發(fā)展以腦中風個案為中心之全面性ADL評估工具

表CM03共25頁第頁發(fā)展以腦中風個案為中心之全面性ADL評估工具背景：日常生活活動(ActivitiesofDailyLiving,ADL)介入一直是腦中風個案職能治療與長期照護的重點之一。然而ADL概念復(fù)雜，至少包含三種概念或?qū)用妫簣?zhí)行能力(capability)、實際表現(xiàn)(actualperformance)及個案從事ADL之自覺困難程度(perceiveddifficulty)（或自覺功能狀態(tài)/滿意度）。ADDINEN.CITEADDINEN.CITE.DATA1-4各種ADL層面各有其學術(shù)與實務(wù)價值。由于ADL評估是介入的關(guān)鍵基礎(chǔ)，且評估過程中，可（須）了解/厘清個案/家屬之需求，因此如何做好ADL評估為ADL介入與成效之關(guān)鍵。然而現(xiàn)有ADL評估工具之常見缺點有三：一、未全面包含主要ADL層面（執(zhí)行能力、實際表現(xiàn)與自覺困難程度）。二、未考量個案需求/預(yù)期：施測過程中，未充分考慮個案之需求、健康識能(healthliteracy)或未執(zhí)行共享決策(shareddecisionmaking)，以至于評估重點與結(jié)果難以符合個案之預(yù)期。三、標準化不佳，尤其是執(zhí)行能力之評估，標準化不足。上述缺點嚴重影響腦中風個案之ADL評估與介入效能。研究目的：發(fā)展以腦中風個案為中心之全面性/標準化ADL評估工具(ComprehensiveandstandardizedADLassessmentsforpersonswithstroke,CSAS)【名稱未納入SDM,Comprehensive,shared,andstandardizedADLassessmentsforpersonswithstroke，應(yīng)可適用于其他生理個案Jan.15.2023】，意即評估過程加入共享決策，厘清個案之特質(zhì)與需求，必要時給予個案衛(wèi)教/咨詢，再由評估人員與個案共同決定ADL評估層面、項目與評估執(zhí)行能力所需器材。此工具將能解決上述缺點，并能提升ADL評估與介入之效能。方法：此三年計劃分成二大步驟完成之。步驟一為發(fā)展CSAS項目與施測流程（包含共享決策與衛(wèi)教），并于臨床測試可行性與預(yù)期時間。以確保CSAS之可行性。步驟二為驗證CSAS之心理計量特性（包含信度、效度與反應(yīng)性）。信度包含施測者內(nèi)與施測者間信度，以及相對應(yīng)之隨機測量誤差。預(yù)期結(jié)果與價值：CSAS將具備四大特色：一、內(nèi)容包含ADL三大層面（執(zhí)行能力、實際表現(xiàn)與自覺困難程度）。二、符合個案需求：施測過程充分與個案/家屬交流，以共同決定施測內(nèi)容。三、標準化。四、可于合理時間內(nèi)完成。上述特色將有助于大幅提升腦中風個案之ADL評估與介入之效能。創(chuàng)新之處：本研究或?qū)⑹菄H上首度融合以「個案為中心」的決策模式且全面評量ADL三層面之標準化評估工具。

三、研究計劃內(nèi)容（以中文或英文撰寫）：研究計劃之背景。請詳述本研究計劃所要探討或解決的問題、研究原創(chuàng)性、重要性、預(yù)期影響性及國內(nèi)外有關(guān)本計劃之研究情況、重要參考文獻之評述等。ADL之于腦中風個案/家屬之重要性日常生活活動(activitiesofdailyliving,ADL)是指在日常生活中普遍執(zhí)行的活動。完整之ADL應(yīng)包含基本日常生活活動(basicADL,BADL)與工具性日常生活活動(instrumentalADL,IADL)二部分：ADDINEN.CITEADDINEN.CITE.DATA5,6BADL是指與自我照顧相關(guān)的活動，如進食、更衣、盥洗等；IADL則是指與社區(qū)獨立生活相關(guān)之活動，如使用電話、外出社交、搭乘大眾交通工具等。腦中風個案常因動作功能之損傷造成個案難以獨立執(zhí)行BADL與IADL，進而影響其生活獨立性、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社會功能(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以及生活質(zhì)量(qualityoflife)。ADDINEN.CITEADDINEN.CITE.DATA7,9因此ADL介入一直是腦中風個案職能治療與長期照護的重點之一。另一方面，由于醫(yī)學的進步，許多重大疾病病患之壽命延長，加上人口老化，且國內(nèi)長期照護法已于民國104年通過，造成需要長期照護（以下簡稱長照）的個案逐漸增多。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長照與失能人口增加，也間接造成ADL/生活獨立/復(fù)能等學理、評估、與臨床介入，于學術(shù)研究與臨床的重要性逐漸增加。ADL評估之重要性 ADL的評估結(jié)果具備四項價值：一、可代表個案生活獨立或失能程度；ADDINEN.CITEADDINEN.CITE.DATA10,11二、可作為ADL訓練與治療的依據(jù)；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、可當成驗證治療成效之指標；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、可預(yù)測個案之照護需求等。ADDINEN.CITEADDINEN.CITE.DATA12另外，IADL的評量結(jié)果除了可代表個案于社區(qū)生活之獨立程度，也可用以篩檢失智癥ADDINEN.CITEADDINEN.CITE.DATA13,14。所以ADL功能之評估，也是職能(occupations)評估的重要內(nèi)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>15，一直是職能治療臨床與研究的重點。ADL之多元概念或?qū)用嬉约按硇栽u估工具理論上ADL至少包含三種概念或?qū)用妫篈DL執(zhí)行能力(capability)、ADL實際表現(xiàn)(actualperformance)及個案從事ADL之自覺困難程度(perceiveddifficulty)或自覺功能狀態(tài)/滿意度（以下以「自覺困難程度」代表之）。ADDINEN.CITEADDINEN.CITE.DATA1-4各種ADL層面之臨床與理論意義迥然不同，甚至評估模式也不一。臨床或研究人員必須明確區(qū)隔與記錄之，否則評估/記錄的概念可能不明確，不利于臨床治療計劃之擬定與療效之評估，也不利于專業(yè)人員間的溝通。另外，厘清這些概念也有助于治療師如何對受評個案說明ADL評估內(nèi)容與價值，以利于后續(xù)ADL治療目標與計劃之決策，甚至后續(xù)追蹤評估之ADL治療成果呈現(xiàn)。表一簡述三種ADL概念/層面之特質(zhì)。以下詳述「執(zhí)行能力」、「實際表現(xiàn)」與從事ADL的「自覺困難程度」之特質(zhì)與差異。一、「執(zhí)行能力」之特質(zhì)個案ADL之執(zhí)行能力代表個案于標準化情境，親身從事各種ADL的能力/表現(xiàn)。ADDINEN.CITEADDINEN.CITE.DATA1,3,4ADL「執(zhí)行能力」為一般臨床職能治療師評估ADL的主要層面。臨床評估時，治療師通常請個案于治療室執(zhí)行每項ADL，治療師再從旁觀察個案執(zhí)行每項ADL之過程與能力，借以評估個案從事各項ADL之能力高低。由于個案的執(zhí)行能力受到ADL情境或器材影響，因此評估各種ADL之情境或器材務(wù)必標準化，若使用不一致之情境或器材，評估結(jié)果將不一致。評估ADL執(zhí)行能力的主要優(yōu)點有二：一、治療師可立即掌握個案從事ADL的執(zhí)行問題，故評估結(jié)果可直接運用于ADL的功能訓練。二、評估結(jié)果可協(xié)助治療師判斷是否需要給予個案輔具處方。因此臨床上，許多職能治療師例行評估個案之ADL執(zhí)行能力。表一：三種ADL概念/層面之特質(zhì)比較執(zhí)行能力(capability)實際表現(xiàn)(actualperformance)自覺困難程度(perceiveddifficulty)概念說明個案于標準化情境，親身從事各種ADL的能力/表現(xiàn)個案平時在家或病房從事ADL之實際情形或依賴程度個案主觀認為從事ADL各項目之困難程度或功能狀態(tài)/滿意度最佳評估對象個案個案與主要照顧者個案最佳評估模式實際施測訪談問卷評估所需時間長短短主要用途探索執(zhí)行問題設(shè)定治療計劃失能指標成效指標治療需求指標成效指標缺點不易標準化/費時他人無法代為受評若個案無法受訪，主要照顧者常高估個案之失能程度他人難以代答代表性評估工具動作與程序技巧測驗(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克連貝爾ADL評估量表(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功能獨立程度量表(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腦中風病患專屬生活質(zhì)量量表(StrokeSpecificQualityofLifeScale)加拿大職能表現(xiàn)測驗(CanadianOccupationalPerformanceMeasure,COPM)國人發(fā)展之評估工具巴氏量表-補充量表(BarthelIndex-basedSupplementaryScales,BI-SS)ADDINEN.CITEADDINEN.CITE.DATA4日常生活活動計算機適性測驗(ComputerizedAdaptiveTestforassessingActivitiesofDailyLiving,ADLCAT)ADDINEN.CITEADDINEN.CITE.DATA20巴氏量表-補充量表(BarthelIndex-basedSupplementaryScales,BI-SS)ADDINEN.CITEADDINEN.CITE.DATA4然而，治療師若欲評估個案之ADL執(zhí)行能力，需先克服以下三項困難：(一)、執(zhí)行不易。（二）、部分個案無法接受施測。（三）、評估時間較長。執(zhí)行不易之難處包含不易標準化與難以記錄。理論上，若欲評估個案之ADL執(zhí)行能力，則必須發(fā)展出標準化的施測程序、情境與器材。然而對于絕大多數(shù)項目之執(zhí)行流程因人/因設(shè)施而易，故不易發(fā)展出適合大多數(shù)個案的標準化流程。故一般執(zhí)行能力之評估流程與實用之器材必須記錄，然而項目內(nèi)容與流程繁瑣，造成很大的紀錄負擔。居家評估個案執(zhí)行ADL能力亦有其難度，治療師或可在個案的居住場所，應(yīng)用住家之ADL相關(guān)器材與情境，評估各項ADL的執(zhí)行能力。然而治療師必須記錄各項ADL情境與器材，以利后續(xù)追蹤評估時，以使個案于前后相同之情境與器材評估。部分個案無法接受施測。如認知功能低、或無法遵從治療師指令者（如：失語癥患者），則治療師無法執(zhí)行ADL能力評估。這些個案之ADL執(zhí)行能力評估，或可用訪談方式，詢問主要照顧者有關(guān)個案于居住環(huán)境時之執(zhí)行能力。然而治療師必須了解以「訪談」的方式評估個案之執(zhí)行能力，并不易控制ADL之執(zhí)行情境或設(shè)備特性，造成訪談結(jié)果之信度與效度不佳。評估時間上，由于評估過程需要個案從事各項ADL，故過程繁復(fù)/費時，包含準備器材與情境、模擬進行ADL活動、評分與記錄。一般而言，僅BADL部分至少約需要20~30分鐘才能完成評估，評估時間較長。評估ADL執(zhí)行能力之代表性評估工具，如「動作與程序技巧測驗(AssessmentofMotorandProcessSkills,AMPS)」評估個案BADL與IADL之執(zhí)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測驗包含二大部分：16項動作技巧項目以及20項處理技巧項目。AMPS最特別的是提供病人選擇測驗項目的機會（意即個案可挑選有興趣執(zhí)行之BADL或IADL項目），以增加他們參與的動機，符合以個案為中心之原則。另一項代表性評估工具為克連貝爾ADL評估量表(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此量表高達170項BADL題目，評估過程與內(nèi)容相當仔細。巴氏量表-補充量表(BarthelIndex-basedSupplementaryScales,BI-SS)為極少數(shù)由國人所發(fā)展的ADL量表。李雅珍等人（含主持人）依據(jù)BI題目，但擴充其評估概念，以額外評估個案于「執(zhí)行能力」與「自覺困難程度」層面之表現(xiàn)。ADDINEN.CITEADDINEN.CITE.DATA4二、「實際表現(xiàn)」之特質(zhì)ADL之「實際表現(xiàn)」代表個案平時在家或病房從事ADL之實際情形或依賴程度，ADDINEN.CITEADDINEN.CITE.DATA1個案之「實際表現(xiàn)」常與其「執(zhí)行能力」有異。因此職能治療師必須留意個案平常/實際表現(xiàn)與執(zhí)行能力之差異。例如較年長的個案，尤其已聘僱看護之個案，雖然個案有全部或部分能力自己從事ADL，但實際從事ADL時，可能皆由看護或他人代勞。若此，個案雖有從事ADL之能力，但仍是「依賴」他人，故實際上個案于ADL未完全獨立。反之，有些個案在標準情境下，無法獨立完成部份ADL項目，但在居家生活中透過環(huán)境改造或輔具的應(yīng)用下，即可獨立完成該ADL項目，或者僅是完成該項目的時間較長。意即直接施測/觀察個案之執(zhí)行能力，并無法獲得個案居家中ADL「真實」或「實際」的表現(xiàn)或依賴程度。所以，若欲掌握個案平常從事ADL活動時之「實際表現(xiàn)」，通常以「訪問」的方式行之，如治療師詢問個案平常吃飯時「是不是」由他人準備東西，或「有沒有」他人幫忙喂食等，但不是問個案「能不能」、「會不會」或「可不可以」自己吃飯，因為「能不能」、「會不會」或「可不可以」自己吃飯代表「能力」，并非個案的日?！刚鎸崱贡憩F(xiàn)。ADL實際表現(xiàn)之評估方式以「口頭」訪問個案或主要照顧者為主，所以可于很短的時間內(nèi)完成評估。個案平常從事ADL之表現(xiàn)，代表個案之「真實」生活獨立（或依賴）狀況，而且施測容易、快速，所以許多其他醫(yī)療專業(yè)皆評量個案ADL之實際表現(xiàn)。諸多著名的ADL量表以評量實際表現(xiàn)為主。另外因為ADL之「實際表現(xiàn)」代表個案之失能程度，故一般大型（或全國性）ADL調(diào)查，皆以評估「實際表現(xiàn)」為主。然而，評量個案實際ADL表現(xiàn)有下列二項缺點：(一)不易找到合適的受訪對象。(二)所得資料不易規(guī)劃治療計劃。以受訪對象而言，研究指出：若受訪者為個案，通常個案以其「能力」回答其實際表現(xiàn)，或由于自尊心使然，個案經(jīng)?！父吖馈棺约旱莫毩⒊潭華DDINEN.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(wèi)院補助，編號NHRI-EX95-9512PI；臺大醫(yī)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，受訪者若為主要照顧者，主要照顧者經(jīng)常夸大個案的依賴程度，造成「低估」個案的獨立程度。所以「個案」或「主要照顧者」皆難以精準呈現(xiàn)個案平常真實的「表現(xiàn)」。就評估所得資料之應(yīng)用而言，若僅評量個案實際ADL表現(xiàn)，治療師對于個案的能力或執(zhí)行ADL所遭遇的困難所知有限，故治療師須再加上評量個案于各種ADL項目之執(zhí)行能力，才能完全掌握個案于執(zhí)行各項ADL項目之困難所在，進而給予訓練或建議。評估ADL實際表現(xiàn)之代表性評估工具，如最常見的巴氏量表(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