中文版重返工作準備度量表運用於台灣工作強化中心職災勞工之再測信度與反應性

Abstract

背景：Franche等學者發展之重返工作準備度量表(Readiness for Return-To-Work Scale, RRTW量表)，包含意圖前期、意圖期、評估準備期、行為準備期等四向度，強調個人動機因素是行為改變關鍵，用以評量個案是否具備重返工作之信心，目前位於哪一重返工作改變階段，進而協助臨床人員發展個別化、以階段為基礎之服務。 目的：探討RRTW量表之尚未重返工作子量表的再測信度，及職災勞工在工作強化介入下該量表之反應性。 方法：進行一前瞻性世代研究，採多中心模式，於台灣北中南三處工作強化中心徵收接受職業重建計畫服務之職災勞工。除了施測RRTW量表，同時以一般性自我效能量表(General Self-Efficacy Scale)與抬重指數(Lifting index)作為外在反應性的參照指標。於受試者進入計畫的第一週進行所有評估工具之前測；隔一週實施RRTW量表之再測；最後於結案當週進行所有評估工具之後測。資料統計方面，計算ICC值(Intraclass Correlation Coefficient)代表再測信度。內在反應性方面，進行Wilcoxon檢定，並計算Cohen’s d與SRM (Standardized response mean)效果值，以及樣本中分數進步量超過MDC (minimal detectable change)之百分比(MDC%)。外在反應性則以Spearman’s ρ與Relative efficiency呈現。 結果：本研究共納入40位職災勞工，其中有24位男性，16位女性；平均年齡為40.1歲，標準差為13.6。再測信度分析納入32名，反應性分析納入39名。結果顯示RRTW量表整體上具有中度-良好之再測信度，意圖前期、意圖期、評估準備期、行為準備期4向度之ICC值分別為0.85、0.69、0.78、0.61。RRTW量表具備可接受之反應性，意圖前期、評估準備期、行為準備期等3向度在工作強化介入後有顯著差異，其中意圖前期與評估準備期有中-大效果量(4向度Cohen’s d為-0.41、-0.04、1.03、0.31)。意圖前期、意圖期尚有可接受的個別層級內在反應性(MDC%為12.82%、33.33%、2.56%、0%)。RRTW量表與一般性自我效能量表(ρ = 0.08 - 0.42)、RRTW與抬舉指數(ρ = 0.03 - 0.22)有小至中等的相關性。Relative efficiency顯示，RRTW之意圖前期、評估準備期、行為準備期比自我效能有較佳的反應性，但抬舉指數比RRTW有較好的反應性。 結論：本研究提供RRTW量表再測信度與反應性證據，使得RRTW量表在臨床或學術上使用更具可信度，且驗證RRTW可作為工作強化中心療效指標之一。

Background: Franche et al. developed the Readiness for Return-To-Work (RRTW) Scale, containing 4 factors— Precontemplation (PC), Contemplation (C), Preparation for action—self-evaluation (PAS), and Preparation for action—behavioral (PAB). The RRTW scale assesses the change stage of readiness for return-to-work. The scale focuses on individual motivation which is regarded as key factor to change. RRTW scale can help practitioner to develop client-centered and stage-based intervention. Purposes: To measure the test-retest reliability and responsiveness of the RRTW scale in lost-time claimants in outpatient occupational rehabilitation in Taiwan. The study only used the section for workers not working of RRTW scale. Methods: We conducted a multi-centered, prospective cohort study in three work hardening centers located in northern, central, southern Taiwan. Lost-time claimants participating the occupational rehabilitation program due to work injury were recruited. Besides RRTW scale, the General Self-Efficacy (GSE) scale and Lifting index were assessed to show as reference measurements for external responsiveness. In pretest, participants finished all assessment in the first week of their work hardening plan. And then, after one week, participants only needed to fill RRTW scale again (retest). In protest, participants finished all assessment in the last week of their work hardening plan. In statistical analysis, we calculated intraclass correlation coefficient (ICC) for test-retest reliability. For internal responsiveness, we conducted Wilcoxon tests, and calculated Cohen’s d, standardized response means (SRM), and the percentages of participants exceeding minimal detectable change (MDC%). For external responsiveness, we calculated Spearman’s ρ and relative efficiency between the RRTW scale and GSE scale or Lifting index. Results: There were 40 participants included in the study, which contains 24 males, and 16 females. The mean age is 40.08 (SD = 13.61). Among them, sample size for test-retest reliability was 32, for responsiveness was 39. The ICC of 4 factors of the RRTW scale is 0.85, 0.69, 0.78, 0.61. The result shows the level of test-retest reliability is moderate to good. The responsiveness of the RRTW scale is acceptable. Statistically significant differences were found in PC, PAS, PAB after work hardening intervention. Cohen’s d were -0.41, -0.04, 1.03, 0.31, which PC had moderate effect size and PAS had large effect size. MDC% were 12.82%, 33.33%, 2.56%, 0%, which means PC and C having acceptable individual level of internal responsiveness. The correlation between RRTW and GSE were small to moderate (ρ = 0.08 - 0.42), and so as the correlation between RRTW and Lifting index (ρ = 0.03 - 0.22). According to relative efficiency, the responsiveness of PC, PAS and PAB were better than GSE, but the responsiveness of Lifting index was better than RRTW. Conclusions: Test-retest reliability and responsiveness of the RRTW scale were partially supported in this study. The results indicate that the RRTW scale is reliable, and improve that RRTW can be one of important outcome measures in occupational rehabilitation program.