經絡拳於長期照顧機構肌少症老人之可行性及成效探討

背景：肌少症是處於喪失獨立自主前的重要關鍵點，若能有效的控制及延緩，可降低失能的發生機率，並提升生活品質。目的：1)評估「活力律動經絡拳」運動方案於長期照顧機構肌少症老人之可行性；2)測試六個月「活力律動經絡拳」於長期照顧機構肌少症老人肌肉質量、肺功能、身體柔軟度、關節活動度、肌力、肌耐力、日常生活功能及睡眠品質之成效。方法：本研究分兩階段進行。第一階段採類實驗法，單組前後測進行前驅試驗，以方便取樣選取一間長期照顧機構共13 位個案完成研究，收案標準為1)年齡 ≧ 65 歲；2)居住於長期照顧機構滿3 個月；3) 認知功能完整；4) 手握力男性 < 28 kg 、女性 < 18 kg；及5)肌肉量：男性小腿圍 < 34cm 、女性小腿圍 < 33cm。排除條件為：1)因脊髓損傷坐輪椅者；2)嚴重心肺疾病者；及3)肌肉骨骼疾病者。第二階段採叢集臨床隨機試驗，以方便取樣方式選取12 間長期照顧機構，再依研究機構以1:1 方式隨機分配至實驗組及控制組，完成研究者實驗組共52 人，控制組51 人。介入措施：第一階段進行每週3 次、每次40 分鐘「活力律動經絡拳」持續一個月；第二階段執行與前驅試驗頻率及時間相同之「活力律動經絡拳」，持續6 個月；控制組則維持原有日常活動。資料收集與分析：運用SPSS 統計分析軟體19.0 版分析研究結果。第一階段於活動介入前後分別進行一次測量，以確認測試工具之合適性。生理測量包含肌肉質量、肺功能、身體柔軟度、關節活動度、肌力及肌耐力；問卷調查包含日常生活活動功能、睡眠品質及活動評值表。一個月前驅試驗後，以簡易性、安全性、適切性及助益性四項指標評值「活力律動經絡拳」之可行性，描述性統計以平均值、標準差、頻率、百分比呈現，推論性統計以paired t test 進行分析；第二階段測試「活力律動經絡拳」之成效，量性資料以描述性統計如第一階段，推論性統計以獨立樣本t、曼-惠特妮U 檢定、費氏精確檢定法、卡方檢定、廣義估計方程式進行及詹森內曼法檢驗。質性資料則以內容分析統整歸類。結果：第一階段之運動方案之可行性指標介於9.62-10.00 (0 分-10 分)。活動後感受到精神好及體力好各佔46.2%，參與個案覺得活動採每週3次(69.2%)、每次40 分鐘(76.9%)、採團體活動(61.5%)較為合適，指導者需具備專業(53.8%)及親切和善(38.5%)特質。第二階段於實驗組測量項目於各時間點比較皆顯著提升(all p < .05)，控制組則呈現顯著下降趨勢。實驗組及控制組之組間比較發現，除下肢肌耐力至六個月實驗組顯著優於控制組外，其餘實驗組於三個月之肌肉質量、肺功能、身體柔軟度、關節活動度、肌力、肌耐力、日常生活功能及睡眠品質顯著優於控制組，六個月成效仍持續顯著。整體活動可行性評價得分由9.52 至9.88(0 分-10 分)。結論：經絡拳有利於改善肌少症老人之肌肉質量、肺功能、身體柔軟度、關節活動度、肌力、肌耐力、日常生活功能及睡眠品質功能，更重要是能熟悉肌少症老人的特性，藉由專業及和善指導方式，將有利後續活動推動及成效維持。

關鍵字

肌少症；老人；經絡拳；長期照顧機構；肌肉質量；肺功能；身體柔軟度；關節活動度；肌力；肌耐力；日常生活功能；睡眠品質

並列摘要

Background: The development of sarcopenia marks a critical point before the loss of independence. Effective control of the condition and delay of its progression can reduce the likelihood of disability and improve quality of life. Purpose: To evaluate the feasibility of the Vitality Acupunch exercise program for older adults with sarcopenia in long-term care facilities, and to test the effect of the 6-month intervention on the participants’ muscle mass, pulmonary function, flexibility, range of motion (ROM), muscle strength, muscular endurance, activity of daily living (ADL), and sleep quality. Method: This study was conducted in two stages. The first stage, which involved a quasi-experimental design, comprised a pilot experiment of the Vitality Acupunch program with a pretest and posttest administered to a single group. Thirteen older adults residing in a long-term care facility were recruited by convenience sampling. The inclusion criteria were being aged 65 years or older; having lived in a long-term facility for over 3 months; having normal cognitive function; having a hand grip strength of less than 28 or 18 kg (for men and women, respectively); and, as an indicator of muscle mass, having a calf circumference under 34 or 33 cm (for men and women, respectively). Individuals who were in a wheelchair because of spinal cord injury or had severe cardiopulmonary or musculoskeletal disease were excluded. The second stage involved a cluster randomized controlled trial in which 12 long-term care facilities were selected by convenience sampling and the participants were randomly assigned to the experimental and control groups at a 1:1 ratio. In total, 52 and 51 participants in the experimental and control groups completed the study, respectively. Intervention measures: In the first stage, the participants completed 40-min sessions of the program three times a week for 1 month. In the second stage, the program was administered with the same frequency and session duration over 6 months. The control group performed daily activities as usual. Data collection and analysis: Analysis was conducted using SPSS 19.0 software. The pretest and posttest in the first stage were conducted once before and after the intervention, respectively, and included physiological assessment of muscle mass, pulmonary function, flexibility, (ROM), muscle strength, and muscular endurance. A questionnaire was also administered on ADL, sleep quality, and activity evaluation. After the 1-month pilot experiment, four indexes of simplicity, safety, suitability, and benefit were used to assess program feasibility. Descriptive statistics were examined in terms of means, standard deviations, frequencies, and percentages. Inferential statistics were analyzed using a paired t test. In the second stage, the program effects were tested. As in the first stage, the quantitative data were analyzed using descriptive statistics, whereas the inferential statistics were subjected to the independent t test, Mann–Whitney U test, Fisher’s exact test, Chi-square test, Johnson–Neyman procedure, and generalized estimating equation analysis. Content analysis was performed on the qualitative data. Results: The feasibility index scores of the exercise programs in the first stage were between 9.62 and 10.00 points on a scale of 0 to 10 points. Overall, 46.2% of the participants reported feeling mentally and physically energized after the activity, respectively. Moreover, 76.9%, 69.2%, and 61.5% of the participants preferred the intervention to be administered in 40-min sessions, thrice a week, and in a group setting, respectively. Furthermore, 53.8% and 38.5% of the participants expressed that the instructor should have characteristics of professionalism and friendliness, respectively. In the second stage, the experimental group exhibited significant improvements in all the indicators at all time points (all p < .05), whereas a significantly declining trend in performance was observed in the control group. The lower-limb endurance of the experimental group was significantly better than that of the control group only at 6 months. Overall, the experimental group significantly outperformed the control group in muscle mass, pulmonary function, flexibility, ROM, muscle strength, and muscular endurance; moreover, their daily life function and sleep quality were significantly better. All of these effects remained significant at 6 months. The feasibility scores of the overall activity were between 9.52 and 9.88 (0 to 10 points). Conclusions: The program effectively improved muscle mass, pulmonary function, flexibility, ROM, muscle strength, muscular endurance, ADL, and sleep quality in the experimental group. Notably, the specific needs of this patient population were met in the intervention. The friendly yet professional instructional style is favorable to subsequent activity promotion and effect maintenance.

並列關鍵字

sarcopenia ； older adults ； Vitality Acupunch ； long-term care facility ； muscle mass ； pulmonary function ； flexibility ； range of motion ； muscle strength ； muscular endurance ； activity of daily living ； sleep quality

參考文獻

Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A. A., Schneider, S. M., Sieber, C. C., Topinkova, E., Vandewoude, M., Visser, M., Zamboni, M., & Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16-31. https://doi.org/10.1093/ageing/afz046

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經絡拳於長期照顧機構肌少症老人之可行性及成效探討

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