2013-01-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660755摘要：背景/目的：中風是導致成年人失能 (disability) 的最主要原因。失能程度之指標通常以病人的日常生活 (activities of daily living, ADL) 依賴程度為代表。ADL 功能復健成效受到病人/家屬的「動機」影響甚大。以「病人為中心」的治療理念考量病人/家屬的需求與動機，因此很有潛力可以提升個案的動機以及ADL 功能復健成效。然而病人與家屬通常對於中風及職能治療的認識程度有限，尤其是職能治療專精於日常生活功能訓練，常不為個案/家屬熟知。由於病人及家屬對於這些基本健康與復健相關知識的貧乏，不但將影響以病人為中心理念的推動，也降低病人接受ADL 功能復健的意願及成效。因此我們計畫的主要目的是提出一個「以病人為中心的職能治療模式」，並驗證其提升中風病人ADL 功能之成效。另外，我們將先發展病人「中風及職能治療之電腦適性知識測驗及教育系統」，以快速、有效提升病人/家屬之中風及職能治療知識，並提升「以病人為中心的職能治療模式」之執行效率。方法： 此 5 年計畫的前3 年，將先發展與驗證「中風及職能治療之電腦適性知識測驗及教育訓練系統」，以確認此系統可有效提升病人/家屬之中風及職能治療知識水平。最後2 年，我們將應用此知識與教育系統，藉以提升醫療人員與病人之溝通效率，並發展「以病人為中心之職能治療模式」。最後我們將設計隨機控制之臨床試驗 (randomized controlled trial)，以驗證此套結合「電腦適性知識測驗及教育系統」及「以病人為中心之職能治療模式」是否有效提升病人之ADL 功能。我們亦將驗證此治療模式之成本效性 (cost effectiveness)及成本效用 (cost utility)。預期結果：我們預期未參與研究之前，病人與家屬之中風及職能治療知識相當有限。我們設計之「中風及職能治療之電腦適性知識測驗及教育訓練系統」，將可以快速、有效地提升病人/家屬之中風及職能治療知識水平。此套結合「電腦適性知識測驗及教育系統」及「以病人為中心之職能治療模式」可以有效提升病人之ADL 功能。而且此模式之成本效性/效用良好。潛在價值與貢獻： 「中風及職能治療之電腦適性知識測驗及教育系統」將適用於臨床，可提升病人與家屬之中風及職能治療知識。因為目前全世界並無類似系統，我們的系統可能是國際上的第一套。因為此電腦適性系統之效率佳，故可以在忙碌的臨床實務中，推動「以病人為中心之職能治療模式」。因此以病人為中心之職能治療模式不但務實可行，也可有效降低病人之失能程度，也符合成本考量。我們將依據研究成果發展臨床治療指引，以有效推動以病人為中心之職能治療模式。我們希望藉由此研究成果可結合「以病人為中心之理念」以及「實證醫學」等二大醫學潮流。同時顧及醫療成本及效用。<br> Abstract: Background and purposes: Stroke is the leading cause of adult disability. A person’s level of independence on activities of daily living (ADL) is considered indicative of the level of disability. The effectiveness of ADL training depends greatly on the motivation of the patients and their family. A patient-centered approach has been advocated for clinical practice and potentially increases the motivation and effectiveness of ADL training. However, the patient and his/her caregiver mostly lack knowledge of stroke and occupational therapy (OT), which is a profession for ADL training. This lack of fundamental knowledge not only hampers the execution of a patient-centered approach but also reduces the effect of ADL training. Thus, our primary purpose is to propose a patient-centered OT approach and examine its effect on ADL function in stroke patients. To prepare for the patient-centered OT approach, we will first develop a computerized adaptive knowledge and education system for testing and improving patients’ and caregivers’ knowledge on both stroke and OT.Method: In the first 3 years of the 5-year project, we will develop the computerized adaptive knowledge and education system. We will also examine the effectiveness of the computerized adaptive knowledge and education system. In the last 2 years, we will employ this system as a component of the patient-entered OT approach to improve the efficiency of patient-caregiver-therapist communication. Finally, we will carry out a randomized controlled trial to determine whether the patient-centered OT approach using the computerized adaptive knowledge and education system will significantly improve ADL function in stroke patients over that of traditional OT. The cost effectiveness and cost utility of the program will also be examined.Expected results: We hypothesize that the patients and caregivers’ original knowledge of stroke and OT will be limited or modest. We expect that the computerized adaptive knowledge and education system will efficiently improve knowledge of stroke and OT of a patient/family. In addition, the patient-centered OT program using the computerized adaptive knowledge and education system will improve ADL independence in stroke patients. The patient-centered OT program will be cost-effective in improving ADL function and utility (as measured by the EQ-5D).Potential value and contributions: The computerized adaptive knowledge and education system will be useful for clinicians to promote stroke and OT knowledge for stroke patients and their families. Because no adaptive stroke and OT knowledge and education system exists yet, our system might be the first in the world. The computerized adaptive knowledge and education system will be so efficient that it can facilitate the administration of patient-centered OT approach in busy clinical settings. Thus, the patientcentered OT approach will be feasible and effective. We will develop clinical guidelines on the basis of the patient-centered OT program to disseminate this program to daily clinical practice. Finally, we hope that our project will allow us to combine patient-centered care and evidence-based medicine while addressing the imperatives of cost effectiveness and utility.以病人為中心職能治療電腦適性測驗中風client-centered approachoccupational therapycomputerized adaptive testingstroke