Journal of Taiwan Occupational Therapy Research and Practice
類風濕性關節炎(Rheumatoid arthritis, RA)是一種常見於影響個人生理功能、心理健康和生活品質之慢性發炎性的關節疾病。根據調查，「提供矯具」占職能治療師處理類風濕性關節炎所有介入手法之27%。RA個案基於自覺疼痛感改善和操作便利等因素，傾向使用彈性纖維材質之腕部矯具。然而腕部矯具使用率偏低之問題長久以來未獲改善。本文檢索Medline, CINAHL, PubMed等電子資料庫中1995至2010年發表之文獻，再透過「輔具滿意度模式」所提出之八項輔具面向探討RA個案使用腕部矯具之使用現況，期以瞭解腕部矯具低使用率之影響因素。本研究結果顯示，在使用效益方面，腕部矯具的使用可使RA個案腕部疼痛獲得顯著改善，但在增進肌力與精細動作表現方面則沒有一致的結果。然而是否需要「腕部動作」和是否需要「費力抓握」等活動特徵與使用效益有密切相關。此外，尺寸大小、調整便利性、易用性、和安全性等輔具特徵皆獲得RA個案正面評價；需改善之特徵有：耐用性和舒適性。因此，本文根據輔具特徵之結果提出兩點建議：(1)透過關節保護之行為教育計畫教導RA個案穿戴腕部矯具參與「需要」腕部動作的活動和「不需要」費力抓握的活動之行為技巧，以改善腕部矯具之使用效益；(2)未來可就通用設計原則進行設計，以改善腕部矯具之耐用性和舒適性。期望本文可提供職能治療師輔具專業服務之參考。
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may significantly affect an individual's physical function, mental health, and his/her quality of life. Results from previous studies indicated that "providing orthoses" was the second most common treatment (27%) used by occupational therapists for individuals with RA. Individuals with RA tended to favor the elastic fabric materials wrist orthosis with respect to pain relief and handling of orthosis. However, the problem of the low utility rate of wrist orthosis has been ignored in the past. In this research, articles published during 1995 to 2010 were searched from electronic databases including Medline, CINAHL, and PubMed. The researchers then applied eight key dimensions in the "Satisfaction with Assistive Technology Model" to investigate current status of utilization of wrist orthosis and possible reasons of its low utility rate among individuals with RA. As for the effectiveness of wrist orthosis, studies demonstrated that patients' wrist pain was alleviated significantly after the intervention. However, there was no consistent finding on patients' muscle strength and fine motor performance. Features such as "task requires a static or mobile wrist" and "task requires power grip" were significantly related to the effectiveness of using wrist orthosis. Individuals with RA were positive on "dimensions", "adjustments", "simplicity of use", and "safety" of wrist orthosis. However, their "durability" and "comfort" were in need of improvement. Suggestions were made according to key satisfaction dimensions: (1) education-behavioral joint protection program can be used to teach patients' skills on "task requires a static or mobile wrist" and "task that not requires power grip" when wearing wrist orthosis and to improve the effectiveness of wrist orthosis; (2)future research should focus on universal design principles to improve "durability" and "comfort" of wrist orthosis. Finally, the content of this paper would provide occupational therapist with information on assistive technology service delivery.