2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/650947摘要：中風是造成死亡與長期失能的重要原因。雖然失能被認為與中風後的長期存活相關，但是先前研究大多只在中風急性期單次測量功能狀態作為預後因子，較少有研究分析中風後功能進步的程度對於存活率的影響，然而中風後功能是可以經由復健醫療改善的，故瞭解功能進步對於存活的作用可以幫助瞭解復健對於中風患者長期存活的潛在效用，倘若減少失能可以提高中風患者的長期存活率，將能強化復健醫學在中風患者整體照顧與長期預後的價值。此外，先前探討中風後失能對於長期存活影響的研究，均無法同時描繪中風後失能與死亡的動態變遷過程，故本計畫提出將失能視為死亡事件前的中介狀態之模型，此將有助於瞭解復健醫學對於改善中風後長期預後可能扮演的角色。本計畫將使用台大醫院腦中風登錄資料，探討中風後失能狀態對於存活率的效應；此外，將以行政院衛生署國民保健局的「臺灣地區老人保健與生活問題長期追蹤調查系列研究」具有代表性的全國抽樣之世代長期追蹤資料，包括功能狀態的重複測量與死亡事件的紀錄，用以建構中風後失能與死亡動態多階段馬可夫模型，探討失能在中風患者其死亡是否具有中介因子之角色，並估算失能與死亡變遷預測機率以求得中風失能對於社會之負擔。藉由上述之研究計畫可瞭解失能在中風患者其長期存活所扮演的角色，對於中風後長期照顧之資源需求配置與醫療決策分析將有所助益。<br> Abstract: Stroke is a leading cause of disability and mortality worldwide, which leads to enormoussocioeconomic burden. Previous studies have shown that disability is an independentprognostic factor on long-term survival after stroke. However, most prior studies measureddisability at only one single time point at acute phase of stroke, and few studies have beendevoted to evaluating the impact of functional improvement on the long-term survival afterstroke. Since stroke-related disability could be reduced by rehabilitation, the associationbetween a reduction in disability and a better survival would highlight the potentialbeneficial role of rehabilitation in reducing long-term mortality of stroke through reducingdisability. Nevertheless, few researchers have investigated the effect of disability as atime-dependent predictor. Moreover, little is known regarding the dynamics between theindependence, disability and death after stroke simultaneously. In the present proposal, wewill treat disability as an intermediate before death in patients with stroke. This approachwould enable us to evaluate the potential benefit of rehabilitation in improving the long-termsurvival after stroke. We will investigate the effects of disability on the survival after strokebased on the data derived from the stroke registry of one medical center. In addition, we willuse the data derived from the “Survey of Health and Living Status of the Elderly in Taiwan”,which is a prospective longitudinal cohort from nation-wide representative samples. Thispanel database consists of mortality records and repeated measurements of functional statusof participants. A three-state Markov model delineating the dynamic transitions betweendisability and death will be constructed to investigate the role of disability as an intermediateof death. The results of our study will be expected to be very informative to elucidate thepotential role of rehabilitation on the long-term care in patients with stroke.腦中風失能死亡