中風患者與其照顧者的家庭功能與生活品質關係之研究

研究背景：病人腦中風後經常有失能的後遺症，影響不僅是病人本身，也會影響其家庭，透過在醫療系統的照護參與，家庭成員可能會開始擔任照顧者的角色甚至可能轉變成為病人的重要決策者，因此許多研究逐漸強調家庭介入及家庭照顧者的照顧準備度會影響病人的生活品質與復健效果。但未見針對腦中風家庭功能及其生活品質相關之研究，故本研究想要探討腦中風病人及照顧者家庭功能與生活品質相關之探討。研究目的：探討腦中風病人及照顧者自覺家庭功能、生活品質概況，並探討腦中風病人及其照顧者不同人口學其生活品質表現概況及其家庭功能與生活品質之相關性。研究方法：採用採橫斷式研究設計，研究對象為台灣中部某醫學中心之腦中風病患及照顧者，以人口學問卷、美國國家衛生研究院腦中風評量表、家庭功能量表、及生活品質量表收集資料，並採用獨立樣本t檢定、單因子變異數分析、皮爾森積差相關分析、及配對t檢定執行資料分析。研究結果：本研究共有51對腦中風病人及其照顧者參與。51位腦中風病人的年齡介於20-81歲，平均年齡為61.98 (SD = 13.51)，以男性為多數(29位，56.9%)。腦中風病人主要照顧者平均年齡則為49.8歲(SD = 11.99)，以女性為多(33位， 64.7%)。研究結果顯示腦中風病人與其照顧者自覺家庭功能健康程度偏向健康程度。至於生活品質方面，中風病人生理層面綜合平均是45.65 (SD = 9.84)，心理層面綜合則是32.87 (SD = 6.48)。主要照顧者生理層面綜合平均是49.29 (SD = 8.23)，心理層面綜合則是46.58 (SD = 10.93)，顯示中風病人與其照顧者於生活品質表現均屬於中下程度，然而配對t檢定結果顯示中風病人生活品質的生理層面綜合與心理層面綜合皆低於照顧者(t = -2.04, p = 0.046; t = -7.81, p < .001) 而人口學特性中與生活品質的整體生理與心理層面之分析，照顧者的教育程度與其生活品質的心理層面綜合達顯著差異( p = .029)，亦即於教育程度高中/職以下的生活品質之心理層面綜合顯示得分高於教育程度為大專以上者。此外，有聘任外籍移工者照顧中風病人，照顧者的心理層面綜合高於聘請一般看護或無聘請看護者的心理層面綜合 ( p = .029)。主要照顧者工作狀態與其生活品質的生理健康層面達顯著差異( p = .003)，亦即於生活品質之生理層面綜合全職者高於兼職或無工作者。而有關生活品質與家庭功能相關分析顯示中風病人的生活品質的生理層面與其健康家庭功能層面呈現顯著相關(r = -.303, p = .031)，亦即病人感受健康家庭功能越好，其生活品質的生理層面綜合表現越好，反之亦然。而照顧者則是生活品質的心理層面綜合與其健康家庭功能層面呈現顯著相關(r = -.298, p = .034)，亦即照顧者感受健康家庭功能越好，其生活品質的心理層面表現越好，反之亦然。研究結論：本研究發現中風病人與其照顧者生活品質呈現中下程度，顯示臨床照護時需特別提供照護介入，以便改善他們的生活品質。此外，雖然本研究參與者對家庭功能評估屬於健康，但是研究亦發現家庭功能與生活品質具有顯著相關，亦說明為提升病患與其照顧者的生活品質，強化其家庭功能的健康是重要的。

關鍵字

中風；照顧者；家庭功能；生活品質

並列摘要

Background Stroke patients often have sequelae of disabilities, which often affect not only the patient but also their family. Through care participation in medical institutions, family members may begin to play the role of caregivers and may even become important decision makers for the patient. Therefore, research has begun to emphasize that family intervention and care readiness of family caregivers can affect the quality of life and rehabilitation of patients. However, there is no research on the relationship between stroke family function and quality of life. Therefore, this study aimed to explore the relationship between family function and the quality of life of stroke patients and their caregivers. Aims The purpose of this study was to explore the family function and quality of life of stroke patients and their caregivers, and to examine demographic differences in terms of their quality of life as well as the correlation between family function and quality of life. Methods A cross-sectional study design was adopted. The participants were 51 pairs of stroke patients and their caregivers, in a medical center in central Taiwan. Data were collected using a Demographic Questionnaire, National Institute of Health Stroke Scale (NIHSS), Family Assessment Device (FAD), and SF-12v2 Health Survey. Data analysis was performed using an independent samples t-test, one-way Analysis of Variance (ANOVA), Pearson product-difference correlation analysis, and paired t-test. Results The 51 stroke patients ranged from 20 to 81 years in age, with a mean age of 61.98 years (SD = 13.51); most of them were males (29, 56.9%). The average age of the primary caregivers of stroke patients was 49.8 years (SD = 11.99), and most of them were women (33, 64.7%). The results of the study showed that stroke patients and their caregivers presented a healthy level of family function. On quality of life, stroke patients scored an average of 45.65 (SD = 9.84) on the physical component summary (PCS) and 32.87 (SD = 6.48) on the mental component summary (MCS); the average score of the primary caregivers was 49.29 (SD = 8.23) on the PCS and 46.58 (SD = 10.93) on the MCS, indicating that the quality of life performance of the stroke patients and their caregivers was in the middle-to-low level. However, the paired t-test results showed that both PCS and MCS scores of stroke patients' quality of life were lower than those of caregivers (t = -2.047, p = 0.046; t = -7.818, p < .001). In the analysis of demographic characteristics and PCS and MCS of quality of life, only the education level of caregivers was significantly different from the mental health score of the MCS of quality of life (p = .029), that is, compared to participants with educational level college or above, those with education below high school/vocational level had a high score on the MCS of quality of life scale. In addition, caregivers who hired foreign migrant workers to help care for stroke patients scored higher on the MCS than those who hired general caregivers or did not hire caregivers (p = .029). There was a significant difference between primary caregivers' different work status and their quality of life on the PCS (p = .003), that is, full-time workers were higher than part-time or non-workers in terms of PCS of quality of life. The correlation analysis of quality of life and family function showed that the PCS of the quality of life of stroke patients was significantly correlated with healthy family function (r = -.303, p = .031), that is, the patient with a healthy family function presented a better PCS score of quality of life and vice versa. For caregivers, the MCS of quality of life was significantly correlated with the healthy family function (r = -.298, p = .034), that is, the caregivers with healthier family function presented better MCS scores on their quality of life and vice versa. Conclusion This study found the quality of life of stroke patients and their caregivers to be moderate to low, indicating that special care interventions should be provided in clinical care to improve their quality of life. Although the family function assessment of the participants in this study was healthy, we found that family function and quality of life were significantly correlated. This indicates that it is important to strengthen the health of stroke patients’ family functions to improve their, as well as their caregivers’ quality of life.