本論文開發並初步評估一套以生活統御感（Life Autonomy and Coherence, LAC）為核心的高頻遠距生活優化服務系統，以回應復健、復能、長期照護、照護轉銜、機構服務及家庭支持中的服務缺口。不同於現有多著重監測或諮詢的遠距醫療平台，本系統支持專業建議轉化為日常生活任務，並經由執行、回報、專業審視及後續調整形成持續性的服務循環。
本研究採三階段設計導向工程架構。第一階段建立生活統御感作為生活導向的成果方向，並發展21題、二因素的LAC量表；該量表具有良好的內部一致性，且與生活品質、身體韌性及健康識能呈現符合理論預期的關聯。第二階段建構5A Star Process，包括Announce Problem、Analyze Performance、Appoint Activity、Approve Ability及Accept Resilience，將專業推理轉化為可循環且可平台化的服務流程。第三階段建構LongHo雙角色平台，個案／照顧者端支援任務查看、執行回報及專業回饋，專業／後台端則支援個案管理、任務指派、專業回饋及服務歷程追蹤。
初步系統測試涵蓋家庭、機構與長期照護及照護轉銜情境。家庭服務紀錄包括6個持續服務案例、1,304個服務日、419次回報、171次治療師回應及33項任務，顯示系統可支持持續性的任務－回報－回饋活動及可追溯的服務紀錄。描述性成果顯示，服務使用者的生活統御感、生活品質及憂鬱症狀呈現有利趨勢，照顧者相關結果則較不一致；上述結果屬探索性發現，尚不能作為臨床療效證據。
形成性可用性評估共納入29位參與者，形成41筆角色別紀錄。四組系統可用性量表平均分數介於67.50至76.88。前瞻性測試共進行192次任務操作，全部最終完成，其中141次（73.4%）獨立完成，51次（26.6%）需要實質提示。主要困難集中於資訊查找、任務建立、回報審閱、目標修改及多步驟導覽，並據此確認後續介面與流程優化方向。
整體而言，本論文建立LAC–5A–LongHo整合架構：生活統御感提供成果方向，LAC-Scale提供評估指標，5A Star Process提供服務流程，LongHo則作為工程載體。研究結果提供系統實施、可追溯性及可用性的初步證據；未來仍需透過較大規模之前瞻性研究、標準化評估、持續可用性優化及長期追蹤，進一步驗證其臨床成效。

This dissertation developed and preliminarily evaluated a high-frequency remote life optimization service system centered on Life Autonomy and Coherence (LAC), addressing service gaps in rehabilitation, reablement, long-term care, care transitions, institutional services, and family support. Unlike telehealth platforms focused mainly on monitoring or consultation, the proposed system supports the cycle through which professional recommendations are translated into daily-life tasks, implemented, reported, reviewed, and adjusted over time.
A three-stage design-oriented engineering framework guided system development. First, LAC was established as the life-based outcome direction and operationalized through a 21-item, two-factor LAC-Scale, which demonstrated good internal consistency and theoretically consistent relationships with quality of life, physical resilience, and health literacy. Second, the 5A Star Process—Announce Problem, Analyze Performance, Appoint Activity, Approve Ability, and Accept Resilience—structured professional reasoning into a cyclical and platformizable service workflow. Third, the LongHo platform was developed as a dual-role system comprising an individual/caregiver interface for task review, reporting, and feedback, and a professional/backend interface for case management, task assignment, professional feedback, and service-history tracking.
Preliminary system testing covered family-based, institutional and long-term care, and care-transition contexts. Family-based records included six continuing cases, 1,304 service days, 419 reports, 171 therapist responses, and 33 assigned tasks, demonstrating sustained task–report–feedback activities and traceable service records. Descriptive outcome findings showed favorable trends in LAC, quality of life, and depressive symptoms among service users, whereas caregiver outcomes were mixed. These findings were exploratory and did not establish clinical effectiveness.
Formative usability evaluation included 29 participants contributing 41 role-specific records. Mean System Usability Scale scores across four groups ranged from 67.50 to 76.88. Across 192 prospective task attempts, all were eventually completed; 141 (73.4%) were completed independently and 51 (26.6%) required substantive prompts. Major difficulties involved information finding, task creation, report review, goal modification, and multi-step navigation, identifying priorities for further interface and workflow refinement.
Overall, this dissertation establishes the integrated LAC–5A–LongHo framework, in which LAC provides the outcome direction, the LAC-Scale provides the assessment indicator, the 5A Star Process provides the service workflow, and LongHo provides the engineering carrier. The findings provide preliminary evidence of system implementation, traceability, and usability, while larger prospective studies, standardized assessments, iterative usability evaluation, and longer-term follow-up are required before clinical effectiveness can be established.

1. Agarwal, S., LeFevre, A. E., Lee, J., L’Engle, K., Mehl, G., Sinha, C., Labrique, A., & WHO mHealth Technical Evidence Review Group. (2016). Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist. BMJ, 352, i1174. https://doi.org/10.1136/bmj.i1174
2. Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. Jossey-Bass. https://doi.org/10.1017/S0714980800007133
3. Argent, R., Daly, A., & Caulfield, B. (2018). Patient involvement with home-based exercise programs: Can connected health interventions influence adherence? JMIR mHealth and uHealth, 6(3), e47. https://doi.org/10.2196/mhealth.8518
4. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
5. Boateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Quiñonez, H. R., & Young, S. L. (2018). Best practices for developing and validating scales for health, social, and behavioral research: A primer. Frontiers in Public Health, 6, 149. https://doi.org/10.3389/fpubh.2018.00149
6. Costello, A. B., & Osborne, J. W. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment Research & Evaluation, 10(7), 1–9.
7. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334. https://doi.org/10.1007/BF02310555
8. Design Council. (n.d.). The Double Diamond. Retrieved June 8, 2026, from https://www.designcouncil.org.uk/our-resources/the-double-diamond/
9. DeVellis, R. F., & Thorpe, C. T. (2022). Scale development: Theory and applications (5th ed.). SAGE Publications.
10. Duong, T. V., Aringazina, A., Baisunova, G., Nurjanah, Pham, T. V., Pham, K. M., Truong, T. Q., Nguyen, K. T., Oo, W. M., Mohamad, E., Su, T. T., Huang, H.-L., Sørensen, K., Pelikan, J. M., Van den Broucke, S., & Chang, P. W. (2017). Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. Journal of Epidemiology, 27(2), 80–86. https://doi.org/10.1016/j.je.2016.09.005
11. Eldridge, S. M., Chan, C. L., Campbell, M. J., Bond, C. M., Hopewell, S., Thabane, L., Lancaster, G. A., & PAFS Consensus Group. (2016). CONSORT 2010 statement: Extension to randomised pilot and feasibility trials. BMJ, 355, i5239. https://doi.org/10.1136/bmj.i5239
12. Eldridge, S. M., Lancaster, G. A., Campbell, M. J., Thabane, L., Hopewell, S., Coleman, C. L., & Bond, C. M. (2016). Defining feasibility and pilot studies in preparation for randomised controlled trials: Development of a conceptual framework. PLOS ONE, 11(3), e0150205. https://doi.org/10.1371/journal.pone.0150205
13. Eysenbach, G., & CONSORT-EHEALTH Group. (2011). CONSORT-EHEALTH: Improving and standardizing evaluation reports of web-based and mobile health interventions. Journal of Medical Internet Research, 13(4), e126. https://doi.org/10.2196/jmir.1923
14. Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J. (1999). Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4(3), 272–299. https://doi.org/10.1037/1082-989X.4.3.272
15. Hemmingsson, H., & Jonsson, H. (2005). An occupational perspective on the concept of participation in the International Classification of Functioning, Disability and Health—Some critical remarks. American Journal of Occupational Therapy, 59(5), 569–576. https://doi.org/10.5014/ajot.59.5.569
16. Hevner, A. R., March, S. T., Park, J., & Ram, S. (2004). Design science in information systems research. MIS Quarterly, 28(1), 75–106. https://doi.org/10.2307/25148625 
17. Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., Altman, D. G., Barbour, V., Macdonald, H., Johnston, M., Lamb, S. E., Dixon-Woods, M., McCulloch, P., Wyatt, J. C., Chan, A.-W., & Michie, S. (2014). Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ, 348, g1687. https://doi.org/10.1136/bmj.g1687
18. Hollnagel, E., Woods, D. D., & Leveson, N. (Eds.). (2006). Resilience engineering: Concepts and precepts. Ashgate.
19. Horn, J. L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30, 179–185. https://doi.org/10.1007/BF02289447
20. Hu, F.-W., Lin, C.-H., Yueh, F.-R., Lo, Y.-T., & Lin, C.-Y. (2022). Development and psychometric evaluation of the Physical Resilience Instrument for Older Adults (PRIFOR). BMC Geriatrics, 22, 229. https://doi.org/10.1186/s12877-022-02918-7
21. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
22. International Organization for Standardization. (2019). ISO 9241-210:2019 Ergonomics of human-system interaction—Part 210: Human-centred design for interactive systems. International Organization for Standardization.
23. Kaiser, H. F., & Rice, J. (1974). Little Jiffy, Mark IV. Educational and Psychological Measurement, 34(1), 111–117. https://doi.org/10.1177/001316447403400115
24. Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: The Index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185(12), 914–919. https://doi.org/10.1001/jama.1963.03060120024016
25. Laver, K. E., Adey-Wakeling, Z., Crotty, M., Lannin, N. A., George, S., & Sherrington, C. (2020). Telerehabilitation services for stroke. Cochrane Database of Systematic Reviews, 2020(1), CD010255. https://doi.org/10.1002/14651858.CD010255.pub3
26. Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9–23. https://doi.org/10.1177/000841749606300103
27. Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382–386. https://doi.org/10.1097/00006199-198611000-00017
28. McDonald, R. P. (1999). Test theory: A unified treatment. Psychology Press. https://doi.org/10.4324/9781410601087
29. Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42. https://doi.org/10.1186/1748-5908-6-42
30. O’Callaghan, G., Fahy, M., Murphy, P., Langhorne, P., Galvin, R., & Horgan, F. (2022). Effectiveness of interventions to support the transition home after acute stroke: A systematic review and meta-analysis. BMC Health Services Research, 22, 1095. https://doi.org/10.1186/s12913-022-08473-6
31. Palazzo, C., Klinger, E., Dorner, V., Kadri, A., Thierry, O., Boumenir, Y., Martin, W., Poiraudeau, S., & Ville, I. (2016). Barriers to home-based exercise program adherence with chronic low back pain: Patient expectations regarding new technologies. Annals of Physical and Rehabilitation Medicine, 59(2), 107–113. https://doi.org/10.1016/j.rehab.2016.01.009
32. Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19(1), 2–21. https://doi.org/10.2307/2136319
33. Peffers, K., Tuunanen, T., Rothenberger, M. A., & Chatterjee, S. (2007). A design science research methodology for information systems research. Journal of Management Information Systems, 24(3), 45–77. https://doi.org/10.2753/MIS0742-1222240302
34. Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what’s being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489–497. https://doi.org/10.1002/nur.20147
35. Polit, D. F., Beck, C. T., & Owen, S. V. (2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30(4), 459–467. https://doi.org/10.1002/nur.20199
36. Renda, M., & Lape, J. E. (2018). Feasibility and effectiveness of telehealth occupational therapy home modification interventions. International Journal of Telerehabilitation, 10(1), 3–14. https://doi.org/10.5195/ijt.2018.6244
37. Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68
38. Skivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., Boyd, K. A., Craig, N., French, D. P., McIntosh, E., Petticrew, M., Rycroft-Malone, J., White, M., & Moore, L. (2021). A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. BMJ, 374, n2061. https://doi.org/10.1136/bmj.n2061
39. Sørensen, K., Van den Broucke, S., Pelikan, J. M., Fullam, J., Doyle, G., Slonska, Z., Kondilis, B., Stoffels, V., Osborne, R. H., Brand, H., & HLS-EU Consortium. (2013). Measuring health literacy in populations: Illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health, 13, 948. https://doi.org/10.1186/1471-2458-13-948
40. Stickdorn, M., & Schneider, J. (Eds.). (2011). This is service design thinking: Basics, tools, cases. BIS Publishers.
41. Taylor, R. R. (Ed.). (2017). Kielhofner’s model of human occupation: Theory and application (5th ed.). Wolters Kluwer.
42. The WHOQOL Group. (1995). The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine, 41(10), 1403–1409. https://doi.org/10.1016/0277-9536(95)00112-K
43. The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/S0033291798006667
44. Wettstein, R., Sedaghat-Hamedani, F., Heinze, O., Amr, A., Reich, C., Betz, T., Kayvanpour, E., Merzweiler, A., Büsch, C., Mohr, I., Friedmann-Bette, B., Frey, N., Dugas, M., & Meder, B. (2024). A remote patient monitoring system with feedback mechanisms using a smartwatch: Concept, implementation, and evaluation based on the activeDCM randomized controlled trial. JMIR mHealth and uHealth, 12, e58441. https://doi.org/10.2196/58441
45. World Health Organization. (2001). International classification of functioning, disability and health (ICF). https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
46. World Health Organization. (2015). World report on ageing and health. https://www.who.int/publications/i/item/9789241565042
47. World Health Organization. (2019). WHO guideline: Recommendations on digital interventions for health system strengthening. https://www.who.int/publications/i/item/9789241550505
48. World Health Organization. (2021). Global strategy on digital health 2020–2025. https://www.who.int/publications/i/item/9789240020924
49. Yao, G., Chung, C.-W., Yu, C.-F., & Wang, J.-D. (2002). Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. Journal of the Formosan Medical Association, 101(5), 342–351.