本研究的目的在於探討髖部骨折老年患者術後三天之活動知識、社會支持、自我效能及下肢活動功能與出院後一個月下肢活動功能之相關,並找出出院後一個月下肢活動功能之重要預測因子。本研究採縱貫性相關研究設計,以立意取樣方式,以高雄市地區二家醫學中心,一家區域教學醫院、一家地區醫院之髖部骨折老年患者為研究對象,有效樣本為100人。研究工具採結構式問卷,問卷內容包括以下六部份:(一)個人基本資料,包括個人屬性因素及疾病相關特性;(二)疼痛視覺量表;(三)活動知識量表;(四)社會支持量表;(五)活動自我效能量表;(六)下肢活動功能量表。 本研究所得資料以SPSS 10.0套裝軟體,以百分比、平均值、標準差、t檢定、單因子變異數分析、皮爾森積差相關及逐步複迴歸分析。本研究結果發現:(1)髖部骨折老年患者出院後一個月下肢活動功能單題平均得分為3.01,標準差為1.28,介於「中度困難」與「輕微困難」之間。得分最高的是「與鄰居或朋友有來往」,平均得分最低者為「整理家務」。(2)年齡越大,出院後一個月下肢活動功能執行越差。(3)教育程度越高,出院後一個月下肢活動功能越好。(4)術後三天疼痛程度越高,出院後一個月下肢活動功能越差。(5)骨折前日常活動執行的越好,出院後一個月下肢活動功能就越好。(6)術後三天活動知識越高,出院後一個月下肢活動功能越佳。(7)術後三天活動自我效能越高,出院後一個月下肢活動功能越好。(8)術後三天的親友或醫護人員社會支持越多,出院後一個月下肢活動功能就越好。親友的社會支持較偏重於情緒性、價值性支持;而醫護人員的社會支持則較偏重於價值觀、訊息性支持。(9)術後三天之下肢活動功能越好,出院後一個月下肢活動功能就越佳。(10)影響出院後一個月下肢活動功能的顯著預測因子為「術後三天下肢活動功能」、「活動自我效能」、「受傷前日常活動功能」及「活動知識」等四項,共可解釋53.6﹪的變異量。 依研究結果,建議臨床護理人員對於年齡越大、教育程度越低的髖部骨折老年患者應給予更多的協助與指導。同時應適當的控制術後疼痛,加強活動知識、活動自我效能及加強術後三天下肢活動功能的執行,使得出院後一個月下肢活動功能的執行更好,以減少因活動不便與限制所帶來的負擔與進一步傷害。
The purpose of this study was to investigate the correlation between the mobility knowledge, social support, self-efficacy and the status of the lower extremity function in the elderly with hip fractures on the third day of the post-surgical stage and their lower extremity functional status one month after they discharged . And to identify the strong predictors of a one-month discharged senior patient's lower extremity functional status. It was a longitudinal correlational study. The subjects of the study were composed of 100 elderly patients with hip fractures from 4 hospitals in southern Taiwan. A structured questionnaires was utilized to collect data from the participants and comprised six parts: (1) personal background information, (2) pain visual analogue scale(VAS), (3) mobility knowledge scale, (4) inventory of socially supportive behavior(ISSB), (5) self-efficacy for function ability scale(SEFA),and (6) lower extremity measurement(LEM). The SPSS 10.0 software was used to analyze data. The statistical methods included percentage, mean, standard deviation and t-test were cited to give a precise description of the set of data. To find out the relationships among the variables, one-way ANOVA, Pearson's correlation, and stepwise multiple regression analysis were conducted. The results of this study demonstrated that :(1) The 1-month discharged patient's LEM between「moderate difficult」and 「mild difficult」. (2) Age and the pain level of 3-day-post-surgery were negatively correlated to the LEM of one month after discharged. (3) The level of education, Bathel index, patient's mobility knowledge, self-efficacy, social support, and the LEM on 3-day-post-surgery were positively related to the 1-month discharged LEM. (4) 4 strong predictors of the 1-month discharged LEM were the patient's 3-day-post-surgery LEM, self-efficacy, Bathel index, and mobility knowledge. These four predictors accounted for 53.6% of the total variances. The results of this study suggested that the clinical nurses should provide the older-aged, lower-educated senior hip fracture patients with more assistance with pain control, and help to enhance their self-efficacy, mobility knowledge and lower extremity functional status to assure the patients’ better lower extremity functional status one month after they discharge and prevent them from further injury during the post-surgical period.