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系統識別號 U0026-2406201613585500
論文名稱(中文) 慢性期創傷性腦傷患者的患病表徵對其生活品質滿意度之影響-以執行功能為中介變項
論文名稱(英文) Effects of Illness Representations on Quality of Life in Chronic Traumatic Brain Injury:Executive Functions as Mediators
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 104
學期 2
出版年 105
研究生(中文) 林昇賢
研究生(英文) Sheng-Sian Lin
學號 S86021022
學位類別 碩士
語文別 中文
論文頁數 96頁
口試委員 指導教授-郭乃文
口試委員-郭進榮
口試委員-官大紳
中文關鍵字 創傷性腦傷  患病表徵  執行功能  生活品質滿意度 
英文關鍵字 Traumatic Brain Injury  Illness Representations  Executive Function  Quality of Life 
學科別分類
中文摘要 目的:創傷性腦傷(Traumatic Brain Injury,簡稱TBI)易伴隨認知功能障礙與情緒行為困擾。對慢性期TBI患者來說,雖無生命危險性,但卻得面臨復原歷程中行為、情緒及認知的後遺症。過去研究指出TBI患者出現無助益的患病表徵(Illness Representations)時,會有較多的心理社會問題。而TBI患者的執行功能(Executive Function,簡稱EF)受損時,也影響其社會適應與生活品質滿意度。故本研究經由實徵資料之統計分析來討論慢性期TBI患者的患病表徵對生活品質滿意度之影響是否透過執行功能來傳遞。
方法:採臨床樣本之立意取樣法,應用國際疾病分類診斷碼(International Classification of Diseases Ninth Revision, ICD-9)432.1;800-801.9;803-804.9;850-854.19;959.0-959.09; 989.9; 959.9,於南部某醫學中心民國101至103年符合頭部損傷診斷碼之病歷共1441份,再經由逐一病歷閱讀排除非TBI診斷者,剩餘1375份。經確診為TBI患者之資料,則進行病歷資料回溯分析,符合納入本研究者共546人,進行電訪並邀請參與研究。其中有327位受試者願電訪,73位回院參與心理衡鑑,最後完成全部評估者共62位。研究工具,包含電話訪談採用台灣地區勞工職傷後身心健康調查問卷、衡鑑執行功能之神經心理測驗組與自陳式之日常生活執行功能量表、患病表徵問卷及生活品質滿意度問卷。主要採用Baron與Kenny(1986)所提出中介效果檢驗程序,來進行迴歸(regression)分析。

結果:62位TBI中,有18%為中重度,平均年齡為32.69±12.81,創傷後平均月數為20.18±5.12,37位為男性,55位教育程度為高中職以上。以患病表徵與執行功能為預測變項,生活品質滿意度為依變項,先分別進行相關分析,再以達顯著的變項作進一步檢驗,共有27組迴歸分析,結果EF變項在其中21組具中介效果。發現患病表徵中的後果表徵、病程發展表徵及情緒表徵皆透過不同的EF部件影響生理健康、心理、社會關係及環境等生活品質範疇之滿意度。且發現由神經心理衡鑑的EF部件注意力監控對生理健康滿意度之影響性,由自我報告的EF日常行為能力對心理和社會關係滿意度之重要性。

討論:患病表徵大部分是透由EF來影響生活品質滿意度,故在臨床介入上應強化個體之EF,將有利於環境適應與提升生活品質滿意度,上述結果可作為神經心理復健計畫之擬定方向。
英文摘要 The previous researches indicated that TBI patients with unhelpful illness representations was associated with psychosocial burden. Recently, there were study suggested that TBI patients remained executive functions impairments that can affect patient’s cognitive, emotional, behavioral, social function and quality of life. However, there is minimal literature that explicitly addresses the effect of illness representations and executive functions on quality of life. The objective of this study was to investigate the effects of illness representations on quality of life in chronic TBI: executive functions as mediators. Purposive sampling was applied and participants were recruited from a medical center in south Taiwan during 2012 to 2014. Finally, 62 TBI patients agreed assessment. Outcome measures were the Executive Function Tests, Illness Representations Questionnaire, and World Health Organization Quality of Life-BREF Taiwan Version. The Regression Analysis were used to test mediation, Baron and Kenny (1986) proposed a four step approach in which several regression analyses are conducted and significance of the coefficients is examined at each step. Conduct a multiple regression analysis with illness representations and executive functions predicting quality of life. EFs of twenty-one group show mediator effect in twenty-seven group. When the consequences, time-line, and emotion of illness representations predict physical health domain, psychological domain, social relationships domain, and environment domain, Executive functions show mediator effect. Executive functions show mediator effect when illness representations predict quality of life. Future, it is worthy of attention to promote quality of life by improving the executive functions of TBI patients, and this result will provide treatment targets to reduce risk for poor outcome.
論文目次 目錄
第壹章 緒論 1
第一節 研究背景與動機 1
第二節 文獻回顧 3
一、創傷性腦傷 3
(一)創傷性腦傷之定義與概念 3
(二)創傷性腦傷之嚴重度指標 4
(三)創傷性腦傷之後遺症與適應問題 5
二、患病表徵 6
(一)患病表徵之定義與概念 6
(二)患病表徵之評估 8
(三)創傷性腦傷患者之患病表徵 10
(四)患病表徵與生活品質滿意度 11
三、執行功能 11
(一)執行功能之定義與概念 11
(二)創傷性腦傷患者之執行功能受損 13
(三)執行功能與生活品質滿意度 15
四、患病表徵與執行功能 16
第三節 研究目的與假設 17
第貳章 研究方法 19
第一節 研究架構 19
第二節 研究流程 20
第三節 研究對象 22
第四節 研究工具 24
第五節 資料分析 37
第參章 研究結果 38
第一節 人口學變項與受傷時神經學變項分析 38
第二節 患病表徵、執行功能及生活品質滿意度之結果分析 40
第三節 患病表徵、執行功能及生活品質滿意度之相關分析 53
第四節 患病表徵、執行功能及生活品質滿意度之中介效果分析 61
第肆章 討論 75
第一節 研究變項之關聯性 75
第二節 研究限制與建議 79
第三節 研究貢獻與未來展望 81
參考文獻 82
中文部分 82
英文部分 83
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附錄二 台灣簡明版世界衛生組織生活品質滿意度問卷之使用授權同意書96
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