2016-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/656455摘要：中風是造成失能和死亡的重要原因，導致很大的經濟與社會負擔。因此如何改善中風後之存活與減少併發症是中風醫療照護的重要議題。先前的研究顯示中風後功能改善程度是中風病人長期存活的重要預測因子，而也有研究指出在中風後進行復健可以改善中風病人之功能表現。然而先前評估中風病人出院後接受門診復健對於改善長期存活之效益的相關研究相當少，再者，更少有研究針對門診復健改善中風後長期存活進行死因別分析以探討其療效的可能機轉。目前國內對於門診復健治療是否能改善中風病人之長期存活的研究仍相當有限，先前的研究其樣本經過高度選擇，代表性較為受限，亦沒有進行死因別分析。故本研究計畫擬使用全民健保資料與相關健康資料庫做為研究資料，分析門診復健對中風後長期存活與預後之療效，並且進行死因別分析。因本研究計畫屬於縱向追蹤之觀察性研究，並沒有對於是否接受復健治療進行隨機分派，為了減少對於接受復健治療與否的選擇性偏差，本計畫將採用傾向分數配對（propensity score matching）的分析方式。傾向分數是指一位中風病人基於其臨床上所有可測量到的特質之下，此病人接受復健治療之機率，藉由傾向分數配對，可以把干擾因子的影響降到最低，以評估初次中風病人出院後接受門診復健對於長期存活與預後的效果。本研究計畫將有助於瞭解門診復健治療對於改善中風預後之效益，對於臨床醫療決策與醫療資源配置將具有重要參考價值。<br> Abstract: Stroke is one of the major causes of disability and death worldwide, resulting in enormousmedical and socioeconomic burden. It is therefore very important to reduce disability and mortalityin patients with stroke. Previous studies have shown that functional improvement after stroke is animportant predictor of the long-term survival in stroke patients, and the functional recovery inpatients with stroke may be enhanced by rehabilitation. However, few studies have investigated theeffectiveness of outpatient rehabilitation on long-term survival after stroke. Moreover, little researchhas analyzed the causes of death and proposed possible mechanisms underlying the effectiveness ofoutpatient rehabilitation on long-term survival in patients with stroke. In Taiwan, research onwhether outpatient rehabilitation could improve the survival in stroke patients is also scarce, and therepresentativeness of previous research is limited by the selected study population and lack ofanalysis on the causes of death. Therefore, the objective of the present study proposal is to carry outa population-based, propensity-score matched, longitudinal follow-up study to evaluate the effectsof outpatient rehabilitation on the long-term survival and outcomes in stroke patients, and toanalyze the causes of death. Our study will use the National Health Insurance database and relateddatabase from the Ministry of Health and Welfare, Taiwan. The propensity score is the probabilityof receiving rehabilitation given all the measured clinical characteristics, including demographicvariables, medical co-morbidities, geographic, socioeconomic, and stroke severity-related variables.Matching on propensity scores can minimize potential selection bias and therefore can establishcomparable rehabilitation and control groups. This study is expected to provide valuableinformation on medical decision making and resource allocation in patients with stroke.