第五章 討論與建議
第五節 建議
本研究的建議如下：
一、 促進下半身癱瘓者社會參與，提升其生活品質。FUNDES 7.1 表現面向領域 6 社會參與的失能程度對其生活品質的整體生活品 質與整體健康 2 個獨立層面及生理健康、心理、社會關係與環境 四大範疇皆呈現低至中度的負相關。因此提高下半身癱瘓者的社 會參與，或許可有效的提升其生活品質。此也符合 ICF 的精神，
促進其社會參與，能增進身心健康。
二、 加強對企業主的宣導，以提高下半身癱瘓者族群的就業率。
許多個案往往因為生理因素及環境因素而無法順利就業，即使認 知功能正常，且具備工作能力，仍無法就業。除了給予適合的就 業輔具及職務再設計外，也可對雇主觀念教育，讓他們瞭解個案 具有生產力，只要給與生理限制的體諒及工時上的方便，脊損個 案並不麻煩。且工作對脊髓損傷者而言，除了個人的成就感、社 會的認同，也可提升個案生活滿意度(Targett, 2004；Lidal, 2009)。
三、 未來可考慮以不同的就業定義來收案。下半身癱瘓者受限於 工作機會的缺乏及自覺對生活品質環境範疇上的不滿意，多數個 案仍然處於失業的狀態，需依靠政府及家人經濟上的援助；雖然
益彩券販售，收入並不穩定，且多數個案收入較受傷前少。
四、 下半身癱瘓者自覺對生活品質環境範疇上的不滿意程度會影 響其社會參與及就業，而社會參與及就業可提升脊髓損傷個案的 生活品質；因此勞動部可針對已就業的脊髓損傷個案，調查其工 作相關輔具或職場職務再設計的需求，以提升其工作效能及職業 安全；對於未就業的脊髓損傷個案，職業重建公部門也可考慮與 醫院合作，瞭解其能力及限制，強化個案的優勢能力，媒合適當 的職種，輔以符合其工作需求的輔具、個人助理及職場職務再設 計，使其能穩定就業，並獲得穩定的收入，增加其成就感與自信 心。
五、 未來亦可針對已加入脊髓損傷協會會員與未加入脊髓損傷協 會會員的個案進行生活品質的調查，因多數的脊髓損傷個案並未 加入協會，可探討他們在生活品質上是否有差異？
六、 本研究是以量化方式的晤談及問卷調查法作為研究工具，建 議未來研究加強質的部分，探究更深層的問題癥結，或可發現其 他影響生活品質的中介變項，對提升下半身癱瘓者的生活品有更 多的幫助。
參考文獻
吳明隆(2007)。SPSS 操作與應用：問卷統計分析實務。台北市：五南。
林茂榮、姚開屏、黃景祥、王德榮(1999)。台灣版世界衛生組織生活 品質問卷量尺語詞的選擇。中華公共衛生雜誌，18，262-270。
周俐君、王智弘、姜義村(2009)。脊髓損傷者就業、工作滿意度與生 活品質研究。復健諮商，3，77-103。
社團法人中華民國脊髓損傷者聯合會(2012)。認識脊髓損傷。摘自
http://fsci.org.tw/modules/tinyd0/index.php?id=7
社團法人中華民國脊髓損傷者聯合會(2011)。脊髓損傷者概況分析．
摘自 http://www.fsci.org.tw/hurt.htm
胡月娟(1992)。殘障病人的心理評估。胡月娟、簡淑真、蔡麗絲編著，
復健護理。台北：合記。
姚開屏(2000a)。台灣簡明版世界衛生組織生活品質問卷之發展及使用 手冊（第一版）。台北：行政院國科會。
姚開屏(2000b)。台灣版世界衛生組織生活品質問卷之發展簡介。中 華公共衛生雜誌，19，316-324。
姚開屏(2002a)。健康相關生活品質概念與測量原理之簡介。台灣醫學 雜誌，6，183-192。
姚開屏(2002b)。台灣版世界衛生組織生活品質問卷之發展與應用。
台灣醫學雜誌，6，193-200。
張彧、王顏和、游正芬、鍾智文、王榮德(2000)。以焦點團體方式探
討影響脊髓損傷者生活品質之因素。中華復健醫學雜誌，28， 87-95。
張彧、王顏和、姚開屏、王榮德(2002)。脊髓損傷生活品質問卷之發 展。台灣醫學，6，209-214。
廖華芳、嚴嘉楓、黃靄雯、劉燦宏、張本聖、吳亭芳、呂淑真、紀彣 宙、張光華(2013)。身心障礙鑑定功能量表之運用。台灣醫學，
17，317-331。
廖華芳(主編)(2015)。身心障礙鑑定功能量表 8.0 版操作手冊。衛生福 利部委託勞務計畫。台北市：社團法人台灣國際健康功能與身心 障礙分類系統(ICF)研究協會。
黃子珍(2001)。探討脊髓損傷病患接受神經再生術後之生活品質與獨 立性身體功能。國防醫學院護理研究所碩士論文，未出版，台北 市。
陳姿怡(2003)。世界衛生組織生活品質問卷台灣簡明版、SF-36、標準 賭博法、時間交換法以及評分量尺的比較-以創傷性脊髓損傷患 者為例。臺北醫學大學傷害防治學研究所碩士論文，未出版，台 北市。
莊月玲(2008)。台灣脊髓損傷者福利需求及其生活品質之研究。陽明 大學衛生福利研究所碩士論文，未出版，台北市。
英文文獻
Anderson, C. J., Vogel, L. C., Klaas, S. J. L., & Lubicky, J. P. (1997).
Long term psychosocial outcomes and life satisfaction of patients with pediatric spinal cord injuries. Jounal of Spinal Cord Medicine, 20, 155-162.
Anderson, C. J., & Vogel, L. C. (2003). Domain-specific satisfaction in adults with pediatric-onset spinal cord injuries. Spinal Cord, 41, 684-691.
Bach, J. R., & Tilton, M. C. (1994). Life satisfaction and well-being
measures in ventilator assisted individuals with traumatic tetraplegia.
Archives of Physical Medicine and Rehabilitation, 75, 626-632.
Berkowitz, M. (1998). Spinal Cord Injury : An Analysis of Medical and Social Costs. New York, NY: Demos Medical Publishing.
Blanes, L., Carmagnani, M. I., & Ferreira, L. M. (2007). Health-related quality of life of primary caregivers of persons with paraplegia.
Spinal Cord, 45, 399-403.
Boswell, B. B., Dawson, M., & Heininger, E. (1998). Quality of life as defined by adults with spinal cord injuries. Journal of Rehabilitation, 64, 27-32.
Brolin, D. E. (1995). Career education: A functional life skills approach.
Columbus, OH: Prentice-Hall.
Chapman, H. M., & Kewman, D. G. ( 2001). Factors affecting employment following spinal cord injury: A qualitative study, Rehabilitation Psychology, 46, 400-416.
Clayton, K. S., & Chubon, R. A. (1994). Factors associated with the quality of life of long-term spinal cord injured persons. Archives of Physical Medicine and Rehabilitation, 75, 633-638.
Conroy, L., & McKenna, K. (1999).Vocational outcome following spinal cord injury. Spinal Cord, 37, 624-633.
Cropanzano, R., Rupp, D. E., & Byrne, Z. S. (2003). The relationship to job performance ratings and organizational citizenship behavior.
Journal of Applied Psychology, 88, 160-169.
Cushman, L., & Dijkers, M. (1990). Depressed mood in spinal cord injury patients: Staff perceptions and patient realities. Archives of Physical Medicine and Rehabilitation, 71, 191-196.
Cushman, L.A., & Hassett, J. (1992). Spinal cord injury: 10 and 15 years after. Paraplegia, 30, 690-696.
Diener, E. D., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71-75.
Dijkers M. (1990). Correlates of life satisfaction among persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 80, 867-876.
Dijkers, M. (1997). Quality of life after spinal cord injury: A meta
analysis of the effects of disablement components. Spinal Cord, 35, 829-840.
DeVivo, M. J., Black, K. J., Richards, S., & Stover, S. L. (1991). Suicide following spinal cord injury. Paraplegia, 29, 620-627.
Dorsett, P., & Geraghty, t. (2008). Health- related outcomes of people with spinal cord injury- a 10 year longitudinal study. Spinal Cord, 46, 386-391.
Falvo, D. R. (2009). Condition of the nerve system: Part II spinal cord, Peripheral nervous system, and neuromuscular conditions. In D. R.
Falvo (Ed.), Medical and psychosocial aspects of chronic illness and disability (4th ed., pp. 91-106). Boston: Jones and bartlett.
Fuhrer, M. j., Rintala, D. H., Hart, K. A., Clearmen, R., & Young, M. E.
(1992). Relationship of life satisfaction to impairment, disability, and handicap among person with spinal cord injury living in the community. Archives of Physical Medicine and Rehabilitation, 73, 552-557.
Fuhrer, M. J. (1996). The subjective well-being of people with spinal cord injury: relationship to impairment, Disability and handicap. Top Spinal Cord Injury Rehabilitation, 19, 56-71.
Galvin, L. R., & Godfrey, H. P. D. (2001). The impact of coping on emotional adjustment to spinal cord injury (SCI): Review of the literature and application of a stress appraisal and coping
formulation. Spinal Cord, 39, 615-627.
Gorzkowski, J. A., Kelly, E. H., Klaas, S. J., & Vogel, L. C. (2010). Girls with spinal cord injury: Social and job-related participation and psychosocial outcomes. Rehabilitation Psychology, 55, 58-67.
Jang, Y., Wang, Y. H. & Wang, J. D. (2005). Return to work after spinal cord injury in taiwan: The contribution of functional independence.
Arches Physical and Medicine Rehabilitation. 86, 681-686.
James, M., DeVivo, M. J., & Richards, J. S. (1993). Postinjury
employment outcomes among African-American and white person
with spinal cord injury, Rehabilitation Psychology, 38, 151-164.
Kennedy, P., Lowe, R., Grey, N., & Short, E. (1995). Traumatic spinal cord injury and psychological impact: A cross-sectional analysis of coping strategies. British Journal Clinical Psychology, 34, 627-639.
Kennedy, P., & Rogers, B. A. (2000). Anxiety and depression after spinal cord injury: A longitudinal analysis. Archives of Physical Medicine and Rehabilitation, 81, 932-937.
Kennedy, P., Duff, J., Evans, M., & Beedie, A. (2003). Coping
effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. British Journal Clinical
Psychological Medicine Settings, 12, 93-98.
Kennedy, P., Lude, P. & Taylor, N. (2006). Quality of life, social
participation, appraisals and coping post spinal cord injury: A review of four community samples. Spinal cord, 44, 95-105.
Krause, J. S. (1992). Employment after spinal cord injury, Archives of Physical Medicine and Rehabilitation, 73, 163-169.
Krause, J. S., & Kjorsving, J. M. (1992). Mortality after spinal cord injury:
A four year prospective study. Archives of Physical Medicine and Rehabilitation, 73, 558-563.
Krause, J. S. (1997). Adjustment after spinal cord injury: A 9 year
longitudinal study. Archives of Physical Medicine and Rehabilitation, 78, 651-657.
Krause, J. S. (1998). Dimensions of subjective well-being after spinal cord injury: An empirical analysis by gender and race/ethnicity.
Archives of Physical Medicine and Rehabilitation, 79, 900-909.
Krause, J. S., Sternberg, M., Maides, J., & Lottes, S. ( 1998).
Employment after Spinal Cord Injury: Differences Related to Geographic Region, Gender, and Race. Archives of Physical Medicine and Rehabilitation, 79, 615-624
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159-174.
Lidal, I. B., Hjeltnes, N., Røislien, J., Stanghelle, J. K., &
Biering-Sørensen, F. (2009). Employment of persons with spinal cord lesions injured more than 20 year ago. Disability and
Rehabilitation, 31, 2174-2184.
Lin, M. R., Hwang, H. F., Yu, W. Y., & Chen, C. T. (2009). A prospective study of factors influencing return to work after traumatic spinal cord injury in taiwan. Arches Physical and
Medicine Rehabilitation. 90, 1716-1722.
Livneh, H., & Antonak, R. F. (1997). Psychosocial adaptation to chronic illness and disability. Gaithersburg, MD: Aspen.
Manns, P. J., & Chad, K. E. (1999). Determining the relation between quality of life, handicap, fitness, and physical activity for persons with spinal cord injury. Archives of Physical Medicine and
Rehabilitation, 80, 1566-1571.
May, L. A., & Warren, S. (2002). Measuring quality of life of persons with spinal cord injury: External and structural validity. Spinal Cord, 40, 341-350.
Meeberg, G. M. (2003). Quality of life: A concept analysis. Journal of Advanced Nursing, 18, 32-38.
Noreau, L., Dion, S. A., Vachon, J., Gervais, M., & Laramee, M. T.
(1999). Productivity outcomes of individuals with spinal cord injury.
Spinal Cord, 37, 730-736.
Post, M. W. M., Van Dijk, A. J., Van Asbeck, F. W. A., & Schrijvers, A.
J. P. (1998). Life satisfaction of persons with spinal cord injury compared to a population group. Scandinavian Journal of Rehabilitation Medicine, 30, 23-30.
Putzke, J. D., & Richards, J. S. (2001). Nursing home residence Quality of life among individuals with spinal cord injury. American Journal of Physical and Medical Rehabilitation, 80, 404-409.
Putzke, J. D., Richards, J. S., Hicken, B. L., & DeVivo, M. J. (2002).
Predictors of life satisfaction: A spinal cord injury cohort study.
Archives of Physical Medicine and Rehabilitation, 83, 555-561.
Robnett, R. H., & Gliner, J. A. (1995). Qual-OT: A quality of life assessment tool. Occupational Therapy Journal of Research, 15, 198-214.
Targett, P. S., Wehman, P. H., McKinley, W. O., & Young, C. L. (2004).
Successful work supports for persons with sci: Focus on job retention. Journal of Vocational Rehabilitation, 21, 19-26.
Tomassen, P. C. D., Post, M. W. M., & Asbeck, F. W. A. ( 2000). Return to work after spinal cord injury. Spinal Cord, 38, 51-55.
Trieschmann, R. B. (1988). Integration into the Community. In R. B.
Trieschmann (Ed.), Spinal cord injury: Psychological, Social, and vocational rehabilitation (2nd ed., pp. 147-236). New York: Demos Publications.
Unalan, H., Gençosmanoğlu, B., Akgün, K., Karamehmetoğlu, S., Tuna,
H., Ones, K., Rahimpenah, A., Uzun, E., & Tüzün, F. (2001).
Quality of life of primary caregivers of spinal cord unjury survivors living in the community: Controlled study with short form-36
questionnaire. Spinal Cord, 39, 318-322.
Ville, I., & Ravaud, J. F. (1998). Work values: A comparison of
non-disabled persons with paraplegia. Disability and Rehabilitation.
20, 127-137.
Vogel, L. C., Anderson, C. J., & Klaas, S. J. (1997). Life satisfaction and long-term outcomes of pediatric spinal cord injuries. Jounral of Spinal Cord Medicine, 20, 467-476.
Whiteneck, G. G. (1992). Outcome evaluation and spinal cord injury.
Neurorehabilitation, 2, 31-41.
Whiteneck, G., (1994). Measuring what matters: Key rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 75, 1073-1076.
Whiteneck, G., Meade, M. A., Dijkers, M. Tate, D. G., Bushnik, T., &
Forchheimer, M. B. (2004). Environmental factors and their role in participation and life satisfaction after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 85, 1793-803.
The WHOQOL Group (1994). Development of the WHOQOL: Rationale and current status. International Journal Mental Health, 23, 24-56.
The WHOQOL Group (1995). The world health organization quality of life assessment (WHOQOL): Position paper from the world health organization. Social Science Medicine, 41, 1403-1409.
The WHOQOL Group (1998). Development of the world health organization WHOQOL-BREF quality of life assessment (WHOQOL). Psychological Medicine, 28, 551-558.
World Health Organization. (2010). World Health Organization Disability Assessment Schedule II (WHODAS 2.0). Geneva: World Health Organization.
Wu, M. Y., & Chan, F. (2007). Psychosocial adjustment patterns of persons with spinal cord injury in Taiwan. Disability and Rehabilitation, 29, 1847–1857.
Yasuda, S., Wehman, P., Targett, P., Cifu, D. X., & West, M. (2002).
Return to work after spinal cord injury: A review of recent research.
Neurological Rehabilitation, 17, 177-186.
Zhan, L. (1992). Quality of life: Conceptual and measurement issues.
Journal of Advanced Nursing, 17, 795-800.
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