團體遊戲式活動於慢性精神病人之健康成效探討

Abstract

背景：慢性精神病人受疾病慢性化影響，身體健康質量、活動力、參與動機都相當減損，且病人也常有情緒不穩定之困擾，人際互動能力亦較一般族群差，整體生活品質相當不佳。近年遊戲科技發展迅速，以活動為設計目的活動型體感遊戲可具感官回饋及趣味性，對身體健康有正向助益。過去研究有樣本數少、退出率高、參與率低等限制，且遊戲介入多僅以單一受試者與遊戲中虛擬角色互動，若能透過團體活動與分組競賽提升動機，讓成員彼此激勵，有可能改善參與率，因而提高成效。過去甚少此類研究，因此本研究主要目的是以慢性精神病人為對象，探討團體遊戲式活動對改善病人生理、心理健康及生活品質之成效。 方法：於北部一家醫學中心精神科日間留院病房採隨機分派方式將慢性精神病人分配到實驗組或對照組，另於北部四間全日型精神康復之家，以機構為單位隨機分派各兩家為實驗組或對照組。所有納入之精神疾病敝人於基準期（pre-program, T1）與介入後的後測評量（post-program, T2）進行評量，評量內容包含身體量測、體能評估及結構性問卷。實驗組受試者接受12週、每週2次，共22次、每次一小時的團體式遊戲活動介入，介入活動以團體遊戲競賽的設計為主，以活動型體感遊戲機的硬體與軟體設備為輔，每名實驗組受試者遊戲時間均會全程參與遊戲活動；對照組受試者則接受原先各機構原有之常規照護。 結果：共納入109位受試者完成前測收案，實驗組55人及對照組54人，思覺失調症類群為最普遍之診斷，12週團體遊戲介入後103位完成後測，流失率5.5%。12週後測發現實驗組在身體質量指標均優於對照組，體重下降0.79 ± 1.97公斤，對照組上升0.14 ± 1.87公斤（p=0.016）；身體質量指數BMI下降0.29 ± 0.70，對照組則上升0.07 ± 0.69（p=0.011）；腰圍下降1.94 ± 3.98，對照組則上升0.40 ± 3.46（p=0.002）；平均臀圍下降2.41 ± 2.71公分，對照組則下降0.07 ± 2.26（p<0.001）。在身體活動度四項指標上，實驗組亦顯著優於對照組，10公尺正常行走下降0.29 ± 0.68秒，對照組上升0.14 ± 0.62秒（p=0.001）；10公尺快速行走下降0.17 ± 0.54秒，對照組上升0.25 ± 0.57秒（p<0.001）；起身走3公尺減少0.47 ± 1.40秒，對照組增加0.54 ± 1.09秒（p<0.001）；實驗組平均後測坐站5次秒數下降0.98 ± 1.75秒，對照組上升0.10 ± 1.54秒（p=0.001）。12週後測並未發現兩組間憂鬱情緒變化存在組間顯著差異（實驗組-1.51 ± 4.04分，對照組 -1.33 ± 6.74分，p=0.874）；於生活品質方面，兩組於多面向均無差異，僅在「環境範疇」面向總分變化存在組間顯著差異（實驗組降低0.64 ± 1.54分），而對照組增加0.31 ± 2.38分（p=0.017）。實驗組受試者對此介入活動的回饋顯示，在最高為五分的滿意度中，平均分數為平均分數3.65至4.02分。 結論：團體遊戲式活動對體重、BMI、腰圍、臀圍及身體活動能力具顯著成效，團體競賽設計並搭配活動型體感遊戲確實能提升活動動機，降低研究退出率。實驗組因正向經歷，在非介入時間亦能增加運動頻率，建議未來日間留院或是全日型康復之家，均可多設計團體活動式介入，運用體感遊戲機輔助運動介入活動，促進慢性精神病人之身心健康。本研究發現實驗組受試者於後測表示對環境範疇的生活品質滿意度下降，尤其在醫療保健方便性、生活資訊方便感受及從事休閒活動機會等方面生活品質降低最多，值得長期追蹤或質性訪談研究探討影響因素，並加以改善。

Background: Patients with chronic psychiatric disorders face reduced physical health, activity levels, and participation motivation due to the chronic nature of their conditions. They often experience emotional instability and poor interpersonal interactions, resulting in a low quality of life. Recent advancements in game technology, specifically activity-based interactive games, offer sensory feedback and enjoyment, positively impacting physical health. However, previous studies have been limited by small sample sizes, high dropout rates, and low participation. These studies primarily involved single participants interacting with virtual characters. This study investigates the effectiveness of group game-based activities and team competitions to enhance motivation and participation, thereby improving chronic psychiatric patients' physical and mental health and quality of life. Methods: Chronic psychiatric patients at a northern Taiwan medical center's psychiatric day care unit were randomly assigned to either an experimental or control group. Four full-day psychiatric rehabilitation homes were randomized, with two homes in each group. Assessments were conducted at baseline (T1) and post-intervention (T2), including physical measurements, fitness evaluations, and structured questionnaires. The experimental group participated in a 12-week intervention, with group-based game activities held twice weekly for 22 one-hour sessions, utilizing activity-based interactive somatosensory games. The control group received standard care from their respective institutions. Results: A total of 109 participants completed the pre-test, with 55 in the experimental group and 54 in the control group, predominantly diagnosed with schizophrenia spectrum disorders. After the 12-week group game intervention, 103 participants completed the post-test, with a dropout rate of 5.5%. Post-test results showed that the experimental group had better physical health outcomes than the control group. Weight decreased by 0.79 ± 1.97 kg in the experimental group but increased by 0.14 ± 1.87 kg in the control group (p=0.016). BMI decreased by 0.29 ± 0.70 in the experimental group and increased by 0.07 ± 0.69 in the control group (p=0.011). Waist circumference decreased by 1.94 ± 3.98 cm in the experimental group and increased by 0.40 ± 3.46 cm in the control group (p=0.002). Hip circumference decreased by 2.41 ± 2.71 cm in the experimental group and by 0.07 ± 2.26 cm in the control group (p<0.001). In terms of physical activity, the experimental group also showed significant improvements: 10-meter standard walk time decreased by 0.29 ± 0.68 seconds (control group increased by 0.14 ± 0.62 seconds, p=0.001); 10-meter fast walk time decreased by 0.17 ± 0.54 seconds (control group increased by 0.25 ± 0.57 seconds, p<0.001); 3-meter get-up-and-go time decreased by 0.47 ± 1.40 seconds (control group increased by 0.54 ± 1.09 seconds, p<0.001); and the sit-to-stand five times test decreased by 0.98 ± 1.75 seconds (control group increased by 0.10 ± 1.54 seconds, p=0.001). No significant differences were found between the groups regarding changes in depression scores (experimental group: -1.51 ± 4.04, control group: -1.33 ± 6.74, p=0.874) or overall quality of life, except for the "environment" domain, where the experimental group decreased by 0.64 ± 1.54 points, and the control group increased by 0.31 ± 2.38 points (p=0.017). Feedback from the experimental group on the intervention activities indicated an average satisfaction score between 3.65 and 4.02 out of 5. Conclusion: Group-based game activities have significantly benefited weight, BMI, waist circumference, hip circumference, and physical activity abilities. The design of group competitions, combined with activity-based interactive games, effectively enhances motivation and reduces dropout rates. Due to positive experiences, the experimental group increased their exercise frequency even outside the intervention sessions. It is recommended that the institutions (psychiatric day care unit or full-day rehabilitation homes) incorporate more group activities using interactive game devices to promote the physical and mental health of chronic psychiatric patients. This study found that post-intervention, the experimental group reported decreased satisfaction with the quality of life in the environmental domain, particularly regarding the convenience of healthcare, access to life information, and opportunities for leisure activities. These areas warrant long-term follow-ups or qualitative research to explore influencing factors and make improvements.