行動不穩之衰弱老人團體運動療效與身體測試切點

The Effect of a Group Exercise Program and Physical Performance Cutoff value for Unstable and Frail Older adults

楊越安(Yue-An Yang)

指導教授 ： 王靜怡

中山醫學大學/醫學科技學院/物理治療學系碩士班/碩士(2019年)

摘要

背景與目的：老人容易出現衰弱及行動困難，隨後發生失能。若能在剛開始衰退時提供有效介入，將能有效預防失能的發生。本研究探討兩個子題：(一)以治療師所帶領的團體運動改善行動不穩之衰弱老人身體功能之療效；(二)身體功能測試區別有無衰弱之鑑別力及切點。方法：使用國健署105年「發展不同行動功能高齡者之運動模式105-106年」計畫中的部份資料進行分析。(一)中部收案的輕中度行動困難老人分為運動組(3個月的介入)與對照組(無介入)。以重複測量二因數變異數分析檢定運動介入前後變化趨勢之組間差異。(二)：將無失能老人分為衰弱組與無衰弱組，以ROC曲線分析身體功能測試鑑別衰弱組別之鑑別力(AUC)，並報告鑑別力達可接受程度(AUC>0.7)者的最適切點。男女分別進行分析。結果：(一)：女性運動組在DEMMI分數、手握力、30秒屈臂、行走速度、三公尺起走、憂鬱呈現優於對照組的進步；男性介入前後無顯著組間差異。(二)：男性衰弱組別鑑別力，除膝伸直肌力外，所有測試皆達AUC>0.7；女性僅手握力與步行速度達標準。結論：(一)：團體運動可以有效改善行動不穩之衰弱女性老人的活動能力。(二)：具鑑別力的測試及其切點可做為評估、引導介入及臨床決策使用。

關鍵字

運動 ； 老人 ； 衰弱 ； 切點 ； 身體功能

並列摘要

Background and purpose: Older adults who suffer from frailty and mobility difficulty are more likely to develop disability in activity of daily living (ADL). Providing effective intervention at early phase of declining could delay or prevent the disablement process. This thesis consisted of 2 studies: (1) to examine the effectiveness of a physical therapist lead group exercise on performances of unstable and frail older adults; (2) to explore the discriminate ability and optimal cutoff points of performance tests in separating older adults with/ without frailty but not yet ADL disabled. Methods: We used partial data collected in HPA projects "Exercise models for elders with various mobility levels" (2016-7). (1) Older adults with mild to moderate mobility difficulty from six centers in middle Taiwan were randomly assigned into intervention (received 3 month exercise) and control groups (no intervention provided). Two-way ANOVA with one repeated measure was used to investigate the group by time interaction effect of exercise on physical performances. (2) ROC curve analysis was used to assess the discriminating ability and the optimal cutoff values for the tests with acceptable ability (AUC>0.7). Results: (1) The women intervention group showed significant improvement in DEMMI score, grip, 30s arm curl, gait speed, timed up and go (TUG) and depression than the control group. The interaction effect was not significant in men. (2) The discriminating ability was acceptable for all tests (except knee extensor strength) in men and for two tests (grip, gait speed) in women. Conclusion: (1) Group exercise could effectively improve mobility function in older women. (2) The tests with acceptable discrimination power could be used to assess, guide intervention, and make clinical decisions.

並列關鍵字

exercise ； older adults ； frailty ； cutoff point ； physical performance

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