腦中風常造成失語症，在成人溝通障礙中可說是影響層面最廣的一種。近年來學界越來越重視由患者自身的角度來瞭解疾病的影響以及醫療介入的成效或必要性，健康相關生活品質的評估就是其中的代表。過去針對失語症患者健康生活品質之相關研究仍然不多，且往往並未控制肢體行動障礙這個也會對健康生活品質造成重大影響的變項。

故本研究擬控制肢體動作障礙方面的差異之後，比較中風後有失語症與無失語症兩組患者的健康相關生活品質，以瞭解失語症的存在對生活品質所造成的影響。同時進一步探討可能影響失語症患者健康相關生活品質的因素，包括其『語言損傷嚴重度』、『功能性溝通能力』、個人情緒狀態及其它人口統計學變項(年紀、性別、教育程度、婚姻狀況、職業、主要照顧者)、中風相關變項(中風後時間、中風類型、罹患疾病數)與生活品質的關連性。

本研究對象為26名失語症患者，並以23名中風無失語症患者為對照組，兩組個案在基本日常生活功能、人口統計學變項及中風相關變項方面均無顯著差異。所有個案均以訪談方式完成『巴氏量表』及『中風失語症生活品質量表中文版(SAQOL-C)』的評估，失語症組個案另外亦接受『中風負擔量表(BOSS)』、『華譜失語症測驗(WAB)』、『溝通效益測驗(CETI)』、『貝克憂鬱量表(BDI-II)』的評估。結果顯示，慢性中風失語症患者在SAQOL-C的溝通相關及整體健康相關生活品質方面都比沒有失語症的對照組差，但在生理、心理社會及能量方面，兩組之間並沒有顯著差異。

另外，失語症患者的語言損傷程度越嚴重、功能性溝通能力越差，其整體健康生活品質越差，在溝通方面感受到的困擾越多、自我感知在溝通及社會關係上呈現出較多的困難，但與其心理苦惱程度並無顯著相關。在個人因素方面，憂鬱程度越高者其在能量方面感受到的困擾越多；罹患疾病數越多者，在SAQOL-C能量及整體健康相關生活品質上也感覺到比較多的困擾，且認知相關心理苦惱較多。

整體而言，失語症確實會對慢性中風患者的健康生活品質造成不利的影響。

To assess the impact of diseases and the effect or necessity of medical interventions through the patients’ point of view has drawn more and more attention in the medical field. This has been reflected by the growing number of studies on the assessment of health related quality of life (HRQOL) after various diseases. Aphasia is common after stroke and is probably the one with most pervasive influence among adult communication disorders. However, there had been limited studies of the HRQOL on aphasic patients. Besides, motor disability, which is a common co-morbidity of stroke related aphasia and might also affect HRQOL greatly, was rarely controlled in previous studies.
The purpose of this study is to compare the HRQOL among chronic stroke patients with and without aphasia, after controlling the factor of motor disability using Bathel Index and Brunnstrom staging. Furthermore, the correlation between aphasic patients HRQOL and possible variables were investigated, including the severity of aphasia, the functional communication ability, personal factors such as emotional status, demographic variables (age, gender, education level, marital status, employment, and main care) and stroke-related variables (time post-onset, type of stroke, disease number).
26 stroke patients with aphasia, and 23 stroke patients without aphasia were recruited in this study. They were matched in daily activities functions, demographic variables, and the stroke-related health variables. All subjects were interviewed with SAQOL-C for assessment of their HRQOL. The aphasic patients were further assessed by the Bound of Stroke Scale (BOSS), the Western Aphasia Battery (WAB), the Communicative Effectiveness Index (CETI), and the Beck Depression Inventory- Second Edition (BDI-II) to assess their HRQOL, severity of language impairment, functional communication ability, and degree of depression respectively.
It was shown that, comparing to stroke patients without aphasia, the aphasic patients reported significantly lower overall HRQOL on the SAQOL-C total score, and the communication subscale, but there is no significant difference on the physical, psychosocial, and energy subscales between the two groups. Furthermore, patients with more severe language impairment or higher communication disability reported significantly poorer total HRQOL on the SAQOL-C, and perceived greater difficulties in communication and social relationships on the BOSS. However, it was not correlated with the subjects’ psychological distress. People with higher depression perceived more trouble in the energy subscale of SAQOL-C. People with more co-morbid diseases also perceived more trouble in the energy subscale of SAQOL-C and had poorer total HRQOL and more cognition associated psychological distress.
In conclusion, the presence of aphasia could have adverse effect on chronic stroke patients’ HRQOL.

頁數
謝誌………………………………………………………………… I
摘要………………………………………………………………… II
目錄…………………………………………………………………… VII
附錄目錄………………………………………………………………… VIII
表目次………………………………………………………………… IX圖目次………………………………………………………………… X
第一章 緒論
第一節 研究背景與動機………………………………………… 1
第二節 研究目的………………………………………………… 8
第三節 研究問題與研究假設…………………………………… 9
第四節 名詞解釋………………………………………………… 10
第二章 文獻探討
第一節 健康相關生活品質的概念……………………………… 13
第二節 失能與生活品質之間的關係…………………………… 28
第三節 失語症患者的健康相關生活品質……………………… 34
第三章 研究方法
第一節 研究架構………………………………………………… 47
第二節 研究設計………………………………………………… 49
第三節 研究工具………………………………………………… 52
第四節 研究對象………………………………………………… 63
第五節 資料收集與分析………………………………………… 72
第四章 研究結果
第一節 有失語症與無失語症之慢性中風患者於SAQOL-C
之表現差異………………………………………………… 74
第二節 失語症患者中風負擔量表、語言損傷程度、
功能性溝通能力及憂鬱狀況之表現……………………… 78
第三節 失語症患者語言損傷程度與健康相關生活品質之關係… 86
第四節 失語症患者功能性溝通能力與健康相關生活品質之關係… 88
第五節 失語症患者憂鬱情緒與健康相關生活品質之關係……… 90
第六節 失語症患者人口統計學變項及中風相關變項
與健康相關生活品質之關係……………………………… 92
第五章 討論
第一節 失語症對慢性中風患者健康相關生活品質的影響………. 94
第二節 影響失語症患者健康相關生活品質之相關因素…………. 99
第三節 SAQOL-C與BOSS內容及施測結果比較………………… 110
第六章 結論與建議
第一節 結論………………………………………………………….... 113
第二節 研究限制…………………………………………………….... 115
第三節 建議………………………………………………………….... 118
參考文獻
中文部分……………………………. ................ 122
西文部分.................................................124
附錄
附錄一 ICF架構各範疇間彼此交互關係………………………......... 137
附錄二Communication-related QOL (CRQOL)模式…………………… 138
附錄三 受試者資料調查表…………………………………………… 139
附錄四 SAQOL-39中文版…………………………………………… 140
附錄五 中風負擔量表………………………………………………… 142
附錄六 溝通效益測驗………………………………………………… 147
附錄七 巴氏量表……………………………………………………… 150
附錄八 受試者同意書………………………………………………… 151
附錄九 台大醫院受試者同意書……………………………………… 152


表目次
頁數
表 2-1 常用之健康相關生活品質量表特色………………………… 24
表 3-3 研究工具內部一致性(Cronbach’s α值) ……………………… 62
表 3-4-1 失語症與無失語症組之人口基本特性…………………… 67
表 3-4-2 失語症與無失語症組中風相關變項…………………… 68
表 3-4-3 失語症組與無失語症組人口基本特性同質性檢定…………… 70
表 3-4-4 失語症組與無失語症組中風相關變項同質性檢定…………… 71
表 4-1-1 研究對象於SAQOL-C之平均分數、標準差、t考驗結果….. 76
表 4-1-2 研究對象於SAQOL-C之題目細項結果……………………… 77
表 4-2-1 失語症組受試者於BOSS各分量表之表現…………………… 80
表 4-2-2 失語症組受試者於BOSS之題目細項結果…………………… 80
表 4-2-3 失語症組受試者於BOSS各分量表間相關…………………… 82
表 4-2-4 華譜失語症測驗結果…………………………………………… 82
表 4-2-5 失語症組受試者語言損傷程度………………………………… 83
表 4-2-6 失語症組受試者於溝通效益測驗之表現……………………… 83
表 4-2-7 失語症組受試者於功能性溝通評量之題目細項結果………… 83
表 4-2-8 失語症組受試者於貝克憂鬱量表第二版之表現……………… 85
表 4-2-9 失語症組受試者於憂鬱評量之題目細項結果………………… 85
表 4-3-1 失語症組受試者之語言損傷程度與 SAQOL-C之相關……… 87
表 4-3-2 失語症組受試者之語言損傷程度與BOSS之相關…………… 87
表 4-4-1 失語症組受試者功能性溝通能力與SAQOL-C之相關……… 89
表 4-4-2 失語症組受試者功能性溝通能力與BOSS之相關…………… 89
表 4-5-1 失語症組受試者之憂鬱狀態與SAQOL-C之相關…………… 91
表 4-5-2 失語症組受試者之憂鬱狀態與BOSS之相關………………… 91




圖目次
頁數
圖2-1 QOL、HRQOL、HS三個概念圖…………………… 16
圖2-2 失能模式與健康相關生活品質間的關連性……… 32
圖2-3 A-FROM架構中範疇及類別模式範例…………… 39
圖3-1 研究架構圖………………………………………… 48
圖3-2 研究設計圖………………………………………… 50

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