中風患者接受以預防跌倒為目的之居家環境 改造的順從性

Abstract

控制居家環境因子常為預防中風患者跌倒的重要策略，然研究顯示影響居家環境改造成效之最主要相關因子可能是患者的順從性，故本研究目的為探討即將出院返家中風患者居家環境改造的順從性，及影響其順從性的相關因子。 本研究由一位職能治療師到14位甫自台大醫院復健復健部出院之中風患者家中進行居家環境評估及提供改造建議，並蒐集可能影響順從性的相關因子包含有社會人口學變項、住家物理環境特質、家庭照護狀況、過去個人經驗、改造項目特質、病情功能相關因素與患者家屬之環境改造健康信念等資料。一個月後，以電話訪談方式確認順從性。研究資料以SPSS For Windows 15.0版套裝軟體進行建檔及資料分析，以描述性統計進行所有依變項與自變項的描述性分析及使用曼惠特尼U檢定（Mann-Whitney U test）、克-瓦二氏單因子等級變異數分析(Kruskal-Wallis test）及斯皮爾曼等級相關( Spearman’s correlation )檢定上述相關因子與環境改造順從性的相關性。 結果顯示每位患者家中潛在環境障礙與危險因子數目之中位數為9.5(範圍：3∼24)，患者居家常見之潛在環境障礙與危險因子主要集中於浴室、出入口、玄關階梯與臥室等處，其中浴室的潛在環境障礙與危險因子最多。職能治療師提供每個中風患者的改造建議數平均為8.7項，中風患者居家環境改造的整體順從性(實際執行改造的數目/治療師建議的改造數目)為74.0%。實際進行居家環境改造順從性最高的項目多為行為改變，其順從性高達100%；而順從性最低的項目為去除或降低門檻高度(0%)。中風患者居家環境改造的順從性與居家環境改造健康信念之利益性認知、罹患性認知及收入有顯著相關，顯示相信居家環境改造有效者、主觀評估中風患者發生跌倒可能性愈高者、及家庭收入愈高者之居家環境改造順從性越高。 本研究的結果顯示藉由改變行為之環境改造方式普遍可被接受。為增進個案對於環境改造之順從性，可增進民眾對於環境改造之必要性認知，及未來政策制定者可考慮增加補助金額提高民眾的意願，以使居家環境改造發揮其最大的效益。

Home modification was prpoposed as an important strategy to prevent falls among older people who are at increased risk of falling. Previous studies suggested that adherence seems to be a crucial issue with respect to the effectiveness of the home modification. This study examined the adherence of home modification recommendations given by an occupational therapist and attempted to identify correlated factors of the adherence among stroke patients. An experienced occupational therapist visited the homes of 14 stroke patients, who had recently discharged from the rehabilitation ward, identified the environmental hazards, and made recommendations for falls prevention. Other data related to the adherence including the socio-demographic details, housing characteristics, family status, past medical history, modification characteristics, health status, and health belief of home modification of caregiver were collected before the discharge of rehabilitation ward. One month later, a telephone survey was conducted to assess the adherence to each recommendation. Descriptive statistics were calculated for the dependent variable and all independent variables for the sample. Mann-Whitney U test, Kruskal-Wallis test and Spearman’s correlation were used to analyze the correlations between the adherence of home modification and each of the correlated factors. The results showed that there were about 3 to 24 environmental hazards (median 9.5 hazards) presented in each home. The bathroom, entrance and stairs, and bedroom were the commonest sites with environmental hazards, especially the bathroom. An average of 8.7 modification recommendations was made by the occupational therapist. At follow up, the caregivers of the 14 stroke patients reported complying 74.0% of the recommendations given by the occupational therapist. Adherence to specific recommendations varied from a high of 100% adherence, such as behavior modification. However, the recommendation of removing or lowering the stopovers was not adhered at all (0% adherence). Bivariate analysis found that participants’ adherence to home modification was significant correlated to their level of belief that home modification are beneficial, their level of perceived susceptibility to falling, and their incomes. The results showed that behavior modification rather than changing the physical environment was more acceptable for stroke patients. Future educational programs emphasizing the necessity of home modification for preventing fall should be organized in clinics as an effort to improve the adherence of home modification. Besides, policy-maker may consider increasing the reimbursement of home modification to motivate people to make home modification for preventing fall.