職能活動介入精神科住院病人預防跌倒成效分析-以南部某精神專科地區醫院為例

研究目的：本研究希望探討南部某間精神科住院病人之跌倒危險因素，職能治療師透過跌倒危險因素設計出符合精神科病人防跌倒活動之介入後，對病人生理指標(下肢肌力、柔軟度、平衡力)及預防跌倒是否有顯著成效。研究方法：本研究採取三個階段進行，第一階段主要透過自2016年11月1日到2017年10月31日病歷回溯法分析病人跌倒風險之因素。第二階段選自2018年3月1日到2018年3月31日住院病人，主要評估病人簡易認知功能評估(MMSE)及Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT)評估工具得知病人是否為認知正常及高風險跌倒，以卡方檢定分析基本屬性與MMSE、EPFRAT的相關性及羅吉斯回歸分析基本屬性高跌倒風險(EPFRAT)之勝算比。第三階段主要透過八週預防跌倒活動介入，以成對樣本t檢定分析生理指標及跌倒人次之前後測，以PASW Statistics 18統計軟體進行分析。結果：從病歷回溯法分析發現前三高跌倒風險因素為服用影響意識之藥物、65歲以上的人、步態平衡失調。在基本屬性與評估工具相關性中發現性別、年齡、教育程度、診斷(精神疾病)對於跌倒風險(EPFRAT)皆有相關，再以羅吉斯回歸發現男性是女生的0.27倍(勝算比=0.27)，達顯著水準(p=0.005)；50歲以下是65歲以上的0.07倍(勝算比=0.07)，達顯著水準(p<0.001)；國中以上是國小以下的0.17倍(勝算比=0.17)，達顯著水準(p=0.001)；思覺失調症是憂鬱症的0.11倍(勝算比=0.11)，達顯著水準(p=0.018)。在經過八週防跌倒活動介入後發現下肢肌力、柔軟度、平衡力及跌倒人次皆有顯著水準。結論：本研究預防跌倒活動介入之結果與先前一些研究的成果一致。跌倒在精神科單位是一件非常容易發生的意外事件，其精神科病人多呈現慢性化，若發生跌倒會加劇他們的傷害，故讓有高跌倒風險之精神科病人參與預防跌倒活動在精神科醫院是一件重要的事。

關鍵字

精神科住院病人；職能活動；預防跌倒；簡易心智量表；精神科跌倒風險評估工具

並列摘要

Purpose: This study explores the risk factors of falls in a psychiatric inpatient hospital in Southern Taiwan. Occupational therapists designed prevention fall activities for psychiatric patients for reducing risk factors after intervention. This study examines, if the patient's physiological indicators (lower limb muscle strength, softness, balance) have a significant effect on the prevention of falls. Methods: The study was conducted in three phases. In the first phase from November 1, 2016 to October 31, 2017 the factors of patient fall risks were mainly analyzed by the retrospective method. The second phase from March 1, 2018 to March 31, 2018 focuses on selected inpatients. The primary assessment patient Mini-Mental State Examination (MMSE) and Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) assessment tools can assess whether the patient is cognitively normal and has a high risk of falling. The correlation between basic attributes and MMSE and EPFRAT can be measured by chi-square test. The logistic regression analyzes the basic attributes of the high fall risk odds ratio. The third phase consists mainly of activities to prevent falls. The paired samples t-test analysis of was used before and after the prevention activities for the analysis of physiological indicators and falls times. For this analysis PASW Statistics 18 statistical software was used. Results: According to the retrospective analysis of medical records, the three high falls risk factors are drug use affecting mental status, age over 65 years, and gait imbalance. The study indicates that gender, age, education, and diagnosis (mental illness) are relevant for the risk of falls in respect to the correlation between basic attributes and assessment tools. The logistic regression found that males were 0.27 times females (odds ratio = 0.27), reaching a significant level (p = 0.005); under 50 years old was 0.07 times over 65 years old (odds ratio = 0.07), reaching a significant level (p < 0.001); above junior high school is 0.17 times elementary school (odds ratio = 0.17), reaching a significant level (p = 0.001); the schizophrenia is 0.11 times of depression (odds ratio = 0.11), reaching a significant level (p =0.018). Conclusion: The results of this study to prevent the involvement of falls are consistent with the results of previous studies. Falling in a psychiatric unit is a very common accident. Psychiatric patients often have a chronic disease, and falls aggrivate their defects. Therefore, it is important for psychiatric patients with high risk of falling to participate in activities for the prevention of falls in psychiatric hospitals.

並列關鍵字

Psychiatric inpatient ； Occupational activity ； Prevention of falls ； Mini-Mental State Examination (MMSE) ； Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT)