34卷6期

• Link 公衛今與昔 Public Health Now and Then
• 我「嘉」廟埕開講：在暗瞑中尋找健康促進的新契機我「嘉」廟埕開講：在暗瞑中尋找健康促進的新契機
• 盧鴻毅、林裕珍、李雅莉、黃靖琇、侯心雅、馬立君、安碧芸
  盧鴻毅、林裕珍、李雅莉、黃靖琇、侯心雅、馬立君、安碧芸
• 無
  none
• 無
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• 557 - 562
• 10.6288/TJPH201534104075

• Link 綜論 Review Article
• 健康保險道德風險的理解與誤解Understanding and Misunderstanding Moral Hazard in Health Insurance
• 李卓倫、紀駿輝、梅蘭、高翊瀚、蔡旻錡
  Jwo-Leun Lee, Chun-Huei Chi, Lan Mei, Yi-Han Kao, Min-Chi Tsai
• 道德風險 ； 健康保險 ； 價格效果 ； 所得效果
  moral hazard ; health insurance ; price effect ; income effect
• 道德風險概念對各國健康保險政策影響極為深遠，而其長久以來爭議的根源有二，第一來自道德風險的定義轉變，第二則來自道德風險的理論競爭。對於健康保險「道德風險」的理論演變而言，台灣本土文獻缺乏對這個理論的詮釋與追蹤，因此對這個觀念的「誤解」也就特別普遍。本文的目的在於釐清這個理論爭議的歷史軌跡，同時提出新的觀點來建議健康保險道德風險理論及政策可以發展的方向。本文先介紹道德風險在代理關係上最原始的定義，再介紹其後衍生在消費者誘因上的定義。透過第二個定義中的價格效果，以及其背後所牽涉到的健康保險需求理論，來論述道德風險理論在政策應用上的誤解與誤用，然後介紹道德風險的第三個定義中的所得效果，來修正價格效果的政策誤解。透過這種概念的釐清，本文同時提出兩種新的觀點，來建議健康保險「道德風險」理論可以發展的方向。最後本文針對健康保險「道德風險」理論的變遷對台灣社會的政策意義進行論述，並以此作為本文的結論。
  The concept of moral hazard has profound impacts on many countries' health insurance policies. Its theoretical framework, however, has been contentious among academics, especially health economists. This academic debate originated from two major sources: the transformation of the definition of, and the competition among different theoretical foundations for moral hazard. The inquiry about the definition and transformation of moral hazard has largely been absent from Taiwan's academic literature. Consequently, misunderstandings about the concept of moral hazard in health insurance abound in Taiwan's academic and policy worlds. The purpose of this article is to investigate the historical development of and transformation in defining moral hazard, and to introduce a new conceptual framework of moral hazard and its policy implications. We begin by introducing the original definition of moral hazard in the context of agency relationships, followed by discussing moral hazard in the framework of consumer incentives. Through the discussion of the price effect of moral hazard and its related theory on the demand for health insurance, we discuss how theory of moral hazard has been frequently misunderstood and misused in health policies. This is followed by discussing the income effect of moral hazard and how it can correct the misunderstandings of price effect of moral hazard in health policies. Further, we also introduce new concepts of moral hazard and propose a future direction of research on health insurance-related moral hazard. Finally, we discuss the significance and implications of the transformational concept of moral hazard to Taiwan's social policies.
• 563 - 575
• 10.6288/TJPH201534103088

• Link 綜論 Review Article
• 醫院品質報告卡之風險校正Risk Adjustment for Hospital Report Cards
• 郭年真、鍾國彪、 賴美淑
  Nien-Chen Kuo, Kuo-Piao Chung, Mei-Shu Lai
• 風險校正 ； 報告卡 ； 醫療品質 ； 資訊公開
  ?risk adjustment?;?report card?;?healthcare quality?;?public reporting
• 醫療照護品質的測量與改善，是近代醫學發展過程中持續被關注之議題。許多國家均發展出醫院品質報告卡，提供病患就醫選擇之參考、或提供雇主、醫療保險人選擇醫療服務提供者之依據。但品質指標的測量結果除了反應照護品質差異外，也常受到病例組合差異的影響。在進行跨醫院之比較時，必須應用風險校正方法，調整病例組合的差異以求公平。傳統上常用於風險校正的統計方法是羅吉斯迴歸和一般線性迴歸，近期亦常見以多階層迴歸建構風險校正模式。常見之風險因子包括人口統計因子、先前利用因子、疾病嚴重度、共病狀態、生理因子、自評健康狀態等。由於台灣的醫療品質指標發展未導入風險校正的技術，導致跨機構間的比較受到限制，因此亟需發展台灣本土化的指標風險校正模式，促進品質指標之可比較性。建議未來主管機關選擇報告卡之品質指標時，應將個別指標之信度納入考量，以避免醫療機構可能被錯誤的歸類到品質表現較好或較差的組別，減損其參考價值。
  Numerous countries develop and publish hospital report cards with the aim of assisting patients, employers, and/or insurers in the selection of appropriate healthcare providers. The variations in quality presented in these reports may be an indication of actual differences in quality; however, it's plausible that the results are biased due to improper adjustments for case-mix or incorrect interpretations. This underlines the importance of using a statistical risk adjustment method when dealing with patient risk data. Use of such methods would improve the quality of comparisons across hospitals. Logistic regression and linear regression are commonly used for the adjustment of risk; however, hierarchical models have been appearing in more recent studies and published report cards. Demographic factors, prior healthcare utilization, severity of illness, physiological risk factors, and self-reported health status are widely used as risk adjustors. Taiwan has built local systems for the monitoring of clinical quality; however, the lack of a reliable mechanism for risk adjustment makes it difficult to compare the quality of care across hospitals. Thus, the development of local risk adjustment models is an urgent requirement for improving the quality of hospital report cards. In accordance with our review, we suggest that the government evaluate the reliability of quality indicators and be more selective with regard to public reporting, in order to prevent the misclassification of outliers, which would otherwise limit the usability of report cards.
• 576 - 591
• 10.6288/TJPH201534104011

• Link 綜論 Review Article
• 照顧服務員分級可行性之探討The Practicability of Care Worker Classification
• 吳肖琪、黃敬淳、 葉馨婷
  Shiao-Chi Wu, Ching-Chun Huang, Shin-Ting Yeh
• 照服員 ； 分級制度 ； 服務內容 ； 支付標準 ； 職涯規劃
  care worker ; policy of classification ; service content ; payment scheme ; career planning
• 照顧服務員為長照重要人力然招募不易；本研究針對實施照服員分級制度國家瞭解其作法，並探討分級可行性。本研究以文獻探討有實施照服員分級制國家之作法，並辦理五場專家會議，共計42人次參與。日本、韓國、德國依照服員能力設計進階制度，證照考核制度皆須經過高時數的照護訓練；日本將服務時間及時段、服務人數、服務區域以及服務人員等級納入長照保險支付制度。我國照服員採單一級認證，長照十年計劃之每小時補助費用仍屬定額，未將個案失能程度、複雜程度、特殊性納入考量，為使照服員量能提升，未來長照十年計劃補助費用及長照保險居家照顧服務給付宜將勞力負荷、夜間加成、偏遠地區、失能程度、失智照顧、疾病類型、特殊生理狀況、高風險家庭納入加成考量。發展照服員分級制度，並設計工酬相符之補助標準及支付制度，將有助於照服人才留任。
  It is difficult to recruit care workers, although care workers are a major part of the workforce within the long-term healthcare system. The aim of the current study was to understand the practices of care worker certification in other countries, and assess the feasibility of the classification system in Taiwan. This study used a literature review to investigate the experience of care worker classification. Five expert meetings were held and 42 experts attended. In Japan, Korea, and Germany, care workers are classified by their personnel working ability, which have to be upgraded by many hours of training. In Japan, the design of the payment system for care workers considers the time, period, volume, area of service, and the level of care workers. Taiwan uses a single-level care worker certification. Therefore, the subsidy per hour is fixed by the payment system, and does not consider the disability, complex, and specific degree of clients. To enhance the quantity and quality of care work, the subsidy and payment of care workers should consider factors, such as labor loading, night bonus, remote areas, degree of disability, dementia care, type of disease, special physical conditions, and families at high risk. Developing multi-level certification and designing equal pay for equal work payment system can promote the retention of care works.
• 592 - 604
• 10.6288/TJPH201534104074

• Link 原著 Original Article
• 探討不安全感與健康意識程度對健康預防行為之影響Do You Feel Insecure? Influence of Health Consciousness on the Relationship between Existential Insecurity and Health Prevention
• 周郁芳、葉淑娟、袁國書、張朝卿、游秋月、 林慧真、陳彥澄
  Yu-Fang Chou, Jennifer Shu-Chuan Yeh, Kuo-Shu Yuan, Ammon Chang, Chiou-Yueh You, Hui-Chen Lin, Yan-Cheng Chen
• 健康預防行為 ； 不安全感 ； 健康意識
  health prevention ; existential insecurity ; health consciousness
• 目標：探討旅客面臨生命受到威脅（不安全感的操弄）時與健康預防行為之關係，是否會受到健康意識的影響。方法：運用實地實驗研究法（field experiment），於國際機場進行實驗，103位旅客參與本研究並隨機分派至二組以進行操弄，運用雙因子不安全感情境（高／低）與健康意識（高／低）的設計，請旅客閱讀衛教宣導單張及進行問卷收集。結果：研究發現旅客感受到不安全感時，健康預防行為較佳；旅客的健康意識正向影響健康預防行為。旅客的健康意識對不安全感與健康預防行為之關係亦具有干擾效果。結論：研究發現不安全感與健康意識皆有助於健康預防行為之提昇，特別是對較高健康意識的旅客。本研究運用實地實驗方法，並與常規的衛教宣導文宣進行比較，實證發現更能夠作為國際機場的公共衛生資訊與教育推廣之參考。
  Objectives: In the current study we determined the relationship between existential insecurity and health prevention. How health consciousness moderates the relationship between existential insecurity and health prevention among passengers at an international airport was also examined. Methods: A field experiment with a 2 (insecurity: high vs. low) x 2 (health consciousness: high vs. low) factorial design was conducted. A total of 103 passengers participated in this study at an international airport. The questionnaires included questions related to health consciousness, existential insecurity, distraction topic, and health prevention. Results: The results indicated that when passengers have high levels of existential insecurity, they have significantly higher health prevention behavior than passengers with low existential insecurity. Specifically, a high level of health consciousness significantly moderated the positive relationship between insecurity and health prevention. Conclusions: The current study contributes to a better understanding of how insecurity concerns are related to health prevention. The relationship between existential insecurity and health prevention can be strengthened by higher health consciousness. Therefore, this study provided support to develop strategies to facilitate health promotion for the Centers for Disease Control.
• 605 - 615
• 10.6288/TJPH201534104007

• Link 原著 Original Article
• 評估地區相對極端氣溫的天氣型態對台灣七大空品區居民健康之影響－以腦血管疾病及缺血性心臟病為例Impact of Area-Specific Temperature Extremes on Health Outcomes in Seven Regions in Taiwan-Using Cerebrovascular and Ischemic Heart Diseases as Examples
• 廖于瑄、王根樹、 王致皓、李亞衡、呂國臣、 蕭朱杏
  Yu-Hsuan Liao, Gen-Shuh Wang, Chih-Hao Wang, Ya-Heng Lee, Kuo-Chen Lu, Kate Chu-Hsing Hsiao
• 相對極端溫度 ； 縱貫性分析 ； 新發生病例
  relative temperature extremes ; longitudinal analysis ; new case
• 目標：本研究探討台灣七大空品區內，相對極端氣溫的天氣型態對民眾健康之影響。各地區有不同的相對極端氣溫門檻值，而健康評估目標則以需住院治療的腦血管疾病與缺血性心臟病新發生病例個數作為反應變數。方法：分別針對312個行政區，定義2003-2010年間每日最低氣溫的第5百分位及最高氣溫第95百分位，為各行政區的極端溫度門檻值，再將每日天氣型態分類為相對極端高溫、相對極端低溫、或正常氣溫之天氣類型。以各空品區中老年人每日新發生病例個數為目標，利用負二項分配描述發生個數的多變異（extra-Poisson variation）特質，考慮同一地區每日觀察值之間相關性，納入空氣污染因子及四季等變數，以廣義線性模式進行分析。結果：居住於不同空品區的居民有顯著不同的發病風險（p＜0.05）。在考慮各地區不同氣溫門檻值下，就腦血管疾病而言，相對極端高溫的天氣型態會增加各空品區的新發病風險；若是夏天的相對極端高溫的天氣型態，則中部、高屏、宜蘭、花東空品區增加的新發病風險將分別由5%、16%、16%、52%增至6%、17%、17%、54%；若是發生於冬天的相對極端高溫的天氣型態，高屏、宜蘭、花東空品區的新發病風險也會增加（以上p值皆＜ 0.05）。就缺血性心臟病而言，各空品區的居民雖仍有顯著不同的發病風險（p ＜ 0.05），但相對極端高溫的天氣型態只顯著影響雲嘉南及高屏空品區易感受族群的新發病風險（風險增加21%與11%，p ＜ 0.05）；相對極端低溫的天氣型態只顯著影響宜蘭空品區易感受族群的新發病風險.，尤其是冬天的低溫使得風險增加22%（p ＜ 0.05）。結論：極端高溫之預警已逐漸受到國際重視，而評估發病風險應考慮不同地區的氣溫異質性，才能針對不同地區的易感受族群，適時提出抗暑或禦寒等保護措施建議，以因應地球暖化影響下越來越多的高溫天氣型態。
  Objectives: This research investigated the effects of area-specific extreme temperatures on health. The outcome variable was defined as the number of new cases of cerebrovascular disease and ischemic heart disease in each of seven regions comprising Taiwan. Methods: For each of the 312 administrative areas, the extreme temperature thresholds were defined as the 5th percentile of daily minimum temperatures and 95th percentile of daily maximum temperatures in 2003-2010, to account for the heterogeneity between areas. Each day was then categorized as experiencing unusually high temperature, unusually low temperature, or normal temperature weather. A generalized linear model was adopted to model the daily number of new cases of disease in each region, with a negative binomial link function for extra-Poisson variation, along with covariates including air pollution and season. Results: Residents in different areas experienced significantly different risk for both of the diseases considered (p < 0.05). Under different threshold values of extreme temperature for the seven regions, extremely-high temperature days were associated with a higher risk of cerebrovascular disease. In summer, extremely high temperature increased risk even more. For instance, the increase of risk for the Central region was 5% overall but 6% in summer (from 16% to 17% in the Kao-Ping region, from 16% to 17% in the Yi-Lan region, and from 52% to 54% in the Hua-Dong region). In winter, the pattern of increased risk remained for extremely-high temperature days (all p-values above < 0.05). For ischemic heart disease, the seven regions also exhibited significantly different risk (p < 0.05). However, extremely-high temperature days only significantly influenced risk in the Yun-Chia-Nan and Kao-Ping regions by 21% and 11%, respectively; while days with extremely-low temperature only affected the susceptible residents in the Yi-Lan region, especially in the winter (risk increased by 22%, p < 0.05). Conclusions: The evaluation of the effect of air temperature on health has attracted much attention in many countries including Taiwan. To evaluate such an effect, heterogeneity in the cutoff temperature values for temperatures among regions should be taken into account. In response to extreme temperatures, in particular to heat waves due to climate change, appropriate measures should be developed to alleviate or prevent negative health consequences for susceptible residents in different regions.
• 616 - 632
• 10.6288/TJPH201534103097

• Link 原著 Original Article
• 評論：評估地區相對極端氣溫的天氣型態對台灣七大空品區居民健康之影響－以腦血管疾病及缺血性心臟病為例Commentary: Impact of Area-Specific Temperature Extremes on Health Outcomes in Seven Regions in Taiwan-Using Cerebrovascular
• 黃彬芳
  黃彬芳
• 無
  none
• 無
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• 633 - 633
• none

• Link 原著 Original Article
• 花蓮地區長期照顧家庭主要照顧者時間貨幣價值之探討－福康評估法之應用Monetary Valuation of Primary Family Caregivers for Long-Term-Care in Hualien: Application of the Well-Being Valuation Method
• 尤素娟、池伯尉
  Su-Chuan Yu, Bo-Wei Chih
• 貨幣價值 ； 家庭主要照顧者 ； 福康評估法 ； 長期照護
  monetary valuation ; informal care ; Well-Being Valuation Method ; long-term-care
• 目標：了解花蓮地區長期照顧之家庭主要照顧者在維持現有整體生活感受下，多增加一個小時照顧時間之貨幣價值評估，並同時檢視影響其整體生活感受之因素。方法：利用福康評估法（Well-being valuation method），以花蓮地區長期照顧管理中心登記使用其中心所提供之各項相關服務個案之家庭主要照顧者為對象，面訪普查資料經刪除個案無主要照顧者或填答不完全之樣本後，共計833份有效樣本進行分析。結果：主要照顧者為男性、年齡較低、教育程度較低、罹患慢性疾病、照顧時間越長及每月收入越高與其自評整體生活品質感受為負向顯著關係。依受訪者實際填答之平均照顧時間及平均月收入計算，在維持其生活感受不變情況下，若多增加一個小時的照顧時間所需補償之金額約為138元；依勞基法所規定之最低薪資與基本工時做調整模擬後，所需補償的金額約175~245元。結論：本研究依勞基法原則估算家庭主要照顧者之貨幣價值，可提供未來我國長期照護保險制度規劃照顧津貼政策之參考。
  Objectives: This paper estimates the monetary value of the loss of well-being by primary informal caregivers who provide long-term care to their family members. Taiwan is rapidly becoming an aging or even aged society. Authorities are planning to establish a long-term care insurance system which will provide both in-kind services (hospital or nursing home care) and cash benefits (subsidies to community or home care). Methods: We used the well-being valuation method to assess the monetary value necessary to maintain the same level of well-being when primary family caregivers are asked to provide an extra hour of care. Data from a survey on primary family caregivers of long-term care in Hualien were used for analyses. Results: Caregivers who were young and male with a low-level education, high income, chronic diseases, and who provided care of longer duration were negatively associated with the well-being of the primary family caregivers. The average number of hours of care per day was 10 hours. The results indicate that an extra hour of informal care is worth approximately NT 138. After adjustment by the Labor Standards Act, an extra hour of informal care is worth approximately NT 236~245. Conclusions: We conclude that the well-being valuation method is a useful complement to the more traditional valuation methods in the health economics literature in general, and more particular for the economic valuation of informal care. If care allowance is built into the long-term care insurance system, it would be necessary to pay the caregivers NT 236~245 for an extra hour of care.
• 634 - 645
• 10.6288/TJPH201534104056

• Link 原著 Original Article
• 殺蟲劑應用於登革熱防疫之成本效用分析：以高雄市為例Cost Effectiveness of Insecticide Spraying for Dengue Epidemic Control in Kaohsiung City
• 曾子容、李昌駿、何惠彬、詹大千
  Tzu-Jung Tseng, David Chang-Chun Lee, Hui-Ping Ho, Ta-Chien Chan
• 登革熱 ； 噴消成本 ； 決策分析 ； 成本效用分析
  dengue fever ; cost of insecticide spray ; decision making ; cost-effectiveness analysis
• 目標：登革熱為一蟲媒傳染病，廣泛流行於東南亞、美洲及西太平洋等地，危及民眾之健康生命安全，目前尚無有效治療方式，病媒防治為首要工作。本研究以成本效用分析探討登革熱疫情初期進行噴消之效用為何？研究成果期能提供防疫決策參考，透過有限資源降低疫情與社會負擔。方法：使用Treeage Pro 2011進行決策樹與敏感度分析，以噴消殺蟲劑與不噴消的疾病發生率與登革熱病患的醫療成本，及噴消所需的成本、傷殘調整生命年作為成本效用分析的參數。結果：決策樹分析結果確定個案半徑100公尺家戶內外同步強制噴藥暨地毯式孳生源清除較好。若進行噴消，當登革熱發生率在0.0536時，每人花費957.16元損失0.0144 DALYs／百萬人；若不噴消，當發生率0.0954時，每人花費1,575.24元，更損失0.0257 DALYs／百萬人，而發生率在0.058至0.091區間內，早期噴消符合成本效用。結論：本研究定義符合登革熱噴消成本效用的發生率區間，在區間外可搭配其他防疫措施（如孳生源清除、環境清理）降低後續登革（出血）熱之幅度及嚴重度。
  Objectives: Dengue fever is a human health and life-threatening mosquito-borne disease in tropical regions of the world, and is prevalent in southeast Asia, Central America, South America, and the western Pacific region. Without effective treatment, insecticide spray to control the vector has been the top priority in attempts to prevent dengue transmission. This study evaluated the cost utility of insecticide spray in the early stage of a dengue outbreak in Kaohsiung. These results will provide suggestions for controlling dengue fever with limited resources and lowering the epidemic size and social burden of dengue fever. Methods: Decision-making and sensitivity analysis were performed with Treeage Pro 2011. The incidence of dengue fever with incorporation of the following factors into a decision tree: with or without early insecticide spraying; manpower; material expenditures; medical expenses of patients; and DALYs. Results: A cost utility analysis indicated that spontaneous spraying of insecticide and environmental clearance indoors and outdoors within a radius of 100 meters of the case premises was a better decision than no spray control. Specifically, it would cost 957.16 NTD/person and 0.0144 DALYs lost per 1 million population with an incidence of 0.0536 with insecticide spray. In contrast, it would cost 1575.24 NTD/person with and 0.0257 DALYs lost per 1 million population with an incidence of 0.0954 without insecticide spray. The early spray approach had good cost utility, with an incidence ranging from 0.058-0.091. Conclusions: This study defined a suitable incidence interval with cost utility with respect to dengue fever control using early insecticide spraying. Despite the cumulative incidence beyond this range, other control strategies may cooperate with insecticide spraying to reduce the outbreak and severity of dengue (hemorrhagic) fever.
• 646 - 656
• 10.6288/TJPH201534104070

• Link 評論 Commentary
• 長短期失能個案居家物理治療服務利用與療效－以台北都會區為例Utilization and Outcomes of Home-Based Physical Therapy for Longand Short-Term Disability Clients Based on an Analysis of Taipei City Residents
• 李宜玲、李世代、曹昭懿、胡名霞
  Yi-Ling Li, Shyh-Dye Lee, Jau-Yih Tsauo, Ming-Hsia Hu
• 失能 ； 居家物理治療 ； 服務利用 ； 長期照護 ； 急性後期照護
  disability ; home-based physical therapy ; utilization ; long-term care ; post-acute care
• 目標：比較長短期失能居家個案之物理治療服務利用及療效之異同，以供日後急性後期照護與長期照護居家物理治療服務政策推動參考。方法：以2012年台北市與新北市無記名居家物理治療資料進行次級分析。走路、洗澡、穿衣與轉位等任一項身體功能，失能超過6個月者定義為長期失能，其餘為短期失能。以t檢定與卡方檢定比較長短期失能個案特徵、物理治療介入次數及巴氏量表得分改善情形，並以羅吉斯迴歸分析各診斷（或處置）個案之失能期長短和功能改善與否之關聯性。結果：717筆個案資料中，長、短期失能個案比例約為7比3。短期失能個案之疼痛、關節受限與轉介前功能較獨立之比例較高。居家物理治療的平均介入次數為5.4 ± 3.2次，長、短期失能個案的服務利用分別為5.5 ± 3.2次及5.2 ± 3.2次，無統計上的顯著差異。介入後，個案的巴氏量表得分平均改善6.0 ± 13.0分，短期失能個案功能改善顯著優於長期失能個案，巴氏量表分別增加8.9 ± 15.6分與4.8 ± 11.7分（p ＜ 0.01）。與長期失能個案相比，短期失能個案功能改善之勝算比，在中風個案為2.28（p=0.007），在關節置換個案為7.28（p=0.011）。結論：長短期失能個案的居家物理治療介入次數相當，但短期失能個案療效較佳。中風、關節置換的短期失能個案進步情況尤其顯著。
  Objectives: This study compared differences in the characteristics, utilization, and outcomes of home-based physical therapy (HPT) between clients with long- and short-term disabilities. Methods: A secondary analysis was conducted on data collected from routine records of HPT in the Taipei metropolitan region in 2012. Clients who had disabilities in walking, dressing, bathing, and transferring for > 6 months were classified as having a long-term disability; the remaining clients were classified as having a short-term disability. The data included socio-demographic data, health functional status, intervention sessions, and Barthel Index (BI) scores. We used t-tests, chisquare tests, and multiple logistic regression models to analyze the differences between long- and short-term disabilities. Results: Delinked data of 717 subjects were included. The ratio of longversus short-term clients with disabilities was approximately 7:3. Significantly more clients with short-term than long-term disabilities reported pain, limited range of motion, and less functional dependence before intervention. The intervention frequency (average, 5.4 ± 3.2 sessions) was similar between groups. After HPT intervention, the average improvement in BI score was 6.0 ± 13.0. The improvements in ADL were significantly greater in the clients with short-term disabilities than the clients with long-term disabilities (8.9 ± 15.6 vs. 4.8 ± 11.7, respectively). The odds ratios between clients with short- and long-term disabilities were 2.28 (p=0.007) for stroke patients and 7.28 (p=0.011) for patients who have undergone arthroplasties. Conclusions: The number of intervention sessions between the clients with long- and short-term disabilities were similar. The effectiveness of HPT intervention was better for clients with short- than long-term disabilities, especially for patients who had undergone arthroplasties or had strokes.
• 657 - 669
• 10.6288/TJPH201534104042