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研究生:劉守莊
研究生(外文):Shou Chuang Liu
論文名稱:運動治療對於改善長期照護機構老年人行走速度的成效:統合分析
論文名稱(外文):The Effect of Therapeutic Exercise on Walking Speed of Older Residents in Long Term Care Facilities:Meta-analysis
指導教授:林佩欣林佩欣引用關係
指導教授(外文):P. S. Lin
學位類別:碩士
校院名稱:長庚大學
系所名稱:復健科學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
論文頁數:146
中文關鍵詞:長期照護運動治療行走速度老年人治療成效統合分析
外文關鍵詞:Long Term CareTherapeutic exerciseWalking speedOlder adultseffectsMeta analysis
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研究背景與目的:在人口快速老化且長期照護高齡化的情況下,維持和增進高齡者的日常生活功能也越來越受到重視。其中安置於長照機構的老人,多伴隨有日常功能依賴的情況,行走能力的下降為常見的依賴項目之一,但目前對於運動治療介入在長照機構老人行走速度的成效上,各研究間仍無一致性的結果。基於此類研究樣本較少、個案間差異性大、各研究設計和使用的運動計畫不同的情況下,本研究的目的為利用統合分析的方式,來探討運動治療介入在長照機構老年個案的行走速度的成效。
研究方法: 利用電子資料庫及人工檢索搜尋自1990年到2007年8月與主題相關的出版和未出版的中、英文文獻資料。文獻納入分析的標準為: (1)研究個案需為居住在長照機構的老人(2)至少接受任一項的運動治療(3)研究結果須包含測量行走速度(4)研究設計為隨機控制、臨床控制型實驗或前後測研究。所有資料皆利用固定效益模式(fixed effect model)完成分析,並利用第二版的全面性統合分析(Comprehensive Meta-analysis)軟體進行效益値(Hedges’ adjusted g)、95%信賴區間、Cochran’s Q的同質性檢定、敏感度分析、出版偏差等的計算和樹狀圖的繪製。此外,並利用干擾因素和統合迴歸分析法找出影響因子。
結果 : 共有17篇研究納入分析,在刪除極端值後發現,運動治療介入後可增進長照機構老人的習慣性行走速度(Hedges adjusted g=0.293, 95%CI=0.148~0.439, p<.05, fail safe N=49),但並無法提升快速行走速度(Hedges’ adjusted g=0.065, 95%CI= -0.116 ~ 0.247, p=.480)。敏感度分析也發現即使排除前後測的研究,運動治療仍可增進整體行走速度(Hedges’ adjusted g=0.237, 95%CI= 0.111 ~ 0.362, p<.05, fail safe N=58)。在干擾因素和統合迴歸分析結果發現,個案有無行走能力受損為可能影響運動治療後行走速度效益値提升的因子。
討論與結論 : 運動治療介入可提升長照機構老人習慣性行走速度,而在快速行走速度成效方面,由於目前研究樣本不足,仍需要更多相關研究納入分析才能加以證實其成效。此外,由於各個干擾因素分類不明確和研究成效分佈不均,除了不同的行走能力為可能的干擾因素外,其餘的變項皆不影響運動治療提升行走速度的成效。
Background and Purpose: As the number older adults increases sharply, the needs of long term care (LTC) for them escalates, too. Maintaining and improving activity of daily function in older adults has become an important issue. Decreasing ambulation ability is a major impairment in the LTC older residents. But many studies about the effects of therapeutic exercise on walking speed in long term care older residents reached different conclusions. Due to small sample size, subjects heterogeneity, different in study design and therapeutic exercise programs, we examined the effects of therapeutic exercise on improving walking speed in long term care older residents by using meta-analytical procedures.
Methods: Published and unpublished studies from 1990 to August 2007 were identified by using electronic and manual searches. Inclusion criteria were (1) Elderly lived in long term care facilities, (2) Exercise groups received at least one kind of therapeutic exercise, (3) Outcome measurements included assessment of walking speed, (4) Study designs were randomized control trial, clinical control trial or before-after design. The fixed effect model was used to complete data analysis. The Comprehensive Meta-analysis (V. 2) software was used to calculate the effect size (Hedges’ adjusted g), its 95% confidence interval, the Cochran’s Q for homogeneity, sensitivity analysis, publication bias and to draw the forest plot. Besides, moderator analysis and meta-regression were used to find the influential factors.
Results: A total of 17 studies had been included in the analysis. After excluded extreme data, the results of the meta analysis showed that therapeutic exercise can improve walking speed, especially in habitual walking speed (Hedges’ adjusted g=0.293, 95%CI=0.148~0.439, p<.05, fail safe N=49), but not in fast walking speed (Hedges’ adjusted g=0.065, 95%CI= -0.116 ~ 0.247, p=.480). Sensitivity analysis showed that after excluding 3 before-after studies, the overall effect size did not change significantly (Hedges’ adjusted g=0.237, 95%CI= 0.111 ~ 0.362, p<.05, fail safe N=58). According to moderator and meta-regression analyses, the difference of initial walking ability in older residents was the potential influential factor.
Discussion and Conclusion: The results support that therapeutic exercise can improve walking speed in LTC older residents, especially in habitual walking speed. Due to small sample sizes, we need more evidence to support the effects of therapeutic exercise on fast walking speed. Except for the initial walking ability of older residents, other factors such as facility types, intervention models, exercise programs and exercise volume were not identified as the moderators.
目錄
指導教授推薦書
口試委員審定書
長庚大學博碩士論文著作授權書
誌謝………………………………………………………………………i
中文摘要…………………………………………………………………ii
英文摘要…………………………………………………………………iv
目錄………………………………………………………………………vi
圖表目錄…………………………………………………………………x
第一章 緒論 ……………………………………………………………1
1.1 研究背景………………………………………………………… 1
1.2 研究動機………………………………………………………… 4
1.3 研究目的………………………………………………………… 5
1.4 研究問題………………………………………………………… 6
1.5 研究假設………………………………………………………… 6
1.6 名詞解釋………………………………………………………… 7
第二章 文獻回顧……………………………………………………… 9
2.1 長期照護之概述………………………………………………… 9
2.1.1.長期照護的定義和目標……………………………………… 9
2.1.2長期照護系統及服務範疇………………………………………9
2.1.3長照機構中個案特性……………………………………………10
2.2 行走速度之重要性……………………………………………… 11
2.2.1行走速度與老化之相關研究……………………………………12
2.2.2行走速度對於日常功能及其他預後因子之相關研究…………13
2.3運動治療介入長照機構老人行走速度之運用與成效……………15
2.3.1 運動治療介入的模式及成效………………………………… 16
2.3.2運動治療介入長照機構老人行走速度之成效…………………21
2.3.3運動治療介入不同行走能力個案的成效………………………30
2.4 統合分析的概念與方法………………………………………… 32
2.4.1 統合分析的定義和目的 ………………………………………33
2.4.2 統合分析的步驟 ………………………………………………34
2.4.3其他潛在性問題…………………………………………………41
第三章 研究設計和方法 ………………………………………………49
3.1 研究架構 …………………………………………………………49
3.2 研究樣本的收集 …………………………………………………50
3.3 研究樣本的篩選 …………………………………………………51
3.4 研究樣本品質評析 ………………………………………………53
3.5 研究工具和編碼一致性 …………………………………………53
3.6 資料分析 …………………………………………………………54
3.6.1 效益值的計算 …………………………………………………54
3.6.2 同質性分析 ……………………………………………………57
3.6.3 出版偏差之計算 ………………………………………………57
3.6.4 干擾因素和統合迴歸分析 ……………………………………58
第四章 研究結果 ………………………………………………………60
4.1 資料檢索 …………………………………………………………60
4.2 研究工具和編碼一致性 …………………………………………60
4.3 基本特性 …………………………………………………………60
4.4 研究樣本品質評析 ………………………………………………62
4.5 運動治療介入後在行走速度上的成效 …………………………62
4.5.1 整體效益值 ……………………………………………………62
4.5.2 快速行走速度效益值 …………………………………………64
4.5.3 習慣性行走速度效益值 ………………………………………64
4.6 習慣性行走速度相關的干擾因素和統合迴歸分析結果……… 65
4.6.1 樣本特徵之干擾因素分析結果 ………………………………65
4.6.2介入特徵之干擾因素分析結果 ………………………………66
第五章 討論…………………………………………………………… 95
5.1 資料搜尋和編碼一致性………………………………………… 95
5.2 基本特性………………………………………………………… 98
5.3 樣本同質性………………………………………………………100
5.4 運動治療介入在行走速度上的成效……………………………101
5.4.1運動治療介入在快速行走速度上的成效…………………… 102
5.4.2運動治療介入在習慣性行走速度上的成效………………… 104
5.5 研究限制與建議………………………………………………… 111
5.5.1研究限制…………………………………………………………111
5.5.2研究建議…………………………………………………………112
第六章 結論…………………………………………………………… 114
6.1 結論……………………………………………………………… 114
參考文獻…………………………………………………………………116
附錄………………………………………………………………………121
附錄一、皮卓量表(PEDro Scale)…………………………………121
附錄二:編碼說明……………………………………………………… 122
附錄三、編碼簿………………………………………………………… 125




圖表目錄
圖目錄
圖2-1、損傷與功能之曲線圖 ……………………………………… 44
圗3-1、研究架構圖 ………………………………………………… 59
圗4-1、文獻搜尋和納入之流程圖……………………………………69
圖4-2、未刪除極端值的漏斗圖………………………………………70
圖4-3、調整後整體效益的漏斗圖……………………………………70
圖4-4、調整後整體效益的統合分析結果和樹狀圖 ……………… 71
圖4-5、敏感度分析—扣除三篇前後測研究之分析結果和樹狀圖…72
圖4-6、快速行走速度的分析結果和樹狀圖…………………………73
圖4-7、習慣性行走速度的分析結果和樹狀圖………………………73
圗4-8、習慣性行走速度之統合迴歸分析圖—每週介入時間的長短
………………………………………………………………………… 74
圗4-9、習慣性行走速度之統合迴歸分析圖—介入週期的長短……75
圗4-10、習慣性行走速度之統合迴歸分析圖—總運動介入量的多寡……………………………………………………………………… 76




圖表目錄
表目錄
表2-1、不同介入模式對於行走速度的成效…………………………44
表2-2、不同運動介入計劃對於行走速度的成效……………………45
表2-3、不同運動介入時期對於行走速度的成效……………………47
表2-4、不同行走能力對於行走速度的成效…………………………48
表3-1、變異來源及自由度……………………………………………59
表4-1、文獻搜尋和納入之過程………………………………………77
表4-2、研究的基本特徵統整表………………………………………79
表4-3、各篇研究的重要特徵…………………………………………81
表4-4、各篇研究的皮卓分數…………………………………………90
表4-5、快速行走速度的效益值………………………………………91
表4-6、習慣性行走速度效益値………………………………………91
表4-7、習慣性行走速度的干擾因素分析結果—不同的個案來源..92
表4-8、習慣性行走速度的干擾因素分析結果—不同的行走能力…92
表4-9、習慣性行走速度的干擾因素分析結果—運動介入模式 … 93
表4-10、習慣性行走速度的干擾因素分析結果—運動介入計劃… 93
表4-11、習慣性行走速度的干擾因素分析結果—介入時期……… 94
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