111 年 國立臺灣大學物理治療系碩士班《呼吸循環物理治療學》
第 A 題20 分
A. 請閱覽以下論文摘錄部份,再回答以下問題。(配分共20分)
A-1: 此段落最可能從論文那部分摘錄:甲.前言,乙.方法,丙.結果,丁.討論。並請說明緣由。(5分)
A-2: 請說明 ML用於發展短版評估工具之優勢為何?並請舉例說明。(15分)
Developing short-form measures with machine learning (ML) may be promising for clinicians. 19,26-28 ML algorithms can be trained to reproduce the scores of the original (long-form) measures using the scores obtained from a selected set of short-form items. 19,26-28 Two advantages of ML-based short-form measures have been reported. First, ML-based short-form measures comprise substantially fewer items than the original long-form measures while retaining the psychometric properties of the original measures. 16,19,26-28 For example, a ML-based short-form measure of the Fugl-Meyer Motor Scale needs only 20% (10/50 items) of the items of the Fugl-Meyer Motor Scale, but the test-retest reliability and responsiveness of the two measures have been shown to be comparable. 16 This advantage can be ascribed to the robust predictive power of ML algorithms to reproduce the scores of the original measures. Second, ML-based short-form measures have administrative methods (e.g., interview or performance rating) and score interpretation identical to those of the original measures. Thus, original users can easily become accustomed to the ML-based short-form measures. These two advantages make ML a promising approach to generating efficient short-form measures with psychometric performance comparable to that of the original measures for clinicians to assess multiple essential functions in patients with stroke.
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核心觀念: 判斷論文段落的性質，以及理解機器學習(ML)在發展評估工具上的優勢。
A-1.
此段落最可能為論文的「丁.討論 (Discussion)」部分。
說明：
此段落主要在論述「機器學習(ML)用於發展短版評估工具」的潛力與優勢，並提出其「可取之處」(advantages)與「臨床應用上的價值」(promising approach for clinicians)。這種對研究結果進行解釋、闡述其意義、並提出其優點和潛在應用的內容，是典型的討論區塊的寫法。
- 前言 (Introduction)：通常介紹研究背景、問題、重要性及研究目的。
- 方法 (Methods)：詳細說明研究如何執行，包含研究設計、對象、工具、步驟等。
- 結果 (Results)：客觀呈現研究數據或發現，通常包含統計分析結果，但不做過多解釋。
- 討論 (Discussion)：解釋研究結果的意義，將結果與先前研究連結，討論研究的優勢、限制，並提出未來的研究方向或臨床應用建議。
A-2.
ML用於發展短版評估工具的優勢有兩點，並舉例說明如下：
- 優勢一：大幅減少項目數量，同時保留原有的心理計量特性。
- 說明：ML演算法能夠從原始的長版評估工具中，選取一部分關鍵項目，並利用這些項目來重現原始長版工具的評分。
第 B 題20 分
B. 請閱覽以下論文摘要,再回答後續問題。(配分共20分)
B-1: 請簡述此研究之主要發現。(10分)
B-2: 請自行解釋此研究要發現之臨床或學術意義(5分)
B-3: 請試給予此論文之標題(title)(5分)
Purpose: To examine the relationships among therapist-reported, patient-reported, and objective assessment scores of balance function.
Methods: Inpatients with stroke and occupational therapists were recruited. The objective balance scores were measured using the Balance Computerized Adaptive Testing (Balance CAT) system. The therapist and patient-reported scores were evaluated using a visual analogue scale (VAS) and Likert-type scale.
Results: Eighty-eight patients and 16 therapists participated. The correlations (r= 0.64 and 0.65; R-squared about 0.42 at baseline and follow-up assessments, respectively) between the therapist-reported VAS scores and the Balance CAT system were larger than those (r=0.31 and 0.21) between the patient-reported VAS scores and the Balance CAT system. Low correlations (r = 0.27 and 0.26 for VAS and Likert-type scores, respectively) were found between the therapist-reported and patient-reported change scores. Low correlations (r = 0.12-0.17) were found between the change scores of therapist- and patient-reported ratings and those of the Balance CAT system.
Conclusions: The therapists' judgments explained <50% of variance of the Balance CAT system scores. Neither therapist-reported nor patient-reported change scores reflected the changes demonstrated by the objective assessments. Further studies are warranted to confirm our findings.
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核心觀念: 理解研究摘要中的目的、方法、結果與結論，並能從中歸納出研究發現、臨床/學術意義，以及為研究命名。
B-1.
此研究的主要發現可以歸納為以下幾點：
- 治療師的平衡功能評估與客觀量測系統（Balance CAT）的相關性較高： 在基線（baseline）和追蹤評估時，治療師透過視覺類比量表（VAS）報告的平衡分數，與Balance CAT系統測得的客觀分數之間的相關性（約為0.64-0.65），顯著高於病患透過VAS報告的平衡分數與Balance CAT系統分數之間的相關性（約為0.31-0.21）。
- 治療師與病患對「改變」的評估相關性低： 治療師回報的平衡功能改變分數（無論是VAS或Likert量表）與病患回報的平衡功能改變分數之間的相關性很低（約為0.27-0.26）。
- 主觀評估的改變與客觀量測的改變相關性極低： 治療師和病患回報的平衡功能「改變」分數，與Balance CAT系統測得的「改變」分數之間的相關性更是非常低（約為0.12-0.17）。
- 治療師的判斷無法完全解釋客觀評估的變異： 治療師的判斷（judgments）僅能解釋Balance CAT系統分數變異量（variance）的50%以下。
- 主觀評估的改變未反映客觀評估的改變： 無論是治療師或病患所報告的平衡功能改變分數，都未能有效反映出客觀評估（Balance CAT系統）所顯示的改變。
【答案】治療師對平衡功能的評估與客觀量測系統的相關性較高，但治療師與病患之間以及與客觀量測系統之間，對於「平衡功能改變」的評估相關性均非常低，顯示主觀評估的改變未能反映客觀評估的改變。
B-2.
臨床意義：
這個研究結果對於臨床實務具有重要啟示。首先，它提示我們在評估中風病患的平衡功能時，雖然治療師的評估與客觀工具（如Balance CAT）有一定程度的一致性，但病患的回報與客觀測量之間存在較大的差異。這可能意味著病患對於自身平衡能力的感受，與實際的運動功能表現之間存在落差。臨床工作者在制定治療計畫和與病患溝通時，應同時參考客觀數據和病患主觀感受，並理解兩者可能不一致。
其次，研究發現「改變」的主觀評估（治療師或病患的回報）與客觀評估的改變之間相關性很低，這表示單純依賴病患或治療師的「感覺」來判斷治療成效，可能無法準確反映病患實際平衡能力的進步。
第 E 題10 分
E. 請閱覽以下文獻內容,再說明 Occupation-Based Coaching 過程的5項原則之第2-4項。(配分10分)
The Occupation-Based Coaching process includes the following five key principles (adapted from Rush & Shelden, 2011):
- Authentic contexts. Authentic contexts are the places in which the child and family situate themselves in everyday life and are settings for intervention.
- Family's interests and routines. Providers support caregivers in creating strategies that can occur within naturally occurring family routines and interests. By doing so, providers do not disrupt the natural cohesiveness and structure of the family and provide authentic opportunities for practice.
- Caregiver interaction and responsiveness. The provider supports the transactional relationship between the caregiver and child as the basis for caregiver insights about the child's behavior. Using the family's patterns creates a chance to foster the family's strengths.
- Reflection and feedback. The provider and caregiver talk through ways to increase the child's participation and to evaluate the effectiveness of strategies that the family tries in between sessions as the problem-solving method. The reflection and feedback process builds the caregivers' knowledge and insights.
- Joint plans. The provider and caregiver identify what each will accomplish between sessions to address the family's goals. The provider and caregiver evaluate the effectiveness of the strategies at each subsequent session.
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核心觀念: 閱讀英文文獻，理解其中列舉的原則，並能依據題意提取特定編號的原則進行說明。
原則說明：
此題要求說明 Occupation-Based Coaching 過程的五項原則中的第二項至第四項。
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原則二：家庭的興趣與例行事務 (Family's interests and routines)
- 說明：此原則強調，提供者（providers）應支持照顧者（caregivers）發展能夠融入家庭日常例行事務（family routines）和興趣（interests）的策略。這樣做的好處是，不僅不會破壞家庭原有的凝聚力與結構，還能提供真實（authentic）的練習機會。換言之，介入策略應與家庭的日常生活緊密結合，而非額外增加負擔。
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原則三：照顧者互動與回應性 (Caregiver interaction and responsiveness)
- 說明：此原則指出，提供者應支持照顧者與孩子之間所建立的互動關係（transactional relationship），並將此關係視為照顧者理解孩子行為（child'
第 F 題10 分
F. 請依據下列文獻內容,說明(配分共10分)
F-1.此研究的研究方法(5分)
F-2.此研究的結果(5分)
Abstract
Objective: This study was carried out to examine the efficacy of a 12-week, low-intensity (1-hour/wk of therapist contact), parent-delivered intervention for toddlers at risk for autism spectrum disorders (ASD) aged 14 to 24 months and their families.
Method: A randomized controlled trial involving 98 children and families was carried out in three different sites investigating the efficacy of a parent delivery of the Early Start Denver model (P-ESDM), which fosters parental use of a child-centered responsive interaction style that embeds many teaching opportunities into play, compared to community treatment as usual. Assessments were completed at baseline and 12 weeks later, immediately after the end of parent coaching sessions.
Results: There was no effect of group assignment on parent-child interaction characteristics or on any child outcomes. Both groups of parents improved interaction skills, and both groups of children demonstrated progress. Parents receiving P-ESDM demonstrated significantly stronger working alliances with their therapists than did the community group. Children in the community group received significantly more intervention hours than those in the P-ESDM group. For the group as a whole, both younger child age at the start of intervention and a greater number of intervention hours were positively related to the degree of improvement in children's behavior for most variables.
Conclusions: Parent-implemented intervention studies for early ASD thus far have not demonstrated the large effects seen in intensive-treatment studies. Evidence that both younger age and more intervention hours positively affect developmental rates has implications for clinical practice, service delivery, and public policy.
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核心觀念: 閱讀學術摘要，提取研究方法與結果的關鍵資訊。
F-1.
此研究的研究方法為「隨機對照試驗 (Randomized Controlled Trial, RCT)」。
具體細節如下：
- 研究設計：採用隨機對照試驗（RCT）設計。
- 研究對象：共納入98名有自閉症譜系障礙（ASD）風險的幼兒（年齡介於14至24個月）及其家庭。
- 介入措施：
- 實驗組：接受為期12週、低強度（每週1小時治療師接觸時間）、由家長執行的早期丹佛模式（Parent-delivered Early Start Denver Model, P-ESDM）介入。此模式強調家長採用以兒童為中心、具回應性的互動風格，並將教學機會融入遊戲中。
- 對照組：接受「社區常規治療」（community treatment as usual）。
- 研究地點：在三個不同的地點進行。
- 評估時程：在研究開始時（基線，baseline）及介入結束後的12週進行評估。
【答案】研究方法為隨機對照試驗（RCT），針對98名14-24個月大、有ASD風險的幼兒及其家庭，將其隨機分配至接受12週低強度家長執行之早期丹佛模式（P-ESDM）介入，或接受社區常規治療，並於基線及12週後進行評估。