臺灣博碩士論文加值系統

背景：慢性精神障礙者(簡稱精障者)有較差健康狀態，其與較低的身體活動參與有關。目前亦指出增加身體活動量對於精障者生理與心理健康有正向的改善，但若能了解精障者身體活動型態及相關影響因子，將能幫助臨床工作者能有效發展出更好的身體活動介入方案。身心障礙者身體活動參與模式(The Physical Activity for People with a Disability Model，簡稱PAD模式)是一套針對身心障礙族群的身體活動參與理論，呈現身體活動參與的促進及阻礙因子。目的：本研究目的有二：(一) 探討精障者之步行活動參與量與型態，包括一週間身體活動量及二十四小時步行活動量分佈；(二) 使用PAD模式了解影響精障者身體活動量的因子。方法：從南台灣社區復健中心與日間病房招募志願參與者(思覺失調症、雙向情緒障礙症及憂鬱症)，要求連續配戴Omron HJ-720口袋型電子計步器七日，並填寫可反映PAD模式相關構念量表(運動自我效能、結果預期、意圖、社會支持及自覺阻礙等)，最後以逐步迴歸分析及線性迴歸分析結合四步驟法 (four step approach) 了解預測精障者身體活動之因子。結果：共有128筆完整資料資料進行分析，多為女性 (52.3%)，以思覺失調症為眾 (69.5%)，平均年齡為41.0 ± 9.9歲，身體活動改變階段為蘊思期 (contemplation) (55.5%)。國際身體活動量表顯示多數精障者的身體活動量乃不足夠 (78.1%)，計步器資料顯示，其平日一般步數為9905.9 ± 4358.7，顯著高於假日的8231.1 ± 5224.5 (t=4.423, p<.001)，且有50%的精障者於假日不具有氧步數(步行連續10分鐘以上)。每日步行量最高時間點為11、16與8點。PAD模式預測模式則顯示，精神症狀越嚴重會有較低的運動改變階段，且來自朋友的社會支持越高會有越高的運動改變階段。顯著的個人因子包括性別、抽菸習慣、身體質量指數、是否接受工作訓練、工作訓練是否需要大量走路及改變階段(意圖)。而環境因子則發現物理、社會環境的支持及家庭收入狀況皆能預測不同的身體活動類型。結論：社區的慢性精障者的身體活動量不足多為短時間的活動類型，較少從事有益健康且長達十分鐘以上的有氧步數。尤其在個人自由時間安排有更少的活動量，如晚間或週末。雖本研究在PAD模式僅發現部分的顯著預測因子，但研究結果建議未來針對精障者身體活動量介入仍宜關注PAD模式中的相關個人與環境因子，如低度活動量之人口學特性(性別、年齡、身體質量指數、家庭收入狀況及精神症狀嚴重度等)、目前的運動改變階段與社會支持情形，使健康促進計畫更有效地執行。

Background: Individuals with severe mental illness (SMI) have poor health conditions compared with the general population. Such inferior health condition may be related to the low participation of physical activity in this clinical population. Although, there is an increasing body of literature reporting the effects of physical activity (PA) on various health outcomes in individuals with SMI), the factors or strategies to improve PA level in SMI remain unclear. Understanding of PA pattern of people with SMI can be useful to develop effective programs for this group. The Physical Activity for People with a Disability Model (PAD Model) was based on various models of physical activity in disability, and this model can be used as a theoretical framework for future interventions on physical activity promotion. Purpose: This study was (1) to explore walking pattern of individuals with SMI (daily steps throughout a 24 hours period for 7 days), and (2) to understand the PA participating predictor in the PAD Model for individuals with SMI . Method: Participants with schizophrenia, bipolar disorder, or major depression were recruited from the psychiatric community mental health centers or day wards. Participants were asked to wear an Omron HJ-720 pedometer for 7 consecutive days as well as to fill in the questionnaires which reflect the main constructs in the PAD model (ex. Self-efficacy, outcome expectation, intension, social support and self-perceived barriers). Finally, we used stepwise regression, linear regression with the four steps in establishing prediction model. Results: We collected 128 of people with SMI. Most were female (52.3%), and schizophrenia (69.5%), and mean of age is 41.04 ± 9.93. As for the stage of change, most were in the stage of contemplation (55.5%). The Intenational Physical Activity Questionnaire results indicated 78.7% of people with SMI are physical inactive. The weekday daily step counts is 9905.9 ± 4358.7 steps, which is significantly higher than weekend (8231.1 ± 5224.5) (t=4.423, p=.000).We found most of SMI have insufficient aerobic steps (i.e. continuously walked for more than 10 minutes) especially in weekend. The 24-hours timeline of step counts shows the peak steps at 11, 16 and 8 o’clock. In analysis of PAD model revealed that severity of psychotic symptom and social support from friends would influence stage of change. The significant personal factors include gender, work training related with walk, smoking. The environmental factors consisting of social/physical support and family income were the significant predictors for the various physical activity level. Conclusion: We found people with SMI generally participate in unstructured and short bout physical activity. They have lower aerobic step counts, especially in their free-time such as night and weekend. The results found some factors could predict PA participation of SMI. The significant personal and environmental factors should be addressed in the future health promotion programs for people with SMI, such as characteristic of demographics (sex, age, BMI, income, severity of psychotic symptom) and their exercise stage of change, social support.

第一章 緒論 1
第一節 研究背景 1
第二節 研究重要性 2
第三節 研究目的 4
第四節 名詞解釋 4
第二章 文獻回顧 6
第一節 精障者的身體活動量及計步器之應用 6
第二節 精障者身體活動參與促進及阻礙因子探討 25
第三節 身心障礙者身體活動參與模式 59
第三章 研究方法 63
第一節 研究設計與流程 63
第二節 研究工具 66
第三節 統計分析 73
第四章 研究結果 75
第一節 受試者基本特性與量表結果 76
第二節 精障者身體活動量及步行活動量與型態 79
第三節 個人與環境因子對於身體活動的影響 85
第五章 討論 93
第一節 慢性精障者主觀與客觀身體活動測量 93
第二節 影響慢性精障者之個人與環境因子 99
第三節 研究限制 106
第六章 結論與臨床應用 107
第一節 結論 107
第二節 臨床意涵與應用 107
參考文獻 109

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