骨質疏鬆症智慧型健康風險評估於護理照護之實證研究

Osteoporosis Intelligent Health Risk Appraisal in Nursing Evidence-Based Study

張淑芳

指導教授 ： 洪欽銘 ； 楊榮森

國立臺灣師範大學/科技學院/工業教育學系/博士(2007年)

摘要

骨質疏鬆症被認為是一種無聲無息疾病，患者初期不會有任何症狀，往往第一個發生的情況便是骨折，其中以髖部骨折最為嚴重，一年內死亡率為15-36 %，此數據相當於乳癌第3、4期死亡率。學者指出「跨科際整合」(multidisciplinary)是預防骨質疏鬆最佳的全方位策略。因此，本研究目的在於結合護理、醫學及電機資訊等跨領域專業，研擬一套「骨質疏鬆症智慧型健康風險評估」軟體，同時藉由完整的護理介入方案設計，主要期望能篩選出婦女罹患骨質疏鬆症風險，並提升其預防骨質疏鬆症知識、信念與遵從行為。

本研究運用所研發的「骨質疏鬆症智慧型健康風險評估」軟體，能依據婦女在骨質疏鬆症危險因子，分別提出其骨正常、骨量不足及骨質疏鬆症之程度，以作為婦女評估其罹患骨質疏鬆症之相對風險，研究結果得知，本軟體之準確率達75 %；本研究依據所研發的軟體，實際進行測量社區婦女在罹患骨質疏鬆症之風險，同時針對篩檢結果為骨量不足及骨質疏鬆之危險群婦女，提供不同護理介入方案。實驗組一主要接受個別護理指導及提供護理指導手冊，實驗組二則僅提供護理指導手冊，而控制組則未提供護理介入。護理實證研究結果得知，危險群婦女在後測知識，實驗組一得分大於控制組，同時較控制組增加42.55 %；另外於前測後第22週，危險群婦女在後後測知識，實驗組一大於實驗組二及控制組，且分別增加17.37 %及36.12 %。另外，針對成本效用分析發現，後測之實驗組一的成本花費低於控制組達5.85倍；而後後測成本效用分析發現，在知識之成本效用上，實驗組一較實驗組二及控制組，在成本花費分別減少1.22倍及1.36倍。此外，本研究所發展之「骨質疏鬆症危險因子問卷」，較國際骨質疏鬆症基金會之「一分鐘骨質疏鬆風險評估表」具有較佳的預測骨質疏鬆症風險能力，其解釋力達24.2 %。
本研究是結合護理、醫學及電機資訊等跨領域專業，於國內外相關研究均屬極為少見，因此具有創新及前瞻性研究，未來將可運用於不同疾病的健康風險評估。其次，研究結合護理方案設計，經由實證研究成果，將可作為社區護理人員，在運用先進資訊軟體同時，結合此有效的護理介入方式，能提升危險群婦女在預防骨質疏鬆症的成效。再者，研究所發展出來骨質疏鬆症智慧型健康風險評估軟體，已申請發明專利，藉由運用產學合作創新模式，將此技術加以轉移，以期能推廣至全國，達到早期預防及健康促進目標。最後，研究所研發的健康風險評估與護理照護模式，可運用於社區遠距居家照護中，提供偏遠及醫療資源不足地區，以進行簡易及有效的健康風險自我管理。

關鍵字

智慧型軟體 ； 骨質疏鬆症 ； 健康風險 ； 護理實證研究

並列摘要

Osteoporosis used to be thought a silent disease because no symptoms can be detected in the early stage. Fracture is usually the first episode in the patients with osteoporosis, especially in hip fracture, of which the one-year mortality rate with one year after fracture was as high as 15-36 %, nearly equal to the sum of mortality rate of patients suffering from the third or fourth stage breast cancer. A multidisciplinary approach has been recommended as the best comprehensive strategy of preventing osteoporosis. Through the coordination of the disciplines of nursing, medical science, and electrical engineering, this study aimed to develop a “Assessment software of the osteoporosis risk “as a tool to evaluate the risk of osteoporosis. Furthermore, we have conducted a comprehensive nursing intervention project and expected its effect to screen the risk of women’s suffering from osteoporosis, and to help to enrich the knowledge and belief of preventing osteoporosis, strengthening the behavior following nursing instructions.
Through the software of “Assessment software of the osteoporosis risk” for evaluation, this study was designed to practically evaluate the risk of women’s sustaining osteoporosis in communities. At the same time, this study provided various kinds of nursing intervention programs for the women diagnosed as osteopenia or osteoporosis. The first experimental group was offered individual nursing intervention and the guide of nursing self-care。The second experimental group was given the guide of nursing self-care only. Finally, the control group was without any nursing intervention. According to the results in our evidence-based nursing studies, for the women in the risk group, in terms of post-test knowledge, belief, and obedient behaviors, the first experimental group scored more than the control group. And the knowledge of osteoporosis was improved by 42.55%. In addition, in the twenty second week after the pre-test, for the women in the risk group, in terms of post-test knowledge, belief, and obedient behaviors, the first experimental group scored better than the second experimental group and the control group. And the knowledge was enhanced by 17.37% and 36.12%, respectively. Moreover, the cost-effectiveness analysis showed that the first experimental group had a lower cost as much as 5.85 times than the control group. The cost-utility analysis in the post-test showed that, in terms of the cost utility of knowledge, the first experimental group cost 1.22 and 1.36 times less than the second experimental group and the control group. In addition, the questionnaire of the risk factors of osteoporosis developed by this study proved to be better than the “One-Minute Osteoporosis Risk Test” (by International Osteoporosis Foundation), for indeed its explanation efficiency had reached as high as 24.2 %.
This study combined the professionalism fields of nursing, medical science, and electrical engineering. With its innovation and prospective studies, the results of this study can be applied to evaluate the health risks of diverse kinds of diseases. Second, this study combining nursing project designs and evidence-based approaches can provide a model for the community nursing staff to participate the prevention program of osteoporosis and improve its effectiveness in applying such advanced information software. Currently we have applied for patent for such software of wisely evaluating health risk of osteoporosis. Via the cooperation between industries and the academic circle, this technology can be promoted to the nationwide to prevent diseases and to enhance health. Finally, the newly designed model of heath risk evaluation and nursing care can be applied to community long distance home care. And it can also be applied in remote areas and the areas with insufficient medical resources to accomplish a simple and effective health risk self-management.

並列關鍵字

intelligent software ； osteoporosis ； health risk appraisal ； nursing evidence-based intervention

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