脊髓損傷個案之社會支持程度及相關因素探討

The Study of Social Support Level and Effects in Persons with Spinal Cord Injury

目的：脊髓損傷患者因疾病導致身、心、社會、人際關係面臨重大挑戰，且社會支持常與健康常有重大關聯，本研究旨在探討某醫學中心住院及門診脊髓損傷患者之社會支持程度及相關因素。方法：採橫斷式研究，本研究樣本來自北部某醫學中心神經修復科2003至2010年住院病人資料庫，收案時間為2010年4月16日至10月08日診斷為外傷性脊髓損傷且受傷滿二年以上18~60歲患者，以結構性問卷進行資料收集，共收案108人，研究調查結果以SPSS17.0套裝軟體進行分析，統計方法包括百分比、平均值、標準差及皮爾森相關分析。結果：收案對象之社會支持程度屬中度，四面向支持程度最高為價值觀支持，其次為情感性支持、實質性支持，訊息性支持則為最低。支持以來自朋友及父母、配偶為主，但在實質性支持來源，僱傭則列居第三。性別與價值觀支持有正相關；婚姻狀況、受傷年數、受傷部位、獨立功能程度與實質性支持呈現顯著負相關；就業與訊息性支持呈顯著相關，整體而言，社會支持程度的相關因素與性別、婚姻狀況、受傷年數、受傷部位、獨立功能程度及就業有關。結論：根據研究結果建議：1.住院復健初期必須及早訓練患者的獨立生活功能；2.學校應提供無障礙學習環境或遠距數位教學課程；3.政府應提供多元化免費的職業訓練及諮詢平台；4.多利用病友俱樂部或舉辦支持團體並針對外籍監護工設計執行合適的訓練；5.強化出院準備服務功能，建立院外聯繫網絡，並配合社會福利資源的應用，運用整合性的照護，以增強脊髓損傷患者的社會支持並促進其生活品質。

Objectives: The purpose of this study was to investigate the degree and influence factors of social support on patients with spinal cord injury in a medical center. Method: 108 patients in a medical center in Taiwan, with diagnosed as traumatic spinal cord injury, onset more than two years, and age between 20 to 60 years old were investigated with structural questionnaire for 4 subcategories of social support. Results: The data showed that the social support for our spinal cord injured patients was intermediary. Among the four subcategories of social support, view of values was scored as highest , the emotional support came in second, and the lowest scores were found in both substance support and informational support. The sources of support are primarily from friends, parents, and spouse. However, regarding the substance support , hired care-giver was the third resources. Positive correlation is identified in gender vs. view of values, and negative correlations are found in marital status, length of injury, level of injury, degree of independent functions vs. substance support. Finally, the study found that the employment status is positively correlated with informational support. Conclusions: The results suggest that: 1.) training for functions of independent in ADL is essential in the early stage of inpatient rehabilitation for spinal cord injury, 2.) proper learning environments such as barrier-free facility and remote digital classes need to be provided by school, 3.) free and accessible vocational education, training and consulting platforms are needed after discharge, 4.) patient support groups and foreign care-giver training can be arranged more in the community, 5.) strengthening of the servicing functionality at patient discharge plan, establishing community networking with social welfare resources to integrate patient care so as to improve the social support and quality of life for the patient with spinal cord injury.