Journal of Taiwan Occupational Therapy Research and Practice
半年刊,正常發行
新近研究顯示制動療法除可改善中風個案上肢習得廢用現象及動作功能,可能對基本日常生活活動之獨立性,以及生理層面生活品質具提升效益。然而過去制動療法的臨床試驗裡,實驗組與控制組治療量並不均等,且成效指標限於動作功能與基本生活功能的獨立性,未能涵蓋個體在自然環境中的整體功能。為克服上述問題,本研究對照修正式制動療法與等量控制傳統復健之相對成效,將22位慢性中風患者隨機分配至修正式制動療法或傳統復健組,接受每天兩小時、一週五天為期三週之治療,每天治療時間外並侷限所有受試健側上肢(目標時間為每日六小時),以提供患側手功能練習的機會。本研究的成效評量,依照國際功能、失能與健康分類架構,採用傅格-梅爾動作復原評估表、渥夫動作功能測驗、九孔插棒測驗(評量身體構造與功能),功能獨立量表及諾丁漢工具性日常生活量表(評量基本與工具性日常生活活動能力),以及中風影響量表與中風專屬生活品質量表(評量參與功能),以共變數分析檢定治療後兩組間的差異。結果顯示,修正式制動療法的成效較好,動作恢復(F(下标 1,18)=3.91)及動作功能(F(下标 1,18)=3.93)優於傳統復健組,生活功能的獨立度較高(F(下标 1,18)=10.75),若干工具性日常生活功能(如行動能力)的表現也較好(F(下标 1,18)=4.14)。此外,生理層面之主觀生活品質也較佳(F(下标 1,18)=4.26)。結果顯示修正式制動療法,較之傳統復健,更能改善個案之動作與日常生活功能,以及自覺生活品質。未來仍需後續研究來澄清修正式制動療法中各要素的貢獻,並探討治療成效的影響因素。
Constraint-induced therapy is a promising approach to eliminating learned nonuse phenomenon and promoting motor function, daily functioning and quality of life after stroke. This controlled clinical trial investigated the effects of a form of modified constraint-induced therapy (mCIT) in comparison to duration-controlled traditional rehabilitation (TR) on motor function, basic and instrumental activities of daily living (ADL) and quality of life in patients with chronic stoke. Twenty-two patients with unilateral hemiparesis after stroke were randomized to the mCIT or the TR (regular occupational therapy and use of restraint outside therapy) group, with 2-hour treatment per weekday for a period of 3 weeks. In addition, the less-affected arm was restrained outside rehabilitation for a target of 3 hours. Outcome measures were organized in accord with the International Classification of Functioning, Disability and Health (ICF) framework, including the Fugl-Meyer Assessment, Wolf Motor Function Test, and Nine-hole Peg Test for the body structure and function domain; Functional Independence Measure and Nottingham Extended Activities of Daily Living Scale for the activity domain; Stroke Impact Scale and Stroke-Specific Quality of Life Scale for the participation domain. Participants in the mCIT group exhibited significantly better motor recovery (F(subscript 1,18)=3.91) and motor function (F(subscript 1,18)=3.93), more independence in basic (F(subscript 1,18)=10.75) and some aspects of instrumental ADL (F(subscript 1,18)=4.14 in mobility), and better perceived quality of life in the physical domains (F(subscript 1,18)=4.26). The findings indicate the therapeutic benefits of mCIT in stroke rehabilitation. Further larger studies are needed to identify the components of mCIT that are important for treatment success and the factors that may affect treatment outcomes.