研究背景：亞急性中風的日常生活活動(Activities of daily living, ADL)表現，是返家後生活品質、職能參與的關鍵基礎，並可分為實際表現、自覺困難二面向。自我效能與平衡、動作、認知功能、憂鬱症狀強度等身體功能，皆為中風後ADL主客觀面向之潛在相關因子。然而，過去鮮有研究同時考量前述多項因子，以較全面的方式驗證ADL二面向的重要因子。同時，自我效能與身體功能間是否存在交互作用且其交互作用是否為ADL二面向表現的重要因子，目前仍乏證據支持，不利於亞急性中風ADL復健之完整、精準治療。

研究目的：本研究旨於分別探討亞急性中風ADL實際表現、自覺困難之相關影響因子，其中潛在影響因子包含身體功能（即平衡、動作、認知、憂鬱症狀強度）、自我效能，及身體功能與自我效能之交互作用因子。

方法：本研究納入中風後2週~6個月、已出院返家之初次中風成人，進行橫斷式資料收集，包含人口學、中風病情、標準化評估等。ADL實際表現、自覺困難分別以巴氏量表、巴氏量表－補充量表之自覺困難量表評估；自我效能以中風自我效能問卷評估；身體功能則評估平衡、動作、認知功能、憂鬱症狀強度等。資料分析採描述性分析、斯皮爾曼相關係數(Spearman's rank correlation coefficient)，分別描述受試者特性與因子兩兩相關性。最後，本研究利用三個多元線性迴歸模型以及赤池訊息量準則(Akaike information criterion)的方法，驗證最適切且最簡化之ADL二面向重要解釋因子。

結果：本研究納入32位受試者（年齡56.0 ± 14.9歲，中風後3.0 ± 1.6月），標準化評估分數除中風自我效能問卷外，多顯著偏離常態（Shapiro-Wilk p <.05）。ADL實際表現，模型二（身體功能＋自我效能）符合模型適切性條件，其結果顯示平衡具顯著迴歸相關係數（β = 0.859, p < .001），因此平衡為ADL實際表現重要因子，且模型二可解釋86.6 %的ADL實際表現變化。ADL自覺困難則於最適切的模型三（身體功能＋自我效能＋交互作用），選出憂鬱症狀強度（β = -1.295, p = .049）與平衡 × 自我效能交互作用（β = 3.037, p = .026）二因子。模型三可解釋61.5 % 的ADL自覺困難變化。

結論：本研究發現，恢復佳的亞急性中風患者ADL實際表現更獨立，與平衡更佳有關；而ADL自覺執行更容易，低憂鬱症狀強度、高自我效能、平衡能力佳為重要因子，且平衡、自我效能對患者執行ADL難易度具共同影響。臨床上，若欲促進ADL實際表現、自覺困難改善，建議可由各面向之解釋因子著手，以期提供精準治療。

People with subacute stroke, activities of daily living (ADL) function acts crucially to further participation of daily life. Furthermore, ADL performance can be divided into two aspects: actual performance (objective) and self-perceived difficulty (subjective). On the other hand, potential determinants of ADL performance include self-efficacy and body functions including balance, motor, cognition and depressive symptoms. However, no studies have explored ADL-associated factors in subacute stroke, not to mention more comprehensive inclusion of potential factors (i.e., various body functions and their interactions with self-efficacy). Thus, this study aims to investigate whether self-efficacy, body functions and the interactions are associated with both ADL performance. We recruited 32 participants with stroke were recruited. ADL objective and subjective performance were evaluated with Barthel Index (BI) and the self-perceived difficulty scale of Barthel Index-Supplementary Scale (BI-SS), respectively. Multiple linear regression, with stepAIC methods, was used to explore the association between body functions, self-efficacy and ADL performance. For ADL actual performance, we found out that postural balance and self-efficacy are two potential associated factors. For ADL self-perceived difficulty, we discovered that the extent of depressive symptoms, as well as the interaction between balance X self-efficacy, are main associated factors. With the findings of the study, we encourage that more emphasis can be put on the both ADL performance, and precise interventions of ADL-associated factors, in subacute stroke rehabilitation.

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