发展以脑中风个案为中心之全面性ADL评估工具

表CM03共25頁第頁发展以脑中风个案为中心之全面性ADL评估工具背景：日常生活活动(ActivitiesofDailyLiving,ADL)介入一直是脑中风个案职能治疗与长期照护的重点之一。然而ADL概念复杂，至少包含三种概念或层面：执行能力(capability)、实际表现(actualperformance)及个案从事ADL之自觉困难程度(perceiveddifficulty)（或自觉功能状态/满意度）。ADDINEN.CITEADDINEN.CITE.DATA1-4各种ADL层面各有其学术与实务价值。由于ADL评估是介入的关键基础，且评估过程中，可（须）了解/厘清个案/家属之需求，因此如何做好ADL评估为ADL介入与成效之关键。然而现有ADL评估工具之常见缺点有三：一、未全面包含主要ADL层面（执行能力、实际表现与自觉困难程度）。二、未考量个案需求/预期：施测过程中，未充分考虑个案之需求、健康识能(healthliteracy)或未执行共享决策(shareddecisionmaking)，以至于评估重点与结果难以符合个案之预期。三、标准化不佳，尤其是执行能力之评估，标准化不足。上述缺点严重影响脑中风个案之ADL评估与介入效能。研究目的：发展以脑中风个案为中心之全面性/标准化ADL评估工具(ComprehensiveandstandardizedADLassessmentsforpersonswithstroke,CSAS)【名称未纳入SDM,Comprehensive,shared,andstandardizedADLassessmentsforpersonswithstroke，应可适用于其他生理个案Jan.15.2023】，意即评估过程加入共享决策，厘清个案之特质与需求，必要时给予个案卫教/咨询，再由评估人员与个案共同决定ADL评估层面、项目与评估执行能力所需器材。此工具将能解决上述缺点，并能提升ADL评估与介入之效能。方法：此三年计划分成二大步骤完成之。步骤一为发展CSAS项目与施测流程（包含共享决策与卫教），并于临床测试可行性与预期时间。以确保CSAS之可行性。步骤二为验证CSAS之心理计量特性（包含信度、效度与反应性）。信度包含施测者内与施测者间信度，以及相对应之随机测量误差。预期结果与价值：CSAS将具备四大特色：一、内容包含ADL三大层面（执行能力、实际表现与自觉困难程度）。二、符合个案需求：施测过程充分与个案/家属交流，以共同决定施测内容。三、标准化。四、可于合理时间内完成。上述特色将有助于大幅提升脑中风个案之ADL评估与介入之效能。创新之处：本研究或将是国际上首度融合以「个案为中心」的决策模式且全面评量ADL三层面之标准化评估工具。

三、研究计划内容（以中文或英文撰写）：研究计划之背景。请详述本研究计划所要探讨或解决的问题、研究原创性、重要性、预期影响性及国内外有关本计划之研究情况、重要参考文献之评述等。ADL之于脑中风个案/家属之重要性日常生活活动(activitiesofdailyliving,ADL)是指在日常生活中普遍执行的活动。完整之ADL应包含基本日常生活活动(basicADL,BADL)与工具性日常生活活动(instrumentalADL,IADL)二部分：ADDINEN.CITEADDINEN.CITE.DATA5,6BADL是指与自我照顾相关的活动，如进食、更衣、盥洗等；IADL则是指与社区独立生活相关之活动，如使用电话、外出社交、搭乘大众交通工具等。脑中风个案常因动作功能之损伤造成个案难以独立执行BADL与IADL，进而影响其生活独立性、ADDINEN.CITE<EndNote><Cite><Author>Haghgoo</Author><Year>2013</Year><RecNum>3</RecNum><DisplayText><styleface="superscript">7</style></DisplayText><record><rec-number>3</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786617">3</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Haghgoo,H.A.</author><author>Pazuki,E.S.</author><author>Hosseini,A.S.</author><author>Rassafiani,M.</author></authors></contributors><auth-address>DepartmentofOccupationalTherapy,UniversityofSocialWelfareandRehabilitationScience,Tehran,Iran.</auth-address><titles><title>Depression,activitiesofdailylivingandqualityoflifeinpatientswithstroke</title><secondary-title>JNeurolSci</secondary-title></titles><periodical><full-title>JNeurolSci</full-title></periodical><pages>87-91</pages><volume>328</volume><number>1-2</number><keywords><keyword>*ActivitiesofDailyLiving</keyword><keyword>Aged</keyword><keyword>Cross-SectionalStudies</keyword><keyword>Depression/diagnosis/*etiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MentalStatusSchedule</keyword><keyword>MiddleAged</keyword><keyword>*QualityofLife</keyword><keyword>SeverityofIllnessIndex</keyword><keyword>Statistics,Nonparametric</keyword><keyword>Stroke/*complications/*psychology</keyword><keyword>SurveysandQuestionnaires</keyword></keywords><dates><year>2013</year><pub-dates><date>May15</date></pub-dates></dates><isbn>1878-5883(Electronic) 0022-510X(Linking)</isbn><accession-num>23522526</accession-num><urls><related-urls><url>/pubmed/23522526</url></related-urls></urls><electronic-resource-num>10.1016/j.jns.2013.02.027</electronic-resource-num></record></Cite></EndNote>7社会功能(socialfunctioning)，ADDINEN.CITE<EndNote><Cite><Author>Carod-Artal</Author><Year>2002</Year><RecNum>4</RecNum><DisplayText><styleface="superscript">8</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786617">4</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Carod-Artal,F.J.</author><author>Gonzalez-Gutierrez,J.L.</author><author>Herrero,J.A.</author><author>Horan,T.</author><author>DeSeijas,E.V.</author></authors></contributors><auth-address>StrokeUnit,NeurologyDepartment,SanCarlosHospital,Madrid,Spain.</auth-address><titles><title>Functionalrecoveryandinstrumentalactivitiesofdailyliving:follow-up1-yearaftertreatmentinastrokeunit</title><secondary-title>BrainInj</secondary-title></titles><periodical><full-title>BrainInj</full-title></periodical><pages>207-16</pages><volume>16</volume><number>3</number><keywords><keyword>*ActivitiesofDailyLiving</keyword><keyword>Aged</keyword><keyword>Cross-SectionalStudies</keyword><keyword>DisabilityEvaluation</keyword><keyword>Female</keyword><keyword>Follow-UpStudies</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>*RecoveryofFunction</keyword><keyword>Stroke/*therapy</keyword><keyword>SurveysandQuestionnaires</keyword></keywords><dates><year>2002</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0269-9052(Print) 0269-9052(Linking)</isbn><accession-num>11874614</accession-num><urls><related-urls><url>/pubmed/11874614</url></related-urls></urls><electronic-resource-num>10.1080/02699050110103337</electronic-resource-num></record></Cite></EndNote>8以及生活质量(qualityoflife)。ADDINEN.CITEADDINEN.CITE.DATA7,9因此ADL介入一直是脑中风个案职能治疗与长期照护的重点之一。另一方面，由于医学的进步，许多重大疾病病患之寿命延长，加上人口老化，且国内长期照护法已于民国104年通过，造成需要长期照护（以下简称长照）的个案逐渐增多。ADDINEN.CITE<EndNote><Cite><Author>Lindeboom</Author><Year>2003</Year><RecNum>2</RecNum><DisplayText><styleface="superscript">6</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786617">2</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Lindeboom,R.</author><author>Vermeulen,M.</author><author>Holman,R.</author><author>DeHaan,R.J.</author></authors></contributors><auth-address>DepartmentofClinicalEpidemiologyandBiostatistics,AcademicMedicalCenter,Amsterdam,TheNetherlands.</auth-address><titles><title>Activitiesofdailylivinginstruments:optimizingscalesforneurologicassessments</title><secondary-title>Neurology</secondary-title></titles><periodical><full-title>Neurology</full-title></periodical><pages>738-42</pages><volume>60</volume><number>5</number><edition>2003/03/13</edition><keywords><keyword>*ActivitiesofDailyLiving</keyword><keyword>DisabilityEvaluation</keyword><keyword>Humans</keyword><keyword>NervousSystemDiseases/*classification/diagnosis/rehabilitation</keyword><keyword>NeurologicExamination/*instrumentation</keyword></keywords><dates><year>2003</year><pub-dates><date>Mar11</date></pub-dates></dates><isbn>1526-632X(Electronic) 0028-3878(Linking)</isbn><accession-num>12630419</accession-num><urls><related-urls><url>/pubmed/12630419</url></related-urls></urls><language>eng</language></record></Cite></EndNote>6长照与失能人口增加，也间接造成ADL/生活独立/复能等学理、评估、与临床介入，于学术研究与临床的重要性逐渐增加。ADL评估之重要性 ADL的评估结果具备四项价值：一、可代表个案生活独立或失能程度；ADDINEN.CITEADDINEN.CITE.DATA10,11二、可作为ADL训练与治疗的依据；ADDINEN.CITE<EndNote><Cite><Author>Law</Author><Year>1989</Year><RecNum>1</RecNum><DisplayText><styleface="superscript">5</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786617">1</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Law,M.</author><author>Letts,L.</author></authors></contributors><auth-address>DepartmentofMedicine,McMasterUniversity,Hamilton,Ontario,Canada.</auth-address><titles><title>Acriticalreviewofscalesofactivitiesofdailyliving</title><secondary-title>AmJOccupTher</secondary-title></titles><periodical><full-title>AmJOccupTher</full-title></periodical><pages>522-8</pages><volume>43</volume><number>8</number><edition>1989/08/01</edition><keywords><keyword>*ActivitiesofDailyLiving</keyword><keyword>Humans</keyword><keyword>OccupationalTherapy/*methods</keyword><keyword>Psychometrics</keyword></keywords><dates><year>1989</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0272-9490(Print) 0272-9490(Linking)</isbn><accession-num>2672821</accession-num><urls><related-urls><url>/pubmed/2672821</url></related-urls></urls><language>eng</language></record></Cite></EndNote>5三、可当成验证治疗成效之指标；ADDINEN.CITE<EndNote><CiteExcludeYear="1"><Year>2002</Year><RecNum>6</RecNum><DisplayText><styleface="superscript">10</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786618">6</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors></contributors><titles><title>OccupationalTherapyPracticeFramework:domainandprocess</title><secondary-title>AmJOccupTher</secondary-title><alt-title>TheAmericanjournalofoccupationaltherapy:officialpublicationoftheAmericanOccupationalTherapyAssociation</alt-title></titles><periodical><full-title>AmJOccupTher</full-title></periodical><pages>609-39</pages><volume>56</volume><number>6</number><edition>2002/12/03</edition><keywords><keyword>ActivitiesofDailyLiving</keyword><keyword>Humans</keyword><keyword>Models,Theoretical</keyword><keyword>OccupationalTherapy/*organization&administration/standards</keyword><keyword>OutcomeAssessment(HealthCare)</keyword><keyword>*ProcessAssessment(HealthCare)</keyword><keyword>TaskPerformanceandAnalysis</keyword><keyword>TerminologyasTopic</keyword></keywords><dates><year>2002</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>0272-9490(Print) 0272-9490</isbn><accession-num>12458855</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>10以及四、可预测个案之照护需求等。ADDINEN.CITEADDINEN.CITE.DATA12另外，IADL的评量结果除了可代表个案于社区生活之独立程度，也可用以筛检失智症ADDINEN.CITEADDINEN.CITE.DATA13,14。所以ADL功能之评估，也是职能(occupations)评估的重要内容ADDINEN.CITE<EndNote><Cite><Year>2020</Year><RecNum>11</RecNum><DisplayText><styleface="superscript">15</style></DisplayText><record><rec-number>11</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786618">11</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors></contributors><titles><title>OccupationalTherapyPracticeFramework:DomainandProcess—FourthEdition</title><secondary-title>AmericanJournalofOccupationalTherapy</secondary-title></titles><periodical><full-title>AmericanJournalofOccupationalTherapy</full-title></periodical><pages>7412410010p1-7412410010p87</pages><volume>74</volume><number>Supplement_2</number><dates><year>2020</year></dates><isbn>0272-9490</isbn><urls><related-urls><url>/10.5014/ajot.2020.74S2001</url><url>/7412410010p1_1599074244.17658.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAn0wggJ5BgkqhkiG9w0BBwagggJqMIICZgIBADCCAl8GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMfAhmrj4dKIzaUAG2AgEQgIICMHvOIOuYOxDLAVCuvHDCSMQqYWjZPEz4v9qgOfwTSc7VJmg4chYlQhF-vW-O2uO4rs1WG3yFrMWsQMc-D2Yp9Y2QgTdiSSRAZ0ZQ75_kGMQXWdIllHVciLJoWeNeFs5zhLINrjupKK1uQ3VKIVeTUrN99py8xFM7MjqIQAHrNyUnSNHIDqRtL448RBbOBxFT_QgbJOD1CnHDcDP8chcVGsvyz-XHgaur5I8Qa2PYcAmwkhawB5Yf-zWdMKHBQqPBJwhoUZAPaRdhUnWU4BXDZeG3dh-9W0XvWRcOokeJaV-LBj75qDSjm7e4YVp06NFlNwDad-ra3eTtO_dZet1TFih6VciOjtRxXUSjqr0VG5f8A_418CK7W8KQsSVlaY5t-34E9zafI3IdL1lbZPW81Udw4tyEAe1U0C4gxglWdrBLPT7R6oq8NXvAnGHRfHmxyG4paO9ArMdq-jrplu3jcGLLCQg5mbLeIJ4V82mzzMU2h1GGmJy0ti5z8v1lWrDiMPLc4AC6INoKn0nly917XQwp8bn9f7KM_XrHs3ia0wdiAYbhMUe_DHWMu5CSVwjFUPvdZL8IWZ4HwAHt1lYaLwMUvJZULBw1dIMRkzE5xed7xOef33RHNCvKZdrqmA4BnO0UYZJXlqLx6VCAdkWmH32liNXe3H_zTedi1Yxr3zW1h83z1Y6A-V8PeKI9JmRoMLKBLsyLYfejZPgT0gfvvv0iEHz9JBwrKKiNgQji92w1</url></related-urls></urls><electronic-resource-num>10.5014/ajot.2020.74S2001</electronic-resource-num><access-date>4/25/2021</access-date></record></Cite></EndNote>15，一直是职能治疗临床与研究的重点。ADL之多元概念或层面以及代表性评估工具理论上ADL至少包含三种概念或层面：ADL执行能力(capability)、ADL实际表现(actualperformance)及个案从事ADL之自觉困难程度(perceiveddifficulty)或自觉功能状态/满意度（以下以「自觉困难程度」代表之）。ADDINEN.CITEADDINEN.CITE.DATA1-4各种ADL层面之临床与理论意义迥然不同，甚至评估模式也不一。临床或研究人员必须明确区隔与记录之，否则评估/记录的概念可能不明确，不利于临床治疗计划之拟定与疗效之评估，也不利于专业人员间的沟通。另外，厘清这些概念也有助于治疗师如何对受评个案说明ADL评估内容与价值，以利于后续ADL治疗目标与计划之决策，甚至后续追踪评估之ADL治疗成果呈现。表一简述三种ADL概念/层面之特质。以下详述「执行能力」、「实际表现」与从事ADL的「自觉困难程度」之特质与差异。一、「执行能力」之特质个案ADL之执行能力代表个案于标准化情境，亲身从事各种ADL的能力/表现。ADDINEN.CITEADDINEN.CITE.DATA1,3,4ADL「执行能力」为一般临床职能治疗师评估ADL的主要层面。临床评估时，治疗师通常请个案于治疗室执行每项ADL，治疗师再从旁观察个案执行每项ADL之过程与能力，借以评估个案从事各项ADL之能力高低。由于个案的执行能力受到ADL情境或器材影响，因此评估各种ADL之情境或器材务必标准化，若使用不一致之情境或器材，评估结果将不一致。评估ADL执行能力的主要优点有二：一、治疗师可立即掌握个案从事ADL的执行问题，故评估结果可直接运用于ADL的功能训练。二、评估结果可协助治疗师判断是否需要给予个案辅具处方。因此临床上，许多职能治疗师例行评估个案之ADL执行能力。表一：三种ADL概念/层面之特质比较执行能力(capability)实际表现(actualperformance)自觉困难程度(perceiveddifficulty)概念说明个案于标准化情境，亲身从事各种ADL的能力/表现个案平时在家或病房从事ADL之实际情形或依赖程度个案主观认为从事ADL各项目之困难程度或功能状态/满意度最佳评估对象个案个案与主要照顾者个案最佳评估模式实际施测访谈问卷评估所需时间长短短主要用途探索执行问题设定治疗计划失能指标成效指标治疗需求指标成效指标缺点不易标准化/费时他人无法代为受评若个案无法受访，主要照顾者常高估个案之失能程度他人难以代答代表性评估工具动作与程序技巧测验(AssessmentofMotorandProcessSkills,AMPS)ADDINEN.CITE<EndNote><Cite><Author>Fisher</Author><Year>1992</Year><RecNum>71</RecNum><DisplayText><styleface="superscript">16</style></DisplayText><record><rec-number>71</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671878173">71</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Fisher,A.G.</author><author>Liu,Y.</author><author>Velozo,C.A.</author><author>Pan,A.W.</author></authors></contributors><auth-address>DepartmentofOccupationalTherapy,ColoradoStateUniversity,FortCollins80523.</auth-address><titles><title>Cross-culturalassessmentofprocessskills</title><secondary-title>AmJOccupTher</secondary-title></titles><periodical><full-title>AmJOccupTher</full-title></periodical><pages>876-85</pages><volume>46</volume><number>10</number><edition>1992/10/01</edition><keywords><keyword>ActivitiesofDailyLiving/*classification</keyword><keyword>Adult</keyword><keyword>*Cross-CulturalComparison</keyword><keyword>DisabilityEvaluation</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>LifeStyle</keyword><keyword>Male</keyword><keyword>OccupationalTherapy/*methods</keyword><keyword>ReproducibilityofResults</keyword><keyword>Taiwan/ethnology</keyword><keyword>UnitedStates</keyword></keywords><dates><year>1992</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0272-9490(Print) 0272-9490(Linking)</isbn><accession-num>1463059</accession-num><urls><related-urls><url>/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1463059</url></related-urls></urls><language>eng</language></record></Cite></EndNote>16克连贝尔ADL评估量表(Klein-BellADLscale)ADDINEN.CITE<EndNote><Cite><Author>Klein</Author><Year>1982</Year><RecNum>100</RecNum><DisplayText><styleface="superscript">17</style></DisplayText><record><rec-number>100</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671949454">100</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Klein,R.M.</author><author>Bell,B.</author></authors></contributors><titles><title>Self-careskills:behavioralmeasurementwithKlein-BellADLscale</title><secondary-title>ArchPhysMedRehabil</secondary-title></titles><periodical><full-title>ArchPhysMedRehabil</full-title></periodical><pages>335-8</pages><volume>63</volume><number>7</number><keywords><keyword>*ActivitiesofDailyLiving</keyword><keyword>Adult</keyword><keyword>*DisabilityEvaluation</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>SelfCare/*psychology</keyword></keywords><dates><year>1982</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0003-9993(Print) 0003-9993</isbn><accession-num>7092535</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17巴氏量表(BarthelIndex,BI)ADDINEN.CITE<EndNote><Cite><Author>Mahoney</Author><Year>1965</Year><RecNum>22</RecNum><DisplayText><styleface="superscript">18</style></DisplayText><record><rec-number>22</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786620">22</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Mahoney,F.I.</author><author>Barthel,D.W.</author></authors></contributors><titles><title>FunctionalEvaluation:TheBarthelIndex</title><secondary-title>MdStateMedJ</secondary-title></titles><periodical><full-title>MdStateMedJ</full-title></periodical><pages>61-5</pages><volume>14</volume><keywords><keyword>*ChronicDisease</keyword><keyword>Humans</keyword><keyword>*PhysicalTherapyModalities</keyword><keyword>*Rehabilitation</keyword></keywords><dates><year>1965</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0025-4363(Print) 0025-4363(Linking)</isbn><accession-num>14258950</accession-num><urls><related-urls><url>/pubmed/14258950</url></related-urls></urls></record></Cite></EndNote>18功能独立程度量表(FunctionalIndependenceMeasure,FIMTM)ADDINEN.CITE<EndNote><Cite><Author>Keith</Author><Year>1987</Year><RecNum>23</RecNum><DisplayText><styleface="superscript">19</style></DisplayText><record><rec-number>23</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786620">23</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Keith,R.A.</author><author>Granger,C.V.</author><author>Hamilton,B.B.</author><author>Sherwin,F.S.</author></authors></contributors><titles><title>Thefunctionalindependencemeasure:anewtoolforrehabilitation</title><secondary-title>AdvClinRehabil</secondary-title></titles><periodical><full-title>AdvClinRehabil</full-title></periodical><pages>6-18</pages><volume>1</volume><edition>1987/01/01</edition><keywords><keyword>*ActivitiesofDailyLiving</keyword><keyword>DataCollection</keyword><keyword>DisabilityEvaluation</keyword><keyword>Humans</keyword><keyword>*Rehabilitation</keyword></keywords><dates><year>1987</year></dates><isbn>0892-8878(Print) 0892-8878(Linking)</isbn><accession-num>3503663</accession-num><urls><related-urls><url>/pubmed/3503663</url></related-urls></urls><language>eng</language></record></Cite></EndNote>19脑中风病患专属生活质量量表(StrokeSpecificQualityofLifeScale)加拿大职能表现测验(CanadianOccupationalPerformanceMeasure,COPM)国人发展之评估工具巴氏量表-补充量表(BarthelIndex-basedSupplementaryScales,BI-SS)ADDINEN.CITEADDINEN.CITE.DATA4日常生活活动计算机适性测验(ComputerizedAdaptiveTestforassessingActivitiesofDailyLiving,ADLCAT)ADDINEN.CITEADDINEN.CITE.DATA20巴氏量表-补充量表(BarthelIndex-basedSupplementaryScales,BI-SS)ADDINEN.CITEADDINEN.CITE.DATA4然而，治疗师若欲评估个案之ADL执行能力，需先克服以下三项困难：(一)、执行不易。（二）、部分个案无法接受施测。（三）、评估时间较长。执行不易之难处包含不易标准化与难以记录。理论上，若欲评估个案之ADL执行能力，则必须发展出标准化的施测程序、情境与器材。然而对于绝大多数项目之执行流程因人/因设施而易，故不易发展出适合大多数个案的标准化流程。故一般执行能力之评估流程与实用之器材必须记录，然而项目内容与流程繁琐，造成很大的纪录负担。居家评估个案执行ADL能力亦有其难度，治疗师或可在个案的居住场所，应用住家之ADL相关器材与情境，评估各项ADL的执行能力。然而治疗师必须记录各项ADL情境与器材，以利后续追踪评估时，以使个案于前后相同之情境与器材评估。部分个案无法接受施测。如认知功能低、或无法遵从治疗师指令者（如：失语症患者），则治疗师无法执行ADL能力评估。这些个案之ADL执行能力评估，或可用访谈方式，询问主要照顾者有关个案于居住环境时之执行能力。然而治疗师必须了解以「访谈」的方式评估个案之执行能力，并不易控制ADL之执行情境或设备特性，造成访谈结果之信度与效度不佳。评估时间上，由于评估过程需要个案从事各项ADL，故过程繁复/费时，包含准备器材与情境、模拟进行ADL活动、评分与记录。一般而言，仅BADL部分至少约需要20~30分钟才能完成评估，评估时间较长。评估ADL执行能力之代表性评估工具，如「动作与程序技巧测验(AssessmentofMotorandProcessSkills,AMPS)」评估个案BADL与IADL之执行能力。ADDINEN.CITE<EndNote><Cite><Author>Fisher</Author><Year>1992</Year><RecNum>71</RecNum><DisplayText><styleface="superscript">16</style></DisplayText><record><rec-number>71</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671878173">71</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Fisher,A.G.</author><author>Liu,Y.</author><author>Velozo,C.A.</author><author>Pan,A.W.</author></authors></contributors><auth-address>DepartmentofOccupationalTherapy,ColoradoStateUniversity,FortCollins80523.</auth-address><titles><title>Cross-culturalassessmentofprocessskills</title><secondary-title>AmJOccupTher</secondary-title></titles><periodical><full-title>AmJOccupTher</full-title></periodical><pages>876-85</pages><volume>46</volume><number>10</number><edition>1992/10/01</edition><keywords><keyword>ActivitiesofDailyLiving/*classification</keyword><keyword>Adult</keyword><keyword>*Cross-CulturalComparison</keyword><keyword>DisabilityEvaluation</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>LifeStyle</keyword><keyword>Male</keyword><keyword>OccupationalTherapy/*methods</keyword><keyword>ReproducibilityofResults</keyword><keyword>Taiwan/ethnology</keyword><keyword>UnitedStates</keyword></keywords><dates><year>1992</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0272-9490(Print) 0272-9490(Linking)</isbn><accession-num>1463059</accession-num><urls><related-urls><url>/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1463059</url></related-urls></urls><language>eng</language></record></Cite></EndNote>16AMPS测验包含二大部分：16项动作技巧项目以及20项处理技巧项目。AMPS最特别的是提供病人选择测验项目的机会（意即个案可挑选有兴趣执行之BADL或IADL项目），以增加他们参与的动机，符合以个案为中心之原则。另一项代表性评估工具为克连贝尔ADL评估量表(Klein-BellADLscale)。ADDINEN.CITE<EndNote><Cite><Author>Klein</Author><Year>1982</Year><RecNum>100</RecNum><DisplayText><styleface="superscript">17</style></DisplayText><record><rec-number>100</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671949454">100</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Klein,R.M.</author><author>Bell,B.</author></authors></contributors><titles><title>Self-careskills:behavioralmeasurementwithKlein-BellADLscale</title><secondary-title>ArchPhysMedRehabil</secondary-title></titles><periodical><full-title>ArchPhysMedRehabil</full-title></periodical><pages>335-8</pages><volume>63</volume><number>7</number><keywords><keyword>*ActivitiesofDailyLiving</keyword><keyword>Adult</keyword><keyword>*DisabilityEvaluation</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>SelfCare/*psychology</keyword></keywords><dates><year>1982</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0003-9993(Print) 0003-9993</isbn><accession-num>7092535</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17此量表高达170项BADL题目，评估过程与内容相当仔细。巴氏量表-补充量表(BarthelIndex-basedSupplementaryScales,BI-SS)为极少数由国人所发展的ADL量表。李雅珍等人（含主持人）依据BI题目，但扩充其评估概念，以额外评估个案于「执行能力」与「自觉困难程度」层面之表现。ADDINEN.CITEADDINEN.CITE.DATA4二、「实际表现」之特质ADL之「实际表现」代表个案平时在家或病房从事ADL之实际情形或依赖程度，ADDINEN.CITEADDINEN.CITE.DATA1个案之「实际表现」常与其「执行能力」有异。因此职能治疗师必须留意个案平常/实际表现与执行能力之差异。例如较年长的个案，尤其已聘僱看护之个案，虽然个案有全部或部分能力自己从事ADL，但实际从事ADL时，可能皆由看护或他人代劳。若此，个案虽有从事ADL之能力，但仍是「依赖」他人，故实际上个案于ADL未完全独立。反之，有些个案在标准情境下，无法独立完成部份ADL项目，但在居家生活中透过环境改造或辅具的应用下，即可独立完成该ADL项目，或者仅是完成该项目的时间较长。意即直接施测/观察个案之执行能力，并无法获得个案居家中ADL「真实」或「实际」的表现或依赖程度。所以，若欲掌握个案平常从事ADL活动时之「实际表现」，通常以「访问」的方式行之，如治疗师询问个案平常吃饭时「是不是」由他人准备东西，或「有没有」他人帮忙喂食等，但不是问个案「能不能」、「会不会」或「可不可以」自己吃饭，因为「能不能」、「会不会」或「可不可以」自己吃饭代表「能力」，并非个案的日常「真实」表现。ADL实际表现之评估方式以「口头」访问个案或主要照顾者为主，所以可于很短的时间内完成评估。个案平常从事ADL之表现，代表个案之「真实」生活独立（或依赖）状况，而且施测容易、快速，所以许多其他医疗专业皆评量个案ADL之实际表现。诸多著名的ADL量表以评量实际表现为主。另外因为ADL之「实际表现」代表个案之失能程度，故一般大型（或全国性）ADL调查，皆以评估「实际表现」为主。然而，评量个案实际ADL表现有下列二项缺点：(一)不易找到合适的受访对象。(二)所得资料不易规划治疗计划。以受访对象而言，研究指出：若受访者为个案，通常个案以其「能力」回答其实际表现，或由于自尊心使然，个案经常「高估」自己的独立程度ADDINEN.CITE<EndNote><Cite><Author>Chen</Author><Year>2007</Year><RecNum>47</RecNum><DisplayText><styleface="superscript">21</style></DisplayText><record><rec-number>47</rec-number><foreign-keys><keyapp="EN"db-id="fvzwzx55vre5wxex5pfvvafip9axxpd5f0ev"timestamp="0">47</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Chen,M.H.</author><author><styleface="boldunderline"font="default"size="100%">Hsieh,C.L.</style></author><author>Mao,H.F.</author><author>Huang,S.L.</author></authors></contributors><auth-address>Chung-ShanMedicalUniversity,CollegeofMedicine,NationalTaiwanUniversity,Taiwan,ROC.</auth-address><titles><title>Differencesbetweenpatientandproxyreportsintheassessmentofdisabilityafterstroke</title><secondary-title>ClinRehabil</secondary-title></titles><pages>351-6</pages><volume>21</volume><number>4</number><edition>2007/07/07</edition><keywords><keyword>ActivitiesofDailyLiving</keyword><keyword>*Caregivers</keyword><keyword>*DisabilityEvaluation</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>*Proxy</keyword><keyword>RegressionAnalysis</keyword><keyword>*SelfAssessment(Psychology)</keyword><keyword>Stroke/*rehabilitation</keyword></keywords><dates><year>2007</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0269-2155(Print)</isbn><accession-num>17613576</accession-num><label><styleface="normal"font="default"charset="136"size="100%">【SCI】(國衛院補助，編號NHRI-EX95-9512PI；台大醫院補助，編號NTUH95-524)</style></label><urls><related-urls><url>/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17613576</url><url>/content/21/4/351.full.pdf</url></related-urls></urls><electronic-resource-num>21/4/351[pii] 10.1177/0269215507072544</electronic-resource-num><language>eng</language></record></Cite></EndNote>21。反之，受访者若为主要照顾者，主要照顾者经常夸大个案的依赖程度，造成「低估」个案的独立程度。所以「个案」或「主要照顾者」皆难以精准呈现个案平常真实的「表现」。就评估所得资料之应用而言，若仅评量个案实际ADL表现，治疗师对于个案的能力或执行ADL所遭遇的困难所知有限，故治疗师须再加上评量个案于各种ADL项目之执行能力，才能完全掌握个案于执行各项ADL项目之困难所在，进而给予训练或建议。评估ADL实际表现之代表性评估工具，如最常见的巴氏量表(BarthelIndex,BI)、ADDINEN.CITE<EndNote><Cite><Author>Mahoney</Author><Year>1965</Year><RecNum>22</RecNum><DisplayText><styleface="superscript">18</style></DisplayText><record><rec-number>22</rec-number><foreign-keys><keyapp="EN"db-id="zz0d59zax0sw5here075prtvztf9vsfxtrex"timestamp="1671786620">22</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Mahoney,F.I.</author><author>Barthel,D.W.</author></authors></contributors><titles><title>FunctionalEvaluation:TheBarthelIndex</title><secondary-title>MdStateMedJ</secondary-title></titles><periodical><full-title>MdStateMedJ</full-title></periodical><pages>61-5</pages><volume>14</volume><keywords><keyword>*ChronicDisease</keyword><keyword>Humans</keyword><keyword>*PhysicalTherapyModalities</keyword><keyword>*Rehabilitation</keyword></keywords><dates><year>1965</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0025-4363(Print) 002