Title

行動輔具使用者操作技巧功能評估工具之研發

Translated Titles

Development of a Functional Performance Skills Test for Mobility Aids Users

DOI

10.6342/NTU.2013.01627

Authors

陳子瑄

Key Words

輔具 ; 結果評量 ; 功能 ; 動作技巧 ; 任務表現與分析 ; assistive device ; outcome assessment ; function ; motor skills ; task performance and analysis

PublicationName

臺灣大學物理治療學研究所學位論文

Volume or Term/Year and Month of Publication

2013年

Academic Degree Category

碩士

Advisor

胡名霞

Content Language

繁體中文

Chinese Abstract

「輔助器具」(assistive technology devices) 或稱「輔具」是指協助身心障礙者克服生理機能障礙,促進生活自理能力之器具。輔具的使用可提昇、維持或增強失能者的生活功能,補償或預防活動及參與上的受限,增進生活自主性以及降低照顧者的負擔。輔具的應用對象除了身心障礙者,亦包含失能者、銀髮族以及部分短暫傷害後功能減退的個案。所使用的輔具當中,又以行動類輔具使用最多,其中包含了拐杖、輪椅和助行器等項目。 在輔助科技服務(assistive technology service)的架構當中,服務的提供者可包含來自不同輔具相關背景的專業人員,構成輔具服務的多專業團隊服務模式(multidisciplinary team approach)。其中,物理治療師主要的角色包含對於輔具使用者提供直接的輔具使用評估、教育訓練與後續追蹤的服務。 輔具使用評估是內政部2012年輔具補助制度所強調的方向,以滿足身心障礙者的輔具需求,並與「身心障礙者輔具費用補助」需求評估的新制接軌。加強輔具評估的政策,針對輔具需求者,規定於輔具補助申請前須由治療師開立輔具評估報告,以確認個案的功能狀況並藉由輔具評估實際配置個案最需要的輔具項目。對輔具使用者而言,希望達到增進日常功能的目的。對服務體系言,亦可以減少不必要的支出而造成資源的浪費。 輔具評估的重要原則之一是確認使用者實際操作輔具的能力,使其在無障礙環境設計的規範下能夠滿足移行的需求達到獨立自主的日常活動功能,並在面對多數一般常見的社區與居家環境障礙具有克服之能力。然而,目前國內所使用評估報告書內容多以個案之身體狀況與輔具之規格與功能為主,對於個案之日常活動能力以及輔具操作表現是否達到獨立自主的評估較為不足,且缺乏一套標準化且具明確操作型定義的評估工具。因此,本研究將參考國外行動輔具操作技巧功能測試之觀念,發展出一套適用於國內常用的行動輔具之操作技巧功能評估工具。 本研究為一描述性方法學之研究設計(descriptive methodological study design),以三個研究階段進行評估工具之研發。第一階段彙整與參考國外行動輔具操作技巧功能測試之相關文獻,歸納出以操作表現為主(performance based)的行動輔具操作技巧評估項目,並初擬其評估工具的內容與項目。第二階段進行德菲法(Delphi method)專家效度檢測,專家成員包含兩名物理治療、一名職能治療背景的專業學者,以及兩名資深地方輔具中心從業員。專家效度檢測方法為透過問卷收集整合專家們審視本研究初擬結果的評估項目之內容,分別就重要性與適切性進行修正。第三階段則以建構完成的行動輔具使用者操作技巧功能評估工具進行實際施測,以驗證其信度與臨床適用性。實測採方便取樣,樣本來源為新北市輔具資源中心接受輔具評估服務的個案。共徵召9名,包含使用六種行動輔具類(手杖、拐杖、助行器、電動輪椅、手動輪椅或電動代步車)之使用者,各種類至少有一名。實測由一名物理治療師對各受測者進行兩次評估,以驗證評估工具之再測信度(test-retest reliability)。實測過程同時以錄影拍攝記錄,再由另外兩位物理治療師透過觀察錄影帶評分的方式獨立給分,以檢測施測者間信度(inter-rater reliability)與施測者內信度(inter-rater reliability)。 本研究完成發展建構國內第一個整合六種行動輔具操作表現的行動輔具使用者操作技巧功能評估工具及其操作手冊。專家效度檢測的結果顯示,本評估工具內所有九項評估項目內容之重要性與適切性分數以五點式的李克特式量表(Likert scale)評分皆達4分以上,顯示本評估工具有良好的內容效度。實測評估之結果則顯示,操作能力與表現時間總分之再測信度、施測者內與施測者間信度的級內相關係數(ICC)值普遍皆有達到0.8以上的良好信度指標。但唯有操作能力總分之再測信度ICC值為0.78,具中等至良好的再測信度。在臨床適用性方面,本評估工具平均施測時間約為20分鐘,臨床上簡易施測,且可在短時間內完成。此外,評估所使用的設備儀器以及空間場地皆可在大多數的輔具中心或輔具相關服務單位取得,不需特殊或昂貴的設備。 總之,本研究所發展之行動輔具使用者操作技巧功能評估工具具有中等至良好之信效度,且操作方便。可做為臨床服務者、研究者、政策擬定者等輔具服務相關人員輔具評估之工具,並可提供國內輔具評估報告書修改之參考依據。未來研究建議以此評估工具進行較大型的推廣,探討其於輔具介入之成效與成果反應性(responsiveness)等面向之心理計量特性,並進一步建立出本評估工具於操作能力以及各評估項目之表現時間的常模 (norm)。

English Abstract

Assistive technology device (ATD) can improve the functional capacities of individuals with disabilities. The use of ATDs ameliorates the problems faced by individuals who have disabilities. Assistive technology has shown not only to compensate and prevent activity limitations and participation restrictions, but also greatly enhances function, independence of daily living, as well as reduce loading on care givers. The users of ATDs include not only people with disability, but also vulnerable elders and injured people. The use of different types of ATDS may depend according to different servility and injury types. Among the various types of ATDs, mobility-related ATDs, such as ambulatory-aids, and wheelchairs are most common of use. The provision of assistive technology service (ATS) is a multidisciplinary effort, the service providers are usually a multidisciplinary team formed by a group of professionals with assistive technology related backgrounds. From a physical therapist’s point of view, assistive technology service includes the evaluation of fitness and needs of ATDs, and also ATD training and follow up evaluations. In 2012, the ministry of interior has put great emphasized on ATD evaluation while giving out supplementary grant to the disabled ATD users. In order to actually meet the needs of the disabled and also to match the new subsidy policy, therapist’s evaluation is needed to confirm the actual needs and usage conditions of the users. To meet this purpose, there is a need for a standardized set of performance-based tests to evaluate the performance and skills required to use mobility-related ATDs. However, to date in Taiwan, there is no qualitative and quantitative assessment tool available yet to effectively measure the functional performance and ATD skills of those users. Thus, this study aims to develop a performance-based mobility device skills test, the Functional Performance Skills Test (FPST) for mobility aid users. This study is a descriptive methodological study, and will undergo a three-phase development process. Initially, FPST will be developed according to literature review of performance-based related outcome measures of mobility aids. Then the content of FPST will be validated via a two-round Delphi method survey. The Delphi panel is formed by a group of 5 experts experienced in physical and occupational therapy and also service providers in assistive technology center. Lastly, FPST is tested in an assistive technology center by 9 mobility aids users to examine its reliability and applicability. This is the first performance based instrument developed in Taiwan that evaluates the performance skills of a collection of mobility aids including cane, crutch, walker, powered and manual wheelchair and scooter users. The results of this study showed that the current instrument has moderate to high test-retest reliability (ICC=0.78) and excellent inter-rater reliability and inter-rater reliability (both ICCs above 0.8). And the Delphi method validation process also resulted in high content validity of the instrument. As for practicality, we found the test easy to perform and the needs for test setup were minimal. The test is generally feasible in medium-sized clinical settings, and the mean time taken to administer is within 20 minutes. In conclusion, the Functional Performance Skills Test is practical and its measurement properties regarding validity and reliability are moderate to excellent. We recommend this instrument to be used by clinicians and assistive technology service providers. And we also recommend this instrument to be used national wide, and it can also serve as a reference for revision of the current evaluation form officially distributed by the ministry of interior. Further works are needed to determine its responsiveness and effects used in assistive technology training. In addition, development of its scoring norm is also recommended for future studies.

Topic Category 醫藥衛生 > 醫藥總論
醫學院 > 物理治療學研究所
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