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研究生: 楊婷婷
Yang, Ting-Ting
論文名稱: 老人跌倒預防介入計畫在預防跌倒相關傷害上之效果:探索性統合分析之應用
The preventive effects on fall related injuries of elderly fall prevention programs: an exploratory meta-analysis
指導教授: 郭鐘隆
Guo, Jong-Long
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2016
畢業學年度: 104
語文別: 中文
論文頁數: 93
中文關鍵詞: 跌倒預防介入計畫統合分析相關傷害效果量
英文關鍵詞: prevention program, meta-analysis, injury, effect size
DOI URL: https://doi.org/10.6345/NTNU202203800
論文種類: 學術論文
相關次數: 點閱:174下載:33
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  • 目的:在老人許多的健康問題中,跌倒是影響老年人健康及獨立生活之重要危險因子,過去關於跌倒預防介入計畫的研究已有證據指出實施多元計畫較單一計畫有效,但相關研究皆偏重在於降低跌倒發生率,忽略了實施老人跌倒預防計畫後是否有效降低跌倒發生後的相關傷害。本研究期望評值跌倒預防介入計畫對於預防跌倒後相關傷害之成效,並探討預防介入計畫的特徵變項對效果量的影響。
    方法:本研究運用探索性統合分析,自西元1996年至西元2016年以英文發表之期刊為研究對象,計算跌倒預防介入計畫的綜合效果及在相關傷害上的預防效果。
    結果:確認跌倒預防介入計畫對預防跌倒相關傷害有顯著效果(Effect size=0.855;95% CI=0.753~0.971;Z=-2.417;p=0.016),但對預防骨折卻無顯著效果(Effect size=0.802;95%CI=0.627~1.025;Z=-1.766; p=0.077)。其預防介入計畫的研究特徵中,高品質的研究有顯著效果量;樣本特徵中:男女皆含、跌倒史大於15%、跌倒傷害史小於30%、獨居大於50%的研究有顯著的效果量;介入特徵中:研究地點為社區、介入時數≦11小時及12~100小時、多元介入方式、有醫療專業背景介入皆有顯著效果量。特徵項目與相關傷害之相關性可提供給後續決策者、臨床工作者及研究者進行介入時的參考方向,並可減少相同研究的複製及節省介入規劃投入的成本、時間與精力。

    Purpose:
    Among various health issues, falls have become a critical risk factor that influence health and independent living for elderly. Previous studies suggested that multidisciplinary prevention programs be more effective than single dimensional ones. Reduction of fall incidence was generally emphasised in earlier research, the effectiveness of reducing fall-related injuries after the implementation of elderly fall-prevention intervention, however, was ignored. The objective of this study was to evaluate the effectiveness of fall-prevention intervention on related injuries cuased after falling, then to determine characteristics variables effects of prevention program on effect size.

    Method:
    An exploratory meta-analysis was applied on the English-published paper reported during 1996-2016. Summary effect of fall-prevention programs and preventive effect of on related injuries were computed.

    Results:
    This study confirmed that fall-prevention intervention programs had significant effect on related injuries caused after falling(Effect size=0.855;95% CI=0.753~0.971;Z=-2.417;p=0.016), but no effect on fracture(Effect size=0.802;95%CI=0.627~1.025;Z=-1.766; p=0.077). Regarding the research characteristic of the fall prevention programs, the papers with high quality obtained significant effect size; in terms of sample characteristic, research with both gender included, a falling history larger than 15%, traumatizing falling history less than 30%, and independent living rate more that 50% were found to have significant effect size; concerning intervention characteristic, studies conducted in the communities, with intervention duration less than or equal to 11 hours or between 12 to 100 hours, multidisciplinary intervention approaches, and with medical background all secured a significant effect size. The relationship between characteristic variables and injuries followed by falling were found and could be served as reference for future intervention. Replication of similar studies could be reduced and cost and effort put into intervention planning could be saved.

    目次 頁次 第一章 緒論.........................................1 第一節 研究動機及重要性...........................1 第二節 研究目的...................................4 第三節 研究問題...................................4 第四節 名詞界定...................................5 第二章 文獻探討.....................................7 第一節 老人跌倒流行病學分析.......................7 第二節 跌倒造成的相關傷害........................10 第三節 國外跌倒預防介入計畫成效..................13 第四節 統合分析法................................17 第五節 跌倒預防介入計畫統合分....................19 第三章 研究方法....................................23 第一節 研究流程..................................23 第二節 資料搜尋與資料篩選........................25 第三節 研究工具..................................29 第四節 研究品質評估..............................29 第五節 研究架構..................................31 第六節 效果量計算................................34 第七節 資料分析..................................36 第四章 分析與結果...................................40 第一節 研究樣本的特徵介紹與分析..................40 第二節 出版偏差檢定..............................49 第三節 跌倒相關傷害與樣本特徵分析................51 第四節 跌倒相關傷害與介入特徵分析................56 第五節 跌倒預防介入計畫對預防跌倒相關傷害效果 量之整體分析..............................59 第六節 跌倒預防介入計畫對預防骨折效果量之整體 分析......................................61 第五章 討論.........................................63 第一節 跌倒相關傷害與研究、樣本特徵分析..........63 第二節 跌倒相關傷害與介入特徵分析................66 第三節 跌倒預防介入計畫對預防跌倒相關傷害、骨 折效果量之整體分析........................68 第六章 結論、限制與建議.............................70 第一節 結論......................................70 第二節 研究特色與貢獻............................72 第三節 研究限制..................................73 第四節 研究建議..................................74 參考文獻........................................... 76 中文部份..........................................76 英文部份..........................................80   表目次 頁次 表1 國外跌倒預防介入計畫成效之文獻整理.........16 表2 跌倒預防介入計畫統合分析之文獻整理.........22 表3 勝算比公式說明.............................34 表4 研究摘要表.................................41 表5 跌倒預防介入計畫研究樣本的特徵變項.........45 表6 以介入方式與研究地點區分介入計畫內容之 摘要表.....................................48 表7 跌倒相關傷害、研究特徵及樣本特徵之效果 量摘要表...................................54 表8 跌倒相關傷害與介入特徵之效果量摘要表.......58 表9 相關傷害效果量摘要表.......................60 表10 骨折效果量摘要表...........................62   圖目次 頁次 圖1 研究實施步驟與流程圖.......................24 圖2 統合分析研究納入及排除流程圖...............28 圖3 研究架構...................................33 圖4 分析調節變項流程圖.........................39 圖5 出版偏差漏斗圖(未刪極端值)...............49 圖6 出版偏差漏斗圖(已刪極端值)............... 50 圖7 相關傷害Forest plot........................60

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