探討促進下肢矯具使用者使用意願之因素

Abstract

輔具可以補償身障者之身體或感官功能的損傷，增進其日常生活動作之能力與獨立性，而國內目前輔具使用之情形，身障者輔具需求最多者為行動輔具(34%)和上下肢矯具(32.5%)。然而，卻有多數研究結果指出平均約33%的輔具未被使用或是被棄置不用，若輔具不被使用者所接受，則無法發揮其功效。故本研究目的為找出下肢矯具被棄用的原因，以及可提升下肢矯具使用者的使用意願之因素。 本研究結合質性與量化研究方法，首先，招募35位下肢矯具使用者進行深度訪談，由兩位研究人員針對訪談逐字稿以同一編碼原則進行獨立編碼。再利用此編碼資料建立一份新的問卷後，招募63位下肢矯具使用者進行問卷填答，並評估其再測信度。再利用描述性統計分析、單因子變異數分析及相關分析找出影響使用者意願之因素。 當使用者穿戴下肢矯具時，遭遇之使用問題受到矯具類型的影響程度較大，特別是髖膝踝足部支架(Hip-Knee-Ankle-Foot Orthosis, HKAFO)，其主要問題為重量太重及穿戴困難。重量太重(F=12.640；p=0.000)與穿戴困難(F=3.457；p=0.022)皆受到踝足部支架與HKAFO之影響較大。若能針對使用者之功能需求解決問題，則使用者可能更願意使用HKAFO輔助其生活。本研究亦找出使用問題與日常生活動作需求(穿戴下肢矯具後，矯具輔助之日常生活動作)間之相關性，特別是「矯具斷裂」與「一般行走」(r=0.253；p=0.045)。若解決矯具斷裂的問題，則使用者穿戴後不用擔心因矯具斷裂而發生跌倒之風險，以增加其使用意願。此外，使用者之心態亦是影響使用意願之重要因素之一，於交付矯具時，由專業人員與使用者進行良好溝通及詳盡說明，則可能減緩使用者對矯具帶來之功效的期望及使用後產生的落差感，以提高使用者之使用意願。 因此，根據使用者可能面臨之使用問題進行矯具之改良，以及交付矯具時，讓使用者了解矯具之功效與問題，則可能增加使用者對矯具之信賴，以提升使用者之使用意願及矯具之使用效益。

Assistive devices are used to compensate for damages of body parts or sensorimotor functions and to enhance the independence of daily living of individuals with disabilities. The mobility aids (account for 34%) and upper/lower limb orthoses (account for 32.5%) are of the most demand for individuals with disabilities. However, about 33% of assistive devices are underutilized or abandoned. If an assistive device is not acceptable to the user, it will not achieve its efficacy. The aim of this study was to examine factors affecting users’ willingness to use orthoses and enhance the acceptance rate of lower limb orthoses. First, thirty-five lower limb orthosis users were recruited for an in-depth interview. Each interview transcript was coded independently by two researchers following the same coding principles. Then, we employed a coding to establish a new questionnaire. We assessed the internal consistency and test-retest reliability after we collected the questionnaire data with sixty-three lower limb orthosis users. We employed the the descriptive statistical analysis, one-way ANOVA, and Pearson’s correlation coefficient to find out what would influence users’ willingness to use orthoses. Problems of using orthoses are mainly influenced by the type of orthoses. The problems of using Hip-Knee-Ankle-Foot Orthosis (HKAFO) are too heavy and difficulties in putting on the orthoses. If we solve these problems, the users will be more willing to use HKAFO to assist their lives. The problems are also affected by the activities of daily living, especially easily-broken orthoses and normal walking. If we solve this problem, the user will not worry about the risk of fall due to easily-broken orthoses and increase their willingness to use the orthoses. Besides, user's mentality is also an important factor which affects using willingness. Users should have a good communication and detailed explanations by experts so that the orthoses can better fit their expectations. This would increase their willingness to use the orthoses. In conclusion, improving each orthosis depends on the problems which users encountered. Understanding the effectiveness of orthoses and potential problems that may occur when wearing the orthoses through patient education, there can increase users' willingness and the utilization efficiency of the orthoses.