- 學位論文
Applying The Common-Sense Model To Explore Early Recovery Phase of Patient with Extremity Injury
Applying The Common-Sense Model To Explore Early Recovery Phase of Patient with Extremity Injury
摘要
背景: The Common Sense Model (CSM) 理論於之前研究被部分運用於外傷病人。然而，完整應用CSM理論於外傷族群的研究有限，尤其是在肢體外傷方面。早期四肢外傷病人，其健康相關生活品質（HRQOL）與外傷認知(illness representations)關係，可能會受到病人因應 (coping)的影響，意即因應在健康相關生活品質與外傷知覺兩個變項中間，扮演重要角色。因此，本研究旨在檢驗CSM全理論中的所有變項可否應用於早期肢體外傷病人，並試圖找出因應於病人生活品質與外傷知覺中間所扮演的角色。 方法: 研究設計採橫斷性模型測試設計，採方便取樣，從印尼東爪哇的兩個醫療中心招募參與者中取得192位四肢外傷病人。研究工具包含：社會人口學變項、疾病變項、印度尼版簡易疾病知覺量表、因應 COPE量表、世界衛生組織的生活品質量(WHOQOL-BREF）。資料析使用Windows的Statistical Package for Social Sciences (SPSS) Version 24.0版本。本研究使用分層多元回歸應用於已確定的HRQOL預測因素，並使用Macro PROCESS的數位調解分析，用於測量疾病表現與HRQOL之間關係的調適效果。 結果: 此研究總共招募了192名早期肢體外傷病人(男性佔60.40％)，平均年齡為38.80歲(SD = 14.22)。大多數病人為中度肢體損傷。在最終預測模型中，發現八個預測因子可以顯著預測病人的整體健康相關生活品質，包括下肢受傷、ISS分數、住院天數、對外傷的關注程度、情緒認知、外傷後不良因應、 低程度的有效因應；該回歸模型中，對肢體外傷健康相關生活品質的預計解釋變異量達90.20％。此外，肢體外傷病人的有效因應和不良因應都是生活品質與外傷知覺兩個變項之間顯著的重要中介因子。 結論: 此研究結果為CSM理論的假設提供了額外證據，並得出結論。為防止肢體外傷病人的健康相關生活品質降低，從肢體外傷早期恢復期開始，即可透過調整外傷知覺和因應方式，用以調整肢體外傷後治療與照護方向。
並列摘要
Background: The Common Sense Model (CSM) has been applied in the injury patients group. However, limited studies on injuries population involve the whole part of the CSM theory, especially in extremity injury. During in early phase, patient illness representations and coping may play a role in the adjustment to extremity injury as indicated by the health-related quality of life (HRQOL). Therefore, this study aimed to examine the assumption of the CSM that coping mediates the relationship between illness representations and HRQOL in injured patient’s early recovery phase following extremity injury. Methods: This correlational model testing design used a convenience sampling method to obtain 192 patients with extremity injury. Participants were recruited from two medical centers in East Java, Indonesia. Participants assessed using socio-demographic and injury characteristics forms, Indonesia version of the Brief Illness Perception Questionnaire (BIPQ), the Brief-COPE, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Data analysis used computer software Statistical Package for Social Sciences (SPSS) Version 24.0 for windows. Hierarchical multiple regression was applied to identified predictors of HRQOL. While multiple mediation analyses by macro PROCESS applied to measure mediation effects of coping on the relationship between illness representations and HRQOL. Findings: A total of 192 participants (60.40% male) were recruited, with a mean age of 38.80 years (SD = 14.22). The majority of the patients had moderate extremity injury. In the final model, eight predictors were found significantly predict overall HRQOL, which consists of having lower extremity injury, the increased value of ISS, LOS, timeline, concern, emotional representation, maladaptive coping, and decreased value of adaptive coping, further this model explained 90.20% variance of HRQOL. Moreover, both adaptive and maladaptive coping interestingly were significant mediators in the relationship between illness representation and HRQOL. Conclusion: The results provide evidence for the assumptions of the CSM, and it was concluded to prevent decreasing HRQOL in patients with extremity injury, treatment could be adjusted by tailoring illness representation and coping since the early recovery phase.