使用輪椅產生的意外：回溯性研究

Abstract

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.