臺灣博碩士論文加值系統

背景：臺灣2017年精神疾病人數統計為2,638,382人，占總人口數約11.18%，2018年領有身心障礙證明(手冊)者為1,173,978人，占總人口數約4.98%，其中慢性精神病患者共127,591人，占領有身心障礙證明(手冊)者總人口數約10.87%，過去應用電玩遊戲為介入措施的研究陸續發現有其成效，但國內外精神醫學或照護領域，未有短期互動式電玩遊戲運用於社區慢性精神障礙病人的相關研究，本研究目的為探討短期互動式電玩遊戲應用於社區慢性精神障礙病人之成效，瞭解短期互動式電玩遊戲對於社區精神障礙病人的可行性，以及該短期介入措施對病人的成效，包含:身心健康、生活品質、身體體能指標等，希望藉由本研究來探討互動式電玩遊戲對於社區精神障礙病人的效果，以供從事社區精神領域相關從業人員之參考。
方法：採前瞻性類實驗前後測設計，取樣於北部地區社區康復之家(全日型復健機構)之精神疾病病人，針對收案對象透過訪談、身體量測、體能評估、結構性問卷收集基本資料，進行三次之資料收集，分別是基準期(baseline, T0)、間隔兩週後的前測(pre-program, T1)，提供為期三週，每週兩次的互動式電玩活動介入，之後進行後測(post-program, T2)，於上述共六次，每次60分鐘互動電玩遊戲介入後，病人完成活動回饋表及電玩適應評估，反映參加活動之感受與意見回饋。
結果：共48位社區精神障礙病人成功收案，男性及女性比例相當，平均年齡52.1±8.2歲，背景以未婚狀態與高中職/五專教育程度者最多，比起前測(pre-program, T1)，病人在後測(post-program, T2)表現於身體組成方面發現: 腰圍顯著下降2.22±4.3公分(Cohen’s d=-0.52，p<0.001)；身體活動方面發現: 10公尺快速行走速度減少0.58秒(Cohen's d=-0.33，p=0.005)；椅子起身走3公尺後坐回速度減少1.02秒(Cohen's d=-0.45，p<0.001)；椅子站起來及坐下5次速度減少0.86秒(Cohen's d=-0.31，p=0.008)。互動電玩介入三週後，病人自述的生活品質改變有疼痛感受增加0.4±1.1分(Cohen's d=0.42，p=0.011)、醫療使用滿意度增加(0.2±0.7分，Cohen's d=0.25，p=0.031)以及滿意想吃的食物都能吃得到(增加0.3±0.9分，Cohen's d=0.31，p=0.033)。病人對此介入活動的回饋顯示在最高四分的滿意度中，平均分數為3.3到3.6分，屬於極佳正向回饋分數，支持此介入活動是病人給予高度可行性及成效性的肯定，最後使用互動式電動遊戲滿意度與可行性中文版問卷評估發現，病人對於此介入活動，顯示良好的滿意度與可行性。
結論：經由互動式電玩活動介入三週後，看見有其成效之處為促使病人腰圍變小；在身體活動方面的成效為10公尺快速行走速度、椅子起身走3公尺後坐回速度及椅子站起來及坐下5次速度皆顯著減少；在生活品質方面，對於身體疼痛的感知能力提升、對於醫療保健服務的方便程度滿意度增加及對於想吃的食物通常都能吃到滿意程度提升，每次互動式電玩活動後正向回饋分數極高，且不論是以四個面向(操作方式、運動舒適度、運動持續度及滿意度)或兩個構面(滿意度及可行性)來看，均擁有良好的滿意度與可行性，值得未來擴大互動電玩到更多不同全日住宿型慢性精神障礙復健機構康復之家，期盼能促進慢性精神障礙病人，重拾生活的樂趣，改善身體活動，提高病後生活品質。

Background: The number of mentally ill patients in Taiwan in 2017 was 2,638,382, accounting for 11.18% of the total population. In 2018, there were 1,173,978 people with a certification of handicap, accounting for about 4.98% of the total population. Among all handicapped individuals, 127,591 were chronically mental disability, 10.87% of all certified handicapped persons. Past studies using video games as intervention had found success, but there are no information about using short-term interactive video games in the field of psychiatry chornic or community homes. Research on patients with chronic mental disorders in the community is warrent. The purpose of this study is to explore the effectiveness and feasibility of short-term interactive video games applied to patients with chronic mental disorders in the community. The effectiveness of patients includes: physical and mental health, quality of life, and physical activity indicators.
Method: Prospective quisi-experiment before and after test design was applied to include mentally-ill patients in the community rehabilitation home (community half wasy house) from the northern Taiwan. After informed consent signed, patients were invited to be interviewed, to be assessed on physical index and physical activitiy as well as to fill out questionnaire booklet. The data was collected at three time points, including the baseline (T0), the pre-program (T1: two weeks after T0) and the post-program (T2: after 3-weeks program). The 2 sessions weekly interactive video game activities were provided for a three-week long period. In the above-mentioned six times video-game program, after each 60-minute interactive video game intervention, the patient completed the activity feedback form and video game adaptation assessment, reflecting the feelings and feedback of participating in the event.
Results: A total of 48 patients with mental disorders in the community were successfully participanted in the study. The proportion of men and women was the same, with an average age of 52.1±8.2 years old. The majority of pateitens were unmariied and with at least high school degree. Compared with the data at the pre-program period (T1), the patients’ data was improved at the post-program period (T2) in body composition, such as decreased waist circumference by 2.22±4.3 cm (Cohen's d=-0.52, p<0.001). After three weeks of interactive video game intervention, several physical activities were improved including reduced speed in “10 meters fast walking” by 0.58 seconds (Cohen's d=-0.33, p=0.005), reduced speed in “get up from chair to walk 3 meters then sit back” by 1.02 seconds (Cohen's d=-0.45, p<0.001), and reduced speed in “chair stand up and sit down 5 times” by 0.86 seconds (Cohen's d=-0.31, p=0.008). After the three-weeks interactive video game intervention, the patient’s self-reported quality of life changes in a fw aspects, such as pain perception increased by 0.4±1.1 points at a 4-point scale (Cohen’s d=0.42, p=0.011), medical use satisfaction increased 0.2±0.7 points (Cohen’s d=0.25, p= 0.031) and the food you want to eat can be eaten increased by 0.3±0.9 points (Cohen's d=0.31, p=0.033). The patients’ feedback on the intervention demonstrated a high level of satisfaction with averaged score of 3.3 to 3.6 on a four-point scale which has been a positive feedback to the feasibility and effectiveness of the 3-week interactive video-game intervention.
Conclusion: After three-weeks interactive video games intervetnion, the waist circumference decreased and the physical activities improved along with the better-quality of life in the perception of physical pain, the convenience of health care services and the food wanted in daily life. The pateints’ feedback on the interventions are very positive in all four aspects (operation mode, sports comfort, exercise duration and satisfaction) and two domains (satisfaction and feasibility). It is suggested to implement such feasible, interesting, and effective interactive interventions to patients with chronic mental disorders in the community settings. It is of hope to promote the patients’ quality of life and improved their physical activities and physical compositions.

口試委員會審定書 i
誌謝 ii
中文摘要 iii
英文摘要 v
目錄 viii
圖目錄 xii
表目錄 xiii
第一章 緒論 1
第一節、研究背景 1
第二節、研究目的 3
第三節、研究問題 3
第二章 文獻探討 4
第一節、社區精神疾患 4
第二節、社區精神疾患病人與身體健康 6
第三節、互動式電玩遊戲 7
第三章 研究方法 12
第一節、研究設計 12
第二節、研究介入措施及流程 13
第三節、研究對象 16
第四節、樣本估計 17
第五節、研究工具 19
一、基本資料 19
二、身體組成 19
三、身體活動 20
四、照護需求層級量表 20
五、台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF) 22
六、生活壓力問卷(CHQ-12) 22
七、短式國際跌倒效能量表(Short FES-I) 23
八、互動式電動遊戲滿意度與可行性之中文版問卷 24
第六節、研究倫理 25
第七節、資料分析 25
第四章 研究結果 26
第一節、基本資料 26
第二節、身體組成 29
第三節、身體活動 31
第四節、照護需求層級評估 33
第五節、生活品質評估 34
第六節、生活壓力評估 40
第七節、跌倒效能評估 42
第八節、短期互動電玩介入活動回饋評價 44
第九節、短期互動式電玩遊戲滿意度與可行性評估 46
第十節、結果統整 48
第十一節、男性研究結果 51
一、男性基本資料 51
二、男性身體組成 54
三、男性身體活動 56
四、男性照護需求層級評估 58
五、男性生活品質評估 59
六、男性生活壓力評估 64
七、男性跌倒效能評估 66
第十二節、女性研究結果 68
一、女性基本資料 68
二、女性身體組成 71
三、女性身體活動 73
四、女性照護需求層級評估 75
五、女性生活品質評估 76
六、女性生活壓力評估 81
七、女性跌倒效能評估 83
第十三節、男性及女性結果統整 85
第十四節、功能比較 92
一、身體組成 92
二、身體活動 94
三、生活品質評估 96
第十五節、高低年齡群比較 98
一、身體組成 98
二、身體活動 100
三、生活品質評估 102
第十六節、曲率檢定比較 104
一、身體組成 104
二、身體活動 105
三、生活品質 106
第五章 討論 107
第一節、社區精神障礙病人基本背景資料、照護需求、身體組成及身體活動之探討 107
第二節、短期電玩遊戲與生活品質之探討 110
第三節、短期電玩遊戲與生活壓力之探討 112
第四節、短期電玩遊戲與跌倒效能之探討 113
第五節、短期電玩遊戲活動回饋、滿意度與可行性之探討 114
第六章 結論與建議 116
第一節、研究結論 116
第二節、三項研究問題結論 118
第三節、對臨床應用的建議 120
第四節、建議與限制 121
第七章 參考文獻 122
附錄 130
附件一、短期互動式電玩遊戲可行性及成效評估研究問卷 130
附件二、互動式電動遊戲滿意度與可行性之中文版問卷 134
附件三、【心動不如行動】:身心健康活動回饋評量表 135
附件四、台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF)信度分析結果 136
附件五、台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF)內容因素分析 143
附件六、生活壓力問卷(CHQ-12)信度分析 147
附件七、生活壓力問卷(CHQ-12) McNemar Test分析 148
附件八、短式國際跌倒效能量表(Short FES-I)信度分析 161
附件九、互動式電動遊戲滿意度與可行性之中文版問卷信度分析 162
附件十、男性病人生活壓力問卷(CHQ-12) McNemar Test分析 163
附件十一、女性病人生活壓力問卷(CHQ-12) McNemar Test分析 176

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