短期互動式電玩遊戲應用於社區精神障礙病人之可行性及成效評估

Intervention Feasibility and Outcomes Evaluation of Applying Short-term Interactive Video Games on Community Patients with Mental Disorders

許芳齊(Fang-Chi Hsu)

指導教授 ： 張榮珍

國立臺灣大學/醫學院/護理學研究所/碩士(2020年)

https://doi.org/10.6342/NTU202000899

摘要

背景：臺灣2017年精神疾病人數統計為2,638,382人，占總人口數約11.18%，2018年領有身心障礙證明(手冊)者為1,173,978人，占總人口數約4.98%，其中慢性精神病患者共127,591人，占領有身心障礙證明(手冊)者總人口數約10.87%，過去應用電玩遊戲為介入措施的研究陸續發現有其成效，但國內外精神醫學或照護領域，未有短期互動式電玩遊戲運用於社區慢性精神障礙病人的相關研究，本研究目的為探討短期互動式電玩遊戲應用於社區慢性精神障礙病人之成效，瞭解短期互動式電玩遊戲對於社區精神障礙病人的可行性，以及該短期介入措施對病人的成效，包含:身心健康、生活品質、身體體能指標等，希望藉由本研究來探討互動式電玩遊戲對於社區精神障礙病人的效果，以供從事社區精神領域相關從業人員之參考。
方法：採前瞻性類實驗前後測設計，取樣於北部地區社區康復之家(全日型復健機構)之精神疾病病人，針對收案對象透過訪談、身體量測、體能評估、結構性問卷收集基本資料，進行三次之資料收集，分別是基準期(baseline, T0)、間隔兩週後的前測(pre-program, T1)，提供為期三週，每週兩次的互動式電玩活動介入，之後進行後測(post-program, T2)，於上述共六次，每次60分鐘互動電玩遊戲介入後，病人完成活動回饋表及電玩適應評估，反映參加活動之感受與意見回饋。
結果：共48位社區精神障礙病人成功收案，男性及女性比例相當，平均年齡52.1±8.2歲，背景以未婚狀態與高中職/五專教育程度者最多，比起前測(pre-program, T1)，病人在後測(post-program, T2)表現於身體組成方面發現: 腰圍顯著下降2.22±4.3公分(Cohen’s d=-0.52，p<0.001)；身體活動方面發現: 10公尺快速行走速度減少0.58秒(Cohen's d=-0.33，p=0.005)；椅子起身走3公尺後坐回速度減少1.02秒(Cohen's d=-0.45，p<0.001)；椅子站起來及坐下5次速度減少0.86秒(Cohen's d=-0.31，p=0.008)。互動電玩介入三週後，病人自述的生活品質改變有疼痛感受增加0.4±1.1分(Cohen's d=0.42，p=0.011)、醫療使用滿意度增加(0.2±0.7分，Cohen's d=0.25，p=0.031)以及滿意想吃的食物都能吃得到(增加0.3±0.9分，Cohen's d=0.31，p=0.033)。病人對此介入活動的回饋顯示在最高四分的滿意度中，平均分數為3.3到3.6分，屬於極佳正向回饋分數，支持此介入活動是病人給予高度可行性及成效性的肯定，最後使用互動式電動遊戲滿意度與可行性中文版問卷評估發現，病人對於此介入活動，顯示良好的滿意度與可行性。
結論：經由互動式電玩活動介入三週後，看見有其成效之處為促使病人腰圍變小；在身體活動方面的成效為10公尺快速行走速度、椅子起身走3公尺後坐回速度及椅子站起來及坐下5次速度皆顯著減少；在生活品質方面，對於身體疼痛的感知能力提升、對於醫療保健服務的方便程度滿意度增加及對於想吃的食物通常都能吃到滿意程度提升，每次互動式電玩活動後正向回饋分數極高，且不論是以四個面向(操作方式、運動舒適度、運動持續度及滿意度)或兩個構面(滿意度及可行性)來看，均擁有良好的滿意度與可行性，值得未來擴大互動電玩到更多不同全日住宿型慢性精神障礙復健機構康復之家，期盼能促進慢性精神障礙病人，重拾生活的樂趣，改善身體活動，提高病後生活品質。

關鍵字

短期互動式電玩遊戲 ； 社區精神障礙病人 ； 身心健康 ； 互動式電玩遊戲可行性 ； 互動式電玩遊戲成效評估

並列摘要

Background: The number of mentally ill patients in Taiwan in 2017 was 2,638,382, accounting for 11.18% of the total population. In 2018, there were 1,173,978 people with a certification of handicap, accounting for about 4.98% of the total population. Among all handicapped individuals, 127,591 were chronically mental disability, 10.87% of all certified handicapped persons. Past studies using video games as intervention had found success, but there are no information about using short-term interactive video games in the field of psychiatry chornic or community homes. Research on patients with chronic mental disorders in the community is warrent. The purpose of this study is to explore the effectiveness and feasibility of short-term interactive video games applied to patients with chronic mental disorders in the community. The effectiveness of patients includes: physical and mental health, quality of life, and physical activity indicators.
Method: Prospective quisi-experiment before and after test design was applied to include mentally-ill patients in the community rehabilitation home (community half wasy house) from the northern Taiwan. After informed consent signed, patients were invited to be interviewed, to be assessed on physical index and physical activitiy as well as to fill out questionnaire booklet. The data was collected at three time points, including the baseline (T0), the pre-program (T1: two weeks after T0) and the post-program (T2: after 3-weeks program). The 2 sessions weekly interactive video game activities were provided for a three-week long period. In the above-mentioned six times video-game program, after each 60-minute interactive video game intervention, the patient completed the activity feedback form and video game adaptation assessment, reflecting the feelings and feedback of participating in the event.
Results: A total of 48 patients with mental disorders in the community were successfully participanted in the study. The proportion of men and women was the same, with an average age of 52.1±8.2 years old. The majority of pateitens were unmariied and with at least high school degree. Compared with the data at the pre-program period (T1), the patients’ data was improved at the post-program period (T2) in body composition, such as decreased waist circumference by 2.22±4.3 cm (Cohen's d=-0.52, p<0.001). After three weeks of interactive video game intervention, several physical activities were improved including reduced speed in “10 meters fast walking” by 0.58 seconds (Cohen's d=-0.33, p=0.005), reduced speed in “get up from chair to walk 3 meters then sit back” by 1.02 seconds (Cohen's d=-0.45, p<0.001), and reduced speed in “chair stand up and sit down 5 times” by 0.86 seconds (Cohen's d=-0.31, p=0.008). After the three-weeks interactive video game intervention, the patient’s self-reported quality of life changes in a fw aspects, such as pain perception increased by 0.4±1.1 points at a 4-point scale (Cohen’s d=0.42, p=0.011), medical use satisfaction increased 0.2±0.7 points (Cohen’s d=0.25, p= 0.031) and the food you want to eat can be eaten increased by 0.3±0.9 points (Cohen's d=0.31, p=0.033). The patients’ feedback on the intervention demonstrated a high level of satisfaction with averaged score of 3.3 to 3.6 on a four-point scale which has been a positive feedback to the feasibility and effectiveness of the 3-week interactive video-game intervention.
Conclusion: After three-weeks interactive video games intervetnion, the waist circumference decreased and the physical activities improved along with the better-quality of life in the perception of physical pain, the convenience of health care services and the food wanted in daily life. The pateints’ feedback on the interventions are very positive in all four aspects (operation mode, sports comfort, exercise duration and satisfaction) and two domains (satisfaction and feasibility). It is suggested to implement such feasible, interesting, and effective interactive interventions to patients with chronic mental disorders in the community settings. It is of hope to promote the patients’ quality of life and improved their physical activities and physical compositions.

並列關鍵字

Short-term Interactive Video Games ； Community Patients with Mental Disorders ； Physical and Mental Health ； Feasibility of Interactive Video Games ； Evaluation of the Effectiveness of Interactive Video Games

參考文獻

天主教耕莘醫療財團法人耕莘醫院（2012）‧Hot Plus互動式健康服務系統‧ 取自http://www.cth.org.tw/?aid=54 pid=30 page_name=detail iid=33

全國法規資料庫（2019）‧精神衛生法‧取自https://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=L0020030

吳玉茹、蔡芸芳、吳文正、王鐘賢（2015）．體感式電玩介入對慢性思覺失調症病人健康體適能之成效．護理雜誌，63(1)，49–58。 doi: 10.6224/JN.63.1.49

呂佩真、簡國龍、陳思遠、季瑋珠（2013）．互動式電動遊戲滿意度與可行性之中文版問卷評估．台灣醫學，17(3)，246–256。 doi: 10.6320/FJM.2013.17(3).03

李信幸（2016）．精障長照機構導入創新體感遊戲健康促進系統之服務體驗洞察（未發表之碩士論文）．南投縣：南開科技大學。 doi: 10.6283/JOCSG.2017.5.1.35