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研究生: 朱健銓
Chu, Chien-Chuan
論文名稱: 桌遊訓練對慢性精神疾病患者影響之研究
A study on the effects of Tabletop Game Training on Patients with chronic mental illness
指導教授: 陳貞夙
Chern, Jen-Suh
口試委員: 孟令夫
Meng, Ling-Fu
王三平
Wang, San-Ping
陳貞夙
Chern, Jen-Suh
口試日期: 2023/10/23
學位類別: 碩士
Master
系所名稱: 復健諮商研究所
Graduate Institute of Rehabilitation Counseling
論文出版年: 2023
畢業學年度: 112
語文別: 中文
論文頁數: 149
中文關鍵詞: 桌遊訓練慢性精神疾病心智功能動作與平衡功能活動參與動機功能性行為
英文關鍵詞: Tabletop game training, chronic mental illness, cognitive functioning, motor and balance function, activity engagement motivation, functional behavior
研究方法: 實驗設計法
DOI URL: http://doi.org/10.6345/NTNU202301818
論文種類: 學術論文
相關次數: 點閱:229下載:38
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  • 慢性精神疾病為21世紀造成失能的前十大主因,在目前台灣的精神醫療模式中,除了用餐、睡覺、盥洗等基本自我照顧之日常生活活動、藥物治療及心理治療外,於精神科病房亦有透過治療性活動來改善慢性精神疾病患者的心智功能、功能性行為、活動參與動機及動作與平衡功能。
    桌遊訓練亦為一種治療性活動,目前大多被運用在第一類智能障礙及失智症長者的治療性活動上,且在部分心智功能及社交技巧方面的改善有所成效,然而卻較少有文獻探討使用桌遊運用在同屬於第一類障礙的慢性精神疾病患者心智功能、功能性行為、活動參與動機及動作與平衡功能的改善狀況。
    本研究採方便取樣(Convenience Sampling)的方式來探討桌遊訓練對慢性精神疾病患者之影響,研究者先從本院精神科醫師轉介之個案依篩選準則選出合格目標族群,共計44名研究參與者,其中實驗組21名,控制組23名。研究參與者於接受訓練前先完成前測,前測完成後實驗組研究參與者除接受一般病房常規訓練活動外,亦同時接受桌遊訓練,控制組則僅參與一般病房常規訓練活動。實驗組之訓練時間為8週,每週3次,每次60分鐘。兩組於訓練完成後,均需接受後測及於3個月後進行追蹤測驗,並將前後測及追蹤測驗結果作統計分析,以探討桌遊訓練對研究參與者之影響。
    研究結果顯示,慢性精神疾病個案參與桌遊訓練後在心智功能、活動參與動機、功能性行為及動作與平衡功能皆有改善。其中,在記憶力、注意力、執行功能、功能性行為(包含:合作與個人表現、工作習慣與品質及社交等)、活動參與動機、起立計時走皆達顯著的改善成效,而參與一般常規訓練活動之慢性精神疾病個案在上述項目亦有部分改善,然改善效果不如實驗組。此外,兩組在功能性伸臂測驗兩組皆呈現退步顯著狀態,但實驗組的退步速度較為緩慢,可能與認知功能有部分明顯改善,有助於功能性伸臂表現維持有關。
    以上結果顯示,桌遊訓練亦可運用在慢性精神疾病患者治療性活動上,以提供較佳之治療成效,維持個案健康及減緩退化。未來,建議後續之研究可以做更廣泛及研究時間更久之收案,使其研究成果能夠推論至其他區域及不同診斷之精神疾病患者,能夠更確認使用桌遊訓練治療團體介入成效。

    Chronic mental illness is one of the top ten leading causes of disability in the 21st century. In the current mental health care model in Taiwan, besides basic self-care activities such as eating, sleeping, and grooming, as well as medication and psychotherapy, therapeutic activities are also used in psychiatric wards to improve the cognitive functioning, functional behavior, activity engagement motivation, and motor and balance function of individuals with chronic mental illness.
    Tabletop game training is one form of therapeutic activity that is primarily used in the treatment of individuals with intellectual disabilities and dementia in the elderly of ICF Category 1. It has shown some effectiveness in improving certain cognitive functions and social skills. However, there is limited literature discussing the use of tabletop games for individuals with chronic mental illness who also fall into the first category of disabilities in terms of cognitive functioning, functional behavior, activity engagement motivation, and motor and balance function.
    The study utilized a convenience sampling approach to investigate the impact of tabletop game training on individuals with chronic mental illnesses. The researchers initially selected a qualified target group based on referral criteria from psychiatrists at the local mental health institution. In total, 44 participants were selected, comprising 21 in the experimental group and 23 in the control group. Participants underwent pre-assessment before training, and after the pre-assessment, those in the experimental group received standard ward training activities along with tabletop game training, while the control group only participated in standard ward training activities. The training duration for the experimental group was 8 weeks, three times a week, for 60 minutes each session. Both groups underwent post-assessment immediately after training and a follow-up assessment after three months to evaluate the impact of tabletop game training on the participants.
    The results of the study indicated that individuals with chronic mental illness who participated in tabletop game training showed improvements in cognitive functioning, activity engagement motivation, functional behavior, and motor and balance function. Significant improvements were observed in areas such as memory, attention, executive functions, functional behavior (including cooperation and personal performance, work habits and quality, and social aspects), activity engagement motivation, and timed up-and-go test. Participants in the control group who engaged in standard training activities also showed some improvement in the aforementioned areas, but the effects were not as significant as those in the experimental group. Additionally, both groups exhibited a significant decline in functional reach test results, but the experimental group experienced a slower rate of decline, which may be related to the noticeable improvement in cognitive functioning and its impact on functional reach performance.
    These findings suggest that tabletop game training can be effectively utilized as a therapeutic activity for individuals with chronic mental illness, providing better treatment outcomes, maintaining the individuals' health, and slowing down their deterioration. Future research is recommended to include a more extensive and longer-term study to extend the findings to different regions and individuals with various psychiatric diagnoses, thereby confirming the effectiveness of tabletop game training in group interventions.

    第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的與問題 8 第三節 名詞解釋 9 第二章 文獻探討 13 第一節 探討慢性精神疾病 13 第二節 桌遊介紹 25 第三節 桌遊訓練的介入成效 29 第三章 研究方法 33 第一節 研究架構與設計 33 第二節 研究參與者與取樣 35 第三節 研究程序 36 第四節 介入訓練方案 38 第五節 資料收集與研究工具 45 第六節 資料處理與統計分析 53 第四章 研究結果 57 第一節 研究參與者之基本資料分析 57 第二節 實驗組及控制組前測分析 61 第三節 桌遊訓練對慢性精神疾病患者心智功能之影響 64 第四節 桌遊訓練對慢性精神疾病患者功能性行為之影響 72 第五節 桌遊訓練對慢性精神疾病患者活動參與動機之影響 77 第六節 桌遊訓練對慢性精神疾病患者動作與平衡功能之影響 79 第七節 心智功能、功能性行為、活動參與動機及動作與平衡功能之相關情形 86 第五章 討論 95 第一節 桌遊訓練對慢性精神疾病患者心智功能之影響 95 第二節 桌遊訓練對慢性精神疾病患者功能性行為之影響 98 第三節 桌遊訓練對慢性精神疾病患者活動參與動機之影響 99 第四節 桌遊訓練對慢性精神疾病患者動作與平衡功能之影響 101 第六章 研究限制與建議 105 參考文獻 108 附錄一 全民健康保險重大傷病證明有效領證統計表 127 附錄二 全民健康保險醫療服務給付項目及支付標準第二章第五節精神醫療治療費 129 附錄三 迷你心智狀態檢查(Mini-Mental State Examination, MMSE) 142 附錄四 中文版意志量表 144 附錄五 慢性精神病患者工作行為量表 145 附錄六 臺北榮民總醫院人體試驗委員會書函 147 附錄七 Turnitin原創性報告 149

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