運用遠距教練介入方案於學齡前感覺處理異常兒童及家長之成效探討：前驅研究

Occupational Performance Coaching for Parents of Preschool Children with Sensory Processing Disorder Delivered via Telehealth: A Pilot Study

邱牧恩(Mu-En Chiu)

指導教授 ： 曾美惠

國立臺灣大學/醫學院/職能治療研究所/碩士(2021年)

https://doi.org/10.6342/NTU202103897

摘要

感覺處理異常是學齡前兒童尋求職能治療的重要主訴，經常造成兒童社會參與、學業表現、生活自理及遊戲等參與困難，以及家長的親職效能感低落及較高的親職壓力。「職能表現教練」運用反思性提問、問題導向、溝通取向及成人學習原則，支持家長確認參與目標、行動及執行改變，以協助兒童能成功參與在有意義的職能任務中及提升參與表現；並提升家長的勝任感及自主性。2020年全球面臨新型冠狀病毒肺炎疫情時期，遠距照護模式成為許多服務傳遞的替代方式之一，而職能治療師也開始大量運用遠距服務模式來提供兒童及家庭介入。然而，台灣目前對於職能治療師運用遠距服務之成效及可行性仍未知。本研究旨在檢驗感覺處理異常兒童之家長於接受遠距教練介入方案，與衛教方案之成效差異；並探討家長對於接受遠距教練介入模式的滿意度及感受。
本研究採用準實驗設計之非隨機實驗控制組前後測設計，以便利取樣於台灣東部醫院收案20位感覺處理異常兒童及家長，收案條件為(1)年齡為3-6歲的兒童及家長，(2)兒童有感覺處理異常的現象(例如:過度敏感、反應不佳、動作笨拙等)，且感覺處理問題已造成兒童生活參與表現困難，(3)感覺處理剖析量表3-10歲中文版測驗結果至少有一項落在邊緣或障礙範圍，(4)家長具備口語訪談和問卷填寫的溝通表達和書寫閱讀能力。20對參與者經非隨機分組至遠距教練組及控制組，兩組皆接受4堂線上教育課程，遠距教練組接受傳統職能治療及6次遠距職能表現教練介入；控制組接受傳統職能治療及六次衛教方案。本研究分別於基準線(T1)、介入前(T2)及介入後(T3)進行測量，施測學前活動卡片組(PACS-C)、加拿大職能表現量表(COPM)、育兒勝任感量表中文版(POSC-C)及親職壓力量表中文版簡版(PSI-SF)；並於後測時給予針對遠距教練介入方案的滿意度及感受之問卷調查。
結果顯示遠距教練介入方案能有效促進學前感覺處理異常兒童的職能表現(d=1.622，p=0.000)及滿意度(d=2.699，p=0.000)，且相較於控制組的進步量有顯著差異(表現p=0.000，滿意度p=0.001)。此外，遠距教練組也顯示較能促進活動參與的多元性，介入後於全量表總分變化量有顯著差異(p=0.007)。在親職功能方面，遠距教練組家長於介入後整體親職壓力總分降低，但兩組於親職壓力及育兒效能感分數無組間差異。家長對於遠距教練介入的滿意度良好(mean=9.60)，並有「可實際促進兒童生活功能表現」、「可增進家長觀察分析孩子的能力」、「對待孩子更有同理心」及「有動力實際執行行動」之主觀感受。整體而言，遠距教練介入可作為職能治療師的服務提供方式之一，並針對「有特定需求」且「具動機」之家長，有助於提升兒童的職能表現，在疫情期間相當適合作為替代的服務模式之一。

關鍵字

職能表現教練 ； 遠距照護 ； 感覺處理異常 ； 兒童參與 ； 親職效能感

並列摘要

Preschool children with sensory processing disorder often have difficulties participating in activities of social interaction, self-care, play and academic learning. The severity of a child’s sensory processing problem was related to low parental sense of competence and high levels of parental stress. Occupational performance coaching (OPC) uses reflective, goal-oriented conversations and adult learning principle to support caregivers to facilitate participation of children in personally-valued activities and attain greater confidence and competence in enabling children’s participation. However, little is known about the feasibility of OPC in Taiwan. Further, the COVID-19 pandemic facilitates the change of service delivery model from face-to-face services to telehealth. However, few studies examined the efficacy of OPC delivered via telehealth practice in Taiwan. The purpose of this study is to examine the efficacy of occupational performance coaching delivered via telehealth on child participation and parent efficacy in families of preschool children with sensory processing disorder. Parents’ experiences of tele-OPC were also explored.
A non-randomized control-group pretest-posttest design was used. Twenty parent-child dyads were recruited from the interdisciplinary assessment center for child development at eastern Taiwan. Inclusion criteria were: (1) children with sensory difficulties age between 3 and 6 years, (2) children having at least a probable dysfunction on one or more sensory sections of Sensory Profile, (3) parents have sufficient language and cognitive skills for the interview. The exclusion criteria were (1) children with comorbidities of specific physical impairment, (2) children with progressive neurodevelopmental disorder. Twenty participants received four times of online parental education courses regarding sensory processing disorder. Afterwards, participants were assigned to intervention group or control group based on their work schedule and availability. The intervention group received 6-week telehealth-delivered occupational performance coaching(tele-OPC) whereas the control group received 6 -week conventional occupational therapy with education information regarding parenting skills and behavioral management strategies for sensory processing disorder. The Canadian Occupational Performance Measure (COPM) was used to identify intervention goals and rate child’s performance and parent’s satisfaction on child’s performance. Child’s participation was measured with the Preschool Activity Card Sort. Parent efficacy was measured with the Parenting Sense of Competence Scale-Chinese version and the Parenting Stress Index–Short Form. The above evaluations were taken place on the baseline(T1), preintervention(T2) and postintervention(T3).
Results showed the OPC group had significant improvement on child’s occupational performance (d=1.622, p=0.000), satisfaction score(d=2.699，p=0.000), and total score of PACS-C ( p=0.007) after intervention (T2-T3). There was also a significant difference between the control and OPC groups in occupational performance (p=0.000) and satisfaction (p=0.001). However, no significant differences were noted in the within-group and between-group comparisons of the PSOC-C and PSI-SF for both groups. Qualitative data showed that parents reported positive experience of OPC intervention, gains in skills of observing and analyzing child behaviors, increased understanding of their own children’s special needs, children’s improvement in daily activity, and increased motivation for implementing strategies to facilitate child’s participation.
The finding indicated that OPC via telehealth could be an effective intervention to improve the occupational performance and participation in daily activities of children with sensory processing disorder and could be considered as an alternative occupational therapy service delivery model during the Covid-19 pandemic. Lastly, it also suggests that OPC via telehealth warrants further research adopting a large sample size and a longer duration to examine its effectiveness on parent efficacy.

並列關鍵字

Occupational Performance Coaching ； Telehealth ； Sensory Processing Disorder ； Children Participation ； Parental Efficacy

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