significant differences in knowledge and attitude.
Conclusion and Suggestion:
This study confirmed that long term care 2.0 "home reablement professional services" can improve the daily life function, mobility function and quality of life of disabled patients, and also help to reduce the work of caregivers. The learning ability (knowledge) and motivation (attitude) of patients in reablement were improved, but there was no significant effect in cooperation (behavior). This indicates that it may take longer time to intervene or adopt other more favorable strategies to improve the degree of cooperation, implement the spirit of reablement in daily life, and prevent the patients from declining the effectiveness of reablement or failing to maintain good health behaviors after the professionals leave.
中文文獻
毛慧芬（2021/04/24），「長照復能專業服務與品質提升研習課程」上課講義。社團法人臺灣職能治療學會110年度職能治療繼續教育課程。
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