- 學位論文
比較太極拳與下肢物理訓練對於預防跌倒之隨機控制試驗
A RANDOMIZED CONTROLLED TRIAL OF COMPARING TAI CHI WITH LOWER EXTREMITY PHYSICAL TRAINING ON FALLS PREVENTION
摘要
目的: 運動是老人跌倒預防措施中不可缺少之項目，其中較有效的方法是採用多元運動訓練。研究顯示太極拳為預防跌倒有效的策略之一。我們以一隨機對照試驗，針對社區跌倒的老人，比較太極拳與下肢多元物理訓練在預防跌倒、平衡和步態功能上的差異。 設計：單盲、平行的隨機對照試驗。 地點：台北市的兩個社區醫院。 參與者：跌倒後至急診求診之男性和女性總共368名進入研究，185位分配至太極拳組，183位至下肢多元物理訓練組。平均年齡為71.8歲。 方法：，太極拳組由太極拳教練進行一對一個別訓練；下肢多元物理訓練組則由物理治療師一對一進行下肢體能訓練，內容包含肌肉強度，拉伸和平衡運動。運動訓練於每位參加者的家中或其附近的公園實施，每週一次，每次一小時，連續24週。鼓勵參與者在家中自我練習並且於運動介入訓練結束後持續追蹤1年。在運動介入3或6個月以及18個月後，測量平衡和步態功能，並追蹤統計老人有無發生跌倒。 結果：在運動介入後6個月，太極拳組未經調整之跌倒人數（43.8%，n = 81）顯著低於下肢多元物理訓練組（57.4%，n = 105）。邏輯式回歸分析顯示，在介入後6個月，太極拳組比較下肢多元物理訓練組，低了44%之跌倒風險；在介入結束後12個月的追蹤則低了53%之跌倒的風險。在線性混合效應模型分析中， Tinetti平衡分數，兩組在6個月後均明顯地增加，但於18個月後下降。Tinetti的步態分數，兩組在3個月和6個月後均增加，但於18個月時返回到基線值。不論是平衡或是步態功能，在太極拳和下肢多元物理訓練組間，都無顯著地差異。 結論： 針對社區居住的跌倒老人，24週的太極拳個別訓練相較於下肢多元物理訓練，降低更多跌倒風險。太極拳在步態與平衡功能的改善達到和下肢多元物理訓練相同的效果。
並列摘要
Objectives: Exercises are most indispensable strategies for falls prevention. Multicomponent exercises have shown most effective among exercise programs. Tai Chi (TC), an alternative exercise, appears to be one of the most effective strategies for preventing falls. We sought to compare TC with multicomponent physical training (PT) in a randomized controlled trial to exam the differences on falls prevention, functional balance and gait for community older fallers. Design: A single-blinded, parallel, randomized, controlled trial. Setting: Two hospital based-communities in Taipei City. Participants: Three hundred sixty-eight men and women visited two emergency departments due to falls were recruited, with 185 allocated to TC group and 183 to the PT group. Mean age is 71.8 years. Methods: Participants of TC group attended one hour individual practicing session, provided by a TC instructor; whereas comparator received lower extremity PT consisted of muscle strength, stretching and balance exercise. Both interventions were held in each participant’s home or nearby park once a week for consecutive 24 weeks. Participants were encouraged of self-practice and were followed-up for one year after intervention. Number of falls, Performance Oriented Mobility Assessment were measured at 3 or 6 months of interventions and at 18 months of follow-up. Results: Over the 6 month of intervention, the unadjusted number of fallers in TC group (43.8 %, n= 81) was significantly fewer than that in PT group (57.4%, n=105). Logistic regression analysis revealed that, compared with PT, TC significantly decreased the risk of falling by 44% over 6 months of intervention and by 53% over 12 months of post intervention follow-up. In the linear mixed-effect model analysis, there were no significant difference of functional mobility scores between TC and PT group at all follow-up measurements. Tinetti balance scores in both groups significantly increased at 6 months, but declined at 18 months. Tinetti gait scores in both groups increased at 3 months and 6 months but returned to baselines at 18 months. Conclusions: TC 24 weeks individual program has greater reduction on the risk of falling compared to multicomponent PT in community-dwelling older fallers. TC can improve functional balance and gait of comparable effects as PT.
參考文獻
延伸閱讀
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