社區化復健對發展遲緩兒童早期療育之療效探討

The Effect of Community-Based Rehabilitation in Early Intervention for Children with Developmental Delay

葉建男(Chien-Nan Yeh)

指導教授 ： 林文德

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00035

摘要

目的：當兒童有發展遲緩的問題而尋求醫療服務時，通常是到醫療院所接受服務。然而，對於需長期接受復健治療的兒童而言，頻繁至醫療院所就醫極為不便，如能改由醫療人員至其就學的機構提供醫療服務，不僅增加就醫之可近性，也可免去兒童外出可能面臨的危險以及感染。本研究目的即在探討復健醫師外診、物理與職能治療師駐診治療之「社區化復健模式」與一般到醫院就診模式，對兒童運動功能發展之成效是否有所差異。方法: 本研究採用病歷回溯法，採用南部某醫學中心之「兒童發展聯合評估中心」評估資料，並依據「嬰幼兒綜合發展測驗動作分測驗」之測量評估工具，來蒐集研究對象接受不同復健治療模式前後之粗動作與精細動作發展年齡及商數，用以比較醫院進駐機構之社區化復健模式（實驗組）及自行至其他醫療機構接受復健者（對照組）兩種不同治療模式的成效。收案時間自2007年6月至2011年3月，收案對象排除同時利用以上兩種模式者。兩組研究對象之特性及前測結果以卡方檢定及獨立樣本t檢定來檢視其分布的一致性，治療成效則以廣義估計方程式（Generalized Estimating Equation）控制相關干擾因素後，比較兩組成效差異之差異（difference in difference），所有統計顯著水準皆訂於0.05。結果：實驗及對照組各有74位，兩組研究對象除了父親年齡及治療次數外，其他特性之分布均無顯著差異。經控制其他變項，實驗組在粗動作的發展年齡與發展商數之改善幅度均顯著大於對照組（2.36, p= 0.04及5.30, p=0.001），但在細動作的發展年齡與發展商數之改善幅度上，兩組並無顯著差異。結論：社區化復健模式對於接受早期療育兒童的粗動作改善成效顯著高於自行就醫的復健模式，加上其治療次數較少，又能減少病患之交通費用負擔，是更具成本效益的復健模式。

關鍵字

社區化復健 ； 早期療育 ； 發展遲緩

並列摘要

Purpose: When children have developmental problems, they usually get medical treatments from hospitals. However, for those who need to receive long-term rehabilitation, getting medical treatment from hospitals is extremely inconvenient. If they can get medical treatment from the school, it may not only increase the accessibility of medical care, but also improve the effectiveness of treatment. The purpose of this study is to explore the effect of community-based rehabilitation model which a team of physician, physical and occupational therapists stationed in the school to provide necessary treatment for children with developmental delay on their motor function. Methods: The study used a retrospective method. Assessment information came from a medical center " Child Development Evaluation Center" in the south of Taiwan, and based on the assessment tool of " motor subtest of Comprehensive Developmental Inventory for Infant and Toddler ", to collect children receiving different treatment models before and after the gross motor and fine motor developmental age and the quotient, to compare the hospital's community-based organizations stationed in rehabilitation mode (experimental group) with self-rehabilitation model to other hospitals (control group) the effectiveness of two different treatment modalities. Enrolled in the time since June 2007 to March 2011, and enrolled in the object while excluding those who used the above two models. Characteristics of the study groups and pre-test results are used chi-square test and independent sample t-test to view the consistency of its distribution. Effectiveness of treatment is the use of generalized estimating equation (GEE) to control confounding factors, the effectiveness of the two groups to compare differences among the difference, and all statistically significant level set at 0.05. Results: The experimental and control group each have 74 subjects, two groups of subjects in addition to his father's age and number of treatments, other features of the distribution was no significant difference. After controlling for other variables, the experimental group in age and development of gross motor development quotient of the magnitude of improvement were significantly greater than the control group (2.36, p = 0.04 and 5.30, p =0.001), but in the age and development of fine motor development quotient of the magnitude of improvement on the two groups no significant differences. Conclusion: Hospital's community-based rehabilitation model for children receiving early intervention to improve gross motor performance was significantly higher than self-rehabilitation model to other hospitals, with fewer of their treatment, patients can reduce the burden of transportation costs, is more cost-effective rehabilitation model.

並列關鍵字

Community-based rehabilitation ； early intervention ； developmental delay

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