台灣版魁北克輔具使用者滿意度評量於輪椅類輔具使用者之應用

Abstract

輔具結果評量是推展輔具服務的重要依據，而瞭解輔具使用者/消費者之主觀感受是輔具結果評量面向中極為關鍵的一環；台灣版魁北克輔具使用者滿意度評量（The Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology, QUEST-T）即因應以使用者為中心之評量趨勢而發展，成為國內少數專門測量輔具使用滿意度的標準化評量工具。QUEST-T的發展建立是以評量各類型輔具使用者之輔具使用滿意度為導向，然因不同形式之輔具，其滿意度之考量可能有所不同，故QUEST-T對於特定輔具項目之適用性尚待深入探討與驗證，就臨床實務而言，國內輔具使用比率以輪椅類輔具（wheeled mobility device）為大宗，故本研究擬以輪椅類輔具使用者為研究對象，檢視QUEST-T之心理計量特性，包括內部一致性、再測信度與建構效度，並探討其對於本土輪椅類輔具使用者之適用程度。 本研究以QUEST-T為評量工具，以輪椅類輔具使用者（手動輪椅、電動輪椅與電動代步車）為研究對象，收案來源為台北市某身心障礙團體與輔具中心，共計蒐集56份有效問卷，其中33名受訪者於一週後接受再測，結果顯示輔具類、服務類與個人主觀想法類項目之內在一致性Cronbach’s α值分別為.84, .80, .81，組內相關係數ICC各為.85, .83, .88，各題之再測信度加權卡帕值weighted Kappa為.35-.75，與國內原發展者之研究數據水準一致。而探討建構效度之因素分析結果顯示本研究可能受限於樣本數量較少，QUEST-T各類次量表之面向並不明確，仍需後續探討。另使用QUEST-T之總分高低劃分高分組、中間組與低分組，並以Kruskal-Wallis test檢定三組間之差異，再以Mann-Whitney U test經Bonferroni adjustment檢定兩組別於各題項滿意度分數之差異，結果顯示QUEST-T具有區辨高與低滿意度族群之敏感性。 本研究之結果驗證QUEST-T之心理計量特性可適用於輪椅類輔具使用者，並揭示輪椅使用者對於輔具使用的特殊考量，強調安全性、耐用度與維修服務之重要。然QUEST-T各面向之關係與建構尚未釐清有待探究，且服務類之題項再測信度強度較為薄弱，題目之內容說明可再加以修訂，對於次量表之運用則宜謹慎。

Outcome measures of assistive technology have been increasing emphasized by related professions, and considered as an important basis of assistive technology service. Moreover, subjective perception such as user/consumer satisfaction is the critical part of assistive technology outcome measurement. The Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology（QUEST-T）was hence developed under the trend of client-centered approach. QUEST-T is one of the few standardized instruments specific to measure satisfaction with the broad range of assistive technology devices（ATD）in Taiwan. However, it is questioned that different types of ATD might be with different considerations about satisfaction; the applicability of QUEST-T for measuring specific type of ATD still needs to be investigated. In Taiwan, wheeled mobility devices（WMD）is the type of ATD used with largest proportion of people with disabilities. So it is necessary to evaluate user satisfaction with WMD. The purpose of the current study is to examine the psychometric properties of QUEST-T including internal consistency, test-retest reliability, construct validity, and its applicability for people using WMD including manual wheelchair, power wheelchair and scooter. Fifty-six subjects were recruited from two centers of assistive technology and two disability organizations in Taipei. Among them, thirty-three participants were re-administered QUEST-T in a week by the same interviewer (an occupational therapist) for exploring the test-retest reliability. The results showed that the internal consistency of the device subscale, service subscale, and personal attitude toward ATD use subscale is acceptable (Cronbach’s α. .84, .80, .81, respectively). These subscales also achieved good test-retest reliability (ICC .85, .83, .88, respectively). For item level, the test-retest stability of items with weighted Kappa ranged from .37 to .75. The findings are consistent with previous study of QUEST-T. However, exploratory factor analysis in this study didn’t agree the construct of the QUEST-T with three dimensions due to the small sample size, and further study will be needed. Furthermore, subjects were divided into three groups: high, middle and low satisfaction by QUEST-T total scores. Kruskal-Wallis test was used to compare groups’ satisfaction differences in item performance, and then Mann-Whitney U test with Bonferroni adjustment was used to discriminate which two groups are significantly different in satisfaction. The result revealed that the QUEST-T is sensitive to identify high and low satisfaction groups. The results of this study confirm the psychometric properties and applicability of QUEST-T in people using WMD. Some special considerations about WMD usage in Taiwan were proposed, too. People using WMD in Taiwan addressed safety, durability and repair service of their WMD usage. Nevertheless, the three dimensional construct of the QUEST-T wasn’t confirmed in this study due to small sample size, and still required to be investigated. The test-retest reliability of the service subscale is weaker than the other subscales. It suggests that wording of the QUEST-T items could be revised in the future, and using subscales simply for assessing satisfaction should be with caution.