脊椎手術後固定装具装着をした患者の入院中の日常生活動作における体験の明確化

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  • Experience in Activities of Daily Living during Hospitalization of Patients wearing Immobilizing Braces after Spine Surgery

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Purpose：Experience in activities of daily living during hospitalization of patients wearing spine immobilization braces were examined to obtain suggestions for daily living assistance for spine surgery patients.　Methods：An interview survey of 18 hospital in-patients，aged ≥ 50 years，who had undergone cervical spine or lumbar surgery and were wearing a spine immobilization brace，was conducted using a semi-structured interview method．The interviews were conducted 2–3 days before the patients were scheduled to be discharged from the hospital，and the data were analyzed with reference to the summarizing content analysis of Mayring．　Results：The experiences in activities of daily living during hospitalization of patients wearingcervical spine immobilization braces were divided into 8 categories：adherence to contraindicated positions accompanying cervical rest，visual field restriction when wearing a collar，movement restrictions accompanying cervical rest，difficulty with eating movements when wearing a collar，burden and feeling of security in wearing a collar，caution when using a walking aid，postoperative effects on the body ，and support in activities of daily living ．In patients wearinglumbar spine immobilization braces，the 8 categories were：adherence to contraindicated positions accompanying lumbar rest，difficulty with eating movements accompanying lumbar rest，burden and feeling of security in wearing a corset，measures to prevent falls when walking，caution when using a walking aid，effects on the body from surgery，modifications in activities of daily living because of contraindicated positions ，and support in activities of daily living ．　Discussion：Patients wearing spine immobilization braces experience many kinds of difficulties in activities of daily living，due to the need for avoidance of contraindicated positions．Patients wearing cervical spine immobilization braces not only had a restricted range of motion in the neck，but also had to contend with restrictions in their visual field and mouth opening，which hindered expansion of their range of activities of daily living．Patients wearing lumbar spine immobilization braces used aids to deal with the difficulties in activities of daily living resulting from the restricted range of motion，and acquired new movements to expand their range of activities of daily living． The challenges faced by patients wearing spine immobilization braces include the need to avoid contraindicated positions and acquiring new daily living activities．For patients to safely expand their activities of daily living，training to predict and avoid danger at an early stage needs to be incorporated into daily living guidance from preadmission.

目　的：脊椎手術患者に対する日常生活支援の示唆を得るために，脊椎固定装具装着患者の入院中の日常生活動作における体験を明らかにすることである。　方　法：頸椎手術・腰椎手術を受け，脊椎固定装具を装着している50 歳以上の成人・老年期にある入院患者18 名を対象に，半構造化面接法による面接調査を実施した。面接時期は退院予定日の2 ～ 3日前とし，データはMayring の要約的内容分析の手法を参考に分析した。　結　果：頸椎固定装具装着患者の入院中の日常生活動作における体験は，【頸部安静に伴う禁忌肢位の遵守】【カラー装着に伴う視野制限】【頸部安静に伴う体動制限】【カラー装着に伴う食事動作の困難感】【カラー装着の負担と安心感】【歩行器を使用するときの注意】【手術後の身体への影響】【日常生活動作のサポート】の8 カテゴリーで構成された。また，腰椎固定装具装着患者では，【腰部安静に伴う禁忌肢位の遵守】【腰部安静に伴う食事動作の困難感】【コルセット装着の負担と安心感】【歩行時に転倒しない対策】【歩行器を使用するときの注意】【手術による身体への影響】【禁忌肢位のための日常生活動作の工夫】【日常生活動作のサポート】の8 カテゴリーで構成された。　考　察：脊椎固定装具装着患者は，禁忌肢位をとらないことを遵守することで，日常生活動作におけるあらゆる困難を体験していた。頸椎固定装具装着患者は頚部の可動域制限に加え，視野制限や開口制限も強いられており，日常生活動作の拡大が阻害されていた。腰椎固定装具装着患者は可動域制限による困難な日常生活動作に対し，補助具を使用したり，新たな動作を獲得することで日常生活動作を拡大していた。脊椎固定装具装着患者の課題は，禁忌肢位をとらないことの遵守と新たな日常生活動作の獲得である。患者が安全に日常生活動作を拡大していくためには，危険を早期に予測し回避するトレーニングを，入院前からの日常生活指導に取り入れていくことが必要である。

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identifier:AA12746582-20170331-19

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