近年來因為醫學的進步，脊髓損傷的死亡率已大為減少，預期壽命逐年增加。如何利用復健提升脊髓損傷病患的生活品質及幫助他們融入社區，促進就業是目前面對的重要課題。
當脊髓損傷病患身體狀況穩定時，就該儘速開始住院復健計畫，藉由各項復健活動來提昇患者的生理機能、避免併發症的發生。脊髓損傷的復健團隊，包括復健科醫師，物理治療師，職能治療師，語言治療師等。由復健科醫師負責評估病人的狀況，規劃復建計畫及復建目標，並統合其他專業治療人士之介入。脊髓損傷的目的為促進病人肢體功能的恢復，增加日常生活的自我照顧能力，進而提昇生活品質。雖然復健是脊髓損傷患者康復的重要一環，但是脊髓損傷相關復健資源使用的研究卻很少。
本研究利用全民健康保險資料庫，將2002年至2007年的承保抽樣歸人檔中選取創傷性脊髓損傷的患者。再利用Andersen 第一階段健康服務利用行為模式，分析創傷性脊髓損傷的患者住院復健治療的使用率，次數與費用，並建立預測的迴歸模型。
本研究對象共737人，其中利用住院復健治療達213人，占所有個案的28.9%。接受復健治療的病患當中接受物理治療207名(97.2%)，接受職能治療121名(56.8%)，接受語言治療5名(2.3%)。住院期間平均接受復健的次數為22.9次，接受物理治療的平均次數為15.05次，接受職能治療的平均次數為14.45次，接受語言治療的平均次數為2.8次。復健平均費用為11474元。復健費用占總住院醫療費用的比例平均為8.24%。影響住院復健利用比率的因素包括性別、受傷部位、合併創傷部位、脊椎手術、受傷原因、醫院權屬別、醫院層級、分區別及部份負擔。
平均復健次數及費用以醫院層級做比較，由高至低分別為醫學中心、區域醫院、地區醫院。若以醫院權屬別做比較，公立醫院及財團法人醫院高於私人醫院。此外本研究也發現接受脊椎手術及免部份負擔的病患的平均復健次數及平均復健費用皆明顯高於無接受脊椎手術和需部份負擔的病患。
利用邏輯斯迴歸預測是否利用復健的因子，統計上有顯著差異且能夠有效預測模型的因子包括受傷部位，脊椎手術，受傷原因，醫院層級，部分負擔。再利用複迴歸預測復健治療使用次數與使用費用的因子，以下幾個為統計上有顯著差異且能夠有效預測模型的因子。使用費用：脊椎手術、醫院層級、部份負擔(adjusted R2=0.199)。使用次數：脊椎手術、醫院權屬別、部份負擔(adjusted R2=0.123)。
本研究發現影響台灣創傷性脊髓損傷復健利用的因素外，還發現復健利用率及費用明顯偏低，可能造成部分的病患並沒有獲得必要及足夠的復健療程，希望藉由這個研究結果提供醫療主管機關制定政策及分配醫療資源的參考。

Because of medical advances, the survival and life expectancy of people suffering from spinal cord injury has continued to improve in recent years. Helping patients with spinal cord injury enhance quality of life, and integrate into the community as well as promoting employment through rehabilitation is critical.
Once a patient with spinal cord injury is in stable condition, inpatient rehabilitation comprising various rehabilitation activities should begin to improve the patient's physiological functions and prevent complications. A rehabilitation team for spinal cord injury includes physiatrists, physiotherapists, occupational therapists and speech therapists. Physiatrists are responsible for assessing the patient's condition, planning rehabilitation program, and integrating other professionals. Rehabilitating for spinal cord injuries can promote the recovery of limbs, improve the daily life of self-care, and enhance the quality of life. Although rehabilitating patients with spinal cord injury is crucial, the research on rehabilitation use is rare.
In this study, we used data from patients with traumatic spinal cord injury derived from a sampled registry of beneficiaries in National Health Insurance Research Database, from 2002 to 2007. According to the first phase Andersen’s behavioral model of health services, we analyzed the usage rates, therapy sessions, and rehabilitation costs, and established a predictive regression model.
We enrolled 737 patients with traumatic spinal cord injury. Among these patients, 213(28.9%) used inpatient rehabilitation services. Among the patients who used rehabilitation, 207 patients (97.2%) received physical therapy, 121 patients (56.8%) received occupational therapy, 5 patients (2.3%) receiving speech therapy. During hospitalization, the median number of therapy sessions was 22.9, the median number of physical therapy sessions was 15.05, and the median number of occupational therapy sessions was 14.45,and the median number of speech therapy sessions was 2.8. The median cost of rehabilitation was NTD$ 11,474.The inpatient rehabilitation expenses to total medical expenses ratio averaged 8.24% .The factors that affected inpatient rehabilitation usage rate were gender, injury sites, associated injuries, spinal surgery, causes of injury, hospital ownership, hospital accreditation level, hospital location and co-payment.
According to the average treatment sessions and fee, medical centers provide more services than metropolitan hospitals do and metropolitan hospitals provide more services than community hospitals do. Regarding hospital ownership, public hospitals and corporate hospitals provide more services than private hospitals. In addition, this study determined that patients who underwent spinal surgery and were exempt from co-payment had higher therapy session and rehabilitation costs than those who did not undergoing spinal surgery and required co-payment.
The logistic regression result indicated that rehabilitation was significantly related to the injured sites, causes of injury, hospital accreditation level, and co-payment. The multiple regression result indicated that the following factors significantly predicted the numbers of therapy sessions and the rehabilitation fee. Rehabilitation fee: spinal surgery, hospital accreditation level, and co-payment. (Adjusted R2 = 0.199).Numbers of therapy sessions: spinal surgery, hospitals ownership, and co-payment. (Adjusted R2 = 0.123).
This study investigated the factors that affect rehabilitation utilization for traumatic spinal cord injury in Taiwan and determined that rehabilitation utilization and rehabilitation costs were low. This is possibly why some patients did not receive the necessary or received inadequate rehabilitation. The result can provide a reference for medical authorities to formulate policies and allocate medical resources.

論文審定書------------------------------------------------------i
誌謝 ---------------------------------------------------------- ii
中文摘要 -------------------------------------------------------iii
英文摘要 -------------------------------------------------------v
目錄 -----------------------------------------------------------vii
圖次 -----------------------------------------------------------ix
表次 -----------------------------------------------------------x
第一章 緒論 --------------------------------------------------- 1
第一節 研究背景---------------------------------------------- 1
第二節 研究動機 --------------------------------------------- 2
第三節 研究目的 --------------------------------------------- 3
第二章 文獻探討 ----------------------------------------------- 4
第一節 脊髓損傷的流行病學概況-------------------------------- 4
第二節 脊髓損傷的分類及功能障礙------------------------------ 7
第三節 創傷性脊髓損傷的復健及成效---------------------------- 10
第四節 脊髓損傷患者的醫療及復健資源利用---------------------- 15
第三章 研究材料與方法 ----------------------------------------- 26
第一節 研究架構 ----------------------------------------------26
第二節 研究假設 ----------------------------------------------29
第三節 研究資料來源---------------------------------------29
第四節 研究對象---------------------------------------------- 31
第五節 研究變項操作型定義-------------------------------------32
第六節 資料處理及分析---------------------------------------- 35
第四章 研究分析與結果 --------------------------------------------- 40
第一節 描述性統計分析-------------------------------------------- 40
第二節 推論性統計分析-------------------------------------------- 44
第三節 影響創傷性脊髓損傷患者利用復健之相關因素預測模式------ 56
第五章 討論 --------------------------------------------------- 61
第一節 台灣創傷性脊髓損傷患者住院復健利用的探討-------------- 61
第二節 假說驗證-----------------------------------------------67
第三節 研究貢獻-----------------------------------------------69
第四節 研究限制 --------------------------------------------- 70
第五節 研究建議 ----------------------------------------------71
參考文獻 -------------------------------------------------------72

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