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以世界衛生組織障礙評估手冊2.0 (WHODAS 2.0) - 36題版初探台灣成年身心障礙者之失能狀況

Application of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) - 36 item Version to Assess the Disability Status on the Adults with Disabilities in Taiwan - a preliminary study

作者:許昕媛
畢業學校:慈濟大學
出版單位:慈濟大學
核准日期:2012-09-27
類型:Electronic Thesis or Dissertation
權限:Copyright information available at source archive--Tzu Chi University....

中文摘要

背景與動機:台灣身心障礙人口數從2002年約83萬人 (3.69%),持續上升到2012年3月約110萬人 (4.74%)。身心障礙者2012年3月人口增加率23.25 ‰,遠比台灣人口增加率3.17‰高出許多。因應身心障礙人口與需求的上升,需以多元觀點評估身心障礙的失能狀況,才能合理且適切配置有限的資源。世界衛生組織於2010年公佈以ICF為基礎所發展的「世界衛生組織障礙評估手冊2.0 (WHODAS 2.0)」,我國於2012年所實施之身心障礙鑑定新制中,便是以此做為身心障礙成人活動參與之評估內容,這與以醫療模式為主的舊制鑑定有非常大的不同,因此本研究欲了解舊制鑑定中以醫療診斷為主的障別之障礙程度評估,與WHODAS 2.0活動參與之評估結果差異情況。目的: (1)以WHODAS 2.0-36題版評估台灣成年身心障礙者之失能狀況,及影響失能之相關因素 (2)初探視覺障礙、聽覺障礙、聲音語言機能障礙、平衡機能障礙、肢體障礙、顏面損傷、慢性精神病患、頑性癲癇、多重障礙之舊制身心障礙鑑定的障礙程度,與WHODAS 2.0測量嚴重程度,兩者程度差異情況及影響差異之相關因素。研究方法:本研究屬於橫斷式調查研究,研究樣本為台灣地區2011年8月至2012年4月間,參與「國際健康功能與身心障礙分類系統 (ICF) 推動計畫-新制身心障礙鑑定工具試測」計畫的成年身心障礙者共7531人,樣本收集方式為各縣市、各障別人口比例分層隨機及便利取樣。研究材料是該計畫所蒐集之次級資料進行分析。結果:以該工具應用於鑑定新制之信效度良好。WHODAS 2.0能力與表現分數最高的領域為「居家生活」,各領域能力分數皆高於表現分數 (p<0.05),差異最大的領域為「生活自理」。影響失能之正相關因素,包含年齡、工作與就學情況、生活情況、障礙程度等。相較於肢體障礙,失能狀況較嚴重的障別為植物人、多重障礙,嚴重度較輕的是視覺障礙、聽覺障礙、重要器官失去功能、慢性精神病患。本研究多數個案WHODAS 2.0嚴重程度評估結果比原舊制鑑定的障礙程度高,但以障別區分時,多數障別舊制障礙程度與WHODAS 2.0嚴重程度相同之比例較高,而舊制鑑定以醫療診斷為主之聲音語言、肢體、平衡機能障礙及以綜合診斷為主之智能障礙與失智症,皆以WHODAS 2.0評估後嚴重度「較重」的比例較高;但重要器官失去功能者以「較輕」比例較高。影響舊制與WHODAS 2.0嚴重程度差異之相關因素,部分障別以工作及就學情況、居住狀況及障礙程度為變重的影響因子。結論:由WHODAS 2.0評估能夠了解該障別失能特性及領域,因此能針對不同障別之領域需求提供服務,資源有限時可以選擇各障別能力及表現分數差異最大之領域給予協助,能有效改善失能。影響失能的相關因素,除了年齡、性別等無法改變之因子,針對人為可改變因素包含工作就學情況、生活情況等做改善,對身心障礙者的失能是很有幫助的。

英文摘要

Background: There were 3.69% people with disabilitiesin 2002 and rose to 4.74% in March 2012, and the disability population growth ratewas 23.25‰ in March 2012, much higher than total population 3.17‰. People with disabilities and their needs will increase rapidly in the future, so assessing disabled status by multi-dimensional viewpoints is necessary in the limited resources situation. World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was published by WHO in 2010,which developed base on ICF and has been used to assess disability qualifications in 2012.Present study will interpret the difference between two criteria.Objective: (a) Application of WHODAS 2.0-36 items version to assess the disabled status for adults with disabilities in Taiwan, and understand the related factors of disabled status. (b) To explore the disabled status differences between the results of present study and certification by Visual, Hearing Disabilities, intractable seizures et al, about 9 kinds of disabilities in Taiwan. Methods: Present study was a cross-sectional survey study, samples were selected by convenience samplingand stratified samplingbase on disabled proportion of cities and disabled categories, who participated the program of "To Advance the International Classification of Functioning, Disability and Health (ICF)" from August 2011 toMarch 2012 (n=7531). Result: The most serious domain of disability was"Domestic life", and the capacity scores more serious then performance in every domains (p<0.05), especially in"Self-care". The positive associations with disabled status were age, work situation, live situation, disabled level, et al. The generality of cases were no change in disabled status between two criteria expect the Language, Physicaland Balance Disabilities, which were mainly assessed by medical model in past disability assessment system, and the Intellectual Disabilities and Dementia were higher which assessed base on comprehensive assessment in the past.The positive associations with disabled status were work situation, live situation,serious level. Conclusion: Using WHODAS 2.0-36 items version can specifically determine the impairment domains for people with disabilities.


口試委員 - 溫淑惠

口試委員 - 劉燦宏

指導教授 - 嚴嘉楓


 

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