臺灣博碩士論文加值系統

目的：針對台中縣新社鄉65歲以上的老人，執行一年的太極拳社區介入，觀察太極村跌傷發生率，有無顯著改變，及太極村跌傷發生率的改變量與對照村跌傷發生率的改變量有無差異，並探討各組的平衡能力、步態與害怕跌倒程度，於介入後的改變。方法：本研究設計採前後（before and after）與同步對照（simultaneous controls）混合，利用立意取樣選取六個村，將其分為太極村與對照村，從2002年8月到2003年7月，以楊氏太極拳十三式進行介入，並在六村張貼預防跌倒海報。資料收集包括：(1)基線測量：於2001年8月採用結構式問卷進行第一次面對面訪視。(2)追蹤訪視：分別在2002年與2003年8月進行第二次及第三次的面對面訪視。(3)跌倒電話追蹤：自2001年8月至2003年8月，每位老人共8次電話追蹤。(4)跌倒就醫記錄：從新社鄉及鄰近地區之醫療院所收集2001年8月至2003年8月新社鄉老人跌傷的就醫記錄。(5)太極拳參與狀況：於每次團體練習後記錄練習者出席狀況。本研究利用波以松回歸（Poisson regression）來評估太極拳社區介入對跌傷發生率的效應，並以概括估計法（generalized estimating equations, GEE）調整同一位老人重複測量的非獨立性；另外，利用一般線性混合模式（general linear mixed model）分析平衡能力、步態及害怕跌倒程度等於介入後的改變。結果：太極村及對照村的跌傷發生率均有顯著下降，但發生率的改變量，並無統計上的顯著差異。太極村及對照村的平衡能力、步態及害怕跌倒程度均不受社區介入影響，但介入後，太極拳練習者的平衡與步態較對照村明顯進步。結論：太極拳的社區介入並不足以有效降低未練習太極拳老人的跌傷發生率及害怕跌倒程度，也無法提升未練習者的平衡能力與步態，但對練習者的平衡能力與步態是有益處的。

Purposes: This study was to observe whether the incidence rate of injurious falls in tai chi village was significantly change or not, and whether the changes of the incidence rates of injurious falls between tai chi village and control village were significant different or not after a one-year Tai Chi community intervention trial was conducted among people aged 65 years or older in Shin-Sher Township, Taichung County, Taiwan. Evaluate the effects of time and intervention in fear of falling, balance, and mobility function. Methods: The study design was a combination of before and after and simultaneous controls. We conducted Tai Chi 13 postures of Yang style from August 2002 to July 2003. The data collections include: (1) baseline interview: personal face to face interview in August 2001. (2) follow-up interview: two times personal face to face interview separately in August 2002 and 2003. (3) follow-up with telephone: 8 times per order person in total from August 2001 to August 2003. (4) records of fall-related medical treatments: collected in clinics and hospitals around Shin-Sher Township from August 2001 to August 2003. (5)Attendance for Tai Chi practice: took down the attendance after group practicing. The Poisson regression model with GEE (generalized estimating equations) approach was used to investigate the effects associated with Tai Chi Chuan. The general linear mixed model was used to investigate the effects of time and intervention in fear of falling, balance and gaits. Result: Both of the incidence rates of injurious falls in Tai Chi village and control village were significantly decreased. The changes of the incidence rates of falls between Tai Chi village and control village were not significant different. There were no effects of intervention in fear of falling, balance and gaits in tai chi village or control village. But, the balance and gaits of tai chi practitioners were significantly improved. Conclusion: The Tai Chi community intervention may not effectively reduce the incidence rate of injurious falls and fear of falling, but, it improved the balance and gait among tai chi practitioners.

中文摘要……………………………………………………………..……..I
英文摘要…………………………………………………………………....II
文目錄………………………………………………………………………Ⅳ
圖表目錄…………………………………………………………………....V
文? 目? 錄
第一章 緒論
? 第一節?研究緣起……………………………………………………1
? 第二節?研究目的……………………………………………………3
? 第三節?文獻探討……………………………………………………4
第二章 研究方法
第一節?研究設計……………………………………………………6
第二節 研究架構……………………………………………………9
? 第三節?研究假設……………………………………………………10
? 第四節?研究對象及資料收集………………………………………11
? 第五節?介入計劃之執行……………………………………………14
? 第六節?統計方法……………………………………………………15
第三章 研究結果
第一節?研究對象基本資料之描述…………………………………16
第二節?跌傷發生率之描述與多變項分析…………………………20
第三節?平衡能力之描述與多變項分析……………………………23
第四節?步態之描述與多變項分析…………………………………24
第五節?害怕跌倒程度之描述與多變項分析………………………25
第六節?電話追蹤訪談與醫療院所收案之跌傷趨勢比較…………26
第七節?太極拳參與狀況之描述……………………………………27
第四章?討論………………………………………………………………28
第五章?結論與建議………………………………………………………31
參考文獻……………………………………………………………………32
附錄…………………………………………………………………………52
圖 表 目 錄
圖2-1 研究測量圖…………………………………………………….……6
圖2-2 研究流程圖…………………………………………………….……7
圖2-3 研究架構……………………………………………………….……8
圖一 介入前後運動量之變化…………………………..………….……39
圖二 介入前後跌傷發生率之變化……………………..………….……40
圖三 介入前後電話追蹤訪談與醫療院所收案之跌傷趨勢……………41
表一 太極村、練習者與對照村基線測量時的基本資料比較……………42
表二 是否完整完成八次電話訪談為依變項之邏輯斯迴歸分析…………44
表三 介入前後每千人年跌傷發生率與改變量……………………………45
表四 跌傷發生率為依變項之波以松迴歸分析……………………………47
表五 介入前後Tinetti平衡檢測、Tinetti步態檢測與害怕跌倒程度的改變....48
表六 線性混合模式分析的結果：Tinetti 平衡檢測、Tinetti 步態檢測與
害怕跌倒程度的相差危險性（RD）和95%信賴區間（CI）……………50
表七 介入期間太極拳練習者12個月的參與率…………………………51

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