復健病患出院後使用輔具之狀況

Use of Assistive Devices in Patients Discharged from Rehabilitation Ward

黃小玲(Sheau-Ling Huang) ； 羅鈞令(Jin-Ling Lo) ； 張彧(Yuh Jang) ； 林佳琪(Chia-Chi Lin) ； 毛慧芬(Hui-Fen Mao)

《台灣醫學》 7卷5期 (2003/09) Pp. 681-688

https://doi.org/10.6320/FJM.2003.7(5).02

摘要

「輔具」可提昇、維持、或增強身心障礙者的功能，是復健治療中重要的治療策略。了解病患使用輔具的現況與問題，是提供良好輔具服務的基礎，然而國內相當缺乏探討病息使用輔具狀況之調查。本研究目的在了解復健病患使用輔具之數量與類型、獲得輔具的管道、出院後持續使用情形、以及不再使用之原因等，以提供臨床專業人員輔具評估建議的參考，落實輔具之功能，提昇輔具服務之品質。
研究對象為89年1月至89年7月間所有台大醫院復健部出院病患；研究方式為由一名職能治療師於病患出院前3日內，以面談方式搜集病患使用輔具的狀況，及輔具服務之相關資訊；並於出院後一個月及二個月時，以電話訪談方式進行追蹤。
研究結果顯示：研究期間共有84人接受面訪，其中男性50人(60%)，平均年齡59歲，診斷以中風(50%)，脊髓損傷(31%)為主。84位住院患者中有使用一項或一項以上輔具者有78名(佔93%)，平均每人使用2.3項輔具，表示復健病房患者普遍有使用輔具的需求。病患最常使用輔具之類別與比率依序為：輪椅(85%)，行走輔具(48%)，便盆椅(43%)，其他類別，如支架、電動床、手功能輔具等。建議病患使用輔具者包含：專業人員(63%)，自行決定(11%)，及其他(26%)(如看護，家屬及朋友)；而輔具獲得管道則以病房本身提供(57%)及醫療器材行購得(32%)為多。
輔具使用追蹤方面：追蹤到的66位病患，其出院前共使用157件輔具，在出院後一個月及二個月時，輔具之持續使用率分別為77.7%及76.4%；而不再使用輔具之原因以病患能力改變，不再需要使用為多(51.4%)，僅少數患者因使用不便、製作或設計不良，環境未能支持等原因而不再使用。
研究結果顯示國內復健病患輔具使用項目較少，且類別僅局限於少數行動輔具。獲得輔具的管道仍有近半數患者未經由專業人員之評估與建議而自行購買，民眾較無輔具為治療性物品之概念，且病患多會接受醫院或醫療器材行容易試用或購得的輔具；故如何加強民眾及專業人員輔具服務的概念，促使輔具本土化，增進輔具獲得之可近性是刻不容緩之課題。

關鍵字

輔具 ； 復健

並列摘要

Assistive technology device (ATD) can improve the functional capacities of individuals with disabilities. Applying ATD is an important treatment strategy in rehabilitation. To understand the use and the problems in the utilization of the ATD are basic steps to improve the quality of ATD service. However, there is still lack of this information in Taiwan. The purpose of this study was to investigate the following topics: the types and the number of ATD used by patients in the rehabilitation ward, the method to get the ATD, the satisfaction of the ATD, the continuing using ATD after hospital discharge, and reasons of disuse.
Subjects were consecutive patients (or their caregivers) discharged from the rehabilitation ward from January 2000 to July 2000. An occupational therapist interviewed them about the ATD use within 3 days before discharge. The therapist also followed them up by telephone at 1- and 2-month after discharge. Total of 84 patients or caregivers were interviewed. Most patients were diagnosed as cerebral vascular accident(50%) and spinal cord injury(31 %). Seventy-eight of the 84 patients(93%) used one or more ATD in the ward (2.3 items per person in average). The result indicated that most patients in the rehabilitation ward need to use ATD to increase their function. The most frequent use of ATD in the study samples were: wheelchair (85 %), aids for ambulation (48%), commode or bathing chair(43%). Only 63 % of subjects got their ATD based on professional recommendations. However, 11% subjects decided the type of ATD by themselves and 26% were suggested by their friends or attendants. Most patients got their ATD from hospital (57%) or bought from the medical supply stores(32%).Sixty-six patients were followed up. They used 157 items of ATD before discharge and only 77.7% and 76.4% of the ATD were continued to use respectively at 1-month, and 2-month after discharge. The major reason they did not use the ATD was that their abilities improved and the ATD did not need to be used (51.4%). This result implicated that the clinician should consider the prognosis factor while providing the ATD prescription, especially for patients in acute stage. We conclude that, patients in our samples used less and more limited types of ATD than those reported in the literature. Almost half patients got their ATD without consulting with professional personnel. How to promote the concept of ATD service and to increase the quality of ATD service are important issues.

並列關鍵字

assistive device ； rehabilitation