脊髓損傷者自我管理方案成效探討

Examination of the Effectiveness of Self-Management Program for Spinal cord Injury Patients

目的：脊髓損傷會造成完全或部份的肢體活動障礙，個案損傷後需面對多重挑戰，建立疾病自我管理機制，則能增進其對疾病及生活之掌控。主要探討復健病房脊髓損傷個案接受自我管理方案對提升自我效能、自覺健康狀態及預防併發症之成效。方法：本研究採類實驗前後測設計，採立意取樣，以復健病房脊髓損傷個案為研究對象，使用「脊髓損傷者自我管理方案」為介入措施，實驗組在前測後施以脊髓損傷者自我管理方案，對照組則僅予以調查。二組於前測後第十三週進行後測，比較實驗組及對照組之自我效能、自覺健康狀態及併發症數。結果：共45位個案完成此研究，實驗組有22位、對照組23位，研究結果顯示二組在基本資料及疾病特性僅損傷時間呈現顯著差異（Z＝-5.76, p＝0.000），使用廣義估計方程式比較實驗組及對照組於自我管理方案之介入成效，發現二組個案於前測及後測時，自覺健康狀態無顯著差異，實驗組在介入措施後自我效能（p＜0.05）顯著高於對照組、於後測時實驗組個案之併發症數顯著高於對照組。結論：本研究建立之「脊髓損傷者自我管理方案」可做為國內各醫院復健病房及出院準備服務提供脊髓損傷者之教育方案，建議後續研究可增加個案數並對於個案進行更長時間之追蹤。

Purposes: Spinal cord injury (SCI) can lead to complete or partial mobility impairment. SCI patients face many challenges, and establishing disease self-management systems can enable them to control the disease and life. The aim of this study is to evaluate the effectiveness of a self-management program in promoting self-efficacy, perceived health status, and preventing complications in SCI patients. Methods: The study employed a quasi-experimental pretest-posttest design, and purposive sampling was used. SCI patients in the rehabilitation ward were recruited as study participants. The experimental group underwent the self-management program before and after testing, whereas the control group only underwent evaluation. All participants were evaluated on self-efficacy, perceived health status, and the number of complications experienced 13 weeks after the pretest. Results: A total of 45 participants completed this study, of which 22 were from the experimental group and 23 were from the control group. The results showed that only the timing of injury revealed a statistically significant difference between the two groups (Z=-5.76, p=0.000). The generalized estimation equation (GEE) was used to evaluate the effectiveness of the self-management program, and we found that there were no significant differences in perceived health status between pretest and posttest in the two groups. However, in the experimental group, self-efficacy scores were significantly higher than the control group (p<0.05), and the number of complications was higher in the experimental group than the control group at posttest. Conclusions: The SCI self-management program established in this study can provide education protocols for SCI patients from rehabilitation wards in various hospitals in Taiwan. However, we suggest that the number of participants and follow-up duration be increased in future studies.