臺灣博碩士論文加值系統

四肢骨骼肌肉質量減少與肌肉功能下降與老年衰弱症、住院息息相關，是引起老人失能及憂鬱的重要危險因子之一。本研究旨在了解踏步機運動對改善住院老人四肢骨骼肌質量指數、下肢行走速度與憂鬱之成效。研究方法採前瞻性隨機分派實驗研究設計，於民國108年4月1日至民國108年12月31日，以南部某醫學中心65歲以上住院老人為研究收案對象，受試者同意參與研究後以不透明信封隨機分派為實驗組(40人)與控制組(40人)，共收案80人。列入收案者先收集基本資料，以及檢測四肢骨骼肌質量指數、六公尺行走速度與憂鬱量表前測值。實驗組主要介入措施為每日以坐姿踩踏步機30分鐘，並記錄踏步機介入總天數及總步數，控制組則予以一般常規照護，另於出院前1天再收集四肢骨骼肌質量指數、六公尺行走速度與憂鬱量表後測值等資料。研究結果發現，在憂鬱分數方面，對憂鬱分數前測大於5.724分者(占70%)，有改善成效，且憂鬱分數前測分數越高者，介入成效越佳；在控制前測是否憂鬱下，實驗組於後測憂鬱的勝算為控制組的0.222倍，達顯著性(p= .010; 95% C. I. = 0.071-0.694)。對其他成效指標，則無證據支持踏步機運動介入有改善成效。因此，踏步機運動可改善住院老人的憂鬱，有臨床推廣之價值。

The reduction of musculoskeletal mass in the limbs and muscle function are closely related to the decline of muscle function and the debilitatingand hospitalization of old age, and is one of the important risk factors that cause disabling and depression in the elderly. The purpose of this study is to understand the effect of stepper exercise on improve the quality of skeletal muscles in the limbs of elderly patients, the ability to walk in the lower limbsand improve the degree of depression. The method of study was a prospective randomized experimental study design.We collected data from December31 2019 to April 1 2019, with the inpatients aged 65 and over in a southern medical center.Total of 80subjects randomized assigned to the experimental group (40 people) and the control group (40 people). The main intervention of the experimental group was 30 minutes per day to do the stepper exercise with the sitting position.Record the total number of days and total steps of stepper intervention. Thecontrol group was given general routine care.The first day using body composition analysis appendicular skeletal muscle mass index, and the assessment tool of the 6 meter walking test to test the lower limbs walking ability, and record whether he fell during hospitalization. In addition, the effects of exercise on the psychological and emotional dimensions of eldering were explored at the time of collection and 1 day before discharge from hospital with a simple measure of old age depression (GDS-SF).
As a result, there has no significant differences were found in body composition (limb muscle mass index) and walking speed of 6 meters between the experimental group and the control group. However, after the stepper exercise interventional, the depression pretest scores >5.724 has significantly improvement. Experimental group depression post test significant lowerthan the control group (OR=0.222, p< .01).
CONCLUSION: The subjects' walking speed at 6 meters all reached the sarcopenia standard. The depression scorecan significantly improve, which has the value of clinical promotion.

誌謝.......................................................................i
中文摘要...................................................................ii
ABSTRACT.................................................................iii
目錄.......................................................................v
第一章　緒論................................................................1
第一節　研究動機及重要性.....................................................1
第二節　研究目的............................................................5
第三節　研究問題............................................................6
第四節　名詞定義............................................................7
第二章　文獻查證...........................................................10
第一節　老人的四肢骨骼肌質量指數及下肢行走速度及其改善方式.....................10
第二節　骨骼肌肉量及肌肉功能之評估方式及標準..................................17
第三節　老人憂鬱...........................................................19
第四節　踏步機運動..........................................................28
第五節　研究架構...........................................................34
第六節　住院老人四肢骨骼肌質量指數流失、下肢行走能力下降與憂鬱程度的相關因素.....35
第三章　研究方法...........................................................40
第一節　研究設計...........................................................40
第二節　研究對象...........................................................41
第三節　研究工具...........................................................42
第四節　介入措施...........................................................45
第五節　倫理考量...........................................................46
第六節　資料收集...........................................................47
第七節　資料分析...........................................................48
第四章　研究結果...........................................................50
第一節　研究變項之現況描述..................................................50
第二節　各組組內四肢骨骼肌質量指數、六公尺行走速度、憂鬱分數前後測之比較........57
第三節　各組組內四肢骨骼肌質量指數過低、六公尺行走速度過低及是否憂鬱前後測之比較60
第四節　二組組間四肢骨骼肌質量指數、六公尺行走速度及憂鬱分數後測之比較.........62
第五節　二組組間四肢骨骼肌質量指數過低、六公尺行走速度過低及是否憂鬱後測之比較..64
第五章　討論與結論..........................................................66
第一節　研究結果討論........................................................66
第二節　結論與建議..........................................................68
第三節　研究限制...........................................................72
中文參考文獻...............................................................73
英文參考文獻...............................................................77
附件一　研究問卷...........................................................93
附件二　個案報告表..........................................................94
附件三　人體研究倫理審查委員會通過證明.......................................97
附件四　受試者同意書........................................................98
附件五　GDS-SF問卷使用作者同意函...........................................106

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