視覺回饋平衡訓練儀之測試再測試信度和校標效度及改善老年人平衡表現之研究

背景：隨著時代的變遷，人口結構逐漸老化，我們也越加重視老人的健康與生活品質，其中影響最大的莫過於老人跌倒問題，因其造成的併發症會使老人健康狀況掉入惡性循環中，進而造成老人生活品質的大幅降低。有良好的平衡能力是指將身體質量中心(Center of Mass,COM )維持在支持底面積(Base of Support, BOS) 維持姿勢穩定的能力，有良好平衡能力對於動作協調與防跌扮演重要角色。方法：使用方法為將其配置於腰部(second lumbar,L2) 位置，透過藍芽與電腦連結，給予受測者正確指令並要求以踝策略做出前、後、左、右四個方向的最大穩定限度(limit of stability, LOS)。使用組內相關係數(ICC)檢測其再測試信度；使用SEM(Standard error of measurement)檢測兩週間測量結果的變異量。再由Balance Gear測得COM的移動角度換算成位移數據與力板測得COP四個方向的位移的相關性，驗證其效度。所有參與者於治療前皆接受步行速度及LOS的測試。之後開始為期三週，每週一次的回饋式平衡訓練。經過三週訓練後，進行後測。結果：本研究受測者為15名年輕人(男10女5；年齡20±0.81；體重67.25±14.16 kg)與20位老年人(男3女17；年齡79.45±10.08；體重55.35±7.30 kg)。年輕人向前傾不具測試-再測試信度，向後、右、左具有中高度的測試-再測試信度(ICC>0.75)，老年人使用3次平均值向後傾不具測試再測試信度，其他3個方向具中度以上測試再測試信度(ICC>0.553) 。傾角的轉換位移量與立板位移的相關性統計為低相關。介入成果經SPSS 統計軟體分析(paired t-test)後，發現老人步行速度由治療前的0.5(m/s)進步到治療後的0.7(m/s)，達到顯著性差異(p<0.05) 。結論：此儀器在年輕組有較佳的測試-再測試信度。由Balance Gear所測得的COM的位移與力板所測得的COP位移不相關。回饋式平衡訓練中，雖然無法看到老人在LOS方面的顯著改善，但在步行速度上達統計顯著。臨床意義：依據目前的結果，無法證實此儀器之效標效度建議未來研究可拉長訓練時間與增加受試者人數。

關鍵字

最大穩定限度；平衡訓練；測試再測試信度

並列摘要

Background: Since the increase in the aging population, the major problems of impact of the elderly is fall and fall-related injuries, for example, fear of falling, improve health care costs, reduced quality of life. We use the self-made instrument called balance gear to evaluation the balance performance. The purpose of the study were (1) to build a test-retest reliability of the balance gear (2) to build a criterion-related validity with force plate (3) to understand the outcome of the elderly received the visual feedback training. Method: We have 15 young and 20 elderly. Use the balance gear to evaluation the four direction limits of stability. Use the intraclass correlation coefficient (ICC) to see the test-retest reliability and use the standard error of measurement(SEM) to see the validity with force plate, finally use paired t test to see the intervention outcome in the elderly group. Result: The test-retest reliability in the young group was excellent (ICC>0.75) than the elderly group. Balance gear did not correlate with the force plate. The intervention in the elderly group show the significant improves in functional performance Conclusion: The instrument have good test-retest reliability in young group. Suggest that next time should increase the case and extend the training time.

並列關鍵字

limits of stability ； balance ； test-retest reliability

參考文獻

Fay B. Horak . Postural orientation and equilibrium:what do we need to know about netural control balance to prevent falls? Age and aging 2006; 35-S2: ii7-ii11

A-M W., Y-C L., S-W C., F-T T., P-Y W. Coordination exercise and postural stability in elderly people:Effect of Tai Chi Chuan. Arch Phys Med rehabil 2001;82:608-12

I. Melzer., N Benjuya., J Kaplanski. Postural stability in the elderly: a comparison between fallers and non-fallers. Age and aging 2004; 33:602-607

Xia shen., Margret K. Y. Mak., Repetitive step training with preparatory signals improves stability limits in patients with parkinson’s disease. J rehabil Med 2012; 44: 944-949

Yen-Ting Wang., Yu-Tien Tsai., Tzuhui-A Tseng., I-T Chiang Alex J. Y. Lee. The effect of neuromuscular training on Limits of stability in female individuals

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視覺回饋平衡訓練儀之測試再測試信度和校標效度及改善老年人平衡表現之研究

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