個別衛教進行骨盆底肌肉運動之成效研究—以一般門診輕中度應力性尿失禁婦女為例

蔡悅琪(Yue-Qi Cai)

指導教授 ： 劉潔心博士

國立臺灣師範大學/教育學院/衛生教育學系在職進修碩士班/碩士(2006年)

摘要

摘要
本研究目的在探討以不同的衛教方式進行骨盆底肌肉運動之成效。研究對象為立意選取自2006年3月9日至同年7月8日研究者的年滿20歲以上女性複診病人，並自填過去一年曾經發生過應力性尿失禁者。研究方法分兩部分：實驗一以「單樣本前後測設計」，全體研究樣本接受三分鐘動機式晤談，並立即評估其成效。實驗二以「實驗組對照組前後測設計」，實驗組接受研究者設計之個別衛教方式，對照組則比照一般門診衛教方式，分別進行骨盆底肌肉運動衛教，12週後比較不同衛教方式之成效。所得的重要結果如下：(一)三分鐘動機式晤談對增強動機有成效。 (二)若知識的前測得分在7分（含）以下時，個別衛教的教學方法達顯著的差異，且前測分數越低的成效越好。(三)但當前測漏尿量大於0.12公克時，以陰道指診法教導骨盆底肌肉運動達到顯著的成效，且前測漏尿量越大的成效越好。 (四)個別衛教組中，「人際支持策略--電話連絡成功次數超過八次者」具有顯著的效果。(五) 個別衛教組中，當「一小時棉墊試驗前測的漏尿量」大於0.44公克時，「行動提示策略--記錄及繳回運動日誌」具有顯著的效果。(六)全體研究樣本之「一小時棉墊試驗後測的漏尿量」除了前測的漏尿量以外，可由“實驗組別”及“晤談後之動機得分”來預測。(七)實驗組之「一小時棉墊試驗後測的漏尿量」除了前測的漏尿量之外，可由來行動提示策略來預測。
在一般門診中有不少被疏忽的輕、中度應力性尿失禁婦女，建議家庭醫師應主動詢問漏尿議題，忙碌的門診工作中可以用三分鐘進行動機式晤談來增強病人進行骨盆底肌肉運動的動機，運用行為科學的跨理論模式來設計衛教內容，缺少生理回饋儀的設備時可以用最方便和可近性的陰道指診法教導骨盆底肌肉收縮技巧，讓尿失禁婦女走出尿失禁的陰影及提升其生活品質。

關鍵字

應力性尿失禁 ； 骨盆底肌肉運動 ； 三分鐘動機式晤談 ； 陰道指診法 ； 個別衛教

並列摘要

Abstract
The purpose of the research is to compare the effects of different types of health education on the pelvic floor muscle exercise. The subjects in this research are over-20-year-old female patients chosen by purposive sampling from those who, coming to the outpatient clinic for the other disease between March 9 and July 8, 2006, stated they experienced stress incontinence in the year before. Two methods are used. In one of them, called the Pretest-Posttest Single Group Design, all the samples take a three-minute motivation interview and the results are assessed right after the interview. In the other, referred to as the Pretest-Posttest Control Group Design, the experimental group receives health education on the pelvic floor muscle exercise specifically designed for each different subject while the control group accepts the similar health education commonly given in the out patient clinic. Twelve weeks later, the effects of the two different types of health education are assessed. The results are as follows. First, all samples are more motivated after a three-minute motivation interview. Second, the experimental group is more impressive in helping increase the scores of understanding stress incontinence. Third, the experimental group shows remarkable progress in reducing urine leakage in the one hour pad test. Fourth, in the experimental group, interpersonal support strategy shows great force in helping reducing urine leakage in the one hour pad test. Fifth, in the experimental group, action hint strategy plays a big role in helping reducing urine leakage when urine leakage is higher than 0.443 grams in the one hour pad test. In addition to pretest urine leakage, posttest urine leakage for all samples can be predicted based on experimental group categories and the motivation scores after the interviews. Seventh, in addition to pretest urine leakage, posttest urine leakage for the experimental group can be predicted based on patient’s adherence.
For numerous women whose slight stress incontinence is often neglected, busy family physicians are advised to actively ask them about urine leakage and to help them with the clinic health education flowchart. The three-minute motivation interview can help patients become more motivated to do the pelvic floor muscle exercise; the education based on Transtheoretical Model can increase the knowledge of stress incontinence; the convenient and accessible digital vaginal palpation for pelvic floor muscle training helps reduce urine leakage; can help women walk out of the shadow of urinary incontinence.

並列關鍵字

stress incontinence ； pelvic floor muscle exercise ； three-minute motivation interview ； vaginal palpation ； individual quided education