臺灣博碩士論文加值系統

背景：住在長期照護機構的住民，多伴有身體功能退化，造成日常生活仰賴他人之情況，而運動的介入，常被用來提昇老人身體功能的方式之一，但因為個案間異質性大且研究設計或測量的標準不一。
目的：本研究的目的為運用系統性回顧（systematic review）與統合分析(meta analysis)方法探討運動介入改善長期照護機構住民身體功能之成效。
方法：使用資料庫PubMed、ProQuest、Cochrane library、EBSCO，華藝線上圖書館和台灣碩博士論文網，搜尋的關鍵字為運動介入、訓練、治療等，限制納入對象為長期照護機構或護理之家住民。
結果：共納入19篇相關文獻，系統性回顧結果重要發現為運動介入後對於可以使用輔具或有行走能力者，下肢肌力的提升是有效益的。其中7篇文獻有相同的測量結果，進一步納入統合分析，評估項目：30秒坐站次數、6公尺行走秒數、坐姿體前彎、害怕跌倒的程度、起身行走測試，在95%的信賴區間上下界線都包含0，沒有統計上顯著意義。
結論：雖然統合分析結果顯示，運動的介入對於改善機構式照護住民的身體功能，統計上是沒有顯著性，實際上並不是代表著沒有成效，是因為機構式照護的住民本身疾病嚴重程度不一，身體活動功能維持不易，研究中運動項目、選樣條件不同，易影響評估的結果。

Background: Most residents of care facilities are experiencing some level of mobility limitation. Physical activity is an essential component to improving the functional abilities in aging adults. It has been proposed that exercise interventions in long-term care settings have significant positive effects on health outcomes.
Purpose: The aim of this review was to evaluate the effectiveness of exercise interventions in long-term care facilities.
METHODS: We searched the PubMed, ProQuest, Cochrane library, EBSCO, Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan, and the reference lists of articles.
Results: Nineteen trials met the inclusion criteria in systematic reviews. Seven of the studies using the same result measurements, and the data were further put into meta-analysis. The effectiveness of exercise interventions on physical functional was further evaluated. However, 30 seconds chair-stand test, 6 meters walking test, Fall efficacy scale, Time up and go test, Chair sit-and-reach-test showed 95% confidence interval boundary between the upper and lower contains 0. There were not statistically significant. Nevertheless, the exercise interventions were still useful to the people who need assistive devices for walking ability due to the strength improvement at lower extremity muscle.
Conclusion: The meta-analysis of this study showed the physical function of long-term care residents were not improved notably after the exercise interventions. However, the majority of clinical trials were not use common set of outcome measures which made the outcomes incomparable. Studies should be designed with adequate power and longer durations of follow-up and use comparable outcome measures to facilitate meta-analysis. It may be advisable that independent researchers conduct studies in future.

中文摘要
英文摘要
目錄 i
表目錄 iii
圖目錄 iv
第一章 緒論
第一節 研究背景與重要性 1
第二節 研究目的 3
第二章 文獻探討
第一節 實證醫學概述 4
第二節 系統性回顧與統合分析 7
第三節 文獻品質評估 12
第三章 研究方法
第一節 研究架構 16
第二節 研究問題界定 17
第三節 資料搜尋方式 18
第四章 研究結果
第一節 文獻蒐尋結果 22
第二節 系統性回顧文獻彙整 23
第三節 納入分析文獻品質 26
第四節 統合分析結果 28
第五章 討論
第一節 文獻蒐尋過程探討 33
第二節 文獻證據等級及品質探討 34
第三節 系統性回顧文獻探討 36
第四節 統合分析結果探討 40
第六章 結論與建議
第一節 結論 43
第二節 研究限制 44
第三節 建議 46
參考文獻
中文部分 48
英文部分 50

表目錄
表一 研究問題的產生 17
表二 檢索關鍵字 19
表三 運動介入研究之設計與成效比較 55
表四 統合分析文獻彙整表 75
表五 系統性回顧文獻彙整表 82

圖目錄
圖一 5S階層圖 5
圖二 統合分析七大步驟 8
圖三 實証証據等級 13
圖四 研究架構圖 16
圖五 文獻篩選流程圖 91
圖六 運動對坐姿體前彎測試效果統合分析森林圖 92
圖七 運動對30秒坐站次數效果統合分析森林圖 92
圖八 運動對6公尺行走秒數效果統合分析森林圖(固定模式) 92
圖九 運動對6公尺行走秒數效果統合分析森林圖(刪除異質性高文獻) 93
圖十 運動對起身行走測試效果統合分析森林圖 93
圖十一 運動對害怕跌倒的程度效果統合分析森林圖 93
圖十二 運動對坐姿體前彎效果漏斗散佈圖 94
圖十三 運動對30秒坐站次數漏斗散佈圖 94
圖十四 運動對起身行走速度漏斗散佈圖 94
圖十五 運動對害怕跌倒程度漏斗散佈圖 95
圖十六 運動對6公尺行走秒數漏斗散佈圖(刪除異質性高文獻) 95
圖十七 統合分析文獻偏差風險圖(risk of bias graph) 95
圖十八 統合分析文獻偏差風險摘要圖(risk of bias summary) 96
圖十九 統合分析總表 96

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