脊髓損傷主要照顧者生活品質及其相關因素之探討

Quality of life in primary caregivers of spinal cord injured individuals and its related factors

巫怡萱(Yi-Hsuan Wu)

指導教授 ： 張彧

國立臺灣大學/醫學院/職能治療研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.03527

摘要

前言：近年來由於醫學進步讓脊髓損傷者存活率增加，並使其需長期面對肢體與功能的障礙。而對於主要照顧者來說，長期照顧與協助損傷者會造成其顯著負擔，同時對照顧者本身的生活品質也有相當大的影響。然而，探討與脊髓損傷主要照顧者生活品質相關的研究仍相當有限，至目前為止，影響其照顧者生活品質之相關因子尚不明確。因此本研究之目的為瞭解脊髓損傷主要照顧者生活品質之現況，與探索影響其生活品質之相關因素，以作為未來臨床介入之參考。
研究方法：本研究為橫斷式研究，採立意取樣，以近五年來北部某醫學中心復健部出院滿半年以上之外傷性脊髓損傷主要照顧者為對象，共30位有效樣本。使用結構式問卷收集資料，其內容包括個案及照顧者基本屬性、個案損傷相關資料、家庭照護狀況、主要照顧者負荷與主要照顧者生活品質情形。所得資料以統計軟體SPSS11.0英文版，進行描述性統計、t檢定、單因子變異數分析及皮爾遜積差相關分析。
研究結果：主要發現如下：使用台灣簡明版世界衛生組織問卷評量脊髓損傷主要照顧者生活品質，整體生活品質平均值為54.1分，與一般人相較其得分較低；其中得分最高為生理健康範疇，最低為心理範疇生活品質。檢測與生活品質相關因素後發現，統計上有顯著相關之因素包括主要照顧者和個案之關係、家庭月收入、每週照顧頻率與照顧負荷。相較於非配偶者，主要照顧者與個案關係為配偶者，於生活品質之生理健康範疇、社會關係範疇與整體生活品質等有顯著較差之情形。相較於家庭月收入在4萬元以上者，4萬元以下屬於較低收入者，於生理健康範疇、環境範疇與整體生活品質等顯著較差。相較於每週照顧頻率在2天以下者，主要照顧者每週照顧頻率在5天以上者，於生理健康範疇、心理範疇與整體生活品質等顯著較差。除社會及情緒性負荷與生理健康範疇、社會性負荷與心理範疇以及時間性負荷與社會關係範疇等部份無顯著相關外，無論在整體照顧負荷或照顧時間之耗費、任務發展之阻礙、身體倦怠、社交活動衝突與負向情緒等層面之負荷感受愈高者，整體生活品質及其範疇均呈現顯著較差，而相關程度皆為中到高度的相關。其他如個案及照顧者基本屬性、損傷嚴重度、受傷時間、自我照顧狀況、協助照顧的人數、與需照顧的總人數等因素，則未達統計上顯著性相關或差異。
結論與建議：本研究結果可提供職能治療與相關醫療專業人員進一步瞭解個案及照顧者基本屬性、個案損傷相關資料、家庭照護狀況、主要照顧者負荷與其生活品質的相關性，並可作為未來職能治療實務、教學、研究參考之依據。臨床治療師應加強醫院與社區治療服務之連結、提供居家復健與照護之正確技巧、加強相關資源提供與應用、運用負荷量表評估照顧者負荷等，以協助瞭解與增進照顧者之生活品質。

關鍵字

脊髓損傷 ； 下肢癱瘓 ； 四肢癱瘓 ； 照顧者 ； 生活品質

並列摘要

Over recent decades, medical advances in the care of people with spinal cord injury (SCI) have led to higher rates of survival and life expectancy, which means that people with SCI now live with their disability for a much longer period of time. Besides, caring SCI for a long time not only becomes a significant burden of primary caregivers, but also may have impact on their own quality of life (QOL). However, studies involving primary caregivers of people with SCI are still limited, and factors affecting QOL for caregivers of SCI are mostly unknown until now. The purpose of this study was to describe QOL of primary caregivers of people with SCI and to explore some important related factors of their QOL. We hope the results could help to provide some useful information for clinical intervention in the future.
The cross-sectional study was conducted by purposively sampling and the effective subjects were 30 primary caregivers of traumatic SCI, being discharged at least 6 months from the rehabilitation ward in certain medical center of North Taiwan in the past five years. A structured questionnaire was used to collect data including caregiver’s characteristics, patient’s characteristics, impairment-related condition, information related to family care condition, caregiver’s burden and caregiver’s QOL. The data was analyzed with SPSS 11.0 for Windows by descriptive statistics, t-test, one way ANOVA, and Pearson’s product moment correlation.
Overall QOL of caregivers rated with the Taiwanese WHOQOL-BREF questionnaire was 54.1 in average which is lower than that of ordinary people. Out of the four domains of the questionnaire, the physical health domain ranked the highest and the psychological domain the lowest. On the other hand, statistically significant factors affecting the QOL included the relationship between care-receivers and their caregivers, monthly household income, weekly caring frequency and caregiver’s burden. Moreover, caregivers having spousal relationship with the people with SCI showed significantly lower scores in overall QOL as well as domains of physical health and social relationship when compared with non-spouse caregivers. Compared with monthly household income over NT40,000 dollars, persons with income lower than NT40,000 dollar showed lower scores in domains including physical health, environment, and overall QOL significantly. Besides, when compared to caregivers whose weekly caring frequency was less than 2 days, those with frequency more than 5 days scored more slowly in domains of physical health, psychology, and overall QOL significantly.
In addition, there were no significant correlation between the social and emotional burden and physical health domains, between social burden and psychological domains, and between time-dependence burden and social relationship domains. Furthermore, primary caregivers who were experiencing greater overall burden, more time spent on caring, larger barrier in task development, higher level of physical fatigue, more severe interference of social life, and more intense negative emotion, showed significantly lower scores in four domains and total QOL. Also, caregivers’ burden was found to be moderately to highly correlated to the overall QOL as well as all QOL domains. Nevertheless, there was no significant difference or correlation among factors such as characteristics of patients and caregivers, impairment severity, injury time, self-care condition, the number of care assistants, and the number of care-receivers for a single caregiver.
The results of the study contribute to the understanding of the relationship between characteristics of patients and caregivers, impairment-related condition, information relating to family care condition, caregiver’s burden, and caregiver’s QOL. These findings also serve as indices for occupational therapy clinical practice, education, and research aiming to enhance the QOL of SCI caregivers. In order to help understanding and improving the QOL of SCI caregivers, it is suggested that occupational therapists should strengthen the linkage between the in-patient and community services, develop practice guidelines for home rehabilitation and home care, promote the utility of related resources, and attend the caregiver’s burden by making appropriate assessment with standard tools such as caregiver burden Inventory.

並列關鍵字

Spinal Cord Injuries ； Quadriplegia ； Paraplegia ； caregivers ； Quality of Life

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