臺灣博碩士論文加值系統

跌倒在老人族群是常見的問題，台灣老人跌倒盛行率約29.2%，曾跌倒過之老人在心理上會害怕再次跌倒，而減少活動量，造成日常活動能力下降，生活品質下降，因而產生焦慮和憂鬱等症狀。研究顯示長期規則運動和安全環境是預防老人跌倒較為有效的策略，但鮮少研究探討老人長期執行運動的遵從性，及長期執行太極拳運動對預防老人跌倒之實證研究；因此，本研究目的有二：1. 探討跌倒老人執行太極拳運動的遵從性；2.探討跌倒老人執行「太極拳運動訓練方案」對預防老人再跌倒及改善其憂鬱程度、害怕跌倒、認知功能、日常活動功能和生活品質之成效。本研究採實驗研究設計，以方便選樣方式，選取北部某二家教學醫院因跌倒進入急診室就醫的老人為研究對象，採用區塊隨機分配，將研究對象隨機分派至實驗組及對照組，每組各99位。實驗組介入「太極拳運動訓練方案」，方案包括：1.太極拳教練每週至老人家中或鄰近公園進行1次一對一60分鐘太極拳運動教學；2.老人每週需自行練習至少3次，每次至少30分鐘，為期6個月。 研究人員於介入前、介入3個月、介入6個月和介入結束後第12個月，至老人家中以訪談方式進行6個結構式問卷（量表）之資料收集，並於全程18個月中，每週1次電訪關懷跌倒老人身體狀況、跌倒情形與運動執行情形。以SPSS 20.0版進行資料處理與分析，包含描述性統計及推論性統計。研究結果發現：(一)、跌倒老人執行太極拳運動的遵從性在方案介入期間為59.6%，介入結束後之第12個月為31.2%; (二)、在方案介入6個月期間，實驗組沒有發生跌倒的機率是控制組的2.4倍(OR 2.4，95%CI 1.28-4.54，P=0.007)；整個研究期間，實驗組在跌倒率比對照組減少42%(OR 0.58，P=0.01)；方案介入三個月，實驗組於害怕跌倒及憂鬱程度之改善程度均較對照組佳(P<0.05)；整個研究18個月期間，實驗組於日常活動功能、認知功能、健康相關生活品質之社會層面之改善程度均較對照組高(P<0.05)。本研究可增加醫護人員了解跌倒老人對執行太極拳運動的遵從性，及太極拳運動對預防老人跌倒及改善老人身心健康之成效，本研究介入方案可提供社區老人活動中心和安養機構規劃太極拳運動課程之參考。

Falls are common in elderly population. The prevalence rate of falls among the elderly in Taiwan was around 29%. The elderly fallers fear of falling again and tend to reduce their activity, resulting in decreased ability of daily living, decreased quality of life, and inducing anxiety and depression. The literature shows that long-term regular exercise and safe environment are the most effective strategies for preventing fall in the elderly. However, few studies had investigated the compliance of long-term executive exercise, nor has any empirical study implemented a long-term Tai Chi exercise program on preventing falls among the elderly fallers. Therefore, the purposes of the study were: 1. to explore the compliance of doing Tai Chi exercise among the elderly fallers; 2. to investigate the effects of doing Tai Chi exercise on preventing fall and improving depression, fear of fall, the cognitive function, the activity of daily living and the quality of life among the elderly fallers. This study used a randomized controlled trial with convenience sampling study design. The elderly fallers were recruited through the ER of two hospitals in northern Taiwan. The participants were randomized in blocks of eight into experimental and control group with 99 elderly in each group. The intervention “Tai Chi exercise training program” in experimental group includes: 1. a Tai Chi coach taught a 60 minutes of Tai Chi exercise lesson once a week at the elderly home or the park; 2. the elderly had to practice a 30 minutes of Tai Chi exercise at least 3 times a week for 6 months. The researchers conducted both groups’ data collection using 6 structured questionnaires at four separate time points, once before the intervention started, once after the intervention implemented 3 months, and 6 months, and once after the intervention finished 12 months. The researcher also make weekly phone call to both groups to check the elderly’s physical and exercise condition for a total of 18 months period. The data was analyzed with SPSS version 20.0 including descriptive statistics and inferential statistics. The results showed that: 1. The compliance rate of doing Tai Chi exercise among the experimental group was 59.6% during the 6 months intervention stage and 31.2% at 12 months post intervention; 2. The risk of non-falling of the experimental group was 2.4 times compare with the control group during the 6-month intervention stages (OR 2.4, 95%CI 1.28-4.54, P=0.007). The degree of improvement on fearing of fall and depression among the experimental group was better than those of the control group at the intervention implemented 3 months (P<0.05). The degree of improvement on daily living activity, cognitive function and social-domain of health-related quality of life among the experimental group was better than that of the control group during the 18 months period (P <0.05). The results of this study might help the health care workers to understand the compliance of doing Tai Chi exercise among the elderly fallers and the effects of doing Tai Chi exercise on preventing of falls, improving the physical and psychological health among the fall elderly. This study may be used as a reference for developing a tai chi exercise program for prevention falls among the elderly in community centers and health institutions.

目　　次

中文摘要 …………………………………………………………………………… i
英文摘要 …………………………………………………………………………… ii
目次 ………………………………………………………………………………… iv
表次 ………………………………………………………………………………… vi
圖次 ………………………………………………………………………………… vii
第一章 緒論
第一節 研究背景與動機 …………………………………………… 1
第二節 問題陳述………… ……………………………………………………… 3
第三節 研究的重要性 ………………………………………………… 4
第四節 研究目的 ……………………………………………………………… 5
第五節 研究問題 ………………………………………………………………… 5
第六節 研究假設 ………………………………………………………………… 5
第七節 名詞界定 …………………………………………………………… 6
第二章 文獻探討
第一節 老人跌倒盛行率與危險因子 ………………………… 9
第二節 跌倒對老人的影響 …………………………………………… 11
第三節 預防跌倒介入措施之相關研究 ……………………… 19
第四節 太極拳運動及其理論 …………………………………… 21
第五節 太極拳運動預防老人跌倒之相關研究 ……… 22
第三章 研究方法
第一節 研究設計 ………………………………………………………………… 33
第二節 研究架構 ………………………………………………………………… 35
第三節 研究場所與對象 …………………………………………… 35
第四節 研究測量工具 ……………………………………………… 37
第五節 介入措施說明 ………………………………………………… 41
第六節 研究步驟與資料收集過程 ……………………………… 42
第七節 資料處理與分析 ……………………………………………… 44
第八節 倫理考量………………………………………………………………… 45
第四章 研究結果
第一節 比較實驗組與對照組介入前之基本屬性資料及相關健康指標為同質
性之檢定 …… …………………………………………………… 47
第二節 太極拳運動訓練方案介入的遵從性與預防再跌倒之成效 ………… 52
第三節 太極拳運動訓練方案對老人的害怕跌倒、憂鬱程度、日常活動功能、
認知功能及健康相關生活品質的成效 …………………………… 60
第五章 討論
第一節 跌倒老人執行太極拳運動訓練方案的遵從性與預防再跌倒之成效 … 79
第二節 太極拳運動訓練方案對跌倒老人的日常活動功能、害怕跌倒、憂鬱程
度、認知功能及健康相關生活品質的成效 ………………………… … 83
第六章 結論與建議
第一節 結論 ……………………………………………………………………… 91
第二節 建議 …………………………………………………………… 92
第三節 研究限制 …………………………………………………… 93
參考文獻
中文部分 ………………………………………………………………………… 95
外文部分 ………………………………………………………………………… 99
附錄
附錄一 人體試驗倫理委員會IRB同意書 ……………… 112
附錄二 區塊隨機分派表 …………………………………………… 114
附錄三　研究對象基本資料 ………………………………… 116
附錄四　簡式心智狀態測驗 ……………………………… 119
附錄五　日常活動功能 ……………………………… 120
附錄六　老人憂鬱量表 ………………………… 121
附錄七　短式國際跌倒效能量表 ………… ……… 122
附錄八　世界衛生組織生活品質問卷台灣簡明版 123
附錄九 問卷使用同意書 ………………………………………… 126
附錄十 介入太極圖示 ………………………………………… 127

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