2015年12月31日
2015年10月13日
近期應用MOHO概念於治療方案之設計中(提昇生活品質方案)，並進行隨機控制試驗之研究成果。
Chen, Y.L., Pan, A.W*.,
Hsiung, P.C., Chung, L., Lai, J.S., Gau, S.S.F., & Chen, T.J. (2015). Life Adaptation Skills Training (LAST) for persons with depression:
A randomized controlled study. Journal of
Affective Disorders, 185, 108-114.
Abstract
Abstract
Abstract
Background: To investigate the efficacy of the “Life Adaptation Skills Training (LAST)” program for persons with depression.
Methods: Sixty-eight subjects
with depressive disorder were recruited from psychiatric outpatient clinics in Taipei city and were randomly assigned to either an intervention group (N=33),
or a control group (N=35). The intervention group received 24-sessions of the LAST
program, as well as phone contact mainly related to support for a total of 24 times. The
control group only received phone contact 24 times. The primary outcome measure utilized was the World Health Organization Quality of
Life-BREF-Taiwan version. Secondary outcome measures included the Occupational
self-assessment, the Mastery scale, the Social support questionnaire, the Beck
anxiety inventory, the Beck depression inventory-II, and the Beck scale for
suicide ideation. The mixed-effects linear model was
applied to analyze the incremental efficacy of the LAST
program, and the partial eta squared (ηp2) was used to examine
the within- and between- group effect size.
Results: The
subjects who participated in the LAST program showed significant incremental improvements
with moderate to large between-group
effect sizes on their level of anxiety (-5.45±2.34, p<0 .05="" span=""> ηp2=0.083) and level of suicidal ideation (-3.09±1.11, p<0 .01="" span=""> ηp2=0.157) when compared to the control group. The
reduction of suicidal ideations had a maintenance effect for three months after
the end of intervention (-3.44±1.09,
p<0 .01="" between-group="" moderate="" span="" with="">effect
sizes (ηp2=0.101). Both groups showed significant improvement on overall QOL, overall
health, physical QOL, psychological QOL, level of anxiety, and level of
depression. The within-group effect sizes achieved large effects in the
intervention group (ηp2=0.328~0.544),
and were larger than that of the control group.
Limitations: A small sample size in the study, a high dropout rate, lower compliance rates
for the intervention group, and lacking of true control group.
Conclusions: The occupation-based LAST program, which focuses on lifestyle rearrangement and coping skills enhancement, could significantly improve the level of
anxiety and suicidal ideations for persons with depression.
2015年1月18日
2015年1月6日
新的應用MOHO於台灣個案之研究成果
應用動機再促進方案於精神分裂症患者之成效研究
王勝輝(台灣大學職能治療研究所碩士論文)
背景及目的：
精神分裂症患者常存在著動機問題，而使其降低職能參與動機，導致較差的功能結果，但職能治療臨床實務上卻缺乏有效且系統性的動機再促進方案。本研究的目的是，根據職能治療學者De las Heras 與Gary Kielhofner等人發展之動機再促進策略，編寫動機再促進團體介入手冊，以應用於精神分裂症患者執行治療性介入，並驗證此動機再促進方案之成效。
方法：
研究者們首先將英文版動機再促進過程手冊翻譯成中文版，並由具精神科職能治療臨床經驗及量表中文化經驗的資深職能治療師協助校稿，以確保中文版之手冊與原版內容相符。作者們依此中文版手冊內之原則，參考臨床精神分裂症患者之活動參與及活動種類，編寫動機再促進團體介入手冊，之後邀請診斷為精神分裂症之個案接受此治療性介入。治療介入前後，受試者填寫自填量表，包括：職能自我評估量表、貝克憂鬱量表第二版中文版、簡式症狀量表，精神科專科醫師評估正性與負性症狀量表，職能治療師評估意志量表、職能治療綜合評量表之工作行為次量表。研究者比較前後測分數，並執行無母數統計法之符號檢定與威克森符號等級檢定及母數統計法之成對樣本t檢定。
結果：
動機再促進團體治療介入手冊在臨床預試及修正後完成，並應用於本研究中，以手冊式方式介入(manualized
approach)。共有10位精神分裂症患者參與研究，年齡介於23到56歲。受試者共接受分別有2次個別操作式活動及6次團體活動的治療性介入，每次50分鐘。受試者的前後測表現，除簡式症狀量表外，在各量表的分數皆有進步。在符號檢定方面，意志量表的進步達統計上之顯著差異。在威克森符號等級檢定方面，意志量表、正性與負性症狀量表之負性量尺及量表總分之進步皆達統計上之顯著差異。在成對樣本T檢定方面，意志量表、正性與負性症狀量表之負性量尺及量表總分、職能自我評估量表之自我能力感部分之進步皆達統計上之顯著差異。
結論：
精神分裂症患者普遍存在有動機問題，但卻缺少以職能治療理論發展的治療介入策略。研究者透過設計具有理論基礎的動機再促進方案，並以手冊式方式進行介入，可促進職能治療介入的標準化，提昇精神職能治療的實證基礎。而研究結果顯示，此方案確實可增加個案的意志表現，增加個案參與職能表現的動機，並改善個案的負性症狀，值得後續進一步研究驗證其在不同族群的適用性。
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