影響冠狀動脈繞道術後病患參與復健運動之因素探討

Factors Influencing the Participation of Post Coronary Artery Bypass Patients in Cardiac Rehabilitation Exercise

背景：心臟復健運動可改善冠狀動脈繞道術後病人生活品質。台灣復健參與率於13年間（1996年61.9%至2009年70.1%）卻僅上升8.2%；相關的影響因素缺乏本土實證資料，對有效提升參與率形成限制，因此，亟需深入探討。目的：探討影響冠狀動脈繞道術後個案參與復健運動之相關因素。方法：本研究為橫斷性、相關性研究，選取南部某醫學中心接受冠狀動脈繞道手術之253位個案為研究對象，主要研究工具為「個案復健運動經驗問卷」、「台灣版SF-36健康評估量表」與「影響參與復健運動方案因素調查表」，並以SPSS 19.0 for Windows進行統計分析。結果：病患參與術後復健運動與否，和醫護人員提供復健運動相關資訊、就醫方便性、生理健康狀態、術後有無復健運動習慣等呈顯著性差異。再以二元邏輯迴歸分析發現有接受復健運動相關訊息、覺得復健運動是重要的、術後有運動習慣和是否參與復健運動等因素，於參與術後復健運動可能性分別是沒有參與者的112倍、7.86倍及3.23倍，且整體正確預測率為90.1%。結論／實務應用：應強化醫護人員對術後復健運動訊息提供之重視，於病人術前早期介入，以有效協助個案早日回復術後的生活功能。

Background: Studies have shown that cardiovascular rehabilitation exercise improves quality of life in post-coronary-bypass-surgery patients. However, the rate of participation in this exercise by this patient group in Taiwan has increased only 8.2% during the past 13 years (from 61.9% in 1996 to 70.1% in 2009). Little is known about the factors that influence patient motivation to participate in cardiovascular rehabilitation exercise.Purpose: This study explores the factors that influence patient participation in rehabilitation exercise following coronary bypass surgery.Methods: This cross-sectional, correlational study recruited a convenience sample of 253 patients who had undergone coronary bypass surgery at a medical center in southern Taiwan. Structured questionnaires, including a patient rehabilitation exercise experience questionnaire, Short Form-36 Health Survey-Taiwan Form, and cardiac rehabilitation exercise design factors questionnaire were used for data collection. SPSS19.0 was used to analyze data.Results: The variables ”healthcare provider recommendation of rehabilitation exercise”, ”exercise program accessibility”, ”physical health status”, and ”patient post-surgical exercise patterns” each had a significant influence on participant participation in post-surgical rehabilitation exercise. Binary logistic regression analyses identified ”receiving information on rehabilitation exercise”, ”level of patient-perceived importance of rehabilitation exercise”, and ”having post-surgical exercise patterns” as important predictors of participation in a rehabilitation exercise program, with OR ratios of 112, 7.86, and 3.23 times respectively. These 3 factors accounted for 90.1% of the total variance.Conclusion: Patient education on coronary bypass post-surgical rehabilitation exercise programs should be emphasized during pre-surgical consultation and care in order to facilitate the recovery of normal life functions following coronary bypass surgery.