| 摘要: | 背景:據中華民國脊髓損傷者聯合會2016年發佈的資料，台灣的脊髓損傷人口約23000人左右，且每年新增約1000至1200位案例。脊髓損傷導致感覺、運動和自主神經的損傷，對個人的獨立自主、身體、心理健康和生活方式產生深遠的影響。文獻顯示，脊髓損傷者之生活品質普遍低於一般健康的人，導致生活品質低下之原因包含續發性健康併發症增加、活動受限、社會參與減少等。
目的:探討脊髓損傷者之身體功能改變與工作狀態、居住地、損傷程度及社會福利(生活輔具補助及復康巴士)之相關性。
方法:本研究使用台灣身心障礙資料庫2012年7月至2020年12月資料，研究樣本包含7,627位脊髓損傷者，但兩年追蹤且有追蹤資料者僅1,229位。本研究主要以卡方檢驗、共變異數分析(ANCOVA)、多因子變異數分析及邏輯斯回歸分析探討傷者的工作狀態、居住地、損傷程度及社會福利與身體功能改變之間的關係。
結果:本研究對象大多數是51至70歲之間，男性多於女性，多數脊髓損傷者居住於社區之中(65.7%)，學歷在高中職以下者佔多數(83.1%)，有就業者僅佔5.7%，損傷程度屬於中重度居多(68.2%)。根據卡方檢定顯示，居住於社區組和機構組在居家活動方面有更顯著的進步(P=0.0154)。就業者比未就業者在行動(P=0.0016)、與他人相處(P=0.0048)及居家活動(P=0.0412)這三大面向更為顯著。而損傷程度較低者恢復狀況更勝於損傷嚴重者(P<0.0001)。但是，不論居住於哪個縣市其身體功能改變與輔具補助金額、復康巴士車輛服務人次皆無顯著相關。
結論: WHODAS 2.0 在所有領域的得分在追蹤2年傷者就業組中均低於未就業組。結果顯示WHODAS 2.0 的匯總分數具有很高的準確性(曲線下面積 0.752)。邏輯斯回歸分析發現顯示，標準化WHODAS 2.0 匯總分數低於 52.717 的傷者重返工作崗位的可能性是分數高於52.717的傷者7.09倍(95%信賴區間，3.18 - 15.83；p < 0.0001)，而WHODAS 2.0匯總分數高於42.935分者入住機構的機率是低於等於42.935分者之2.304倍(95%信賴區間，1.736 - 3.059；p < 0.0001)另外，依據傷者之損傷嚴重度而言，入住機構率極重度是輕度的8.071倍(95% 信賴區間，4.775 - 13.642；p < 0.0001);而未就業率重度是輕度的2.938倍(95% 信賴區間，1.49 - 5.794；p < 0.005)。
Background: According to data released by the Spinal Cord Injury Association of the Republic of China in 2016, the population of individuals with spinal cord injuries in Taiwan is approximately 23,000, with an annual increase of around 1,000 to 1,200 new cases. Spinal cord injury results in damage to sensation, movement, and autonomous nervous system, leading to profound effects on individuals' independence, physical and psychological health, and lifestyle. Literature shows that individuals with spinal cord injuries generally have lower quality of life compared to the general population, which can be attributed to increased secondary health complications, restricted activities, and reduced social participation.
Objective: This study aims to explore the correlation between changes in physical functioning of individuals with spinal cord injuries and their employment status, place of residence, injury severity, and social welfare support (assistive devices subsidy and rehabilitation bus service).
Methods: This study utilized data from the Taiwan Disability Database from July 2012 to December 2020, including a sample of 7,627 individuals with spinal cord injuries. However, only 1,229 participants with complete data for a two-year follow-up were included in the analysis. The study employed chi-square tests, analysis of covariance (ANCOVA), multifactor analysis of variance, and logistic regression analysis to investigate the relationship between employment status, place of residence, injury severity, social welfare support, and changes in physical functioning.
Results: The majority of participants in this study were between 51 and 70 years old, with a higher proportion of males than females. Most individuals with spinal cord injuries resided in the community (65.7%), had a high school education or lower (83.1%), and only 5.7% were employed. The majority of injuries were classified as moderate to severe (68.2%). The chi-square test results indicated that the community group showed more significant improvement in home activities compared to the institutional group (P=0.0154). Employed individuals demonstrated more significant improvements in mobility (P=0.0016), interpersonal relationships (P=0.0048), and home activities (P=0.0412) compared to unemployed individuals. Additionally, individuals with lower injury severity showed better recovery outcomes than those with more severe injuries (P<0.0001). However, there were no significant correlations between changes in physical functioning and the amount of assistive devices subsidy or the number of rehabilitation bus service users, regardless of the place of residence.
Conclusion: WHODAS 2.0 scores in all domains were lower in the employed group compared to the unemployed group in the two-year follow-up. The results demonstrated a high accuracy of WHODAS 2.0 total score (area under the curve 0.752). Logistic regression analysis revealed that individuals with a standardized WHODAS 2.0 total score below 52.717 had a 7.095 times higher likelihood (95% confidence interval, 3.18 - 15.83; p < 0.0001) of returning to work compared to those with a score above 52.717. Moreover, individuals with a WHODAS 2.0 total score above 42.935 had a 2.304 times higher probability (95% confidence interval, 1.736 - 3.059; p < 0.0001) of institutionalization compared to those with a score below or equal to 42.935. Furthermore, in terms of injury severity, the rate of institutionalization for individuals with extremely severe injuries was 8.071 times higher (95% confidence interval, 4.775 - 13.642; p < 0.0001), and the rate of unemployment for individuals with severe injuries was 2.938 times higher (95% confidence interval, 1.49 - 5.794; p < 0.005) compared to those with mild injuries. |
