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研究生:薛文媛
研究生(外文):Hsueh, Wen-Yuan
論文名稱:以「家庭為中心」介入方案於腦中風患者參與之成效
論文名稱(外文):The effect of family-centered approach on participation for persons with stroke
指導教授:吳亭芳吳亭芳引用關係
指導教授(外文):Wu, Ting-Fang
學位類別:碩士
校院名稱:國立臺灣師範大學
系所名稱:復健諮商研究所
學門:社會服務學門
學類:身心障礙服務學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:111
中文關鍵詞:腦中風參與以家庭為中心照顧者憂鬱
外文關鍵詞:strokeparticipationfamily-centeredcaregiverdepression
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近年來,由於醫學知識與技術的提升,腦中風患者的致死率大幅下降,但仍有許多患者生活無法獨立。隨著國際健康功能與障礙分類系統(ICF)的提出,相關專業開始著重患者參與的議題。在提升腦中風患者參與的介入方式中,大多僅著重於患者本身,甚少將家庭成員納入介入策略中。本研究期待透過以家庭為中心的介入提升腦中風患者社交與社區參與。
本研究採準實驗設計,透過照顧者參與意願之有無將研究參與者分為實驗組與控制組,探討介入前後以及介入後一個月的追蹤成效。實驗組以家庭為中心的介入,控制組則以個案為中心介入。兩組介入時間皆為每周一至兩次90-120分鐘課程,課程總計八次。資料分析以描述性統計、Wilcoxin排序和檢定、Wilcoxin符號等級檢定研究參與者在社區、社交參與和憂鬱程度的改變。
本研究基於資源方便性,在臺北市某教學醫院收案,參與者分成實驗組九位與對照組八位。介入前兩組在年齡(p=0.007)與社區參與多樣性(p=0.037)上具有顯著差異。介入後兩組在各依變項皆無統計上顯著差異,然發現實驗組的憂鬱程度降低、社交參與多樣性提升、社交/社區參與中想改變的程度提升以及社區參與困難程度有下降的趨勢。兩組在追蹤時,所有依變項於統計皆未達顯著差異,但在社區參與多樣性與參與頻率有上升的趨勢。
本研究在統計上未能顯現以家庭為中心的介入優於以個案為中心的介入,但在追蹤時的依變項變化情形有正向發展的趨勢,建議未來可以探究較多樣本、較長介入以及提早介入的成效。
Due to the progress of medical technology, the mortality has reduced significantly in stroke patients recently. However, there were still lots of stroke patients cannot live independently in community. health professions started focusing on the issues of patients’ participation since the International Classification of Functioning, Disability, and Health (ICF) issued. Most of the interventions which enhancing the participation of stroke patients focused on the patients themselves, rare of them focused on their family. This study intended to enhancing social and community participation in stroke patients through family-centered approach.
This study used a quasi-experimental pre-posttest research design. Participants were divided into experimental and control groups based on the caregivers’ willingness to joined the intervention or not. Nine were in the experimental group and eight were in the control group. Patients in both groups received one or two 90-120-minute treatment sessions a week, with a total of eight sessions. Patients in experimental group received family-centered approach in which both the patients and their family members attended the treatment sessions, and those in control group received client-centered intervention in which only the stroke patients attended the treatment sessions. Data was analyzed by descriptive statistics, Wilcoxin rank sum test, and Wilcoxin signed ranks test.
There was no statistically significant difference between the experimental and control groups in all variables, although the trends of the depression reducing, the diversity of social participation increasing, the desire to change in social/community participation and the difficulty of community participation decreasing in the experimental group were found. In the one-month follow up, there was still no statistically significant difference between the experimental and control groups in all variables, although there was an increasing trend in community participation diversity and participation frequency.
This study does not indicate that family-centered approach is better than client-centered approach. However, there are positive trends in community participation diversity and participation frequency. Further studies could recruit more participants and implement intervention early in the onset and longer intervention duration.
致謝 I
中文摘要 II
ABSTRACT III
目錄 V
圖目錄 VII
表目錄 VIII

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與研究問題 3
第三節 名詞解釋 5

第二章 文獻探討 9
第一節 腦中風患者之參與 9
第二節 針對參與的復健介入方式 13
第三節 以家庭為中心之介入方案 18

第三章 研究方法 21
第一節 研究設計 21
第二節 研究對象 24
第三節 研究工具 26
第四節 研究介入方案 30
第五節 研究流程 34
第六節 資料分析 36

第四章 研究結果 37
第一節 研究對象之基本特性 39
第二節 施行團體介入之成效 43
第三節 以家庭為中心與以個案為中心之組間成效比較 59
第四節 研究者觀察紀錄 65

第五章 研究討論 69
第一節 研究結果摘要 69
第二節 以家庭為中心介入方案之成效討論 71
第三節 研究限制與建議 81
第四節 實務上的應用 84

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