實證研究之臨床應用－園藝治療是否可改善住院病人之健康結果？

本實證臨床應用係透過實證醫學五大步驟來執行，包括形成一個臨床可回答的問題、尋找最佳文獻證據、嚴格文獻評讀、將證據應用在病人身上、檢討實施成效。搜尋文獻證據由2017年發表之園藝效益的統合分析文獻結果，顯示分析76項次比較園藝治療與對照組的結果，介入園藝治療可較對照組顯著提升參與者之健康結果（health outcomes）（平均差異值=0.42, 95% CI：0.36-0.48）。本組成員以專案方式應用實證證據於臨床，由護理師提供園藝治療介入措施，收案對象為住院中之成人、意識清楚、可下床活動（以輔助或坐輪椅皆可）、單側或雙側肢體肌力至少3分以上，經說明後同意參與活動者。排除有精神障礙、需絕對臥床、自殺或自傷傾向等病人。以「園藝福祉效益量表」、「身體功能狀況」、及情緒困擾分數（以0-10計分）來評量園藝介入之成效，即對個案身心健康結果。2018年11月18日～12月7日共收案11人，包括介入組7人（男性2人、女性5人）、對照組4人（男性4人、女性0人）。比較兩組基本資料無差異，顯示具有同質性。比較介入成效，發現在「園藝福祉量表」方面，分析介入組在介入5天園藝治療後較介入前，在「我的肢體運動夠強」、「我有興趣嗜好」、「我覺得心情放鬆」、「我具有成就感」、「我擅長園藝栽培技術」之項目，均有顯著進步（p＜0.05）。介入組在「身體功能狀況」，在介入5天園藝治療後，在「我的手部活動靈活」、「我彎腰自如」項目皆較前測顯著增加（p＜0.05）；在「情緒困擾」的差異分析，顯示介入組情緒困擾指數介入前、後平均分數由5.27下降至2.55，且達到顯著差異（p＜0.05）。對照組則在身體功能狀況、情緒困擾程度的前後測皆無顯著差異。實證應用結果，顯示園藝治療可顯著改善住院病人的園藝福祉效益、身體功能及情緒困擾。但因此次臨床應用期間較短，個案數較少，故值得增加收案量及追蹤較長時間，如追蹤1個月、2個月，也可應用於臨床工作人員等，進一步深入的分析探討運用之成效，以嘉惠更多需要的人。

關鍵字

園藝治療；健康；結果

並列摘要

This empirical application used five steps of evidence-based medicine (EBM), including formulating an answerable question, tracking down the best evidence, critically appraising the evidence for validity, impact, and applicability, integrating with our clinical expertise and patient values and reviewing implementation effectiveness. After systematic reviews, the author chose the meta-analysis literature of horticultural therapy effectiveness in 2017, and the results determined that horticultural therapy intervention could increase healthy outcomes of participants (mean= 0.42, 95% CI: .36-.48). Our team members used a project mode for application of EBM literature to clinical settings, the nurses provided horticultural therapy intervention steps, the participants were hospitalized adults with clear consciousness and ability ambulation (either assisted or in a wheelchair), unilateral or bilateral limb muscle power scale at least 3 points and who had all agreed to participate in the project after explanation by the research team. Excluded patients were those with mental disorders, and who were absolutely bed-ridden, suicidal, or suffering from auto-lesions. The 「Horticultural Well-being Scale」、「Physical function condition」and 「emotional distress」 (0-10 scoring) was used to assess the effect of the intervention horticultural therapy vis-à-vis physical and mental health outcomes of patients, and from 2018/11/18 to 2018/12/7, a total of eleven participants, including a case group of seven people (2 males and 5 females) and a control group of four people (4 males and 0 females) were enrolled. In comparing the two group results, the basic information had no significant difference, showing homogeneity. Comparing implementation effectiveness, it was found that for the 「Horticultural Well-being Scale」after 5 days, the items ＂I have strong physical exercise＂, ＂I am interested in hobbies＂, ＂I feel relaxed＂, ＂I have a sense of accomplishment＂, ＂I am good at horticultural cultivation techniques＂ showed overall significant differences for the case group (p＜.05); for the 「Physical function condition」, after 5 days of horticultural treatment, the analysis was significantly different in items of ＂My hand movements are flexible＂, ＂My waist bend smooth＂ (p＜.05). In analysis of「emotional distress」, before and after scores on the index showed average scores dropped from 5.27 to 2.55 as being significantly different (p＜.05). The control group in「Physical function condition」and 「emotional distress」showed no significant difference. The results of empirical application demonstrated that horticultural therapy could significantly improve the physical functioning and emotional condition of hospitalized patients. However, the period of clinical application was short and the case number was small, so it is worthwhile to increase the number of cases received and track the data for a longer time. For example, tracking one month or two months could also be applied to clinical staff and the like. Such results could be used to benefit those cases requiring more focus.

並列關鍵字

horticultural therapy ； health ； outcome

參考文獻

邱馨慧、蔡佳良(2008)．園藝治療對老年慢性疾病患者的應用方式與成效．中華體育季刊，22(2)，79-85。doi: 10.6223/qcpe.2202.200806.1609

劉懿儀、朱芬郁(2018)．園藝治療方案對失智症老人正向情緒與福祉效益之研究．教育科學研究期刊，63(3)，257-289。doi: 10.6209/JORIES.201809_63(3).0009

羅家倫(2017)．園藝治療與運動治療對於改善銀髮族憂鬱及自尊低落之成效研究．福祉科技與服務管理學刊，5(4)，299-312。doi: 10.6283/JOCSG.201712_5(4).299

Kamioka, H., Tsutani, K., Yamada, M., Park, H., Okuizumi, H., Honda, T., ... Mutoh, Y. (2014). Effectiveness of horticultural therapy: A systematic review of randomized controlled trials. Complementary Therapies in Medicine, 22(5), 930-943. https://doi: 10.1016/j.ctim.2014.08.009.

Masel, E. K., Trinczek, H., Adamidis, F., Schur, S., Unseld, M., Kitta, A., ... Watzke, H. H. (2018). Vitamin “G”arden: A qualitative study exploring perception/s of horticultural therapy on a palliative care ward. Supportive Care in Cancer, 26(6), 1799-1805. https://doi: 10.1007/s00520-017-3978-z.

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實證研究之臨床應用－園藝治療是否可改善住院病人之健康結果？

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