「網路互動式充能自我管理方案」對代謝症候群成人之生理指標成效：前驅隨機控制試驗

背景：代謝症候群病人普遍存有多重病徵難以控制的問題，長期缺乏控制將導致疾病惡化、併發合併症與造成生命威脅。目的：本研究旨在探討「網路互動式充能自我管理方案(IESM方案)」對代謝症候群成人生理指標之影響。研究設計：雙組前後測、雙盲之前驅隨機控制試驗。方法：方便取樣台灣南部地區之代謝症候群成人個案，以隨機區段(randomized block )方式分派至實驗組8人與對照組8人，實驗組個案接受為期6週的「網路互動式充能自我管理方案」介入及一般常規照護；而對照組接受網路自我管理衛教及一般常規照護。本研究以代謝症候群相關生理指標來評量介入措施之前後測值，並以概化估計方程式分析介入成效。結果：概化估計方程式分析顯示組別與時間對各生理指標均有交互作用。控制年齡變項後，兩組組內時間效應分析，實驗組在第6週與第3個月的體重、身體質量指數、腰圍、收縮壓、醣化血色素、總膽固醇與三酸甘油脂均較前測有顯著改善；對照組在第3個月的體重、身體質量指數、腰圍、收縮壓與舒張壓反而較前測顯著增加。控制年齡與前測變項後，組間效應分析，實驗組在第3個月的體重(MD= -2.67 kg, p< .001)、身體質量指數(MD= -0.18 kg/m2, p= .003)、腰圍(MD= -3.51cm, p= .016)顯著優於對照組。結論/實務應用：網路互動式充能自我管理方案提供方便、零距離、可及性的健康服務。前驅研究結果顯示本方案可改善代謝症候群成人的腰圍、體重與身體質量指數，說明方案應用於實務面是可行的。

關鍵字

代謝症候群；充能；自我管理；網路；隨機控制試驗

並列摘要

Background: Metabolic syndrome is a cluster of conditions that may be difficult to control. If any of these conditions are not well-controlled, it may cause serious diseases, develop several complications, and even lead to life-threatening problems. Purpose: The aim of the study was to explore the effects of the Internet interactive Empowerment-based Self-Management (IESM) protocol on adults with metabolic syndrome. Study design: A two-group, pretest–posttest, double-blind pilot randomized controlled trial. Methods: Based on convenience sampling, we recruited the adults with metabolic syndrome from the southern Taiwan. With a randomized block design, the participants were divided into two groups, an experiment and a control group with eight adults respectively. The experiment group received the IESM protocol for 6 weeks and general routine care. On the other hand, the control group received the online self-management health education and general routine care. In this study, the physiological parameters of metabolic syndrome were used to evaluate the effects of IESM protocal. The generalized estimating equation (GEE) models were used to analyze. Results: The GEE models analysis showed that the interactions of group and time on physiological indicators were significant. After controling the age variable, within-group effect showed that the experimental group had greater improvement on weight, body mass index, waist circumference, systolic blood pressure, glycated hemoglobin, total cholesterol and triglyceride at sixth week and third month when computed with pretest. Conversely, the control group had significant increase on weight, body mass index, waist circumference, systolic blood pressure, and diastolic blood pressure at third months. After controlingthe age and pretest variables, between-group effect showed that the body weight (MD = -2.67 kg, p < .001), body mass index (MD = -0.18 kg/m2, p = .003), and waist circumference (MD = -3.51cm, p = .016) of the experimental group at three months was significantly better than the control group. Conclusion/Implications for practice: IESM protocol provides convenient, zero-distance, and accessible health services. The findings showed that the IESM protocol can facilitate reduction in the weight, body mass index, and waist circumference of adults with metabolic syndrome, indicating that the protocol is feasible in practice.