跳到主要內容

臺灣博碩士論文加值系統

(3.236.28.137) 您好!臺灣時間:2021/07/25 20:05
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:張展嘉
研究生(外文):Chan-Chia Chang
論文名稱:使用輪椅產生的意外:回溯性研究
論文名稱(外文):Wheelchair-related accidents: A retrospective study
指導教授:毛慧芬毛慧芬引用關係
指導教授(外文):Hui-Fen Mao
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職能治療研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:76
中文關鍵詞:輪椅意外輪椅意外人活動與輔助科技模式
外文關鍵詞:wheelchairaccidentwheelchair-related accidentHuman-Activity-Assistive Technology modelHAAT model
相關次數:
  • 被引用被引用:5
  • 點閱點閱:1688
  • 評分評分:
  • 下載下載:58
  • 收藏至我的研究室書目清單書目收藏:0
肢體障礙者使用輪椅雖可達到代步的正面效果,然而使用時也可能產生負面影響,如發生意外。在現今重視實證實務趨勢下,瞭解使用輪椅發生的意外情況及其原因,是輪椅使用結果評量中極重要的一環。本研究目的為了解使用手動與電動輪椅後所產生的意外類型與結果,並進一步瞭解可能產生意外的原因,藉由使用者的主觀經驗並參考「人、活動與輔助科技模式」,將意外的相關因子歸因成使用者特質、輪椅特徵、從事的活動與環境四類,以初步瞭解國內輪椅發生意外的情況。
本研究為橫斷式研究設計,研究樣本為95、96年所有接受台大醫院輔具中心評估,並能自行推行手動或電動輪椅以代步者,共計91名。由一位職能治療師進行約15分鐘電話訪談,完成訪談共73名,完成率80.2%,訪談內容乃依據研究者設計之結構式問卷,包含:基本人口學與臨床資料、輪椅使用行為調查、輪椅意外種類和結果與相關因子。資料分析分為:1)以描述性統計陳述基本人口學與臨床資料、輪椅使用行為調查、輪椅意外種類和結果與相關因子等,以頻率、百分比描述變項分布情形。2)以卡方檢定及t檢定,檢驗有無意外發生者在各項因子之差異。
結果參與本研究之73名個案中曾發生輪椅意外有48人(65.8%),共發生76件意外,其中手動輪椅佔46件、電動輪椅佔30件。輪椅意外類型可分為翻覆與跌倒66件、輪椅失去功能或感到危險10件,及因接觸輪椅而受傷,最後一類在本研究樣本中並未有個案提及。意外的結果:53.9%的事件導致輪椅翻倒,其中往前或往後翻倒佔75.6%;意外造成使用者受傷的比例為56.6%,其中4.6%需要住院。比較有意外與無意外個案在基本人口學資料,並無顯著差異;但在輪椅每日使用時數,有意外者比沒有意外者平均顯著高出2.8個小時。
針對有發生意外的使用者在各項相關因子分析中,發現使用者當時多未使用安全帶及防傾桿,且其中手動輪椅使用者更明顯,達九成使用者不用安全帶及防傾桿,但使用者自認造成意外的成因中皆未提及上述兩項行為。輪椅類型、從事的活動及環境特徵則顯示:手動輪椅較電動輪椅易在室內進行轉位活動及上下坡時發生意外;電動輪椅的意外事件中較高比例(73.3%)發生於戶外。
本研究是國內第一篇探討社區輪椅使用者發生之各類意外與其相關因子的研究,結果初步報導國內使用輪椅發生意外的概況,可作為預防輪椅意外之衛教與廠商作為輪椅設計之參考。
Although people with physical disability will get positive help with mobility devices, like wheelchair, they may suffer some adverse effects, such as accidents. Currently, to realize the situation of the accidents in outcome measurements of wheelchair usage is very important with emphasis on evidence-based practice. The purpose of this study is to comprehend the types and consequences of wheelchair-related accidents. Based on the “Human-Activity-Assistive Technology model,” we may categorize the related factors into four parts: users’ characteristics, wheelchair activities, type and features of wheelchair, and context of wheelchair using. The results of this study may contribute to the preliminary understanding of wheelchair-related accidents in Taiwan.
This cross-sectional study recruited 91 clients of the center of assistive technology in National Taiwan University Hospital within 2006 and 2007. The main inclusion criteria are as follow: self-propelling manual or powered wheelchairs for mobility. One occupational therapist conducted 15-minute telephone interviews based on the self-designed questionnaire, and 73 participants (respond rate: 80.2%) were involved in the study. Statistical analyses showed the descriptive statistics, including: demographic and clinical information, the behavior of wheelchair using, and the types, consequences and related factors of the accidents. In addition, Chi-square test and Student’s t–test were used to test the differences on related variables between people with and without accidents.
Out of the 73 participants in this study, 48 (65.8%) occurred wheelchair-related accidents. They have reported 76 accidents, involving 46 manual and 30 powered wheelchairs. After the reclassification, the wheelchair accidents can be divided into 66 tips and falls, 10 dangerous operations to the user and no function of wheelchair, and injuries by contacting wheelchair itself. However, the last type was not reported by the current participants. During the accidents, 53.9% of the wheelchairs have turned over, most commonly forward or backward (account for 75.6%). 56.6 percept of the users were injured, which need hospitalization for 4.6%. The demographics between people with and without accidents were not significantly different. However, in the daily number of hours of usage, People with accidents on average are significantly higher than none for about 2.8 hours.
Focusing on the factors between people with accidents, we found that wheelchair users rarely used seat belts and anti-tippers at that time, of which the most obvious manual wheelchair users. 90 percept of the manual wheelchair user didn’t use seat belts and anti-tippers, but they didn’t report that those two behaviors were related to the accidents. While considering the wheelchair activities, type and features of wheelchair, and the context of wheelchair using, we found that the manual wheelchairs were more accident-prone than the powered wheelchairs when users transferred indoors and slopped up and down. In addition, the powered wheelchair accidents more happened outdoors (73.3%).
This study is the first one to explore the wheelchair-related accidents in Taiwan. Our findings could work for preventive health education program, and design guide of wheelchair manufacturers.
誌謝 --------------------------------------------------------------------------------------------------i
中文摘要 -------------------------------------------------------------------------------------------ii
英文摘要 ------------------------------------------------------------------------------------------iii
第一章 序論 --------------------------------------------------------------------------------------1
第二章 文獻探討 --------------------------------------------------------------------------------4
第一節 輔助科技及輪椅類輔具 -------------------------------------------------------4
第二節 輪椅對行動障礙者的重要性 -------------------------------------------------6
第三節 輪椅使用結果評量與探討意外發生之重要性-----------------------------8
第四節 使用輪椅產生之意外 --------------------------------------------------------10
第五節 輪椅意外的相關因子 --------------------------------------------------------14
第六節 文獻探討總結 -----------------------------------------------------------------17
第三章 研究目的 -------------------------------------------------------------------------------18
第四章 研究問題與研究假說 ----------------------------------------------------------------18
第五章 研究方法 -------------------------------------------------------------------------------19
第一節 研究設計與架構 --------------------------------------------------------------19
第二節 研究對象 -----------------------------------------------------------------------19
第三節 研究工具 -----------------------------------------------------------------------20
第四節 研究程序 -----------------------------------------------------------------------22
第五節 資料分析 -----------------------------------------------------------------------23
第六章 結果 -------------------------------------------------------------------------------------24
第一節 基本人口學及臨床資料----------------------------------------------------------24
第二節 意外的種類與意外的結果-------------------------------------------------------25
第三節 輪椅意外相關因子的描述-------------------------------------------------------27
第四節 意外相關因子間的關係----------------------------------------------------------29
第五節 意外與否在各因子的差異比較-------------------------------------------------32
第七章 討論 -------------------------------------------------------------------------------------34
第一節 意外類型與意外結果之討論----------------------------------------------------34
第二節 意外相關因子間之討論----------------------------------------------------------37
第三節 意外相關因子間關係之討論----------------------------------------------------39
第四節 意外與否在各因子的差異比較之討論----------------------------------------41
第五節 研究限制----------------------------------------------------------------------------42
第八章 結論與建議 ----------------------------------------------------------------------------43
第九章 參考文獻 ----------------------------------------------------------------------------45
表 --------------------------------------------------------------------------------------------------52
圖 --------------------------------------------------------------------------------------------------70
附件一、使用輪椅造成的意外及其成因調查表 ----------------------------------------73
內政部統計處(2006)。九十五年身心障礙者生活需求調查性別分析。台北:內政部。
內政部多功能輔具資源整合中心(2008)。歷年成果報告。
行政院衛生署(2003)。輪椅衛教手冊。台北:衛生署。
江偉君(2005)。輪椅上的公主。台灣:二魚文化。
汪受寬(2000)。史記。香港:中華。撰自[西漢]司馬遷。
李淑貞(2001)。國際健康功能與身心障礙分類。上網時間:2008/5/14。World Wide Web:http://repat.moi.gov.tw/files/ICF%20簡介.pdf
李文貴、楊延壽、張敏(2002)。電氣痙攣治療副作用的預防與處理。台灣醫學,6(5)。頁752-757。
邱榮基、蔚順華、江傳江(2007)。比較輪椅使用者之競賽式及傳統式推進時肩關節擠壓之三維運動分析。大專體育學刊,9(1)。頁65-78。
吳英黛、胡名霞、柴惠敏、吳雪玉、毛慧芬(2004)。全國輔具使用現況調查研究。行政院衛生署委託研究報告。
吳岱穎、陳建志、林光洋(2004)。預防接種相關副作用的省思。基層醫學,19(7),頁164-173。
胡名霞(2004)。長期照護個案行動輔具使用調查報告。物理治療,29(6)。頁405-420。
身心障礙者醫療及輔助器具補助方法(民88)。中華民國八十八年十月六日台(88)內社字第八八九零六五二號令修正衛生署醫字第八八零五九一六九號公佈。
陳景聰(2008)。坐輪椅的軍師:孫臏。台灣:三民。
黃小玲、羅鈞令、張彧、林佳琪、毛慧芬(2003)。復健病患出院後使用輔具之狀況。台灣醫學,7(5),頁681-688。
輔具分類說明表(2007)。上網時間:2008/7/28。World Wide Web:http://repat.moi.gov.tw/16sitemap/category.asp
Batavia, M., & Batavia, A. I. (1999). Pressure ulcer in a man with tetraplegia and a poorly fitting wheelchair: a case report with clinical and policy implications. Spinal Cord, 37(2), 140-141.
Brechtelsbauer, D. A., & Louie, A. (1999). Wheelchair use among long-term care residents. Ann Long Term Care, 7(6), 213-220.
Calder, C. J., & Kirby, R. L. (1990). Fatal wheelchair-related accidents in the United States. American Journal of Physical Medicine & Rehabilitation,69(4), 184-190.
Cook, A. M., & Hussey, S.M. (2002). Assistive technologies: Principles and practice (2nd ed.). St. Louis, MO: Mosby.
Cooper, R. A. (1998). Wheelchair selection and configuration. New York: Demos Medical Publishing.
Cooper, R. A., Boninger, M. L., Spaeth, D. M., Ding, D., Guo, S., Koontz, A. M., et al. (2006). Engineering better wheelchairs to enhance community participation. IEEE Trans Neural Syst Rehabil Eng, 14(4), 438-455.
Corthell, D. (1986). Rehabilitation Technologies 13th Institute on Rehabilitation Issues, Research and Training Center, University of Wisconsin-Stout.
Crepeau, E. B., Cohn, E. S., & Boyt Schell, B. A. (2003). Occupational Therapy (10th ed.). Baltimore: Lippincott Williams & Wilkins.
DeRuyter, F. (1995). Evaluating outcomes in assistive technology: do we understand the commitment? Assistive Technology, 7(1), 3-8; discussion 9-16.
DeRuyter, F. (1997). The importance of outcome measures for assistive technology service delivery systems. Technology and Disability, 6(1), 89-104.
Edlich, R. F., Woodard, C. R., Pine, S. A., & Jackson, E. M. (2001). Bony prominence pain caused by elevated wheelchair seating pressures. American Journal of Emergency Medicine, 19(2), 164-165.
Ernest, M. (1993). Avoidable injuries. CMAJ Canadian Medical Association Journal, 148(5), 716.
Frank, A. O., Ward, J., Orwell, N. J., McCullagh, C., & Belcher, M. (2000). Introduction of a new NHS electric-powered indoor/outdoor chair (EPIOC) service: benefits, risks and implications for prescribers. Clin Rehabil, 14(6), 665-673.
Fuhrer, M. J. (2001). Assistive technology outcomes research: challenges met and yet
unmet. American Journal of Physical Medicine and Rehabilitation, 80, 528-535.
Fuhrer, M. J., Jutai, J. W., Scherer, M. J., & DeRuyter, F. (2003). A framework for the conceptual modelling of assistive technology device outcomes. Disability and Rehabilitation, 25, 1243-1251.
Fuhrer, M. J. (2007). Assessing the efficacy, effectiveness, and cost-effectiveness of assistive technology interventions for enhancing mobility. Disability and Rehabilitation: Assistive Technology, 2(3), 149-158.
Gaal, R. P., Rebholtz, N., Hotchkiss, R. D., & Pfaelzer, P. F. (1997). Wheelchair rider injuries: causes and consequences for wheelchair design and selection. Journal of Rehabilitation Research and Development, 34(1), 58-71.
Gavin-Dreschnack, D., Nelson, A., Fitzgerald, S., Harrow, J., Sanchez-Anguiano, A., Ahmed, S., & Powell-Cope, G. (2005). Wheelchair-related Falls: Current Evidence and Directions for Improved Quality Care. Journal of Nursing Care Quality, 20(2), 119-127.
Hammel, J. (1996). What’s the outcome? Multiple variables complicated the measurement of assistive technology outcomes. Rehab Management, 9, 97-99.
Harrell, F. E., Jr., Lee, K. L., & Mark, D. B. (1996). Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med, 15(4), 361-387.
Hass, U., Brodin, H., Andersson, A., & Persson, J. (1997). Assistive technology selection: a study of participation of users with rheumatic arthritis. IEEE Transactions on Rehabilitation Engineering, 5, 263-275.
Kimura, F., Ishida, S., Furutama, D., et al. (2006). Wheelchair economy class syndrome in amyotrophic lateral sclerosis. Neuromuscular Disorders, 16(3), 204-207.
Kirby, R. L., Atkinson, S. M., & MacKay, E. A. (1989). Static and dynamic forward stability of occupied wheelchairs: influence of elevated footrests and forward stabilizers. Archives of Physical Medicine & Rehabilitation, 70(9), 681-686.
Kirby, R. L., Ackroyd-Stolarz, S. A., Brown, M. G., Kirkland, S. A., & MacLeod, D. A. (1994). Wheelchair-related accidents caused by tips and falls among noninstitutionalized users of manually propelled wheelchairs in Nova Scotia. American Journal of Physical Medicine & Rehabilitation, 73(5), 319-330.
Kirby, R. L., & Ackroyd-Stolarz, S. A. (1995). Wheelchair safety—adverse reports to the united states Food and Drug Administration. American Journal of Physical Medicine & Rehabilitation,74, 308-312.
Kirby, R. L., Coughlan, S. G. & Christie, M. (1995). Could changes in the wheelchair delivery system improve safety? Canadian Medical Association Journal,153(11), 1585-1591.
Kirby, R. L., & Smith, C. (2001). Fall during a wheelchair transfer: a case of mismatched brakes. American Journal of Physical Medicine & Rehabilitation, 80(4), 302-304.
LaPlante, M. P., Hendershot, G. E., & Moss, A. J. (1992). Assistive technology devices and home accessibility features: prevalence, payment, need, and trends. Advance Data(217), 1-11.
Merbitz, C. (1996). Fequency measures of behavior for assistive technology and rehabilitation. Assistive Technology, 8, 121-130.
Nelson, A., Ahmed, S., Harrow, J., Fitzgerald, S., Sanchez-Anguiano, A., & Gavin-Dreschnack, D. (2003). Fall-related fractures in persons with spinal cord impairment: a descriptive analysis. Sci Nursing, 20(1), 30-37.
Pluym, S. M., Keur, T. J., Gerritsen, J., & Post, M. W. (1997). Community integration of wheelchair-bound athletes: a comparison before and after onset of disability. Clin Rehabil, 11(3), 227-235.
Pooyania, S., Kirby, R. L., & Smith, C. (2006). Wheelchair-related thumb injury of multifactorial etiology: a case report. Archives of Physical Medicine & Rehabilitation, 87(12), 1656-1657.
PubMed. Accident Prevention [Subheading]. MeSH Database. Retrieved 5.13, 2006, from http://www.ncbi.nlm.nih.gov/sites/entrez
Reid, D.T. (2004). Critical review of the research literature of seating interventions: A focus on adults with mobility impairments. Assistive Technology, 14, 118-129.
Routhier, F., Vincent, C., Desrosiers, J., & Nadeau, S. (2003). Mobility of wheelchair users: a proposed performance assessment framework. Disabil Rehabil, 25(1), 19-34.
Roxborough, L. (1995). Review of the efficacy and effectiveness of adaptive seatin for children with cerebral palsy. Assistive Technology, 7, 17-25.
Sawatzky, B. J., Slobogean, G. P., Reilly, C. W., Chambers, C. T., & Hol, A. T. (2005). Prevalence of shoulder pain in adult- versus childhood-onset wheelchair users: a pilot study. Journal of Rehabilitation Research & Development, 42(3 Suppl 1), 1-8.
Scherer, M. J., & Galvin, J. C. (1997). Outcome and Assistive Technology. REHAB management, Feb./Mar., 103-105
Scherer, M. J.(2002). Assistive Technology: Matching Device and Consumer for Successful Rehabilitation. Washington, DC: American Psychological Association.
Stickel, M.S., Ryan, S., Rigby, P.J., & Jutai, J.W. (2002). Toward a comprehensive evaluation of the impact of electronic aids to daily living: evaluation of consumer satisfaction. Disability and Rehabilitation, 24, 115-125.
Technology-Related Assistance for Individuals with Disabilities Act of 1988 As Amended in 1994 §103-218.
The Assistive Technology Act of 1998.
Trudel, G., Kirby, R. L., Ackroyd-Stolarz, S. A., & Kirkland, S. (1997). Effects of rear-wheel camber on wheelchair stability. Archives of Physical Medicine & Rehabilitation, 78(1), 78-81.
Ummat, S., & Kirby, R. L. (1994). Nonfatal wheelchair-related accidents reported to the national electronic injury surveillance system. American Journal of Physical Medicine & Rehabilitation,73, 163-167.
United States Census 2000: Dsability and American families 2000, census 2000 special reports. (2005). From http://www.census.gov/prod/2005pubs/censr-23.pdf
Willke R.J., Burke L.B., & Erickson P. (2004). Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels. Controlled Clinical Trials, 25(6), 535-552.
World Health Organization: International classification of functioning disability and health-ICF, Geneva, 2002, WHO.
Xiang, H., Chany, A. M., & Smith, G. A. (2006). Wheelchair related injuries treated in US emergency departments. Injury Prevention, 12(1), 8-11.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top