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系統識別號 U0026-2701201411422300
論文名稱(中文) 燒燙傷後的功能結果
論文名稱(英文) Functional Outcome after Burn Injury
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 102
學期 1
出版年 103
研究生(中文) 黃于芳
研究生(英文) Yu-Fang Hwang
學號 TA8941110
學位類別 博士
語文別 英文
論文頁數 102頁
口試委員 指導教授-施陳美津
召集委員-陳琮琳
召集委員-蘇純瑩
口試委員-謝俊昇
口試委員-張哲豪
中文關鍵字 燒燙傷  手部  指縫楔形墊  重返工作  心理計量  信度  效度  生活品質 
英文關鍵字 Burn  Hand  Web Space Pressure Inserts  Return-to-Work  Psychometric  Reliability  Validity  Quality of Life 
學科別分類
中文摘要 本論文係有關燒燙傷後的功能結果研究,主要內容可分為四部分:(1) 探討指縫楔形墊對燒燙傷後指縫斜坡的功效,(2) 探討手部燒燙傷病患重返工作及工作調適的影響因素, (3)台灣燒燙傷健康量表精簡版之心理計量,及(4)燒燙傷後的生活品質。
指縫疤痕的形成不只有美觀的問題,還可能造成手功能喪失。指縫楔形墊已被用來治療燒燙傷後指縫斜坡角度的升高,為探討其功效,我們讓手部燒傷患者於壓力手套內每個指縫間嵌入客製化的指縫楔形墊,目的是為了在指縫產生額外的壓力,以抑制指縫疤痕往遠端遷移而導致的指縫斜坡角度升高。本研究的受試者是來自南部某醫學中心的24位手部燒燙傷患者(燒燙傷手共36隻)。待患者傷口癒合,他們立即接受指縫楔形墊的壓力治療,研究者並定期以關節量角器量測並記錄其指縫斜坡角度。統計方法是以配對t檢定來檢驗治療前後角度之差異;並以獨立t檢定來檢驗最終角度與正常人角度之差異。經過234.6  177.0天的治療,四個指縫斜坡角度確實有統計上顯著地降低(p < 0.001);最重要的發現是,第一個指縫斜坡角度降低至與正常受試者角度無異。根據本研究結果顯示,指縫楔形墊確實有助於改善指縫斜坡角度。
重返工作為手部燒燙傷患者的重要功能結果,為探討這些患者重返工作及工作調整的影響因素,本研究共收集108位患者的人口學、就業及燒燙傷相關資料。我們應用logistic回歸分析來分析結果,在108位患者中,燒燙傷前有工作的患者在傷後較容易擁有工作。針對燒燙傷前已有工作的89位患者而言,其中有77位能重返工作(重返工作率為86%),且受傷前為家庭主要經濟來源者,其重返工作可能性較高;住院較久、雙手或軀幹燒燙傷者,花比較久的時間重返工作;年紀較大或燒燙傷面積較小的患者,其留在原工作的可能性較高。本研究結果顯示,重返工作與否不只和燒燙傷因素有關,也受人口學及就業因素影響。因此,為幫助手部燒燙傷患者回到工作崗位,重返工作計畫的實施是極其必要的。
生活品質已被視為一種燒燙傷患者主觀性功能結果之量測,燒燙傷健康量表即為了量測燒燙傷患者的生活品質所設計。為檢驗台灣燒燙傷健康量表精簡版之心理計量,我們將燒燙傷健康量表精簡版翻譯成中文,並探討其信效度。共有(另一群)108位患者參與此研究,每位患者除了基本人口學及燒燙傷相關資料,還需填寫台灣燒燙傷健康量表精簡版及台灣版SF-36問卷。為檢測台灣燒燙傷健康量表精簡版再測信度,有41位患者填寫此份問卷兩次,除了簡易活動領域外,再測分數是介於0.74 到0.93間。其他結果顯示:各領域的分數呈現顯著的天花板效應;在內在一致性方面,除人際關係領域外,其餘Cronbach’s alpha 分數都高於 0.70;在效標效度方面,台灣燒燙傷健康量表精簡版及台灣版SF-36問卷在相關領域上呈現中度相關;在區辨效度方面,不同的住院天數及燒燙傷面積在分數上呈現顯著的差異。整體而言,台灣燒燙傷健康量表精簡版的信效度表現還算不錯,在未來,更精簡的版本將有助於更有效地量測台灣燒燙傷患者的生活品質。
台灣燒燙傷健康量表精簡版乃為量測台灣燒燙傷病人生活品質所設計之問卷,其優點是較能反映出燒燙傷的特殊性,缺點是所得之結果無法與一般族群或其他種病患比較。所幸台灣版SF-36問卷乃一般生活品質問卷,可適用於一般族群或各類疾病患者,且台灣版常模已建立,可將燒傷患者填寫結果與之比較。結果發現,本研究的燒燙傷患者在台灣燒燙傷健康量表精簡版之大部分領域,都能適應良好,唯與燒燙傷相關以及工作領域表現稍差。與台灣版SF-36問卷常模比較,我們的燒燙傷患者在生理功能領域有三項、心裡功能領域有一項,分數低於常模。此結果顯示,即便燒燙傷多年,生理功能仍受到某種程度的影響。
燒燙傷後的恢復牽扯到多樣且複雜因素,瞭解這些因素能幫助醫護人員訂定治療目標及其優先順序。台灣燒燙傷健康量表精簡版為量測台灣燒燙傷病人生活品質所設計之問卷,未來研究可據此來找出影響灣燒燙傷病人生活品質的因素。

英文摘要 This dissertation concerns the functional outcome after burn injury. The main contents can be divided into four parts: (1) the investigation on the effectiveness of web space pressure inserts for post-burn dorsal slant, (2) the study on the factors related to return to work and work modification in patients with hand burns, (3) the validation of a Taiwanese version of the Burn Specific Health Scale-Brief, and (4) the quality of life after burn injury.
Web space scar formation not only faces burn patients with cosmetic issues, but it also may result in hand dysfunction. The web space pressure insert has been one of the treatment modalities for post-burn dorsal slant. To investigate the effectiveness of the modality, an individualized custom-made web space pressure insert was fitted into each web space. Inserts were worn underneath the pressure glove to create additional pressure on each web space and to inhibit distal migration of the scar to avoid the increase in the angle of the dorsal slant of the web space. Twenty-four survivors with 36 burned hands, who had been treated in the burn clinic of National Cheng Kung University Hospital, were recruited for this study. When skin wounds were closed, the participants received custom-made web space pressure inserts. The dorsal slant of each web space was measured by a conventional goniometer every time the participants visited the burn clinic. The initial and final measurements were used to compare the change in the angle of the dorsal slant of the web space. Paired t-tests were computed to determine the effectiveness of pressure inserts. The final dorsal slant angle of each web space was also compared with the unburned value by independent t-test. After 234.6  177.0 days of intervention, the mean dorsal slants of 36 dorsal burn hands’ four web spaces were all significantly reduced (P < 0.001). The most important finding was that the angle of the first dorsal slant could be improved to normal. A custom-made web space pressure insert could be used to improve postburn dorsal slant.
Return to work is an important functional outcome for patients suffering from hand burn injury. To study the factors related to return to work and work modification in patients with hand burns, we collected demographic and burn-related data from patient charts and analyzed it to determine the work status of former patients with burned hands and what influenced their returning to work. From 284 former patients with burns, we screened 159 with burned hands, 108 of whom were interviewed through the telephone about their work status. We used logistic regression analysis to analyze factors for having work, returning to work, the length of time required to return to work, and job modifications. We found that (1) having preburn employment increased the likelihood of having postburn employment; (2) being the primary wage earner in a family increased the likelihood of having work and of a return to work postburn; (3) a longer stay in the hospital, and burn injuries on both hands and trunk increased the time required to return to work; and (4) being older and having a smaller percentage of total body burn area decreased the likelihood of returning to a job modified because of a burn injury. Returning to work was affected not only by burn-related factors but also by general demographic and employment factors. We urge occupational therapy departments to include a return-to-work program in their routine services to improve the chances of patients with hand burns to return to work. We strongly recommend that a multicenter prospective study of hand-burn injuries should be performed.
Quality of life (QoL) has been regarded as a subjective measure of functional outcome for burn survivors. The Burn Specific Health Scale (BSHS) was designed to determine QoL among burn survivors. For the validation of a Taiwanese version of the Burn Specific Health Scale-Brief (BSHS-B-Taiwanese), we translated the brief version of the Burn Specific Health Scale (BSHS-B) into traditional Chinese (Taiwanese) and to evaluate its psychometric properties in order to measure quality of life of burn patients in Taiwan. The BSHS-B-Taiwanese was translated and reviewed by an expert committee. Patients were invited to participate in this study while they visited the outpatient burn clinic. Another one hundred and eight burn patients participated in this study by filling out the BSHS-B-Taiwanese and SF-36 Taiwanese version. Forty-one of 108 patients completed a retest on the BSHS-B-Taiwanese. A ceiling effect was found for psychosocial functioning and all domains of the BSHS-B-Taiwanese. Internal consistency shown by Cronbach’s alpha was all above 0.70 except for the interpersonal relationships domain. Of these, Cronbach’s alpha  0.9 was found in the work, heat sensitivity and body image domains. Test-retest reliabilities ranged from 0.74 to 0.93 except for the simple activity domain. As for the criterion validity, most of the BSHS-B-Taiwanese version was shown to have fair to moderate correlations with the SF-36-Taiwanese in corresponding domains. The discriminant validity of the BSHS-B-Taiwanese was demonstrated by significant score differences in several domains between subgroups of different severity regarding length of hospital stay and TBSA. Our finding suggests that the BSHS-B-Taiwanese is generally reliable and valid. A shorter version of BSHS-B-Taiwanese together with a generic instrument, such as SF-36, can be used to measure the QoL of burn patients in Taiwan.
Although the BSHS-B-Taiwanese is intended to reflect the impact of burn injury on the QoL, the results derived from this instrument cannot be generalized for comparison with the general population or other conditions. The SF-36 is a generic outcome measure designed for a board range of population and allows comparison to be made. To capture the full pictures of the QoL post-burn, we report data from the use of the BSHS-B-Taiwanese and the SF-36-Taiwanese.Also, a comparison with norm was made by SF-36. The findings showed that our patients adapted well after their burn injury in most of domains of the BSHS-B-Taiwanese. However, burn-related and work domains were found to be lower than 0.8. There were 3 domains in Physical Composite Scale (PCS), and 1 domain in Mental Composite Scale (MCS) lower than SF-36-Taiwanese norm. This indicated the physical function was still affected to some extent by burn injury, even many years post burn.
The process of recovery post-burn has involved a complex interaction among psychological, social and physical factors. Understanding the factors does help burn professionals to identify priorities and goal of burn care. The BSHS-B-Taiwanese has been constructed to describe l quality of life after burn injury Future study will attempt to identify which factors predict quality of life after burn injury measured by BSHS-B-Taiwanese.
論文目次 Table of Contents
Abstract………………………………………………………………………………………………………………………………………I
Abstract in Chinese…………………………………………………………………………………………………………V
Acknowledgement……………………………………………………………………………………………………………VIII
Table of Contents……………………………………………………………………………………………………………IX
List of Tables…………………………………………………………………………………………………………………XII
List of Figures………………………………………………………………………………………………………………XIV

Chapter 1 General Introduction……………………………………………………………………………1
1.1 Brief Introduction…………………………………………………………………………………………………1
1.2 Motivation………………………………………………………………………………………………………………………4
1.3 References………………………………………………………………………………………………………………………5

Chapter 2 Effectiveness of Web Space Pressure Inserts for Post-Burn Dorsal Slant…………………………………………………………………………………………………9
2.1 Introduction…………………………………………………………………………………………………………………9
2.2 Materials and methods………………………………………………………………………………………10
2.3 Results……………………………………………………………………………………………………………………………13
2.4 Discussion……………………………………………………………………………………………………………………13
2.5 Conclusion……………………………………………………………………………………………………………………15
2.6 References……………………………………………………………………………………………………………………16
2.7 Appendix…………………………………………………………………………………………………………………………24

Chapter 3 Factors Related to Return to Work and Work Modification in Patients with Hand Burns………………………………………………25
3.1 Introduction…………………………………………………………………………………………………………………………25
3.2 Methods……………………………………………………………………………………………………………………………27
3.3 Results……………………………………………………………………………………………………………………………28
3.4 Discussion……………………………………………………………………………………………………………………31
3.5 Conclusion……………………………………………………………………………………………………………………38
3.6 References……………………………………………………………………………………………………………………39
3.7 Appendix…………………………………………………………………………………………………………………………45

Chapter 4 Validation of a Taiwanese version of the Burn Specific Health Scale-Brief…………………………………………………………………………………47
4.1 Introduction…………………………………………………………………………………………………………………………47
4.2 Methods……………………………………………………………………………………………………………………………48
4.3 Results……………………………………………………………………………………………………………………………52
4.4 Discussion……………………………………………………………………………………………………………………53
4.5 Conclusion……………………………………………………………………………………………………………………58
4.6 References……………………………………………………………………………………………………………………59
4.7 Appendix…………………………………………………………………………………………………………………………69

Chapter 5 Quality of Life in Patients with Burn Injury…………79
5.1 Introduction…………………………………………………………………………………………………………………………79
5.2 Methods……………………………………………………………………………………………………………………………80
5.3 Results……………………………………………………………………………………………………………………………83
5.4 Discussion……………………………………………………………………………………………………………………83
5.5 Conclusion……………………………………………………………………………………………………………………84
5.6 References……………………………………………………………………………………………………………………85

Chapter 6 Future Work: Factors Related to Quality of Life after Burn Injury……………………………………………………………………………………………………………90

REFERENCES………………………………………………………………………………………………………………………………93
Curriculum Vitae……………………………………………………………………………………………………………102
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