桌遊訓練對慢性精神疾病患者影響之研究

Abstract

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 leadingcauses 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.