三種難易度之三種類型雙重任務計時起走測試是否可作為社區老人跌倒的預測因子?

Three Complexity Levels of Three Types of Dual-Tasking Timed Up and Go Test as Predictors of Falls Among Community-Dwelling Older Adults?

彭雅祺(Ya-Chi Peng)

指導教授 ： 陳惠雅

中山醫學大學/醫學科技學院/醫學檢驗暨生物技術學系碩士班/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00138

摘要

目的：三難易度(簡單、中等、困難)之三類型(端水杯、減數、記憶)雙重任務計時起走測試中哪一類型與難易度是社區老年跌倒危險族群預測因子？方法：方便取樣60歲以上者。測量年齡、性別、教育程度、病史、身體質量指數、聽力、視力、足輕觸覺、足震動覺、下肢肌力、踝活動度、握力、認知、身體活動量、平衡、行走速度、單一TUG完成時間、雙重TUG完成時間、雙重TUG綜合分數等。追蹤6個月之跌倒情形。結果：分析54人，6人跌倒(11.1%)。跌倒者與非跌倒者在以下變項有顯著差異－教育程度、第一及第二蹠骨頭中間背側面、第三蹠骨頭背側面、第五蹠骨頭背側面、大拇趾內側蹠側面輕觸覺、膝伸肌肌力、踝背屈關節活動度、簡單記憶測試綜合分數(p<0.05)。以完成時間測量TUG找出第五蹠骨頭背側面輕觸覺為預測因子，勝算比為0.332 (R2= 0.428)。以綜合分數測量TUG找出第五蹠骨頭背側面輕觸覺為預測因子，勝算比為0.210 (R2= 0.543)。54人中57.4%為臨近衰弱組，5人跌倒，以完成時間測量TUG未能找出預測因子。結論：未找出何類型及難易度雙重任務計時起走測試有較佳的社區老年跌倒危險族群預測能力，可能由於收案族群屬於較為健康者、受試者與施測者對跌倒定義認定有差距以及樣本數過小。相較於完成時間，合併第一與第二任務表現如綜合分數是目前研究極需努力的方向。第五蹠骨頭背側面輕觸覺相對於其他危險因子，有最佳的跌倒預測能力，臨床跌倒篩檢時應考量。對於臨近衰弱組，本研究則沒有發現預測因子。未來仍須使用大樣本數、尋找有有行走能力障礙前兆的族群及告知受試者精確跌倒定義。

關鍵字

跌倒 ； 雙重任務 ； 任務類型 ； 任務難易度 ； 衰弱 ； 社區老人

並列摘要

Objective: To investigate what are the best predictors of falls among community-dwelling older adults among three complexity levels (easy, medium, difficult) of three types (cup, subtraction, memory) of dual-tasking timed up and go test (TUG). Methods: A convenient sample of older adults over 60 years old were recruited. Age, sex, educational attainment, comorbidities, body mass index, hearing, vision, tactile sensitiv¬ity and vibration of foot, strength of lower limb, range of motion of ankle, of foot, grip strength, cognition, balance, walking speed, completed time of single-tasking TUG, completed time and combined score of dual-tasking TUG of subjects were examined. The fall status were followed up for six months. Results: Of the 54 elderly, 6 (11.1%) were the fallers. Fallers and nonfallers performed significantly differently in educational attainment, tactile sensitivity of three sites of foot, strength of dominant knee extensor, dorsiflexion range of motion of ankle, combined score in the easy level of memory type of dual-tasking TUG (p< 0.05).When TUG were measured by completed time, the logistic regression resulted in: tactile sensitivity of dorsum of the fifth metatarsal heads was predictor, odds ratio 0.332 (R2= 0.428). When TUG were measured by combined score, the logistic regression resulted in: tactile sensitivity of dorsum of the fifth metatarsal heads was predictor, odds ratio 0.210 (R2= 0.543). 31 participants (57.4%) were prefrail among which 5 were fallers (16.1%), when TUG were measured by completed time, the logistic regression resulted in no predictors. Conclusions: We failed to find out the best predictors of falls among performance indices of dual-tasking TUG, probably due to inappropriate group, poor interviewing skill or our small sample size. “Combined score” needs to be expanded futher. Among the variables examined in our study, tactile sensitivity of dorsum of the fifth metatarsal heads is the best predictor of falls, so this factor should be examined in the clinic. For the prefrailty, there were no predictors of falls in our results. Future study should survey pre-walking-disabled group, include larger samples and improve interviewing skills with clear definition of falls.

並列關鍵字

falls ； dual tasks ； type of tasks ； complexity of tasks ； frailty ； comunty-dwelling

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