Title

下肢運動介入措施對改善社區老人肌力的成效:系統性文獻回顧

Translated Titles

The effect of lower extremity exercise on improving the community elderly from muscle power: A systematic review

DOI

10.6834/csmu202100031

Authors

林瑋詩

Key Words

老人 ; 預防跌倒 ; 下肢運動 ; 系統性回顧 ; elderly ; fall prevention ; lower limb exercise ; systematic review

PublicationName

中山醫學大學護理系長期照護碩職專班學位論文

Volume or Term/Year and Month of Publication

2021年

Academic Degree Category

碩士

Advisor

白香菊

Content Language

繁體中文

Chinese Abstract

背景:台灣人口結構正步入老化階段,隨著高齡化的趨勢,老人照護問題將嚴重衝擊臺灣現況,在老年族群中跌倒及跌倒後造成的傷害是常見的問題之一,老人跌倒不僅造成身體的傷害,亦會增加家庭照護者的負擔與醫療體系,老年人從事日常生活動作時,為了安全與穩定性,會採取減少肌肉力量使用及下肢關節活動範圍的動作策略,因此,過去研究表示肌力不足是最容易造成跌倒的原因,運動已被證實可以改善認知功能、增進平衡能力、預防慢性疾病發生,然而透過運動介入是否能改善老年人的肌力使得老年人可更有效的從事日常生活動作,間接降低跌倒的風險是值得探討的。 目的:藉由系統性文獻回顧方式,探討下肢運動措施介入對改善社區老人肌力的成效。 方法:利用Cochrane Library、 PuMed、Embase及華藝線上圖書館等電子資料庫,依據本研究設定關鍵字(65歲以上社區老人、下肢運動、改善下肢肌力、預防跌倒)搜尋中、英文文獻,再依納入及排除條件,排除不符合的文獻,運用Critical Appraisal Skill Programme(CASP)之評讀工具評讀文獻,統整國內外下肢運動介入措施對老年人改善肌力的成效。 結果:符合本研究納入條件者共有11篇文章,透過評讀與分析,本研究發現提供運動可改善下肢肌力,使得老年人可更有效的從事日常生活動作,然而運動訓練在降低跌倒的次數或再次跌倒的頻率並未達統計上顯著意義。 結論:運動訓練能改善社區老人的肌力,提升身體功能性,維持獨立生活的能力。

English Abstract

Background: The increasing elderly population in Taiwan raises the possibility of disability and care-cost of fall related injuries. Fall related injuries have become a critical issue, which not only impacts the health of the injured but also aggravates the burden on the caregivers and the financial pressure on the public health system. In terms of safety and stability in daily activities, the elderly face reduction in muscle strength and the motion range in joints. Previous studies suggest that lack of muscle strength significantly enhances fall-risk among the elderly. Exercise intervention has been reported to improve cognitive function and balance and prevent chronic diseases. Therefore, whether exercise training can make the elderly more active and efficient in daily tasks and consequently reduce fall-risk is worth exploring. Aims: The purpose of the study was to conduct a systematic review of literature to examine the effect of lower extremity exercise in improving the muscle strength of the community elderly. Methods: Using identified keywords (elderly or community‐dwelling older people; extremity, lower, or lower limb exercise; muscle stretching or improving muscle power; falls or falling), this study conducted a systematic literature search for relevant English and Chinese language studies published in electronic databases, such as Cochrane Library, PuMed, Embase, and Airiti Library. Results of the literature search were screened using proposed inclusion and exclusion criteria. Eleven articles were included for systematic review after removing the irrelevant ones. Subsequently, the Critical Appraisal Skill Programme (CASP) was utilized to review the literature. This study reviewed the literature relating to the effect of lower limb exercise intervention to improve muscle strength in elderly adults. Results: There were 11 articles that met the study criteria. Through appraisal and analysis, our results showed that exercise training can make the elderly more active and efficient in daily tasks and that dominant lower extremity muscle strength can improve after exercise. However, the impact of exercise training on reducing the risk of falling and re-falling among elderly was not statistically significant. Conclusion: The results indicate that exercise training improves muscle power as well as the ability to live independently in the elderly.

Topic Category 醫藥衛生 > 社會醫學
醫學院 > 護理系長期照護碩職專班
Reference
  1. 張雁霖、吳明芬、潘錫光、張麗銀、李維馨、劉文雄(2014).某醫學中心住院跌倒病人用藥分析.臺灣臨床藥學雜誌,22(4),219-232。http://dx.doi.org/10. 6168%2fFJCP.2014.2204.03
  2. 陳可欣、何雲仙、高靖秋(2007).實證護理於臨床之應用.榮總護理,24(4),320-328。http://dx.doi.org/10.6142%2fVGHN.24.4.320
  3. 陳玉枝(2014).實證護理概念與臨床應用.領導護理,15(2),2-12。http://dx.doi.org /10.29494%2fLN.201406_15(2).0002
  4. 陳美芳、林家綾、蔡宗廷、朱素鳳、洪淑玲、顏碧汝、蔡錦墩.(2013).以系統性文獻回顧探討台灣居家老年人跌倒之相關或危險因素.台灣公共衛生雜誌,32(5),403-423。http://dx.doi.org/10.6288%2fTJPH2013-32-05-01
  5. 陳慶餘(2015).臺灣年老衰弱症的研究與應用.長期照護雜誌,19(2),137-148。https://www.airitilibrary.com/Publication/Index/15612546-201509-201510280029-201510280029-137-148
  6. 黃子芸、陳姝希、吳鴻文、黃禮芸、黃宜萱、陳依柔、曾侑鉦(2016).複合式運動方案對社區老年人動作功能及跌倒之影響.物理治療,41(2),156-158。http://dx.doi.org/10.6215%2fFJPT.2016.P29
  7. 黃資雅、杜明勳、陳宏益、陳弘哲(2015).老人跌倒之評估與預防.家庭醫學與基層醫療,30(1),2-8。https://www.airitilibrary.com/Publication/Index/ P20090727001-201501-201502020055-201502020055-2-8
  8. 賓孟晨、梁淯傑、洪彰岑、甘能斌、何健章、謝錦城(2017) .環狀運動對老年人下肢功能性體適能與步態穩定性之影響.運動生理暨體能學報,24(2),1-10。http://dx.doi.org/10.6127%2fJEPF.2017.24.01
  9. 蔣立琦、林佳慧、王桂芸(2013).實證護理的新時代-全面啟動發展護理科學.護理雜誌,60(5),11-17。http://dx.doi.org/10.6224%2fJN.60.5.11
  10. 衛生福利部國民健康署(2019).健康促進統計年報.取自https://www.hpa.gov.tw/ Pages/ashx/File.ashx?FilePath=~/File/Attach/10443/File_11960.pdf
  11. 蕭伃伶、陳靜敏、張佳琪.(2012).社區長者預防跌倒介入之成效.新臺北護理期刊,14(1),29-42。http://dx.doi.org/10.6540%2fNTJN.2012.1.004
  12. 謝昌成、蕭雅尤、林妙秋、陳碧奇(2010).老人衰弱症.家庭醫學與基層醫療,25(11),410-417。http://dx.doi.org/10.6965%2fFMPMC.201011.0410
  13. 韓德生(2016).肌少症的評估與診斷.長期照護雜誌,20(2),115-124。http:// dx.doi.org/10.6317%2fLTC.20.115
  14. 英文文獻
  15. Aoyagi, Y., Shephard, R. J. (1992). Aging and muscle function. Sports Medicine, 14(6), 376-396. https://doi.org/10.1152/physrev.00061.2017
  16. Crowe, M., Sheppard, L. (2010). A review of critical appraisal tools show they lack rigor: alternative tool structure is proposed. Journal of Clinical Epidemiology, 64(1), 79-89. https://doi.org/10.1016/j.jclinepi.2010.02.008
  17. Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J. McBurnie, M. A. (2001). Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. https://doi.org/10.1093/gerona/56.3.m146
  18. Fulop, T., Larbi, A., Witkowski, J. M., McElhaney, J., Loeb, M., Mitnitski, A., Pawelec, G. (2010). Aging, frailty and age-related diseases. Biogerontology, 11(5), 547-563. https://doi.org/10.1007/s10522-010-9287-2
  19. Guyatt, G. H., Oxman, A. D., Kunz, R., Vist, G. E., Falck-Ytter, Y., Schünemann, H. J. (2008). What is “quality of evidence” and why is it important to clinicians? Bmj, 336(7651), 995-998. https://dx.doi.org/10.1136%2Fbmj.39490.551019.BE
  20. Guyatt, G., Cairns, J., Churchill, D., Cook, D., Haynes, B., Hirsh, J., Sackett, D. (1992). Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA, 268(17), 2420-2425. https://doi.org/10.1001/jama.1992.03490170092032
  21. Lord, S. R., Menz, H. B., Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prevention. Physical Therapy, 83(3), 237-252. https://doi.org/10.1093/ptj/83.3.237
  22. Lang, P. O., Michel, J. P., Zekry, D. (2009). Frailty syndrome: a transitional state in a dynamic process. Gerontology, 55(5), 539-549. https://doi.org/10.1159/000211949
  23. Milne, R., Oliver, S. (1996). Evidence-based consumer health information: developing teaching in critical appraisal skills. International Journal for Quality in Health Care, 8(5), 439-445. https://doi.org/10.1093/intqhc/8.5.439
  24. Netz, Y., Argov, E. (1997). Assessment of Functional Fitness among Independent-Older Adults: A Preliminary Report. Perceptual and Motor skills, 84(3), 1059-1074. https://doi.org/10.2466%2Fpms.1997.84.3.1059
  25. Porritt, K., Gomersall, J., Lockwood, C. (2014). JBI's systematic reviews: study selection and critical appraisal. AJN The American Journal of Nursing, 114(6), 47-52. https://doi.org/10.1097/01.NAJ.0000450430.97383.64
  26. Siwek, J., Gourlay, M. L., Slawson, D. C., Shaughnessy, A. F. (2002). How to write an evidence-based clinical review article. American Family Physician, 65(2), 251. https://www.aafp.org/afp/2002/0115/p251.html
  27. World Health Organization (2018, Jan 16). Falls.data. retrieved Jan 31, 2021 from https://www.who.int/news-room/fact-sheets/detail/falls